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one in which it had happened for the second time in the same person, has been transcribed by almost all writers, and has led many to entertain a belief that the disease could never occur twice in one individual. This belief, however, is quite erroneous. Rayer saw one well-marked instance of recurrence; Bateman and Withering saw several ; Blackburne saw two such cases; and Dr. Tweedie observes—“ We certainly have met with several well-authenticated instances of a second attack of scarlatina in the same person.” I have known second attacks of scarlet fever in the same person without any doubt. A little girl whom I attended in 1850, took scarlet fever. The disease was very decided in character, but passed over favourably. A month afterwards, the little patient complained of feeling sick and cold, and I feared that the symptoms of dropsy were about to present themselves. Instead of this, the skin a second time became universally red, and the throat sore; the patient passed again through a most marked attack of scarlet fever.
I am able, too, to speak from experience in my own person on this subject, for I have suffered from the disease, not twice only, but thrice. When a child, I suffered severely from scarlet fever, during a time when it was occurring epidemically in my native village. The rash was universal, and intensely red; the throat sore; the recovery slow. In the spring of 1850, whilst attending cases of scarlet fever, I sickened, became ill, and passed through a very severe second attack of the disease. The skin was
again red, the throat sore and ulcerated, and the recovery gradual. Still more curious, whilst attending a boy, in the month of April 1852, who had a severe attack of scarlet fever, I became exceedingly unwell, suffered from shivering, and sore throat, and had a faint red blush on the chest and neck. I am minute in these particulars, because it is important to settle satisfactorily all points that admit of being settled in these inquiries ; for by such means difficulties are exhausted, and fewer questions are left for investigation. I have not been able to collect statistical information on this subject of recurrences, so that it is impossible to state their frequency.
I take it, nevertheless, that the phenomenon of recurrence is most exceptional, and it is satisfactory to know that I can discover neither in literature, nor in general experience, one single case in which a second attack of scarlet fever has proved fatal.
I could not conclude this section on the natural history of scarlet fever, without reference to the mortality of the disorder, and specially in respect to the position which the disease holds in this particular to theother diseases of the zymotic class. Every writer on scarlet fever since its full recognition as a disease, has described, in mournful terms, its frightful ravages. Mr. Kearsley, of Philadelphia, writing about it a hundred years since as it appeared in America, says, “it baffled every effort to stop its progress, and seemed, by its dire effects, to be more like the sword of vengeance to stop the growth of the colonies, than the natural progress of a disease.” To this day the yearly
victims of the disorder are exceedingly numerous in all parts of the world, wherever it exists.
In considering the mortality of scarlet fever, several questions force themselves on our notice, some of which have been already answered incidentally. I allude to the subjects of age, of sex, and of season.
Two questions still remain : first, the influence of locality on the fatality of scarlet fever; second, the relative mortality of scarlet fever in comparison with other epidemic diseases.
To examine these questions, I have had recourse to the pages of the Registrar-General, and have referred, therefore, only to the disease as it occurs in our own country. The table below shows the comparative mortality from scarlet fever, in towns and rural districts. To insure correctness, each statement of deaths was obtained from a population of a million.
The mortality from scarlet fever in a million of people is, therefore, greater in towns than it is in rural districts. *
* While giving the above table as expressing the facts supplied, I think it fair to state, that later records show a less prominent mortality from scarlet fever in towns as compared with country districts. My
The following table indicates the different rates of mortality per million from scarlet fever, in eleven districts of England, during the years 1838, 1839, 1840, 1841, 1842, 1847, 1848. The last column will supply at a glance the comparative mortality.
North Western Counties
Deaths in seven years Relative per million. order. . 10,328 • 7,838
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The above table needs but few observations. It indicates an extraordinary mortality in the northwestern counties, which still obtains. The fever does not fall, however, on the whole country at the same time, but is, at similar periods, absent to a great extent in one locality, and extensively present in another.
The subject of the relative mortality of scarlet fever in reference to other epidemic diseases, possesses peculiar interest; and I have taken some pains to illustrate it by several tables. The first of these shows the relative mortality of seven epidemic dis
friend Dr. Greenhow, indeed, is of opinion that the mortality of towns is absolutely not greater : and that the annual mortality from scarlet fever in the healthiest country district in England is higher in proportion to the population than in either Liverpool, Birmingham, or London. eases. The returns are, for England in the years 1838, 1839, 1840, 1841, and 1842, and for London in 1843. The calculations are based on the numbers of deaths in a population of a million, as in a previous table.
Total. .21,549 In special years, the relative position of these mortality figures is somewhat changed.
In the next table, the relative mortality in a total of 79,256 deaths from six epidemic diseases occurring in London during the period of twelve years, from 1840 to 1851, is exhibited:
In the following and final table the subject of relative mortality is carried further, by a calculation based on 462,227 deaths from seven epidemic diseases, occurring during a period of eleven years, viz., in England in 1838, 1839, 1840, 1841, 1842, 1847,