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nearly every case that has ended fatally under my observation, the parents have assured me that they suffered from the affection in its mildest form. And yet I must add that, in one instance, where I had opportunity to investigate all the facts faithfully, a whole family of children seemed altogether insusceptible to the malady. A member of this family, on one occasion, slept with a relative during the time when she suffered from the disorder, and escaped. A servant was introduced into the house, and soon afterwards passed through the fever; she was tended by the family, and one of the circle, who had never suffered, though she was an attendant on the invalid, and, it is to be feared, conveyed the disease to another family, showed no sign of the disease herself. This insusceptibility appeared also to have been inherited from the parents of these children ; the father and mother having, throughout their lives, escaped from the contagion, although their sisters and brothers had been sufferers from it.

Admitting, therefore, the view that hereditary predisposition to any specific form of scarlet fever does not exist, we may accept that, in certain very rare cases, there is manifested an entire insusceptibility of the disease, and that this insusceptibility is hereditary.

If, then, we allow (and I think we are bound to allow as much), that the variety of type of scarlet fever is not dependent on differences of poison, nor on meteorological state, locality, physical condition of the patient at the time of infection, age, nor on hereditary taint, where shall we look for an explana

tion of the singular phenomenon, that of two children attacked at the same time, the one may be comparatively well at the period when the other lies dead, each event being encircled in the period of a few days? The question is one of the most profound and important in the field of medical inquiry. At this stage of our knowledge we must leave it with but one supposition ; that there is, in the organism itself, a directing cause which modifies the violence of the poison, or intensifies its action; a cause allied to that agency which altogether prevents, in nearly every case, a repetition of the disease in those who have passed through its stages, whether gently or severely.

ON DOUBTFUL SCARLET FEVER. I have twice met with examples of disease in which I have been at a loss to say, whether the cases were or were not scarlatinal in their nature.

A young woman, a servant at an inn, was seized with slight shiverings, sensations of chilliness, weight in the head, and thirst. These symptoms lasted about twelve hours, when the body became covered with a bright red rash, the throat sore, and the tongue loaded and white. She was kept in bed, and ordered a simple effervescing medicine. Twelve hours after the first appearance of the eruption, it had entirely disappeared, and the patient expressed herself as feeling quite well. Three weeks afterwards, the same symptoms returned, and passed off as favourably as before, leaving no secondary disease. The disease was communicated to no one else.

In the second case, the patient, a young married woman, was placed in less favourable circumstances; her room was imperfectly lighted and ventilated, her dwelling was situated in a dirty locality, and her attendants were indifferent nurses. A class of symptoms appeared, precisely analogous at first to those described above; but in this case, as the sore throat and eruption faded, great bodily prostration succeeded, attended with griping pains in the bowels and copious diarrhea. This patient recovered very slowly, but communicated disease to none, although two children slept in the same bed with her, and an infant was at her breast.

The two cases thus described were in the same village (Barnes), and were occurring at the same time; but they were the only cases of the kind in the neighbourhood; and, although identical with cases of mild scarlet fever, so that no other name could possibly be given to them, they passed off without leaving any special sequelæ, and the patients propagated no disease to other persons around who were susceptible. The recollection of these cases has always left on my mind the fact that there is another poison almost identical in its effects with scarlatinal poison, but which has not the physical properties rendering it capable of distribution and contagion.


RHEUMATIC FEVER. Under the term “dengue,” orscarlatinal rheumatism, Dr. Wood of America, and a few other authors, have

described an epidemic, in which certain symptoms of scarlet fever are combined with those of acute rheumatism. Dr. Aitken, in his work on The Practice of Medicine, thus describes this epidemic:—“A peculiar febrile disease, conjoined with sudden severe pains in the small joints, which swell, succeeded by general heat of skin, intense pain in the eyeballs, and the appearance of cutaneous eruption on the third or fourth day. The disease is infectious, with an epidemic tendency.”

After describing that the disease has been observed in certain parts of the East and West Indies, and in the southern parts of America, Dr. Aitken, adds—" it" (the disorder) is not known in Great Britain."

Now, while it is true that we have no record of an epidemic of " dengue” in this country, it is certain that we not unfrequently meet with scarlet fever connected with acute rheumatic fever. I believe we were first indebted to Dr. Golding Bird for the mention of this fact. Afterwards, in 1845, at a meeting of the Belfast Medical Society, Dr. Kelso, of Lisburn, read a paper, in which he referred to twenty cases of the kind that occurred under his observation-(See report of proceedings of the Belfast Society in the Dublin Hospital Gazette for January 1st, 1846.) More recently, Dr. Ross has noticed very ably a similar conjunction of the scarlatinal and rheumatic disorders.

In April 1850, scarlet fever being then prevalent in the district, I attended a family on Barnes Green

that had been attacked with the prevailing disease. There were four children seized in this household; they were affected nearly at the same time. The introduction of the disease was clearly made out, and the fever took, in every case, the type of scarlatina anginosa. On the second day of the eruption two of the children, both boys, were seized with severe pains in the joints, particularly in the wrists, ankles, and knees, and on the following day there was as clear rheumatic swelling of these joints as in any case of acute rheumatic fever that I have ever witnessed ; I saw, myself, at the same time, the scarlatinal skin and throat, the strawberry tongue, and the rheumatic joints. On the following day the rash had much subsided, and the skin, which had before been dry and hot, began to throw out the ordinary acid secretion of rheumatic fever. The next day the cases might be said to have assumed altogether the rheumatic state, and in one child the endocardial membrane became affected. For more than a week these two children appeared to be gradually recovering; but at the end of this period there was a recurrence of the acute rheumatic signs, together with indications of albuminuria. At this same time the two other children, who had passed simply through the scarlatinal disease, became affected with albuminuria, and also with pain and swelling of the joints. The recovery of each was extremely slow, owing chiefly to the frequent recurrence of rheumatic arthritis ; but ultimately they did all recover, and that soundly. Singularly enough, during their

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