3. THE PREVENTIVE TREATMENT OF SCARLET FEVER.

By Dr. PETER HOOD, London.

In the ordinary run of cases the first symptom usually complained of is headache, next soreness and swelling of the throat, followed by vomiting-and we find that the aforementioned symptoms are relieved by the vomiting taking place. The healthy action of the liver is interfered with, and the bile, instead of taking its natural course, finds its way into the stomach, and is invariably found in the materials ejected. Hence the importance of giving an emetic at the onset of the fever, if vomiting have not occurred. We may to a certainty judge, for our guidance, of the presence of bile in the stomach by the appearance of the tongue; if this member be covered, or only partially so, with a brown fur, bile will be thrown up as soon as the act of vomiting occurs.

We sometimes meet with a case of continuous vomiting, attended with extreme irritability of stomach; this condition, if judiciously managed, is not fraught with danger, as there is more to be apprehended from the absence of vomiting that when it is in excess. The perverted course of the bile points to a defect existing in the liver, which defect is one of congestion. Here, again, we are called upon to assist nature in relieving this important organ; no medicine operates so beneficially in this case as a dose of calomel and scammony. And if we take the appearance of the tongue as our guide throughout the whole period of the fever, and when it is otherwise than perfectly clean administer gentle alterative medicines to sustain the healthy action of the liver, we shall most effectually prevent dropsy from occurring, and avoid deafness and all the other sequelæ attendant on this disease.

When the stomach has been relieved by vomiting, either by the operation of nature or art, and the liver and bowels also by the administration of an efficient dose of medicine, it is then the proper time to avail ourselves of the antiseptic property of quinine, which drug is, according to my experience, as powerful in destroying the scarlatinal germ as it is potent in the cure of ague. I do not hesitate to say that, if the previous injunctions as to the emetic and purgative are attended to, any medical man who has never before employed this medicine in the treatment of scarlet fever, will never employ any other when he witnesses the gratifying progress of a case only twenty-four hours after using it. He will find the pulse diminished in frequency, the soreness of throat and difficulty of swallowing scarcely complained of, obviating all necessity for the use of gargles, sponging, canstics, etc., the heat of skin most sensibly decreased, and the restlessness, frequently so distressing a symptom, succeeded by

a calm composure. In the worst forms of scarlet fever, in which the blood of the patient is in a dyscrastic state, indicated by virulent coryza, discharges from the mouth, eyes, and ears, owing to the disintegration of the mucose surfaces, it is imperative to administer iron with the quinine, and suitable doses of the tincture of sesquichloride of iron, or of the sulphate of iron, should be diligently persevered with; at the same time paying strict attention to procuring a daily alvine evacuation.

I must refer to one other subject connected with the treatment of scarlet fever, which I regard almost as important as the use of quinine itself. This is the disinfection of the sick room by the employment of chlorine; and here I must differ from what Dr. Budd's experience has led him to say on this subject. I quote the passage to which I refer:-"Many medical men are in the habit of fumigating the sick room, either constantly or several times a day, with chlorine or sulphurous acid pending the whole course of the fever. There can be no objection to this measure, but I do not myself attach much importance to it. Experience of the largest and most decisive kind has shown that chlorineand I believe the observation applies equally to the other chemical agent-in the degree of atmospheric impregnation respirable by man, has no appreciable influence in preventing the spread of infectious disorders." Dr. Budd has not told us in what manner he has employed disinfecting agents, chlorine more especially, to enable us to judge whether his method of using them were likely to be efficient or not.

My experience of the beneficial effects of a free use of chlorine is directly opposed to Dr. Budd's views; and I am able to state from my own observation that, if this gas be properly used in the sick room of the patient, the contagion of scarlet fever will be confined to that room. My method of using it is as follows. I direct large coarse towels to be saturated with a solution of chloride of lime, and hung over the backs of chairs, and a sheet to be hung in front of the bed-room door. We may judge of the quantity required for disinfecting the room by smell and taste on going into it. This process should be continued throughout the course of the fever.

I have always found the effect of breathing the chlorine to be most refreshing to the patient and most soothing to the throat; for frequently, when patients have complained of a difficulty in swallowing previously to its being used, directly they have breathed the gas they have exclaimed, "I can breathe much better now."

I could give numerous instances of the power possessed by chlorine in localising the scarlatinal poison. I will confine myself, however, to one as a type of the others; and I select this instance on account of the unusual opportunity I had of

watching the progress of the case from the commencement, when it showed signs of being most severe, to its termination. I extract this case from short notes made at the time, giving the treatment employed for the subjugation of the fever.

Two years ago I was on a visit to a family in Scotland, where I stayed three weeks. On the morning after my arrival, the lady of the house came to me in great tribulation and asked me to see her little girl, eight years of age, who, she feared, had scarlet fever. This lady, two years previously, had lost a girl from scarlet fever about the same age, and her second son was very nearly following his sister. The mother told me that the illness of her other children began exactly with the same symptoms as the present little girl had. She had been quite well the day before, but in the evening complained of cold and had a rigor. I learnt that the child had been delirious throughout the night. She complained of intense headache, her throat was very painful, the tonsils were much swollen and of a deep red colour, and she had great difficulty in swallowing. Her eyes were blood-shot, and she had been repeatedly sick. Her skin was burning-hot, and there was a rash all over her body. Pulse 120; tongue very foul, and her breath very foetid; great restlessness and intense thirst. I first saw her on the 9th of Aug., at 10 a.m. I ordered one grain of calomel, and one grain of James' powder, to be made into a powder with some sugar, one to be given every four hours; a tea-spoonful of the effervescing citrate of magnesia to be given one hour after each powder. Small pieces of ice and iced water to quench the thirst. This was very grateful to the child. The air of the room was impregnated with chlorine in the way described. When I saw her at 7 p.m. the child was better. She had taken three powders. The sickness and headache had left her. Her throat was less sore on swallowing; she having felt almost instant relief from this symptom the moment she breathed the chlorine. She had had several most offensive watery evacuations throughout the day. The rash and heat of skin remained the same. The tongue had quite changed its appearance from the brown colour of the morning, to a red, chalky condition. I ordered the powders to be left off, and no other medicine to be given until the morning, when she was to have a dose of the citrate of magnesia. On August 10th, the rash, which yesterday was of a dingy red, this morning was a vivid scarlet. The burning heat of skin and quickness of pulse remained the same. I ordered her one grain and a half doses of quinine, with ten-drop doses of dilute sulphuric acid, with tincture and syrup of orange peel to be given in water every six hours. Her diet was beef-tea and bread. When I saw her at midnight I heard that she had fallen asleep at 7 p.m., and remained so until that time. On the 11th,

the child was in all respects better. She had slept until 3 a.m.; awoke, and fell asleep again. The rash still continued. The pulse was less rapid, the heat of skin less, the throat more comfortable. She felt so well that she wanted to get up and be dressed. The tongue was more furred to-day. I ordered her a dose of scammony and calomel to be taken at night. On the 12th she was much better. The eruption was paler, the tongue cleaner, the pulse reduced to 95. The result from the powder was a healthy evacuation. On the 13th, the eruption had faded away. The patient was ordered to have a warm bath at night. It is unnecessary to continue the history of this case. The child went

on for three weeks upon the same treatment, and never had a bad symptom—taking her quinine every six hours, with an occasional aperient at bed time, with beef-tea for her diet, and a warm bath every second night. Desquamation proceeded most satisfactorily, and at the end of this time her skin had resumed its normal character.

I attribute the short duration of the rash to the effect of the quinine and acid, as ever since I have employed these remedies I have found that the continuance of the rash is rarely beyond three days. On the other hand, I have often observed that, in cases where ammonia or chlorate of potash have formed the basis of treatment, the rash has lasted for a greater number of days.

The house in which this child was ill, was full of visitors, children, and servants, yet every one of them escaped the infection of scarlet fever; and I am unable to attribute their immunity from the disease to any other cause than the free use that was made of the disinfecting power of chlorine.-British Med. Journal, Feb. 6, 1869, p. 118.

4.-PROPHYLAXIS OF SCARLET FEVER.

Mr. AMOS BEARDSLEY, of Grange, Lancashire, sends us an important note respecting a method of arresting the spread of scarlatina, which he has found very valuable. When a patient suffers from scarlatina, he is to be washed all over, once or twice a day, with diluted carbolic acid. Mr. Beardsley says

that in no case in which he has tried it with the first case in a house has there been any further spread of scarlatina in the family. For example, about a year ago he had a girl, seven years old, under his care, one of a family of five; she was attacked with well-marked scarlatina, and was immediately ordered to be systematically sponged with carbolic acid-one drachm to a pint of water. Also the rest of the household were desired to put carbolic acid into their washing water. Although there were no means of properly separating the other children from the invalid, none of them took the fever; the one patient

was severely ill, and scarlatina was in all the surrounding villages, and in remote parts of the village where the family lived. Mr. Beardsley has now had so much experience as to be convinced that this plan is most useful in preventing the emanation of contagious influence from patients, especially during the desquamating stage. We shall hope to give a more extended account of the results he has obtained on a future occasion.-Practitioner, Feb. 1869, p. 111.

5.-DIGITALIS IN SCARLET FEVER.

By Dr. SYDNEY FENNELL, Llandaff.

For some years past it has been my custom to prescribe for my scarlet fever patients tincture of digitalis, in conjunction with nitric ether and nitrate of potass. The success of this treatment justifies me in recommending others to adopt it, now that the disease is again ravaging the country.

Of course, the ordinary action of digitalis in controlling the force of the heart's beat is well known; but may it not have also some power over that network of nerves embracing the whole arterial system, from the aorta to the extemities? I think so, from the peculiar soft, wave-like feeling imparted to the finger by the pulse at the wrist after a few full doses of the drug. And on this supposition I based my treatment of scarlet fever by digitalis; for whatever would reduce overaction in the arterial capillaries would lessen inflammation. Digitalis will do this without reducing the general strength, as antimony, venesection, &c., certainly do. I will not go so far as to assert that it is capable of curing inflammations of internal organs, such as the lungs, &c. ; yet even in these it is extremely useful in controlling vascular action, and, when administered early in the fever, the inflammatory action in the glands of the neck subsides gradually, the fever leaves the patient in the usual time, desquamation is very slight, and the chances of chronic nephritis are reduced to a minimum. I will not say the infectious character of the disease is destroyed, yet I can confidently assert its power is lessened.

No one would suspect, if suppuration of the glands had commenced, that digitalis would prevent the formation of an abscess; yet I find, from my experience of these cases, the abscesses much circumscribed, which I attribute to the use of this drug.

I was surprised to find infants of about a month old tolerate so much as five drops of the tincture for a dose (though one