"SCARLATINA IN INDIA,

TO THE EDITOR OF THE /" INDIAN MEDICAL GAZETTE."

Sir ?In your last number are published two papers, by Messrs. Gibson and Bradshaw, on scarlatina in India, which, interesting as they are, as showing that the disease may be imported, I should not feel myself called upon to notice, were it not that the latter comments at some length on a case

I published under the title of "Erythema Scarlatiniforme." Mr. Bradshaw looks on the case as one of pure scarlatina, and asks why I did not cull a spade a spade. I must confess that my mind was influenced?"hampered," if he prefers the term?. by the prevalent idea that scarlatina was unknown in India. I did not know of one recorded case. I had never seen a case as far as I know, and all tiie evidence I could collect was en- tirely negative. I had frequently enquired from other surgeons, men of good experience, and had always received the same negative reply.

Under these circumstances, exercising, perhaps, too much the caution which Mr. Maunsell thinks it uecessary to recommend to me, I did not feel myself justified in naming as "scarlatina" one isolated case, occurring in a house occupied by two families which numberd 18 or 19 individuals, most of whom were children; and amongst whom, after the most careful enquiry, I could not find a trace of another case, either amongst the inmates or their servants. I entirely lacked that collatera

220 THE INDIAN MEDICAL GAZETTE. ? [October 2, 1871.

evidence which was present in the experiences of Messrs.

Maunsell, Gibson and Bradshaw. The possible origin of the disease, de novo, I am prepared to

admit, but I should certainly look for something more than one individual isolated case, especially in a crowded household, the sanitary condition of which was far from satisfactory. Con-

sidering the widespread belief of the non-existence of scarlet fever in India, it is a pity, I think, that the cases mentioned as occurring in 1861 to 1868 were not made more widely known.

I am not equally prepared to defend the term " erythema scarlatiniforme," though I cannot admit Mr. Bradshaw's state-

ment that there is no shadow of resemblance between that

disease and my own case. . Not satisfied in my own mind that it was scarlatina, I had to find some other disease with which it agreed ; rather than attempt to invent a new name.

From the few authorities at my command, Dr. Tilbury Fox's valuable little manual of skin diseases, was the only one which aided me at all. From Hillier, Neligan, Wilson, and Hebra's

I could gain nothing. The name " erythema scarlatiniforme" I borrowed from Dr. Fox, but, in his first edition at any rate, he is very meagre in his notice of the subject. At page 62, under the heading " rubella, rubeola notha, bastard measles, anamolous exanthem," he concludes that the disease is the

erythema scarlatiniforme of Hardy. He mention^ the absence

of crescentic arrangement of the rash, and of catarrhal symptoms, hut mentions the existence of redness of the fauces and of

desquamation. At page 80, under the head of rosalia, he again passingly notices the subject, denying the existence of des-

quamation, as if the disease was one involved in obscurity. The strawberry tongue is certainly not pathognomonic of scarlatina in India, for it is very common to find in the remittents and intermittents of children, a thickly coated white tongue with red tip, and edges, and numerous prominent red

enlarged papillae, studding the surface. One other point I must allude to before concluding. If scarlatina is, or has been, pre- valent amongst the hill natives, it is not only a most important fact, but also one that it seems passing strange, should have been unnoticed hitherto.

However difficult eruptions in the native are to recognise at first, owing to the modification in color, &c., arising from the darkness of the skin, familiarity will soon make them as plain as they are in the pale European; and surely men well

acquainted with the diseases of natives, cannot have heen

wanting in the hills, who could have recognised a skin affection like scarlet fever. But after all, native evidence on such a

subject is all but valueless. In their ideas, and in their memo- ries of past events, they are extremely hazy, and having less than a dozen terms to express the whole mass of skin dis ases, any difference suek as that between scarlet fever and other

eruptions would not strike them. Measles is common enough amongst natives, even in the

plains, and most probably it was this disease that was pronounc- ed to be common amongst the hill natives,

Yours faithfully, Alexander Garden,

Civil Saharunpore, August 12th, 1871.