The infectivity and management of scarlet fever / by W.T. Gordon Pugh.

  • Pugh, William Thomas Gordon, 1872-1945.
Date:
1905
Catalogue details

Licence: In copyright

Credit: The infectivity and management of scarlet fever / by W.T. Gordon Pugh. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of the superficial layers of the skin, resulting in desquamation, may also be due to a selective j)roperty of the scarlatinal toxin. In certain features, it is true, the two diseases appear on super- ficial examination to lx* not (julte analogous; some of these I shall dwell uj)on later. The rash in scarlet fever, perhaps the most striking ditfeience, may (piite jmssibly be due to some bacterial product circulating in the blood, for it is closely simulated by tlie erythema, which results, for example, from the adniinistiation of certain drugs, or of a soaj) and water enema. Scarlet fever much more closely resembles diphtheria than it does small|)ox, the distinctive skin lesions of which appear to be the direct result of the extrusion from the circu- lation of a virus, which recent researches suggest is possibly a })rotozoon. These lesions follow a continuous and charac- teristic course from papule to scab, and to them in the later stages of the disease infection would appear to be confined, while protraction of infectivity beyond the stage of separation of the scabs is said to be unknown. Criteria of Infectivity.— Before discussing in detail the infectious convalescent, it is necessary to indicate l)i iefly the general rules that have governed the time of deten- tion. It was originally believed that the period of infectivity coincided with that of desquamation. Occasionally, however, ])atients leaving hospital after desc[uamation was completed, were found to be the apparent cause of fresh outbreaks in their homes. It was then noticed that a large proportion of such })atients had suffered, either before or after leaving hos- ])ital, from discharges from the nasal or aural ]>assages, or from unhealthy conditions of the nasal mucous membrane with or without visible discharge. Rhinitis and otorrhu'a. therefore, beeame additional criteria of iiifeetivity. It wa> at the same time generally accepted that the seeondaiy de.>- <|uamation of hands and feet, which sometimes occurred, was not inteetious. 'I'he |)?aetiee of discharging patients (luring the |)rimary (les(|uamation had not made much head- way at the time of the investigations which I shall quote ; and, excej)t when s])eeially stated, it maybe assumed that six weeks was adoj)te(l as the minimum j)eriod of isolation, anff prirnaiy des(|uamation, ihinitis, and eai* discharge reganh'd as reasons foi' further detention. Certain Features of Diphtheria.—For the latter apprcciation of the lesults. it will be well to recall, also. c(Mtain of tlie known featuri's of diphtheria. (1) In the liist plac(\ (he K lebs-Locdller bacillus occasionally pi'i-sists for loni: pi'iiods. In sonu* of these patients the throat doi‘s not (piite