1. The bacteriological examination of the throat or nose in 100 cases of scarlet fever on admission to hospital showed the following incidence of the different serological types of streptococci. Of 91 cases yielding positive results on the first examination, haemolytic streptococci of Type 1 were found in 8, Type 2 in 14, Type 3 in 26 and Type 4 in 12; the remaining 31 fell into the heterogeneous group. In the 9 patients who gave a negative swab on admission a later test showed Type 1 in 2 cases, Type 2 in 4 cases, Type 3 in 1 case and heterogeneous strains in 2 cases.2. The heterogeneous group comprised individualistic strains, none of which occurred with sufficient frequency to form a fifth type.3. In 50 out of the 100 cases examined at weekly intervals the type of streptococcus remained the same throughout the attack.4. In 50 cases there was a change of type during the course of the disease; a second type appeared in 38, a third in 10 and a fourth in 2.5. The change of type was considered to be a reinfection since it appeared most often in the youngest children and after the 3rd week of treatment; the source of reinfection was traced in two instances.6. In 3 patients, in whom the Dick reaction remained positive, the appearance of the new type coincided with a second attack of clinical scarlatina.7. Of the 50 patients in whom no change of type was demonstrated 20 still carried the haemolytic streptococci on discharge after periods in hospital ranging from 4 to 8 weeks.8. Of the total 100 cases there were on discharge 49 throat carriers of haemolytic streptococci and 6 nose carriers. None of the 55, so far as was ascertained, gave rise to “return cases” of scarlet fever.9. There was evidence of correlation between serological type of streptococcus on the one hand and severity of scarlatinal attack and occurrence of complications on the other. The importance of this in hospital practice is emphasised.10. The Dick test and Schultz-Charlton reaction were carried out on all cases in the series; the results indicated that the four serological types have different immunological values.11. The evidence in favour of qualitative as opposed to quantitative differences in toxin production by the different types is discussed.
Hospital trials on the control of dust-borne infection by oiling blankets, ward linen, garments, and floors were carried out in scarlet fever and measles wards in this hospital during the spring of 1942 and of 1943. The work in a scarlet fever ward, while on the whole encouraging, awaits the result of further tests before being recorded. The results of a controlled test in two measles wards are now reported.The haemolytic streptococcus has for many years been recognized as a predominant secondary invader in measles and as an important cause of its serious complications-e.g., otitis media, mastoiditis, and bronchopneumonia. The virus-damaged mucous membrane of the respiratory tract, the catarrhal nature of the primary infection, and the overcrowding of patients in hospital at epidemic times all combine to favour the acquisition and spread of streptococci. 1917and 1918(Michie and Lull, 1928. Its most serious consequences were pneumonia, empyema, and otitis media, which in the majority of cases were due to haemolytic streptococci. Cole and MacCallum (1918) found that a haemolytic streptococcal throat-carrier rate of 11.4% among measles patients on admission to hospital had risen to 38.6% after 3 to 5 days in the wards and to 56.8%,b after 8 to 16 days. They concluded that the chance of developing post-measles streptococcal infection was increased by residence in hospital, and that the high incidence of pneumonia, and the resulting high mortality, were due in part to infection occurring within the hospital. The sequence of events has become clearer since Griffith (1934) extended his method for the seiological typing of Str. pyogenes. Allison and Brown (1936) were thus enabled to make a survey in a measles ward. They took nose and throat swabs from 43 patients once weekly from admission to discharge, and appropriate swabs on the occurrence of any complication. By typing the strains of Str. pyogenes which they had isolated they showed that cross-infection with these organisms occurred in 22-i.e., 51.2%-of the 43 patients; and that of the patients thus cross-infected 13 developed complications as a result (7 otitis media ; 1 scarlet fever with otitis media ; 1 rhinitis; 4 rise of temperature only). In other words, 19% of the measles patients developed otitis media consequent upon crossinfection with streptococci. investigated possible measures for the control of dust-borne infection in wards. The dust-laying effect of spindle oil when applied to floors was tested in field trials by Thomas, who found that the method produced a prolonged and marked reduction in the number of bacteria in the air during sweeping. Since, however, the main source of the bacteriacarrying particles lay in the bed-clothes, van den Ende and co-workers devised methods for the -treatment of woollen and cotton materials with technical while oil, which reduced by 990% the number of micro-organisms liberated during bedmaking. The method of oiling ward articles by the use of oil-in-water emulsions (van den Ende and during the laundering process ...
The typing of scarlatinal streptococci.-From the mass of conflicting claims of the specificity of the agglutinative reactions of hemolytic streptococci from various infections, we have concentrated on the work of Smith [5] and Griffith [6, 7], who described a serological classification of homolytic streptococci, obtained from cases of scarlet fever. Griffith described four main serological types of scarlatinal streptococci, constantly associated with cases of scarlet fever, and during the past five years I have used his methods and technique, with slight modifications, in the study with my colleague, Dr. W. Gunn, of haemolytic streptococci from scarlet fever and other infections due to, or associated with, these organisms. The value of this method of investigating hwmolytic streptococci from scarlet fever is seen in the following instances:(1) The ready identification of the great majority of strains as scarlatinal.(2) The identification of the same type (a) as the infecting agent when scarlet fever occurs in more than one member of the same family, (b) as the cause of an outbreak in a diphtheria or measles ward, or (c) as an epidemic in a public school as shown recently by Glover and Griffith [8].(3) The correlation between infecting type and the clinical severity of the disease.(4) The prevalence of a particular type, indicating the mildness or severity of an epidemic.(5) The relation between strains found in secondary attacks to those isolated during the primary infection.(6) The quantitative and qualitative study of the toxigenic properties of different types. TABLE I.-THE DISTRIBUTION OF SCARLATINAL TYPEs OF STREPTOCOCCI IN 700 CASES OF
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