SCARLATINA IN INDIA?CADDY & NIELD COOK.
August 1899.1
?lipml ^rfiqlts. SCARLATINA IN INDIA. By ARNOLD f.u.c.s.
&
CADDY,
J. NIELD
Eng.,
dp.h.
Member of the Clinical Pathological Societies
,$? of
Medical
COOK,
Camb.,
Officer of Health, Calcutta,
London.
Two very have
cases
of
a
disease
simulating scarlatina
closely having come under our notice, thought lit to record them in view of
we
the
freely expressed opinion that scarlatina is unknown in India, except in a few instances where it has been directly imported from Europe. Both these cases occurred in the European Female Orphan Asylum, 79, Lower Circular Road, Calcutta. This institution was founded in 1815, and the occupants
are
girls
who have
lost either father or mother or both parents. The majority of the children are of pure European parentage, and with very few exceptions have been born and bred in India. The Asylum is superintended by two Sisters of the Order of St. John the Baptist, Clevver. When full it contains 52 children. The building stands in a large compound, the grounds being very well kept. There are 15 native male
271
servants living and sleeping in out-buildings 011 the premises. Two punklia coolies come in from outside during the hot weather to work by day and two mehtrani ayahs who come daily to sweep; these latter bring their children with them, and they in 110 way come in contact with the European inmates. The buildings consist of a central block of two floors, facing east, and a detached wing, facing south, situated at the north-east angle of the main building and at right angles to it. The groundfloor of this wing is occupied by a chapel, and the upper floor is used as an isolation ward when required. Both floors are united by covered ways to the main building, these ways being freely open to the air. The buildings are kept scrupulously clean. The water-supply is excellent, and the surface drains are periodically overhauled. There are no sewer connections. The milk-supply is good, the cows being kept on the premises in a large airy, well-drained byre. All milk is boiled before consumption, and the food is carefully inspected by the Sisters every day. As a general rule, the health of the inmates is excellent.
Case I?Kate N., aged 6 ; born in India ; living at the European Female Asylum, Calcutta. Previous Orphan health always good. On the morning of the 17th January, 1894, was attacked with fever and sore throat and was put to bed. On the 18th January she was seen by the medical officer of the Asylum. She had then a temperature of 104.? Her throat was sore, the fauces and tonsils being reddened. Tongue coated with a white fur with the fungiform papillte showing through. Conjunetivte were congested, and the skin of the neck, chest, abdomen and flexures of the elbows were covered with a
V2
.
THE INDIAN MEDICAL GAZETTE.
bright red, diffused rash which disappeared on pressure only to return when the pressure was removed. The
examined and found to contain T'? albumen 011 after boiling. Dr. William Coulter of this city saw the child and pronounced the clinical characters to be those of scarlatina and advised immediate isolation. As the isolation ward was not available, arrangements were made to send the child to the European General Hospital, where she went next day. A dose of castoroil was ordered meanwhile.
urine
was
settling
For the further history of this case, wo are indebted to Major H. W. Pilgrim, i.m.s., the Superintendent of the Hospital, who kindly placed the notes at our disposal. On the 19th January, on admission to hospital, temper103*4, skin warm, pulse frequent. The body studded with minute spots of scarlet hue ; was given a diaphoretic mixture every three hours and a gargle of boracic acid to be used frequently. The lungs, liver and spleen were pronounced normal. 20th Jany Slept well ; tongue dry ; pulse 120?. There was an ulcer 011 the right tonsil and general congestion of the throat and enlargement of the cervical glands. Skin still red. The urine slightly acid, sp. gr. 1014. Albumen, nil. The temperature rose to 104? in the afternoon, when two grains of ph'iiacetin were giveu. Diet?Milk, 2 pints ; chicken broth, 1 pint. 2\stJany.?Temp. 101? at 6 a.m. Tongue still dry; papilloe enlarged. Fauces congested ; no pain 011 swallowing. Rash fading 011 the legs Temp. 102? at 6 p.m. Tinct. aconite m. i given with the diaphoretic mixture every three hours, and a gargle of chlorate of potash used Took, nourishment well ature
22nd Jany.?Temp. 100? at midnight. Rash fading chest and abdomen. Throat less congested and less painful. Urine sp. gr. 1010 ; acid. Albumen, nil. Highest temp. 101.? Bowels open three times to-day. Treament continued. 23rd Jany.?Temp. 98-6? at 6 a.m. Rash faded everywhere. Branny desquamation 011 face, abdomen and sides. Complains of itchiness. Throat much better; gland in neck smaller. No albumen found in the urine. The body was washed with 1 in 40 carbolic lotion. Temp. 101? at 6 p.m. 24th Jany.?Temp. 98*6? at 6 a.m., and rose only to 100? at G p m. Branny desquamation of back. Congestion of throat very slight. Carbolic oil to be rubbed on the skin. 25th Jany.?Temp, normal, rising to 99? at 0 p.m. Skin peeling off in patches, the size of a pea. Bowels once moved. No albumen in urine. Treatment continued. 26th Jany ?Temp, normal all day. Desquamation continued. Glands under the chin still enlarged. Treatment continued. 011
27th Jany. ?Temp, normal. Mixture omitted. 2 8th
Jany? Temp.
desquamating. only.
Urine free from albumen.
normal. Throat all right. Still Diet increased. Tongue cleaning at tip _
She continued to improve from this date. The skin of the hands peeled off on the 6th February. Temperature remained normal except for trifling rises to 99? 011 February 2nd and 3rd. The enlargement of the tonsils slowly subsided. Desquamation continued on the hands and feet until the 18th February. On the 4th February she was given a tonic mixture of iron and quinine and improved steadily. She was discharged quite well 011 the
21st
February.
Shortly after this patient was taken ill, three other inmates of the Asylum developed simple sore throats, without fever or rash of any kind;
[August
1899.
they were isolated for a while, and in a few days allowed to return to their every-day occupations On the 19th January, the drains of the Asylum were thoroughly overhauled by the Corporation Sanitary Authorities and pronounced in good order. The cow b}7re was inspected, and as several of the cows and calves were covered with an impetiginous eruption on the skin of the neck and groin, Dr. W. J. Simpson, who was then Medical Officer of Health, made cultures from the skins of these animals 011 January 24:?"' "V'! V'V V :\v.. '
-
'
v
.
?5^
'' .,**
\
?
?
*
*v
?
\
.
'
? ?
\
..i.
.
?'*'*"*
"I:..\ ?t--'
.{
.
*
?
.:***?
so
that
-
?
??
.
,
4
overgrown with
of bacteria with. From the seal}7 papules on the neck of calf No. II, which had originally been inoculated with the streptococcus obtained from the skin of the girl, a streptococcus was obtained identical in appearance with that inoculated {vide Plate I). 2Gth June 1899.?Cultures made from the
were
/ Vc ;\
.
/.:.\
275
t
.
,
%. \.
v
$
%t
*
*
?.
v..,y V*
.
,
NR.,
II
I From Skin
From Skin
Calf.
of
of
Girl.
*Y'^?a
*H *
/
i
L tv
>
'
'*
*
\
'
?* '
?
?:
?
.
fe, '*
te
???
?/??
*"t
...
*?
?
*
August 1899.1
?lipml ^rfiqlts. SCARLATINA IN INDIA. By ARNOLD f.u.c.s.
&
CADDY,
J. NIELD
Eng.,
dp.h.
Member of the Clinical Pathological Societies
,$? of
Medical
COOK,
Camb.,
Officer of Health, Calcutta,
London.
Two very have
cases
of
a
disease
simulating scarlatina
closely having come under our notice, thought lit to record them in view of
we
the
freely expressed opinion that scarlatina is unknown in India, except in a few instances where it has been directly imported from Europe. Both these cases occurred in the European Female Orphan Asylum, 79, Lower Circular Road, Calcutta. This institution was founded in 1815, and the occupants
are
girls
who have
lost either father or mother or both parents. The majority of the children are of pure European parentage, and with very few exceptions have been born and bred in India. The Asylum is superintended by two Sisters of the Order of St. John the Baptist, Clevver. When full it contains 52 children. The building stands in a large compound, the grounds being very well kept. There are 15 native male
271
servants living and sleeping in out-buildings 011 the premises. Two punklia coolies come in from outside during the hot weather to work by day and two mehtrani ayahs who come daily to sweep; these latter bring their children with them, and they in 110 way come in contact with the European inmates. The buildings consist of a central block of two floors, facing east, and a detached wing, facing south, situated at the north-east angle of the main building and at right angles to it. The groundfloor of this wing is occupied by a chapel, and the upper floor is used as an isolation ward when required. Both floors are united by covered ways to the main building, these ways being freely open to the air. The buildings are kept scrupulously clean. The water-supply is excellent, and the surface drains are periodically overhauled. There are no sewer connections. The milk-supply is good, the cows being kept on the premises in a large airy, well-drained byre. All milk is boiled before consumption, and the food is carefully inspected by the Sisters every day. As a general rule, the health of the inmates is excellent.
Case I?Kate N., aged 6 ; born in India ; living at the European Female Asylum, Calcutta. Previous Orphan health always good. On the morning of the 17th January, 1894, was attacked with fever and sore throat and was put to bed. On the 18th January she was seen by the medical officer of the Asylum. She had then a temperature of 104.? Her throat was sore, the fauces and tonsils being reddened. Tongue coated with a white fur with the fungiform papillte showing through. Conjunetivte were congested, and the skin of the neck, chest, abdomen and flexures of the elbows were covered with a
V2
.
THE INDIAN MEDICAL GAZETTE.
bright red, diffused rash which disappeared on pressure only to return when the pressure was removed. The
examined and found to contain T'? albumen 011 after boiling. Dr. William Coulter of this city saw the child and pronounced the clinical characters to be those of scarlatina and advised immediate isolation. As the isolation ward was not available, arrangements were made to send the child to the European General Hospital, where she went next day. A dose of castoroil was ordered meanwhile.
urine
was
settling
For the further history of this case, wo are indebted to Major H. W. Pilgrim, i.m.s., the Superintendent of the Hospital, who kindly placed the notes at our disposal. On the 19th January, on admission to hospital, temper103*4, skin warm, pulse frequent. The body studded with minute spots of scarlet hue ; was given a diaphoretic mixture every three hours and a gargle of boracic acid to be used frequently. The lungs, liver and spleen were pronounced normal. 20th Jany Slept well ; tongue dry ; pulse 120?. There was an ulcer 011 the right tonsil and general congestion of the throat and enlargement of the cervical glands. Skin still red. The urine slightly acid, sp. gr. 1014. Albumen, nil. The temperature rose to 104? in the afternoon, when two grains of ph'iiacetin were giveu. Diet?Milk, 2 pints ; chicken broth, 1 pint. 2\stJany.?Temp. 101? at 6 a.m. Tongue still dry; papilloe enlarged. Fauces congested ; no pain 011 swallowing. Rash fading 011 the legs Temp. 102? at 6 p.m. Tinct. aconite m. i given with the diaphoretic mixture every three hours, and a gargle of chlorate of potash used Took, nourishment well ature
22nd Jany.?Temp. 100? at midnight. Rash fading chest and abdomen. Throat less congested and less painful. Urine sp. gr. 1010 ; acid. Albumen, nil. Highest temp. 101.? Bowels open three times to-day. Treament continued. 23rd Jany.?Temp. 98-6? at 6 a.m. Rash faded everywhere. Branny desquamation 011 face, abdomen and sides. Complains of itchiness. Throat much better; gland in neck smaller. No albumen found in the urine. The body was washed with 1 in 40 carbolic lotion. Temp. 101? at 6 p.m. 24th Jany.?Temp. 98*6? at 6 a.m., and rose only to 100? at G p m. Branny desquamation of back. Congestion of throat very slight. Carbolic oil to be rubbed on the skin. 25th Jany.?Temp, normal, rising to 99? at 0 p.m. Skin peeling off in patches, the size of a pea. Bowels once moved. No albumen in urine. Treatment continued. 26th Jany ?Temp, normal all day. Desquamation continued. Glands under the chin still enlarged. Treatment continued. 011
27th Jany. ?Temp, normal. Mixture omitted. 2 8th
Jany? Temp.
desquamating. only.
Urine free from albumen.
normal. Throat all right. Still Diet increased. Tongue cleaning at tip _
She continued to improve from this date. The skin of the hands peeled off on the 6th February. Temperature remained normal except for trifling rises to 99? 011 February 2nd and 3rd. The enlargement of the tonsils slowly subsided. Desquamation continued on the hands and feet until the 18th February. On the 4th February she was given a tonic mixture of iron and quinine and improved steadily. She was discharged quite well 011 the
21st
February.
Shortly after this patient was taken ill, three other inmates of the Asylum developed simple sore throats, without fever or rash of any kind;
[August
1899.
they were isolated for a while, and in a few days allowed to return to their every-day occupations On the 19th January, the drains of the Asylum were thoroughly overhauled by the Corporation Sanitary Authorities and pronounced in good order. The cow b}7re was inspected, and as several of the cows and calves were covered with an impetiginous eruption on the skin of the neck and groin, Dr. W. J. Simpson, who was then Medical Officer of Health, made cultures from the skins of these animals 011 January 24
-
'
v
.
?5^
'' .,**
\
?
?
*
*v
?
\
.
'
? ?
\
..i.
.
?'*'*"*
"I:..\ ?t--'
.{
.
*
?
.:***?
so
that
-
?
??
.
,
4
overgrown with
of bacteria with. From the seal}7 papules on the neck of calf No. II, which had originally been inoculated with the streptococcus obtained from the skin of the girl, a streptococcus was obtained identical in appearance with that inoculated {vide Plate I). 2Gth June 1899.?Cultures made from the
were
/ Vc ;\
.
/.:.\
275
t
.
,
%. \.
v
$
%t
*
*
?.
v..,y V*
.
,
NR.,
II
I From Skin
From Skin
Calf.
of
of
Girl.
*Y'^?a
*H *
/
i
L tv
>
'
'*
*
\
'
?* '
?
?:
?
.
fe, '*
te
???
?/??
*"t
...
*?
?
*
