SCARLET FEVER

Evening Post, Volume CXXXVIII, Issue 39, 15 August 1944, Page 6

SCARLET FEVER

MANY MILD GASES

PRECAUTIONS NECESSARY

Scarlet fever, in a mild form, is widespread in the Wellington health district; the figures for notified cases are much higher, than for some years past, and it is certain that in addition to these known cases there have been many more which have been passed over, as trifling. Herein, said the District Medical Officer of Health, Dr. Hubert Smith, today, lay the danger of continuing spread, for the unrecognised cases were the main cause of spread of infection to others. Scarlet fever, which 50 years ago was a killing disease, had gradually lost its violence, and in itself was no longer a serious danger, but the complications which might follow neglect could be most serious, and there was always the possibility that the disease might change in nature again and regain the severity it had m earlier epidemics. "There is, therefore, a direct responsibility upon parents and contacts to do everything possible to ensure the protection of others from infection," he said. Scarlet fever, continued Dr. Smith, came in cycles, generally far-spaced. In 1941 there were 50 cases in the Wellington Central district (including the Wairarapa); in 1942 there were 96 cases; but in 1943, 625 cases. Already this year the figure for 1943 had been passed, and the notifications continued to be high. Although the notifications had been moving upwards through 1942, the epidemic started in August in 1943; prior to August, 1943, there had been an average of 15 cases a month, but then the notifications jumped to 60 a month. Now they were much higher again; May, 1944 (five weeks), 265; June, 246; and the present month (two weeks), 136 notifications, the greater number of which were from Wellington City. There had been four deaths since August, 1943. Considerable additional hospital accommodation had to be provided, and most of the cases which required hospital treatment had been nursed in temporary quarters at ' Trentham. Children's wards at the Public Hospital were closed to visitors. INFECTION FROM MINOR CASES. "Apart from these 'official' cases there are many undiagnosed and minor cases that have been treated at. home, or not treated at all, for they appeared to be 'just sore throats and a bit of a rash,' and these are the cases which have been mainly responsible for spreading the trouble," said Dr. Smith. "The position is admittedly difficult; mothers are often unable to get prompt medical service, and if the sore throat clears up and the rash subsides quickly they may not think much of it. The child plays about and the disease is spread further. Yet these 'very mild cases' can be dangerous and may lead to dangerous complications, besides spreading infection." He mentioned the case of a child with serious kidney trouble. The mother was positive that it had not had scarlet fever, but when she thought back, under questioning, she remembered the sore throat and a minor rash that had disappeared by morning. To close schools in an attempt to slop a scarlet fever epidemic was no solution, said Dr. Smith. Indeed, it was a question whether it did not do more harm than good, for it led to contacts and healthy children playing together throughout the day, whereas contacts of known cases and other children were at least kept apart during school hours. Because one in the family had scarlet fever it was no joke for mothers to keep brothers and sisters from school during the three or four weeks of illness and convalescence in case of home nursing, and there were some mothers who were ready to hide cases they did recognise to save themselves that bother. That, to say the least, was very bad citizenship, and worse parenthood. The schools were closing shortly for term holidays and parents would be expected to take great care to keep contacts from othei children. CROWDS AND OVERCROWDING. Because scarlet 'fever was spread by droplets from the nose and mouth, crowds and overcrowding should be avoided. Picture shows were not good for children during epidemic periods, and they would be far better playing in the fresh air in the daytime and in bed at night. Trams, buses, and tiains were°consistently overcrowded now, and that was another main cause for he continuance of the epidemic. Adult contacts played a lesser'part in spreading scarlet fever than children, but they should be most careful particularly during the first week aftei contact, and, in cases of home nursing, isolation of patients from those who had to mix with .others should be as thorough as it could be made. Adult contacts should as far as possible avoid travelling in peak hours, and they should, of course, avoid contact with children. HOME NURSING. In mild cases no particular skill in treatment was called for, said Ur. Smith. The child should rest in bed and be kept from chills, for the first week or ten days particularly. The illness started with a sore throat, some general upset, possibly stomach pains and sometimes vomiting, followed usually by a rash in twelve to twentyfour hours. The rash might.vary from a flush on the face and chest to a rash on the body, arms, legs, and buttocks. Such a rash could not be mistaken, but in mild types the flush or rash might last only a few hours and might pass unrecognised unless the mother took the care required by the prevalence of scarlet fever at present. Mild cases could be nursed at home, provided always that the patient could be kept apart from the rest of the household. Where there was overcrowding and where the family could not be kept free from contact, even mild cases should be transferred to hospital. A doctor should always be called, for no casual examination or opinion would determine whether a case was mild or threatening, and all cases, for the protection of the community, should be notified to the District Medical Officer of Health. The period of danger for a contact was in the first week, for the incubation period of the disease was from two to seven days, but where patients were nursed at home brothers and sisters should be kept from other children for the full period of convalescence —at least three weeks. Persistent illness, or persistent discharge from the nose or ears, or sores in the nostrils or about the mouth were indications that the germs of the disease were still active. Such cases required further medical attention, and continued segration was essential in the public interest. "Avoidance of crowds and close cpn? tact, whether in trams, buses, trains, or places of entertainment, and reliance on sunshine and the open air and good ventilation in the home and school are the best means of protection against continued spread of the disease," said Dr. Smith. "Scarlet fever in this present widespread epidemic is fortunately quite mild in form, but it is not to be taken lightly. The consequences of neglect and carelessness are too serious, for the individual and for the community."