This contagious powder of the small-pox, and of the scarlet fever, becomes mixed with saliva in the mouth, and is thus carried to the tonsils, the mucus of which arrests some particles of this deleterious material; while other parts of it are carried into the stomach, and are probably decomposed by the power of digestion; as seems to happen to the venom of the viper, when taken into the stomach. Our perception of bad tastes in our mouths, at the same time that we perceive disagreeable odours to our nostrils, when we inhale very bad air, occasions us to spit out our saliva; and thus, in some instances, to preserve ourselves from infection. This has been supposed to originate from the sympathy between the organs of taste and smell; but any one who goes into a sick room close shut up, or into a crowded assembly-room, or tea-room, which is not sufficiently ventilated, may easily mix the bad air with the saliva on his tongue so as to taste it; as I have myself frequently attended to.
Hence it appears that these heavy infectious matters are more liable to mix with the saliva, and inflame the tonsils, and that either before or at the commencement of the fever; and this is what generally happens in the scarlet fever, always I suppose in the malignant kind, and very frequently in the mild kind. But as this infection may be taken by other means, as by the skin, it also happens in the most mild kind, that there is no inflammation of the tonsils at all; in the same manner as there is generally no inflammation of the tonsils in the inoculated small-pox.
In the mild scarlatina on the fourth day of the fever the face swells a little, at the same time a florid redness appears on various parts of the skin, in large blotches, at length coalescing, and after three days changing into branny scales.
M. M. Cool air. Fruit. Lemonade. Milk and water.
Scarlatina maligna. The malignant scarlet fever begins with inflamed tonsils; which are succeeded by dark drab coloured sloughs three or five lines in diameter, flat, or beneath the surrounding surface; and which conceal beneath them spreading gangrenous ulcers. The swellings of the tonsils are sensible to the eye and touch externally, and have an elastic rather than an œdematous feel, like parts in the vicinity of gangrenes. The pulse is very quick and weak, with delirium, and the patient generally dies in a few days; or if he recovers, it is by slow degrees, and attended with anasarca.
M. M. A vomit once. Wine. Beer. Cyder. Opium. Bark; in small repeated doses. Small successive blisters, if the extremities are cooler than natural. Cool air on the hot parts of the skin, the cool extremities being at the same time covered. Iced lemonade. Broth. Custards. Milk. Jellies. Bread pudding. Chicken. Touch the ulcers with a dry sponge to absorb the contagious matter, and then with a sponge filled with vinegar, with or without sugar of lead dissolved in it, about six grains to an ounce; or with a very little blue vitriol dissolved in it, as a grain to an ounce; but nothing so instantaneously corrects the putrid smell of ulcers as a solution of alum; about half an ounce to a pint of water, which should be a little warmish, and injected into the fauces gently by means of a syringe. These should be repeated frequently in a day, if it can be done easily, and without fatigue to the child. A little powder of bark taken frequently into the mouth, as a grain or two, that it may mix with the saliva, and thus frequently stimulate the dying tonsils. Could a warm bath made of decoction of bark, or a cold fomentation with it, be of service? Could oxygene gas mixed with common air stimulate the languid system? Small electric shocks through the tonsils every hour? ether frequently applied externally to the swelled tonsils?
As this disease is attended with the greatest degree of debility, and as stimulant medicines, if given in quantity, so as to produce more than natural warmth, contribute to expend the already too much exhausted sensorial power; it appears, that there is nothing so necessary to be nicely attended to, as to prevent any unnecessary motions of the system; this is best accomplished by the application of cold to those parts of the skin, which are in the least too hot. And secondly, that the exhibition of the bark in such quantity, as not to oppress the stomach and injure digestion, is next to be attended to, as not being liable to increase the actions of the system beyond their natural quantity; and that opium and wine should be given with the greatest caution, in very small repeated quantity, and so managed as to prevent, if possible, the cold fits of fever; which probably occur twice in 25 hours, obeying the lunations like the tides, as mentioned in Sect. XXXII. 6. that is, I suppose, the cold periods, and consequent exacerbations of fever, in this malignant scarlatina, occur twice in a lunar day; which is about ten minutes less than 25 hours; so that if the commencement of one cold fit be marked, the commencement of the next may be expected, if not disturbed by the exhibition of wine or opium, or the application of blisters, to occur in about twelve hours and a half from the commencement of the former; or if not prevented by large doses of the bark.
No one could do an act more beneficial to society, or glorious to himself, than by teaching mankind how to inoculate this fatal disease; and thus to deprive it of its malignity. Matter might be taken from the ulcers in the throat, which would probably convey the contagion. Or warm water might be put on the eruption, and scraped off again by the edge of a lancet. These experiments could be attended with no danger, and should be tried for the public benefit, and the honour of medical science.
[12]. Miliaria. Miliary fever. An eruption produced by the warmth, and more particularly by the stimulus of the points of the wool in flannel or blankets applied to the skin, has been frequently observed; which, by cool dress, and bed-clothes without flannel, has soon ceased. See Class [I. 1. 2. 3]. This, which maybe called miliaria sudatoria, has been confounded with other miliary fevers, and has made the existence of the latter doubted. Two kinds of eruptions I have seen formerly attended with fever, but did not sufficiently mark their progress, which I conceived to be miliary eruptions, one with arterial strength, or with sensitive irritated fever, and the other with arterial debility, or with sensitive inirritated fever.
In the former of these, or miliaria irritata, the eruptions were distinct and larger than the small-pox, and the fever was not subdued without two or three venesections, and repeated cathartics with calomel.