7. In seventeen cases it was impossible to obtain any information truthful or untruthful about the vaccinal state of the patients.
8. The series as a whole gives a mortality rate of 35 per centum for males and 51 per centum for females. It will be noted that the mortality is considerably higher in females than in males at all age groups. Why this is so is not known.
9. It is well-known that in smallpox, as in all the acute exanthemata, expectant treatment is the only rational treatment. Nevertheless, an attempt was made to assess the value, if any, of streptocide in smallpox. The drug appears to be of undoubted value in relieving and clearing up the septic complications which so often occur in the focal phase of the disease. This is understandable when it is remembered how frequently a haemolytic streptococcus is isolated from the boils and abscesses which appear at this stage. On the toxic phase, that is to say on smallpox proper, the drug appears to exert no influence at all. It indubitably saved life in one or two cases where severe and extensive skin-sloughing had occurred, and its action was dramatic in the cases showing renal complications. One of these cases, a young boy of nine developed an acute nephritis during convalescence from smallpox. His urine became "smoky" and dropped to six ounces in the twenty-four hours and he developed facial oedema. Within eight hours of the administration of streptocide his fever had abated from 102° to normal and his recovery thenceforward was uninterrupted.
10. The other patient was a young woman of twenty-seven who was recovering from a severe attack of unmodified, discrete smallpox. For no apparent reason she began to have repeated rigors in the second week of convalescence. Culture of the urine revealed a haemolytic streptococcus and the exhibition of streptocide brought about an immediate recovery. The drug was used in 105 cases altogether, and as local experience increases, there are more grounds for belief that it has some value, especially in children, in tiding the patient over those days of the focal phase when septic absorption is at its height.
11. It would appear desirable that the usual points regarding its administration in smallpox should be observed, although it is not necessary to use the drug in the high dosage given in cases of meningitis mainly because the effect to be obtained by its use in the former disease is so much less clear cut.
12. Another line of treatment which was tried was the injection intramuscularly of convalescent serum. This method was employed in thirty-one cases of whom nine died and twenty-two recovered. These figures prove nothing. In one toxic puerperal case serum acted dramatically, and the result obtained in this one case appears to justify an extended trial of such serum. It was found in the course of the epidemic that sera from patients who had only just recovered were ineffective. To be of any use at all, serum must, apparently, be collected from patients who developed smallpox at least one month before, and preferably six weeks. Anti-bodies to the virus seem to take long to develop.
13. As the serum had to be taken from convalescents at Kennedy Town Hospital this line of treatment was not used as widely as it deserved to be, for converted police station is not an ideal place in which to collect and store serum under aseptic conditions.
P. B. Wilkinson, M.R.C.S., L.R.C.P. (Lon.), M.B., B.S. (Lon.), M.R.C.P. (Lon.),
Medical Officer.
M 90
7. In seventeen cases it was impossible to obtain any information truthful or untruthful about the vaccinal state of the patients.
8. The series as a whole gives a mortality rate of 35 per centum for males and 51 per centum for females. It will be noted that the mortality is considerably higher in females than in males at all age groups. Why this is so is not known.
9. It is well-known that in smallpox, as in all the acute exanthemata, expectant treatment is the only rational treatment. Nevertheless, an attempt was made to assess the value, if any, of streptocide in smallpox. The drug appears to be of undoubted value in relieving and clearing up the septic complications which so often occur in the focal phase of the disease. This is understandable when it is remembered how frequently a haemolytic streptococcus is isolated from the boils and abscesses which appear at this stage. On the toxic phase, that is to say on smallpox proper, the drug appears to exert no influence at all. It indubitably saved life in one or two cases where severe and extensive skin-sloughing had occurred, and its action was dramatic in the cases showing renal complications. One of these cases, a young boy of nine developed an acute nephritis during convalescence from smallpox. His urine became "smoky'' and dropped to six ounces in the twenty- four hours and he developed facial oedema. Within eight hours of the administra- tion of streptocide his fever had abated from 102° to normal and his recovery thenceforward was uninterrupted.
10. The other patient was a young woman of twenty-seven who was recovering from a severe attack of unmodified, discrete smallpox. For no apparent reason she began to have repeated rigors in the second week of convalescence. Culture of the urine revealed a haemolytic streptococcus and the exhibition of streptocide brought about an immediate recovery. The drug was used in 105 cases altogether, and as local experience increases, there are more grounds for belief that it has some value, especially in children, in tiding the patient over those days of the focal phase when septic absorption is at its height.
11. It would appear desirable that the usual points regarding its administration in smallpox should be observed, although it is not necessary to use the drug in the high dosage given in cases of meningitis mainly because the effect to be obtained by its use in the former disease is so much less clear cut.
12. Another line of treatment which was tried was the injection intramuscularly of convalescent serum. This method was employed in thirty-one cases of whom nine died and twenty-two recovered. These figures prove nothing. In one toxic puerperal case serum acted dramatically, and the result obtained in this one case appears to justify an extended trial of such serum. It was found in the course of the epidemic that sera from patients who had only just recovered were ineffective. To be of any use at all, serum must, apparently, be collected from patients who developed smallpox at least one month before, and preferably six weeks. Anti-bodies to the virus seem to take long to develop.
a
13. As the serum had to be taken from convalescents at Kennedy Town Hospital this line of treatment was not used as widely as it deserved to be, for converted police station is not an ideal place in which to collect and store serum under aseptic conditions.
P. B. Wilkinson, M.R.C.S., L.R.C.P. (Lon.), M.B., B.S. (Lon.), M.R.C.p. (Lon.),
Medical Officer.
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