SCARLET FEVER 297 



the most likely cause of the disease is the Streptococcus scarlatinas of 

 Gordon. Probably the organisms isolated by Baginsky and Class are 

 different forms of the same streptococcus. 



As regards dissemination, it has long been known that scarlet 

 fever, like small-pox, is most commonly spread by direct infection 

 through the medium of infected clothing and other articles, or 

 materials handled by the patient. The means by which infection 

 has thus been carried are manifold, and need not claim our attention 

 here. As we have seen, in 1870 a wider field of conveyance of scarlet 

 fever was revealed by the investigations of Dr M. W. Taylor of 

 Penrith. While studying an outbreak of scarlet fever, he observed 

 that the main incidence of the disease fell upon customers of a certain 

 milk-shop where scarlet fever was existent. Since that date abundant 

 evidence has been forthcoming to show that to the channels of 

 infection previously recognised, that of conveyance by milk must be 

 added. Scarlet fever is disseminated in many ways from person to 

 person, and also by the vehicle of "fomites." The virus is not 

 diffusible, but is evidently tenacious of life. Infected garments that 

 have been put aside for months have been known to originate an 

 outbreak of the disease. Linen has been known on many occasions 

 to infect laundresses. There is no evidence that the virus can be 

 conveyed by water. As a rule, probably the infection of scarlet fever 

 is not greatly spread by aerial connection, but by articles (toys, books, 

 bed-clothes, letters, etc.), and such infected articles if set aside in 

 stagnant air, at a moderate temperature, and in the absence of day- 

 light, may retain the infection, like garments, for months. 



Infectivity begins at the earliest stage of the attack, but is prob- 

 ably greatest when the fever is at its highest. In most cases the 

 patient is free from infection at the end of six weeks. There is now 

 strong evidence that at least the later desquamation is not infective. 

 Probably the infection lingers longest in the nasal, tonsillar, buccal, 

 and pharyngeal mucus, and especially in any chronic discharge from 

 those mucous membranes. Discharges from the ear may retain 

 infection for months.* 



It is most probable that milk obtains its infection of scarlet fever 

 from being brought into contact with persons suffering, as a rule, 

 from the early and acute stages of the disease. 



Streptococcus Scarlatinae (Klein and Gordon). Streptococcus Conglomer- 

 atus (Kurth). The organism was isolated from the blood, nasal and tonsillar 

 discharge of persons suffering from scarlet fever in its earlier and later stages. Not 

 from urine or skin. It has been isolated from blood of persons dying from scarlet 

 fever. Assumed to be identical with streptococcus isolated from diseased udders of 

 cows and from their milk. Found by Klein in ulcerations of teats and udders of 



* See also Report to Metropolitan Asylums Board on Return Cases of Scarlet Fever, 

 by W. J. Simpson, M.D., 1901, p. 24 ; also Brit. Med. Jour., 1902, vol. ii., p. 445 

 (M. H. Gordon). 



