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, Alcock,
Dewees, Dawson, Dewar, Hammond, &c., would not have pronounced
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 assume 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 quantity 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 practitioners. 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 quantities 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 CARBONICUM,
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 Aurelianus,[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 practitioners 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 asserted, and even Richter
restricts his commendations to the vague assertion "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 homoeopathic doses, being afraid of
the bad consequences of larger quantities 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 classes of physicians, assert 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 Froehlichsthal,[28] and others, have treated their
scarlet-patients with _cold affusions_. Henke, Raimann, Froehlich,
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 mass 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, diaphoretic,
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 passes 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.
47. A few minutes before the perspiration breaks out, the patient
becomes slightly irritated, which irritation is removed by the
appearance of the sweat. I mention this circumstance, to prevent his
being taken out just before the perspiration is started. When he becomes
restless _during perspiration_, he is taken from his pack and placed in
a bathing-tub partly filled with cool or tepid water, (usually of about
70 deg.,) which has been prepared in the meanwhile; there he is washed down
from head to foot, water from the bath being constantly thrown over him
until he becomes cool. Then he is wrapped in a dry sheet, gently rubbed
dry, and either taken back to his bed, or dressed and allowed to walk
about the room. When the fever and heat rise again, the same process is
repeated.
48. ACTION OF THE PACK AND BATH.--RATIONALE.
The action of the wet-sheet pack is thus easily accounted for:
According to a well-known physical law, any cold body, whether dead or
alive, placed in close contact with a warm body, will abstract from the
latter as much heat as necessary to equalize the temperature of both.
The transfer of caloric will begin at the place at which the two bodies
are nearest to each other. The wet sheet, which touches the patient's
body all over the surface, abstracts heat from the latter, till the
temperature of the sheet becomes equal to that of the body. In
proportion as the surface of the body yields heat to the sheet, the
parts next to the surface impart heat to the latter, and so forth, till
the whole body becomes cooler, whilst the sheet becomes warmer. As the
heat imparted to the sheet cannot escape from it, the sheet being
closely wrapt up in the blanket and bed, the current of caloric once
established towards every part of the surface of the body will still
continue; after the temperature of the sheet and the body has become
equal, there will be an accumulation of heat around the body, frequently
of a higher degree than the body itself. To explain this phenomenon, we
ought to consider that we have not to do with _two dead_ bodies, but
with _one dead_ and _one living_ body, which constantly creates heat,
thus continuously supplying the heat escaping from it to the sheet, and
keeping up the current of caloric _and electricity_ established towards
the surface. There cannot be a doubt that the abstraction of electricity
from the feverish organism contributes in a great measure to the relief
of the excited nerves of the patient, as well as to the excess of
temperature observed around the body in the wet-sheet pack (after the
patient has been in it for some time); and that, in general, electricity
deserves a closer investigation in the morbid phenomena of the human
body than it has found to this day.
49. WHAT EFFECT COULD BE EXPECTED FROM A WARM WET-SHEET?
The first impression of the wet-sheet is, as I stated before, a
_disagreeable_ one. If it were _agreeable_--as a warm sheet, for
instance, would be, which has been occasionally tried, of course without
doing any good--_it would not produce a reaction at all, and
consequently there would be no relief for, and finally no cure of the
patient effected by it_. But the impression of the cold sheet, being
powerful, is transferred at once from the peripherical nerves, which
receive the shock, to the nervous centres (the spine, the cerebellum and
the brain), and, in fact, to the whole nervous system, and the reaction
is almost immediate; the vascular system, participating in it, sends the
blood from the larger vessels and the vital parts, to the capillaries of
the skin; and when, through repeated applications of the sheet, the
system is relieved and harmony restored, in a sufficient degree, in and
among the different parts of the organism, to enable them to resume
their partly impeded functions, a profuse perspiration brings the
struggle to a close, by removing the morbid matter which caused the
fever, whereupon the skin is refreshed and strengthened, and the whole
body cooled and protected by a cool bath from obnoxious atmospheric
influences.
50. I am not aware that a better rationale can be given of the action of
other remedies. Any physician can understand that its effect must be at
once powerful and safe, and that there is no risk in the wet-sheet pack
of the reaction not taking place, as it may be the case in severer
applications of cold water, without the pack. One objection I have often
heard, viz.: that the process is very troublesome. But what does trouble
signify, when the life and health of a fellow-being is at stake?--It is
true, the physician is frequently compelled to render the services of a
bath-attendant, and stay with the patient much longer than in the usual
practice; but he gets through sooner, and, if not the patient and his
friends, his own conscience will pay him for his exertions and sacrifice
of time.
There is little trouble with small children, who make a fuss only, and
become refractory, when the parents, grandmammas and aunts set the
example. When all remain quiet, and treat the whole proceeding as a
matter of necessity, children usually submit to it very patiently, and
soon become quiet, should they be excited at the beginning. The fewer
words are said, and the quicker and firmer the physician performs the
whole process, the less there is trouble. After having been taught how
to do it, the parents or friends of the patient will be able to take the
most troublesome part of the business off the physician's hands, who, of
course, has more necessary things to do, during an epidemic, than to
pack his patients and attend to them in all their baths himself.
Only with spoiled children I have had trouble, and more with them that
spoiled them. The best course, then, is to retain only one person for
assistance, and to send the rest away till all is over. There are
people, who _will_ be unreasonable; of course, it is no use to attempt
reasoning with them. I remember the grandmother of a little patient,
with whom the pack acted like a miracle, removing a severe inflammatory
fever in two hours and a half, telling me "she would rather see the
child die, than have her packed again," although she acknowledged the
pack to have been the means of her speedy recovery. It is true there was
some trouble with the child, but only because the whole family were
assembled in the sick-room to excite the child through their
unseasonable lamentations and expressions of sympathy about the
"dreadful" treatment to which she was going to be submitted. Grandmother
would not have objected to a pound of calomel!--But we shall speak
about objections and difficulties in a more proper place.
51. NO CUTTING SHORT OF THE PROCESS OF SCARLATINA--THE MORBID POISON
MUST BE DRAWN TO THE SKIN AS SOON AS POSSIBLE.
Scarlet-fever is a disease, which cannot be cut short. Any attempt to
stop the process of incubation, after the contagion has once been
received within the body, or to prevent its being thrown out upon the
surface, would destroy the patient's life: the morbid poison must be
concocted, and it _must come away by being drawn to the skin as soon as
possible_, to prevent its settling in the vital parts, and injuring
them. The safest way of assisting nature in her efforts of eliminating
the poison, is to open the way, which she points out herself. We know
that the sooner and the more completely the eruption makes its
appearance, the brighter and the more constant the rash, the less there
is danger for the patient, and _vice versa_. Well, there is not a better
remedy than the wet-sheet pack, to serve the purpose of nature, i. e.,
to remove the morbid poison from the inner organs, and draw it to the
surface; whilst at the same time it allays the symptoms, improves the
condition of the skin for the development of the rash, and relieves the
patient, without depriving him of any part of that organic power so
indispensable for a cure, and without which the best physician in the
world becomes a mere blank. Under the process of wet-sheet packing, the
heat invariably abates, the pulse becomes slower and softer, the
violence of the symptoms is alleviated, the skin becomes moist, the
restlessness and anxiety of the patient give way to a more quiet and
comfortable condition; he perspires and falls in a refreshing sleep. Is
there any other remedy, that has the same general and beneficial effect?
I know of none.
52. NECESSITY OF VENTILATION--MEANS OF HEATING THE SICK-ROOM--RELATIVE
MERITS OF OPEN FIRES, STOVES AND FURNACES.
Next to its intrinsic value, our method gives the patient the great
advantage of enjoying _pure fresh air_, either in or out of bed, as it
keeps the skin and the whole system in such order as to resist the
effects of atmospheric influences better than under a weakening process.
And every body knows, or, at least, every body ought to know, that free
circulation of fresh air is one of the most important means, in
contagious diseases, of preventing the malady from becoming malignant,
and of lessening the intensity of the contagion. Although the times are
passed, when patients in the heat of fever were almost roasted in their
beds, whilst a drink of cooling water was cruelly and stupidly denied
them; the temperature of the sick-room is, in general, still kept too
high, and not sufficient care is taken to renew the air as frequently, I
ought to say as constantly, as necessary for the benefit of the patient.
Usually there is no ventilation; very seldom a window is opened,
especially in the cold season, when epidemics of scarlatina are most
common, and commonly the room is crowded with friends of the patient,
who devour the good air, which belongs to him by right, and leave him
their exhalations to breathe instead. There is nothing better able to
destroy contagious poisons than oxygen and cold; and if we consider that
every human being absorbs every minute a volume of air larger than the
bulk of its own body, we must understand how necessary it is to keep
people away from the sick-room, who are not indispensably necessary to
the patient, and to provide for a constant supply of fresh air. But
whatever may be the arrangement for that purpose, the patient should not
be exposed to a draught. Stoves and fire-places are pretty good
ventilators for drawing off the bad air from the room; if you take care
not to have too much fire, and to allow a current of pure air to enter
at a corresponding place, the top of a window, or a ventilator in the
wall opposite the fire-place, there will always be pure air in your
sick-room. The air coming from furnaces, which unfortunately have become
so general, is good for nothing, especially when taken from the worst
place in the house, the cellar or basement. I consider the worst kind of
stoves better than the best kind of furnaces; only take care not to heat
the stove too much, or to exclude the outer air, which is indispensable
to supply the air drawn off by the stove for feeding the fire. The
difference between a furnace and a tight stove or fire-place is this:
The furnace takes the bad air from the basement or cellar, frequently
made still poorer through its passing over red hot iron, which absorbs
part of its oxygen, and fills the room with it. The room being filled
with poor air, none of the pure air outside will enter it, because there
is no vacuum. Thus the bad air introduced into the room, and the bad air
created by the persons in it, will be the only supply for the lungs of
the patients. But should the furnace take its air from outside the
house, as it is the case with some improved kinds, there would still be
no ventilation in the sick-room, except there be a fire-place beside the
register of the furnace. With the stove or fire-place it is different:
The stove continually draws off the lower strata, i. e. the worst part,
of the air to feed the fire, whilst pure air will rush in through every
crevice of the doors and windows to supply every cubic-inch of air
absorbed by the stove. Thus the air in the room is constantly renewed,
the bad air being carried off and good air being introduced. However,
the openings through which the pure air comes in, must be large enough
in proportion to allow a sufficient quantity of air to enter the room to
make fully up for the air absorbed by the stove; for, if not, the air
in the room will become thin and poor, and the patient will suffer from
want of oxygen. An open fire, from the necessity of its burning brighter
and larger to supply sufficient heat, a comparatively large part of
which goes off through the chimney, will require a greater supply of
air, and consequently larger ventilators or openings for the entrance of
the pure air from outside the room. In very cold weather, and in cold
climates in general, stoves are preferable to fire-places, the latter
producing a draught, and not being able to heat a room thoroughly and
equally, causing one side of the persons sitting near them to be almost
roasted by the radiant heat in front, whilst their backs are kept cold
by the air drawing from the openings in the doors and windows towards
the fire to supply the latter. In merely cool weather, and in moderately
cold climates, especially in damp places, I would prefer an open fire to
a stove. In cold climates stoves are decidedly preferable, especially
earthen ones, as they are used in Germany and Russia. Iron stoves must
never be heated too much, as the red hot iron will spoil the air of the
room, by absorbing the oxygen, as you can easily see by noticing the
sparks, which form themselves outside the stove in very hot places.
53. TEMPERATURE OF THE SICK-ROOM.
The _temperature of the sick-room_ should not be much above 65 deg.
Fahrenheit; in no case should it rise above 70, whilst I do not see the
necessity of keeping it below 60, as some hydriatic physicians
advise.[31] The patient, in the heat of fever, will think 60 deg. high
enough, and rather pleasant; and if others do not like a temperature as
low as that, they may retire. The person necessary for nursing the
patient may dress warmly and sit near the fire. Let the sick-room be as
large as possible; or open the door and windows of a room connected with
it. Towards the close of the disease, after desquamation has begun, the
temperature of the room may be kept at 70 deg., as then the fever and heat
have subsided and the delicate skin of the patient requires a
comfortable temperature.
54. WATER-DRINKING.
As the patient should have a constant supply of pure air for his lungs,
so he should also have _plenty of pure cold water_ for his stomach, to
allay his thirst and assist in diminishing the heat of fever, and in
eliminating the morbid poison from his blood. Though cold, the water for
drinking should not be less than 48 or 50 deg. Fahrenheit. Whenever there is
ice used for cooling the water, the nurses should be very careful not to
let it become colder, than the temperature just indicated, except in
typhoid cases, when the stimulating effects of icy cold water and ice
may prove beneficial.
55. DIET
I have little to say with regard to _diet_, at least to physicians.
During great heat and high fever, the patient should eat little or
nothing; but he should drink a good deal. Substantial food must be
avoided entirely. When the fever abates, he can take more nourishment,
but it should be light. Meat and soup should only be given, when
desquamation has fairly begun. Stewed fruit (especially dried apples)
will be very agreeable to the patient. In great heat, a glass of
lemonade may be given occasionally; however, great care must be taken
not to spoil the patient's taste by sweets, or to allow him all sorts of
dainties, such as candies, preserves, &c., as it is the habit of weak
parents, who like to gratify their darlings' momentary desires at the
expense of their future welfare. In torpid cases, some beef-tea,
chicken-broth, and even a little wine with water, will raise the
reactive powers of the patient. During convalescence, meat may be
permitted to such patients as have been accustomed to eat it, and, in
general, the patients may be allowed to gradually resume their former
diet (provided it were a healthy one), with some restriction in regard
to quantity. In general, under water-treatment, the digestive organs
continuing in a tolerably good state, and the functions in better order,
we need not be quite so careful with respect to diet, as if the patient
were left to himself, or treated after any other method of the
drug-system. Let the food be plain, and the patient will scarcely ever
eat too much. To stimulate his appetite by constantly asking him whether
he would not like this or that, is sheer nonsense; and to satisfy his
whims, against our better conviction, is culpable weakness.
From this general outline, I shall now pass to the treatment adapted to
the different forms of scarlatina.
56. TREATMENT OF SCARLATINA SIMPLEX, OR SIMPLE SCARLET-FEVER.
_Scarlatina simplex_, or _simple scarlet-fever_ (9), without
inflammation of the throat, is generally so mild in its course, that it
requires little or no treatment. However, I would not have parents look
upon it as "scarcely a disease," as neglect and exposure may bring on
bad consequences (7 and 25). If the fever and heat are very moderate,
the first days an ablution of the body with cool water (say 70 deg.), twice
a day, is sufficient. The patient had better be kept in bed, or, if
unwilling to stay there, he should be warmly dressed and move about his
room, the temperature of which, in this case, should not be below 70 deg.
Fahrenheit, and the windows should be shut, as long as the patient is
out of bed.
When the period of efflorescence, or standing out of the rash, is over,
packs ought to be given, to extract the poison completely from the
system, and to prevent any sequels, such as anasarca, &c. (25). Should
the rash suddenly disappear before the fifth or sixth day, or should it
linger in coming out, a long pack will bring it out and remove all
danger. The packs, once begun, should be continued, once a day, during
and a few days after desquamation. The patient may go out on the tenth
or twelfth day warmly dressed, after his pack and bath, and walk for
half an hour; sitting down or standing still to talk in the open air is
not to be permitted. During, and some time after convalescence, the
patient should take a cool bath, or a cold ablution every morning,
immediately on rising from bed, and walk after it as soon as he is
dressed. In very cold and disagreeable weather, the walk should be taken
in the house; but the patient should not sit down, or stand about,
before circulation and warmth are completely restored in every part of
the body, especially in the feet. I cannot insist too much upon exercise
being taken immediately after every bath, as, without it, the bath may
do more harm than good, and dressing, with many, will take so much time,
that they will take cold before getting their clothes on.
If the patient should take cold, or feel otherwise unwell, during
convalescence, the packs must be resorted to again, and continued till
he is quite well.
57. TREATMENT OF SCARLATINA ANGINOSA, OR SORE-THROAT SCARLET-FEVER.
In _scarlatina anginosa_, or _sore-throat scarlet-fever_, which is the
most common form of the disease (1-7) we have to discriminate, whether
1) the _reaction is mild_, the heat of the body not being much above
100 deg. Fahr. and the pulse full, but not above 110 to 120, the pain and
swelling of the throat moderate, the brain little or not affected; or
2) _violent_, the heat from 106 to 112, the pulse 120 to 150 beats or
more, the inflammation of the throat decided and extensive, the brain
very much affected; or
3) _torpid_, little or no heat, the pulse quick and weak, the
inflammation of the throat undecided, varying, the rash appearing slowly
or not at all, and what there appears of a pale, livid color, the
patient more or less delirious.
58.--1. TREATMENT OF THE MILD OR ERETHIC FORM OF SCARLATINA ANGINOSA.
The _mild_ or _erethic form_ of scarlatina anginosa requires about the
same treatment as scarlatina simplex. I would, however, for the sake of
safety, advise a pack and bath per day, through the whole course of the
disease, in the afternoon, when the fever begins to rise; and during the
period of eruption, when all the symptoms increase, two and even three
packs a day may be required. This depends on the increasing heat and
fever, as well as on the condition of the throat. The greater the heat
and fever, and the more troublesome the inflammation, the more packs. If
the fever and pain increase some time after the pack, in which the
patient may stay for an hour or two, the packing must be repeated. The
length of the pack depends much on circumstances; as long as the patient
feels comfortable and can be kept in it, without too much trouble, he
ought to stay. In case the patient cannot be prevailed upon to stay
longer than an hour, or if the fever increases soon after the pack, it
may be necessary to repeat packing every three or four hours, which is
the general practice of several water-physicians in Germany and England.
59. If the patient becomes restless soon after having been packed, the
heat and fever increasing, as may be ascertained from the pulse at the
temples and the general appearance of the face, the sheet must be
changed, as directed above (46) till the patient becomes quiet and feels
more comfortable. In case of repeated changing of sheet, the patient
should stay in the last sheet, till he has perspired about half an hour,
or longer, before he is taken out to the bath, which should be of about
70 deg., as in all the mild forms of scarlatina. The length of the bath
depends on the heat, and reaction of the patient, who should be well
cooled down all over, before going to bed again or dressing. He ought
not to be out of bed for a long time, and only after a bath, as this
will protect him from taking cold.
60. The throat should be covered with a wet compress, i. e. a piece of
linen four to eightfold, according to its original thickness, dipped in
cold water (60 deg.-50 deg.), well wrung out and changed as often as it grows
hot. It should be well covered to exclude the air. This compress should
be large enough to cover the whole of the throat and part of the chest;
it should closely fit to the jaw, and reach as far up as the ear to
protect the submaxillary and parotid glands located there.
61. When the period of eruption is over, there is commonly less fever,
and the packs and baths may be diminished.
62. Towards the end of the period of efflorescence, when the rash
declines, fades, disappears, and the skin begins to peal off, an
ablution in the morning of cool water, with which some vinegar _may_ be
mixed, and a pack and bath in the afternoon, are quite sufficient,
except the throat continue troublesome, when a pack should also be given
in the morning. The packs, once a day, should be continued about a week
after desquamation. The patient may safely leave the house in a
fortnight. I have frequently had my patients out of doors in ten or
twelve days, even in winter.[32]
63. This going out so early, in bad weather, is by no means part of the
treatment. I mention it only to show the curative and protective power
of the latter, and have not the slightest objection to others using a
little more caution than I find necessary myself. It is always better,
we should keep on the safe side, especially when there is no one near
that has sufficient experience in the matter. I can assure my readers
upon my word and honor, that though I never kept any of my
scarlet-patients longer in-doors than three weeks (except a couple of
malignant cases), I have never seen the slightest trouble resulting from
my practice.
64. In case of some trouble resulting from early and imprudent exposure,
which is about as apt to occur in the house as out of it, a pack or two
will usually be sufficient to restore order again. As long as the
patient moves about, warmly dressed, there is no danger of his taking
cold after a pack, and provided packing be continued long enough, and
the patient be forbidden to sit down or stand still in cool places, or
expose himself to a draught, there is nothing to be apprehended.
65. I have no objection to homoeopathic remedies being used at the
same time, nor would I consider acids, as mentioned above (39, note), to
be objectionable in cases of severe sore throat; but I must caution my
readers against the use of any other remedies, especially aperients,
except in cases, which I shall mention hereafter (72). In a couple of
cases, where I acted as consulting physician, I have observed dropsical
symptoms proceeding from laxatives and the early discontinuation of the
packs during convalescence. Let the bowels alone as long as you can:
there is more danger in irritating them than in a little constipation.
As for the rest we have injections, which will do the business without
drugs, of which I confess I am no friend, especially in eruptive fevers.
66.--2. TREATMENT OF THE VIOLENT, OR STHENIC FORM OF SCARLATINA
ANGINOSA.
The _violent_, or _sthenic form_ of scarlatina anginosa becomes
dangerous only through the excess of reaction, when the heat is extreme
(upwards of 105 deg. Fahrenheit, sometimes 112 to 114), the pulse can
scarcely be counted, as it hammers away full and hard in a raging
manner, the throat being inflamed and swollen to suffocation, and the
patient in a high state of delirium; but it need not frighten the
physician or parent acquainted with the use of water. We have the means
of subduing that violence without weakening the patient. It is in this
form of scarlatina that the greatest mistakes are committed by
physicians unacquainted with the virtues of water, and that our
hydriatic method shows itself in all its glory; for where there is an
abundance of heat, water cannot only be safely applied, but it is also
sure to bring relief. It is in this form of the disease that the cold
affusions recommended by Currie and his followers, have shown themselves
so beneficial, and that the wet-sheet, used properly and perseveringly,
is almost infallible.
67. TEMPERATURE OF THE WATER--DOUBLE SHEET--CHANGING SHEET.
The water for the wet-sheet pack, in this violent form, ought to be
cold; in summer it should be iced down to 46-48 deg. Fahr. The sheet ought
to be coarse or doubled, in order that it should retain more water, and
it should not be wrung out very tight. In a thick wet-sheet the patient
will be better cooled than in a thin sheet, and he will be able to stay
longer in it before changing. It may be advisable, however, with very
young and rather delicate persons, not to double the sheet about the
feet, as they might be apt to remain cold, which would send the blood
more to the head. But, although the patient will feel easier in the pack
for a while, the heat and fever will soon increase again, and, in
proportion as the sheet grows warmer, he will become more and more
restless, and the changing of the sheet will become indispensable. When
the symptoms increase again, in the second pack, the sheet is changed a
second time, and so on till the patient perspires and becomes relieved
for a couple of hours or longer; which usually happens in the third or
fourth sheet. After the first, every following sheet is wrung out
tighter and tighter, and the last one may be taken single, or doubled
only at its upper end.
68. LENGTH OF PACK--PERSPIRATION.
To make quite sure of the reaction, the single sheet may be tried first,
except in exceedingly violent cases, and the double sheet may be
resorted to, if the single sheet prove inefficient. Or, should there be
any doubt, the double sheet may be dipped in water of a higher
temperature than that given above, say 55 to 60 deg.. With young and
delicate children I prefer this course, especially if they be very
excitable, and the shock of very cold water may be expected to be too
much for their nerves. In these matters some discrimination should be
used: it is always better we should keep on the safe side, and rather
give a pack more than frighten the little patients out of their wits.
Proceed safely, but firmly and try to obtain your object in the mildest
manner possible.
69. Before perspiration comes on, there is a little more excitement for
a few minutes (41), which must not induce the friends of the patient to
take him out of the pack; only when it continues to increase, instead of
the perspiration breaking out and relieving the patient, it will be
necessary to change the sheet, another time, as in that case the
organism is not fully prepared for perspiration. After the breaking out
of the latter, the patient invariably feels easier, and continues so for
some time. When the feverish symptoms increase, during perspiration,
which can be ascertained by feeling the pulse on the temples and by the
thermometer, it is time to remove the patient from the pack, to give him
his bath. Half an hour's perspiration is commonly sufficient; if the
patient feel easy, however, and can be prevailed upon to stay an hour,
or longer, till a good thorough perspiration brings permanent relief, it
will be better. It would be unwise to let the patient stay too long and
get him in a state of over-excitement; but, on the other hand, parents
ought to remember that very few children _like_ to be packed, and that
a patient in high fever is a bad judge of his own case. I have always
found those children the best patients, who had been brought up in
strict obedience to their patients' dictates, before they were sick, and
this, as well as the daily habit of taking baths, and the quiet and firm
behavior of the physician and friends of the patient under treatment
generally remove all difficulty.
70. LENGTH OF BATH.
Although the temperature, in sthenic cases, should be a little lower
than in erethic cases, it is not advisable to use the water very cold,
as this would cause too strong a reaction, and consequently new
excitement. The safer way is to let the temperature of the bath be
between 70 and 65 deg., according to the age and constitution of the patient
(the younger and more delicate the patient, the higher the temperature),
and to let him stay long enough in the bath to become perfectly cool all
over, which can be ascertained by placing the hand or the thermometer
under the arm-pits, which usually retain the warmth longest. I
understand, in advising such a temperate bath of several minutes,
duration, that the patient be hot and the rash standing out full and
bright on coming from the pack; or else the bath must be colder and
shorter, not exceeding a minute or two.
71. CAUTION.
After the bath, the patient is rubbed dry, and either taken to his bed,
or, if he feels well enough, dressed and induced to walk about the room,
or placed in a snug corner (not near the fire, however), till he feels
tired and wishes to go to bed. During his stay out of bed, the rash
ought to be an object of constant attention for his friends; for as soon
as it becomes pale, the patient ought to be sent to bed immediately and
covered well, or should then the rash continue to become paler and
paler, the pack should be renewed, and the patient kept in bed ever
after, till desquamation is over.
72. THE WET COMPRESS.
In bed, a wet compress is put on the throat, and another on the stomach,
which, beside the direct influence it has on that organ, acts as a
derivative upon the throat and head, and as a diaphoretic upon the skin,
assisting in allaying the fever and heat. This compress on the stomach
is an excellent remedy with small children and infants in a restless,
feverish condition. I often use it, even with infants scarce a week old,
and always with perfect success. I wish, mothers could be made to
substitute it for paregoric and the like stupefying stuff, to procure
their crying infants relief and themselves rest. There is more power in
the compress than any one who is not familiar with its use, can imagine.
At the same time it has a very good effect on the bowels, which should
be kept regular, either with the assistance of tepid injections, or, if
they fail to operate, with a moderate dose of castor oil. If possible,
however, avoid the irritation of the digestive apparatus through
medicines, which are apt to counteract the external applications, whose
object is to draw the morbid poison as early and as completely as
possible to the skin.
73. HIGHLY INFLAMED THROAT--CROUP.
If the _throat_ is in a highly inflamed condition, repeated packing is
the surest means of allaying the inflammation and preventing _croup_.
Although I have had very bad cases under my hands, I never saw a case of
scarlet-croup under water-treatment. All you have to do is, to pack your
patient early enough and often enough to keep the inflammation down, to
keep a wet compress on his throat and chest, and, in general, treat him
as I have prescribed. The condition of the throat will improve in
proportion to your perseverance in packing.
74. NECESSITY OF ALLAYING THE HEAT.
The packs and baths should be continued, even when the patient cannot be
prevailed upon to stay long enough in the packs to perspire. The heat of
the skin and the general inflammatory condition of the whole organism
_must_ be allayed, especially, when there is much _delirium_. In that
case, the patient ought to be kept long enough in the bath to clear off
the head, and care ought to be taken, that he should never stay in the
pack to become much excited.
75. THE HALF-BATH--THE SITZ- OR HIP-BATH.
Should the half-bath or shallow-bath (which are technical terms for the
bath described above), not be sufficient to relieve the head, the
patient must be placed in a _sitz-_ or _hip-bath_ of 65 deg. to 70 deg. and stay
there, with his body covered by a blanket or two, till the head is easy.
During and after the sitz-bath, the parts exposed to the water, as well
as the lower extremities, should be rubbed repeatedly, to favor the
circulation of the blood. The head should be covered with a compress,
dipped in cold water and but slightly wrung out, to be changed every
time it becomes warm. The time required will vary according to the
condition of the patient, from half an hour to one hour and a half.
There is no danger of his taking cold, provided the body be covered
sufficiently. The room ought not to be too warm, as a hot room will
increase the tendency of the blood to the head; 65 to 70 deg. is perfectly
warm enough. I would rather have it between 60 and 65.
76. The _sitz-bath_ may be taken in a small wash-tub, if there is no
proper sitz-bath-tub at hand. It should be large enough to allow the
water to come up to the navel of the patient, and to permit rubbing. Too
large a tub would not allow the patient to sit in it comfortably. If
there is no tub to fit, a common bathing-tub may be raised on one end,
by putting a piece of wood under it, so as to keep the water all in the
other end, allowing the feet of the patient to be kept out of the water.
This latter practice is more convenient with very small children, with
whom, however, the sitz-bath will scarcely be required, a half-bath of
sufficient duration being almost always efficient. It is not advisable
for persons little acquainted with the use of water as a curative, to
let the patient stay very long in the sitz-bath, it being safer to pack
the patient again, and to repeat the sitz-bath after the pack, if his
delirium is not removed, or not lessened in half an hour or
three-quarters of an hour. This alternating with the pack and sitz-bath
should be repeated, till the head becomes clear.
77. In excessive heat and continuous delirium, a half-bath may be given,
also, every time the packing sheet is changed. The rule is that _we_
ought not to yield, but the _symptoms must_; and they will, if the
treatment is persevered in. Only go at it with courage and confidence.
There is nothing to be apprehended from the treatment: where there is
too much heat, there is no danger of a lack of reaction, and
consequently no occasion for fears that the rash might be "driven in." A
physician afraid of using water freely in violent cases of
scarlet-fever, would resemble a fireman afraid of using his engine, for
fear of spoiling the house on fire.
78. ACTION OF THE SITZ-BATH EXPLAINED.
The _sitz-bath_ acts in a direct manner upon the abdominal organs and
the spine, and through the latter on the brain. Indirectly, it helps in
removing the inflammatory and congestive symptoms in the throat and
head, by cooling the blood, which circulates through the parts immersed
in the water, and by doing so cools also the upper parts of the body,
equalizes the temperature, and diminishes the volume of the mass of the
blood, thus making its circulation easier, _whilst it has no tendency to
impede the action of the skin_. Besides, the abstraction of electricity,
by the sitz-bath, should be taken in account of its action. After the
sitz-bath, the reaction takes place in those parts which were immersed
in the water, thereby making the relief of the upper parts more lasting.
79. RELAXATION OF TREATMENT TOWARDS THE END OF THE THIRD
PERIOD--CONTINUATION OF PACKS DURING AND AFTER DESQUAMATION.
When the patient is through the first part of the period of
efflorescence the symptoms decrease, and he will be easier. Under the
treatment prescribed, the time when the excitement is highest, is much
abridged, and usually the treatment can be relaxed in less than
twenty-four hours. When the patient is easier, the treatment may be
given as in the milder form of scarlatina anginosa, with due regard to
the state of the throat. In proportion as the heat abates, the packs
should not be repeated so often, the sheet not changed; the patient
should stay longer in the packs, and the baths should be shorter. The
sitz-bath would then be out of season. The packing should be repeated
whenever the symptoms increase again; but even if they should not, one
pack and bath a day are necessary.
80. During and after desquamation, the treatment should be continued as
indicated in milder cases, except the throat continue troublesome, when
more packs should be used. If the throat is well, the patient may leave
his room by the sixteenth day, under the precautions given above.
81.--3. TREATMENT OF TORPID FORMS OF SCARLATINA--DIFFERENCE IN THE
TREATMENT POINTED OUT.
When the _reaction_ is _torpid_, the pulse small, weak, quick, the skin
dry, the rash slow to appear, and when it appears in small, pale, livid
spots, instead of bright scarlet patches (16-25); the treatment ought to
be calculated to produce a short, but powerful, stimulus upon the
surface of the body, after which a long pack should assist the organism
in producing a slow, continuous and increasing reaction. If in violent
reaction a repetition of short packs and long cooling baths is
indicated,--in torpid reaction, cold and short tonic baths or affusions
and long packs are required, in proportion to the degree of the reactive
power of the patient. Therefore the packing sheet should be very cold,
but thin and well wrung out, so as to make a strong, but transitory,
impression, soon overcome by the reaction it calls forth, upon which all
our success depends. The patient stays in the pack till he becomes quite
warm and tired. Perspiration is seldom produced; if it is, it may be
considered a favorable symptom. I have had patients stay in the pack for
four, five, six and seven hours, and almost always, when I took them
out, their skin was covered with eruption. The only phenomenon, which
should induce the physician to relieve the patient of the pack before he
becomes perfectly warm, is increased delirium, which in torpid reaction,
indicates a tendency to a typhoid character of the disease, when the
warm and moist atmosphere of the long pack would be more favorable to
the disease than to the patient, by weakening the nerves still more. In
that case, a long half-or sitz-bath is required, the former, under
constant rubbing, from 15 to 20 minutes, the latter from 30 to 40
minutes; the temperature of either from 65 deg. to 70 deg..
82. LENGTH OF PACK.
Usually it is time for the patient to come out from his pack, when the
pulse becomes fuller and stronger, the face begins to flush and the head
to be affected. Frequently he sleeps till awakened by the increasing
heat. A drink of cold water will quiet him for a while, which may be
administered by means of a glass tube (julep-tube), in order not to
disarrange the pack by lifting him up. As long as the head is not
affected, there is no danger of his staying too long. The longer he can
stay, the surer the eruption will appear.
83. COLD AFFUSIONS AND RUBBING.
After the pack, the patient is placed in an empty bathing or wash-tub,
and cold water (of 65 deg.-60 deg. Fahr., only with very young and delicate
children a little higher, with adults rather lower) is thrown over him
in quick succession by means of a dipper, whilst he is well rubbed all
over his body, especially the extremities. Not too much water should be
poured over the head; however, the head should be always wetted first.
This process should not last longer than a minute or two, except the
patient continue very warm during it, in which case it should be
prolonged, as the perfect cooling of the body is necessary to prevent
the fever from coming on soon after and the patient continuing weak.
After the bath, he should be rubbed dry, first with the bare hands of
the attendants, and then with a dry sheet, and put to bed again, or, if
he feel inclined to stay up, dressed warmly and be induced to walk about
as long as he can.
84. ICE-WATER AND SNOW-BATH IN MALIGNANT CASES.
If no rash appear during the first pack, which will scarcely fail, the
proceeding should be repeated, and the patient stay longer in the pack
than the first time. In very bad cases, when the patient fails at once
under the action of the poison (malignant scarlet-fever) iced water or
snow may be resorted too. I know several instances of patients, having
been given up by their physicians, reviving again under the influence of
a snow-bath, which produced a healthy reaction, when nothing else was of
avail. I have never had occasion myself to resort to such extremes, cold
water having always answered my purposes; but I would not hesitate a
minute to use snow and ice in a case where I could think it useful and
necessary. Such proceedings _look_ cruel; but it _is_ decidedly more
cruel to let the patient's life be destroyed from want of timely
assistance. I distinctly remember a case, which occurred in Cassel, when
the physician objected to "tormenting the poor boy," and wanted the
father to "let him die in peace." But the father,[33] who had some
knowledge of, and a great deal of confidence in hydriatics, put the
little patient, a boy of 8 or 9 years, into a bathing-tub filled for the
greater part with snow, covered him over with the cold material, and
left him there till he became conscious; then he was rubbed all over,
placed in a dry pack (without a sheet), and left to perspire, which
ensued and brought out the rash. The patient was out of danger in four
hours' time, and Dr. S., on calling again in the evening, was quite
astounded at seeing him alive, out of bed, and covered with a tolerably
bright eruption.
85. WINE AND WATER, IF NO REACTION CAN BE OBTAINED.
Should the patient remain cold in his pack for longer than an hour,--a
case, which will seldom occur,--a little wine and water may be given him
to assist the organism in producing a reaction; and, in case of need,
the dose may be repeated once or twice in intervals of half an hour. The
quantity should be adapted to the age and constitution of the patient,
and by no means sufficient to affect the head. Instead of water, it may
also be mixed with warm broth or tea, or hot water and sugar, to make it
agreeable to the little patient.
86. ABLUTIONS AND RUBBING WITH ICED WATER OR SNOW.
In a few very obstinate cases, when no rash would appear after two or
three long packs, I have succeeded by washing the patient with ice-water
or snow, rubbing him dry with my bare hands, and then packing him in a
dry blanket. After staying there for several hours, more or less
eruption always appeared.
87. WET COMPRESS.
The wet compress on the throat in torpid cases should not be changed
often, but left till it becomes almost dry. Should the feet of the
patient be cold, a bottle filled with hot water and wrapped in a piece
of blanket or a sheet should be placed near them, either within the
pack, or out of it, when the patient is lying in bed. The feet should
always be kept warm.
88. VENTILATION ALL-IMPORTANT.
If the circulation of air is necessary in any other form of
scarlet-fever, it is all-important in torpid reaction, especially when
it inclines to a typhoid type. We should never forget that it is the
oxygen of the air that nourishes the process of combustion going on in
every living body, and that in the same manner as no fire can burn
bright without a sufficient supply of air, the combustion within the
patient will be slower in proportion as there is less pure air in the
sick-room, and consequently his reaction will be weaker, and _vice
versa_. A sick-room, filled with a number of people, and with a large
fire in it, or fed with the corrupted air of a furnace, without the
access of pure air, will always prove a dangerous place for a patient
in torpid fever, the fire and every living soul in it absorbing the
oxygen indispensable to his recovery. And if the case become typhoid,
there is little hope of saving the patient's life without plenty of pure
air.
89. CONTINUATION OF PACKS--CONVALESCENCE.
Whether the eruption appear or not, the packs should be continued during
the whole course of the disorder, and as long as the throat continues
troublesome; and one pack and bath a day should be given during some ten
or twelve days, after every symptom has disappeared. The patient, during
convalescence should not go out, except after his bath and in fine sunny
weather, till he feels quite well. However, he should not be kept
unnecessarily too long in-doors either, as exercise in the open air will
assist him in regaining his strength. If the weather is clear and
bright, the low temperature of the air need not be minded. I never saw
any one take cold after a pack and bath that walked out warmly dressed
in clear and cold weather.
90. MINERAL ACIDS, IN CASE OF SEVERE SORE-THROAT.
In case the throat be very troublesome, there cannot be any objection to
using the mineral acid, as I have indicated above (35), except
homoeopathic remedies should be thought preferable and found to afford
sufficient relief. Some good may, and no harm can be done by either.
91. PUTRID SYMPTOMS--GARGLE--SOLUTION OF CHLORIDE OF SODA--DRINK:
CHLORATE OF POTASS--LIQUOR CALCII-CHLORIDI.
Should _putrid symptoms_ make their appearance (21), I would strongly
advise the acid in full and repeated doses, as well as the frequent
repetition of the packs. In putrid cases, not only the syrup, but also
the gargle will do good service. Gargling is so much the more advisable
as the putrid matter should be frequently removed. If nothing else can
be had, pure water or water and vinegar may be used. The temperature of
the gargle should be about 70 deg.-75 deg. Fahrenheit. For the same purpose, the
_aqua chlorina_, and the _chloride of soda_ have been strongly
recommended.[34] A few drops of the solution may be used, also, on the
compress outside.
92. TREATMENT OF AFFECTIONS OF THE NERVOUS CENTRES.
In affections of the nervous centres, the _brain_, the _cerebellum_, and
the _spine_ (see 17-19), the danger which threatens the patient's life
is principally averted by the sitz-bath. The nervous system needs
support, and the circulation must be regulated. In every case where the
packs do not relieve the symptoms in the head and spine, the sitz-bath
is probably the only remedy to remove the danger. It should be about
70 deg., and the patient should stay in it till relieved, which will
probably be in half an hour or there about. After the sitz-bath, if the
patient feel quite easy and inclined to sleep, he may be put to bed; if
he continues restless and still complains of pain, he should be put in a
wet pack of about 65 deg.. There he should stay till he complains of more
pain, when he should take his bath and repeat the sitz-bath. Thus he
should alternate till he becomes entirely relieved.
93. SITZ-BATH, ANCHOR OF SAFETY.
If there be much delirium, the sitz-bath may be required longer, and the
pack shorter, as indicated above (81). In all such cases the packs and
sitz-baths, alternately, ought to be continued, till the nervous
symptoms disappear altogether, and should they make their appearance
again, the treatment must be resumed without delay.
94. I repeat that in such cases, the sitz-bath is the only anchor of
safety I know of. I have tried to remove these dangerous symptoms by
packs, affusions, baths, but almost always in vain; whilst the sitz-bath
has never failed to insure success. As I am the only writer on hydriatic
treatment of scarlatina (as far as I know), who mentions the virtue of
the sitz-bath in those cases, and as I am probably the first who
ventured to use it, with one of my own children, in 1836, when all
seemed to fail, I shall corroborate my advice by a couple of cases.
95. CASES.
During an epidemic of scarlatina in 1836 two of my children were
attacked by the disease, a boy of about eight, and another of five
years, the younger one two days after the older one. I ordered them to
be packed, and all seemed to go well, when, during my absence from the
city (of Freiberg) a medical friend, who called, persuaded my wife to
desist from continuing the hydriatic treatment, and use some remedies of
his instead. On my return, I found the elder boy (the other began only
to show some slight symptoms) in a very bad state: the cerebellum and
spine were distinctly affected by the contagious poison; the patient
complained of insupportable pain in the back of his head, the spine and
all over his body, so that no one dared to touch him. The fact of the
packs having been discontinued during twenty-four hours being concealed
from me, and the boy being subject to herpes and inclined to scrofula, I
began to fear that the treatment would not be applicable in such cases,
and became really alarmed about my child. I was then almost a novice in
Priessnitz's practice, at least in the treatment of acute diseases,
which seldom occurred at Graefenberg, and, had I had more confidence in
blood-letting and drugs, I would probably have resorted to them. For a
while I was doubtful about the course I should pursue, when Dr. B., my
medical friend, made his appearance and I learned what had happened
during my absence. Instead, however, of giving way to his earnest
solicitations to rely on the old practice, I at once became encouraged
by his confession, and declared I would persevere in my own practice,
which was quite new to him, and in which no physician of the place as
yet believed. He assured me, from the symptoms, that the boy could not
live twenty-four hours, unless he be bled, and that even then he would
not answer for his life. Having lost six children before under
allopathic treatment, and having never had much confidence in drugs
during the time I had been connected myself with the practice, I firmly
refused to allow either bleeding or drugging, and expressed my
resolution to see what water could do, resigning myself to the
possibility of a bad issue of the case. I need scarcely assure my
readers, that my feelings were far from agreeable, and that my
resolution required all the reminiscence of the bad success of
allopathic treatment of former cases in my family, and the confidence I
had in Priessnitz and his system, to support it. I tried the pack again,
which did little or no good. Judging from the effects of the sitz-bath
in cases of affection of the brain during continued fevers, that it
might be of service also in the present case (Priessnitz's directions
did not go so far, nor had I treated a similar case since my return from
Graefenberg), I put my boy with great care into a sitz-bath of 70 deg. F. and
left him there for a little over half an hour, when he felt greatly
relieved. He was taken to his bed and allowed to become warm, when he
began to complain again. I then packed him, seemingly without much
effect; therefore the sitz-bath was repeated and proved quite
successful. I then packed the patient immediately after the sitz-bath
and left him two hours in the pack, where he slept almost all the time.
When he awoke, he complained again of pain in his head, which partly
yielded to the half-bath. About three hours after the bath, he
complained more of the pain in his head and spine, and I repeated the
sitz-bath and the pack. He slept in the pack for about three hours, and
when I took him out, he was covered with red spots. Feeling pretty well,
he was dressed and permitted to stay up. In the forenoon, my friend
called to see whether our patient were still living, and could hardly
believe his own eyes when, on cautiously putting his head in at the
door, he saw the boy walking up and down the room to warm his feet. In
the afternoon, the pain returned and the rash faded. I repeated the
pack, and the pain not yielding entirely, I gave him one more sitz-bath
in the evening and a pack after it, in which he stayed asleep almost all
the time, nearly four hours, upon which the rash stood out finely and
never disappeared until desquamation set in. I managed to keep him in
bed after the relapse mentioned, till desquamation was over. I need
scarcely say that I continued to pack him (twice a day) till after
desquamation, when the packs were given once a day for about a week
longer. On the seventeenth day (which was the fifteenth with the younger
boy, who had the fever in a very mild form, and was treated accordingly)
the two scarlet-convalescents were seen playing in the street, throwing
snowballs at each other; a fact, which increased not a little the
sensation caused by this miraculous cure. Although my friend was not
converted to the new method, this case had a very decided encouraging
influence upon myself, and, I am convinced, became the means of
salvation for many hundred lives afterwards, treated partly by myself
directly, partly by other physicians, or the parents of the patients,
after my prescriptions. I felt the importance of my success in this
difficult case of scarlatina, and warmly thanked Providence for having
assisted me in saving my child for the benefit of many others.[35]
96. The circumstance that, at the same time my two boys were taken sick
with scarlatina, a servant of mine became afflicted with _small-pox_, my
daughter with _varioloids_, and my mother and wife with _influenza_,
afforded me an ample opportunity of trying the effects of the
water-cure and my own courage and skill in the new method. The servant
was cured, chiefly by long packs, in twelve days, so that she was able
to resume her household duties, and though she had been covered with
pocks all over, not the slightest mark remained on her body; my little
girl was out of doors in a fortnight, and a few days were sufficient to
rid the ladies of influenza. The complete success I had in the treatment
of all these cases, contributed not a little to encourage me to employ
the method upon others, with whom I have ever since been equally
successful, with one single exception, which I shall mention hereafter.
97. One of the last cases of affection of the brain in torpid scarlatina
I treated, was that of a scrofulous little boy of six years, from
Williamsburgh, N. Y., who was at my establishment, with his mother and
sisters, taking treatment for scrofulous ulceration of the parotid
glands, and other symptoms of that dangerous disease. The reaction was
torpid, and the brain became affected almost from the commencement.
There was a little rash coming out, but in small dark purple spots,
looking much more like measles than scarlet-fever. The delirium
increased during the period of efflorescence, instead of giving way. The
spine evidently sympathized in the suffering of the brain and
cerebellum. Homoeopathic remedies, which were earnestly asked for by
the mother, had no effect whatever; acids only produced a slight relief
of the inflammation of the throat; the packs increased the symptoms in
the head and spine. The appearance of the tongue, the peculiar kind of
delirium, the small quick pulse, &c. showed, that the case was going to
take a typhoid turn; when I ordered a sitz-bath, which almost
immediately relieved the head and improved the pulse, I then, proceeded
in about the same manner as described above in my son's case, with the
difference, that I allowed longer intervals. The patient, according to
the severity of the symptoms, took one or two packs a day, and the same
number of sitz-baths, had wet compresses on his ears and throat, and was
kept in bed with very few exceptions, when the nurse would take him on
her knees, wrapt in a blanket. The good effect of the sitz-bath was so
obvious, that the child's father, who had been informed by telegraph of
the critical condition of his son, asked himself for a repetition of it,
when he found that neither medicines nor packs produced the slightest
change. The child always became quiet and slept after the bath. Not only
was his life saved, but he also escaped all the dreaded consequences of
the disease. I am confident, that under any other kind of treatment, he
would have lost his life, or at least he would have lost his hearing.
But, far from increasing, the affection of his ears was rather improved
when he left, and his general health a great deal better than when he
was first placed under my care. I had a great deal of trouble with that
little patient, not only because he did not allow me a night's rest for
a week, and the case produced quite an estampeda in the
establishment,[36] but also, and chiefly, because of the interference
of a half-bred Irish woman, who had brought him up, and who, on account
of the mother's bad health, acted in the double quality of a nurse and a
governess towards the children. This woman, being averse to the
treatment and the place, which gave her little pleasure, and to the
rules of which she would not submit, procured all sort of dainties and
excited the child by her foolish remonstrances against any application I
found necessary, making at the same time an unfavorable impression on
the simple minds of the family, by telling lies and tales, thereby not
only placing difficulties in my way, in a case which was difficult in
itself, but even preventing the parents from acknowledging by one word
of thanks the sacrifices of time and health I had cheerfully made. What
a blessing it would be for physicians and patients, could unnecessary
and unreasonable people be kept away from persons afflicted with painful
and dangerous diseases!--
98. IMPOSSIBILITY OF ANSWERING FOR THE ISSUE OF EVERY TYPHOID CASE.
Although a _typhoid character_ of scarlatina will rarely set in, when
the patient has been subject to the packs from the beginning of the
disease, there will be cases when water-treatment can neither prevent
such an event or even save the life of the patient afflicted by
scarlet-fever. There will be a case, _now and then_, to baffle any mode
of treatment, and the physician must not be blamed for losing a patient
of scarlatina occasionally, but it is not necessary that people should
continue to die of this disease in such numbers, as they have been
destroyed till now.
99. Any case, where typhoid symptoms set in (16-25), is dangerous, and
the physician and his mode of treatment deserve commendation, if the
patient is saved by it; and it is in such cases, also, that the
hydriatic physician requires the most skill, experience and courage.
100. IS WATER APPLICABLE IN ALL TYPHOID CASES?
The question has been raised, whether in typhoid cases, and in cases of
torpid reaction in general, water is at all applicable? I can answer the
question only in the affirmative; but I must add, that the treatment of
such cases requires more than confidence and courage: it requires a nice
discrimination to know the exact moment, when water may be applied, what
should be its temperature, how long the bath should last, what kind of
baths should be given, whether the pack will be of service, &c.
101. RULES FOR THE APPLICATION OF WATER IN TYPHOID CASES.
As a general rule, in typhoid cases, bathing should form one of the
principal features of the treatment; i. e. the patient should have more
baths than packs in proportion to the treatment of other cases.
102. The temperature of the baths should be in proportion to the
reactive power of the body; i. e. the longer the patient has been sick,
and the weaker he is, the higher should be the temperature of the water,
but never so high as to have rather a weakening than a strengthening
effect upon the nervous system. The highest temperature which may be
used should not exceed 75 deg. F.
103. When the delirium is active, the patient restless, almost raging,
the water should be used colder; when the delirium is more passive, the
patient weak, muttering, the water should be warmer: in the former case,
the water may be between 50 and 60 deg., in the latter, between 60 and 70 deg..
104. When the skin is hot and dry, a wet-sheet pack will produce relief,
and assist in bringing out the rash. After the pack, a half-bath should
be given, the duration of which must be regulated by the condition of
the brain. If the delirium continues, the bath should be prolonged.
105. The patient should not leave the bath before his head is clearer.
It may be necessary for the patient to stay in the bath for more than
half an hour.
106. In a low condition, with passive delirium, the packs should not be
continued very long, as they will be apt to increase the bad condition
of the brain. In that case they should be used only to prepare the body
for the bath following it.
107. When the skin is cool and moist, neither a bath nor a pack is
indicated. When the skin is rather cool and dry, an affusion of cold
water and frictions with the bare hands should be used, and the patient
packed afterwards in a dry blanket, to assist in producing a reaction.
In such cases I have found very cold water to be of more service than
water of a warmer temperature. When the patient has not been too much
weakened already, a rash is likely to be produced by the proceeding, and
in consequence of repeated baths, the nervous system to be relieved and
a healthier reaction to be obtained.
108. Should putrid symptoms appear, I would advise the use of mineral
acids and chloride of lime, in addition to hydriatic treatment.
109. In no case would I advise a hydriatic practitioner to overdo,
either in regard to the temperature or to the quantity of the baths. The
state of the brain and of the skin should always guide him. The increase
of delirium will require a bath, and the dryness and heat of the skin a
pack. If both symptoms exist, the bath is to be preferred, as the
condition of the nervous system should always command the principal
attention of the physician. When the nervous system is supported, the
whole of the organism is, and the condition of the skin usually improves
with the former.
110. ILLUSTRATIONS.
I shall give a couple of illustrations:
In the winter of 1845-46, during an epidemic, which ravaged the city of
Dresden and the neighboring villages, I was called to see a child,
belonging to a tradesman, blessed with a large family, but without
sufficient means to support them. I found the whole family crammed
together in a room of moderate size, the patient lying in a bed near the
window. There was a large fire in a sheet-iron stove, upon which the
mother was preparing the scanty dinner of the family. The air was filled
with the exhalations of the living, beside the smell from the potatoes
and sourkrout, which was undergoing the cooking process, the sundry
boots and shoes lying around or being under repair in the hands of the
father, and a few pieces of linen hanging behind the stove for the
purpose of drying. In an adjoining alcove lay the body of a little boy,
who had expired the day before, a victim of scarlet-fever.
I found the patient, a fair-haired little girl of about eight years, in
a state of sopor, which had lasted a day and a half; there had been
delirium for two or three days, during which time the child had never
had a clear moment. There was a purple rash all over the body. The
temperature of the body I found 112 F., on placing my pocket-thermometer
under the pit of the arm; the pulse was small, but exceedingly quick.
There was considerable inflammation of the throat and swelling of the
face; the breath was very bad. There was a blister on the throat and a
mustard plaster on each of the soles of the feet.
I sent for a large wash-tub and water, which I mixed with some warm
water, so as to make it about 65 deg.. I had the child undressed, and placed
in the empty tub, after removing the blister and mustard; then I poured
the water slowly over her head, shoulders and the rest of the body. The
second pail brought her to consciousness, but only for a moment. As the
delirium returned, I continued to pour water over her; till the tub was
filled about nine inches, when I used the water from the bath. In
fifteen minutes, I found the heat of the body diminished about five
degrees. Soon after, the child became conscious, and its mind cleared
off more and more, as she continued in the bath. In thirty minutes, the
heat was 103, and the pulse, which first could not be counted, 135, when
I removed her from the bath and put her in a wet-sheet pack, where she
fell asleep. The pulse continuing slower, coming down to 126, and the
heat not increasing, I left her in the pack for an hour and three
quarters, when I observed an increase of heat, a quickening of the pulse
and a return of delirium.
The water of the first bath still standing in the room, but having
become warmer, and it being found troublesome to carry much water
up-stairs to a fifth story; I sent for a pail more of fresh water,
lowering the temperature of the bath to 71 deg., and, placing the child in
the bath, threw water over it, as I had done before. This time the bath
produced a beneficial effect much sooner, and I removed the patient from
it in about twelve minutes. The heat of the body had gone down to 101,
the pulse was 118, and the patient was perfectly conscious, complaining
a good deal of her throat. I placed a wet compress on the throat and
chest and had her put to bed, but ordered the bed to be removed further
from the window, and the latter partly to be kept open. I need scarcely
say, that I had opened it soon after entering the room.
When I returned in about five hours, I found the patient covered with a
thick feather-bed, the window closed, the air of the room as bad as
before; the patient was delirious, the heat 110, the pulse upwards of
150.
I repeated the bath as before, but continued only twenty minutes; then I
packed her again, placed a wet compress on her head, opened the window
entirely, and left, promising to be back in an hour.
This time, on my return, I found the window open, the air better, the
child conscious in her pack. I left her a quarter of an hour longer;
then placed her in a bath of fresh water, of 70 deg., kept her there five
minutes, and put her back to bed. It being late in the evening, I
recommended changing the compress on the throat and placing another on
the stomach, and in case of renewed delirium, a cold compress on the
head, to be changed frequently.
When I called in the morning, I found the patient again in delirium, the
heat 110 deg., the pulse 140.
The bath was repeated for twenty-five minutes, when the heat went down
to 100 deg., and the pulse to 120. The patient being conscious, I had her
packed again and left her about two hours in the pack. When I returned,
I found her head almost clear; the bath of 70 deg. for ten minutes
brightened her very much. Her throat continued very troublesome, one of
the submaxillary glands was very much swollen, and broke afterwards, on
the fifth day of my treatment, discharging fetid matter. Also the
parotid gland on the same side became seriously affected, swoll
considerably and looked as if the ear might be endangered. The patient
developing heat enough, I used nothing but wet compresses, and water and
vinegar for a gargle.
The heat and delirium returning, the patient was bathed and packed twice
more the same day; the pack lasting only an hour to an hour and a
quarter. The night was pretty good; there was little delirium.
The third day, the patient was packed twice, and had four baths, and the
bowels being costive, an injection of tepid water in the evening.
The fourth day, the rash having disappeared, and the heat being down to
98, whilst the pulse continued weak and quick, and the patient still had
some delirium, I gave her a pack in the forenoon, without a bath
previous, of an hour and a half, and a short bath after it; and in the
afternoon, the patient having more delirium, the half-bath of 70 deg. was
repeated, and the patient kept in it for twenty minutes.
On the fifth day the ulcerating gland burst outside and the parotid
gland became relieved. Pack and baths as the day before. In the evening
the patient complaining of pain in the bowels, a sitz-bath of 70 deg. for
twenty minutes was administered, and an injection after it, which
relieved her.
The rest of the time, one pack and bath in the morning, and a bath in
the afternoon were deemed sufficient. On the eighteenth day of my
treatment the patient left the house for the first time, and continued
improving from day to day, the packs being continued for about two weeks
longer on account of the broken gland, which continued to discharge. I
tried to persuade the parents to continue the packs till the gland was
healed, but they found it too much trouble.
The patient drank a good deal of water during the whole of the
treatment, ate very little and only light food, principally water-soup
or panada, and gruel, and kept in bed almost entirely the first ten or
twelve days. Her deceased little brother had the same symptoms, and I am
confident, she would have followed him, had she not come under hydriatic
treatment.
111. A later case, to which I have alluded before, was the following:
The driver of a lady, who was under my care in Florence, attending to
one of the lady's maids, who was sick with typhoid scarlatina, was taken
ill. Like most uneducated people, he could not understand how water
could do any good for diseases, and went to the village-store to buy
some patent medicine, which he took. The remedy producing no good
effect, he bought some other medicine--purgative pills, as I
understood--and took it. Some friends of the village, which, like other
villages, especially in America, was full of doctors--brought him
nostrums and popular remedies, which he took for some days, till he
could not leave the bed any more, delirium set in, and I was at last
applied for. I found him with all the symptoms of typhus, and scarcely
any of scarlatina, except the tongue, which seemed to struggle between a
typhoid and scarlatinous appearance, but soon took all the form and
color of the former. There was no rash, not much of a sore-throat, but
constant delirium and rapid sinking of the strength of the patient.
Under these circumstances, I believed I must treat him more for typhus
than for scarlatina, and used cold baths; in which course I was
encouraged by the fine reaction ensuing after every bath, and the slight
clearing off of his mind for a few minutes. Internally, I used the
muriatic-acid in the forms mentioned above (39), and the solution of
chloride of lime, which was also used for a wash and sprinkled about the
room. In order to draw the eruption towards the skin--provided there be
any of the scarlatinous poison in his system,--I tried a few packs, but
without avail. He grew weaker and weaker, though his skin continued to
become red after every bath, and on the sixth day early in the morning,
when we were about changing his linen, and I was holding him sitting up
in bed, he expired in my arms. This is the only case of scarlet-fever, I
lost under hydriatic treatment; and it is yet doubtful whether it can be
considered as belonging to that disease. I have always considered it,
and continue to do so now, a case of typhus, partly communicated by the
typhoid exhalations of the other servant, and partly created in his own
body, as he complained for more than a fortnight before, of nervous and
feverish symptoms, which indicated a serious disease threatening him.
The contagion of scarlatina may have made the case more dangerous by
complicating it; but, be this as it may, it is certain that the symptoms
were such from the beginning that a cure must have appeared most
improbable at first sight to any physician of any school; and if there
was a possibility of saving his life, it could only be done by the
course I took; a course which had proved successful in several cases of
typhus I had treated before, and which looked about as bad, and even
worse than that of poor William McNought.
112. The young woman, who apparently communicated the typhoid contagion
to William, was in quite as critical a condition as her fellow-servant;
and for a while I doubted of her recovery. She continued delirious for
more than a fortnight, and there were distinct putrid symptoms, her
throat and glands ulcerating, and breaking in two places outside. For
longer than a week she had not a lucid moment, became extenuated and
powerless. We had to lift her into the baths and out; involuntary
discharges from the bowels and the bladder took place; petechiae
appeared, and every thing indicated a steady decay. Neither acids nor
chloride of lime seemed to have any effect; the only thing, which
revived her, was the tepid half-bath, of 70 deg., which she took twice a day
for about twenty minutes. She was usually carried into the bath-room
near by, and was commonly able to walk back assisted by the nurses. She
took a pack occasionally for an hour or an hour and a half, as long as a
few spots of the rash made their appearance. Her skin peeled off but
imperfectly (there was not an appearance of desquamation on the driver's
person, although he died about the tenth day after the disease had
manifested itself). The patient not producing much heat, I used a
poultice of hemlock-leaves and bran on her glands, the gargle of
muriatic-acid, and ablutions of water and vinegar externally, when the
skin was not prepared for a bath. Although of a weak, scrofulous habit,
and having always been sickly, not only her life was saved, but her
health became afterwards stronger, and her looks much better than they
ever were before. The gland kept discharging for three or four months
longer, and I have no doubt, to her great benefit.
With this patient, I never found the heat to exceed 100 deg. Fahr. and the
delirium never had a very active character. For the greater part of the
time, her skin was more cool than warm, and sometimes even clammy.
FOOTNOTES:
[7] Elements of Medicine, Vol. I. London, 1836.
[8] J. Armstrong, Practical Illustrations of the scarlet-fever, measles,
&c. London, 1818.
[9] W. Withering. An account of the scarlet-fever, &c. London, 1779.
[10] Hamilton, in Edinburgh Journal.
[11] F. Jahn, in Hufeland's Journal, 1829.
[12] J. Wendt, das Wesen, die Bedeutung und aerztl. Behandl. des
Scharlachs. Breslau, 1819.
[13] F. A. G. Berndt, D. Scharlachepidemie im Kuestriner Kreise,
1817-19, &c. Berlin, 1820.--The same, Bemerk. ueber das Scharlachfieber,
&c. Greifswalde, 1827.
[14] Peart, Practical informations on malignant scarlet-fever and
sore-throat, in which a new mode of treatment is freely communicated.
London, 1802.
[15] J. B. Brown, On scarlatina, and its successful treatment by the
Acidum-aceticum-dilutum of the Pharmacopaeia. London, 1846.
[16] The forms in which I have given this acid are the following:
Take three ounces of raspberry syrup and fifteen drops of muriatic acid.
Rub the whole of the acid with two or three spoonfuls of syrup in a
porcelain mortar (or, if there is none, in a soup-plate with the foot of
a wine-glass, or a tumbler) for a minute or two; then add some more of
the syrup and rub again, and thus continue till the acid is well divided
and mixed up with the syrup. Of this mixture give the patient a
teaspoonful every hour or two, or oftener, according to the symptoms.
An other form for a gargle is this:
Take a cup of coarse pearl-barley (or of rice), roast it till yellow;
then boil it with one quart of water for ten minutes; add one
teaspoonful of muriatic-acid, and four or six tablespoonfuls of honey;
mix it well and use it for a gargle, tepid. The decoction should be
passed through some linen, or a sieve, before the acid and honey are
added, to keep back the barley or rice-grains.
The syrup should be used for inflammation of the tonsils; the gargle for
inflammation of the fauces or pharynx.
[17] Schnitzlein, das Scharlachfieber, seine Geschichte, Erkenntniss und
Heilung: Muenchen, 1851.
[18] Schneemann, die sichere Heilung der Scharlachkrankheit durch eine
neue, voellig gefahrlose Heilmethode. Hannover, 1848.
[19] Lindsley, Boston Med. and Surg. Journal, May, 1850.
[20] C. A. W. Richter, das Wasserbuch. Berlin, 1856.
[21] Berend, Oppenheimer Zeitschrift. April, 1848.
[22] Hauner, Deutsche Klinik, 1850, No. 41.
[23] Hufeland, Hedenus, Burdach, Berndt, Cramer, Maclure, Feron, &c.
[24] Lehmann, Harnier, Wagner, Vogel, Steimmig, Schwartze, Cock, Pfaff,
Baumgaertner, Belitz, &c.
[25] Currie, on the effects of cold and tepid water. London.
[26] Kolbany, Beobacht. ueber den Nutzen des lauen und kalten Wassers im
Scharlachf. Pressburg, 1808.
[27] Reuss, d. Wesen der Exantheme. Nuernberg, 1818. Vol. III.
[28] A. Edler von Froehlichsthal, Abhandl. ueber d. kraeftige, sichere und
schnelle Wirkung der Uebergiessungen &c. im Faul-, Nerven-, Gallen-,
Brenn- und Scharlachfieber. Wien, 1842.
[29] L. Hesse, in Rust's Magaz. Vol. XXVII. 1.
[30] R. Steimmig, Erfahr. und Betracht. ueber d. Scharlachfieber und
seine Behandl. Karler., 1828.
[31] P. ex. Reich, who kept the sick-room quite cold, and made his
scarlet-patients walk out in any weather; he assures us that he cured
his patients in five days, an interesting fact, for the correctness of
which, however, the Doctor alone is responsible.
[32] A visit at my establishment of a gentleman, a short time ago, whom
I treated for scarlatina anginosa in the city of New-York in February,
1851, reminds me of the sensation caused among his friends by our
walking out together on the tenth day in a snow-storm, to take dinner at
a restaurant's, where we consumed a partridge and sundry other articles,
after which we took a further walk of half an hour. Some physicians of
my acquaintance told me "I was killing the man," to which I replied, I
would let them know, when he was dead. However, he never experienced the
slightest inconvenience from his early exposure; on the contrary, he
felt bright and strong on coming home, and has been in pretty good
health ever since. He saved, last year, the life of a nephew, who had
been given up, by packing him, in scarlet-fever, whilst two of the
patient's sisters were allowed to die soon after--unpacked!--Their uncle
had been compelled to leave the place of their residence, and the
parents had neither courage nor confidence in the water-cure to repeat
the process, though their son--whom I saw a few weeks afterwards in
vigorous health,--had been saved by it. They had more confidence in
drugs which had done nothing for him.
[33] Mr. Rossteuscher, who became afterwards proprietor of a
water-cure-establishment near Cassel.
[34] "And something may be done by way of gargles, to correct the state
of the throat, and to prevent the distressing and perilous consequences,
which would otherwise be likely to flow from it. A weak solution of the
chloride of soda may be employed for this purpose; and if the disease
occur in a child that is not able to gargle, this solution may be
injected into the nostrils and against the fauces, by means of a syringe
or elastic bottle. The effect of this application is sometimes most
encouraging. A quantity of offensive sloughy matter is brought away; the
acid discharge is rendered harmless; the running from the nose and
diarrhoea cease, &c."
"From several distinct and highly respectable sources, _chlorine_ itself
has been strongly pressed upon my notice, as a most valuable remedy in
the severest forms of scarlet-fever." Watson, Principles and Practice of
Physic.
Dr. Watson also recommends a _drink_, prepared of a drachm of _chlorate
of potass_ to a pint of water, and has found great improvement from the
use of a pint to a pint and a half of this solution daily.
Brown gives his scarlet-patients the pure _liquor calcii chloridi_, or
the _aqua oxymuriatica_ in quantities of one teaspoonful every two or
three hours and considers this remedy as almost a specific. A solution
of the same remedy may be used as a gargle, and also as a wash; and if
used internally, I would rather recommend it in preference to the pure
liquor, in the hands of persons not used to medical practice. In putrid
cases, also the packing sheet may be dipped in a thin solution of
chloride.--From an aversion to drugs--very natural in a hydriatic
physician--I have never tried medicated sheets, getting along very
nicely without them, but I think they must have sufficient virtue to
recommend themselves to physicians and parents, who would like to try
them.
[35] Captain Claridge, who communicated the above case to the English,
and by reprint also to the American public, erroneously reported it a
case of _measles_. How he could have made the mistake, I do not know, as
the word "Scharlachfieber" in German does not resemble "measles" at all,
the latter being called "Masern" in my mother-tongue; but the thought
that many a case, which had a bad issue, might have been treated, these
twenty-one years, after my method, and many a life might have been
saved, but for the mistake of C. C., has often distressed me.
[36] Nothing is more dangerous to the interest of an establishment,
where many people are promiscuously collected, than a case of contagious
disease, such as small-pox, scarlatina, measles, typhus, &c. I remember
a hydriatic establishment in Pennsylvania being broken up entirely, and
the physician deprived for a time of the means of subsistence, by his
honest and well-founded confidence in the hydriatic treatment of
small-pox, and by the generous steps he took in taking a friendless
patient, afflicted with that dreaded disease, to his own house, to cure
him. He anticipated the pleasure it would procure him to show how
quickly and how safely he would dispose of the case, and exulted in
being able to communicate the fact to his patients. Alas, he little
knew, how feeble their confidence in the water-cure was as yet, and how
much more they thought of their own safety, than of the water-cure,
their physician and the life and health of a poor destitute
fellow-creature. They all left him--part of them came to Florence--and
long before he had cured his small-pox patient, he had not one of his
old patients left to witness the cure! However impolitic it may appear,
I cannot but express my admiration of Dr. S.'s noble conduct on the
occasion, who proved himself not only an honest adherer to our excellent
mode of treatment, but also a kind and generous man, worthy of more
encouragement than he received at the time.
With that event before me and with a number of some thirty-five or forty
patients in the house, I, of course, tried to make them as easy as I
could, and confiding in the power of my treatment, sent my own two
children, _Paul_, about eight and a half, and _Eliza_, about four years
old, to play with the little scarlet-patient, to show how little I was
afraid of the disease. In doing so, I, at the same time, satisfied my
own heart, by insuring the possibility of treating my darlings myself
for scarlatina, which I might not be able to do, were I to let the
opportunity escape. Both were taken by the disease, and finding their
reaction rather torpid, and the whole process of the disease not without
danger, I was glad--when all was over--that I had been able to treat
them myself.
I am happy to declare, that none of _my_ patients were frightened away,
and that all those who were attacked by the contagion, came off in a
very short time and without the least bad consequences. The only
exception, in the case of a person who was not a patient, and who came
under my hands, after other remedies had been tried on him, I shall
communicate hereafter.