ACUTE SPECIFIC DISEASES
15. Scarlet Fever (Febris Rubra) – Scarlatina.
THE mortality of Scarlet fever is very large, the disease destroying every year in this country the lives of some twenty thousand persons. During the same time it more or less completely disables, often for a long period, a hundred thousand others. Yet, judging by the results and have been effected by disinfection, separation, and preventive treatment, by far the larger amount of this waste of life and costly sickness might be averted.
Scarlet fever is chiefly prevalent in children, especially from the second to the fifth year of life. It is by no means infrequent during the second year, and even occurs before the end of the first, although infants a few months old seem to enjoy a special immunity. We have often attended families in which all the children have been suffering from the disease except the baby, who, crowing and smiling all the time, was the only one unaffected. After the tenth year the susceptibility rapidly diminishes. The common notion that Scarlatina is a mild, and Scarlet fever a severe form of the disease, is incorrect, for the terms are synonymous.
VARIETIES.- There are three varieties, or, more correctly, degrees of intensity; for though it is convenient to speak of Scarlatina simplex, S. Anginosa, and S. maligna, they are but one disease, manifesting different degrees of severity. Exposure to the infection of S. simplex may give rise to an attach of S. maligna and the reverse. The same organs are affected, the same functions are disturbed, and organs are same secondary diseases follow in each case. The characteristics of each variety are as follows :- 1. S. simplex. A scarlet rash with moderate fever and slightly enlarged and inflamed tonsils. 2. S. anginosa, those of S. simplex of the throat, and swelling of the submaxillary glands. 3. S. Maligna. The rash is of a dark-red colour, often haemorrhagic, and comes out later than in the other varieties, and often imperfectly or irregularly; there is no ulceration of the throat or glandular enlargement, but profound toxaemia, shown by a very high temperature, very rapid and feeble pulse, restlessness and delirium soon giving place to come. Death may occur within thirty-six hours.
MODE OF PROPAGATION.- Although we are ignorant of the origin of Scarlet fever, we know that it spreads by infection, and that most rapidly and persistently. It is by no means necessary to have direct contact with a patient, or to imbibe or touch anything that has been directly contaminated by him – it is not even necessary to be in the same room, in order to take the disease. The poison rapidly diffuses itself throughout the whole house unless stringent preventive disinfecting measures are adopted, and no inmate can be said to be safe unless he has previously had the disease, and even then he is not absolutely had the disease, and even then be is not absolutely so. The poison may be conveyed in milk. The unseen germs, which no microscope can detect, are not only very rapid and fatal in their action, they are also very tenacious. They lurk in all kinds of places, and cling to everything. The clothes of attendants as well as of the patient, the bedding, furniture, and walls of the rooms, persistently retain the poison. and they have been known to communicate the disease after an interval of one or two years.
GENERAL SYMPTOMS.- Scarlatina has an incubation period of two to five days. It commences with the ordinary symptoms of fever – chills, shivering, hot skin, frontal headache, rapid pulse, nausea, vomiting, thirst, and sore throat. The last-named symptom is generally the first complained of by the patient.
After a short time the pulse becomes very quick, often in children 120 to 140 in the minute. In about forty-eight hours after the occurrence of these symptoms, the rash comes out, first on the breast, then on the neck, face, body, and cover the great joints and limbs, till the whole body is covered with it.
The eruption usually fades away in the same order. Its appearance is a bright-scarlet efflorescence, consisting of innumerable smooth spots, not raised above the skin, having the colour and semblance of a boiled lobster-shell. The colour disappears on pressure, but immediately returns on its removal.
The tongue at first is coated with a creamy fur, the tip and the edges are red, the papillae are red and raised, giving it a peculiar strawberry-like appearance. This is always exhibited in the course of the disorder, and not infrequently at its commencement. The tongue afterwards becomes preternaturally clean and raw looking. A diffused redness, sometimes of a dark claret colour, covers the mouth, fauces, etc., which disappears as the febrile symptoms and rash subside. On above the fifth day the efflorescence generally begins to decline, and by about the eight or ninth entirely disappears, leaving the patient prostrate.
During a period of uncertain length, the outer skin comes off as scurf, or moulded masses are thrown off, especially from the hands and feet. The disease does not, however, always pursue this uniform course. In the exceedingly dangerous form we have described, the eruption is either entirely wanting, or livid and partial. In the anginose variety the mucous membranes are threatened with gangrene, the glands and even the cellular tissue of the neck are very much swollen, membranous exudation as in Diphtheria may form in the pharynx and spread up into the nose, constitutional disturbance is profound and the child may quickly die. Short of this there may be extensive suppuration and sloughing in the tissue of the neck.
TREATMENT.- At the commencement of the illness, of before its true nature is recognised, the febrile symptoms may be modified by a dose of Aconite every two for three hours. When the characteristic redness of the skin or throat shows itself, Belladonna should be administered in a similar manner; or if the fever continue high, the two medicines may be given alternately, at intervals of two hours. If the case be one of S. simplex no other medicine will probably be needed, until it is on the decline, when Sulph. should be taken night and morning for two or three days. In S. anginosa, Aconite will hardly be needed, Apis or Mercurius will have to take the place of Belladonna, and, if the heat of skin or restlessness be considerable, in alternation with Gelsemium. In S. maligna, Ailan, or Ammonium-Carb.will be more especially called for.
Difference between MEASLES
1. Rash comes out on the fourth day
2. Catarrhal symptoms are prominent watery discharge from the eyes and nose, sneezing, harsh cough etc.
3. The rash begins near the roots of the hair
4. The rash is of a pinkish-red of raspberry colour. The white streak produced by the back of the nail is not uniform, and lasts a shorter time than in Scarlet fever.
5. The eruption is somewhat rough, so as to be felt by passing the hand over the skin, and is crescentic groups, with natural skin between.
6. Liquid, tender, watery eye 7. The cuticle is thrown off in minute portions, like fine scale of bran 8 The most common sequelae are diseases of the lungs, eyes, ears and skin.
1. Rash appears on the second day.
2. Catarrhal symptoms are usually absent, but there is great heat of the skin, sore throat, and sometimes delirium.
3. The rash begins on the neck and face.
4. The eruption is of a bright scarlet colour, and by drawing the back of the nail over the skin a white streak is produced, which lasts two or three minutes.
5. The rash usually presents no inequalities to sight or touch, and is so minute and closely crowded as to give the skin a uniformly red appearance.
6. A peculiar brilliant stare, as if the eyes were glazed.
7. Desquamation of the cuticle is usually in large patches, especially from the hands and feet.
8. The most frequent sequelae are dropsy, especially after milk cases, and glandular swellings.
DANGERS.- Pneumonia, Bronchitis, Diphtheria, and inflammation of the larynx may arise during the course of the disease. Phthisis, Diphtheria, disease of the glands and bones, Chronic Ophthalmia, Otorrhoea, and skin diseases may follow the attack.
TREATMENT.- In the early stage Aconite should be given every two or three hours to subdue the fever. As soon as the symptoms peculiar to the disease manifest themselves, Pulsatilla must be administered alone every two or three hours, or, if necessary, in alternation with the Aconite at intervals of two hours. The cough almost invariably attendant upon the disease may be mitigated by a dose or two Belladonna or Hyoscyamus If the eye-symptoms are very troublesome, great smarting and intolerance of light, they should be bathed every few hours with a lotion of Euphrasia, in the proportion of a teaspoonful to a teacupful of water.
INDICATIONS FOR THE ABOVE AND OTHER REMEDIES.
REMEDIES.- Aconitum – Febrile symptoms at the outset or during the process of the disease. A dose every third or fourth hour.
Ant.Tart.- Where there are decided bronchial symptoms, or nausea with white-furred tongue.
Belladonna.- Sore throat, dry, barking cough, etc.; headache, drowsiness, or restlessness, and tendency to delirium.
Bryonia.- Imperfect or suppressed eruption, stitching pains in chest, difficult breathing, cough, etc. For a sudden recession of the eruption, this remedy, or Aconite may be given every half hour.
Euphrasia.- May be called for when the discharge of tears is profuse.
Gelsemium.- Slow development or retrocession of the rash.
Mercurius Sol. 3x and Cor. 3x.- Ulcerous, glandular, or dysenteric affections.
Phosphorus.- Dry, hollow cough, with tendency to Pneumonia.
Pulsatilla.- Almost specific, especially for the symptoms of cold, gastric derangement, phlegm in the chest, etc. It is most useful after the fever has been modified by Aconite, and rarely any other remedies are required.
Sulphur.- After the eruption has completed its natural course, and the other remedies are discontinued. It may avert secondary diseases. A dose morning and night, for several days.
Measles is often succeeded by diseases of the lungs, eyes, ears, bones, or some affection of the skin. These are often far more serious than the malady itself, and generally require professional treatment. They may often be prevented by the administration of Sulphur, or other remedy indicated. Sequelae are infrequent after homoeopathic treatment. If, however, after the decline of the eruption, the patient retains a temperature above 100oF., some complicating disturbance may be suspected.
REMEDIES FOR THE SEQUELAE.
Inflammatory Affections of the Eyelids.- Aconite, Belladonna, Mercurius- Cor.- Sulph.
Purulent Discharge from Ear, or Deafness.- Hepar-Sulph., Mercurius, Pulsatilla, Silicea, Sulphur
Glandular Swellings.- Calcarea-Card., Iodium, Lye., Mercurius
Chest Complication.- Arsenicum, Hepar-Sulph., Kali bichromicum, Spongia
Cutaneous Eruptions.- Iodium, Arsenicum, Sulphur
Styes.- Belladonna, Calcarea carb., Pulsatilla- Sulph.
Consumption – Wasting, Cough, Hoarseness, etc.- Arsenicum, Drosera, Hepar-S, Phosphorus, Spongia, and Cod-liver oil.
MEASLES and CONSUMPTION.-
Tubercular diseases of the lungs, or more often of the bowels, or of the bronchial glands, or miliary tuberculosis (in which very minute tubercles are seeded over, it may be several organs) are by no means infrequent sequels in delicate children. When, therefore, a child makes but slow or imperfect recovery from Measles and the temperature remains up, a grave constitutional disease may be suspected, and no time should be lost in obtaining professional advice.
ACCESSORIES.- When Measles occur before weaning, the infant may refuse to suck, in consequence of the closure of the nasal passages; resort must then be had to artificial feeding with spoon. Cold water, gum-water, barley-water, etc., and the best drinks. No stimulants. As the fever abates, milk diet may be given, gradually returning to more nourishing food. Should the eruption be imperfectly developed, or recede suddenly, the child should be put into a hot bath, or be packed in a blanket wrung out or hot water. During the whole of the illness the wet-pack and tepid sponging, with careful drying, should be employed once or twice a day, and the linen should be frequently changed. We have emphasized “frequent change linen,” as there exists a widespread prejudice among mothers and nurses against clean clothes in this disease. The patient should be kept warm in bed, with the room equably warmed to about 65o, but light and well ventilated, a shawl or curtain being so suspended as to protect the eyes. A fire, except in the very height of summer. After the disease has subsided the patient should be warmly clad (in flannel), and taken into the open air frequently when the weather is fine. But he must not go out of doors too soon, or be at all exposed to cold, draughts, or wet.
PREVENTIVES.- Pulsatilla every morning and Aconite every evening for a week or ten days, during the prevalence of Measles.
INDICATIONS FOR THE ABOVE AND OTHER REMEDIES.
Aconitum.- Hot, skin, thirst, headache, restlessness, and other febrile symptoms.
Ailanthus Gland.- Malignant Scarlatina, with purple or nearly suppressed rash, foetid discharge from the nostrils, cracking at the angles of the mouth, etc. It should be given directly unfavourable symptoms are observed, and frequently repeated until improvement ensues. This is indicated by increase of the eruption, by its assuming a scarlet colour, and by diminished circulatory and nervous disturbances.
Ammonium-Carb.- Very decided physical and mental prostration.
Apis.- Urgent throat symptoms, and when there is more oedema than ulceration.
Arsenicum.- Severe prostration, excessive thirst, cold clammy sweats, frequent weak pulse, threatened diarrhoea.
Belladonna.- Is specific in, and exerts a direct power over, Scarlet fever it its simple form. When the eruption is of a scarlet colour the disease will frequently yield to the action of this remedy without the aid of any other.
Gelsemium.- Imperfect eruption, nervous restlessness, remittent symptoms.
Mercurius Sol.6.- Inflamed, swollen, or ulcerated throat; different swallowing; copious saliva, ulcers in the mouth; acrid discharge from the nostrils.
Muriatic Acid.- Malignant sore throat, with extreme depression, tremors, etc.
Sulphur.- When the disease is on the decline, to prevent secondary complaints; a dose morning and night for several days.
Veratrum Viride.- Severe cerebral disturbance, vomiting, and very rapid pulse.
ADDITIONAL REMEDIES.- Ant.Tart. (in the first stage, if attended with convulsions, cold sweat, difficult breathing or vomiting); Coffea or Hyoscyamus (restlessness and sleeplessness); Cuprum-Acet. (sudden retrocession of the rash); Digit. (little urine, dropsy); Arum triph. (ulceration of throat, raw condition of nostrils, lips, and mouth); Crot. or Echinacea (S. anginosa or S. maligna); Hepar Sulph. (to prevent after-effects of Scarlet fever).
SECONDARY DISEASES (Sequelae).- The following are the chief :- 1. Inflammatory swelling of the glands of the neck, which in scrofulous children may attain a large size, suppurate, and the pus burrow under the muscles of the neck. Mercurius, Hepar S., and Calcarea, are the chief remedies. 2. The inflammation of the throat may be extended along the Eustachian tubes, producing deafness by their obstruction, or by suppuration of the tympanum, or some other mischief of the ear. The remedies recommended are Belladonna, Mercurius, Aurum, or Pulsatilla3. But the most frequent and dangerous sequel is Anasarca, the treatment of which will be found in Section 16.
Complete suppressions of urine without dropsy is far from uncommon.. It may last for several days, and terminate either in the gradual resumption of the functions of the kidneys, or in blood-poisoning, sudden Convulsions, and death.
ACCESSORIES.- The patient should be placed in a separate room which can be so ventilated as to secure a copious and continual supply of fresh air; for the one means above all others which mitigates the virulence and infectiveness of Scarlet fever is ventilation. The room should be as free from furniture as possible. Curtains, carpets, and woollen stuffs should be removed.
A fire is necessary in cold weather. Condy’s fluid or carbolic acid should be freely used about the room; and a sheet across the open door, kept moist with the disinfectant, will purify the air for the patient, and lessen the infection through the house. Sponging the surface of the body with tepid water, piece by piece, moderates the great heat and always restlessness, quiets delirium, lowers the pulse, and favours sleep. A wet bandage to the throat, when it is affected, is a sovereign remedy, and seldom fails to relieve.
It should be fastened both at the back of the neck and at the top of the head, so as to protect the glands near the angles of the jaws. Inhalation of steam from hot water is useful when the throat is sore and painful. The wet-pack, especially at the commencement, is often most valuable, and if may be repeated several times, at few hours’ interval, as long as severe febrile symptoms continue; but it requires to be administered by an experienced person.
When the eruption is slow in coming out, or is suddenly suppressed, the child should have a hot bath (see Section 7) or be packed in a blanket wrung out of hot water. During convalescence, warm clothing, including, flannel is necessary; and subsequent a change of air, if possible to the seaside. The patient must not, however, go out too early, as secondary symptoms are of frequent occurrence from neglect of this precaution.
In all cases of S. Anginosa, or indeed in all but the mildest cases of Scarlatina, a toilet of the throat should be instituted. The simplest is swabbing the throat with carbolic oil (1 to 10). The best method is that of Caiger (Practitioners’ Encyclopaedia of Medicine and Surgery, p.72), “A four-ounce rubber ball syringe, the nozzle of which should be short to avoid risk of damaging the palate…is introduced between the bicuspid or molar teeth, passed over the surface of the tongue, and then directed backwards, so that the stream of fluid impinges on the tonsils and back of the pharynx, the patient’s head being meanwhile bent over a basin to catch the escaping lotion…three drachms of powdered chlorate of potash and a quart of water gradually added, the vessel being frequently….shaken up…This solution should be diluted a pint of fluid used on each occasion.”
DIET.- During the whole course of the fever, milk, either alone or with plain or soda-water, thin gruel, sago, arrowroot, yolk of egg beaten up with cold milk, grapes, oranges, and cooked fruits, should be the staple diet. The drink may consist of cold water, gum-water, barley-water, weak lemonade, etc. in small quantities as frequently as desired. As soon as the fever subsides, the patient may gradually and cautiously return to more substantial food. Stimulants are rarely necessary except in malignant cases, when wine, brandy, Liebig’s extract of beef, beef-tea, etc., may be given regularly in frequent small doses, under medical care.
1. To to adopted by the unaffected : During the prevalence of Scarlatina, a dose of Belladonna should be given, morning and night, to children who have not had the disease. The first or second dilution of the tincture is best for this purpose. Should the disease occur notwithstanding this treatment, its severity will be much mitigated. The author has great faith in the virtue of Belladonna thus used, both as the result of his own experiences, and from the testimonies of numerous confreres and correspondents.
2. To be adopted by the attendants upon the invalid : The attendant should have as little intercourse with the other members of the household as possible. She should wear over her ordinary clothes as overall which she can readily take off the hang on a peg before she leaves the sick-chamber. She should also dip her hands into a disinfectant after touching the patient, and especially before quitting the room. Condy’s fluid or Chloride of Lime – one tablespoonful of either to about a gallon of water – is usually employed for this purpose.
All excretions from the invalid should be disinfected with the Chloride of Lime solutions, and disposed of at once. All washing apparel that has been used by the patient should, on its removal, be immediately placed in a vessel containing a sufficient quantity of either of the above disinfectants, and be put out of doors as soon as possible, and afterwards boiled in the disinfectant. Woollen cloths, bedding, etc., that do not admit of being boiled, should either by burnt or fumigated by burning a sulphur candle, procurable at any oilman’s. The sick- chamber itself, when the patient is permitted to leave it, should be disinfected in a similar way, doors, windows and fireplaces having been securely closed.
16. Post-Scarlatinal Dropsy (Acute Tubular Nephritis.)
Homoeopathists may rejoice in the fact that under homoeopathic treatment this grave sequel of Scarlet fever is neither so frequent nor so intractable as in allopathic practice.
SYMPTOMS.- About the twelfth day after the subsidence of the fever, the subcutaneous areolar tissue becomes infiltrated with serous fluid; there is often frequent desire to pass water, which is scanty and high-coloured or smoky-looking or bloody, and albuminous. If examined by a microscope, the urine is seen to contain renal tube-casts. The pulse is quick, the temperature raised, it may be to 103o, the skin dry; the child is thirsty; and the body, face, and limbs are pale and oedematous. Occasionally the cavities of the body are more or less filled with fluid. When the cavity of the chest is invaded, there are the following symptoms – short, difficult breathing, violent action of the heart, increasing distress and lividity of the face, often followed by death. Occasionally the kidney complication exists from the outset of Scarlet fever, and is rather form of the disease than a sequel.