Thompson, Herbert Park

2018-01-31T11:38:50Z

2018-01-31T11:38:50Z

1906

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.

http://hdl.handle.net/1842/27528

The University of Edinburgh

Annexe Thesis Digitisation Project 2017 Block 16

Already catalogued

The value of urotropine, hexamethylenetetramine and metramine in the prophylaxis of scarlatinal nephritis: derived from 300 cases of scarlatina

Thesis or Dissertation

Doctoral

MD Doctor of Medicine