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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    would most probably have been prevented, had the boy been confined to the house. . . . T i i • * In 1853, when treating of this same subject, 1 had occasion to protest against the opinion which was then very popular, that albuminous urine was to be found at some time or other m every case of scarlatina. How such a proposition could be entertained for a moment, when contradicted by strong negative testimony, 1 am at a loss to understand; but within the last few days.the same assertion has been made to me, and I look forward with much interest to hear the conclusions to which such a learned Society as the Edinburgh Medico-Chirurgical will arrive. I did not examine the urine of all my scarlatina patients every day, but it was done very frequently, and I am satisfied that no such critical phenomenon as has been alleged took place. In none of the 43 cases, save in No. 7, which did not show any mani- fest signs of scarlatina till exposure to the cold and wet of melting snow developed the dropsy, was any albuminuria or dropsy present. There is surely no need to multiply proof, but I may quote from my previous paper, one authority who was remarkable for the accuracy of his observations. Mr'William Wood, who reported on the epidemic of 1836, tells us,—“ In Heriot’s Hospital, of 45 boys who were attacked by scarlatina, 8 had dropsy and albuminous mine; while at the Merchant Maidens’ Hospital, which is closely adjacent, and during the very same period, 21 girls had the fever, but not one of them dropsy or albuminous urine.” My views with regard to albuminuria may be shortly stated thus:—The kidney complication giving rise to albuminous urine, either as a dangerous sequela, or as a critical evacuation merely, does not necessarily form an item in the train of symptoms which indicate scarlatina, though frequently typical in some epidemics. Three circumstances appear to favour its development, ls£, The intensity of the poison which gave rise to the primary disease; 2<7, Predisposition on the part of the patient; 3d, Incautious exposure to cold during convalescence. Albuminuria has been observed in many varieties of scarlet fever, perhaps more frequently in the mild than in the more severe forms. This can be explained in two ways, either by supposing that the poison had chosen the kidneys as emunctories from the system, or that, owing to the trivial nature of the case, less than ordinary care had been taken in preventing exposure to cold. I am disposed to consider the three cases of albuminuria observed in 1855, as illustra- tions of the intensity of the poison and predisposition combined. They all had a smart attack of fever, copious eruption, and desqua- mation of the whole cuticle. They were carefully guarded against cold, but yet kidney derangement came on; and as others, placed in exactly similar circumstances had equally severe symptoms, and no albuminuria, we may fairly infer that there was some predis- position on the part of these patients to a renal infection. No. 7 of the epidemic of 1861 must be admitted to be an excellent