"Pericarditis after scarlet-fever"

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To the Editor of the Medical Gazette.

Sir,

Dr. Somerville Scott Alison, in his article on the above subject, has alluded to several authors who have not, and to some who have, treated of the disease. I wish you to allow me the favour of stating, that I drew particular [728/729] attention to this subject in a paper on Dropsy after Scarlet-Fever, which I read to the Westminster Medical Society on Dec. 7, 1839. An abstract of the paper appeared in the report of the Society in the Lancet, seven days later. I related thirteen cases in detail to the Society, and out of these there was well-marked pericarditis in three cases, and extensive hydrops pericardii, probably unconnected with local inflammation, in two others.

I am not surprised that Dr. Alison is unacquainted with my paper, and I chiefly write to express my dissent from his opinion that pericarditis occurs at an early period in scarlet-fever. I consider that it arises only as a consequence of the renal disease which is apt to follow scarlet-fever. I admit that the kidney is generally disordered during the first few days of the fever, and that its functions are disordered during the rheumatic swellings of the joints which sometimes accompany the eruption, or appear very soon after it; but I am of opinion that percarditis only comes on as a consequence of that congestive disease of the kidneys in which they fail duly to separate the urea from the blood, which disease is never established till a fortnight, and generally not till about three weeks, from the commencement of the fever. Dr. Alison remarks that pericarditis is liable to follow obstructive disease of the kidneys. I have seen it do so independently of scarlet-fever: it occurred only in this manner in the cases related in my paper. I have taken notes of a great number of cases of scarlet-fever, both with and without renal sequalæ, since reading the paper in 1839; these cases tend to confirm the opinion I have expressed respecting pericarditis, and I see nothing in the three cases related by Dr. Alison to induce me to modify that opinion. The subject of the first case was not seen till near death, between two and three months after the fever; in the second case the disease certainly commenced early, but the child, on a previous occasion, had an attack of an inflammatory nature in the left hypochondrium, and Dr. Taylor discovered hypertrophy of the heart only forty-four days after the fever commenced: I therefore conclude that there was disease of the heart in a chronic form, which was rendered acute by the scarlet-fever, as it might have been by any thing which would excite the circulation; and so I am inclined to look on this case as an exception, tending to prove the rule I have expressed. The subject of the remaining case was not seen by Dr. A. till nine weeks after the scarlet-fever, and there is no account by any medical man of the previous illness.

There are many valuable remarks in Dr. Alison's article, and I shall look forward with interest to his promised cases of anasarca following scarlatina.

I am, sir,

Your obedient servant,

John Snow, M.D.

Frith Street, Soho Square,

Feb. 25, 1845.