A contribution to the natural history of scarlet fever : based upon official statistical records of mortality and morbidity / by John T. Wilson.

  • John T. Wilson
Date:
[1897]
Catalogue details

Licence: Public Domain Mark

Credit: A contribution to the natural history of scarlet fever : based upon official statistical records of mortality and morbidity / by John T. Wilson. 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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    munities. Uniform clinical statistics might constitute a basis from which other observations would spring, and even prove helpful in working out the bacteriology of scarlet fever. Variations in fatality are probably largely concerned with influences affecting the life history of an obligatory parasite which is the actual cause of the disease. But it is possible that in the severer types involving the cervical glands and cellular tissue, these complications are due to a mixed infection. Hospital experience combined with the investigations of the sanitary departments might show that the influences which promote variations in type and fatality are well within the range of practical hygiene. It is believed that the change to a benign type not only manifests itself by a low fatality, but also by a diminished power of diffusion. The direct outcome of which should be to diminish the prevalence of the disease; but this may not necessarily be the ultimate result, since along with diminished power of diffusion, there also exists difficulty of recognition, and thus increased facilities for diffusion, even in the presence of the best possible organized system of prevention. In the absence of such facilities, a decrease in fatality is likely to be accompanied by diminished prevalence or decrease in morbidity. We will now consider scarlet fever in relation to sanitary administration. The Influence of Preventive Measures.—These measures comprise : (i) the education of the public as to their duty in the early recognition, notification, and isolation of cases occurring in persons under their care ; (2) control of school attendance ; (3) regulation of milk supplies ; (4) compulsory notification ; (5) hospital isolation ; and (6) Disinfection at the expense, and by the order of sanitary authorities and their officers. That these are all excellent and highly approved prophylactic measures will not be disputed, and it is now incumbent upon sanitary authorities and the general public throughout Great Britain to see that they are carried out. But this condition of things is of very recent date. Active preventive measures against scarlet fever, during the two decades 1870 90 were confined almost entirely to the large towns. Since 1890 they have gradually become general. The decline in mortality began in the Seventies (and coincides with the commencement of preventive efforts), but we have seen that the decline in mortality was not confined to the large towns which led the way in active prevention; towns without even the nucleus of a sanitary department, and rural districts which made no pretence to sanitary effort of any kind, all participated in the reduction of scarlet fever mortality. Again, in comparing one country with another, we find in some, which have not even yet practised hospital isolation (t.g. United States), the mortality has fallen just as in those which have hospital isolation. On general grounds we may safely assert that preventive measures, especially hospital isolation, where exercised, must have had some influence in lowering mortality. By isolation, dissemination of infection is checked, and prevalence of the disease diminished. By proper hospital treatment fatality is lessened, and there is evidence in the reports of health officers that these benefits have in some measure been attained. Without attempting to estimate the prophylactic effects of such measures in the reduction of mortality in localities where they have been in force, we may, in considering the cause of the general reduction which has occurred throughout Great Britain, almost leave them out of account, as the country in general did not enjoy the benefit of such measures to any great extent during the period under consideration. As in the days of Graves, at the beginning of the century, when many physicians in Dublin attributed the reduced fatality of scarlet fever, as compared with previous years, to their method of treatment, so at the present day it is not uncommon to find reasons, expressed or implied, for the reduction in scarlet fever mortality, quite at variance with those which the result of my enquiry seems to indicate. Diminished mortality has been largely attributed to hospital isolation* and the percentage (70 to 80 in some towns) of scarlet fever cases removed to hospital is frequently held up as a criterion in sanitary administration. It is to be feared that the prophylactic value of this excellent sanitary measure is, by some authorities, over-rated. If we contrast the progress of mortality in some of the principal towns in Scotland with the preventive measures in force, we find that in Glasgow, hospital isolation was largely * In the final report of the Royal Commission on Vaccination, the Commissioners say :—“ We think that the steps which have been taken, in various ways, to isolate persons suffering from scarlet fever have largely contributed to this decline,” while the dissenters tell us, without hesitation, that regarding smallpox, scarlet and typhus fevers in London, “the recent development of proper hospital isolation has been most strikingly effectual in reducing, almost to nsignificance, the mortality from those diseases, in the case of which it has been most largely resorted to.”
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