A MIRROR OF HOSPITAL
PRACTICE.
FEVER J* NOTES ON A CASE OF SCARLET By Surgeon J. Hoey, Madras Medical Service.
On the 3rd of December, I was called on to see a little girl, aged 5 years, the daughter of an officer residing in Bangalore, who complained of being ill. Up to the morning of the 3rd the child was in good health ; she then complained of a pain in her throat, and on examina-
tion it was found to be very red and somewhat swollen. The skin covered with a bright scarlet blush, most was hot and dry, and marked on the chest and abdomen. The blush had not extended to the legs and face. The temperature was io2?F. and the pulse Bowels 140. The tongue was covered with a creamy fur. confined. Suspecting scarlet fever ; the case was isolated. On the morning of the 4th, the blush had changed to a decided rash, and had extended to the legs, and in some degree to The tongue was thickly covered with fur and red the face. points appeared through the coating. The urine was scanty, and It contained no became decomposed shortly after being voided. The throat was considerably albumen. The reaction was acid. "the-tonsils a few points and and red swollen ; being enlarged very of whitish pultaceous deposit was observed dipping into the glands. Some streaks of blood appeared in the sputa. The temperature was ioo?F. and pulse 130. The rash was distinctive of scarlet fever. In the evening the throat was still more swollen, and the congestion had extended to the soft palate. There was some oedema of the chest, where the rash was most abundant. The child appeared very dull and drowsy. There was no membrane apparent in the throat. The voice was not affected ; the breath was foetid. On the 5th, the temperature was ioo?F. in the morning. The rash had extended all over the body but least marked on the face. The throat not more swollen and less red. The tongue was darker in color. The temperature in the evening was ioo?F. j and pulse 120?. Voice still unaffected and no vomiting. Child J dull and heavy. On the morning of the 6th the temperature was 99'4? F. The rash continued vivid : the throat not more swollen. The tongue was very red at the edges, and the patient more lively. Pulse 125, of good volume and force ; urine clear and increased in quantity. The skin felt rough on passing the hand lightly over it. In the evening the temperature was 99"2?F. The skin moist
J
*
M.
this interesting case we are indebted H. Forces, Madras.?Ed., /. M. G.
For
to
the
Surgeon-General,
and slight furfuraceous desquamation on the face. Bowels moved once ; the stools were white. The tongue was cleaning at the edges and presented a very red appearance. There was slight pitting on pressure over the chest and back. Urine more abundant and clear. Pulse 133, and temperature ioi*2?1*. On the 8th the temperature was ioo?F. The rash had all but disappeared. Desquamation had begun all over the body. Tongue clean; pulse 115. The patient felt much better, but complained of some pain and stiffness at the angles of the lower jaw. There was no swelling visible externally ; bowels confined. In the evening the temperature was 102? F. There was some sediment in the urine, but no albumen. The tonsils were considerably swollen, and the lymphatics of the neck were visibly enlarged and somewhat painful, i'ulse 140. On the 9th, the child felt much more lively. The neck was more swollen. Temperature ioo'2? F. On the 10th, the temperature was normal. The patient fell much better, only complaining of some pain at the angles of the jaw. The urine contained a great quantity of phosphates and a trace of albumen. Tongue clean. The temperature rose in the evening to 101? F. On the nth, the temperature was normal and the swelling in the neck had not increased. On the 12th, the temperature was normal and the albumen had disappeared from the urine. Up to the night of the 17th the child had been daily improving, but on that night having been restless and tossed the bed-clothes off, she got a chill and was attacked by vomiting and shivering, the temperature rising loss of appetite. The to io2'5?F., with furred tongue and An child complained of frontal headache and drowsiness. a small amount of albumen. examination of the urine, showed On the 19th, the temperature was again normal. The urine Since then the was healthy and passed in considerable quantity. child has had no return of the fever, and the appetite is good. on. The is still going Some desquamation desquamation has been in part furfuraceous and in part flaky. I have stated the above case at considerable length, so that there may be no doubt as to its being a case of scarlet fever. How did the This being so. the important question comes. child contract the disease ? After the most careful investigation into every possible source of the disease, I have failed to find the slightest clue that would furnish an answer to this question. Up to the time of the child's illness there was not a single case of scarlet fever in Bangalore, so far as I could learn from enquiries made in every quarter. I ascertained that the child's parents had not received any parcel or package from England for months previously. The whole washing of the family is done on the premises, the soiled linen not being removed from the house. The children seldom meet other children?a matter of small importance, unless there was some evidence that the disease existed in the station. It is needless for me to discuss here all the other possible sources of contagion, which I carefully examined, but with negative results. The simple fact remains?Here is a case of Scarlet fever (a disease known to be very rare in India) occurring in Bangalore. If it arises only from contagion or infection, I have completely failed to trace its source in this case to either one or the other.
Bangaltre, ijth January,
1SS2.
-U
/
/
PRACTICE.
FEVER J* NOTES ON A CASE OF SCARLET By Surgeon J. Hoey, Madras Medical Service.
On the 3rd of December, I was called on to see a little girl, aged 5 years, the daughter of an officer residing in Bangalore, who complained of being ill. Up to the morning of the 3rd the child was in good health ; she then complained of a pain in her throat, and on examina-
tion it was found to be very red and somewhat swollen. The skin covered with a bright scarlet blush, most was hot and dry, and marked on the chest and abdomen. The blush had not extended to the legs and face. The temperature was io2?F. and the pulse Bowels 140. The tongue was covered with a creamy fur. confined. Suspecting scarlet fever ; the case was isolated. On the morning of the 4th, the blush had changed to a decided rash, and had extended to the legs, and in some degree to The tongue was thickly covered with fur and red the face. points appeared through the coating. The urine was scanty, and It contained no became decomposed shortly after being voided. The throat was considerably albumen. The reaction was acid. "the-tonsils a few points and and red swollen ; being enlarged very of whitish pultaceous deposit was observed dipping into the glands. Some streaks of blood appeared in the sputa. The temperature was ioo?F. and pulse 130. The rash was distinctive of scarlet fever. In the evening the throat was still more swollen, and the congestion had extended to the soft palate. There was some oedema of the chest, where the rash was most abundant. The child appeared very dull and drowsy. There was no membrane apparent in the throat. The voice was not affected ; the breath was foetid. On the 5th, the temperature was ioo?F. in the morning. The rash had extended all over the body but least marked on the face. The throat not more swollen and less red. The tongue was darker in color. The temperature in the evening was ioo?F. j and pulse 120?. Voice still unaffected and no vomiting. Child J dull and heavy. On the morning of the 6th the temperature was 99'4? F. The rash continued vivid : the throat not more swollen. The tongue was very red at the edges, and the patient more lively. Pulse 125, of good volume and force ; urine clear and increased in quantity. The skin felt rough on passing the hand lightly over it. In the evening the temperature was 99"2?F. The skin moist
J
*
M.
this interesting case we are indebted H. Forces, Madras.?Ed., /. M. G.
For
to
the
Surgeon-General,
and slight furfuraceous desquamation on the face. Bowels moved once ; the stools were white. The tongue was cleaning at the edges and presented a very red appearance. There was slight pitting on pressure over the chest and back. Urine more abundant and clear. Pulse 133, and temperature ioi*2?1*. On the 8th the temperature was ioo?F. The rash had all but disappeared. Desquamation had begun all over the body. Tongue clean; pulse 115. The patient felt much better, but complained of some pain and stiffness at the angles of the lower jaw. There was no swelling visible externally ; bowels confined. In the evening the temperature was 102? F. There was some sediment in the urine, but no albumen. The tonsils were considerably swollen, and the lymphatics of the neck were visibly enlarged and somewhat painful, i'ulse 140. On the 9th, the child felt much more lively. The neck was more swollen. Temperature ioo'2? F. On the 10th, the temperature was normal. The patient fell much better, only complaining of some pain at the angles of the jaw. The urine contained a great quantity of phosphates and a trace of albumen. Tongue clean. The temperature rose in the evening to 101? F. On the nth, the temperature was normal and the swelling in the neck had not increased. On the 12th, the temperature was normal and the albumen had disappeared from the urine. Up to the night of the 17th the child had been daily improving, but on that night having been restless and tossed the bed-clothes off, she got a chill and was attacked by vomiting and shivering, the temperature rising loss of appetite. The to io2'5?F., with furred tongue and An child complained of frontal headache and drowsiness. a small amount of albumen. examination of the urine, showed On the 19th, the temperature was again normal. The urine Since then the was healthy and passed in considerable quantity. child has had no return of the fever, and the appetite is good. on. The is still going Some desquamation desquamation has been in part furfuraceous and in part flaky. I have stated the above case at considerable length, so that there may be no doubt as to its being a case of scarlet fever. How did the This being so. the important question comes. child contract the disease ? After the most careful investigation into every possible source of the disease, I have failed to find the slightest clue that would furnish an answer to this question. Up to the time of the child's illness there was not a single case of scarlet fever in Bangalore, so far as I could learn from enquiries made in every quarter. I ascertained that the child's parents had not received any parcel or package from England for months previously. The whole washing of the family is done on the premises, the soiled linen not being removed from the house. The children seldom meet other children?a matter of small importance, unless there was some evidence that the disease existed in the station. It is needless for me to discuss here all the other possible sources of contagion, which I carefully examined, but with negative results. The simple fact remains?Here is a case of Scarlet fever (a disease known to be very rare in India) occurring in Bangalore. If it arises only from contagion or infection, I have completely failed to trace its source in this case to either one or the other.
Bangaltre, ijth January,
1SS2.
-U
/
/
