Imagens das páginas
PDF
ePub

me, acute uræmia following within a few days or hours on a scarlatinal attack, is most frequent when that attack has assumed the aspect of malignancy; while the prolonged anæmic albuminous dropsy succeeding to a scarlatinal attack is most common after one of the milder forms of the disorder. The experience of other observers may be contrary to mine in this respect; but although such difference may exist, the general fact is not shaken, that the same sequelæ may follow different phases of the acute disorder. It is also worthy of notice that the occurrence of scarlatina, in any of its forms, is equally protective; in other words, a patient who has suffered from simple scarlet fever is as well protected from the malignant type of the malady, as one who has already suffered from the malignant type. This fact is such a matter of common experience that it need not be dwelt on, except to enforce the identity of the poisons acting in both sets of cases.

That neither season nor peculiar known meteorological change is the cause of the distinction in type, is, I think, established by fact. It is true that sometimes a great epidemic of the disease breaks forth, and proves largely fatal, owing to the occurrence of numbers of cases, malignant in kind. But again, in these illustrations, if all the facts be gathered together, there are a proportionate number of mild, as of severe cases. It happens, not uncommonly, that a district of country remains for many years free from an epidemic visitation of scarlet fever. In the period, during which the disorder is absent, large numbers of

children are born, each one susceptible to the affection. Suddenly the disease is set up by the introduction of a case into the locality; and, the train once lighted, every house becomes the habitat of the dreaded visitor. In such epidemics as these, there are always a large number of malignant cases and a frightful mortality; but there is an equal number of milder cases always to be found, if sought for with care; and even a larger number of mild than of malignant cases, in proportion to the population attacked. My own observations would lead to the opinion, that the proportion of malignant to mild cases is as one to five; but this is a point which requires much more elaborate investigation than I have been able to bestow upon it; for, if there should be a law in the background regulating the proportion of malignant and benign cases in a given number of sufferers, the establishment of such law would give a new reading as to the cause of difference, such as has not before been surmised.

That the locality in which the disease occurs influences the type, seems to me equally unproven. I thought at one time, certainly, that in low dirty houses, the malignant tendency was most developed; but further observation has dispelled this view. For, although it must be conceded, that nothing more materially interferes with the successful treatment of the disorder, in all its forms, than the confinement of the patient in a foul unventilated chamber, I must confess to have seen the mildest phases of the complaint passed through in such places; while, on the

other hand, I have observed the severest forms of malignancy in the rooms of the well-provided classes, where the strictest cleanliness and the most perfect ventilation were provided.

Once more, the physical condition of the patient at the period of attack, seems as little to influence the course of his malady as the external conditions by which he is surrounded. I have known (and every other practitioner, I doubt not, has known the same) instances, in which the whole of a family of children having been attacked, the weakest of the members, the scape-goat of the whole, has passed through the stages of the fever with impunity, while the strongest have fought for every inch of life, or have actually succumbed. And this same observation holds good, to my mind, on a larger scale; for I can recall no fact to sustain the impression that the indifferently fed children of the poor are either more or less susceptible of scarlet fever than the well fed children of the rich, or are more or less susceptible of the malignant forms of the affection.

Lastly, there seems no evidence to support an hypothesis of hereditary tendency to any specific type. We see this hypothesis negatived in the simple circumstance that, in children born of the same parents, the disease may assume different types in different cases. I have also put the question as to the form in which parents of affected children did themselves suffer in early life; but the answer has never conveyed any such fact, as could show the sign of an hereditary claimancy to a specific variety. On the contrary, in

G

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.

« AnteriorContinuar »