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74
1909]
formerly heard spoken of as a very dangerous malady, was then a very mild
affection and he told them that from 1799-1822 he did not recollect having
seen a fatal case, although he had long practised in the country before
he became first physician to the hospital of Tours. The numerous cases
which he met with both at his hospital and in private practice seemed at that
time to have satisfied him that Scarlet Fever was the mildest of all the
infections. But in 1824 an epidemic broke out in Tours, with the result that
before it had finished, Bretonneau, who had formerly looked upon Scarlet Fever
as a slight malady, now consider it as equally mortal with Plague, Typhus
Fever, and Cholera. Thus during a quarter of a century this disease, which
appeared as an epidemic without showing any severity, all at once became
changed in its character, and cruelly smote all whom it touched. Very severe
epidemics of Measles and Small Pox do without doubt sometimes occur, but
as epidemics they do not show such extremes of mildness and severity as
Scarlet Fever. It is a disease which apparently is more influenced than
Measles or Small Pox by a dominating epidemic constitution, and hence it
arises that an epidemic of Scarlet Fever is sometimes very mild and at other
times very severe.
The Medical Officer of Health is old enough to recollect a very serious
epidemic of this disease in Ireland about 1856 or 1857 when he with his sister
and his brother were attacked with it in a very grave form and which, indeed,
was fatal to his brother, and later on (in Gloucester in 1874) he had an opportunity
of seeing four cases which were of a type as severe as any he has seen,
or, indeed, read of, and all of which proved fatal. The neck in each case became
the seat of an inflammation so severe that presently it passed into such a
gangrenous condition that the cervical muscles were laid bare, as if they
had been most carefully dissected, exposing the throbbing blood vessels. Such
cases as these are very rare, and indeed Trousseau with all his experience
seems to have seen only one such case, for he writes as follows:—" I recollect
"a lad of 14 years of age in whom the gangrenous condition was so extensive
"that the muscles of the neck were dissected as occurs in diffuse phlegmonous
"inflammations, showing the carotids pulsating at the bottom of a horrible
"wound. The patient recovered, but a hideous deformity remained as a
"consequence of the gangrenous destruction of the tissue. A similar case is
"described by Graves."
It is fortunate, then, that Scarlet Fever of this severe type does not now
prevail, but looking at its past history who shall say that at any time there
may not be a recurrence of it in its severest form.