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HYDRIATIC TREATMENT
OF
SCARLET FEVER
IN ITS DIFFERENT FORMS.
OR
HOW TO SAVE,
THROUGH A SYSTEMATIC APPLICATION OF THE WATER-CURE, MANY
THOUSANDS OF LIVES AND HEALTHS, WHICH NOW ANNUALLY
PERISH.
Being the Result of
TWENTY-ONE YEARS' EXPERIENCE, AND OF THE TREATMENT AND
CURE OF SEVERAL HUNDRED CASES OF ERUPTIVE FEVERS.
BY
=CHARLES MUNDE, M.D., Ph.D.=
New-York:
WILLIAM RADDE, 300 BROADWAY.
1857.
Entered according to Act of Congress, in the year 1857, by
WILLIAM RADDE,
In the Clerk's Office of the District Court of the United States,
for the Southern District of New-York.
HENRY LUDWIG, Printer,
_39 Centre-street, N.-Y._
PREFACE.
In offering this pamphlet to the Public in general, and to Parents and
Physicians in particular, I have no other object than that of
contributing my share to the barrier which the medical profession has
attempted, for more than two hundred years, to raise against the
progress of the terrible disease which carries off upon an average, half
a million of human beings annually. All the efforts of medical men to
stop the ravages of Scarlet-Fever have hitherto proved unavailing; every
remedy which was considered, for a while, a specific proved subsequently
inefficient; and, notwithstanding the assertion to the contrary of a
few, the Dr. Jenner who shall discover a reliable prophylactic against
scarlatina, is probably not yet born. The patients die in the same
proportion as they did two hundred and fifty years ago, and the
physicians who have any success at all in the treatment of the terrible
scourge, are those who treat for symptoms and leave the disease to
Nature.
Under these circumstances, a mode of treatment which promises a decrease
in the number of victims, from the experience of a quarter of a
century, and a score of epidemics of different characters, cannot but be
received with pleasure by the public. I have treated scarlet-fever
hydriatically for twenty-one years, and out of several hundred cases
never lost a patient, except one who died of typhus during an epidemy of
scarlatina; and my observations, during twenty-five years, of the
practice of other physicians of the same school, present a result about
as favorable as my own.
My present position is such, that no self-interest, if I could have any
in a question of such importance for the human race; would induce me to
publish this article, as a rush of scarlet-fever patients would only
tend to destroy the practice at my establishment, instead of increasing
my income. My purpose, therefore, must be honest; and the zeal which I
have manifested for many years in the promulgation of the Water-Cure is
no longer the effect of enthusiasm, but of the observations and practice
of Priessnitz's method during the best part of a man's life, and the
conviction of its merits gained from _facts_.
I consider Hydro-therapeutics as one of the healthiest branches of the
Tree of Medical Science, but not, like some others do, as the whole
Tree. I do not pretend to be able to cure every thing with water; but in
yielding to other medical systems what belongs to them, I earnestly
claim for the Water-Cure, what belongs to it, frankly accusing for the
little progress the hydriatic system has made in this country, the
spirit of charlatanism and speculation on one side, and ignorance,
self-conceit, self-interest and laziness on the other. According to my
experience, and the result obtained by other hydriatic practitioners,
eruptive fevers decidedly belong to Hydro-therapeutics, or the
Water-Cure. If the result obtained by men like Currie, Bateman, Gregory,
Reuss, Froelichsthal, &c., long before Priessnitz, were highly
satisfactory, the important additions and the more systematic
arrangement of the treatment of the inventor of the Water-Cure and
myself, have made the method almost infallible in eruptive fevers, and
my innermost conviction is, that all the other modes of treatment of
these fevers put together will not do the tenth part of the service
which may with certainty be expected from the systematic use of water as
I give it in this treatise.
Owing to the reluctance of the profession to allow Hydro-therapeutics an
honorable place among medical systems, I address myself more to parents
than to physicians. Had I intended to write for the latter, exclusively,
the important subject which I am treating, would have received another
coat. However, nothing of value to the physician has been omitted,
whilst much has been said, which though _he_ does not need it, seemed to
me indispensably necessary for people not initiated in the medical art.
In regard to the style and language in general, I solicit the reader's
indulgence. I may appear pretentious in publishing the present pamphlet,
written in a tongue which is not my own, without submitting it,
previously, to the correction of an English or American pen; but this
publication has been called forth by the tears of mothers mourning over
the bodies of their darlings during the present winter, and too much
time has been lost already in preparing it, for those whose life might
have been saved, by an earlier publication, whilst I am fully aware of
the imperfections of a work, which has been done during the few, often
interrupted, leisure-hours left to me by the position I occupy. But
whatever may be its defects, I feel convinced, that it cannot fail doing
some little good; and should but one mother's tears remain unshed, I
would never regret having published it. The good it will do, must depend
on the favor with which it is received.
CHARLES MUNDE.
FLORENCE WATER-CURE,}
NORTHAMPTON, MASS. }
_March, 1857._
TABLE OF CONTENTS.
PART THE FIRST.
DESCRIPTION OF SCARLET-FEVER.
PAGE
1. Definition--Scarlet-Fever or Scarlatina 13
2. Division of the process of the disease into _Periods_ 13
3. Period of Incubation, or Hatching 13
4. Period of Eruption, or Appearing of the Rash 14
5. Period of Efflorescence, or Standing out of the Rash 15
6. Period of Desquamation, or Peeling off 16
7. Period of Convalescence 17
8. Varieties of Forms of Scarlatina 17
9. _Scarlatina simplex_, or simple Scarlet-Fever 17
10. _Scarlatina anginosa_, or Sore-Throat Scarlet-Fever 18
11. Mild Reaction (erethic) 19
12. Violent Reaction (sthenic) 19
13. Torpid Reaction (asthenic) 19
14. Scarlatina miliaris 19
15. Scarlatina sine Exanthemate 20
16. _Malignant Forms of Scarlatina_ 20
17. Sudden Invasion of the Nervous Centres 20
18. Affection of the Brain 20
19. 20. Affection of the Cerebellum and Spine 21
21. Putrid Symptoms 21
22. Condition of the Throat, and other Internal Organs 21
23. Other bad symptoms 22
24. Destruction of the Organ of Hearing 22
25. Other Sequels, Dropsy, &c. 22
26-27. The _Contagion_ of Scarlatina very active 23
28. _Diagnosis_ 24
29. Diagnosis from Measles 24
30. _Prognosis_ 25
31. Favorable symptoms 25
32. Unfavorable symptoms 26
PART THE SECOND.
TREATMENT OF SCARLET-FEVER.
33. _Different Methods of other Schools_ 27
34. The Expletive Method 27
35. The Anti-gastric Method 28
36. Ammonium carbonicum 29
37. Chloride of Lime 30
38. Acetic Acid 30
39. Mineral Acids. Muriatic Acids--Prescriptions 30
40. Frictions with Lard 30
41. Belladonna 31
42. There is neither a Specific nor a Prophylactic to be
relied on 32
43. _Water-Treatment_, as used by Currie, Reuss, Hesse,
Schoenlein, &c. 33
44. Priessnitz's Method--The wet-sheet-Pack 34
45-47. Technicalities of the Pack and Bath 34-36
48. Action of the Pack and Bath--Rationale 36
49. 50. What effect could be expected from a warm wet-sheet? 38
51. No cutting short of the process of Scarlatina--the morbid
poison must be drawn to the skin as soon as possible 40
52. Necessity of Ventilation--Means of Heating the sick-room--
Relative merits of Open Fires, Stoves and Furnaces 41
53. Temperature of the sick-room 43
54. Water-drinking 44
55. Diet 44
56. _Treatment of Scarlatina simplex_ 45
57. _Treatment of Scarlatina anginosa_ 46
58-65. _Treatment_ of the _mild_, or erethic _Form_ of
scarlatina anginosa 40-50
66. _Treatment_ of the _violent_, or sthenic _Form_ of
scarlatina anginosa 50
67. Temperature of the water--double sheet--Changing sheet 51
68. 69. Length of Pack--Perspiration 52
70. Length of Bath 53
71. Caution 53
72. The wet Compress 54
73. Highly inflamed Throat--Croup 54
74. Necessity of allaying the Heat 55
75-77. The Half-bath--The Sitz- or Hip-Bath 55-56
78. Action of the sitz-bath explained 56
79. 80. Relaxation of Treatment towards the end of the third
period--Continuation of Packs during and after
Desquamation 57
81. Treatment of _torpid Forms_ of scarlatina--Difference
in the Treatment pointed out 58
82. Length of Pack 59
83. Cold Affusions and Rubbing 59
84. Ice-Water and Snow-Bath in malignant cases 59
85. Wine and Water, &c., if no reaction can be obtained 60
86. Ablutions and Rubbing with Iced-Water or Snow 61
87. Wet Compress 61
88. Ventilation all-important 61
89. Continuation of Packs--Convalescence 62
90. Mineral Acids, in case of severe sore Throat 62
91. Putrid Symptoms--Gargle--Solution of Chloride of Soda--Drink:
Chlorate of potass--Liquor calcii chloridi 62
92. _Treatment of Affections of the Nervous Centres_ 63
93. 94. Sitz-bath, anchor of safety 64
95.-97. Cases 65-68
98. 99. Impossibility of answering for the issue of every
typhoid case 71
100. Is Water applicable in all typhoid cases? 71
101.-109. Rules for the application of water in typhoid cases 71-73
110.-112. Illustrations 73-78
PART THE THIRD.
113. _Treatment of other Eruptive Fevers_ 80
114. Small-Pox 80
115. Varioloids, and Chicken-pocks 82
116. Measles 82
117. Urticaria, Zoster, Rubeola 83
118. Erysipelas 83
119. Erythema 83
120. 121. Additional Rules for the Treatment of Eruptive
Diseases 83-84
122. _Conclusive Remarks_--Obstacles 84
123. Want of Water 84
124. Dripping Sheet, substitute for the Half-bath 84
125. Rubbing Sheet, substitute for the Half-bath 85
126. Where there is a will, there is a way 85
127. Prejudice of Physicians against the Water-Cure 86
128. Rebellion! 87
129.-130. Facts 87
131. More Facts! 89
132. Conclusion: Help yourselves, if your physicians will not
help you! 90
PART I.
DESCRIPTION OF SCARLET-FEVER.
1. SCARLET-FEVER, OR SCARLATINA,[1]
is an eruptive fever, produced by a peculiar contagious poison, and
distinguished by extreme heat, a rapid pulse, a severe affection of the
mucous membranes, especially those of the mouth and throat, and by a
burning scarlet eruption on the skin.
2. DIVISION OF THE PROCESS OF THE DISEASE INTO PERIODS.
Its course is commonly divided into four distinct periods, viz.: the
period of incubation, the period of eruption, the period of
efflorescence, and the period of desquamation; to which may be added:
the period of convalescence.
3. PERIOD OF INCUBATION, OR HATCHING.
The time which passes between the reception of the contagious poison
into the system and the appearance of the rash, is called the period of
incubation; incubation or incubus meaning, properly, the sitting of
birds on their nests, and figuratively, the hatching or concoction of
the poison within the body, until prepared for its elimination. There is
no certainty about the time necessary for that purpose, as the
contagion, after the patient has come in contact with it, may be
lurking a longer or a shorter time about his person, or in his clothes
and furniture.
As in almost all eruptive fevers, so in scarlatina, the patient begins
with complaining of shivering, pain in the thighs, lassitude, and
rapidly augmenting debility; frequently also of headache, which, when
severe, is accompanied with delirium, nausea and vomiting. The fever
soon becomes very high, the pulse increasing to upwards of 120 to 130
strokes in a minute, and more; the heat is extreme, raising the natural
temperature of the body from 98 to 110-112 degrees Fahrenheit, being
intenser internally than on the surface of the body. The patient
complains of severe pain in the throat, the organs of deglutition
located there becoming inflamed, and swelling to such a degree that
swallowing is extremely difficult, and even breathing is impeded. The
tongue is covered with a white creamy coat, through which the points of
the elongated papillae project. Gradually the white coat disappears,
commencing at the end and the edges of the organ, and leaves the same in
a clean, raw, inflamed state, looking much like a huge strawberry. This
is called the _strawberry tongue_ of scarlet-fever, and is one of the
characteristic symptoms of that disease. There is a peculiar smell about
the person of the patient, reminding one of salt fish, old cheese, or
the cages of a menagerie.
4. PERIOD OF ERUPTION, OR APPEARING OF THE RASH.
Commonly, on the second day, towards evening, sometimes on the third,
and only in very bad cases later, the rash begins to make its
appearance, under an increase of the above symptoms, especially of the
fever and delirium, and continues to come out for about twelve hours.
Usually the eruption commences in the face, on the throat and chest;
thence it spreads over the rest of the trunk, and finally it extends to
the extremities. The minute red points, which appear at first, soon
spread into large, flat, irregular patches, which again coalesce and
cover the greater part, if not the whole, of the surface, being densest
on the upper part of the body, particularly in front, in the face, on
the neck, the inner side of the arms, the loins, and the bend of the
joints. The scarlet color of the rash disappears under the pressure of
the finger, but reappears immediately on the latter being removed.
Sometimes the eruption takes place with a profuse warm sweat, which
prognosticates a mild course and a favorable issue of the disorder.
Together with the appearance of the rash, the disease develops itself
also more internally: the inflammation of the mouth and throat
increases; the tonsils and fauces swell to a high degree; the eyes
become suffused and sensitive to the light; the mucous membranes of the
nose and bronchia become also affected, the patient sneezes and coughs,
and all the symptoms denote the intense struggle, in which the whole
organism is engaged, to rid itself of the enemy which has taken
possession of it.
5. PERIOD OF EFFLORESCENCE, OR STANDING OUT OF THE RASH.
During the first day or two of the period of efflorescence, which lasts
three or four days, the above symptoms usually continue to increase.
Sometimes, however, the patient is alleviated at once on the rash being
formed. This alleviation always takes place when the rash comes with
perspiration, and also under a proper course of water-treatment. If the
rash continues to stand out steadily, the symptoms decrease on the third
day; the patient becomes more quiet, the pulse slower (going down to 90
and even to 80 strokes per minute); the rash, then, gradually and
steadily fades, and finally disappears altogether.--Sometimes the rash
fades or disappears too early, in which cases, usually, the internal
symptoms increase, the brain and spine become affected, and the
situation of the patient becomes critical.
6. PERIOD OF DESQUAMATION, OR PEELING-OFF.
About the sixth or seventh day, the epidermis, or cuticle of the skin
begins to peal off, commencing in those places which first became the
seat of the rash, and gradually continuing all over the body. In such
parts as are covered with a thin delicate cuticle (as the face, breast,
&c.) the cuticle comes off in small dry scurfs; in such parts as are
covered with a thicker epidermis, in large flakes. There have been
instances of almost complete gloves and slippers coming away from
patients' hands and feet.--The fever subsides entirely, and so does the
inflammation of the throat and mouth, which become moist again. Also the
epithelia, or the delicate cuticles of the mucous membranes, which have
been affected by the disease, peal off and are coughed up with the tough
thick mucus covering the throat, or they are evacuated with the faeces
and the urine, forming a sediment in the latter.--Desquamation is
usually completed in from three to five days; sometimes it requires a
longer time; under hydriatic treatment it seldom lasts more than a few
days. Whilst desquamation is taking place, a new cuticle forms itself,
which, being exceedingly thin at first, gives the patient a redder color
than usual for some time, and requires him to be cautious, in order to
prevent bad consequences from exposure.--
Thus the disease makes its regular course in about ten days, and, under
a course of hydriatic treatment, which not only assists the organism in
throwing off the morbid poison and keeps the patient in good condition,
but also protects him from the influence of the atmosphere, the patient
may consider himself out of danger and leave the sick-room under proper
caution, of which we shall speak hereafter.
7. THE PERIOD OF CONVALESCENCE,
under the usual drug-treatment, is, however, usually protracted to twice
or thrice the duration of the disease, the patient being compelled to
keep the house for five or six weeks, especially from fear of
_anasarca_, or dropsy of the skin, frequently extending to the inner
cavities of the body, and proving fatal. This dangerous complaint has
been more frequently observed after mild cases of scarlet-fever than
after malignant cases, probably from the fact that in mild cases the
patient is more apt to expose himself, than when the danger is more
obvious and all possible care is taken.--Sometimes also severe rheumatic
pain, or rather neuralgia, in the joints, swelling of the glands, and
other sequels prolong his sickness. I never observed a case of dropsy,
or of neuralgia, after a course of water-treatment.
8. VARIETIES OF FORMS OF SCARLATINA.
The above is the description of scarlet-fever, as it most frequently
occurs. But far from taking always that regular course, the constitution
of the patient, the intensity of the epidemy and the virulence of the
poison, the treatment and other circumstances influencing the
development of the disease, cause several anomalies, from scarlatina
simplex to scarlatina maligna, which too often baffles all the resources
of the Medical Art.
9. SCARLATINA SIMPLEX, OR SIMPLE SCARLET-FEVER.
In the _mildest form_ of the disease, called _scarlatina simplex_, or
_simple scarlet-fever_, there is no inflammation of the throat, the
fever is moderate, and the patient suffers very little. Unfortunately
this form is so rare, that many experienced physicians never saw a case.
Probably, it was a case belonging to this class, which was mentioned a
number of years ago by one of the writers on Priessnitz's practice, when
a lady with scarlet-fever joined a dancing party at Graefenberg, a case
for reporting which the author[2] has been ridiculed by the opponents of
the Water-Cure, but which by no means belongs to impossibilities; for
scarlatina simplex having been declared by eminent physicians (not of
Priessnitz's school) to be "scarcely a disease,"[3] becoming fatal only
through the officiousness of the doctor,[4] and other physicians of note
recommending cold rooms and open air through the whole course of the
disease,[5] or at least towards the latter part of it;[6] I do not see
why a patient under water-treatment should not be safer in producing
perspiration by dancing than in sitting in a cold room or in walking in
the open street. The fact, of course, is unusual, and I do not exactly
recommend its practice, but it is not at all impossible, and ridiculing
the reporter of it shows either ignorance of the disease or a bad will
towards the new curative system, to which those are most opposed who
know the least of it.
10. SCARLATINA ANGINOSA, OR SORE-THROAT SCARLET-FEVER.
Wherever the _throat_ is affected, which is almost always the case, the
disease is called _scarlatina anginosa_, or _sore-throat scarlet-fever_.
This is the form described at the commencement of this article. There
are several varieties, however, of scarlatina anginosa.
In any case, the organism, invaded by the contagious poison, will try to
rid itself of its enemy. The reaction is necessarily in proportion to
the violence of the miasma and to the quantity of organic power
struggling against it.
11. MILD REACTION (ERETHIC).
If the poison is not virulent, and the body of the patient in a
favorable condition, the _reaction_ is _mild_, and the poison is
eliminated without any violent efforts on the part of the organism. This
is the case in scarlatina simplex, and in mild forms of scarlatina
anginosa.
12. VIOLENT REACTION (STHENIC).
If both, the contagious poison and the organism, are very strong, a
_violent reaction_ will take place, and the safety of the patient will
be endangered by the very violence of the struggle, by which internal
organs may be more or less affected.
13. TORPID REACTION (ASTHENIC).
The more violent the contagious poison, and the weaker the organic
power, the less decidedly and the less successfully will the organism
combat against the poison, and the more inroad will the latter make upon
the system, affecting vital organs and paralyzing the efforts of the
nervous system by attacking it in its centres. In such cases of _torpid
reaction_, the patient frequently passes at once into a _typhoid state_.
This is what we call _scarlatina maligna_, or _malignant scarlet-fever_.
14. SCARLATINA MILIARIS
Sometimes the red patches of the rash are covered with small vesicles of
the size of mustard-seed, which either dry up or discharge a watery
liquid, leaving thin white scurfs, that come away with the cuticle
during desquamation. Although this form, called _scarlatina miliaris_,
being the result of exudation from the capillary vessels, shows an
intensely inflamed state of the skin, its course is usually mild and its
issue favorable; because the morbid poison comes readily to the
surface.
15. SCARLATINA SINE EXANTHEMATE.
There are also mild cases of scarlet-fever, when little or no rash
appears, and the throat is very little affected. These are the result of
a particularly mild character of the epidemy, together with a peculiar
condition of the skin, the desquamation of which shows that the poison
went to the surface without producing the usual state of inflammation,
or the rash peculiar to the disease. This form, called _scarlatina sine
exanthemate_, is extremely rare.
16. THE MALIGNANT FORMS OF SCARLET-FEVER
are caused by the character of the epidemy, but, perhaps, more
frequently by the weak and sickly constitution of the patient and the
external circumstances affecting it. Thus, persons of scrofulous habit,
being naturally of a low organization, without much power of resistance,
are much more liable to experience the destructive effects of scarlatina
than those whose organism possesses sufficient energy to resist the
action of the morbid poison, and to expel it before it can do any
serious harm inside the body.
17. SUDDEN INVASION OF THE NERVOUS CENTRES.
Of the different forms of scarlatina maligna the most dangerous is the
sudden invasion of the nervous system, particularly the _brain_, the
_cerebellum_ and the _spine_, by which the patient's life is sometimes
extinguished in a few hours. In other cases the symptoms deepen more
gradually, and death ensues on the third, fifth or seventh day.
18. AFFECTION OF THE BRAIN.
When the _brain_ is affected, the patient suddenly complains of violent
headache, vomits repeatedly, loses his eye-sight, has furious delirium,
or coma (a state of sleep from which it is difficult to rouse the
patient); his pupils dilate; the pulse becomes small, intermits;
sometimes the skin becomes cold; there is dyspnoea (difficulty of
breathing), fainting, paralysis, convulsions, and finally death; or,
sometimes, the paroxysm passes suddenly by with bleeding from the nose
or with a profuse perspiration.
19. AFFECTION OF THE CEREBELLUM AND SPINE.
In affections of the _cerebellum_ and _spinal marrow_, the patient
complains of violent pain in the back of the head and neck, in the
spine, and frequently in the whole body. These also frequently terminate
with the destruction of life.
20. During all these invasions of the nervous centres there is little or
no rash, and what appears is of a pale, livid hue.
21. PUTRID SYMPTOMS.
Next to those most dangerous forms--most dangerous, because the organic
power (the _vis medicatrix naturae_), from which the restoration of
health must be expected, and without which no physician can remove the
slightest symptom of disease, becomes partly paralyzed from the
beginning--_putrid symptoms_ present a good deal of danger, although
they give the organism and the physician more time to act.
22. CONDITION OF THE THROAT, AND OTHER INTERNAL ORGANS.
The condition of the _throat_ requires the most constant attention. From
a highly inflamed state, it often passes into a foul and sloughy
condition; the breath of the patient becomes extremely fetid; the
nostrils, the parotid and submaxillary glands swell enormously, so that
swallowing and breathing become very difficult. There is an acrid
discharge from the nose; the gangrenous matter affects the alimentary
canal, causing pain in the stomach, the bowels, the kidneys and the
bladder; a smarting diarrhoea with excoriation of the anus, and
inflammatory symptoms of the vulva. Also the bronchia, lungs, pleura and
pericardium become affected, as sneezing, cough (the so-called
scarlet-cough) and the pain across the chest and in the region of the
heart indicate.
23. OTHER BAD SYMPTOMS.
These symptoms may present themselves with the rash standing out; but
most frequently they occur when there is little or no eruption, or when
it fades, becomes livid, or disappears altogether. A sudden
disappearance of the rash, before the sixth day, commonly increases the
typhoid symptoms, and must be considered a bad omen. Also the invasion
of the larynx, which is happily of rare occurrence, is commonly fatal.
24. DESTRUCTION OF THE ORGAN OF HEARING.
When the glands pass into a sloughing state, the parts connected with
them are frequently damaged. Thus the ulceration of the parotid gland
often causes deafness, by the gangrenous matter communicating to the
eustachian tube and the inner ear, where it destroys the membrane of the
drum and the little bones belonging thereto, or by closing up the tube.
When the discharge from the outer ear is observed, the destruction has
already taken place, and it is too late to obviate the injury.
25. OTHER SEQUELS, DROPSY, &C.
Beside the ulceration of glands and deafness, some of the sequels of
scarlatina are white swelling of one or more of the joints, usually the
knee, chronic inflammation of the eyes and eyelids, and partial
paralysis. These chiefly occur in scrofulous subjects. Dropsy, which I
have mentioned before, is one of the sequels that frequently prove
fatal.
26. THE CONTAGION OF SCARLATINA VERY ACTIVE.
The _contagion_ of scarlatina is very active, and adheres for a long
time to the sick-room, bedding, clothes and furniture. The best means to
destroy it, is plenty of air. It is difficult to say when the contagion
is over, as much depends on the season of the year and the care with
which the house is aired. Physicians and visitors at the sick-room are
very apt to carry it about, unless they be exceedingly careful in
changing their clothes and washing themselves, hair and all, before
entering other rooms inhabited by persons who had not had the disorder
before. It is astonishing how easily such persons are taken by it; and
it even sometimes happens that such as have gone through it, take it
again in after years. I am authorized by experience, that the idea as if
patients under water-treatment, or even such as take a cold bath every
morning, were inaccessible to the contagion, is erroneous. I have had
patients under treatment for chronic diseases, who had had scarlatina
several years before, and neither this nor the water-cure protected them
from taking it again. With some of them, however, the throat only became
affected and no desquamation took place, whilst the character of the
complaint with the rest was rather mild. I have been astonished to read
that in a meeting of a medical society of this country, which took place
a very short time ago, some members could have raised the question
whether scarlatina was really contagious. I admit that the profession in
general has not made great progress in the cure of the complaint, but it
does not require great study and long experience to know that
scarlet-fever is contagious!
27. The form of the disorder in one patient does not imply the
necessity of another who caught it from him having it in the same form.
A person can take the contagion from one who dies of malignant
scarlet-fever and have it in the mildest form, and vice versa. The
character of the disease depends very much on the constitution, as I
have said above. However, if the epidemy in general is of a malignant
character (which may again depend, partly at least, on the constitution
of the atmosphere), it will prove so in many individuals who are taken
with it, and the precautions ought to be so much the more careful on
that account.
28. DIAGNOSIS.
After what has been said about the symptoms of scarlatina, it cannot be
difficult to distinguish it from similar eruptive diseases. However, as
there is much resemblance between _scarlatina_ and _measles_, at least
in the milder form of the former, I shall give a few symptoms of each,
to assist parents in making the distinction.
29. DIAGNOSIS FROM MEASLES.
In scarlatina the heat is much greater, and the pulse is much quicker
than in measles.--In scarlatina the throat is inflamed, usually the
brain affected, and the patient smells like salt-fish, old cheese or the
cages of a menagerie; in measles, the eyes are affected, inflamed, and
incapable of bearing the light; the organs of respiration likewise
(thence coryza, sneezing, hoarseness, cough); the perspiration smells
like the feathers of geese freshly plucked.--In scarlatina the period of
incubation is a day less than in measles; namely, in scarlatina the rash
appears on the second day after the first symptoms, in measles on the
third.--The scarlet-rash consists of large, irregular, _flat_ patches,
which cover large spaces with a uniform scarlet-red, being brightest in
those parts which are usually covered by the garments of the patient;
in measles the spots are small, roundish or half-moon-like, with little
grains upon them, and usually of a darker color; the measle-rash is
thickest in such parts as are exposed to the air.--In scarlatina the
symptoms of fever and the affection of the mucous membranes continue two
days after the eruption has begun to make its appearance; in measles the
eruption diminishes those symptoms at once.--The scarlet-rash stands out
a day or two less than the measle-rash, and comes off in laminae, whilst
the latter comes off in small scales or scurfs.
30. THE PROGNOSIS,
under a well conducted course of hydriatic treatment is, in general,
favorable. Much depends, however, on the season of the year (in damp and
cold weather--partly owing to a lack of pure air in the sick-room--the
disease is more dangerous than in summer); on the general health of the
patient (not on his mere looks, for well-fed and stout children are
subject to affections of the brain); on the age of the patient (adults
are generally more in danger than children); on the form of the disease
and the character of the fever (erethic or mild fever being the most
favorable, whilst typhoid fever is the worst; a violent character of the
fever is not very dangerous under hydriatic treatment, as we have plenty
of means to limit its ravages without weakening the patient); on the
eruption, the condition of the throat, the process of desquamation, &c.
31. FAVORABLE SYMPTOMS
are the following: Absence of internal inflammation; a bright florid
rash; a regular, steady appearance, standing out, and disappearance of
the latter; a regular and complete pealing off of the cuticle; a
decrease of the pulse after the eruption of the rash; an easy and
regular respiration; a natural expression of the features; a moist
skin.
32. UNFAVORABLE SYMPTOMS
are: A fetid breath, with ulceration and sloughing of the throat and
glands; a smarting and weakening diarrhoea; involuntary evacuations of
the bowels; dizziness, deafness, coma, grinding of the teeth; retention
of urine; petechiae; a rapid decline of the patient's strength; a quick,
small, weak pulse; rapid breathing; twitchings, tetanus, hiccough,
&c.--Closing up of the nose frequently precedes a dangerous affection of
the brain. A sudden disappearance of the rash, or of the inflammation of
the throat, is a bad omen. With such symptoms as these, there is usually
little or no rash, and the little there is, of a pale, livid color, and
the skin, in general, inactive.
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.