A contribution to the natural history of scarlatina derived from observations on the London epidemic of 1887-1888, being a dissertation for the degree of doctor of medicine in the University of Oxford / by D. Astley Gresswell.

  • Gresswell, Astley.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: A contribution to the natural history of scarlatina derived from observations on the London epidemic of 1887-1888, being a dissertation for the degree of doctor of medicine in the University of Oxford / by D. Astley Gresswell. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    cases presenting marked peeling. I would repeat that these cases were in no way whatever selected; the number of cases examined having been determined solely by the time at my disposal. It needs to be borne in mind, however, that marked peeling does not necessarily signify severity of attack; but certainly there is a general relation of this sort. Prof. Thomas, speaking on the subject of desquamation in relation to character of rash, said: ' Die In- tensitat des Abschuppung ist in gewisser Hinsicht vom Exanthem abhangig ; man darf aber nicht annehmen, dass jcdesmal auf ein intensives Exanthem eine reichliche Abschuppung, und umgekehrt auf ein schwaches Exanthem eine geringe Abschuppung folgen miisse.' To this, for my part, I would add that, speaking generally, a very marked rash signifies severity of attack; and that stress is also and more especially to be laid upon the earliness of the peeling as an indication of severity, the peeling in really severe cases being indeed general over the whole body at a very early stage—so early in some instances as the second day. Incidental rashes, of one sort and another, to the exclusion of such as are contagious or infectious, were presented by not a few of the patients under consideration; they were, for instance, herpes, psoriasis^ urticaria, and erythematous, papular, and pustular rashes. In a few cases, intercurrent mischief was evidently the determining cause ; in others, the rashes may have been such as would have developed in any case, scarlatinal infection wholly aside. Never- theless, it is of interest to remark that the percentage of patients who presented rashes, whether of one kind or another, was larger among those attacked in September and October than it was amons those attacked later. And this time-distribution of the rashes should, perhaps, be taken into account in considering the influence of season. As for age, it appears that no patient under two years, or over twenty years, presented any other than the scarlatinal rash. Among patients at intermediate ages, the rashes were fairly equally distributed. For, of the 36 patients, in all affected, 23 were over two and under nine years of age, and the remaining 13 were over nine and under twenty years of age; thus bearing to the total numbers of patients, at corresponding ages, proportions in the first set of cases of 7-0 per cent., and in the second set of 7-2 per cent. The percentage, however, at three years of age was i2-o^ and at six years it was 8-3. In regard to