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Concurrent Scarlatina and Enteric Fever

E. M. D. Cosgrave
1897 BMJ (Clinical Research Edition)  
ALTHOUGH many cases sre on record of convalescents from enteric fever contracting scarlatina, and on the other hand of convalescents from scarlatina contracting enteric, true concurrence, that is, tlce incubation and pyrexial stages of the two diseases occurring simultaneously, is not common, and has only lately been recorded, and that in but few instances. A convenient starting point which sums up previous knowledge is a paper 2 by Murellison, who, writing in 1859, says that in ten years he
more » ... in ten years he saw only one case of scarlatina contracting enteric fever, and that supervened on the twenty-sixth day; he gives, however, some cases of scarlatina supervening in enteric, but goes on to say, " No cases have hitherto been published s-howing the possibility of these two diseases coexisting." This extreme view he afterwards modified, and in his classic work on fevers 3 says, " In the London Fever Hospital, where it was the practice to treat all forms of fever in the same wards, it was not uncommon for a patient suffering from enteric fever to contract scarlet fever, and I have notes of eight cases in which the eruptions of the two diseases coexisted." Murchison gives notes of two of these cases; in one the scarlatina eruption came out late in enteric-probably in the third week; and in the other case it appeared on the twenty-second day. On the other hand Murchison says4 " scarlatina appears indeed to predispose to enteric fever." The textbook accounts have not advanced further than this. Dr. John William Moore in his excellent work on fevers,5 merely mentions Murchison's eight cases, but without analysing them, and gives none of his own. Dr. Marcus Hartfield 6 alludes to cases of coincident scarlatina, small-pox, and measles reported by Vogel, hut does not mention the coexistence of scarlatina and enteric. Curiously enough other observers went off on an entirely different line. Dr. John Harley, writing in Reynolds's System of Medicine,7 announced his theory that enteric fever and scarlatina were manifestations of the same poison; and in i87I he read a paper at the Royal Medical and Chirurgical Society,8 arguing, from the general inflammation of the lymphatic glands sometimes occurring in scarlatina, that " the pathological changes accompanying an ordinary attack of scarlatina include all those of the first stage of enteric fever, and that the transition from one disease to another is but a natural pathological sequence, readily determined by any cause which may increase the intestinal lesion." However, as the cases given showed the symptoms of fullydeveloped enteric on the thirty-second, circa thirty-fifth. fifty-eighth, forty-first, fifty-second, and thirty-second day of scarlatina, these seem to have been cases of enteric following searlatina. Dr. Bayard Holmes, in a paper on Secondary Mixed Infection in Typhoid Fever,9 which was published in I889, does not allude to scarlatina; and Dr. H. N. Joynt, in a paper On the Influence of One Fever on Another,10 published in I891, deals with the modifying influence of scarlatina on other zymotic diseases, and vice versa, but does not give a single case of scarlatina and enteric coexisting or in sequence. Dr. J. H. Sequeira in I89I published two cases of enteric fever, complicated by scarlatina, treated at the North-West Fever Hospital in i8go.1' One case was admitted into hospital with scarlatina on the tenth day of enteric, and the other developed the rash of scarlatina five days after rose spots had appeared. These were evidently cases of scar-'Read at
doi:10.1136/bmj.1.1881.129 fatcat:yfub6cwz5neppkc3wm7hjztbhe