It is time to approach the etiological question

The historical study of scarlet fever begins with chronological uncertainty.

At what time did she come to take a place among human diseases, and complete the so original group of eruptive fevers?

We can choose between the two answers that follow.

Doctors do not usually go beyond the XVI th century, the first descriptions that relate to scarlet fever. On this account, and supposing that they took it at birth, its date would be a thousand years later than that of smallpox and measles.

Bateman offers another version that seems to me, with some reservations, quite judicious.

According to him, the ancients would have known these three fevers; but their incomplete information have left many obscurities were dispelled VI th century by the Arabs. It is they who have clearly demonstrated the existence of these fevers, not without leaving many doubts about their individual nature. Their successors, slaves too servile to their teaching, continued for more than a thousand years, to confuse these three diseases into one, of which they represented only varieties. The illusion lasted until the end of the XVII th century, and it is only then that an observation more attentive and accurate, showed the distinctive characteristics and the independent origin of these species rashes .

It goes without saying that I leave to Bateman the responsibility of his personal belief in the antiquity of these fevers; but I can agree, without fold of my own convictions, their coexistence at the VI th century. The contemporary appearance of smallpox and measles represents the first manifestation of an unusual epidemic constitution, resulting from a combination of influences unknown in their nature and betrayed by their effects. The land was therefore ready to receive scarlet fever, and it is probable that it was soon to bear fruit. Did I not find a way in the writings of the Arabs to produce certain cutaneous efflorescence which seemed, by exclusion, to refer to scarlet fever itself? This illness would have been at that time suspected, interview, vaguely indicated. But when one thinks of the confusion with which the differential diagnosis of smallpox and measles has been so difficult to extricate, it is no longer surprising that this indecision contributed to prolonging indefinitely the incognito of scarlet fever, lost so to speak among the morbid exanthemums. Only at the cost of innumerable observations, summing up the experience of several centuries, did she finally receive her nosological baptism. There is no evidence that it did not cooperate early in the epidemics that were initially attributed exclusively to smallpox and measles.

Hufeland had probably lost sight of these precedents, he should at least take into account, when he said that “Scarlet fever is a new disease that has started to see that XVII th century . ”

Whatever the rest, the version that we prefer, I am, for one, intimately convinced, that there was not in reality, between the simultaneous advent of the smallpox and the measles, and the the subsequent annexation of scarlet fever, the interval several times secular which is supposed to separate these two facts, if one relates only and without criticism, to the dates inscribed by their historians.

I have hitherto, as a matter of fact, posited the recent origin of scarlet fever, and will be excused from demonstrating it the absence in the collections of Hippocratic antiquity. To admit its existence at that time, in spite of the obstinate silence of the texts, it would be necessary to pretend that it has been completely unknown by so many great observers, an assumption which rightly rebuffs Shark . I could have invoked here the support of many authoritative accounts of scholarship; but I would expose myself to tedious repetitions of which my thesis can happen. I therefore address without further preamble, the biography of scarlet fever which is the subject of this article.

When we consult, in chronological order, the main nosographers that marked in science, from the XVI th century, we began to see the new fever in its most salient features. However, it is only after long fluctuations, that it will be affirmed highly as the expression of a specific morbid entity.

It is because, in principle, the attention of the physicians was directed exclusively to the form of the cutaneous phenomena, and gave especially to the color of the exanthema a semeiotic value incompatible with its mobility.

The observation was not long in finding that “all the tones, all the hues meet there as on the palette of the painter .”

Its color has been compared to that of fire , cochineal , minium , cooked crayfish , raspberry , gooseberry , rose , plum violet or wine lees . In 1817, Joseph Frank saw at the hospital clinic of Vilna, a man with scarlet fever, whose color resembled a bishop’s dress . Sometimes, as in erysipelas, red is mixed with a saffron shade . He is even cases where stains of a milk-whiteintermingle with purple spots. There are also bluish streaks similar to stretch marks resulting from sapling. More often, among the red spots, one sees a multitude of miliform, pearly-white elevations , assimilated by Alibert who liked comparisons, to silkworm eggs scattered on the skin. It is not rare that these vesicles take more volume and form, by their bringing together, bubbles containing a serous and clear liquid which thickens while yellowing. Finally, the eruption is so little marked on certain patients, that it is difficult to see it, and that it reveals itself only by desquamation. Needless to say, it is completely absent in some cases, although the substance of the affection is not modified in any way (scarlatina sine scarlatiniis ).

Same mobility, or if you want, same ataxia in the configuration of the spots and their mode of appearance. Instead of tending to join, the plates remain isolated; their circumference is confusedly traced. There are some who only appear and disappear. Others persist all the time of the eruptive period. We see at times, which are colored more vividly than the others. Often the efflorescence takes several days to cover the skin, and this slow contrast with the suddenness of its explosion in some cases. In short, there are no unexpected combinations that the epidemic genius does not hold in reserve to divert the diagnosis.

If the method of the first historians of scarlet fever deserves the reproach of having stopped at its bark, it is also just to recognize as attenuation, that its insidiousness always suspicious, can make it impenetrable, even to the most exerted analysis .

“What disconcerts especially the operations of art,” said Alibert, in that figurative language of which he is accustomed, “it is the versatility of this inconceivable affection. When nature acts as an enemy, it has its ruses and its pitfalls of war. It is complicated to escape the search of the most scrupulous observer. It takes a thousand forms to better take advantage . ”

It is indeed with scarlet fever that the word of a judicious writer could literally be applied: “Everything happens in sick people’s beds in abnormalities” .

To the causes which have slowed the progress of his study, it is certainly necessary to add his confused synonymy, often borrowed from the most disparate diseases, as proves the summary indication given by Augustin Vogel, one of his most estimable monographs : ” Febris scarlatina hoc nomine and multis aliis PURPUR , RUBEOLARUM , MORBILLORUM IGNEORUM , ZON , IGNIS SACRI , ROSSALIARUM veniens .” This explains the apparent divergences of certain contemporary descriptions, and the uncertainty of their interpretation.

Let us now follow scarlet fever, from its authentic beginnings on the medical scene, to the moment when it will seize, in order not to divest itself of it, of the role which belongs to it.

It is to Philippe Ingrassias (1510-1580) that we owe the first, rather precise, description of the scarlatinous eruption. He tells us that the people of Naples had lately been called by the vulgar names of rossalia or rossania . He also calls her robelia by bringing her closer to measles and smallpox:

” And Variolas, and Morbillos, and Robeliam sive Rossaliam invenimus .”

Ingrassias did not find this disease in the works of Arab doctors, unless, he says, the species they mention under the vague name of alhamica or alhumera is not rossia herself: supposition which seems plausible to him.

Here is the concise description he gives of this exanthem.

“We call Russia a disease which covers the whole extent of the skin with a multitude of spots, large or small, red with fire, with barely perceptible elevation, resembling many erysipelas, distinct from each other, and giving to all the body a flamboyant appearance . ”

This picture is far from offering a complete characteristic of scarlet fever; but he clearly traces the efflorescence.

It is even to be remarked that the author is already protesting against the error of the physicians who confounded this disease with measles, on the strength of their analogies. His practical tact was not wrong.

“Some people think that measles and russell are the same disease. As for me, without referring to what others have said, I have personally had many opportunities to see the difference. Nonnulli sunt who morbillos idem cum rossalia esse existimant. Our autem sæpissimè distinctos esse affectus, nostrismet oculis, non aliorum duntaxat relationi confidantes, inspeximus . ”

But it is easy to see, from Ingrassias’ development of the history of smallpox and measles, that it was much less known, rare, or too much new to have attracted attention to the same degree.

It is generally accepted among doctors, that’s Baillou (1538-1616) who described one of the first, scarlet fever at the XVI th century. However, if one inquires about the name under which he has spoken, one does not get an answer. On this occasion, I consulted a crowd of authors, even the most recent, and Alibert is the only one, unless I am mistaken, who added to his synonymy: rubiolæ de Baillou .

This reluctance would seem to indicate that it is sufficient to look at the works of the illustrious French epidemic to see the eruptive fever.

I must have less piercing eyesight; because it is not without difficulty that I verified the fact by meticulously confronting the texts. The allusions to scarlet fever are very sparse in Epidemics and Ephemerides . The Latin of Baillou is often obscure. His concise manner and his taste for digressions add to the embarrassment of the reader. He often speaks of a red rash without any other indication. It is necessary, one can believe me, a lot of attention to unravel the scarlet fever, in paintings where miss the most important features of its pathognomony. I will not be accused of exaggerating, if you will accompany me for a moment, in the research that I thought I should do to clarify this point undecided historical nosology .

A spotted fever epidemic ( febris purpurata ) raging in Paris in the winter of 1573. Was it scarlet fever? It can not be said, according to the information we are given. We know only that all who escaped fell into the doldrums, with symptoms of general dissolution ( liquefacto toto corpore ) and involuntary alvine evacuations . These consecutive accidents do not belong to scarlet fever any more than to measles, smallpox, or any other serious eruptive fever. In a word, these words: liquefacto corporecould have represented serous, subcutaneous, or cavitary effusions, which terminate scarlatina so frequently; but the result does not agree with this version. It is probable that the disease designated by Baillou was a petechial fever. It must not be forgotten that in his day the words ” red fever” were used by the people and even by doctors to collectively describe eruptions whose color analogy did not exclude the diversity of nature.

During the winter of 1574, remarkable for the persevering reign of the southern wind, the serenity of the sky, and the absence of the characteristics peculiar to the season, Baillou observed a constitution very much laden with eruptive diseases. ” Morbillorum, variolarum, puncticularum, exanthematon, rubiolarum magna ilias is leaking .”

In this confused meeting of eruptions, I recognize the measles ( morbillorum ), the smallpox ( variolarum ), the petechiae ( puncticularum ) . The word exanthematon may designate erythema , erysipelas , shingles , miliaria , & c. Baillou alone could tell us his thoughts. What was certainly, very clear to him, is far from it for us.

Remain rubiolarum , which I apply, without hesitation, to our scarlet fever.

It should be noted that this word is, to a letter, the namesake of rubeola , which represents measles , in the vocabulary of certain monographs of the time. This is probably what gave the change to Dr. Yvaren of Avignon, to which the medical literature owes a French edition of Epidemics and Ephemerides of Baillou . My learned friend has always made rubiolæ by measles without noticing that its author had reserved exclusively for this disease, called morbilli adopted by contemporary Latin culture.

This is because I recognize the authority of Mr. Yvaren, translation arrangements, I allowed myself to point out, by the way, this oversight .

As for the word to choose to represent the eruptive fever reported by Baillou, one asks if there would have been anachronism, to take that of scarlet fever , which appeared, for the first time, only a long time after, and can to be under the pen of Sydenham.

I would share this scruple if it were these denominations which prejudge a theory. A serious translator would not replace the malignant fever of Baillou with entero-mesenteric fever , follicular enteritis , dothienentery , & c. It would thus distort the author’s thought, anticipating future discoveries. But it is no longer the case when the names of diseases only indicate external characters, and, for example, shades of color. At the XVI th century as now, scarlet fever was scarletand his name is completely independent of any opinion of his nature. Perhaps it would have been better to francise the Latin word; once warned, the readers would have unequivocally meant scarlet fever , and would not have risked taking rubella for measles, a confusion against which Baillou formally protests.

I return to the passage that interests me, and as I continue to read it, I note that the author observed concurrently red spots ( maculæ rubræ ) occurring during the course of certain diseases, accompanied by a large internal fire, disappearing promptly or not. persisting for very little time. “These spots,” he says, “are confined to ruby . But the eruption of the latter is prolonged further, follows a regulated course, and presents pathognomonic symptoms. There are superficial spots, others more salient. Sometimes they precede the feverish movement; at other times, they accompany him and show themselves at the 4 th , 5 th , 6 thday at the latest. In the latter case, they are more serious, and even very dangerous, unless the fever falls. ”

The rubiole thus characterized can only be scarlet fever.

Baillou quotes, in this connection, one of those observations which one always reads with interest, whatever Bordeu says .

“The adviser Séguier, at the end of the assembly, experienced pain and a feeling of unusual warmth, and instantly his whole body became red, and was covered with rubiole spots” ( rubiolis contaminatum ).

The precocity and suddenness of the general rash are a fairly common feature of scarlet fever. If the author does not name the fever by name, it is found in the unusual heat of the patient. Practitioners are well aware that fever and eruption are common occurrences. Borsieri also saw the eruption precede fever . Finally we know that the invasion is often abrupt and without prodromes. ME Gintrac saw children suddenly beaten at school, in the middle of their games, at the table, and so on.

Immediately after the short story I have just borrowed from him, Baillou, driven by his subject, seized the opportunity to trace the symptomatic picture of the rubiole; further proof that this exanthematous fever was still little known, and should be recommended to the attention of practitioners.

“Here,” said he, “are the signs of rubiole; feverish heat, sometimes soft to the touch, sometimes very lively; jactation and agitation; feeling of breaking in the limbs; anxiety accompanied by vomiting or nausea, coming from a morbid condition of the orifice of the stomach or the malignity of affection; watery eyes; propensity to sleep, without being able to engage in it; for one scarcely begins to fall asleep, when one is awakened with a start by coughing. The pathognomonic symptoms are, in short, coughing, burning, and, so to speak, the burning of the eyes, the hoarseness of the voice, the jactation. The other symptoms are secondary and common. The disease is more especially on the upper parts, and easily affects the lungs and trachea-artery. Thus, in a large number of subjects, inflammation of the uvula is seen, with hindrance of swallowing, dry sore throat (as expressed by Hippocrates), or by phlogosis as an erysipelatosa, and, consequently, suffocation. For many, parotids accompany, precede or follow the disease. ”

This description is remarkable in that it would apply better in its first part to measles, while we find in the second, angina , the difficulty of swallowing , erysipelatous redness or, as we would say today ay, scarlatinal of the throat , the formation of blockages parotid : a set of phenomena that properly belong to scarlet fever.

China Rifampicin