Discussion on the serum treatment of scarlet fever / R.A. O'Brien.

  • O'Brien, Richard Alfred, 1878-1970.
Date:
[1927?]
Catalogue details

Licence: In copyright

Credit: Discussion on the serum treatment of scarlet fever / R.A. O'Brien. Source: Wellcome Collection.

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    0 [Reprinted from the Proceedings of the Royal Society of Medicine, 1927, Vol. XX (Section for the Study of Disease in Children and Section of Medicine, pp. 155—158, 168, 161—165)7] enevx DISCUSSION ON THE SERUM TREATMENT OF SCARLET FEVER. / ft,is £ - —^ Dr. R. A. O’Brien. As my own clinical opportunities are limited, I recently referred the three important questions before us to the superintendents of three hospitals—all outside London— because I anticipated that experienced London clinicians would be present at this meeting and also because the disease in the north has probably been of a more severe type than the very mild type commonly seen in London. The three superintendents generously gave me permission to quote their opinions and experience this evening. In the Edinburgh Medical Journal, December, 1926, Dr. Benson, of the City Hospital, Edinburgh, described his results in the treatment of 100 cases of scarlet fever. He concludes that: “ The administration of antitoxic serum within the first forty-eight hours of the disease has a very favourable influence on the specific toxaemia of scarlet fever. In relieving the more urgent symptoms of the acute stage it undoubtedly renders the patient more comfortable. ‘ There are indications that the liability to subsequent complications is diminished, ‘ The administration of serum even on the first day of illness apparently does not act as an absolute safeguard against the subsequent development of complications of septic type in convalescence. “ In toxic cases of scarlet fever, serum should be administered either intravenously or intramuscularly at the earliest opportunity and the dose repeated if necessary.” Dr. Benson has since treated between two and three hundred patients with English concentrated serum. The dose was usually 10 c.c.—exceptionally 20 c.c. He says : ‘'The former dose exercises a definitely favourable effect in the mild and moderate cases. The serum does not seem to touch the septic type of the disease. Serum rashes were troublesome. Serum therapy is certainly worth while, more particularly in the sharper cases. I am not, however, prepared to discharge my patients in the third week of convalescence merely on the strength of serum treatment.” Dr. Harries, of the City Hospital, Birmingham, writes : “ We have used scarlet fever antitoxin for about eighteen months, and concentrated antitoxin as a routine in all except the mildest cases for six to eight months. Serum sickness is infrequent and trifling when it occurs. A dose of 10 c.c. is sufficient in the average case. “ There is some reason for hoping that serum will diminish complications and will reduce the necessary stay in hospital. If it has these effects, it is obvious that the money spent on antitoxin would be well spent. It is unnecessary to reiterate the well-known effects of scarlet fever antitoxin on the toxaemia of scarlet fever. The more striking the case the more striking are the results of treatment with scarlet fever antitoxin. The problem of scarlet fever is, in my opinion, one of late morbidity, and it is impossible to forecast what com¬ plications a patient with a mild initial attack may develop in the second or third