— =e. 
oe 
has agitated every British community, no public anxiety 

NATURE 
41 


THURSDAY, NOVEMBER 17, 1870 


THE PRESENT EPIDEMIC OF SCARLET 
FEVER 
es prevalence of scarlet fever at this time throughout | 
England and Wales is a question that not only affects 
medical men, but is one that demands the attention of the 
people of England. They ought to ask themselves the 
question as to how it is that a malady which is placed by 
medical writers under the class of “ preventible” diseases 
is allowed to prevail to the extent of destroying several 
hundreds of persons weekly. Scarlet fever seems to 
enjoy that immunity which is accorded to what are called 
“necessary evils ;” but when we come to inquire what 
right this disease has to carry off ten or twelve thousand | 
persons annually, we find that it ought no more to exist 
amongst us than small-pox or cholera. 
Scarlet fever is essentially a contagious disease, and ex- 
hibits all the phenomena of a malady which, being com- 
municated from one individual to another, is more or less 
under the control of human action. Under these circum- 
stances, it is impossible for the Government to stop such 
a disease by mere Acts of Parliament, or for medical men 
to superintend efficiently arrangements for the prevention 
of its spread. It is only by the intelligent apprehension 
on the part of the public who are infected, that any hope 
of the arrest of the disease can be expected. We there- 
fore take this opportunity of addressing the public on the 
subject. Unless heads of families and the public gene- 
rally are acquainted with the real nature of this disease, 
no external organisation of any kind is sufficient for its 
control. 
We need not refer here specifically to the returns of 
the Registrar-General, to show how fearfully prevalent 
scarlet fever has been. In London the weekly mortality has 
been as high as one hundred and ninety in a week, giving 
a mortality for London alone of nearly ten thousand a 
year. Professor Huxley, in his late address at Liverpool 
as President of the British Association, says that in the 
years 1863, 1864, and 1869, 90,000 persons were killed in 
England and Wales by scarlet fever. These figures point 
to a much higher mortality for scarlet fever than we have 
ever had to record for cholera. The point most remark- 
able about this mortality is, that whilst death from cholera 
has been manifested about scarlet fever. Every one has 
submitted to it as a necessary evil, and no one has made 
any efforts to diminish its prevalence. 
Yet, when we come to inquire into the nature of scarlet 
fever, and the laws of its distribution, there seems to be 
no more reason why it should prevail amongst us than 
plague, small-pox, or cholera, whose laws of distribution 
we now know, and on which we can exert the most ob- 
vious control. Scarlet fever is a contagious disease, and 
it is not too much to say that we have ad/ contagious 
diseases under our positive control, Their nature, and 
the laws of their distribution, are so well known, that 

it is possible to teach the humblest individual in- | 
terested in their destruction the means by which it may | 
be effected. | 
VOL, IIT; 

We need not here enter into the discussion of the nature 
of “poison germs,” of “ microzymes,” or other ultimate 
forms which the poisons of contagious diseases may 
assume, but we may affirm that in every body affected 
with scarlet fever there is produced poisonous matter, 
which, passing from the diseased body, is capable of gene- 
rating anew the same disease as that which affects the 
body from which it is derived. The proofs of this are so 
abundant that we cannot for a moment admit that the 
question is open to discussion. The point of most im- 
portance here is to know how long the “ poison germs ” of 
scarlet fever retain their vitality—the terrible power of 
starting anew the changes of which they are the offspring. 
With regard to scarlet fever, we have more evidence of these 
“poison germs” retaining their vitality than with many 
other contagious diseases. Sir Thomas Watson, in his 
classical lectures on the “ Practice of Physic,” mentions a 
case in which a piece of flannel worn round the neck of 
a scarlet fever patient, being accidentally discovered two 
years after, and applied to the person of a servant in the 
family, produced an attack of scarlet fever. Were it 
necessary, I could mention several instances coming 
within my knowledge and reading, of the scarlet fever 
poison lying dormant in woollen clothes for years, and 
not having lost its vitality, or power of communicating 
the disease. 
Another point of importance with regard to the scarlet 
fever “ poison germs,” is the length of time which a person 
once affected with scarlet fever is capable of communica- 
ting the disease to others. When a person has got well of 
scarlet fever as far as general health goes, it is by no 
means the case that he is no longer capable of communi- 
cating the diseasé, but many days after he is strong 
and apparently healthy, he is capable of disseminating 
“poison germs” from his body. A recent instance has 
been recorded in one of our medical journals, of the 
prevalence of scarlet fever in families supplied from the 
milk of a particular dairy. On searching inquiries being 
made, it was found that the persons connected with the 
farm from which the milk was supplied, had been affected 
with scarlet fever. Although they had not been allowed 
to milk the cows till they had recovered from the 
scarlet fever, it was, nevertheless, found that they 
had been engaged in this occupation whilst the effects 
of scarlet fever in the desquamation of the cuticle of the 
skin was still going on. There are abundant other 
examples on record to show that until the desquamation 
of the cuticle which always follows scarlet fever is com- 
plete, no person who has had scarlet fever is safe from 
giving it to others. 
Such then being the nature of the poison of this disease, 
what ought to be known in families where it breaks out, 
and what to be done as the result of this knowledge to 
prevent its spread? It is no use saying that the doctors will 
give all necessary directions. In the first place, it may 
be said that the doctor in nine cases out of ten will not 
give any directions at all. It is not his interest to do 
so ; and if it were, he gets no information in his books or 
lectures on the subject at all. The medical profession 
is not required by its governing or examining bodies to 
know anytiting about public health or preventive medi- 
cine. In the next place, however admirable may be 
| the directions of medical men, persons utterly ignorant 
D 
