Baryta c. Swelling of the cellular tissue of the neck, also of the submaxillary and parotid glands.
Belladonna. Great paleness of the face, much moaning and grinding of the teeth. Stupidity, half sleeping and waking..
Hellebore. The urine is scanty and deposits a dark, coffee- ground-like sediment.
Kali carb. The dropsy commences with a Sacculated welling of the eyelids.
Lycopodium. The urine deposits red sand.
Phosphorus. Urine deposits a gray sandy sediment.
Pulsatilla. There is much pain in one ear or the other and some deafness.
Rhus tox. The eyelids present a bladder-like appearance and the child is very restless at night, particularly the last part.
Squilla. In some cases.
Veratrum. Vomiting and purging with much prostration.
See also the treatment of other dropsical affections.
Among the most important, although perhaps not the most common of the sequelae of scarlet fever, should be recorded the intense painfulness with swelling of the back of the hands, wrists, and even of the feet, which sometimes appears as the eruption is going off. The back of the hands and wrists seems to have some especial relation to scarlet fever, for in some cases the original eruption, and in others, even the subsequent dropsical affection, is entirely confined to them. This is a very dangerous sequelae, unless arrested by the proper remedies, to which however it yields with great promptitude, and is thus described by a recent observer: “This (sequelae) is seen in the inflammation, shining swelling and intense pains in the (Wrist and ankle) joints, which sometimes appears as the eruption subsides and desquamation commences. By Allopathic writers this is termed scarlatinal rheumatism, and it may be said to resemble simple arthritic inflammation also in its disposition, so much greater in children than in adults, to metastasis to the heart. But it differs from all ordinary arthritic inflammation by a almost equally marked tendency to purulent effusion into the affected joints. This form of disease, though fortunately rather rare, is sometimes epidemic. Sometimes also it is complicated with great swelling in the neck, enlargement of the sub-maxillary glands, and other indications of acute scrofulosis. ( Am, Hom. Review, II., P.438. We meet now and with secondary inflammation of the joints which may even go on the formation of pus. I saw the hand thus affected in a child who died on the sixth day of the disease. The wrist and the back of the hands are the parts usually affected. The symptom is always a very ill- omened one, even though it should be but evanescent, &c. West. I have several times, when the rash of scarlet fever was disappearing, known pain and swelling of the larger joints to supervene, simulating very closely the local phenomena of sub- acute rheumatism. Watson.
The remedies for this painful affection, especially where it appears by itself as the principal symptom, may be found in Belladonna, Bryonia, Lachesis; or others, where other complications present.
Neuralgic pains in extremities and other parts, study Lachesis, Colchicum, Mercurius Sol., Arsenicum, Digitalis, and Cannabis.
Scrofula, in the form of enlarged and even suppurating cervical and submaxillary glands, in many cases, forms an important sequelae of scarlet fever. This affection may begin in the course of the original disorder, especially of the anginose variety, or it may be subsequently and more gradually developed. Dr. Condie’s description of this affection as it appears in the course of the scarlet fever itself, with slight modification, will apply equally well to its subsequent development in other cases. “One of the most common and remarkable accompaniments of scarlatina anginosa is an inflammatory intumescence of the submaxillary ganglions, which in general present itself the day subsequent to that in which the swelling occurs in the pharynx. There then takes place a swelling painful to the touch, and sometimes tense and red. The inflammation is at first confined to the glands, but in many cases soon extends to the surrounding cellular tissue, often producing an enormous tumefaction, reaching around the front of the throat from ear to ear, and preventing the jaw from being opened wider than just to permit the tip of patient’s tongue to be protruded. Ordinarily the swelling is produced by an oedematous condition of the cellular tissue of the throat, and quickly disappears as the inflammation of the glands diminishes, Occasionally however, a suppuration takes place, commencing either in the glands or in the cellular membranes, an an abscess results. Sometimes two, or even three or four abscesses may be seen running at the same time, in the slow convalescence after a severe attack of scarlatina in scrofulous children.
The remedies needed in such cases may be found indicated under Scrofula in a succeeding chapter, to which reference may be made. Silicea, Hepar, Baryta c., Calcarea c., and Mercurius iod., may be particularly mentioned, as worthy of especial study in this connection.
MEASLES MORBILLI.
In frequency and importance the measles constitutes the second of the eruptive fevers of childhood.. Like scarlet fever, this disorder arises from a specific epidemic and infectious miasm, and usually occurs but once. The nature of the miasm itself, as in the case of other endemic, epidemic, infectious and contagious disease, is by no means satisfactorily settled. A certain mould, or fungous growth on damp straw or other decaying vegetable matter, has been observed to give rise to the measles in newly- enlisted soldiers lodged in barracks. In a similar manner, decaying animal matter, putrescent fish, has been known to cause the severest epidemics of this disorder. In both these classes of cases, in which many lives were lost, the development of the measles, as a malignant disorder, seems to have been favored by the impurity of the air and low and damp temperature of the climate. ( Compare Carpenter’s Human Physiology, Chapter III.; and Pereira’s “Treatise on Food and Diet. New York, 1843, p. 43).. Unlike scarlet fever, this disease is apt of be much more severe when it occurs later in life, than when it appears in early childhood. The epidemic character of measles seems also rather more strongly marked than that of scarlet fever, and its contagiousness possibly a little less so, for its epidemic influence is much more universal in the districts where it breaks out, than is the scarlet fever; and the disease itself is at once much more universal and far less dangerous.
Diagnosis. From scarlet fever, with which the measles is most apt to be confounded, it cannot always be certainly distinguished, in sporadic cases, before the appearance of the eruption. But the absence of vomiting, (although even this symptom may sometimes precede the appearance of measles,) the presence of catarrhal symptoms, or an apparent influenza, will usually be sufficient to prevent even the inexperienced practitioner from giving a wrong diagnosis. While the prevalence of one epidemic or the other will in most cases, greatly assist him in determination of their nature. At any rate where there is room for doubt, it is far better to give a guarded diagnosis; and thus avoid the imputation of ignorance or inexperience, which would arise in case of a mistake.
Symptoms. After a period of incubation of thirteen or fourteen days, the eruption of measles makes its appearance. But about the tenth day after the exposure to the infection, the introductory fever arises. This fever is often severe, attend with lassitude, shivering, thirst, dry cough. “The eyes become vascular and watery, the eyelids heavy, turgid and red. The membrane which lines the nasal cavities, the fauces, the larynx, trachea, and bronchial tubes, is affected. Hence we have, generally, as symptoms, much sneezing as well as lachrymation, a copious defluxion from the nostrils, soreness of the throat, and an obvious redness of the fauces, and most commonly a dry, hoarse, peculiar cough, so that the symptoms which usher in an attack of measles, are the symptoms of coryza and catarrh. In some instances there is diarrhoea also, indicating a simultaneous affection of the mucous membrane of the intestines; and not unfrequently vomiting: but the vomiting, as in small-pox, ceases on the coming out of the eruption. Watson
The eruption usually makes it appearance on the fourth day, sometimes much later. It comes out first upon the face, whence in the course of a couple of days it extends over the body and extremities. The eruption of measles consists of a rash made up at first of minute papillae, slightly elevated, which, as they multiply, coalesce into blotches that have more or less a horse- shoe or crescentic shape and leave the intermediate portions of the skin of their natural color. On the third or fourth day of the disease, the skin begins to be covered with an eruption of small distinct red spots, these first becoming visible about the throat and face. The blotches of eruptions are of an irregular circular or semicircular figure, and continue for the most part distinct from one another. The several spots or points in them rise slightly above the general level and are felt to be rough and uneven under the fingers. ( Robt. Willis’ “Illustrations of Cutaneous Disease, Folio, London, 1841). After about forty-eight hours from its appearance, and the time it is at its height on the trunk, the eruption begins to disappear form the face, and by the ninth or tenth day it will have disappeared entirely; thus making its whole duration about six days. The desquamation of measles, less constant and noticeable than that of scarlet fever, takes place in minute branny scales, instead of the larger portions of cuticle which are sometimes thrown off after the latter disease. In severe cases of measles however, as in scarlet fever, the desquamation is more extensive; and in some instances even the nails of the gingers are similarly thrown off, and replaced by new growth.
