FOOTNOTES:

[1] The expression _scarlatina_ does not imply, as it is believed by many, on account of its diminutive form, a peculiar mild form of the disease: it is nothing but the Latin and scientific name for scarlet-fever.

[2] Captain Claridge.

[3] Thomas Watson, M. D. Lectures on the Principles and Practice of Physic.

[4] Sydenham.

[5] G. C. Reich, M.D. Neue Aufschluesse ueber die Natur und Heilung des Scharlachfiebers, Halle, 1810.

[6] L. Hesse, M. D. in Rust's Magazin, Vol. XXVII., H. 1 S. 109.

PART II.

TREATMENT OF SCARLET-FEVER.

DIFFERENT METHODS OF OTHER SCHOOLS.

33. Before giving the description of hydriatic treatment of scarlet-fever, I shall, for the sake of a better appreciation, glance over the different methods which have been recommended by other schools.

34. THE EXPLETIVE METHOD (_blood-letting_)

has been advocated by some of the best authorities, and there cannot be a doubt but that it must have rendered good service in cases of violent reaction, or else men like de Haen, Wendt, Willan, Morton, Alc.o.c.k, Dewees, Dawson, Dewar, Hammond, &c., would not have p.r.o.nounced themselves in favor of it. However it requires nice discrimination and a great deal of experience, as in any case where it does no good it is apt to do a great deal of harm, by weakening the patient and thus depriving him of that power which he so much needs in struggling against the enemy invading his system. Besides, the expletive method has found many antagonists of weight: Simon, Williams, Tweedie, Allison and others have shown the danger of a general and indiscriminate use of it. Williams,[7]

in his comparison of the epidemics of scarlatina from 1763 to 1834, has come to the conclusion that the possibility of a cure in cases of blood-letting, compared with the cases where the patients have not been bled, is like 1:4; i. e. four patients have died after blood-letting, when only one died without bleeding. "Experience has equally shown, says Dr. Allison, that the expectation entertained by Dr. Armstrong[8] and others, that by early depletion the congestive or malignant form of the disease may be made to a.s.sume the more healthy form of inflammation and fever, is hardly ever realized; and in many cases, although the pulse has been full and the eruption florid in the beginning, _blood-letting (even local blood-letting) has been followed by a rapid change of the fever to a typhoid type, and manifestly aggravated the danger_."--My own experience would prompt me to declare myself against blood-letting in general, even if I had not a sufficient quant.i.ty of water at hand to manage the violent or irregular reaction of a case. Blood-letting, in any case of eruptive fever, and with few exceptions in almost every other case, appears to me like pulling down the house to extinguish the fire. A little experience in hydriatics, a few buckets of water, with a couple of linen sheets and blankets, will answer all the indications and remove the danger without sending the patient from Scylla into Charybdis.

35. THE ANTI-GASTRIC METHOD,

consisting in the free use of emetics or purgatives, has been recommended by some eminent pract.i.tioners. Withering,[9] Tissot, Kennedy and others are in favor of the former, and find fault with the latter, whilst Hamilton,[10] Willard, Abernethy, Gregory, &c., prefer purgatives, and some, of course, look upon calomel as the anchor of safety, which they recommend in quant.i.ties of from five to ten grains per hour.[11] The friends of one part of the anti-gastric method make war upon the other: Withering finding purgatives entirely out of place and Sandwith, Fothergill and others having seen nothing but harm done by them, whilst Wendt,[12] Berndt,[13] Heyfelder and others caution their readers against emetics. The anti-gastric method has been of some service in epidemics and individual cases, when the character of the disease was decidedly gastric and bilious. To use emetics or purgatives indiscriminately would do much more harm than good; as, for instance, during a congestive condition of the brain, the former, and with inflammatory symptoms of the bowels, the latter, would be almost sure to sacrifice the patient to the method.

36. THE AMMONIUM CARBONIc.u.m,

recommended by Peart,[14] has been considered by many as a specific capable of neutralizing the scarlatinous poison, whilst others have used it only as a powerful tonic in torpid cases. Experience has shown that it is not a specific, and that its use as a tonic, requiring a great deal of care and discrimination, is a good deal more dangerous than the mode of treatment I am going to recommend in cases where tonics are required.

37. CHLORIDE OF LIME.

About the same opinion may be given on _Chloride of Lime_. As a gargle, and taken internally, the aqua-chlorina has done good service in malignant scarlatina, especially in putrid cases.

38. ACETIC ACID.

Brown[15] recommends diluted _Acetic Acid_ as a specific against all forms of scarlatina. Experience, however, has not supported his confidence in the infallibility of his remedy.

39. MINERAL ACIDS (MURIATIC ACID--PRESCRIPTIONS)

have also been used with good effect in some epidemics. _Muriatic acid_ I have frequently used myself for inflammation of the throat, in connection with hydriatic treatment, and it has almost always contributed to relieve the symptoms materially.[16]

40. FRICTIONS WITH LARD

were used already by Caelius Aurelia.n.u.s,[17] and recently re-introduced into practice, by Drs. Daene and Schneemann,[18] in Germany, and by Dr.

Lindsley,[19] in America. Even hydriatic physicians[20] have tried them with some success. However, notwithstanding the strong recommendations of the remedy on the part of the above named pract.i.tioners and others, the efficacity of it as a general remedy for scarlet-fever has not been confirmed. On the contrary, Berend[21] and Hauner[22] found that it did not prevent desquamation, as it had been a.s.serted, and even Richter restricts his commendations to the vague a.s.sertion "that it seemed to him as if the cases when he used the lard were made milder than they would have been without it."

41. BELLADONNA.

The remedy which has attracted and still attracts in a very high degree the attention of physicians and parents, is _Belladonna_. This remedy was first introduced as a specific and prophylactic by Hahnemann, and soon recommended not only by his own disciples, but by some of the best names of the "regular" school.[23] But soon after, as many physicians of standing declared themselves adversaries to Hahnemann's discovery,[24]

and whatever may be the merits of belladonna as a specific and prophylactic in some quarters, it is certain that it never answered the expectation raised by its promulgators in others. As far as my own experience extends, I have seen very little or no effect from it. I have restricted myself, it is true, to h.o.m.oeopathic doses, being afraid of the bad consequences of larger quant.i.ties in children; but from what I have seen in my own practice and that of some other physicians with whom I was familiar, I cannot but advise my readers not _to rely_ either on the prophylactic or the curative power of belladonna, when a safer and more reliable remedy is offered to them. A remedy may be excellent in certain cases and certain epidemics, and many an honest and well-meaning physician may be deceived into the belief that he has a general remedy in hand, whilst others, or himself, on future occasions discover that he has allowed himself to be taken in. Had not belladonna and aconite proved beneficial in many cases, they would scarcely have acquired their reputation, but with all due respect for Father Hahnemann and his system, I must deny belladonna to be a general, safe and reliable remedy in the prevention and cure of scarlet-fever.

42. THERE IS NEITHER A SPECIFIC NOR A PROPHYLACTIC TO BE RELIED ON.

All these different methods and remedies, and many others, have been and are still used with more or less effect. But where there are three physicians to recommend one of them, there will always be four to contradict them. They may all do some good in certain epidemics or individual cases; they may relieve symptoms; they may save the life of many a patient who would have died without them (although many a patient who died, might have lived also, had he been under a more judicious treatment, or--under no treatment at all.) But none is reliable in general; none contains a specific to neutralize the morbid poison; none is a reliable prophylactic, such as vaccina for small-pox; and if single physicians, or whole cla.s.ses of physicians, a.s.sert to the contrary, the fault must lie somewhere, either in their excess of faith in certain authorities, which induces them to throw their own pia desideria into the scales, or in a want of cool, impartial observation continued for a sufficient length of time to wear out sanguine expectations. _The fact is that there neither exists a reliable prophylactic, nor has a safe specific been found as yet; that all is guess-and-piece work; and that people are taken by scarlet-fever and die of it about the same as before those vaunted methods and remedies were discovered._ I wish to impress my readers with this fact--the proofs of which they can easily find in the mortality lists of the papers--to make them understand that by giving up for the hydriatic method any of the modes and remedies, which have been in use hitherto, they do not run a risk of losing anything.

43. WATER-TREATMENT, AS USED BY CURRIE, REUSS, HESSE, SCHOENLEIN, &C.

Beside the above modes of treatment _cold_ and _tepid Water_ has been extensively used and recommended by reliable authorities. Currie,[25]

Pierce, Gregory, Bateman, von Wedekind, Kolbany,[26] Torrence, Reuss,[27] von Frohlichsthal,[28] and others, have treated their scarlet-patients with _cold affusions_. Henke, Raimann, Frohlich, Hesse,[29] Steimmig,[30] Gregory, Jr., Schoenlein, Fuchs, and others, have not ventured beyond _cool_ and _tepid ablutions_. The former, although the general result has been very satisfactory, have proved dangerous in some cases; and the latter, though safer in general, have not been efficient in many others. The use of water, though safer than other remedies, has never become general, _owing to the unsystematic, unsafe, or inefficient forms of its application_.

Fear and prejudice--fed by the great ma.s.s of physicians, who generally take too much care of their reputation to expose it in the use of a remedy the effects of which are so easily understood by every one--have also been obstacles to its promulgation; and the exaggerations of some of its advocates in modern times, bearing for a great part the characteristics of charlatanism, have scared many who might have become converts to Priessnitz's method, to whose genius and good luck we are indebted for the most important, most harmless, and at the same time the most efficient and most reliable discovery, viz.:

44. PRIESSNITZ'S METHOD--THE WET-SHEET-PACK,

a remedy which, alone, is worth the whole antiphlogistic, diaph.o.r.etic, and, indeed, the whole curative apparatus of the profession, in ancient and modern times, for any kind of fevers, and especially for eruptive diseases. Nor did the physicians before Priessnitz know anything about the use of the _sitz-bath_ for affections of the brain in torpid reaction, which in such cases, is the only anchor of safety. In short, water-treatment was, like other methods, an excellent thing for certain symptoms, but not generally and safely applicable in every case.

To appreciate the effects of the wet-sheet pack, one must have seen it used for inflammatory fever, when it acts like a charm, frequently removing all the feverish symptoms, and their cause, in a few hours.

45. TECHNICALITIES OF THE PACK AND BATH.

Let me give you its technicalities, and the rationale of its action:

A linen sheet, (linen is a better conductor than cotton,) large enough to wrap the whole person of the patient in it (not too large, however; if there is no sheet of proper size, it should be doubled at the upper end) is dipped in water of a temperature answering to the degree of heat and fever, say between fifty and seventy degrees Fahrenheit, and more or less tightly wrung out. The higher the temperature of the body, and the quicker and fuller the pulse, the lower the temperature of the water, and the wetter the sheet. This wet sheet is spread upon a blanket previously placed on the mattress of the bed on which the packing is to take place. The patient, wholly undressed, is laid upon it, stretched out in all his length, and his arms close to his thighs, and quickly wrapped up in the sheet, head and all, with the exception of the face; the blanket is thrown over the sheet, first on the packer's side, folded down about the head and shoulders, so as to make it stick tight to all parts of the body, especially the neck and feet, tucked under the shoulders, side of the trunk, leg and foot; then the opposite side of the blanket is folded and tucked under in the same manner, till the blanket and sheet cover the whole body _smoothly_ and _tightly_. Then comes a feather-bed, or a comforter doubled up, and packed on and around the patient, so that no heat can escape, or air enter in any part of the pack, if the head be very hot, it may be left out of the pack, or the sheet may be doubled around it, or a cold wet compress, not too much wrung out, be placed on the forehead, and as far back on the top of the head as practicable, which compress must be changed from time to time, to keep it cool. Thus the patient remains.

46. The first impression of the cold wet sheet is disagreeable; but no sooner does the blanket cover the sheet, than the chill pa.s.ses away, and usually before the packing is completed, the patient begins to feel more comfortable, and very soon the symptoms of the fever diminish. The pulse becomes softer, slower, the breathing easier, the head cooler, the general irritation is allayed, and frequently the patient shows some inclination to sleep. When the fever and heat are very high, the sheet must be changed on growing hot, as then it would cause the symptoms to increase again, instead of continuing to relieve them. The best way to effect this changing of the sheet is to prepare another blanket and sheet on another bed, to unpack the patient and carry him to the new pack, where the process described above is repeated. Sometimes it is necessary to change again; but seldom more than three sheets are required to produce a perspiration, and relieve the patient for several hours, or--according to the case--permanently. The changing of the sheet may become necessary in fifteen, twenty, twenty-five, thirty or forty minutes, according to the degree of fever and heat. In every new sheet the patient can stay longer; in the last sheet he becomes more quiet than before, usually falls asleep, and awakes in a profuse perspiration, which carries off the alarming symptoms.