for two days before the eruption appears. At the end of the second day,
the characteristic, bright scarlet efflorescence, somewhat similar to
the color of a boiled lobster, usually first shows itself. The scarlet
appearance is not confined to the skin; but the tongue, the throat, and
the whites of the eyes put on the same appearance; with this only
difference, that on the tongue and on the throat the scarlet is much
darker; and, as Dr. Elliotson accurately describes it,—“the tongue looks
as if it had been slightly sprinkled with Cayenne pepper.” The eruption
usually declines on the fifth, and is generally indistinct on the sixth
day; on the seventh it has completely faded away. There is usually,
after the first few days, great itching on the surface of the body. The
skin, at the end of the week, begins to peel and to dust off, making it
look as though meal had been sprinkled upon it.
There are three forms of scarlet fever,—the one where the throat is
_little_, if at all affected, and this is a mild form of the disease;
the second, which is generally, especially at night, attended with
delirium, where the throat is _much_ affected, being often greatly
inflamed and ulcerated; and the third (which is, except in certain
unhealthy districts, comparatively rare, and which is VERY dangerous),
the malignant form.
216. _Would it be well to give a little cooling, opening physic as soon
as a child begins to sicken for Scarlet Fever?_
_On no account whatever._ Aperient medicines are, in my opinion, highly
improper and dangerous both before and during the period of the
eruption. It is my firm conviction that the administration of opening
medicine, at such times, is one of the principal causes of scarlet fever
being so frequently fatal. This is, of course, more applicable to the
poor, and to those who are unable to procure a skillful medical man.
217. _What constitutes the principal danger in Scarlet Fever?_
The affection of the throat, the administration of opening medicine
during the first ten days, and a peculiar disease of the kidneys ending
in _anasarca_ (dropsy), on which account, the medical man ought, when
practicable, to be sent for at the onset, that no time may be lost in
applying _proper_ remedies.
218. _How would you distinguish between Scarlet Fever and Measles?_
Measles commences with symptoms of a common cold; scarlet fever does
not. Measles has a _peculiar hoarse_ cough; scarlet fever has not. The
eruption of measles is in patches of a half-moon shape, and is slightly
raised above the skin; the eruption of scarlet fever is _not_ raised
above the skin at all, and is one continued mass. The color of the
eruption is much more vivid in scarlet fever than in measles. The chest
is the part principally affected in measles, and the throat in scarlet
fever.
There is an excellent method of determining, for a certainty, whether
the eruption be that of scarlatina or otherwise. I myself have, in
several instances, ascertained the truth of it: “For several years M.
Bouchut has remarked in the eruption of scarlatina a curious phenomenon,
which serves to distinguish this eruption from that of measles,
erythema, erysipelas, etc., a phenomenon essentially vital, and which is
connected with the excessive contractability of the capillaries. The
phenomenon in question is a _white line_, which can be produced at
pleasure by drawing the back of the nail along the skin where the
eruption is situated. On drawing the nail, or the extremity of a hard
body (such as a pen-holder), along the eruption, the skin is observed to
grow pale, and to present a white trace, which remains for one or two
minutes, or longer, and then disappears. In this way the diagnosis of
the disease may be very distinctly written on the skin; the word
‘Scarlatina’ disappears as the eruption regains its uniform
tint.”—_Edinburgh Medical Journal._
219. _Is it of so much importance, then, to distinguish between Scarlet
Fever and Measles?_
It is of great importance, as in measles the patient ought to be kept
_moderately_ warm, and the drinks should be given with the chill off;
while in scarlet fever the patient ought to be kept cool—indeed, for the
first few days, _cold_; and the beverages, such as spring water, toast
and water, etc., should be administered quite cold.
I had the honor to read a _Paper on the Treatment of Scarlet Fever_
before the members of Queen’s College Medico-Chirurgical Society,
Birmingham,—which _Paper_ was afterwards published in the _Association
Journal_; and in Braithwaite’s _Retrospect of Medicine_; and in
Ranking’s _Half-Yearly Abstract of the Medical Sciences_; besides in
other publications. Moreover, the _Paper_ was translated into German,
and published in _Canstatt’s Jahresbericht_, iv. 456.
220. _What is the treatment of Scarlet Fever?_
_What to do._—Pray pay particular attention to my rules, and carry out
my directions to the very letter—as I can then promise you _that if the
scarlet fever be not malignant_, the plan I am about to recommend will,
with God’s blessing, be generally successful.
What is the first thing to be done? Send the child to bed; throw open
the windows, be it winter or summer, and have a thorough ventilation;
for the bed-room must be kept cool, I may say cold. Do not be afraid of
fresh air, for fresh air, for the first few days is essential to
recovery. _Fresh air, and plenty of it, in scarlet fever, is the best
doctor_ a child can have: let these words be written legibly on your
mind. In the _Times_, is the following, copied from the _Bridgewater
Mercury_:—
“GROSS SUPERSTITION.—In one of the streets of Taunton there resides a
man and his wife who have the care of a child. This child was attacked
with scarlatina, and to all appearance death was inevitable. A jury of
matrons was, as it were, impaneled, and, to prevent the child ‘dying
hard,’ all the doors in the house, all the drawers, all the boxes, all
the cupboards were thrown wide open, the keys taken out, and the body of
the child placed under a beam, whereby a sure, certain, and easy passage
into eternity could be secured. Watchers held their vigils throughout
the weary night, and in the morning the child, to the surprise of all,
did not die, and is now gradually recovering.”
These old women—this jury of matrons—stumbled on the right remedy, “all
the doors in the house ... were thrown wide open,” and thus they
thoroughly ventilated the apartment. What was the consequence? The child
who, just before the opening of the doors, had all the appearances “that
death was inevitable,” as soon as fresh air was let in, showed symptoms
of recovery, “and in the morning the child, to the surprise of all, did
not die, and is now gradually recovering.” There is nothing
wonderful—there is nothing surprising to my mind—in all this.
Ventilation—thorough ventilation—is the grand remedy for scarlatina! Oh,
that there were in scarlet fever cases a good many such old women’s—such
a “jury of matrons”—remedies! We should not then be horrified, as we now
are, at the fearful records of death, which the Returns of the
Registrar-General disclose!
Take down the curtains of the bed; remove the valances. If it be summer
time, let the child be only covered with a sheet: if it be winter time,
in addition to the sheet, he should have one blanket over him.
Now for the throat.—The best _external_ application is a barm and
oatmeal poultice. How ought it to be made, and how applied? Put half a
teacupful of barm into a saucepan, put it on the fire to boil; as soon
as it boils take it off the fire, and stir oatmeal into it, until it is
of the consistence of a nice soft poultice; then place it on a rag, and
apply it to the throat; carefully fasten it on with bandage, two or
three turns of the bandage going round the throat, and two or three over
the crown of the head, so as nicely to apply the poultice where it is
wanted—that is to say, to cover the tonsils. Tack the bandage: do not
pin it. Let the poultice be changed three times a day. The best medicine
is the acidulated infusion of roses, sweetened with syrup. [For the
prescription of the acidulated infusion of roses with syrup, see
question 209.] It is grateful and refreshing, it is pleasant to take, it
abates fever and thirst, it cleans the throat and tongue of mucus, and
is peculiarly efficacious in scarlet fever; as soon as the fever is
abated it gives an appetite. My belief is that the sulphuric acid in the
mixture is a specific in scarlet fever, as much as quinine is in ague,
and sulphur in itch. I have reason to say so, for, in numerous cases, I
have seen its immense value.
Now, with regard to food.—If the child be at the breast, keep him
entirely to it. If he be weaned, and under two years old, give him milk
and water, and cold water to drink. If he be older, give him toast and
water, and plain water from the pump, as much as he chooses; let it be
quite cold—the colder the better. Weak black tea, or thin gruel, may be
given, but not caring, unless he be an infant at the breast, if he take
nothing but _cold_ water. If the child be two years old and upwards,
roasted apples with sugar, and grapes will be very refreshing, and will
tend to cleanse both the mouth and the throat. Avoid broths and
stimulants of every kind.
When the appetite returns, you may consider the patient to be safe. The
diet ought now to be gradually improved. Bread and butter, milk and
water, and arrow-root made with equal parts of new milk and water,
should for the first two or three days be given. Then a light batter or
rice pudding may be added, and in a few days afterward, either a little
chicken or a mutton-chop.
The essential remedies, then, in scarlet fever, are, for the first few
days—(1) plenty of fresh air and ventilation, (2) plenty of cold water
to drink, (3) barm poultices to the throat, and (4) the acidulated
infusion of roses’ mixture as a medicine.
Now, then, comes very important advice. After the first few days,
probably five or six, sometimes as early as the fourth day, _watch
carefully and warily, and note the time, the skin will suddenly become
cool_, the child will say that he feels chilly; then is the time you
must now change your tactics—_instantly close the windows, and put extra
clothing_, a blanket or two on his bed. A flannel night-gown should,
until the dead skin has peeled off, be now worn next to the skin, when
the flannel night-gown should be discontinued. The patient ought ever
after to wear, in the daytime, a flannel waistcoat. On the importance,
the vital importance, of the wearing of flannel next to the skin, see
Flannel Waistcoats. His drinks must now be given with the chill off; he
ought to have a warm cup of tea, and gradually his diet should, as I
have previously recommended, be improved.
There is one important caution I wish to impress upon you,—_do not give
opening medicine during the time the eruption is out_. In all
probability the bowels will be opened: if so, all well and good; but do
not, on any account, for the first ten days, use artificial means to
open them. It is my firm conviction that the administration of
purgatives in scarlet fever is a fruitful source of dropsy, of disease
and death. When we take into consideration the sympathy there is between
the skin and the mucous membrane, I think that we should pause before
giving irritating medicines, such as purgatives. The irritation of
aperients on the mucous membrane may cause the poison of the skin
disease (for scarlet fever is a blood poison) to be driven internally to
the kidneys, to the throat, to the pericardium (bag of the heart), or to
the brain. You may say, Do you not purge if the bowels be not open for a
week? I say emphatically, No!
I consider my great success in the treatment of scarlet fever to be
partly owing to my avoidance of aperients during the first ten days of
the child’s illness.
If the bowels, after the ten days, are not properly opened, a dose or
two of the following mixture should be given:
Take of—Simple Syrup, three drachms;
Essence of Senna, nine drachms:
To make a Mixture. Two teaspoonfuls to be given early in the morning
occasionally, and to be repeated in four hours, if the first dose
should not operate.
In a subsequent Conversation, I shall strongly urge you not to allow
your child, when convalescent, to leave the house under at least a month
from the commencement of the illness; I therefore beg to refer you to
that Conversation, and hope that you will give it your best and earnest
consideration! During the last seventeen years I have never had dropsy
from scarlet fever, and I attribute it entirely to the plan I have just
recommended, and in not allowing my patients to leave the house under
the month—until, in fact, the skin that has peeled off has been renewed.
Let us now sum up the plan I adopt:
1. Thorough ventilation, a cool room, and scant clothes on the bed, for
the first five or six days.
2. A change of temperature of the skin to be carefully regarded. As soon
as the skin is cool, closing the windows, and putting additional
clothing on the bed.
3. The acidulated infusion of roses with syrup is _the_ medicine for
scarlet fever.
4. Purgatives to be religiously avoided for the first ten days at least,
and even afterward, unless there be absolute necessity.
5. Leeches, blisters, emetics, cold and tepid spongings, and painting
the tonsils with caustic, inadmissible in scarlet fever.
6. A strict antiphlogistic (low) diet for the first few days, during
which time cold water to be given _ad libitum_.
7. The patient _not_ to leave the house in the summer under the month;
in the winter, under six weeks.
_What_ NOT _to do_.—Do not, then, apply either leeches or blisters to
the throat; do not paint the tonsils with caustic; do not give
aperients; do not, on any account, give either calomel or emetic tartar;
do not, for the first few days of the illness, be afraid of _cold air_
to the skin, and of cold water as a beverage; do not, emphatically let
me say, _do not_ let the child leave the house for at least a month from
the commencement of the illness.
My firm conviction is, that purgatives, emetics, and blisters, by
depressing the patient, sometimes cause ordinary scarlet fever to
degenerate into malignant scarlet fever.
I am aware that some of our first authorities advocate a different plan
to mine. They recommend purgatives, which I may say, in scarlet fever,
are my dread and abhorrence. They advise cold and tepid spongings—a plan
which I think dangerous, as it will probably drive the disease
internally. Blisters, too, have been prescribed; these I consider
weakening, injurious, and barbarous, and likely still more to inflame
the already inflamed skin. They recommend leeches to the throat, which I
am convinced, by depressing the patient, will lessen the chance of his
battling against the disease, and will increase the ulceration of the
tonsils. Again, the patient has not too much blood; the blood is only
poisoned. I look upon scarlet fever as a specific poison of the blood,
and one which will be eliminated from the system, _not_ by bleeding,
_not_ by purgatives, _not_ by emetics, but by a constant supply of fresh
and cool air, by the acid treatment, by cold water as a beverage, and
for the first few days by a strict antiphlogistic (low) diet.
Sydenham says that scarlet fever is oftentimes “fatal through the
officiousness of the doctor.” I conscientiously believe that a truer
remark was never made; and that under a different system to the usual
one adopted, scarlet fever would not be so much dreaded.
If any of my medical brethren should do me the honor to read these
pages, let me entreat them to try my plan of treating scarlet fever, as
my success has been great. I have given full and minute particulars, in
order that they and mothers (if mothers cannot obtain medical advice)
may give my plan a fair and impartial trial. My only stipulations are
that they must _begin_ with my treatment, and _not mix_ any other with
it, and carry out my plan to the very letter. I then, with God’s
blessing, shall not fear the result; but shall rejoice that I have been
of some little service in my generation.
221. _How soon ought a child to be allowed to leave the house after an
attack of Scarlet Fever?_
He must _not_ be allowed to go out for at least a month from the
commencement of the attack, in the summer, and six weeks in the winter;
and not even then without the express permission of a medical man. It
might be said that this is an unreasonable recommendation: but when it
is considered that the whole of the skin generally desquamates, or peels
off, and consequently leaves the surface of the body exposed to cold,
which cold flies to the kidneys, producing a peculiar and serious
disease in them, ending in dropsy, this warning will not be deemed
unreasonable.
Scarlet fever dropsy, which is really a _formidable disease, generally
arises from the carelessness, the ignorance, and the thoughtlessness of
parents in allowing a child to leave the house before the new skin is
properly formed and hardened_. Prevention is always better than cure.
Thus far with regard to the danger to the child himself. Now, if you
please, let me show you the risk of contagion that you inflict upon
families, in allowing your child to mix with others before a month at
least has elapsed. Bear in mind, a case is quite as contagious, if not
more so, while the skin is peeling off, as it was before. Thus, in ten
days or a fortnight, there is as much risk of contagion as at the
_beginning_ of the disease, and when the fever is at its height. At the
conclusion of the month the old skin has generally all peeled off, and
the new skin has taken its place; consequently there will then be less
fear of contagion to others. But the contagion of scarlet fever is so
subtle and so uncertain in its duration, that it is impossible to fix
the exact time when it ceases.
Let me most earnestly implore you to ponder well on the above important
facts. If these remarks should be the means of saving only one child
from death, or from broken health, my labor will not have been in vain.
222. _What means do you advise to purify a house from the contagion of
Scarlet Fever?_
Let every room be _lime-washed_ and then be whitewashed; if the
contagion has been virulent, let every bed-room be freshly papered (the
walls having been previously stripped of the old paper and then
lime-washed); let the bed, the bolsters, the pillows, and the mattresses
be cleansed and purified; let the blankets and coverlids be thoroughly
washed, and then let them be exposed to the open air—if taken into a
field so much the better; let the rooms be well scoured; let the
windows, top and bottom, be thrown wide open; let the drains be
carefully examined; let the pump water be scrutinized, to see that it be
not contaminated by fecal matter, either from the water-closet or from
the privy; let privies be emptied of their contents—_remember this is
most important advice_—then put into the empty places lime and powdered
charcoal, for it is a well-ascertained fact that it is frequently
impossible to rid a house of the infection of scarlet fever without
adopting such a course. “It would be well if we were to use whitewash in
many cases where great cleanliness of surface cannot be obtained. We
remove in this way, by an easy method, much of the dullness and still
more of the unwholesomeness of dirt.”—Dr. Angus Smith. “In St. George’s,
Southwark, the medical officer reports that scarlatina ‘has raged
fatally, almost exclusively where privy or drain smells are to be
perceived in the houses.’” Let the children who have not had, or who do
not appear to be sickening for scarlet fever, be sent away from home—if
to a farm-house so much the better. Indeed, leave no stone unturned, no
means untried, to exterminate the disease from the house and from the
neighborhood.
223. _Will you describe the symptoms of Chicken-pox?_
It is occasionally, but not always, ushered in with a slight shivering
fit; the eruption shows itself in about twenty-four hours from the child
first appearing poorly. It is a vesicular disease. _Vesicles._ Small
elevations of the cuticle, covering a fluid which is generally clear and
colorless at first, but becomes afterward whitish and opaque, or
pearly.—_Watson._ The eruption comes out in the form of small pimples,
and principally attacks the scalp, the neck, the back, the chest, and
the shoulders, but rarely the face; while in small-pox the face is
generally the part most affected. The next day these pimples fill with
water, and thus become vesicles; on the third day they are at maturity.
The vesicles are quite separate and distinct from each other. There is a
slight redness around each of them. Fresh ones, while the others are
dying away, make their appearance. Chicken-pox is usually attended with
a slight itching of the skin; when the vesicles are scratched the fluid
escapes, and leaves hard pearl-like substances; which, in a few days,
disappear. Chicken-pox never leaves pit-marks behind. It is a child’s
complaint; adults scarcely, if ever, have it.
224. _Is there any danger in Chicken-pox; and what treatment do you
advise?_
It is not at all a dangerous, but, on the contrary, a trivial complaint.
It lasts only a few days, and requires but little medicine. The patient
ought, for three or four days, to keep the house, and should abstain
from animal food. On the sixth day, but not until then, a dose or two of
a mild aperient is all that will be required.
225. _Is Chicken-pox infectious?_
There is a diversity of opinion on this head, but one thing is
certain—it cannot be communicated by inoculation.
226. _What are the symptoms of Modified Small-pox?_
The modified small-pox—that is to say, small-pox that has been robbed of
its virulence by the patient having been either already vaccinated, or
by his having had a previous attack of small-pox—is ushered in with
severe symptoms, with symptoms almost as severe as though the patient
had not been already somewhat protected either by vaccination or by the
previous attack of small-pox—that is to say, he has a shivering fit,
great depression of spirits and debility, _malaise_, sickness, headache,
and occasionally delirium. After the above symptoms have lasted about
three days, the eruption shows itself. The immense value of the previous
vaccination, or the previous attack of small-pox, now comes into play.
In a case of _unprotected_ small-pox, the appearance of the eruption
_aggravates_ all the above symptoms, and the danger begins; while in the
_modified_ small-pox, the moment the eruption shows itself, the patient
feels better, and, as a rule, rapidly recovers. The eruption of
_modified_ small-pox varies materially from the eruption of the
_unprotected_ small-pox. The former eruption assumes a varied character,
and is composed, first of vesicles (containing water), and secondly of
pustules (containing matter), each of which pustules has a depression in
the center, and thirdly of several red pimples without either water or
matter in them, and which sometimes assume a livid appearance. These
“breakings-out” generally show themselves more upon the wrist, and
sometimes up one or both of the nostrils. While in the latter
disease—the _unprotected_ small-pox—the “breaking-out” is composed
entirely of pustules containing matter, and which pustules are more on
the face than on any other part of the body. There is generally a
peculiar smell in both diseases—an odor once smelt never to be
forgotten.
Now, there is one most important remark I have to make,—_the modified
small-pox is contagious_. This ought to be borne in mind, as a person
laboring under the disease must, if there be children in the house,
either be sent away himself, or else the children ought to be banished
both the house and the neighborhood. Another important piece of advice
is, let _all_ in the house—children and adults, one and all—be
vaccinated, even if any or all have been previously vaccinated.