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SCARLET FEVER IN INDIA.
546
SCARLET FEVER IN INDIA.
should be sent to the Senior Medical Officer, Med. I., ’ passed in the second period is a certain sign of latent oedema,. Attempts have also been made to estimate Ministry of Health, Whitehall, London, S.W.I. The statement adds that the Lister Institute has cardiac reserve by determining how long a patient at prepared an antivaccinal horse serum, doses of which rest can hold his breath after full expiration ; he then It is exercised by a quick walk and again holds his can be supplied on application to the Ministry. also calls attention to a reference, in the report breath after full expiration. The time taken depends of the Committee on Vaccination, to the success partly on volition, but also to a large extent on the which has been obtained in certain cases by the rapidity with which carbon dioxide accumulates treatment of post-vaccinal encephalitis by intra- in the blood. venous injection of serum derived from persons who SCARLET FEVER IN INDIA. have been recently vaccinated. IT is not so many years ago that enteric fever was EARLY CARDIAC FAILURE. supposed to be rare amongst Indians. This belief, WHEN there is a long history of diminished cardiac owing to blood tests and more frequent post-mortem is now exploded, and it appears that reserve, and one finds localised or generalised oedema, examinations, evidence of stasis in the liver and lungs, and definite the impression, widespread until recently, that scarlet is almost if not entirely non-existent amongst pathological signs in the heart itself, the diagnosis fever must go the same way. It is at any rate Indians, of cardiac failure is simple. But this is an endseriously challenged1 boy Dr. P. T. Patel, who is in result, an acknowledgment of defeat by the patient and by his doctor, and to-day, when the prevention charge of the principal infectious diseases hospitals and early diagnosis of disease is rightly emphasised, in Bombay. Few physicians can have practised for and when heart failure is still responsible for the many years in India without occasionally coming deaths of many men and women at the height of across a sporadic case having all the classical features their mental abilities, we must focus attention of scarlet fever, but such cases are almost always in, Europeans, and it is usually impossible to trace chiefly on the early condition. A recent review their Leonard Rogers remarked (1919) that by Prof. L. Bogend6rferl shows that the greatest scarletorigin. fever occurs in India as an imported infection, importance, as Mackenzie taught, is still to be that there is no evidence that it is an indigenous attached to an accurate history ; it is essential at the it that if ever attacks Indians. and disease, rarely same time to make a close study of the patient’s This is the view that has hitherto been generally for due in otherwise to mentality, symptoms reality From time to time, however, cases resembearly cardiac failure may easily be attributed to accepted. scarlet fever have been reported in Indians, and neurosis. Bogendorfer describes tests for the estima- ling K. in 1920 Macleod came to the conclusion that the tion of cardiac function, but since Nature knows no disease did affect Indians, though showing no disaverage, attempts to estimate cardiac reserve by to become epidemic among them. Since position absolute increase of the the after pulse-rate counting exercise such as knee-bending are likely to fall to the then isolated cases have been repeatedly observed in and elsewhere, and Dr. Patel is now ground. The same applies to blood pressure and the Bombay of from his own observation, that definitely quality of the pulse ; the latter is often used to scarlet fever opinion, is in India, and he quotes indigenous gauge the power of the heart, but actually it depends cases in support of this view. The suggestion many of but on the volume beat the not only heart, per also on many arterial factors. Repeated examina- is made that climatic conditions have modified the tion of the same patient, however, may be very disease, and it is clear that the rash may easily be valuable. Less often emphasised, but well worth overlooked on a dark skin. attention are minor disturbances of water metabolism. The heart normally works with part only of its ARISTIDES AGRAMONTE. available power ; with increased needs reserve powers Dr. Agramonte, who has just died of heart disease which the healthy heart can easily and rapidly supply are called into play. With ordinary daily wear and at New Orleans at the age of 62 years, was the last tear the reserve power of the heart becomes insufficient, survivor of the four actors in a brilliant episode in and water tends to be stored in the body by day, the story of yellow fever. With Walter Reed, James only to be excreted at night. Hence the importance, Carroll, and Jesse Lazear, he was sent by the Surgeonas as Quincke pointed out, of nocturnal enuresis General of the United States Army to Cuba in June, an early symptom. The body, Bogendorfer points 1900, to investigate the epidemic of yellow fever out, can retain considerable amounts of fluid without then raging there. The sequel is well known. Two the development of visible oedema, and even 4-7 litres of the commissioners, along with other volunteers, accumulated may give rise to no signs of oedema or lived among yellow fever patients in wards from which transudate into the body cavities. This latent mosquitos were excluded, and remained free from oedema, he says, can only be unmasked by the regular infection even though surrounded by the excreta and use of the weighing scales and with the estimation of vomit of these patients, proving that transference of intake and output of fluid. Kauffmann has shown the disease takes place normally through the bite of in apparently fully compensated heart disease that the mosquito alone. Dr. Agramonte was a native raising the end of the bed will result in increased of Cuba and left the island at 2 years of age when his secretion of urine ; 5 oz. of tea are given hourly to father was killed by Spanish troops. He qualified the patient lying flat in bed and the bladder is at Columbia College in New York in 1892, and soon emptied hourly ; after four hoursthe foot of the bed after became bacteriologist to the Board of Health. is raised and the patient is kept in this position for in 1901 he was transferred to the University of two hours, urine again being passed hourly. Small Havana, leaving that post to be head of the departamounts of rather more highly coloured, acid urine, ment of tropical diseases at the new medical school with a higher specific gravity, perhaps containing a of Louisiana State University. This summer he trace of albumin, are passed in the first period; was elected president of the Pan-American Medical an increased amount of urine of low specific gravity Congress to be held next year in New Orleans. ____
1 Zeit. für Ärztl. Fortbild., May 1st, p. 288.
1
Indian Med. Gaz., June, 1931.
SCARLET FEVER IN INDIA.
should be sent to the Senior Medical Officer, Med. I., ’ passed in the second period is a certain sign of latent oedema,. Attempts have also been made to estimate Ministry of Health, Whitehall, London, S.W.I. The statement adds that the Lister Institute has cardiac reserve by determining how long a patient at prepared an antivaccinal horse serum, doses of which rest can hold his breath after full expiration ; he then It is exercised by a quick walk and again holds his can be supplied on application to the Ministry. also calls attention to a reference, in the report breath after full expiration. The time taken depends of the Committee on Vaccination, to the success partly on volition, but also to a large extent on the which has been obtained in certain cases by the rapidity with which carbon dioxide accumulates treatment of post-vaccinal encephalitis by intra- in the blood. venous injection of serum derived from persons who SCARLET FEVER IN INDIA. have been recently vaccinated. IT is not so many years ago that enteric fever was EARLY CARDIAC FAILURE. supposed to be rare amongst Indians. This belief, WHEN there is a long history of diminished cardiac owing to blood tests and more frequent post-mortem is now exploded, and it appears that reserve, and one finds localised or generalised oedema, examinations, evidence of stasis in the liver and lungs, and definite the impression, widespread until recently, that scarlet is almost if not entirely non-existent amongst pathological signs in the heart itself, the diagnosis fever must go the same way. It is at any rate Indians, of cardiac failure is simple. But this is an endseriously challenged1 boy Dr. P. T. Patel, who is in result, an acknowledgment of defeat by the patient and by his doctor, and to-day, when the prevention charge of the principal infectious diseases hospitals and early diagnosis of disease is rightly emphasised, in Bombay. Few physicians can have practised for and when heart failure is still responsible for the many years in India without occasionally coming deaths of many men and women at the height of across a sporadic case having all the classical features their mental abilities, we must focus attention of scarlet fever, but such cases are almost always in, Europeans, and it is usually impossible to trace chiefly on the early condition. A recent review their Leonard Rogers remarked (1919) that by Prof. L. Bogend6rferl shows that the greatest scarletorigin. fever occurs in India as an imported infection, importance, as Mackenzie taught, is still to be that there is no evidence that it is an indigenous attached to an accurate history ; it is essential at the it that if ever attacks Indians. and disease, rarely same time to make a close study of the patient’s This is the view that has hitherto been generally for due in otherwise to mentality, symptoms reality From time to time, however, cases resembearly cardiac failure may easily be attributed to accepted. scarlet fever have been reported in Indians, and neurosis. Bogendorfer describes tests for the estima- ling K. in 1920 Macleod came to the conclusion that the tion of cardiac function, but since Nature knows no disease did affect Indians, though showing no disaverage, attempts to estimate cardiac reserve by to become epidemic among them. Since position absolute increase of the the after pulse-rate counting exercise such as knee-bending are likely to fall to the then isolated cases have been repeatedly observed in and elsewhere, and Dr. Patel is now ground. The same applies to blood pressure and the Bombay of from his own observation, that definitely quality of the pulse ; the latter is often used to scarlet fever opinion, is in India, and he quotes indigenous gauge the power of the heart, but actually it depends cases in support of this view. The suggestion many of but on the volume beat the not only heart, per also on many arterial factors. Repeated examina- is made that climatic conditions have modified the tion of the same patient, however, may be very disease, and it is clear that the rash may easily be valuable. Less often emphasised, but well worth overlooked on a dark skin. attention are minor disturbances of water metabolism. The heart normally works with part only of its ARISTIDES AGRAMONTE. available power ; with increased needs reserve powers Dr. Agramonte, who has just died of heart disease which the healthy heart can easily and rapidly supply are called into play. With ordinary daily wear and at New Orleans at the age of 62 years, was the last tear the reserve power of the heart becomes insufficient, survivor of the four actors in a brilliant episode in and water tends to be stored in the body by day, the story of yellow fever. With Walter Reed, James only to be excreted at night. Hence the importance, Carroll, and Jesse Lazear, he was sent by the Surgeonas as Quincke pointed out, of nocturnal enuresis General of the United States Army to Cuba in June, an early symptom. The body, Bogendorfer points 1900, to investigate the epidemic of yellow fever out, can retain considerable amounts of fluid without then raging there. The sequel is well known. Two the development of visible oedema, and even 4-7 litres of the commissioners, along with other volunteers, accumulated may give rise to no signs of oedema or lived among yellow fever patients in wards from which transudate into the body cavities. This latent mosquitos were excluded, and remained free from oedema, he says, can only be unmasked by the regular infection even though surrounded by the excreta and use of the weighing scales and with the estimation of vomit of these patients, proving that transference of intake and output of fluid. Kauffmann has shown the disease takes place normally through the bite of in apparently fully compensated heart disease that the mosquito alone. Dr. Agramonte was a native raising the end of the bed will result in increased of Cuba and left the island at 2 years of age when his secretion of urine ; 5 oz. of tea are given hourly to father was killed by Spanish troops. He qualified the patient lying flat in bed and the bladder is at Columbia College in New York in 1892, and soon emptied hourly ; after four hoursthe foot of the bed after became bacteriologist to the Board of Health. is raised and the patient is kept in this position for in 1901 he was transferred to the University of two hours, urine again being passed hourly. Small Havana, leaving that post to be head of the departamounts of rather more highly coloured, acid urine, ment of tropical diseases at the new medical school with a higher specific gravity, perhaps containing a of Louisiana State University. This summer he trace of albumin, are passed in the first period; was elected president of the Pan-American Medical an increased amount of urine of low specific gravity Congress to be held next year in New Orleans. ____
1 Zeit. für Ärztl. Fortbild., May 1st, p. 288.
1
Indian Med. Gaz., June, 1931.