PART III Medical and Surgical Diseases, and their Homoeopathic and General Treatment
STRICTLY speaking, apart from injury, there is no such thing as a local disease. Every disturbance of health, in however remote a part of the body, has some effect on the whole. Therefore, in one sense, all disease are general disease. But for convenience of refine in this volume, diseases that affected markedly certain arts of the body (as the Respiratory System or the Alimentary system) are classified under regional headings. In this chapter the Specific infectious disease, s due to microscopic parasites, terms, etc.) will be considered. and also a few diseases like diabetes, Anaemia, etc., which cannot be readily referred to any one region,. The specific infectious fevers will be considered rest, then the general diseases like Diabetes, Anaemia, etc., which cannot be readily referred to any one region. The specific infectious rivers will be considered first, then the general disease like anemia. the specific infectious disease include those that are apt to occur in epidemics, where the agents which cause them become widely speak. Several of them are characterized by the appearance on the skin of an eruption known as the rash, or exanthem hence they are sometimes called the exanthemata. They are also accompanied by a rise of temperature, and are the principal members of the group known as ‘fevers.
They are also called Zymotic disease, from the resemblance of the poisons that cause from to ferments acting in. the blood and on the body. From the point of few of public health, they are preventable by sanitary measure, s and their range of alter years has been considerably curtailed by the works of Public health off.
In all of them there is a patent period between the time of reception of the poison and the accession of the fever, during which time period of incubation) the patient papers in good health. In the different diseases the eruption appears at different times. The following table shows the period of incubation and the day of the disease after the first rise of temperature upon which the rash appears.
PERIODS OF INCUBATION, QUARANTINE AND ISOLATION.
Disease Incubation Quarantine Isolation Appearance of Rash.
Days Days Weeks plus From commencement of disease if symptoms have disappeared Chicken-pox 14 20 1a After all crusts have separated Ist day
Cholera 1-4 – –
Diphtheria 1-4 10 3
Enteric 7-21 21 6 6th to (typhoid 8th day
Erysipelas 1-4 7 –
German Measles 12-22 21 2 Ist or 2nd day Influenza 1-3 – 2
Measles 10-14 16 3 4th day
Mumps 14-25 26 3
Plague 1-7 21 3
Ringworm (scalp) – 14 4b After disappearance of symptoms
Scarlet Fever 1-7 10 6 2nd day
Small-pox 12 18 1a 3rd day
Whooping Cough 4-12 21 6
Small-pox, cholera, diphtheria, membranous croup, erysipelas, scarlatina or scarlet fever, typhus, typhoid (enteric), relapsing, continued and puerperal fevers, tuberculosis, cerebro- spinal meningitis, anterior polio-myelitis, and other diseases in certain localities must at once be notified to the Medical Officer of Health for the district. Certificates are supplied free by the local authority. Practitioners fee, 2s. 6d. (private patient) or Is. (public practice). Penalty for omission to notify, 40s.-Act of 1889 and Public Health (London) Act, 1891.
DEFINITION- Small-pox is a continued infectious fever accompanied by a pustular eruption, which generally leaves behind permanent cicatrices. It seldom recurs.
Some years ago there as scarcely a family which had not a bewail the loss of some member from this deadly scourge, while on every side we were met by persons who se deeply-pitted faces showed what they had at some time or other been sufferers. But happily deaths from this loathsome disease are now more rare. In the ten years 1864 to 1873 the total number of deaths from small-pox in England and Wales was 69,839, and average of 6,984, in the next ten years and annual average ad fallen to (,803, in 1886 in number was 506. The violent outbreak of 1871-72, in which two years no fever than 42,807 persons were carried off attracted the attention of government, numerous sanitary regulations were issued, and the practice of vaccination rigidly unforced Since then the death rate from small-pox has steadily declined. In 1886 it was 275, in 1889 23, in 1890 16, in 1910, 19, and for the last ten years the numbers have been small. the practice of isolation of all contracts as soon as the case of the disease has been notified, has been successful in stamping out threatening epidemics on many occasions, and it is now universally followed. Since vaccination has been made a matter of choice on the part of parents. there has been a steady decline in the number of vaccination. This causes alarm to those who believe that vaccination alone gives security, but that experience of Leicester (virtually an unvaccinated town), wherein the method of isolation of contacts was first practised, shows that even an unvaccinated community can control the spread of the disease effectively by wise public health methods.
VARIETIES-It p;resents two varieties Variola Discrete and Variola Confluens., (I) In v. discreta the pustules are comparatively few, remain distinct from each other, and may be easily counted. It is the simplest form of the disease, a nd except during the first dentition, is rarely fatal. (2) In V. confluence the pustules are numerous, their outline irregular, or they run into each other, forming large continuous suppurate g surfaces. It is attended with the greatest dengue to life; for the severity of the disease bears a direct proportion to the amount of he eruption, and the danger arises chiefly from the large quantity of postal;action. If the pustules are confluent not the face, whether they are so or not on other parts, we class it with the they are so or not on other parts,. we class it with the they are so or not on other parts, we class if with the confluent kind. The dancer is always rendered greater, cateris paribus, when the eruption is very full about the head face, and neck (Marson). There is also a variety in which the pustules partially coalesce, termed Variola Semi-confluens.
COURSE-Small-pox runs through four stages The latent or incubative period lasts about twelve days from the reception of the poison; the primary or initiatory fever continues about fourth-eight hours the stage of maturation about nine days; and the secondary fever and decline of The eruption very in length according to the severity of the disease.
SYMPTOMS-As in most other fevers, the following symptoms appear in the first state;l chilliness, heat, headache, sometimes delirium; a thickly-furred white tongue; a deep flush upon he face; a hard, frequent pulse; a feeling of bruised pain all over the body, but especially in the back and loins;l more or less pain or especially in the back and loins; more or less pain or tenderness at the pit of the stomach, and vomiting. The pains in. he loins and the vomiting are the most characteristic of the promontory symptoms, and are seldom absent. when these are excessive and continuous, they are the precursors of a severe form of the disease. On the third or fourth day, the eruption, often so minute as to escape observation, appears in a form of red spots, or small hard pimples, which feel like shot in the skin. I appears first on the face, neck, and wrists, then on the body, and finally on the lower extremities. if examined, the eruption may be seen upon he palate, and is often formed on the lining membrane of the larynx, trachea, and bronchi, giving rise to sore-throat, salivation, cough, painful expectoration, and hoarseness. The implies gradually increase in size until about the eighth day from the commencement of the fever; the contents, at fist watery and transparent change to yellowish matter as the pimples become ripened into pustules (postulation). the pustules are depressed in. the centre are surrounded for a hot distance by a rose-red areola. During the time the pustules are filling up there is swelling of the eyelids and face, sometimes to such a degree as to obliterate the freighters. A peculiar, disagreeable odour now begins to emanate from the patient, which is so characteristic that the disease at this state might be known by this alone. On the first appearance of the eruption the fever subsides. but in the confluent form, when it is at its height, a fresh attack sets in, which, to distinguish fit from the precursory fever, is called the secondary fever.
In about eight days from the first appearance of the eruption the pustules break, and discharge their contents scales then form, which dry up, and in a healthy state of constitution fall of in the course of four or five days. When this take place, purplish-red stains are left behind, which very slowly fade away; minor indelible depressed scars remain, which are called pits. In the latter case the persons so marked is said to be pitted with the small-pox.
In Variola confluence, the secondary fever is often very intense and is the most dangers period of the disease. Severe, and even fatal result may arise from exhaustion, suppuration, erysipelatous inflammation. suffocative breathing, and blood- poisoning.
DIAGNOSIS-An early recognition of this disease both on account of the patient himself, and for the protection of others, is or great importance. Severe pain, evidently not muscular, in thus small of the back, of often a characteristic symptoms. As distinguished from Measles, the eruption is more perceptible to the touch, and gives the sensation of shot under the skin. Neither is the eruption of Small-pox disturbed in crescentric patches as it that of measles. the difference between he promontory symptoms foe the two diseases would also assist in forming a differential diagnosis. As distinguished from Enteric Fever, its attack is abrupt and severe, rather than insidious and uncertain. As distinguished from Chicken-pox, its eruption suppurates and the fever is high; while in Chicken-pox the eruption is vesicular, does not often suppurate, and the fever is mild. The rash of chicken post appears and the first day and is vesicular from the first. The solid, shot-like feeling of the small-pox eruption is never found in Chicken-pox.
DANGERS-The greatest danger arises from the secondary fever in the confluent form of the disease, at about the might to the twelfth day, when the pustules are ripening.; for then the fever is likely to return, and the vital strength has already been much exhausted. Fatal; chest symptoms may arise, or there may be ulceration o opacity of the cornea, and loss of sight. An inflamed condition of the skin between the pustules, instead of the rose-red areola, is a bad sign. Haemorrhages are of grave import. Infancy and advanced age are unfavorable periods; beyond sixty years of age, Mr. Marston states, hardly any who taken it escape death. Violent and uncontrollable delirium is often an attendant on the confluent variety, and if it occurs early, in persons who have lived freely or irregularly, is an unfavorable symptom. Draymen, barmen, potmen, tailors, and prostitutes are very unfavourable subjects to be attacked with Small-pox, owing to their habits of indulging freely, and almost daily, in strong drinks (Marson). A too plethoric habit, sleeplessness, and irritability are also unfavourable. On the other hand, a quiet, contented, hopeful state of mind favours recovery. small, dark, and badly ventilated dwelling, poor or scanty food, insufficient clothing, want of cleanliness, intoxicating beverages and other similar influences are also elements which determines the more severe form of this malady. But in the United Kingdom, every case that is discovered is at once removed to the hospital.
It is worthy of remark as Dr,. Letheby states in one of his quarterly reports on the sanitary condition of London, respecting an outbreak of small-pox and the increase of Scarlatina, that;’these sudden out bursts of Zymotic disease show that the force manifests itself in all its original vigor.
CAUSE-The agent which causes Small-pox must almost certainly be a minute organism which is transferred from case to case, by as yet no bacterium or micrococcus, or protozoan has been demonstrated to be the cause, through from time to time claims to the discovery have been made. In the pustules are found germ of suppuration, Streptococci and Staphylococci, and to their activity the secondary fever is due, but they are not the primary case of the disease.
EPITOME OF TREATMENT.
1. Primary fever-Aconite, Belladonna, Ver-Vir., Baptisia.
2. Eruptive stage-Antim tart., Thuja, Sarracenia, Sulphur
3. Suppurative stage-Antim tart., Mercurius, Apis, lach.
4. Retrocession of the eruption-Camph., Sulphur
5. Confluent and malignant cases-Sulph., Arsenicum, Phosphorus, Lachesis, Crot..
6. Complications-Phosphorus, Ant-Tart. (Pneumonia).
Aconite, Bryonia, (congestion of the Lungs). Bryonia, I-Bich. Antim tart (Bronchitis). Rhus. (severe pain in the back). Mercurius (Glandular swellings). Apis. Belladonna (Dropsical Swelling, Closed eyes, Swollen throat). bell., Hyoscyamus, Stramonium, Ver-Vir. (Delirium). Arsenicum, Baptisia (sudden abstraction and threatened Syncope).
7. To prevent pitting-Sarracenia. keep the face covered and protected from light. It is the actinic rays in sun, light that cause increased irrational and inflammation in the skin, and if the patient is kept in a red light, by red window-curtains or red glass, the actinic rays are shut off. This act is the basis of the medieval treatment of Small-pox by wearing red articles of clothing, and so fourth. There was supposed to be healing property in merc redness, but it is the shutting off of the other rays of light that constitutes the remedial process.
8. Desquamation-Sulph., with cleanliness and frequent tepid sponging. Sponging with a dilute lotion to Carbolic Acid (I- 40) is very grateful to the patient when there is irritation.
9.Sequalae-Sulph., Merc-Cor. (Ophthalmia). Hepar sulph.l, Phosphorus, Sulphur (Boils). See also under Complications, above.
10. Prophylatics-Variolinum 6 o 30, a dose night a d morning, should be taken by all who come within range of he infection. Vaccinatum 30 may be given in the same way. (See Homoeopathic World. vol. xxxii.p.546) Other prophylactics are Vaccination, Sulphur, Ant-Tart., Thuja,
Aconitum-shivering, heat, dryness of the skin, rapid pulse, swimming and pain in he head, near and vomiting, and pain in the back and loins it may be used at any time during the course of the disease, when febrile symptoms are prompt If there a much sickness with the fever, and a very rapid pulse, Veratrum Viride may be substituted for Aconite Baptisia has been highly praised in the early stages.
Antimonium Tart-Is almost specific for small-pox, and should be administered as soon s the nature of the disease is ascertained; it is specially valuable during the eruptive stages and also in. the primary fever, if near and vomiting or convulsions should occur. Indeed, during nearly the whole course of the disease it may be given for the primary fever, and sulph. during desquamation, to prevent after-affects, Ant-Tart. is the only remedy required.
Belladonna-Severe head symptoms, delirium, in-tolerance of light, etc.; a few doses will usually afford relief.
Mercurius-Salivation, Ulcerated throat, foetid breath, or bloody diarrhoea, especially during suppuration.
Apis-Excessive swelling of the face, eyelids, etc.
Coffea.- Two or three doses, if thee be restlessness and sleeplessness.
Camphor.- If the eruption suddenly disappear, or suddenly become malignant, with Dyspnoea, coldness of the skin, and symptoms of Paralysis of the Brain, two or three drops in a little tepid water, every ten or fifteen minutes, for several times, till the skin becomes warm and the eruption re-appears.)
Opium-Drowsiness or stupor and stertorous breathing.
Lachesis-During one epidemic this medicine was found invaluable in those cases in which a typhoid condition ensued during the state of maturation (probably due to septicemia).
Sulphur.-When the disease pursues and irregular course; when the eruption exhibits a tendency to disappear from the surface; when the pustules, instead of being transparent or yellows, are green, purple, or black; when the blood with which they are filled announces a decomposition of this flied, it is not to Arsenicum that we should have recourse, but to Sulphur (Taste).
During the formation of the pustules, and when there is furious itching, and when he disease is on the decline ist should be given as a preventive to the usual Sequalae, and continues till recovery is complete. Carbo-Veg., Ac-Nit., or Arsenicum, under similar condition or when Sulph. only partially succeeds. Vaccinine, internally, is said to destroy the odour and effluvia of Small-pox. Variolinum, given every four hours, has been said to cut short an attack.
PREVENTIVES-Variolinum, Sulphur, Cimic., Vaccinium, Sarracenia Purpura, and some other remedies see P. 118) are said to have curative or prophylactic virtue in this disease. The administration of the Tincture of sulphur will, as our experience prove, act as a preventive, jenner us reported to have failed in vaccinating thirty soldiers hen they were receiving Sulphur treatment; subsequently all the men took the genuine Cow-pox. Fresh air and free ventilation are invaluable prophylactics.
ACCESSORY MEANS- All Small-pox cases in England are taken to hospitals and treated there, But if hospital treatment is not available the following suggestions are important. The patient should be kept cool, and the sheets and linen frequently changed, ample provision being made both for the uninterrupted admission of fresh airs and the free escape of tainted air. The bad ventilation of a small room, to high temperature and hot cordials interrupt the tendency to recovery. In cold weather a fire should be kept burning in the apartment, and the patient have an extra blanket, but the windows kept open. If the weather is mild the patient is better treated entirely in the open air,.
Nothing is of so much importance as pure air, and that in an unlimited quantity. In this hospital we have kept tour windows open constantly by night and by day throughout the months of February., March, April. etc.; and this has been attended with the very best results, four our mortality is the lowest of all the Small-pox hospital sin London, and we were reviving our patients front the same source, s and some time before this epidemic reached its height.( Dr. A. Collie, late Resident Officer of the Homerton Fever Hospital). During the entire course of the disease, especially when the skin becomes hot, painful, or irritable, the whole surface may be sponged with warm water,, to which a spoonful of Perfumed Carbolic Acuity ahead been aged, and well dried with a soft towel. This generally affords great relief. the use of Perfumed Carbolic Acid in the above manner, and the infusion of his vapour in the air of the apportionment, tend to mitigate Small-pox. In the early stage of the disease, great advantage may also be derived front the wet-pack (see Secale26) followed by a sponge bath. Frequently changing the posture of the patient in bed, so as to avoid constant pressure one the back or nates, prevents bed-sores. After the pustules burst, powdered starch or flour should be freely applied to absorb the matter. Cleanliness, frequent tepid washing, and an occasional warm bath,. are especially necessary during h last state of he disease.
To prevent pitting, the pustules should be frequently smeared over with olive oil, cold cream, or a mixture of one-third of glycerine with two-thirds of water. A still better mixture is one of cream and flour, in such proportions as will make a thick paste. This should be freely painted over the face and neck, and renewed when necessary. But this means the action of light on the pustules (which so to speak, photographs then on the skin) may be prevented, as well as th consequent pitting at the same time we allay the irritation which accompanies the site of maturation. the hands of children should be muffled and lightly secured, to prevent scratching, which might lead to ulceration. Adults may wear loose gloves. This precaution is especially necessary while the patient is asleep, the acts unconsciously.
DIET-Tea and dry toast, raw eggs beaten up with cold milk, beef- tea, etc.; grapes, roasted apples, and wholesome ripe fruits in season. For drink, cold water is generally prepared and any objection to it by nurses or friends should be firmly resisted; in addition, milk diluted with about one third or one half soda water, lemonade, raspberry vinegar-water, current-jelly-water, and barley-water. For further hints on diet and beverages see Part II.
DISINFECTION-The only absolutely safe method to adopt with infected clothing and bedding is to burn them. If this be objected to, they should be either baked or boiled at a temperature of 212 degree. Rooms should be disinfected by fumigating with burning Sulphur, with all apertures closed over with formalin vapour. The walls should then be divested of their paper, or colour, or whitewash; the floor thoroughly scrubbed and washed over with a solution of lime of of zinc; walls and ceilings well limewashed; and afterwards the doors and windows kept open for several days.
35-Cow-pox (Vaccinia) and Vaccination
DEFINITION-Vaccinia is disease of the cow, which by inoculation, was accidentally discovered, a hundred years ago, by Jenner, to be protective against Small-pox in man.
VACCINATION is the process by which the disease vaccinia is artificially introduced into the human system for the purpose of protecting it against Small-pox.
This process is in strict accordance with the homoeopathic principle, a s it is preventive of Small-pox in consequence of the Homoeopathic relationship it bears to that disease. Its tendency is not only to prevent a fatal termination, and render the disease mild in its course, e should it occur, but to keep off the disease altogether. That it does succeed in effecting this we think the evident available tends to prove. At the same time it must be admitted that the process of vaccination is one of blood-poisoning. A Royal Commission appointed to inquire into he whole question after severe years ‘labour, reported in 1896. Although the Commissions, among whom were a number of eminent medical men, were unanimous on the point of its protective efficacy they reported as follows Where vaccination has been most through the protection appears to have been greatest. the fact that the re-vaccination of adults places them in so favorable a condition, as compared with the unvaccinated, affords further confirmation of the conclusions suggested by the evidence. We have not disregarded the arguments adduced for the purpose of showing that a belief in vaccination is unsupported by a just view of the facts. We have endeavored to give full weight to them. Having done so, it has appeared to us impossible to resist the conclusion that vaccination has a protective effect in relation to Small-pox. The most careful inquiries have failed to determine the real source of the vaccine, and whether it be Small-pox, modified by passing through the cow, or an entirely distinct disease, no one can say. To diminish risks, the Commissioners recommend the use of calf vaccine.