I have put on record certain
Clinical Observations more especially in relation to
Nephritis in 300 cases of Scarlatina, which were
treated at the Edinburgh City Hospital from the 9th.
August 1905 to the 5th. January 1906.
I have had access to the City Hospital records from
1900 to 1906, and in my study of the cases and
calculations therefrom, I have paid particular
attention to Nephritis.
As the only method of arriving at a satisfactory
prophylaxis against the Nephritis of Scarlatina is
dependent on the study of the cause of the disease,
I have given what I consider the most important
views that have been expressed on this point.
And to appreciate the various attempts that have
been made in counteracting Scarlatinal Nephritis,
it is necessary to make a short review of them.
CONCLUSIONS:
1. Scarlatinal Aeuhritis is a distinct part of the
disease, and should not be looked upon as an inevitable sequela, which presents itself in a certain percentage of cases; and as such it
should be open to treatment.
2. The cause of Scarlatina is an organism, but of
what particular variety, sufficient evidence has
not been given to determine it.
3. The only form of treatment that is likely to be
of any real value in counteracting the Nephritis,
is the prophylactic; the object being to either
kill outright or to weaken the virus by a substance, which is in itself harmless.
And as the virus is in the general circulation
at the beginning of the disease, it must perforce
be present in the kidneys and urinary system
in general.
4. The diet and general medical supervision of the
patient should be strict.
A milk and farinaceous diet should be insisted
upon for the first 3 weeks, during which time
patients should Le kept in bed, and they should
be kept in the house for the 2 weeks following.
And care should be taken until desquamation is
completed.
Patients should be encouraged to take plenty of
diluents, as long as there is no evidence of fluid
collecting in any part of the body.
5. All methods of excretion should encouraged and
helped in every way possible.
Thus the Fauces should be frequently swabbed,
gently, and gargled with Sodium Bicarbonate
solution to remove the mucus, and this should be
followed by a weak antiseptic solution, e.g.,
Chlorine water or Listerine.
A Higginson's syringe should be used when gargling is not feasible, but care should be taken that it
is not done too forcibly, to cause the extremely
infectious Tonsillary-exudate to be driven up the
Eustachian tubes, as the child splutters and
swallows.
Desquamation should te encouraged by frequent
sponging and occasional tepid baths, to prevent a clogging of the exits of the sebaceous glands with
partially cast off epithelium.
Constipation should, of course, be avoided, but
purging lowers the arterial tension and should be
guarded against.
For, a low arterial tension is detrimental to
diuresis, which should be encouraged.
Rather above than below the normal amount of urine
should be the guide.
The daily examination of the urine should be a matter of routine.
6. With regard to the use of a prophylactic drug
against the Nephritis of Scarlatina, the only one
that has proved itself to be of any value, in my
experience, is Urotropine.
Hexamethylenetetramine certainly did not succeed
in diminishing the Nephritis, nor did Metramine.
If anything, the Nephritis was slightly increased
by these two latter, if one compares the cases
treated by them, and the ones treated with no
drugs, in the same period.
It is true that Urotropine had the distinct
advantage of having cases in August and the first
18 days of September, which is a time that the
Nephritis percentage is usually low.
But the fact, that of the 47 consecutive cases
treated with Urotropine, not one had Nephritis,
and only one had Albuminuria, is, I consider,
encouraging enough to suggest the further use of
the drug in Scarlatina.
Hexamethylenetetramine was substituted for
Urotropine, in my cases, because it was so much
cheaper in treating a large number of patients,
but I do not consider that it is the exact equivalent of Urotropine
when considered from the clinical results.
I see no reason to believe that Metramine is therapeutically any better or worse than Hexamethylenetetramine.
7. And, therefore, finally, I would suggest that all
cases of Scarlatina should be treated from the
beginning with 5 grain doses, thrice daily, for
children up to 12 years; and for patients above that
age, 7.5 grains, thrice daily.
In the administration of this drug the importance of
dilution with water must not be overlooked.
And I would recommend that this treatment should be
continued to the end of the 28th day of the disease.
