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Scarlatina Simplex Or Simple Scarlet-fever
In the _mildest form_ of the disease, called _scarlatina simp...
Category: TREATMENT OF OTHER FEVERS
Source: Hydriatic Treatment Of Scarlet Fever In Its Different Forms
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
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
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
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.
Next: Treatment Of Other Eruptive Fevers
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