CASE OF SCARLATINA IN INDIA. By K. N.
Registrar,
Medical
DAS, M.D.,
College Hospital, Calcutta,
The revival of the important inquiry, whether scarlatina occurs in India, by Drs. Caddy and Cook through the Indian Medical Gazette, and almost simultaneously by Mr. James Cantlie, in an article for discussion in the Journal of Tropical Medicine for July, leads me to record the following case which had all the clinical phenomena of scarlatina. Myrtle, T., cet. 6, born in India, both parents European, resident of Saraghat, came down to Calcutta for a few days with her mother and a sick sister, who was admitted into the General Hospital for fever. The patient Myrtle lived at the house of her aunt near Ballygunge. The mother started for Sara with Myrtle a few daj's later (on the afternoon of 25th February J 899). The history of the case after this is better given in the following account by the father submitted to " me in a letter: Before Myrtle got to Sara at 9 P.M., she complained of not feeling well, looked rather dull and had slight fever and sore-throat. Next morning the fever rose high to 10560 F., and continued high like this till she was taken down to Calcutta on the 28th. During this time her sore-throat became worse, she feeling
402
THE INDIAN MEDICAL GAZETTE.
great pain when swallowing her nourishment. The medical officer at Sara attended, and on the 26th noticed a rash breaking out over her face and body which resembled measles. The next day 27th, the eruption seemed thicker and closer together and of a deeper red. Her throat was now very painful, and Mrs. T. getting alarmed took her down to Calcutta, arriving on the 1st March when Dr. K. N. Das saw her." When seen by me, her condition was as follows : Patient dull, eyes congested, complained of headache. There was a bright red, generally diffused, rash all over the body fading on pressure. Marked dyspnoea with swelling of the glands of the neck. Typical strawberry tongue. Soft palate, uvula, fauceal pillars, very much congested and swollen. Tonsils very much enlarged, almost touching each other in the median line,
with small sloughing patches. Much difficulty in deglutition. Nothing abnormal discovered in heart, lungs, liver or spleen. Bowels constipated. Urine very scanty and contained V albumen. A few hyaline casts present. Treatment.?A mixture containing pot. chloras, quinine murias and tinct. ferri perchlor. was ordered, as also the following paint for the
[Nov.
1899.
Pot. chloras, liq. ferri perchlor., and glycerine. Steam atomiser also used. Diet, milk with Be tiger's food
throat:?Rx,
boro-glyceride was
and soup.
Subsequent 'progress.?Next dyspnoea
was
found
morning
to be worse, and leeches
the were
at the angles of the lower jaw with immediate relief. The rash was gradually fading away. Marked desquamation was noticed in a couple of days. The condition of the throat gradually became better. Urine was examined regularly. Its quantity increased and the albumen decreased, the latter entirely disappearing in a few days. She complained of much pain in the wrist and elbow joints, these being distinctly stiff. Nourishment was taken very well all along. The course of temperature is shown in the accompanying chart.
applied
Remarks.?It is certain that the infection took place in Calcutta before the child started for Sara. There is no history of infection from Europe. Case No. I of Drs. Caddy and Cook remained in the General Hospital till 2ist February 1S90, about which time a sister of the present patient was lying ill with fever, and the mother was a constant visitor to the General
ENTERIC FEVER IN
Nov. 1899.1
Hospital. Could not this be a possible source of infection ? It was evident that the disease did not prove infectious to others. Is it, as Dr. Cantlie suggests, that the diminished infective power of scarlatina is due to climatio in his masterly contribuchanges ? Gresswell tion on the " Natural History of Scarlatina " says that it is possible that changes of constitution dependent upon season and climate also have their influence, and that in this way " the comparative benignity of scarlatina, so frequently observed in warm weather as compared with its manifestations in the same country in colder weather, following a hot and dry season, may be explained, as also the fact that the disease is so generally mild when introduced into certain hot latitudes even among Europeans." Gresswell farther adduces facts to show that the influence of season means a change in the virus dependent or indirectly on "
directly
meteorological changes.
Dr. Cantlie suggests whether it is possible that scarlet fever is present in the tropics in some "altered form." It would, I think,be profitable if facts are collected with regard to the clinical phenomena of measle3* (as seen and diagnosed in this country).
* We see one or two cases of measles with all clinical symptoms nearly every year among Native prisoners in jails, but have never seen a very extensive spread of the disease in India. The possibility of endemic dengue must also be remembered.?Ed., I.M.G,
NATIVES OF INDIA.
403
Registrar,
Medical
DAS, M.D.,
College Hospital, Calcutta,
The revival of the important inquiry, whether scarlatina occurs in India, by Drs. Caddy and Cook through the Indian Medical Gazette, and almost simultaneously by Mr. James Cantlie, in an article for discussion in the Journal of Tropical Medicine for July, leads me to record the following case which had all the clinical phenomena of scarlatina. Myrtle, T., cet. 6, born in India, both parents European, resident of Saraghat, came down to Calcutta for a few days with her mother and a sick sister, who was admitted into the General Hospital for fever. The patient Myrtle lived at the house of her aunt near Ballygunge. The mother started for Sara with Myrtle a few daj's later (on the afternoon of 25th February J 899). The history of the case after this is better given in the following account by the father submitted to " me in a letter: Before Myrtle got to Sara at 9 P.M., she complained of not feeling well, looked rather dull and had slight fever and sore-throat. Next morning the fever rose high to 10560 F., and continued high like this till she was taken down to Calcutta on the 28th. During this time her sore-throat became worse, she feeling
402
THE INDIAN MEDICAL GAZETTE.
great pain when swallowing her nourishment. The medical officer at Sara attended, and on the 26th noticed a rash breaking out over her face and body which resembled measles. The next day 27th, the eruption seemed thicker and closer together and of a deeper red. Her throat was now very painful, and Mrs. T. getting alarmed took her down to Calcutta, arriving on the 1st March when Dr. K. N. Das saw her." When seen by me, her condition was as follows : Patient dull, eyes congested, complained of headache. There was a bright red, generally diffused, rash all over the body fading on pressure. Marked dyspnoea with swelling of the glands of the neck. Typical strawberry tongue. Soft palate, uvula, fauceal pillars, very much congested and swollen. Tonsils very much enlarged, almost touching each other in the median line,
with small sloughing patches. Much difficulty in deglutition. Nothing abnormal discovered in heart, lungs, liver or spleen. Bowels constipated. Urine very scanty and contained V albumen. A few hyaline casts present. Treatment.?A mixture containing pot. chloras, quinine murias and tinct. ferri perchlor. was ordered, as also the following paint for the
[Nov.
1899.
Pot. chloras, liq. ferri perchlor., and glycerine. Steam atomiser also used. Diet, milk with Be tiger's food
throat:?Rx,
boro-glyceride was
and soup.
Subsequent 'progress.?Next dyspnoea
was
found
morning
to be worse, and leeches
the were
at the angles of the lower jaw with immediate relief. The rash was gradually fading away. Marked desquamation was noticed in a couple of days. The condition of the throat gradually became better. Urine was examined regularly. Its quantity increased and the albumen decreased, the latter entirely disappearing in a few days. She complained of much pain in the wrist and elbow joints, these being distinctly stiff. Nourishment was taken very well all along. The course of temperature is shown in the accompanying chart.
applied
Remarks.?It is certain that the infection took place in Calcutta before the child started for Sara. There is no history of infection from Europe. Case No. I of Drs. Caddy and Cook remained in the General Hospital till 2ist February 1S90, about which time a sister of the present patient was lying ill with fever, and the mother was a constant visitor to the General
ENTERIC FEVER IN
Nov. 1899.1
Hospital. Could not this be a possible source of infection ? It was evident that the disease did not prove infectious to others. Is it, as Dr. Cantlie suggests, that the diminished infective power of scarlatina is due to climatio in his masterly contribuchanges ? Gresswell tion on the " Natural History of Scarlatina " says that it is possible that changes of constitution dependent upon season and climate also have their influence, and that in this way " the comparative benignity of scarlatina, so frequently observed in warm weather as compared with its manifestations in the same country in colder weather, following a hot and dry season, may be explained, as also the fact that the disease is so generally mild when introduced into certain hot latitudes even among Europeans." Gresswell farther adduces facts to show that the influence of season means a change in the virus dependent or indirectly on "
directly
meteorological changes.
Dr. Cantlie suggests whether it is possible that scarlet fever is present in the tropics in some "altered form." It would, I think,be profitable if facts are collected with regard to the clinical phenomena of measle3* (as seen and diagnosed in this country).
* We see one or two cases of measles with all clinical symptoms nearly every year among Native prisoners in jails, but have never seen a very extensive spread of the disease in India. The possibility of endemic dengue must also be remembered.?Ed., I.M.G,
NATIVES OF INDIA.
403
