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46
trunk though none on the legs and arms. The throat was dirty,
the glands enlarged, the tongue peeling and the patient very toxic.
Over the pubes there was a dark desquamated patch of some
twelve square inches where exfoliation had occurred. There were
moist sounds in the chest, which by the third day after admission
exhibited consolidation. The patient died in another 48 hours.
The other death occurred in a girl of seven, admitted on the
second day of disease with a moderate attack and who was given
10 c.c.'s serum. The illness ran a very mild uncomplicated course
until the eighteenth day from the onset when a subcutaneous
haemorrhage was noticed on the legs. In a few hours other similar
haemorrhages had occurred and the feet became gangrenous.
Within 48 hours of the occurrence of the first haemorrhage the
patient was dead.
Complications.—Adenitis occurred in 39 (12.7 per cent.), otonhoea
23 (7.5), albuminuria 14 (4.6), nephritis 2 (0.6), rheumatism
3 (1.0), tonsillitis 4 (1.3), abscess 4 (1.3), and rhinorrhea 8 (2.6).
Operations.—Mastoid operations were performed on four patients.
Two other patients had minor operations, one an incision of a
gland and the other an incision of a mastoid abscess.
Double Infection.—One patient was incubating whooping cough,
one mumps and one incubating whooping cough and mumps
on admission.
Cross Infection.—Two cases of mumps occurred, following the
development of the disease in the patient who was admitted
incubating it.
Serum Treatment.—Serum, which is given to those exhibiting a
sharp reaction providing their admission was within five days from
the onset of the illness, was given to 104 patients, 10 c.c.'s to 80 and
20 c.c.'s to 24. Serum reactions occurred in 22.5 per cent. of those
patients who received 10 c.c.'s, but in 41.6 per cent. of those who
received 20 c.c.'s.
Of the eight patients who had previously been inoculated
against diphtheria, four suffered from reactions, one of the four
having received 20 c.c.'s and the other three 10 c.c.'s.
33 of the 104 who received serum developed complications, a
percentage of 31.7, as compared with the figure of 26 or a percentage
rate of 27.6 of the 203 who had no serum.
Return Cases.—The discharge home from hospital was followed
by a case of scarlet fever within 28 days in the case of 33 patients.
Relapses.—Two patients suffered from a second attack of
scarlet fever within a short period after their being discharged
from hospital after the first attack. A girl of eight years whose
onset was the 3rd April was removed to hospital on the 6th, discharged
on the 4th May and readmitted on the 6th. Another girl
of seven years whose onset was the 14th April was admitted to
hospital on the 16th, discharged on the 14th May and readmitted
on the 19th.