CASE OF SCARLATINA IN THE HILLS. By Assistant Surgeon T. Maunsell, E/F. Bde., R. H. A. felt some uneasiness for two or three days Captain E before the 16th May, 1870, from what he considered to be relaxed sore throat: on that day the tonsils, particularly the right, were painful and inflamed, and he complained of difficulty in swallowing, and the soft palate and uvula were of a bright red colour, the latter very much increased in size and fleshy looking. 17th May.?Passed a bad and restless night: throat very much inflamed; tonsils enlarged and of a bright red colour; soft palate and uvula also of a bright red colour and cedematous; slight effusion of blood in the mesial line of hard palate, only liquids can be swallowed, and with difficulty. Pulse quick, and tongue coated with a white fur, except at tip and edges, where it is of a bright red colour; urine high coloured ; frontal headache and general
malaise. \Sth.?Throat much less painful; oedema subsiding, but there is a well-marked rash over chest and fore-arms and upper part
of back.
The rash consists of small dots of
a
bright
scarlet
colour, confluent by their margins, no skin of normal appearance between them, not elevated to the touch, completely disappear-
ing under pressure, and rapidly re-appearing when the pressure is removed. 19th.?Rash well out over trunk and extremities, permanent, and of the same character as described on 18th. Throat better, and oedema subsiding. Tenderness at angles of jaw, particularly right, where there is a good deal of swelling, corresponding to the lymphatic glands. Tonsils, soft palate, and uvula still of a bright red colour, but less inflamed. still well out. but not so bright as on yesterday. 20th.?Eash Throat better; colour of soft palate, tonsils, and uvula much paler.
21 st.?Rash beginning to fade from parts where it first made its appearance ; still strongly marked on loins ; patient feels the throat all right; aidema quite gone; soft palate, tonsils, and uvula getting paler in colour. The tenderness at angles of jaws subsiding. Tongue cleaning, and of the silvery appearance. 22nd.?Rash almost gone ; throat better. 23rd.?Rash gone; throat,quite well?a fine mealy scurf corresponding to the amount of rash coming off the skin. 26th.?Patient quite well now, only states that his skin is rough (cutis anserina), particularly at back and loins. 30th.?Some slight oedema under the lower eye-lids, best seen under left. Desquamation was very slight over the body generally, but is very marked on the hands, and it continued for three weeks or more. Skin, on trunk, especially about the loins very rough and dry.
THE INDIAN MEDICAL GAZETTE.
252 The
temperature
for albumen.
was
not
taken,
nor was
the urine examined
Remarks.?I believe the foregoing to be very interesting, as the presence of Scarlatina in the hills, and indeed in the plains, is denied by many medical men in India. At the time it occurred, there were, I was informed by a Civil Surgeon at the station, very many exactly similar cases in the station. I find in the Indian Medical Gazette for 1st July, 1870, a case of "Erythema Scarlatinaform" by Dr. Garden of Saharunpore, in which the of the case above given, and symptoms are almost similar to those " in an epidemic of scarlatina, in his remarks, Dr. Garden asks, would not this case be accepted as a fairly typical case of the mild form ? Scarlatina, however, is, as far as 1 am aware, an unknown disease in India, and the case moreover wants one of the chief factors of that disease, viz., contagiousnessIn my case though some certainly no one in the same house took the disease, " fever and sore of the servants in the adjoining compound had throat." but I was informed by the Civil Surgeon, there were I have since several similar cases at the time in the station. learned that other cases occurred at the same station (in children) were well marked, but did not prove contagious. I have, however, seen very severe cases in England, notably two, each of which occurred in the midst of large families, where the disease was not taken by those in immediate contact with the sufferer. Bearing in mind the difficulties which had only recently to be overcome in establishing the presence of typhoid fever in India, and which is now admitted by all, I think we should be careful how we call and classify such cases as the above, and the one described by Dr. Garden; as though probably the disease at present only exists on the country in a mild or modified form, it may nevertheless at no distant date assume the severe type it is so well rceognized by at home.
[December 1,
1870-
malaise. \Sth.?Throat much less painful; oedema subsiding, but there is a well-marked rash over chest and fore-arms and upper part
of back.
The rash consists of small dots of
a
bright
scarlet
colour, confluent by their margins, no skin of normal appearance between them, not elevated to the touch, completely disappear-
ing under pressure, and rapidly re-appearing when the pressure is removed. 19th.?Rash well out over trunk and extremities, permanent, and of the same character as described on 18th. Throat better, and oedema subsiding. Tenderness at angles of jaw, particularly right, where there is a good deal of swelling, corresponding to the lymphatic glands. Tonsils, soft palate, and uvula still of a bright red colour, but less inflamed. still well out. but not so bright as on yesterday. 20th.?Eash Throat better; colour of soft palate, tonsils, and uvula much paler.
21 st.?Rash beginning to fade from parts where it first made its appearance ; still strongly marked on loins ; patient feels the throat all right; aidema quite gone; soft palate, tonsils, and uvula getting paler in colour. The tenderness at angles of jaws subsiding. Tongue cleaning, and of the silvery appearance. 22nd.?Rash almost gone ; throat better. 23rd.?Rash gone; throat,quite well?a fine mealy scurf corresponding to the amount of rash coming off the skin. 26th.?Patient quite well now, only states that his skin is rough (cutis anserina), particularly at back and loins. 30th.?Some slight oedema under the lower eye-lids, best seen under left. Desquamation was very slight over the body generally, but is very marked on the hands, and it continued for three weeks or more. Skin, on trunk, especially about the loins very rough and dry.
THE INDIAN MEDICAL GAZETTE.
252 The
temperature
for albumen.
was
not
taken,
nor was
the urine examined
Remarks.?I believe the foregoing to be very interesting, as the presence of Scarlatina in the hills, and indeed in the plains, is denied by many medical men in India. At the time it occurred, there were, I was informed by a Civil Surgeon at the station, very many exactly similar cases in the station. I find in the Indian Medical Gazette for 1st July, 1870, a case of "Erythema Scarlatinaform" by Dr. Garden of Saharunpore, in which the of the case above given, and symptoms are almost similar to those " in an epidemic of scarlatina, in his remarks, Dr. Garden asks, would not this case be accepted as a fairly typical case of the mild form ? Scarlatina, however, is, as far as 1 am aware, an unknown disease in India, and the case moreover wants one of the chief factors of that disease, viz., contagiousnessIn my case though some certainly no one in the same house took the disease, " fever and sore of the servants in the adjoining compound had throat." but I was informed by the Civil Surgeon, there were I have since several similar cases at the time in the station. learned that other cases occurred at the same station (in children) were well marked, but did not prove contagious. I have, however, seen very severe cases in England, notably two, each of which occurred in the midst of large families, where the disease was not taken by those in immediate contact with the sufferer. Bearing in mind the difficulties which had only recently to be overcome in establishing the presence of typhoid fever in India, and which is now admitted by all, I think we should be careful how we call and classify such cases as the above, and the one described by Dr. Garden; as though probably the disease at present only exists on the country in a mild or modified form, it may nevertheless at no distant date assume the severe type it is so well rceognized by at home.
[December 1,
1870-
