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THREE ATTACKS OF SCARLET FEVER WITHIN FOUR MONTHS
548
ROYAL SOCIETY OF MEDICINE : OTOLOGY
mortem, both lungs were found to be completely collapsed except for small areas at the apices due probably to absorption of alveolar air following tracheal obstruction. There was a small patch of broncho-pneumonia in the right lung, and the mediastinal tissues were the seat of surgical emphysema. The failure of tracheotomy was apparently due to pressure of air on the lower trachea and primary bronchi. I to
indebted to Mr. R. A. Grant for publish these notes. am
permission
THREE ATTACKS OF SCARLET FEVER WITHIN FOUR MONTHS BY J. TODESCO, M.D., D.P.H. RESIDENT MEDICAL SUPERINTENDENT, BOROUGH HOSPITAL, CROYDON
5 years, was admitted to the Borough June 15th, 1934, suffering from scarlet Hospital fever. He had not previously had any infectious or other diseases.
A BOY,
aged
on
!
On admission there was marked general erythema ; the throat was much injected and the tongue was peeling. Temp. 1026°F. ; pulse-rate 140. On the fifth day after admission he was given 10 c.cm. of antistreptococcal scarlet fever serum, his temperature having kept up between 101°-103° F. during this period and the rash persisting. By the tenth day his temperature was normal, the rash had faded, and tongue peeled. Two days later desquamation was noted becoming general with " glovelike " peeling of his hands and feet. He made an uninterrupted recovery and was discharged on July 19th.
He was readmitted on July 22nd with a general scarlet. fever rash, injected throat, and coated tongue. Temp. 1024° F. ; pulse-rate 160. Another 10 c.cm. of scarlet fever serum was given on admission after previous desensitisation. Four days later his rash had faded and the
temperature was normal, the tongue having peeled. On July 28th he developed a blotchy general serum rash which disappeared the next day, but the temperature was He subsequently did not peel or develop any complications. On August 26th a general scarlet fever rash was noticed for the third time with injection of the throat and a coated tongue. Temp. 100° F. ;; pulse-rate 120. He was given.
normal.
another 10 c.cm. of scarlet fever serum. The temperature kept between 100°-102° F. for two days when it became normal and the rash faded. On that day following the injection of serum a severe focal reaction appeared in the thigh with much redness and swelling at the site of injection ; this was followed by a general serum rash lasting for 24 hours, and by then the swelling of the thigh had subsided. Left-sided adenitis developed on August 31st which persisted until Sept. 14th with no fever. He did not show any signs of desquamation and was discharged on Sept. 24th.
Though two attacks of scarlet fever following each other either during hospital isolation or within an interval of years have often been noted, three attacks of this disease are very unusual. This child seems to have been particularly susceptible to scarlet fever and possibly the repeated injections of scarlet fever serum increased this susceptibility temporarily. It should be noted that the only complication noticed was adenitis which did not appear until the third attack. I wish to thank Dr. Oscar Holden, medical officer of health for Croydon, for permission to publish this case.
MEDICAL SOCIETIES ROYAL SOCIETY OF MEDICINE SECTION’ OF OTOLOGY
AT the meeting of this section, held on March lst, the president, Mr. E. A. PETERS, occupying the chair, a discussion took place on the
Diagnosis
of Senile Deafness and its Amelioration
Mr. W. S. THACKER-NEVILLE, in opening, dealt with aural treatment. He analysed the case-sheets of 120 of his private patients who were over 60 years of age, with the following result. Their average age was 70 years ; 62 were men. Of the 120, 5 com12 a had of grossly abnormal tympanic plained pain ; membrane, 5 of them having dry perforations ; 102 complained of deafness. Of the 18 who made no complaint of deafness 7 had vertigo and tinnitus or vertigo alone, and 2 had pulsation due to otitis media. Tinnitus, usually due to vascular lesions, was present in 60 cases. Bone conduction of sound of a watch was absent on both sides in 61 cases, present on one side in 18, and present on both sides in 14. It was not examined for in 27 patients. Air conduction for the watch was present on both sides in 67 cases, on one side only in 26, while it was absent on both sides in 11 ; in 16 cases this was not tested. The low limit was ascertained in 94 patients, a total of 127 ears being tested ; 63 of these patients heard 32 double vibrations per second, 36 heard 64 double vibrations, while in 13 the low limit was raised above 64 vibrations. Rinn6s test was used on 172 ears ;
in 140 of these it was positive, in 23 it was negative, and in 5 air and bone conduction were equal. Schwabach’s test was employed in 72 ears; it was normal in response in 9, absent in 1, and the average for 62 patients was 4-2 seconds. Wax was present in quantity in thirteen ears, and in 16 patients the teeth were at fault. Rhinitis, including hypertrophy of turbinates, deviated septum, and vaso-rhinitis, was present in 9, and sinusitis in 40 patients. Treatment of senile deafness was certainly, in Mr. Thacker-Neville’s opinion, worth while. Hearing improved at times under it, and often tinnitus and vertigo could be lessened. The otologist, when dealing with people of this age, must be physician and alienist as well, and under no circumstances must the nose be left out of his sphere of investigation. He had carried out many treatments on these senile patients-he was practising at a spa where old people predominated-and he considered that most of them benefited by a mixture of bromides and vasodilators, together with an occasional bulbo-capnine. Others, however, required calcium diuretin, a most useful drug in his view. Limitation of the intake of fluids and absence of salt he regarded as an unsuitable treatment of the vertigo of old age, as in senility it was usually of vascular origin. He suggested that acetylcholine injections might prove useful. In his treatment of the middle ear and ther Eustachian tubes he had employed the catheter and massage, the Zund-Burguet, oto-masseurs, and autoinsufflators. Of these, the Eustachian catheter was definitely beneficial, while help was given by autoinsuffiators. For the nose he used nasal sprays, drops, or ointments, the material being ephedrine,
ROYAL SOCIETY OF MEDICINE : OTOLOGY
mortem, both lungs were found to be completely collapsed except for small areas at the apices due probably to absorption of alveolar air following tracheal obstruction. There was a small patch of broncho-pneumonia in the right lung, and the mediastinal tissues were the seat of surgical emphysema. The failure of tracheotomy was apparently due to pressure of air on the lower trachea and primary bronchi. I to
indebted to Mr. R. A. Grant for publish these notes. am
permission
THREE ATTACKS OF SCARLET FEVER WITHIN FOUR MONTHS BY J. TODESCO, M.D., D.P.H. RESIDENT MEDICAL SUPERINTENDENT, BOROUGH HOSPITAL, CROYDON
5 years, was admitted to the Borough June 15th, 1934, suffering from scarlet Hospital fever. He had not previously had any infectious or other diseases.
A BOY,
aged
on
!
On admission there was marked general erythema ; the throat was much injected and the tongue was peeling. Temp. 1026°F. ; pulse-rate 140. On the fifth day after admission he was given 10 c.cm. of antistreptococcal scarlet fever serum, his temperature having kept up between 101°-103° F. during this period and the rash persisting. By the tenth day his temperature was normal, the rash had faded, and tongue peeled. Two days later desquamation was noted becoming general with " glovelike " peeling of his hands and feet. He made an uninterrupted recovery and was discharged on July 19th.
He was readmitted on July 22nd with a general scarlet. fever rash, injected throat, and coated tongue. Temp. 1024° F. ; pulse-rate 160. Another 10 c.cm. of scarlet fever serum was given on admission after previous desensitisation. Four days later his rash had faded and the
temperature was normal, the tongue having peeled. On July 28th he developed a blotchy general serum rash which disappeared the next day, but the temperature was He subsequently did not peel or develop any complications. On August 26th a general scarlet fever rash was noticed for the third time with injection of the throat and a coated tongue. Temp. 100° F. ;; pulse-rate 120. He was given.
normal.
another 10 c.cm. of scarlet fever serum. The temperature kept between 100°-102° F. for two days when it became normal and the rash faded. On that day following the injection of serum a severe focal reaction appeared in the thigh with much redness and swelling at the site of injection ; this was followed by a general serum rash lasting for 24 hours, and by then the swelling of the thigh had subsided. Left-sided adenitis developed on August 31st which persisted until Sept. 14th with no fever. He did not show any signs of desquamation and was discharged on Sept. 24th.
Though two attacks of scarlet fever following each other either during hospital isolation or within an interval of years have often been noted, three attacks of this disease are very unusual. This child seems to have been particularly susceptible to scarlet fever and possibly the repeated injections of scarlet fever serum increased this susceptibility temporarily. It should be noted that the only complication noticed was adenitis which did not appear until the third attack. I wish to thank Dr. Oscar Holden, medical officer of health for Croydon, for permission to publish this case.
MEDICAL SOCIETIES ROYAL SOCIETY OF MEDICINE SECTION’ OF OTOLOGY
AT the meeting of this section, held on March lst, the president, Mr. E. A. PETERS, occupying the chair, a discussion took place on the
Diagnosis
of Senile Deafness and its Amelioration
Mr. W. S. THACKER-NEVILLE, in opening, dealt with aural treatment. He analysed the case-sheets of 120 of his private patients who were over 60 years of age, with the following result. Their average age was 70 years ; 62 were men. Of the 120, 5 com12 a had of grossly abnormal tympanic plained pain ; membrane, 5 of them having dry perforations ; 102 complained of deafness. Of the 18 who made no complaint of deafness 7 had vertigo and tinnitus or vertigo alone, and 2 had pulsation due to otitis media. Tinnitus, usually due to vascular lesions, was present in 60 cases. Bone conduction of sound of a watch was absent on both sides in 61 cases, present on one side in 18, and present on both sides in 14. It was not examined for in 27 patients. Air conduction for the watch was present on both sides in 67 cases, on one side only in 26, while it was absent on both sides in 11 ; in 16 cases this was not tested. The low limit was ascertained in 94 patients, a total of 127 ears being tested ; 63 of these patients heard 32 double vibrations per second, 36 heard 64 double vibrations, while in 13 the low limit was raised above 64 vibrations. Rinn6s test was used on 172 ears ;
in 140 of these it was positive, in 23 it was negative, and in 5 air and bone conduction were equal. Schwabach’s test was employed in 72 ears; it was normal in response in 9, absent in 1, and the average for 62 patients was 4-2 seconds. Wax was present in quantity in thirteen ears, and in 16 patients the teeth were at fault. Rhinitis, including hypertrophy of turbinates, deviated septum, and vaso-rhinitis, was present in 9, and sinusitis in 40 patients. Treatment of senile deafness was certainly, in Mr. Thacker-Neville’s opinion, worth while. Hearing improved at times under it, and often tinnitus and vertigo could be lessened. The otologist, when dealing with people of this age, must be physician and alienist as well, and under no circumstances must the nose be left out of his sphere of investigation. He had carried out many treatments on these senile patients-he was practising at a spa where old people predominated-and he considered that most of them benefited by a mixture of bromides and vasodilators, together with an occasional bulbo-capnine. Others, however, required calcium diuretin, a most useful drug in his view. Limitation of the intake of fluids and absence of salt he regarded as an unsuitable treatment of the vertigo of old age, as in senility it was usually of vascular origin. He suggested that acetylcholine injections might prove useful. In his treatment of the middle ear and ther Eustachian tubes he had employed the catheter and massage, the Zund-Burguet, oto-masseurs, and autoinsufflators. Of these, the Eustachian catheter was definitely beneficial, while help was given by autoinsuffiators. For the nose he used nasal sprays, drops, or ointments, the material being ephedrine,