V. Of the Treatment of Scarlet Fever.
Little modification is required in the treatment of scarlet fever. The most important difference between continued fever without and with an eruption, is the greater predominance of nervous affection in the former and of inflammatory affection in the latter. Accordingly, in scarlatina there is not only a greater tendency to inflammation than in ordinary fever, but the inflammation which is set up in the febrile circle of organs approximates more to the character of pure inflammation. There is greater vascular action, with less nervous and sensorial depression. The consequence is, that blood-letting may be carried to a greater extent, and will be attended with still more decided and more certain efficacy than in ordinary fever. After a decided impression has been made upon the vascular excitement by general bleeding, the application of ten or twelve leeches to the throat is of sovereign efficacy. If scarlatina be treated in this manner on the second day, or sometimes even on the third, though it commence with exceedingly severe symptoms, yet the patient will be convalescent in the course of three or four days.
It is not probable that much advantage would be derived from the detail of numerous cases to illustrate the modification of treatment, and the circumstances under which particular remedies should be chosen. A few are subjoined as specimens of the ordinary extent to which bleeding may be carried, and of the usual conditions under which wine may be exhibited, and of the results, when favourable, produced by each remedy.
Case CXI.
Mary Ann Hunt, æt. 24, servant. Admitted on the 14th day of fever: attack commenced with shivering, succeeded by heat, nausea, and head-ache; until last night, has had no stool for five days. At present, no pain of head or chest; much pain of limbs; sleeps well; severe pain over the epigastrium, increased considerably by coughing and by pressure; tongue thickly coated with a whitish-yellow fur, through which the papillæ appear large and prominent; much thirst; no appetite; no stool to-day; skin warm; catamenia regular; pulse 135, of good strength.
V.S. ad ℥xxvj. Haust. Sennæ Sal. quam primum. Acid. Mist. pro potu. Mist. Acet. Amm. C. 6tâ q. h.
15th. Pain of limbs quite gone; that of epigastrium also entirely removed; no tenderness on the fullest pressure; tongue more clean; less thirst; several stools; slept well; skin cool; pulse 84, soft. Blood in both basons very buffy. Cont. med.
16th. Continues quite free from pain; tongue nearly clean; two stools; skin cool, moist; pulse 88. Pt. med.
18th. No return of pain; tongue clean; pulse 87; four stools; skin natural. Pt. med.
22d. Sat up yesterday and the day before, since which the skin has become more warm, the pulse more quick, and the tongue more loaded, but there is no local pain, and the bowels are open.
23d. Pains of limbs returned; slept ill; tongue loaded at root; pulse 110.
24th. Pains diminished; pulse 100; tongue still furred; skin warm.
26th. Pains gone; skin cool and moist; tongue the same; two stools; pulse 100.
28th. Tongue more clean; skin warm; pulse 76.
35th. Convalescent. Inf. Case. c. Senna bis.
41st. Dismissed cured.
Case CXII.
Eleanor Welby, æt. 21, servant. Attacked four days ago with chilliness, shivering and pain of head. At present, pain of head gone; mind distinct; little or no sleep; eyes suffused and injected; no uneasiness of chest nor cough; throat sore, with difficult deglutition; tenderness of abdomen on pressure; tongue loaded on body with white fur, extremely red at edges and tip; lips and teeth sordid; some thirst; bowels regular; pulse 129, of good strength, yet easily compressed; efflorescence of skin of dark red colour, approaching to a dusky hue. V.S. ad xvj. Hirud. viij. gutturi. Ol. Ricini, ʒiij. quam primum. Mist. Acid. pro potu.
6th. No uneasiness of head; slept ill; eyes suffused and injected; face swollen; still complains of soreness of throat, which is undiminished; tongue moist; teeth sordid; lips sordid and cracked; less thirst; three stools; pulse 120, firm; blood very sizy and cupped. Rep. V.S. ad ℥xiij. et Hirudines viij. gutturi. Pt. Med.
7th. Expression of countenance more natural; face less swollen; more sleep; throat greatly relieved; deglutition quite easy; no tenderness of abdomen on full pressure; tongue more clean and moist; lips and teeth less sordid; pulse 111; eruption less distinct. Haustus Sennæ Sal. c. m.
8th. No uneasiness of head, throat, or abdomen; sleep natural; tongue beginning to clean, much less red; pulse 114; skin exfoliating.
9th. Convalescent.
14th. Has been gradually gaining strength and is now quite well. Dismissed cured.
Case CXIII.
Mary Jones, æt. 33, married. Three days ago attacked with shivering, succeeded by glows of heat, severe pain in the back and lower extremities, with much head-ache. At present, pain of head severe, especially over the forehead; mind distinct; scarcely any sleep; no uneasiness of chest; some cough; abdomen tender on pressure; tongue not much loaded; some thirst; no appetite; one stool; pulse 108, of some power.—V.S. ad ℥xvj. Ol. Ricini, ʒiij. q. p. Mist. Acid. pro potu.
Hora 3tia, p. m. Pain of head diminished since the bleeding, but by no means removed; much pain of back; some of abdomen; pulse 112, strong, full, sharp, and not easily compressed. Blood with firm and thick buff. Rep. V.S. ad ℥xvj. statim. Pulv. Aper. Mit. h. s.
4th. After the second bleeding last night, the pain was entirely removed: she slept well, and the pain continued absent until this morning, when it returned with great severity, or rather violence. She was bled to the extent of fourteen ounces with immediate and great relief: blood in both cups with firm buff and proportion of crassamentum large: at present, the head is quite free from pain; there is scarcely any pain in the back; no tenderness of the abdomen; tongue loaded in middle with white fur, moist at edges, of natural colour; four stools; pulse 120, weak.—Pt. med.
5th. No return of pain in the head; that of back continues; slept ill; tongue much more clean and quite moist; four stools; pulse 120, weak; skin warm and damp. Omit. pulv. Pt. alia med.
6th. Pain of head returned with great severity last night, for which she was bled to the extent of four ounces with only temporary relief; no sleep on account of the severity of the pain; skin hot; entire scalp extremely hot; face pallid; nothing unnatural in the appearance of the eye, and no intolerance of light; pulse 120, sharp, but easily compressed; tongue loaded with white fur; thirst; four stools; buff on blood pretty firm.
C. C. ad ℥x. nuchæ. Camphoræ, gr. v. c. Extract. Hyosci. gr. iij. 6ta. q. h. Pulv. Aper. Mit. h. s. Lotio frigida capiti raso.
7th. Pain of the head entirely removed since the cupping, and has not since returned; slept well; face continues very pallid; tongue loaded with white fur in middle; very pallid; pulse 120, of good strength; feels quite easy, but very weak. Cont. Pilulæ. Capt. Haust. Quininæ Sulph. 6ta. q. h.
8th. No return of pain in the head; some in loins; scarcely any sleep; tongue the same; four stools; pulse small and extremely weak. Pt. Med. omnia. Capt. Vini Albi, ℥iv. in dies.
9th. Free from pain in the head, back, and every organ; scarcely any sleep; much restlessness; delirium; countenance pallid and sunk; feels very weak; tongue the same; four stools; pulse 120, not so weak as yesterday. Pt. Med. Vini Albi ad ℥viij.
10th. Slept ill; much restlessness and delirium; frequent and deep sighing; severe pain in the lower extremities recurring in paroxysms; she says the pain is as if some one were rending her limbs from her; tongue white, moist; four stools; pulse 110, weak; takes and relishes her wine. Statim capiat Haustus Anodynus, c. Liq. Opii Sedativi, gtts. xl. Augt. Vini Albi, ad ℥x. Cont. alia med.
11th. Long and tranquil sleep after the draught; less delirium; no sighing; no return of pains in the limbs; mind perfectly distinct; “feels greatly better;” countenance much more animated; tongue the same; pulse 108, more strong and firm, but still easily compressed. Cont. Med. Rept. Haustus Anodynus hora decubitus.
12th. Slept well all night; “feels very much better to-day;” no return of pain; complains only of sense of lowness; pulse 96, weak. Pt. Med. omnia.
13th. Continues to improve in all respects.
14th. Feels stronger; pulse 108, of good strength; occasional muscular tremor. Pt.
18th. Continues steadily to improve. Pt. Jus. Bov. lbj. in dies. Vini Albi, ℥vj.
23d. Convalescent. Omit. Med. Inf. Cascaril. c. Senna, bis.
33d. Free from complaint. Dismissed cured.
In this case bleeding was carried to the utmost extent to which it could be carried with safety, and rather beyond it; but it was one of those cases in which less was to be apprehended from the bleeding than from the disease.
Case CXIV.
Frances Jacob, æt. 17, destitute. Four days ago seized with nausea, vomiting, headache, and other febrile symptoms. At present, much pain of epigastrium, which is extremely tender on pressure; throat sore; deglutition very painful; much vertigo; scarcely any headache; no sleep; mind confused through the night; some pain of chest on full inspiration; cough, with viscid copious sputa; very considerable dyspnœa; aspect of countenance leaden-coloured and oppressed; skin warm, of a dusky, unhealthy red colour; tongue very red, not much loaded; bowels constipated; pulse 135, tremulous and indistinct. Abradat. Capillitium. Hirud. viij. faucibus externis. Postea Empl. Emoll. Empl. Lyttæ nuchæ. Inhal. Vap. Aq. Calid. Garg. c. Borat Sodæ. Ol. Ricini ʒiij. q. p. Pulv. Aper. Mit. h. s.
5th. No pain of head; no sleep; mind confused; much low talkative delirium; still uneasiness of chest on full inspiration; throat less painful; deglutition more easy; dyspnœa and cough the same; abdomen tender; tongue unchanged; four stools; pulse 120, feeble and indistinct; skin covered universally with very unhealthy red, dusky efflorescence. Pulv. Aper. Mit. h. s. Mist. Camphor, ℥iss. c. Tt. Hyosciami, ʒj. et Ammon. Carbon, gr. x. 4ta. q. h. Vini Albi, ℥vi. in dies.
6th. Much delirium; some sleep; skin of same colour; rather more sensible to-day; says she has no pain of head, but sense of severe soreness all over her; much cough; four stools; pulse 120, weak. Pt. Med. et Vin.
7th. Slept well; less delirium; “feels much better;” countenance greatly improved; skin more warm; colour much more natural; throat still painful; deglutition difficult; some tenderness of the epigastrium on full pressure; scarcely any over the abdomen; tongue red at edges, brown and dry in middle; much thirst; three stools; pulse 108, soft, not very weak; lips and mouth surrounded with an herpetic eruption; skin not abraded, but covered with soft scab. Pt. Med. omnia.
8th. Slept well; asleep at present; no delirium pulse 108, soft.
9th. Still more improved; pulse 96, soft.
13th. Pulse 87; other symptoms the same. Pt.
14th. Complains more of pain of epigastrium, which is considerably tender on pressure; other symptoms the same. Catap. Sinap. epigast. Pt. alia.
15th. Epigastrium much relieved; other symptoms the same. Pt.
18th. Convalescent.
24th. Dismissed cured.
Case CXV.
Margaret Skey, æt. 37, married. Five days ago attacked with sense of cold, shivering, and heat, together with pains in the bones. At present complains of pain in small of back; no headache; no pain of chest; some cough; no tenderness of abdomen; tongue white and dry; much thirst; bowels constipated; sleeps tolerably; pulse 112. Haust. Sennæ Sal. q. p. et c. m. Rep. Mist. Acid. pro potu.
6th. Abdomen very tender; tongue red; four stools; much thirst; skin warm; face flushed; pulse 100, easily compressed. Hirud. x. abdom. Postea Catap. Emoll. Rep. alia.
8th. Much delirium through the night; considerable muscular tremor; pain of abdomen gone; tongue tremulous, but not much coated; much thirst; four stools; pulse 100, weak; frequent shivering. R. Quininæ Sulph. gr. ij. Aq. Rosae, ℥j. M. Sit Haustus, 6tis. q. h. sumendus. Jus. Bov. lbj. in dies. Rep. alia.
10th. No sleep; mind confused; two stools passed in bed; urine in bed; respiration laborious; pulse 90, weak. Alcohol (brandy) ℥iv. ex Aqua per diem. Pt. Med.
13th. Slept better; less delirium; two stools not passed in bed; pulse 96.
15th. More power; stools not passed in bed; other symptoms the same. Pt.
17th. Strength again rather diminished; tongue rather brown; much thirst; pulse 100; no pain. Pt.
21st. Little change, excepting that the tongue is more brown, dry, and tremulous; pulse 108, extremely feeble; mind distinct; no delirium; two stools. Aug. Alcohol ad ℥vj.
22d. Tongue less brown and more moist; pulse 108, stronger; slept well. Pt.
24th. Countenance much more animated; tongue more clean, quite moist, still brown towards root; pulse 110. Pt.
25th. Countenance still more improved; tongue more clean; no longer brown; pulse 102, weak.
26th. Much improved; tongue nearly clean; two stools; pulse 108, weak.
27th. Gains strength. Alcohol ad ℥iij.
34th. Convalescent, but still very weak. Cerevis. lbj. Pt. alia.
45th. Has been gradually, though very slowly gaining strength; tongue now clean; appetite good; bowels regular (Low Diet); 2 ozs. meat daily.
52d. Dismissed cured.