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I was entirely on a wrong track. The man was correct when he said that he was made worse by the medicines (tonics) which were prescribed for him. They suppressed secretion, which was the physiological act requiring more excitation ; they confined the current of the blood, and, in proportion as they did so, they supported the disturbance in the circulation.

It is equally obvious that the treatment by the hot bath, given though it might have been almost by accident, and certainly without any idea of relieving an embarrassed right ventricle, was the rational, as it was therefore by necessity the successful treatment. Any other form of derivation would have given relief—the abstraction of a little blood, a sharp purge, or diaphoretic; but the warm bath was and is the simplest remedy.

I have learned much from this case of reduplication; the essence of all which is to the effect that whenever, without evident sign of disease of the lungs or of organic changes in the heart or nervous centres, there are manifested indications of vascular irregularity commencing at the heart itself; then, however clear may be the signs of anæmia and debility, no good will come from any treatment in the absence of some system of derivation; that tonics, administered alone, invoke more mischief; and that coincident debility disappears without them, when the troubled heart is set at liberty.

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ESSAY IV.

CONTRIBUTIONS TOWARDS A MORE PERFECT CLINICAL

HISTORY OF SCARLET FEVER.

For some years past, I have been directing particular attention to Scarlet Fever, with a view to bring forward certain facts tending to supply a more correct clinical history of this, as yet, formidable disease. Some of my labours in this direction have already been laid before the members of the Epidemiological Society, and have appeared in abstract in the periodical literature of the day. I propose, on the present occasion, to collate these scattered materials, and, with certain new observations, to condense into one clinical essay the result of all that I have as yet accomplished. It is little enough, I am well aware; but such as it is, it is herewith offered.

POINTS RELATING TO THE NATURAL HISTORY OF

SCARLET FEVER. The question of the occurrence of scarlet fever at different periods of life is one of much interest, and has occupied the attention of various observers. Regarding this, an opinion has been promulgated that the disease is rare, if not absent, in babes at the breast and in children under two years of age. This statement was, I believe, first made by the distinguished Withering; but Dr. Nieuwenhuys, of Amsterdam, in an admirable paper on small-pox and scarlet fever, has repeated, within these late years, an almost similar opinion. He seems to have been led to this view by seeing cases in which infants had escaped the disease whose mothers were suffering from it, and were occasionally suckling these same children during the period of the disease. If this statement were true, it would convey one of the most curious facts in medicine. It is, however, one of those errors which occasionally will creep into the works of the ablest writers, if they give the history of their individual knowledge alone.

It happened to me that, in the first case of scarlet fever I ever saw in a puerperal woman, the infant at her breast died of the disease, and that another child of hers, under two years, took the malady and suffered from it in the malignant form. Here, then, were facts at once offered which showed that no rule such as that which has been suggested really obtains, or at least that such rule had its exceptions. I thought, therefore, that it would be interesting to follow out the subject, and, from a rigid analysis, to learn the fatality of scarlet fever in the early terms of existence.

In this direction I took, in the first place, my own reports of cases of the disease, and collected from the printed return-books of three friends who held parochial appointments (viz., the late Mr. Brown, of Saf

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fron Walden, in Essex; Mr. Palmer, of Sheen ; and Mr. Beresford, of Narborough, Leicestershire), the cases there reported from the year 1849 to 1853. To these I added statistics from the accounts of Messrs. Ryland and Parsons, who observed and noted the disease in Birmingham from the year 1832 to 1835. The result of this work gave me 431 cases of the disorder. Of these cases, 329 were in children under ten. In 242 cases under five, there were no less than fifteen in infants under two years of age.

To pursue the question further, I next turned to the mortality tables of the Registrar-General. The following is an epitome of this research :

“Out of a total of 12,962 deaths from scarlet fever in children under five years of age, occurring in the county of Kent in 1843, in London in 1845, 1846, and 1848, and in England in 1847, there were

No.

Age. Under 1 year . . . 1,289 Over 2 and under 3. . 3,338 Over 1 and under 2. . 2,874

Over 3 and under 4 . . 3,063

Over 4 and under 5 . .. 2,398 Total under 2 years 4,163 Total from 3rd to 5th yrs. 8,799

Total from 1 to 5 years, 12,962. Again, “in a total of 3,795 deaths in patients under five years, occurring in the London hospitals, in Manchester, and in Birmingham, in the year 1839, in twenty-four towns in 1840, and in London in 1842, there wereAge.

No. Total.
Under the second year .
Over the second, and under the third . . 1797 ? 3795
Over the third, and under the fifth

• 1588 While it is thus clear, from indisputable evidence,

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that the idea of an immunity from scarlet fever in the earliest period of life is founded in error, it comes out, also, from a more extended inquiry, that the mortality from scarlet fever is actually greatest in the period of infancy, if that be extended from one to five years. Thus, out of 31,744 cases of scarlet fever, occurring in Manchester in the year 1839, in Liverpool in 1839, in Birmingham in 1839, in twenty-four town districts in 1840, in London in 1842, 1843, 1844, 1845, 1846, 1848, and in England in 1847, the ages were

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We gather from these details, as an exposition of our first inquiry, that scarlet fever attacks most frequently in the third and fourth years of life: that it declines rapidly after the fifth year, and is almost lost after the fortieth. At the same time it would be unfair to attribute to age any direct relationship to the cause of the malady: age cannot be looked upon either as predisposing or preventive. It is due to the non-recurrent character of the disease after one attack, and to extreme susceptibility to it of all who have not suffered, that the ratio of cases at different ages is so marked. Children of three or four, who are by that time permitted to run about, and are also susceptible to the disorder, are naturally more subject to exposure than infants on whom the mother's eye is constantly watchful; the former, therefore, suffer most. And for the reasons that the majority of cases take

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