writes :?" I hare never
really '
seen a
of
case
scarlatina,
of any
nor
similar disease, in India. Soon after I went to
Howrah,
and I treated many cases. The and continued, and the exanthem, in generally strong many cases, was very like that of scarlatina; latterly, it more resembled that of measles. There was no renal
tlie
red fever'
fever
prevalent,
was
was
complication,
and
did not occur in any
anasarca
This fever attacked
case.
persons of all ages. It did not appear to be contagious. did not see any fatal case. This outbreak was described Dr. Edward Goodeve in the Indian Annals A
previous
outbreak
was
described
by
I have
seen
Medical Science.
Dr. H. H. Goodeve
in the transactions of the Medical and
Bengal.
of
I
by
Physical Society
and treated several
cases
of
of acute renal
affection with
anasarca preceded by fever, which, however, was by either exanthem or pharyngitis, and which was of periodic character. I have always regarded the absence of scarlatina from Bengal as a fact of interest; and, had any case occurred within my reach, I should have sifted it most eagerly ; but I repeat that I have never met with
unattended
even a
Dr.
doubtful case." observes :?" Several
Fayrer
years
I
ago,
saw
two
children who had very recently arrived from England, in whom all the
symptoms
were
those of scarlatina in
renal
a
mild
These
are the form, complications. as scarlatina in India, ever cases that I have regarded only (in my experience), and as they had a history of contagion before leaving England, they may be excluded, except that they shew that the disease may thus occur in India, though not indigenous. I have no recollection that the disease spread. The red fever, dengue or scarlatina rheumatica, and also rubeola or rotlieln, occur frequently, though this year I hav9 I have seen severe cases of both, but they did not seen them. not spread in the house, and the patients?adults as well as children,?recovered. The rash and sore-throat were severe, the febrile disturbance great, and the prostration considerable, but there were no renal complications.
but there
were
no
"
"
I have had
of the
European Female Orphan Asylum during that period. A mild rubeoloid has occurred occasionally in a few children. It showed no tendency to spread, and could hardly in the worst case be dignified as measles. for 12 years;
"
any
charge
some
But I have
of these diseases have visited it
renal
dropsy
preceding scarlatina,
and I
seen
occur can
in children here without
explain
it
only by regard-
it as one of the many Protean forms in which the evil influence we for want of a more exact name call malaria work3
ing
its evil effects." Dr. F. N. Macnamara writes :?" I have seen in Calcutta
cases
of fever which would, I
place tlxe existence or otherwise of true scarlet citj, if possible, beyond doubt or question, we have addressed a circular letter to all the medical practitioners of Calcutta, asking for an expression of their opinion and statement of their experience on the subject. There is, in the replies received, a remarkable unanimity on the negative side. Dr. Chevers, who has had, since 1853, abundant opportunities in Howrah and Calcutta of studying the diseases of the town, In order to
fever in this
sure, have been
Particularly I remember the case of five children of an Armenian family, living in the China Bazar; one of the children was first attacked; and from this child
called scarlet fever in
SCARLATINA IN CALCUTTA.
amongst children
am
the fever
spread
to
of these children
England.
the other four.
ware
quite
The symptoms in the
those of scarlet
case
fever, including
diphtheritic inflammation of the throat. To the best of my recollection, also kidney affection shewed itself iu some of the children, but on this point my recollection is somewhat hazy. The difficulty with me in receiving these cases as cases of genu-* iue scarlet fever, is that scarlet fever has uever been an epidemic the
October 2,
ROYAL MEDICAL BENEVOLENT FUND SOCIETY OF IRELAND.
1871.]
in the town, to the best of my belief?has nerer broken out in as lias the allied affection, any of the schools?but why not, measles, if the disease is ever imported into even one family
Dr. Abbot, has written but
in the town ?
Calcutta, having only
never
seen
a
seen a case
of
scar-
young sailor with the
former medical officer of the General
Hospital, 1857,
to say that he observed two cases there in have been unable to trace the notes of them.
On the
Dr. Charles remarks :?" I have latina in
we
a
217
us
whole,
the evidence
on
the
subject
hitherto recorded
in these pages, amounts to this:?Scarlet fever does
India, in
European communities,
either
as
an
occur
isolated case
in
or a
rash, but without the other symptoms. No other case that I have seen resembled scarlatina. The disease nearest to it, but
limited out-break. It does not appear to show any great tendency to spread, and in all cases there is a demonstration or a strong
very' different, is rotheln, of which I have
suspicion
both
Europeans
among
Brown told General
me
natives.
and
he had
case
a
seen
The
of scarlatina in
Dr. Pliin Smith had
many cases, Dr. John
late
sailor at the
a
in
European (age 8 ?) in 1804 or 1865. Air. Chambers, a former pupil of mine, told me he had a case this year in, I think, a Eurasian Hospital.
a case
a
woman."
typical case of scarlatina in my hospital or private practice in this city. The disease is one which is so plainly distinguished by prominent special indications, as a rule, that had I seen it, the fact must have been vividly impressed on my mind. I have, howerer, heard of the occasional occurrence of isolated cases, even in Calcutta, but from what I have been able to gather with regard to such reputed instances of scarlatina, there is reason to believe that they were imported from Europe. Now that the Suez Canal route has brought us virtually so much nearer the countries where the disease prevails, both endemically and epidemically, we may expect to see more of it in future, and be prepared to see it spread in an epidemic form." Dr. Woodford, in a large practice, extending over twenty years in Calcutta, has only met with some 5 or 6 cases in children. The disease did not spread nor prevail epidemically. Dr. Waller, who has had a large general practice in this town a
for many years, states that he has never met with
Payne
been aroused in
Calcutta,
and progress of
points
of
resemblance,
at the outset of the
negative
as
All the or
a
case.
observes : ?" I have never seen in India
I could call scarlatina.
ters
to
an
remaining conversed,
case
that
illness which at first
rather
presented some points I may say, the result has uniformly been continued similarity."
strongly
case, but
identity
a
More than once my suspicions have and have led me to watch the charac-
or even
medical
men
marked
with whom
we
have corres-
corroborate the views above
given. Dr. Hospital" is of opinion that a latent form of scarlet fever does occur in Calcutta, though very rarely." He has grounded this opinion on hearsay, having never had a case of his own in seven years' Calcutta experi"I have," he writes, "ascertained the details of two ence. such cases rather minutely, and these have led me to form an opinion almost amounting to a belief that such a disease occurs, that its skin and throat symptoms are overlooked, being slight, but that acute desquamative nephritis with dropsy and some times with dangerous debility, occurs in children and runs just such a course as that after manifest scarlet fever." It will be observed that Drs. Chevers and Fayrer describe such cases, and assign to them a different causation. They are deserving, therefore, of further careful clinical study. The native ponded
or
has
far
as
firms
W. J. Palmer of the General
practitioners whom we responded and have, it
addressed is
our
circular letter have not
presumed, nothing
to tell.
of its
is not ever
a
importation into this country jot of evidence that the disease
from
Europeindigenous, country. As
is
occurred among the natives of the concerned, the evidence now adduced con-
Calcutta is our
original
assertion.
The
disease,
as a
contagious
ex-
anthem, may be said to be unknown here, and isolated instances
puzzling as to etiology. enquiry or discussion.
are
Dr. Ewart writes :?" I have never met with
Dr.
There
The
subject
is still open for
really '
seen a
of
case
scarlatina,
of any
nor
similar disease, in India. Soon after I went to
Howrah,
and I treated many cases. The and continued, and the exanthem, in generally strong many cases, was very like that of scarlatina; latterly, it more resembled that of measles. There was no renal
tlie
red fever'
fever
prevalent,
was
was
complication,
and
did not occur in any
anasarca
This fever attacked
case.
persons of all ages. It did not appear to be contagious. did not see any fatal case. This outbreak was described Dr. Edward Goodeve in the Indian Annals A
previous
outbreak
was
described
by
I have
seen
Medical Science.
Dr. H. H. Goodeve
in the transactions of the Medical and
Bengal.
of
I
by
Physical Society
and treated several
cases
of
of acute renal
affection with
anasarca preceded by fever, which, however, was by either exanthem or pharyngitis, and which was of periodic character. I have always regarded the absence of scarlatina from Bengal as a fact of interest; and, had any case occurred within my reach, I should have sifted it most eagerly ; but I repeat that I have never met with
unattended
even a
Dr.
doubtful case." observes :?" Several
Fayrer
years
I
ago,
saw
two
children who had very recently arrived from England, in whom all the
symptoms
were
those of scarlatina in
renal
a
mild
These
are the form, complications. as scarlatina in India, ever cases that I have regarded only (in my experience), and as they had a history of contagion before leaving England, they may be excluded, except that they shew that the disease may thus occur in India, though not indigenous. I have no recollection that the disease spread. The red fever, dengue or scarlatina rheumatica, and also rubeola or rotlieln, occur frequently, though this year I hav9 I have seen severe cases of both, but they did not seen them. not spread in the house, and the patients?adults as well as children,?recovered. The rash and sore-throat were severe, the febrile disturbance great, and the prostration considerable, but there were no renal complications.
but there
were
no
"
"
I have had
of the
European Female Orphan Asylum during that period. A mild rubeoloid has occurred occasionally in a few children. It showed no tendency to spread, and could hardly in the worst case be dignified as measles. for 12 years;
"
any
charge
some
But I have
of these diseases have visited it
renal
dropsy
preceding scarlatina,
and I
seen
occur can
in children here without
explain
it
only by regard-
it as one of the many Protean forms in which the evil influence we for want of a more exact name call malaria work3
ing
its evil effects." Dr. F. N. Macnamara writes :?" I have seen in Calcutta
cases
of fever which would, I
place tlxe existence or otherwise of true scarlet citj, if possible, beyond doubt or question, we have addressed a circular letter to all the medical practitioners of Calcutta, asking for an expression of their opinion and statement of their experience on the subject. There is, in the replies received, a remarkable unanimity on the negative side. Dr. Chevers, who has had, since 1853, abundant opportunities in Howrah and Calcutta of studying the diseases of the town, In order to
fever in this
sure, have been
Particularly I remember the case of five children of an Armenian family, living in the China Bazar; one of the children was first attacked; and from this child
called scarlet fever in
SCARLATINA IN CALCUTTA.
amongst children
am
the fever
spread
to
of these children
England.
the other four.
ware
quite
The symptoms in the
those of scarlet
case
fever, including
diphtheritic inflammation of the throat. To the best of my recollection, also kidney affection shewed itself iu some of the children, but on this point my recollection is somewhat hazy. The difficulty with me in receiving these cases as cases of genu-* iue scarlet fever, is that scarlet fever has uever been an epidemic the
October 2,
ROYAL MEDICAL BENEVOLENT FUND SOCIETY OF IRELAND.
1871.]
in the town, to the best of my belief?has nerer broken out in as lias the allied affection, any of the schools?but why not, measles, if the disease is ever imported into even one family
Dr. Abbot, has written but
in the town ?
Calcutta, having only
never
seen
a
seen a case
of
scar-
young sailor with the
former medical officer of the General
Hospital, 1857,
to say that he observed two cases there in have been unable to trace the notes of them.
On the
Dr. Charles remarks :?" I have latina in
we
a
217
us
whole,
the evidence
on
the
subject
hitherto recorded
in these pages, amounts to this:?Scarlet fever does
India, in
European communities,
either
as
an
occur
isolated case
in
or a
rash, but without the other symptoms. No other case that I have seen resembled scarlatina. The disease nearest to it, but
limited out-break. It does not appear to show any great tendency to spread, and in all cases there is a demonstration or a strong
very' different, is rotheln, of which I have
suspicion
both
Europeans
among
Brown told General
me
natives.
and
he had
case
a
seen
The
of scarlatina in
Dr. Pliin Smith had
many cases, Dr. John
late
sailor at the
a
in
European (age 8 ?) in 1804 or 1865. Air. Chambers, a former pupil of mine, told me he had a case this year in, I think, a Eurasian Hospital.
a case
a
woman."
typical case of scarlatina in my hospital or private practice in this city. The disease is one which is so plainly distinguished by prominent special indications, as a rule, that had I seen it, the fact must have been vividly impressed on my mind. I have, howerer, heard of the occasional occurrence of isolated cases, even in Calcutta, but from what I have been able to gather with regard to such reputed instances of scarlatina, there is reason to believe that they were imported from Europe. Now that the Suez Canal route has brought us virtually so much nearer the countries where the disease prevails, both endemically and epidemically, we may expect to see more of it in future, and be prepared to see it spread in an epidemic form." Dr. Woodford, in a large practice, extending over twenty years in Calcutta, has only met with some 5 or 6 cases in children. The disease did not spread nor prevail epidemically. Dr. Waller, who has had a large general practice in this town a
for many years, states that he has never met with
Payne
been aroused in
Calcutta,
and progress of
points
of
resemblance,
at the outset of the
negative
as
All the or
a
case.
observes : ?" I have never seen in India
I could call scarlatina.
ters
to
an
remaining conversed,
case
that
illness which at first
rather
presented some points I may say, the result has uniformly been continued similarity."
strongly
case, but
identity
a
More than once my suspicions have and have led me to watch the charac-
or even
medical
men
marked
with whom
we
have corres-
corroborate the views above
given. Dr. Hospital" is of opinion that a latent form of scarlet fever does occur in Calcutta, though very rarely." He has grounded this opinion on hearsay, having never had a case of his own in seven years' Calcutta experi"I have," he writes, "ascertained the details of two ence. such cases rather minutely, and these have led me to form an opinion almost amounting to a belief that such a disease occurs, that its skin and throat symptoms are overlooked, being slight, but that acute desquamative nephritis with dropsy and some times with dangerous debility, occurs in children and runs just such a course as that after manifest scarlet fever." It will be observed that Drs. Chevers and Fayrer describe such cases, and assign to them a different causation. They are deserving, therefore, of further careful clinical study. The native ponded
or
has
far
as
firms
W. J. Palmer of the General
practitioners whom we responded and have, it
addressed is
our
circular letter have not
presumed, nothing
to tell.
of its
is not ever
a
importation into this country jot of evidence that the disease
from
Europeindigenous, country. As
is
occurred among the natives of the concerned, the evidence now adduced con-
Calcutta is our
original
assertion.
The
disease,
as a
contagious
ex-
anthem, may be said to be unknown here, and isolated instances
puzzling as to etiology. enquiry or discussion.
are
Dr. Ewart writes :?" I have never met with
Dr.
There
The
subject
is still open for
