Epidemic of scarlet fever at Donaldson's Hospital during the autumn and winter of 1861 / by James D. Gillespie.

  • Gillespie James D. (James Donaldson), 1824-1892.
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: Epidemic of scarlet fever at Donaldson's Hospital during the autumn and winter of 1861 / by James D. Gillespie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    may sufficiently account for their apparently greater susceptibility to attacks of scarlatina. Were I to attempt, by a comparison of the symptoms, to range the cases I have detailed, under any of the definitions of the varieties of scarlatina given by authors, I should be notably puzzled. Where was the florid eruption of the first variety, the acute sore throat of the second, the sloughing of the textures in the third, or even the scarlatina faucium, or sine exanthemate, of the fourth ? The prevailing type of the disease I witnessed was simply fever, the sore throat being almost imperceptible; the eruption, when present, being in nine cases out of ten only a slight mottling on the chest, which would most assuredly have escaped notice, had atten- tion not been specially directed to the appearance of the skin ; but the strawberry tongue was an invariable symptom except in the very severe cases, where it assumed more the typhoid character. It may be said that those cases which were characterized by such undecided symptoms, were hardly worthy of being ranked as scarla- tina, but yet the three fatal cases to which I now propose directing your attention, began exactly like the milder ones, and did not dis- play, save in their fatal issue, the ordinary features of scarlatina. In none of the three was the characteristic eruption present, in none was the sore throat of any intensity, but in all three the poison appeared to go at once to the brain, causing such a striking simi- larity of symptoms, that, save in the mere question of the time taken to destroy each, one description would have sufficed for all. The time when these fatal cases occurred is so far remarkable, that they took place while surrounded by the mildest forms of the disease, nor could they be in any way connected with each other, the two first becoming affected on two successive days, and the third only five days thereafter. That urasmic poisoning was not the cause of death I infer from the fact, that there was no diminution in the quantity of urine excreted, and no apparent change in its character. In only one of the three could a post-mortem examination be obtained; but what was disclosed on tliat occasion would lead me to conjectuie? that much the same appearances would have been brought to light in the others had inspection been permitted. I do not expect ever to witness again such a remarkably pure case of death from apncea, as my presence in the hospital enabled me to observe, when the boy J. W. so suddenly breathed his last. The appearance of the medulla oblongata may perhaps sufficiently account for the instan- taneous suspension of the respiratory functions, and this, by eat mg to congestion, will explain the enormous dilatation of t le pupi s which accompanied the change. . f A notable feature in the cases I have narrated is the absence o sequel®. Except in Case 7, which I may call undeveloped scarla- tina, no secondary affection whatever was noticed ; and, as _ 1,1 previously mentioned, the dropsical symptoms and albuminuri