25. Read 1 July, 1794.

[1312] “Several children brought up portions of a film, or membrane of a whitish colour, resembling the coagulated matter which was found in the trachea of those children whose bodies were opened. This was thrown off by violent coughing or retching; and the efforts made to dislodge it were often so distressing that the child appeared almost in a state of strangulation.” [1313] Sinclair’s _Statist. Account of Scotland_, IX. 190. [1314] _Ibid._ II. 412. [1315] _Ibid._ IX. 461. [1316] Livingston to Lettsom, Aberdeen, 13 May, 1790, in _Memoirs of Dr Lettsom_, III. [1317] R. Willan, M.D., _Reports on the Diseases in London, 1796-1800_. Lond. 1801, p. 2. [1318] “Cursory Remarks on the Appearance of the Angina Scarlatina in the Spring of 1793.” _Mem. Med. Soc. Lond._ IV. (1795), p. 280. [1319] W. Rowley, M.D., _An Essay on the Malignant ulcerated Sore-Throat, containing reflections on its causes and fatal effects in 1787, etc._, London, 1788; _The Causes of the Great Numbers of Deaths ... in Putrid Scarlet Fevers and Ulcerated Sore-Throats explained, etc._, London, 1793. Based on the practice of the St Marylebone Infirmary. [1320] James Sims, M.D. “Sketch of a Description of a Species of Scarlatina Anginosa which occurred in the Autumn of 1798.” _Mem. Med. Soc. Lond._ V. (1799), p. 415. [1321] This is the source of Noah Webster’s information for London; he adds that the “cat distemper” appeared in Philadelphia in June, and was very fatal in New York and over the Northern States. [1322] E. Peart, M.D., _Practical Information on the Malignant Scarlet Fever and Sore-Throat_. London, 1802. See also _Med. and Phys. Journ._ IX. 16, report for Dec. 1802: “so very general that few of those who have continued in the same house have entirely escaped it”; and the reports, _ibid._ X. 76, 276. [1323] Clark, u. s. Monteith, _Report of the Newcastle Dispensary from its Foundation_, 1878. [1324] Polwhele’s _Cornwall_. Part VII. _Diseases_, p. 59. [1325] F. Skirmshire, _Med. Phys. Journ._ VI. 424. [1326] R. Freeman, _ibid._ IX. 157. [1327] H. Gilbert, _ibid._ IX. 249. [1328] Goodwin, _ibid._ IX. 509. [1329] Braithwaite, _ibid._ XI. [1330] Willan, _Cutan. Dis._ 1808, p. 379, particulars from Dr Binns, with full discussion of the methods of treatment. Willan was told by Dr Stanger that there were 71 cases in the Foundling Hospital from June to October, 1804, with 4 deaths. [1331] W. Blackburne, M.D., _Facts and Observations concerning the Prevention and Cure of Scarlet Fever, &c._ London, 1803. [1332] James Hamilton, M.D., _Obs. on the Utility, &c. of Purgative Medicines_. 4th ed. Edin. 1811. App. III. p. 66 (three boys in Heriot’s Hospital died of dropsy). Autenrieth, _Account of the State of Medicine in Great Britain_. Extracts translated by Graves, u. i. [1333] Ferriar, _Med. Hist. and Reflect_. III. 128. [1334] R. J. Graves, M.D., _A System of Clinical Medicine_. Dublin, 1843, p. 493. [1335] T. Bateman, M.D., _Reports on the Diseases of London, and the State of the Weather, from 1804 to 1816_. London, 1819. [1336] Clarke, _Ed. Med. and Surg. Journ._ XXX. [1337] Goodwin, of Earlsoham, _Med. and Phys. Journ._ XXIV. 465. [1338] Samuel Fothergill, M.D. _Med. and Phys. Journ._ XXXII. 481. [1339] N. Bruce, _Med. Chir. Trans._ IX. 273. [1340] Heysham to Joshua Milne, in the latter’s _Treatise on the Valuation of Annuities_. Lond. 1815. App. p. 755. [1341] Currie, _Med. Reports_, 1805, II. 458; Armstrong, _Pract. Illustr. of the Scarlet Fever, Measles, &c._ Lond. 1818; Lodge, of Preston, in _Med. and Phys. Journ._ XXXIII. (1815), p. 358. [1342] W. Macmichael, M.D., _A New View of the Infection of Scarlet Fever, &c._ London, 1822, pp. 30, 59, 78, 81-2. The title of another essay appears to reflect the same ideas, _Caution to the Public, or hints upon the nature of Scarlet Fever, designed to show that this disease arises from a peculiar and absolute virus, and is specifically infectious in its mildest as well as in its most malignant form_. By William Cooke, London, 1831. [1343] Kreysig, “Ueber das Scharlachfieber,” _Hecker’s Annalen_, IV. 273, 401, 1826, says that scarlatina had been “not only almost uninterrupted in all Europe since twenty-six or twenty-seven years [1799 or 1800], but also frightfully fatal.” The period in which this was written appears to have been one of fatal scarlatina in some parts of Germany; so also the years 1817-19, and the years 1799-1805 (as in Great Britain and Ireland). But the sweeping assertion as to frightful scarlatina mortality in all Europe without interruption since 1799 is clearly a flight of rhetoric, and is as nearly as possible the reverse of the truth so far as concerns Britain and Ireland. [1344] Blackmore, _Lond. Med. Gaz._ VI. 114. [1345] Sandwith, _Edin. Med. and Surg. Journ._ XL. 249. [1346] Aulsebrook, _Lancet_, 12 Nov. 1831, p. 217: cases of very malignant suddenly fatal scarlatina in infants and young persons up to the age of twenty-two. In the house of a canal boatman a son and two daughters, from 21 to 13 years, died in the course of two days after a very sudden and brief illness. [1347] Rumsey, _Trans. Prov. Med. Assoc._ III. 194. [1348] Hamilton, _Edin. Med. Surg. Journ._ XXXIX. 140. [1349] Cowan, _Journ. Statist. Soc._ III. [1350] Sidey, Stark and others in _Edin. Med. and Surg. Journ._ 1835-36. H. Kennedy, M.D., _Account of the Epidemic of Scarlatina in Dublin from 1834 to 1842_. Dublin, 1843. [1351] The principal epidemics of scarlatina which have been inquired into by inspectors of the medical department since 1870 have been the following: In 1870, Camborne, Wing. 1873, Fleetwood-on-Wyre. 1874, Hetton (Durham). 1877, Massingham, Portsmouth. 1879, Pontypool, Easington (Durham), Fallowfield (near Manchester), Yeadon. 1880, Bedlington (near Morpeth), Stourbridge, Swindon, Castleford, Llanelly, Huntingdon, Barkingside (Orphans’ Home near Romford). 1881, Durham, Halifax, Thame. 1882, Bedwelty (Tredegar and Aberystruth), Potton. 1883, Sutton in Ashfield, Thorne, Donington and Moulton (Spalding). 1885, Sandal (near Wakefield). 1886, Atherton, Hayfield, Hindley, Wombwell. 1889, Spennymoor (Durham), Macclesfield, Faringdon, Brixham. [1352] William Ogle, M.D., in the _49th Report of the Registrar-General_ (_for 1886_), p. xiv. [1353] See a paper, with Tables, on “Age, Sex and Season in relation to Scarlet Fever,” by Arthur Whitelegge, M.D. in _Trans. Epidemid. Soc._ N. S. VII. p. 153, for Nottingham and some other towns. A paper by Dr Ballard, “On the Prevalence and Fatality of Scarlatina as influenced by Sex, Age and Season,” which was written twenty years before but left unpublished, follows Whitelegge’s in the _Trans. Epidem. Soc._ N. S. VII. (1887-8). [1354] A table of figures showing this will be found in Dr B. A. Whitelegge’s second lecture on “Changes of Type in Epidemic Diseases.” _Brit. Med. Journ._ 4 March, 1893. [1355] Longstaff, _Trans. Epid. Soc._ N. S. IV. (1880), 421, and _Studies in Statistics_. London, 1891, p. 310. D. A. Gresswell, _Contribution to the Natural History of Scarlatina_. Oxford, 1890, p. 193. [1356] _Journ. Scot. Meteorol. Soc._ July, 1874, p. 195. [1357] _Cutaneous Diseases._ Vol. I. 1808, p. 254. [1358] An unfortunate event that came under the writer’s notice some years ago may be illustrative of this. Two women with cancer of the breast were operated on, the one after the other, in the same operating theatre. Their beds were in the same hospital ward, but separated by the whole length of the ward. A few days after the operations, one of the women developed erysipelas, which was most extensive on the back; very soon after the other woman got the disease in a precisely similar way; they both died of it. As it seemed improbable that No. 1 had been infected in the ward, or that No. 2 had been infected from No. 1, (some dozen surgical cases between them escaping,) the suggestion arises of a common source of both infections in the operating theatre. The operating table was covered by a woollen cloth, of red colour so as not to show blood stains; it must have contained a good deal of putrid invisible blood from former operations. [1359] The first instance showing this came from a dairy at Hendon. See James Cameron, M.D. _Trans. Epid. Soc._ V. (1885-6), p. 104; and _ibid._ VIII. 40. One of the latest and most fully investigated came from a dairy near Glasgow, J. B. Russell, M.D., LL.D., and A. K. Chalmers, M.D. _Glas. Med. Journ._ Jan. 1893, p. 1. An outbreak at Wimbledon and Merton is described, _Rep. Med. Off. Loc. Gov. Bd._ for 1886, p. 327. See also _ibid._ for 1882, p. 63. The scarlatina caused by cream (with strawberries) is traced, _ibid._ for 1875, p. 72. A very clear case of scarlatinal epidemic due to contaminated milk occurred at Blackheath, both among children and adults, in April, 1894. [1360] E. M. Crookshank, _Path. Trans._ XXXIX. 382, in an extensive prevalence of cowpox on a dairy farm near Cricklade. No scarlatina could be traced in the neighbourhood. [1361] Alfred Carpenter, M.D. _Lancet_, 28 Jan. and 4 Feb. 1871. [1362] Wall, _Gent. Magaz._ 1751, p. 71, 501. He quotes Severinus to the effect that the great epidemic of _garrotillo_ in the province of Naples in 1618 was preceded by a murrain. [1363] Prince A. Morrow, “Drug Eruptions,” edited for the New Sydenham Society by T. Colcott Fox, in _Selected Monographs on Dermatology_. London, 1893. [1364] Hirsch, III. 87. [1365] Cullen, _First Lines of the Practice of Physic_, Part I., Book II. chap. 5, § 2, and Book III. chap. 4. [1366] _On Cutaneous Diseases_, vol. I., London, 1808, pp. 319, 326, 333. He included also the _garrotillo_ of Spain and the throat-plague of Naples (1618) among the “varieties of scarlatina,” inasmuch as they had not unfrequently a rash which was of the erysipelatous kind. Hirsch (u. s.) and Max Jaffe (“Die Diphtherie in epidemiologischer und nosologischer Beziehung vornehmlich nach Französischen und Englischen Autoren zusammengestellt,” Originalabhandlung in _Schmidt’s Jahrbücher_, CXIII., 1862, pp. 97-120) do not seem to doubt the diphtheritic nature of the _garrotillos_ of Spain and Italy in the 16th and 17th centuries, but they agree with Willan in classing most of the 18th century throat-distempers of English and American writers as scarlatinal, reserving as diphtheritic, or as more nearly allied to diphtheria, Starr’s “morbus strangulatorius” of Cornwall, some cases of infants recorded by Denman (_supra_, p. 714), Rumsey’s cases of “croup” (_supra_, p. 716), and the epidemic described by Bard, of New York (_supra_, p. 690). These matters of identification appear to be like matters of taste, for which the best rule is _non disputandum_. I have already pointed out that Bard himself did not hesitate to identify the epidemic throat-disease of his time with that which Douglass had described in New England thirty years before. [1367] P. Bretonneau, _Des inflammations spéciales du tissu muqueux et en particulier de la Diphthérite_, Paris, 1826, with supplement in 1827. [1368] Id. _Arch. gén. de méd._, Jan., 1855. [1369] Mackenzie, _Ed. Med. and Surg. Journ._, April, 1825, p. 294, and _Med. Chir. Rev._, 1827, p. 289, for Glasgow in 1819. The disease which Mackenzie called croup, was generally known in Glasgow at that time as “croupy sore throat.” It was very fatal, attacking several children in the same family, was reckoned contagious, was not a modification of scarlatina, was very different from idiopathic croup as it began on the tonsils and descended to the larynx and trachea, and, lastly, was sometimes marked by gangrenous foetor. Robertson, _Edin. Med. and Surg. Journ._ (1826) XXV. 279, for Kelso in 1825. Bewley, _Dub. Journ. of Med. Sci._ VIII. 401, for Dublin in 1835-36. An outbreak observed by Brown, at Haverfordwest, in 1849-50, involving some 200 cases and 40 deaths, was identified in 1858 with diphtheria (_Med. Times and Gaz._, May, 1858, p. 566, see also _Med. Chir. Trans._ XL. 49). Outbreaks more vaguely recalled in 1858 as diphtheria occurred at Ashford in 1817, and at Leatherhead (30 deaths in the workhouse) at an uncertain date (_2nd Rep._ (1859) _Med. Offices Privy Council_, pp. 244, 320). F. Ryland, _Diseases and Injuries of the Larynx and Trachea_, London, 1837, pp. 161-175, described a similar disease as a complication of measles at Birmingham in 1835. [1370] _Med. Times and Gazette_, _Lancet_, _British Med. Journal_, _&c._ for 1858 and 1859. See references in Hirsch, III. 89. [1371] _Second Report_ (for 1859) _by the Medical Officer of the Privy Council_, London, 1860, p. 161 _seq._ Dr Greenhow published an essay on Diphtheria in 1860. Lectures important for the nosological definition were published by Sir William Jenner in 1861 (reprinted in 1893). Other essays called forth by the epidemic were by W. F. Wade (1858), Ernest Hart (1859), Edward Copeman (Norwich, 1859). Christison, J. W. Begbie and others wrote upon it in Scotland. [1372] Mr Jones, of Fletching, Sussex, wrote that scores of cases (probably at least 50 or 60) have had more or less eruption. In one case it was general and bright.... It was like scarlatina ... but the whole surface was covered with minute miliary vesicles of clear fluid, ‘one mass of small vesications.’ There was a great deal of itching and no subsequent dropsy. In other cases the eruption was partial. _Rep. Med. Off. Privy Council_, II. (1859), p. 284. [1373] Starr’s description for 1748 is referred to _supra_, p. 695. Sanderson, _Report_, u. s. p. 263, says of the disease in 1858: “At Launceston the diphtheritic pellicle was tough, leathery, and highly elastic; and on the mucous surface of the fauces and pharynx it attained so great thickness (from one-tenth to one-eighth of an inch) that it was compared by several practitioners to the coriaceous lichens which grow on rotten bark. In the other districts this was never observed.” [1374] G. B. Longstaff, M.D., “The Geographical Distribution of Diphtheria in England and Wales,” in _Supplement to the 17th Annual Report of Loc. Gov. Board_, 1887-8, p. 135. See also Downes, _Trans. Epid. Soc._ N. S. VII. 193. Farr, _Rep. Reg. Genl._ for 1874, p. 219, gave the following illustration: “It is remarkable that of diphtheria, out of the same number born, more die in the healthy districts of England than in Liverpool; the proportions are 1029 in the healthy districts and 442 in Liverpool of 100,000 born. The deaths from scarlet fever are 2140 in the healthy districts to 3830 in Liverpool.” [1375] _8th Detailed Report of the Reg. Gen. Scot._, p. xxxix. [1376] R. T. Thorne, M.B., _Diphtheria: its Natural History and Prevention_. Milroy Lectures for 1891. London, 1891. [1377] Farr, _Rep. Reg.-Genl._ XXIV. (1861), p. 217. [1378] Longstaff, u. s. [1379] G. Budd, M.D., “Obs. on Typhoid or Intestinal Fever.” _Brit. Med Journ._, 9 Nov. 1861, p. 485. [1380] _Supra_, pp. 210, 213. [1381] Matthew A. Adams, cited by Thorne, u. s. with diagram. [1382] M. W. Taylor, M.D., “Diphtheria in connection with Damp and Mould Fungi.” _Trans. Epic. Soc._ N. S. VI. (1886-7), p. 104. Thorne, u. s. gives instances in which diphtheria seemed to choose out wet and impervious soils. [1383] L. Traube, _Gesammelte Beiträge, &c._, Berlin, 1871, II. 11. [1384] Thorne, u. s. has collected and analysed very fully the instances of diphtherial epidemics traced to cows’ milk. It is commonly assumed that the epidemics are either wholly diphtherial or wholly scarlatinal, but not a mixture of the two diseases. [1385] W. N. Thursfield, _Lancet_, 3 Aug. 1878, p. 180, has contended for some such correlation between diphtheria and enteric fever in their respective preferences, at that time, for rural and urban districts. [1386] William Heberden, M.D. junior. _Observations on the Increase and Decrease of Diseases, particularly the Plague._ Lond. 1801. [1387] Among the numerous medical writers who have used it are Macmichael, Watson and Chevers. Among historians Lecky (I. 573) has thought it worthy of mention among the progressive improvements of the 18th century. [1388] Heberden (l. c. p. 42) accounted for the enormous increase of the article “convulsions” in the Bills by the inclusion under that term of most of the deaths originally entered under “chrisomes and infants,” which were infants under one month. But the latter had been mostly transferred at an early period while convulsions was still a small total; and even at the worst period of the public health in London, about 1730-40, they would not have accounted for a sixth part of the deaths under convulsions. The probability of the deaths from “griping in the guts” having been transferred to “convulsions” was pointed out in a review of Heberden’s essay in the _British Critic_ on its appearance, without reasons given such as I adduce in the sequel. [1389] _Observ. Med._ IV. cap. 7, § 2. [1390] _Ibid._ III. cap. 2, § 54. [1391] _Pathol. Cerebri._ Pordage’s Transl. p. 25. [1392] Walter Harris, M.D., _Tractatus de Morbis Acutis Infantum_. Lond.