NOTES ON THE ERUPTIVE FEVER PREVAILING IN AND AROUND CALCUTTA
By Surgeon
S. M. Shirgore, Civil
Surgeon, li-Pergunnahs.
regarding the eruptive fever, to which the attention of medical practitioners in Calcutta has been so strongly drawn during the last six months, have no pretension to refinement or research: they are meant merely to exhibit in a very general way the impressions which have been forced on me by the occurrence of an unusual number of cases of this form of disease in my private practice in this city. The disease is by no means a new one in Calcutta. Cases of it have occurThe
following
notes
THE INDIAN MEDICAL GAZETTE.
34
practice during the last six years, but they have been more numerous, more severe, and better defined recently, than I have ever observed them to be. I am not over the mark in that I have met with 50 or 60 -well-marked instances red yearly in my
saying
within the last few months.
I have
seen cases
among all classes Armenians
community?Europeans, Eurasians, Jews,
of the
The features of the disease do not appear to be in any way modified by race. I have met with cases in all parts of the city and its suburbs. None of the cases under my care have proved fatal, nor have I had any personal knowledge
and Natives.
of death being caused by the disease or ita sequelae. It has occurred in persons of both sexes and all ages, but I have seen it more frequently in adults than in children. I would not,
however, from this circumstance draw
a
conclusion that adults
relatively to numbers living in Calcutta more liable to it than children; I merely note that the impression I have gained is as I have stated, whatever may be the true explanation of the are
am inclined to consider the disease an infectious one, because when one case has occurred in a house others have generally followed. On the other hand, I have seen solitary instances occurring in a house without any precautions been adopted to prevent the infection of the rest of the
circumstance. I
iiaving family.
I have seen a whole family become affected one after another; but the interval between successive seizures has some times been long, in some instances extending to a fortnight. I shall
detail the symptoms which I have observed the
now
disease to manifest in the majority of my patients: I shall remark on what I have come to consider exceptional features subsequently. A
is not
rigor
common.
A have
seen
the symptom well marked
and heard other patients complain of chilliness. The onset of the disease is, however, generally sudden, the patient often being awakened out of sleep by severe pain. This in
some
cases,
and high fever of the disease.
the most marked features of the
early stages pain is of a rheumatic character, and more articular than muscular, generally affecting all the limbs and joints: lumbar pain is often very severe. I have sometimes seen this pain so severe as to prevent the patient moving in bed without exciting positive agony. It is a continuous pain, and there is no redness nor swelling. The skin is ardent, These symptoms often flushed and dry, and pulse about 100. last for about three days, when some relief is obtained. I are
The
have not observed coryza generally moist and covered with or
and
sore a
throat.
thick white
cases
tongue is
fur, the tip enlarged pa-
being frequently red, and a few appearing amongst the fur. There is much restlessness, and sleep is impossible owing
sides
pillae
The
sometimes
in all to the
I have
seen delirium in some cases, and there is always less depression, but I have not found it amount to prostration in any instance. The bowels are natural; there is much nausea from the beginning; indeed I have found this to
pain:
more or
marked feature of the malady, amounting to a positive of food ; vomiting is not common however, and thirst of: the urine is natural. The fever has not been complained does not resolve with sweating, nor is this a marked feature of in my experience. On the remission any stage of the disease of fever and pain an eruption generally appears. It is a measly eruption, occurring often in crescentic patches,
be a
loathing
and so
brighter
uniform
pimples,
or
in colour than true measles. vivid
vesicles
nor
as
that of scarlatina.
scabs.
papulated,
The colour is not I have not seen
It appears on the face first and
spreads rapidly all over the body. It lasts about three days, fading first where it first appeared. I have not observed the palms of the hands to be first or mainly affected in any case. Meantime pain and fever abate, and with the exception that slight pain frequently persists in the joints, convalescence is established with the disappearance of the eruption. I have
[February
observed decided desquamation.
never
The skin
1, 1S72. assumes
a
appearance and feel, but there is no sealing, neither have I observed sequelae of any sort, and never dropsy or albuminuria. While the majority of my cases have presented the general
rough
features I have thus described, some cases have constituted au exception. Thus, the eruption has appeared simutaneously with the fever, or supervened on the second day. Such cases are
pain. I have also observed the almost absent and fever slight. I
milder and exhibit less intense
eruption have
while the
pain
was
noticed the occurrence of
pain
without
an eruption eruption has been delayed, in some instances as much as a week elapsing between the decline of fever and pain and its occurrence : patients have left their beds and fancied themselves well, and subsequently got out of sorts and gone through the usual eruptive stage. In some cases, after the eruptive stage has passed, I have seen the small joints of the fingers become swollen and painful and remain so for a week or more: in others pain has persisted as long as two months or more. I have thought the rheumatic symptoms worse in arthritic subjects. I have observed vomiting in tvo cases, and in some slight conjunctivitis has occurred ; no heart never
showing at
some
of the case.
period
The
symptoms have attracted my notice in any observed
case.
I have never
of the disease. I have not I consider the disease to be a specific exanthem. heard of a second attack, though I have known persons who have had it once exposed to infection. I don't know of any other a
marked
relapse
disease which presents the same sequence of symptoms, and though it is more like measles, than any other disease, I consider it, decidedly different in its nature from either measles or
scarlatina,
as
they
are
commonly
met with in
practice.
has been expectant and palliative, and consisted generally of mild aperients and salines. The cases have done well without quinine. I have treated the pain with hot fomen-
My
treatment
tations, and a combination of one part of compound camphor and two parts of aconite liniment, with benefit. I have administered hydrate of chloral when the pain was intense, but without much relief: I have, however found iodide of potassium very useful in the pain which often persists after acute symptoms have passed and eruption has gone. These notes have been put
together in the hurry of general practice, but as a record of rough impressions gained from a considerable experience of the disease, they may be useful for comparison with what other practitioners in Calcutta have met.