TREATMENT OF SCARLET-FEVER
33. DIFFERENT METHODS OF OTHER SCHOOLS.
Before giving the description
of hydriatic treatment of scarlet-fever, I shall,
for the sake of a better appreciation, glance over
the different methods which have been recommended by
other schools.
34. THE EXPLETIVE METHOD (blood-letting)
has been advocated by some of the
best authorities, and there cannot be a doubt but
that it must have rendered good service in cases of
violent reaction, or else men like de Haen, Wendt,
Willan, Morton, Alcock, Dewees, Dawson, Dewar, Hammond,
&c., would not have pronounced themselves in favor
of it. However it requires nice discrimination
and a great deal of experience, as in any case where
it does no good it is apt to do a great deal of harm,
by weakening the patient and thus depriving him of
that power which he so much needs in struggling against
the enemy invading his system. Besides, the expletive
method has found many antagonists of weight:
Simon, Williams, Tweedie, Allison and others have
shown the danger of a general and indiscriminate use
of it. Williams, in his comparison of the
epidemics of scarlatina from 1763 to 1834, has come
to the conclusion that the possibility of a cure in
cases of blood-letting, compared with the cases where
the patients have not been bled, is like 1:4; i. e.
four patients have died after blood-letting, when
only one died without bleeding. “Experience
has equally shown, says Dr. Allison, that the expectation
entertained by Dr. Armstrong and others, that by
early depletion the congestive or malignant form of
the disease may be made to assume the more healthy
form of inflammation and fever, is hardly ever realized;
and in many cases, although the pulse has been full
and the eruption florid in the beginning, blood-letting
(even local blood-letting) has been followed by a rapid
change of the fever to a typhoid type, and manifestly
aggravated the danger.” My own
experience would prompt me to declare myself against
blood-letting in general, even if I had not a sufficient
quantity of water at hand to manage the violent or
irregular reaction of a case. Blood-letting, in
any case of eruptive fever, and with few exceptions
in almost every other case, appears to me like pulling
down the house to extinguish the fire. A little
experience in hydriatics, a few buckets of water, with
a couple of linen sheets and blankets, will answer
all the indications and remove the danger without
sending the patient from Scylla into Charybdis.
35. THE ANTI-GASTRIC METHOD,
consisting in the free use of emetics
or purgatives, has been recommended by some eminent
practitioners. Withering, Tissot, Kennedy
and others are in favor of the former, and find fault
with the latter, whilst Hamilton, Willard, Abernethy,
Gregory, &c., prefer purgatives, and some, of course,
look upon calomel as the anchor of safety, which they
recommend in quantities of from five to ten grains
per hour. The friends of one part of the anti-gastric
method make war upon the other: Withering finding
purgatives entirely out of place and Sandwith, Fothergill
and others having seen nothing but harm done by them,
whilst Wendt, Berndt, Heyfelder and others
caution their readers against emetics. The anti-gastric
method has been of some service in epidemics and individual
cases, when the character of the disease was decidedly
gastric and bilious. To use emetics or purgatives
indiscriminately would do much more harm than good;
as, for instance, during a congestive condition of
the brain, the former, and with inflammatory symptoms
of the bowels, the latter, would be almost sure to
sacrifice the patient to the method.
36. THE AMMONIUM CARBONICUM,
recommended by Peart, has been
considered by many as a specific capable of neutralizing
the scarlatinous poison, whilst others have used it
only as a powerful tonic in torpid cases. Experience
has shown that it is not a specific, and that its
use as a tonic, requiring a great deal of care and
discrimination, is a good deal more dangerous than
the mode of treatment I am going to recommend in cases
where tonics are required.
37. CHLORIDE OF LIME.
About the same opinion may be given
on Chloride of Lime. As a gargle, and
taken internally, the aqua-chlorina has done good service
in malignant scarlatina, especially in putrid cases.
38. ACETIC ACID.
Brown recommends diluted Acetic
Acid as a specific against all forms of scarlatina.
Experience, however, has not supported his confidence
in the infallibility of his remedy.
39. MINERAL ACIDS (MURIATIC ACID--PRESCRIPTIONS)
have also been used with good effect
in some epidemics. Muriatic acid I have frequently
used myself for inflammation of the throat, in connection
with hydriatic treatment, and it has almost always contributed to relieve the
symptoms materially.
40. FRICTIONS WITH LARD
were used already by Caelius Aurelianus, and recently re-introduced into practice, by Drs. Daene and Schneemann, in Germany, and by Dr.
Lindsley, in America. Even hydriatic physicians
have tried them with some success. However, notwithstanding
the strong recommendations of the remedy on the part
of the above named practitioners and others, the efficacity
of it as a general remedy for scarlet-fever has not
been confirmed. On the contrary, Berend and
Hauner found that it did not prevent desquamation,
as it had been asserted, and even Richter restricts
his commendations to the vague assertion “that
it seemed to him as if the cases when he used the
lard were made milder than they would have been without
it.”
41. BELLADONNA.
The remedy which has attracted and
still attracts in a very high degree the attention
of physicians and parents, is Belladonna.
This remedy was first introduced as a specific and
prophylactic by Hahnemann, and soon recommended not
only by his own disciples, but by some of the best
names of the “regular” school. But
soon after, as many physicians of standing declared
themselves adversaries to Hahnemann’s discovery,
and whatever may be the merits of belladonna as a specific
and prophylactic in some quarters, it is certain that
it never answered the expectation raised by its promulgators
in others. As far as my own experience extends,
I have seen very little or no effect from it.
I have restricted myself, it is true, to homoeopathic
doses, being afraid of the bad consequences of larger
quantities in children; but from what I have seen
in my own practice and that of some other physicians
with whom I was familiar, I cannot but advise my readers
not to rely either on the prophylactic or the
curative power of belladonna, when a safer and more
reliable remedy is offered to them. A remedy may
be excellent in certain cases and certain epidemics,
and many an honest and well-meaning physician may
be deceived into the belief that he has a general remedy
in hand, whilst others, or himself, on future occasions
discover that he has allowed himself to be taken in.
Had not belladonna and aconite proved beneficial in
many cases, they would scarcely have acquired their
reputation, but with all due respect for Father Hahnemann
and his system, I must deny belladonna to be a general,
safe and reliable remedy in the prevention and cure
of scarlet-fever.
42. THERE IS NEITHER A SPECIFIC
NOR A PROPHYLACTIC TO BE RELIED ON.
All these different methods and remedies,
and many others, have been and are still used with
more or less effect. But where there are three
physicians to recommend one of them, there will always
be four to contradict them. They may all do some
good in certain epidemics or individual cases; they
may relieve symptoms; they may save the life of many
a patient who would have died without them (although
many a patient who died, might have lived also, had
he been under a more judicious treatment, or under
no treatment at all.) But none is reliable in general;
none contains a specific to neutralize the morbid poison;
none is a reliable prophylactic, such as vaccina
for small-pox; and if single physicians, or whole
classes of physicians, assert to the contrary, the
fault must lie somewhere, either in their excess of
faith in certain authorities, which induces them to
throw their own pia desideria into the scales,
or in a want of cool, impartial observation continued
for a sufficient length of time to wear out sanguine
expectations. The fact is that there neither exists
a reliable prophylactic, nor has a safe specific been
found as yet; that all is guess-and-piece work; and
that people are taken by scarlet-fever and die of
it about the same as before those vaunted methods
and remedies were discovered. I wish to impress
my readers with this fact the proofs of
which they can easily find in the mortality lists
of the papers to make them understand that
by giving up for the hydriatic method any of the modes
and remedies, which have been in use hitherto, they
do not run a risk of losing anything.
43. WATER-TREATMENT, AS USED
BY CURRIE, REUSS, HESSE, SCHOENLEIN, &C.
Beside the above modes of treatment
cold and tepid Water has been extensively
used and recommended by reliable authorities.
Currie, Pierce, Gregory, Bateman, von Wedekind,
Kolbany, Torrence, Reuss, von Froehlichsthal,
and others, have treated their scarlet-patients with
cold affusions. Henke, Raimann, Froehlich,
Hesse, Steimmig, Gregory, Jr., Schoenlein,
Fuchs, and others, have not ventured beyond cool
and tepid ablutions. The former, although
the general result has been very satisfactory, have
proved dangerous in some cases; and the latter, though
safer in general, have not been efficient in many
others. The use of water, though safer than other
remedies, has never become general, owing to the
unsystematic, unsafe, or inefficient forms of its
application.
Fear and prejudice fed
by the great mass of physicians, who generally take
too much care of their reputation to expose it in the
use of a remedy the effects of which are so easily
understood by every one have also been
obstacles to its promulgation; and the exaggerations
of some of its advocates in modern times, bearing
for a great part the characteristics of charlatanism,
have scared many who might have become converts to
Priessnitz’s method, to whose genius and good
luck we are indebted for the most important, most
harmless, and at the same time the most efficient
and most reliable discovery, viz.:
44. PRIESSNITZ’S METHOD--THE
WET-SHEET-PACK,
a remedy which, alone, is worth the
whole antiphlogistic, diaphoretic, and, indeed, the
whole curative apparatus of the profession, in ancient
and modern times, for any kind of fevers, and especially
for eruptive diseases. Nor did the physicians
before Priessnitz know anything about the use of the
sitz-bath for affections of the brain in torpid
reaction, which in such cases, is the only anchor of
safety. In short, water-treatment was, like other
methods, an excellent thing for certain symptoms,
but not generally and safely applicable in every case.
To appreciate the effects of the wet-sheet
pack, one must have seen it used for inflammatory
fever, when it acts like a charm, frequently removing
all the feverish symptoms, and their cause, in a few
hours.
45. TECHNICALITIES OF THE PACK AND BATH.
Let me give you its technicalities, and the rationale
of its action:
A linen sheet, (linen is a better
conductor than cotton,) large enough to wrap the whole
person of the patient in it (not too large, however;
if there is no sheet of proper size, it should be doubled
at the upper end) is dipped in water of a temperature
answering to the degree of heat and fever, say between
fifty and seventy degrees Fahrenheit, and more or
less tightly wrung out. The higher the temperature
of the body, and the quicker and fuller the pulse,
the lower the temperature of the water, and the wetter
the sheet. This wet sheet is spread upon a blanket
previously placed on the mattress of the bed on which
the packing is to take place. The patient, wholly
undressed, is laid upon it, stretched out in all his
length, and his arms close to his thighs, and quickly
wrapped up in the sheet, head and all, with the exception
of the face; the blanket is thrown over the sheet,
first on the packer’s side, folded down about
the head and shoulders, so as to make it stick tight
to all parts of the body, especially the neck and
feet, tucked under the shoulders, side of the trunk,
leg and foot; then the opposite side of the blanket
is folded and tucked under in the same manner, till
the blanket and sheet cover the whole body smoothly
and tightly. Then comes a feather-bed,
or a comforter doubled up, and packed on and around
the patient, so that no heat can escape, or air enter
in any part of the pack, if the head be very hot,
it may be left out of the pack, or the sheet may be
doubled around it, or a cold wet compress, not too
much wrung out, be placed on the forehead, and as
far back on the top of the head as practicable, which
compress must be changed from time to time, to keep
it cool. Thus the patient remains.
46. The first impression of the
cold wet sheet is disagreeable; but no sooner does
the blanket cover the sheet, than the chill passes
away, and usually before the packing is completed,
the patient begins to feel more comfortable, and very
soon the symptoms of the fever diminish. The pulse
becomes softer, slower, the breathing easier, the head
cooler, the general irritation is allayed, and frequently
the patient shows some inclination to sleep.
When the fever and heat are very high, the sheet must
be changed on growing hot, as then it would cause the
symptoms to increase again, instead of continuing
to relieve them. The best way to effect this
changing of the sheet is to prepare another blanket
and sheet on another bed, to unpack the patient and
carry him to the new pack, where the process described
above is repeated. Sometimes it is necessary
to change again; but seldom more than three sheets
are required to produce a perspiration, and relieve
the patient for several hours, or according
to the case permanently. The changing
of the sheet may become necessary in fifteen, twenty,
twenty-five, thirty or forty minutes, according to
the degree of fever and heat. In every new sheet
the patient can stay longer; in the last sheet he becomes
more quiet than before, usually falls asleep, and
awakes in a profuse perspiration, which carries off
the alarming symptoms.
47. A few minutes before the
perspiration breaks out, the patient becomes slightly
irritated, which irritation is removed by the appearance
of the sweat. I mention this circumstance, to
prevent his being taken out just before the perspiration
is started. When he becomes restless during
perspiration, he is taken from his pack and placed
in a bathing-tub partly filled with cool or tepid
water, (usually of about 70 deg.,) which has
been prepared in the meanwhile; there he is washed
down from head to foot, water from the bath being
constantly thrown over him until he becomes cool.
Then he is wrapped in a dry sheet, gently rubbed dry,
and either taken back to his bed, or dressed and allowed
to walk about the room. When the fever and heat
rise again, the same process is repeated.
48. ACTION OF THE PACK AND BATH.--RATIONALE.
The action of the wet-sheet pack is thus easily accounted
for:
According to a well-known physical
law, any cold body, whether dead or alive, placed
in close contact with a warm body, will abstract from
the latter as much heat as necessary to equalize the
temperature of both. The transfer of caloric
will begin at the place at which the two bodies are
nearest to each other. The wet sheet, which touches
the patient’s body all over the surface, abstracts
heat from the latter, till the temperature of the
sheet becomes equal to that of the body. In proportion
as the surface of the body yields heat to the sheet,
the parts next to the surface impart heat to the latter,
and so forth, till the whole body becomes cooler,
whilst the sheet becomes warmer. As the heat
imparted to the sheet cannot escape from it, the sheet
being closely wrapt up in the blanket and bed, the
current of caloric once established towards every
part of the surface of the body will still continue;
after the temperature of the sheet and the body has
become equal, there will be an accumulation of heat
around the body, frequently of a higher degree than
the body itself. To explain this phenomenon, we
ought to consider that we have not to do with two
dead bodies, but with one dead and one
living body, which constantly creates heat, thus
continuously supplying the heat escaping from it to
the sheet, and keeping up the current of caloric and
electricity established towards the surface.
There cannot be a doubt that the abstraction of electricity
from the feverish organism contributes in a great measure
to the relief of the excited nerves of the patient,
as well as to the excess of temperature observed around
the body in the wet-sheet pack (after the patient
has been in it for some time); and that, in general,
electricity deserves a closer investigation in the
morbid phenomena of the human body than it has found
to this day.
49. WHAT EFFECT COULD BE EXPECTED FROM A WARM
WET-SHEET?
The first impression of the wet-sheet
is, as I stated before, a disagreeable one.
If it were agreeable as a warm sheet,
for instance, would be, which has been occasionally
tried, of course without doing any good it
would not produce a reaction at all, and consequently
there would be no relief for, and finally no cure of
the patient effected by it. But the impression
of the cold sheet, being powerful, is transferred
at once from the peripherical nerves, which receive
the shock, to the nervous centres (the spine, the cerebellum
and the brain), and, in fact, to the whole nervous
system, and the reaction is almost immediate; the
vascular system, participating in it, sends the blood
from the larger vessels and the vital parts, to the
capillaries of the skin; and when, through repeated
applications of the sheet, the system is relieved
and harmony restored, in a sufficient degree, in and
among the different parts of the organism, to enable
them to resume their partly impeded functions, a profuse
perspiration brings the struggle to a close, by removing
the morbid matter which caused the fever, whereupon
the skin is refreshed and strengthened, and the whole
body cooled and protected by a cool bath from obnoxious
atmospheric influences.
50. I am not aware that a better
rationale can be given of the action of other remedies.
Any physician can understand that its effect must be
at once powerful and safe, and that there is no risk
in the wet-sheet pack of the reaction not taking place,
as it may be the case in severer applications of cold
water, without the pack. One objection I have
often heard, viz.: that the process is very
troublesome. But what does trouble signify, when
the life and health of a fellow-being is at stake? It
is true, the physician is frequently compelled to
render the services of a bath-attendant, and stay
with the patient much longer than in the usual practice;
but he gets through sooner, and, if not the patient
and his friends, his own conscience will pay him for
his exertions and sacrifice of time.
There is little trouble with small
children, who make a fuss only, and become refractory,
when the parents, grandmammas and aunts set the example.
When all remain quiet, and treat the whole proceeding
as a matter of necessity, children usually submit
to it very patiently, and soon become quiet, should
they be excited at the beginning. The fewer words
are said, and the quicker and firmer the physician
performs the whole process, the less there is trouble.
After having been taught how to do it, the parents
or friends of the patient will be able to take the
most troublesome part of the business off the physician’s
hands, who, of course, has more necessary things to
do, during an epidemic, than to pack his patients
and attend to them in all their baths himself.
Only with spoiled children I have
had trouble, and more with them that spoiled them.
The best course, then, is to retain only one person
for assistance, and to send the rest away till all
is over. There are people, who will be
unreasonable; of course, it is no use to attempt reasoning
with them. I remember the grandmother of a little
patient, with whom the pack acted like a miracle,
removing a severe inflammatory fever in two hours
and a half, telling me “she would rather see
the child die, than have her packed again,”
although she acknowledged the pack to have been the
means of her speedy recovery. It is true there
was some trouble with the child, but only because
the whole family were assembled in the sick-room to
excite the child through their unseasonable lamentations
and expressions of sympathy about the “dreadful”
treatment to which she was going to be submitted.
Grandmother would not have objected to a pound of
calomel! But we shall speak about objections
and difficulties in a more proper place.
51. NO CUTTING SHORT OF THE PROCESS
OF SCARLATINA--THE MORBID POISON MUST BE
DRAWN TO THE SKIN AS SOON AS POSSIBLE.
Scarlet-fever is a disease, which
cannot be cut short. Any attempt to stop the
process of incubation, after the contagion has once
been received within the body, or to prevent its being
thrown out upon the surface, would destroy the patient’s
life: the morbid poison must be concocted, and
it must come away by being drawn to the skin as
soon as possible, to prevent its settling in the
vital parts, and injuring them. The safest way
of assisting nature in her efforts of eliminating
the poison, is to open the way, which she points out
herself. We know that the sooner and the more
completely the eruption makes its appearance, the
brighter and the more constant the rash, the less there
is danger for the patient, and vice versa.
Well, there is not a better remedy than the wet-sheet
pack, to serve the purpose of nature, i. e., to remove
the morbid poison from the inner organs, and draw it
to the surface; whilst at the same time it allays
the symptoms, improves the condition of the skin for
the development of the rash, and relieves the patient,
without depriving him of any part of that organic power
so indispensable for a cure, and without which the
best physician in the world becomes a mere blank.
Under the process of wet-sheet packing, the heat invariably
abates, the pulse becomes slower and softer, the violence
of the symptoms is alleviated, the skin becomes moist,
the restlessness and anxiety of the patient give way
to a more quiet and comfortable condition; he perspires
and falls in a refreshing sleep. Is there any
other remedy, that has the same general and beneficial
effect? I know of none.
52. NECESSITY OF VENTILATION--MEANS
OF HEATING THE SICK-ROOM--RELATIVE MERITS
OF OPEN FIRES, STOVES AND FURNACES.
Next to its intrinsic value, our method
gives the patient the great advantage of enjoying
pure fresh air, either in or out of bed, as
it keeps the skin and the whole system in such order
as to resist the effects of atmospheric influences
better than under a weakening process. And every
body knows, or, at least, every body ought to know,
that free circulation of fresh air is one of the most
important means, in contagious diseases, of preventing
the malady from becoming malignant, and of lessening
the intensity of the contagion. Although the times
are passed, when patients in the heat of fever were
almost roasted in their beds, whilst a drink of cooling
water was cruelly and stupidly denied them; the temperature
of the sick-room is, in general, still kept too high,
and not sufficient care is taken to renew the air as
frequently, I ought to say as constantly, as necessary
for the benefit of the patient. Usually there
is no ventilation; very seldom a window is opened,
especially in the cold season, when epidemics of scarlatina
are most common, and commonly the room is crowded
with friends of the patient, who devour the good air,
which belongs to him by right, and leave him their
exhalations to breathe instead. There is nothing
better able to destroy contagious poisons than oxygen
and cold; and if we consider that every human being
absorbs every minute a volume of air larger than the
bulk of its own body, we must understand how necessary
it is to keep people away from the sick-room, who
are not indispensably necessary to the patient, and
to provide for a constant supply of fresh air.
But whatever may be the arrangement for that purpose,
the patient should not be exposed to a draught.
Stoves and fire-places are pretty good ventilators
for drawing off the bad air from the room; if you take
care not to have too much fire, and to allow a current
of pure air to enter at a corresponding place, the
top of a window, or a ventilator in the wall opposite
the fire-place, there will always be pure air in your
sick-room. The air coming from furnaces, which
unfortunately have become so general, is good for
nothing, especially when taken from the worst place
in the house, the cellar or basement. I consider
the worst kind of stoves better than the best kind
of furnaces; only take care not to heat the stove
too much, or to exclude the outer air, which is indispensable
to supply the air drawn off by the stove for feeding
the fire. The difference between a furnace and
a tight stove or fire-place is this: The furnace
takes the bad air from the basement or cellar, frequently
made still poorer through its passing over red hot
iron, which absorbs part of its oxygen, and fills
the room with it. The room being filled with
poor air, none of the pure air outside will enter it,
because there is no vacuum. Thus the bad air
introduced into the room, and the bad air created
by the persons in it, will be the only supply for the
lungs of the patients. But should the furnace
take its air from outside the house, as it is the
case with some improved kinds, there would still be
no ventilation in the sick-room, except there be a
fire-place beside the register of the furnace.
With the stove or fire-place it is different:
The stove continually draws off the lower strata, i.
e. the worst part, of the air to feed the fire, whilst
pure air will rush in through every crevice of the
doors and windows to supply every cubic-inch of air
absorbed by the stove. Thus the air in the room
is constantly renewed, the bad air being carried off
and good air being introduced. However, the openings
through which the pure air comes in, must be large
enough in proportion to allow a sufficient quantity
of air to enter the room to make fully up for the
air absorbed by the stove; for, if not, the air in
the room will become thin and poor, and the patient
will suffer from want of oxygen. An open fire,
from the necessity of its burning brighter and larger
to supply sufficient heat, a comparatively large part
of which goes off through the chimney, will require
a greater supply of air, and consequently larger ventilators
or openings for the entrance of the pure air from
outside the room. In very cold weather, and in
cold climates in general, stoves are preferable to
fire-places, the latter producing a draught, and not
being able to heat a room thoroughly and equally,
causing one side of the persons sitting near them to
be almost roasted by the radiant heat in front, whilst
their backs are kept cold by the air drawing from
the openings in the doors and windows towards the
fire to supply the latter. In merely cool weather,
and in moderately cold climates, especially in damp
places, I would prefer an open fire to a stove.
In cold climates stoves are decidedly preferable, especially
earthen ones, as they are used in Germany and Russia.
Iron stoves must never be heated too much, as the
red hot iron will spoil the air of the room, by absorbing
the oxygen, as you can easily see by noticing the
sparks, which form themselves outside the stove in
very hot places.
53. TEMPERATURE OF THE SICK-ROOM.
The temperature of the sick-room
should not be much above 65 deg. Fahrenheit;
in no case should it rise above 70, whilst I do not
see the necessity of keeping it below 60, as some
hydriatic physicians advise. The patient, in the
heat of fever, will think 60 deg. high enough,
and rather pleasant; and if others do not like a temperature
as low as that, they may retire. The person necessary
for nursing the patient may dress warmly and sit near
the fire. Let the sick-room be as large as possible;
or open the door and windows of a room connected with
it. Towards the close of the disease, after desquamation
has begun, the temperature of the room may be kept
at 70 deg., as then the fever and heat have subsided
and the delicate skin of the patient requires a comfortable
temperature.
54. WATER-DRINKING.
As the patient should have a constant
supply of pure air for his lungs, so he should also
have plenty of pure cold water for his stomach,
to allay his thirst and assist in diminishing the
heat of fever, and in eliminating the morbid poison
from his blood. Though cold, the water for drinking
should not be less than 48 or 50 deg. Fahrenheit.
Whenever there is ice used for cooling the water,
the nurses should be very careful not to let it become
colder, than the temperature just indicated, except
in typhoid cases, when the stimulating effects of
icy cold water and ice may prove beneficial.
55. DIET
I have little to say with regard to
diet, at least to physicians. During great
heat and high fever, the patient should eat little
or nothing; but he should drink a good deal.
Substantial food must be avoided entirely. When
the fever abates, he can take more nourishment, but
it should be light. Meat and soup should only
be given, when desquamation has fairly begun.
Stewed fruit (especially dried apples) will be very
agreeable to the patient. In great heat, a glass
of lemonade may be given occasionally; however, great
care must be taken not to spoil the patient’s
taste by sweets, or to allow him all sorts of dainties,
such as candies, preserves, &c., as it is the habit
of weak parents, who like to gratify their darlings’
momentary desires at the expense of their future welfare.
In torpid cases, some beef-tea, chicken-broth, and
even a little wine with water, will raise the reactive
powers of the patient. During convalescence, meat
may be permitted to such patients as have been accustomed
to eat it, and, in general, the patients may be allowed
to gradually resume their former diet (provided it
were a healthy one), with some restriction in regard
to quantity. In general, under water-treatment,
the digestive organs continuing in a tolerably good
state, and the functions in better order, we need
not be quite so careful with respect to diet, as if
the patient were left to himself, or treated after
any other method of the drug-system. Let the
food be plain, and the patient will scarcely ever
eat too much. To stimulate his appetite by constantly
asking him whether he would not like this or that,
is sheer nonsense; and to satisfy his whims, against
our better conviction, is culpable weakness.
From this general outline, I shall
now pass to the treatment adapted to the different
forms of scarlatina.
56. TREATMENT OF SCARLATINA SIMPLEX,
OR SIMPLE SCARLET-FEVER.
Scarlatina simplex, or simple
scarlet-fever (9), without inflammation of the
throat, is generally so mild in its course, that it
requires little or no treatment. However, I would
not have parents look upon it as “scarcely a
disease,” as neglect and exposure may bring on
bad consequences (7 and 25). If the fever and
heat are very moderate, the first days an ablution
of the body with cool water (say 70 deg.), twice
a day, is sufficient. The patient had better be
kept in bed, or, if unwilling to stay there, he should
be warmly dressed and move about his room, the temperature
of which, in this case, should not be below 70 deg.
Fahrenheit, and the windows should be shut, as long
as the patient is out of bed.
When the period of efflorescence,
or standing out of the rash, is over, packs ought
to be given, to extract the poison completely from
the system, and to prevent any sequels, such as anasarca,
&c. (25). Should the rash suddenly disappear
before the fifth or sixth day, or should it linger
in coming out, a long pack will bring it out and remove
all danger. The packs, once begun, should be
continued, once a day, during and a few days after
desquamation. The patient may go out on the
tenth or twelfth day warmly dressed, after his pack
and bath, and walk for half an hour; sitting down
or standing still to talk in the open air is not to
be permitted. During, and some time after convalescence,
the patient should take a cool bath, or a cold ablution
every morning, immediately on rising from bed, and
walk after it as soon as he is dressed. In very
cold and disagreeable weather, the walk should be taken
in the house; but the patient should not sit down,
or stand about, before circulation and warmth are
completely restored in every part of the body, especially
in the feet. I cannot insist too much upon exercise
being taken immediately after every bath, as, without
it, the bath may do more harm than good, and dressing,
with many, will take so much time, that they will
take cold before getting their clothes on.
If the patient should take cold, or
feel otherwise unwell, during convalescence, the packs
must be resorted to again, and continued till he is
quite well.
57. TREATMENT OF SCARLATINA ANGINOSA,
OR SORE-THROAT SCARLET-FEVER.
In scarlatina anginosa, or
sore-throat scarlet-fever, which is the most
common form of the disease (1-7) we have to discriminate,
whether
1) the reaction is mild, the
heat of the body not being much above 100 deg.
Fahr. and the pulse full, but not above 110 to 120,
the pain and swelling of the throat moderate, the
brain little or not affected; or
2) violent, the heat from 106
to 112, the pulse 120 to 150 beats or more, the inflammation
of the throat decided and extensive, the brain very
much affected; or
3) torpid, little or no heat,
the pulse quick and weak, the inflammation of the
throat undecided, varying, the rash appearing slowly
or not at all, and what there appears of a pale, livid
color, the patient more or less delirious.
58. -- 1. TREATMENT OF
THE MILD OR ERETHIC FORM OF SCARLATINA ANGINOSA.
The mild or erethic form
of scarlatina anginosa requires about the same treatment
as scarlatina simplex. I would, however, for the
sake of safety, advise a pack and bath per day, through
the whole course of the disease, in the afternoon,
when the fever begins to rise; and during the period
of eruption, when all the symptoms increase, two and
even three packs a day may be required. This
depends on the increasing heat and fever, as well
as on the condition of the throat. The greater
the heat and fever, and the more troublesome the inflammation,
the more packs. If the fever and pain increase
some time after the pack, in which the patient may
stay for an hour or two, the packing must be repeated.
The length of the pack depends much on circumstances;
as long as the patient feels comfortable and can be
kept in it, without too much trouble, he ought to
stay. In case the patient cannot be prevailed
upon to stay longer than an hour, or if the fever
increases soon after the pack, it may be necessary
to repeat packing every three or four hours, which
is the general practice of several water-physicians
in Germany and England.
59. If the patient becomes restless
soon after having been packed, the heat and fever
increasing, as may be ascertained from the pulse at
the temples and the general appearance of the face,
the sheet must be changed, as directed above (46)
till the patient becomes quiet and feels more comfortable.
In case of repeated changing of sheet, the patient
should stay in the last sheet, till he has perspired
about half an hour, or longer, before he is taken
out to the bath, which should be of about 70 deg.,
as in all the mild forms of scarlatina. The length
of the bath depends on the heat, and reaction of the
patient, who should be well cooled down all over,
before going to bed again or dressing. He ought
not to be out of bed for a long time, and only after
a bath, as this will protect him from taking cold.
60. The throat should be covered
with a wet compress, i. e. a piece of linen four to
eightfold, according to its original thickness, dipped
in cold water (60 deg.-50 deg.), well wrung
out and changed as often as it grows hot. It
should be well covered to exclude the air. This
compress should be large enough to cover the whole
of the throat and part of the chest; it should closely
fit to the jaw, and reach as far up as the ear to
protect the submaxillary and parotid glands located
there.
61. When the period of eruption
is over, there is commonly less fever, and the packs
and baths may be diminished.
62. Towards the end of the period
of efflorescence, when the rash declines, fades, disappears,
and the skin begins to peal off, an ablution in the
morning of cool water, with which some vinegar may
be mixed, and a pack and bath in the afternoon, are
quite sufficient, except the throat continue troublesome,
when a pack should also be given in the morning.
The packs, once a day, should be continued about a
week after desquamation. The patient may
safely leave the house in a fortnight. I have
frequently had my patients out of doors in ten or
twelve days, even in winter.
63. This going out so early,
in bad weather, is by no means part of the treatment.
I mention it only to show the curative and protective
power of the latter, and have not the slightest objection
to others using a little more caution than I find
necessary myself. It is always better, we should
keep on the safe side, especially when there is no
one near that has sufficient experience in the matter.
I can assure my readers upon my word and honor, that
though I never kept any of my scarlet-patients longer
in-doors than three weeks (except a couple of malignant
cases), I have never seen the slightest trouble resulting
from my practice.
64. In case of some trouble resulting
from early and imprudent exposure, which is about
as apt to occur in the house as out of it, a pack or
two will usually be sufficient to restore order again.
As long as the patient moves about, warmly dressed,
there is no danger of his taking cold after a pack,
and provided packing be continued long enough, and
the patient be forbidden to sit down or stand still
in cool places, or expose himself to a draught, there
is nothing to be apprehended.
65. I have no objection to homoeopathic
remedies being used at the same time, nor would I
consider acids, as mentioned above (39), to
be objectionable in cases of severe sore throat; but
I must caution my readers against the use of any other
remedies, especially aperients, except in cases, which
I shall mention hereafter (72). In a couple of
cases, where I acted as consulting physician, I have
observed dropsical symptoms proceeding from laxatives
and the early discontinuation of the packs during
convalescence. Let the bowels alone as long as
you can: there is more danger in irritating them
than in a little constipation. As for the rest
we have injections, which will do the business without
drugs, of which I confess I am no friend, especially
in eruptive fevers.
66. -- 2. TREATMENT OF
THE VIOLENT, OR STHENIC FORM OF SCARLATINA ANGINOSA.
The violent, or sthenic
form of scarlatina anginosa becomes dangerous
only through the excess of reaction, when the heat
is extreme (upwards of 105 deg. Fahrenheit,
sometimes 112 to 114), the pulse can scarcely be counted,
as it hammers away full and hard in a raging manner,
the throat being inflamed and swollen to suffocation,
and the patient in a high state of delirium; but it
need not frighten the physician or parent acquainted
with the use of water. We have the means of subduing
that violence without weakening the patient. It
is in this form of scarlatina that the greatest mistakes
are committed by physicians unacquainted with the
virtues of water, and that our hydriatic method shows
itself in all its glory; for where there is an abundance
of heat, water cannot only be safely applied, but it
is also sure to bring relief. It is in this form
of the disease that the cold affusions recommended
by Currie and his followers, have shown themselves
so beneficial, and that the wet-sheet, used properly
and perseveringly, is almost infallible.
67. TEMPERATURE OF THE WATER--DOUBLE
SHEET--CHANGING SHEET.
The water for the wet-sheet pack,
in this violent form, ought to be cold; in summer
it should be iced down to 46-48 deg. Fahr.
The sheet ought to be coarse or doubled, in order
that it should retain more water, and it should not
be wrung out very tight. In a thick wet-sheet
the patient will be better cooled than in a thin sheet,
and he will be able to stay longer in it before changing.
It may be advisable, however, with very young and
rather delicate persons, not to double the sheet about
the feet, as they might be apt to remain cold, which
would send the blood more to the head. But, although
the patient will feel easier in the pack for a while,
the heat and fever will soon increase again, and, in
proportion as the sheet grows warmer, he will become
more and more restless, and the changing of the sheet
will become indispensable. When the symptoms
increase again, in the second pack, the sheet is changed
a second time, and so on till the patient perspires
and becomes relieved for a couple of hours or longer;
which usually happens in the third or fourth sheet.
After the first, every following sheet is wrung out
tighter and tighter, and the last one may be taken
single, or doubled only at its upper end.
68. LENGTH OF PACK--PERSPIRATION.
To make quite sure of the reaction,
the single sheet may be tried first, except in exceedingly
violent cases, and the double sheet may be resorted
to, if the single sheet prove inefficient. Or,
should there be any doubt, the double sheet may be
dipped in water of a higher temperature than that
given above, say 55 to 60 deg.. With young
and delicate children I prefer this course, especially
if they be very excitable, and the shock of very cold
water may be expected to be too much for their nerves.
In these matters some discrimination should be used:
it is always better we should keep on the safe side,
and rather give a pack more than frighten the little
patients out of their wits. Proceed safely, but
firmly and try to obtain your object in the mildest
manner possible.
69. Before perspiration comes
on, there is a little more excitement for a few minutes
(41), which must not induce the friends of the patient
to take him out of the pack; only when it continues
to increase, instead of the perspiration breaking
out and relieving the patient, it will be necessary
to change the sheet, another time, as in that case
the organism is not fully prepared for perspiration.
After the breaking out of the latter, the patient
invariably feels easier, and continues so for some
time. When the feverish symptoms increase, during
perspiration, which can be ascertained by feeling
the pulse on the temples and by the thermometer, it
is time to remove the patient from the pack, to give
him his bath. Half an hour’s perspiration
is commonly sufficient; if the patient feel easy,
however, and can be prevailed upon to stay an hour,
or longer, till a good thorough perspiration brings
permanent relief, it will be better. It would
be unwise to let the patient stay too long and get
him in a state of over-excitement; but, on the other
hand, parents ought to remember that very few children
like to be packed, and that a patient in high
fever is a bad judge of his own case. I have always
found those children the best patients, who had been
brought up in strict obedience to their patients’
dictates, before they were sick, and this, as well
as the daily habit of taking baths, and the quiet and
firm behavior of the physician and friends of the
patient under treatment generally remove all difficulty.
70. LENGTH OF BATH.
Although the temperature, in sthenic
cases, should be a little lower than in erethic cases,
it is not advisable to use the water very cold, as
this would cause too strong a reaction, and consequently
new excitement. The safer way is to let the temperature
of the bath be between 70 and 65 deg., according
to the age and constitution of the patient (the younger
and more delicate the patient, the higher the temperature),
and to let him stay long enough in the bath to become
perfectly cool all over, which can be ascertained
by placing the hand or the thermometer under the arm-pits,
which usually retain the warmth longest. I understand,
in advising such a temperate bath of several minutes,
duration, that the patient be hot and the rash standing
out full and bright on coming from the pack; or else
the bath must be colder and shorter, not exceeding
a minute or two.
71. CAUTION.
After the bath, the patient is rubbed
dry, and either taken to his bed, or, if he feels
well enough, dressed and induced to walk about the
room, or placed in a snug corner (not near the fire,
however), till he feels tired and wishes to go to
bed. During his stay out of bed, the rash ought
to be an object of constant attention for his friends;
for as soon as it becomes pale, the patient ought
to be sent to bed immediately and covered well, or
should then the rash continue to become paler and
paler, the pack should be renewed, and the patient
kept in bed ever after, till desquamation is
over.
72. THE WET COMPRESS.
In bed, a wet compress is put on the
throat, and another on the stomach, which, beside
the direct influence it has on that organ, acts as
a derivative upon the throat and head, and as a diaphoretic
upon the skin, assisting in allaying the fever and
heat. This compress on the stomach is an excellent
remedy with small children and infants in a restless,
feverish condition. I often use it, even with
infants scarce a week old, and always with perfect
success. I wish, mothers could be made to substitute
it for paregoric and the like stupefying stuff, to
procure their crying infants relief and themselves
rest. There is more power in the compress than
any one who is not familiar with its use, can imagine.
At the same time it has a very good effect on the bowels,
which should be kept regular, either with the assistance
of tepid injections, or, if they fail to operate,
with a moderate dose of castor oil. If possible,
however, avoid the irritation of the digestive apparatus
through medicines, which are apt to counteract the
external applications, whose object is to draw the
morbid poison as early and as completely as possible
to the skin.
73. HIGHLY INFLAMED THROAT--CROUP.
If the throat is in a highly
inflamed condition, repeated packing is the surest
means of allaying the inflammation and preventing croup.
Although I have had very bad cases under my hands,
I never saw a case of scarlet-croup under water-treatment.
All you have to do is, to pack your patient early
enough and often enough to keep the inflammation down,
to keep a wet compress on his throat and chest, and,
in general, treat him as I have prescribed. The
condition of the throat will improve in proportion
to your perseverance in packing.
74. NECESSITY OF ALLAYING THE HEAT.
The packs and baths should be continued,
even when the patient cannot be prevailed upon to
stay long enough in the packs to perspire. The
heat of the skin and the general inflammatory condition
of the whole organism must be allayed, especially,
when there is much delirium. In that case,
the patient ought to be kept long enough in the bath
to clear off the head, and care ought to be taken,
that he should never stay in the pack to become much
excited.
75. THE HALF-BATH--THE SITZ- OR HIP-BATH.
Should the half-bath or shallow-bath
(which are technical terms for the bath described
above), not be sufficient to relieve the head, the
patient must be placed in a sitz- or hip-bath
of 65 deg. to 70 deg. and stay there, with
his body covered by a blanket or two, till the head
is easy. During and after the sitz-bath, the
parts exposed to the water, as well as the lower extremities,
should be rubbed repeatedly, to favor the circulation
of the blood. The head should be covered with
a compress, dipped in cold water and but slightly
wrung out, to be changed every time it becomes warm.
The time required will vary according to the condition
of the patient, from half an hour to one hour and a
half. There is no danger of his taking cold,
provided the body be covered sufficiently. The
room ought not to be too warm, as a hot room will
increase the tendency of the blood to the head; 65
to 70 deg. is perfectly warm enough. I would
rather have it between 60 and 65.
76. The sitz-bath may
be taken in a small wash-tub, if there is no proper
sitz-bath-tub at hand. It should be large enough
to allow the water to come up to the navel of the
patient, and to permit rubbing. Too large a tub
would not allow the patient to sit in it comfortably.
If there is no tub to fit, a common bathing-tub may
be raised on one end, by putting a piece of wood under
it, so as to keep the water all in the other end,
allowing the feet of the patient to be kept out of
the water. This latter practice is more convenient
with very small children, with whom, however, the
sitz-bath will scarcely be required, a half-bath of
sufficient duration being almost always efficient.
It is not advisable for persons little acquainted
with the use of water as a curative, to let the patient
stay very long in the sitz-bath, it being safer to
pack the patient again, and to repeat the sitz-bath
after the pack, if his delirium is not removed, or
not lessened in half an hour or three-quarters of
an hour. This alternating with the pack and sitz-bath
should be repeated, till the head becomes clear.
77. In excessive heat and continuous
delirium, a half-bath may be given, also, every time
the packing sheet is changed. The rule is that
we ought not to yield, but the symptoms
must; and they will, if the treatment is persevered
in. Only go at it with courage and confidence.
There is nothing to be apprehended from the treatment:
where there is too much heat, there is no danger of
a lack of reaction, and consequently no occasion for
fears that the rash might be “driven in.”
A physician afraid of using water freely in violent
cases of scarlet-fever, would resemble a fireman afraid
of using his engine, for fear of spoiling the house
on fire.
78. ACTION OF THE SITZ-BATH EXPLAINED.
The sitz-bath acts in a direct
manner upon the abdominal organs and the spine, and
through the latter on the brain. Indirectly, it
helps in removing the inflammatory and congestive
symptoms in the throat and head, by cooling the blood,
which circulates through the parts immersed in the
water, and by doing so cools also the upper parts of
the body, equalizes the temperature, and diminishes
the volume of the mass of the blood, thus making its
circulation easier, whilst it has no tendency to
impede the action of the skin. Besides, the
abstraction of electricity, by the sitz-bath, should
be taken in account of its action. After the
sitz-bath, the reaction takes place in those parts
which were immersed in the water, thereby making the
relief of the upper parts more lasting.
79. RELAXATION OF TREATMENT TOWARDS
THE END OF THE THIRD PERIOD--CONTINUATION
OF PACKS DURING AND AFTER DESQUAMATION.
When the patient is through the first
part of the period of efflorescence the symptoms decrease,
and he will be easier. Under the treatment prescribed,
the time when the excitement is highest, is much abridged,
and usually the treatment can be relaxed in less than
twenty-four hours. When the patient is easier,
the treatment may be given as in the milder form of
scarlatina anginosa, with due regard to the state
of the throat. In proportion as the heat abates,
the packs should not be repeated so often, the sheet
not changed; the patient should stay longer in the
packs, and the baths should be shorter. The sitz-bath
would then be out of season. The packing should
be repeated whenever the symptoms increase again;
but even if they should not, one pack and bath a day
are necessary.
80. During and after desquamation,
the treatment should be continued as indicated in
milder cases, except the throat continue troublesome,
when more packs should be used. If the throat
is well, the patient may leave his room by the sixteenth
day, under the precautions given above.
81. -- 3. TREATMENT OF
TORPID FORMS OF SCARLATINA--DIFFERENCE IN
THE TREATMENT POINTED OUT.
When the reaction is torpid,
the pulse small, weak, quick, the skin dry, the rash
slow to appear, and when it appears in small, pale,
livid spots, instead of bright scarlet patches (16-25);
the treatment ought to be calculated to produce a
short, but powerful, stimulus upon the surface of
the body, after which a long pack should assist the
organism in producing a slow, continuous and increasing
reaction. If in violent reaction a repetition
of short packs and long cooling baths is indicated, in
torpid reaction, cold and short tonic baths or affusions
and long packs are required, in proportion to the degree
of the reactive power of the patient. Therefore
the packing sheet should be very cold, but thin and
well wrung out, so as to make a strong, but transitory,
impression, soon overcome by the reaction it calls
forth, upon which all our success depends. The
patient stays in the pack till he becomes quite warm
and tired. Perspiration is seldom produced; if
it is, it may be considered a favorable symptom.
I have had patients stay in the pack for four, five,
six and seven hours, and almost always, when I took
them out, their skin was covered with eruption.
The only phenomenon, which should induce the physician
to relieve the patient of the pack before he becomes
perfectly warm, is increased delirium, which in torpid
reaction, indicates a tendency to a typhoid character
of the disease, when the warm and moist atmosphere
of the long pack would be more favorable to the disease
than to the patient, by weakening the nerves still
more. In that case, a long half-or sitz-bath
is required, the former, under constant rubbing, from
15 to 20 minutes, the latter from 30 to 40 minutes;
the temperature of either from 65 deg. to 70 deg..
82. LENGTH OF PACK.
Usually it is time for the patient
to come out from his pack, when the pulse becomes
fuller and stronger, the face begins to flush and the
head to be affected. Frequently he sleeps till
awakened by the increasing heat. A drink of cold
water will quiet him for a while, which may be administered
by means of a glass tube (julep-tube), in order not
to disarrange the pack by lifting him up. As
long as the head is not affected, there is no danger
of his staying too long. The longer he can stay,
the surer the eruption will appear.
83. COLD AFFUSIONS AND RUBBING.
After the pack, the patient is placed
in an empty bathing or wash-tub, and cold water (of
65 deg.-60 deg. Fahr., only with very
young and delicate children a little higher, with
adults rather lower) is thrown over him in quick succession
by means of a dipper, whilst he is well rubbed all
over his body, especially the extremities. Not
too much water should be poured over the head; however,
the head should be always wetted first. This
process should not last longer than a minute or two,
except the patient continue very warm during it, in
which case it should be prolonged, as the perfect
cooling of the body is necessary to prevent the fever
from coming on soon after and the patient continuing
weak. After the bath, he should be rubbed dry,
first with the bare hands of the attendants, and then
with a dry sheet, and put to bed again, or, if he
feel inclined to stay up, dressed warmly and be induced
to walk about as long as he can.
84. ICE-WATER AND SNOW-BATH IN MALIGNANT CASES.
If no rash appear during the first
pack, which will scarcely fail, the proceeding should
be repeated, and the patient stay longer in the pack
than the first time. In very bad cases, when the
patient fails at once under the action of the poison
(malignant scarlet-fever) iced water or snow may be
resorted too. I know several instances of patients,
having been given up by their physicians, reviving
again under the influence of a snow-bath, which produced
a healthy reaction, when nothing else was of avail.
I have never had occasion myself to resort to such
extremes, cold water having always answered my purposes;
but I would not hesitate a minute to use snow and
ice in a case where I could think it useful and necessary.
Such proceedings look cruel; but it is
decidedly more cruel to let the patient’s life
be destroyed from want of timely assistance.
I distinctly remember a case, which occurred in Cassel,
when the physician objected to “tormenting the
poor boy,” and wanted the father to “let
him die in peace.” But the father, who
had some knowledge of, and a great deal of confidence
in hydriatics, put the little patient, a boy of 8
or 9 years, into a bathing-tub filled for the greater
part with snow, covered him over with the cold material,
and left him there till he became conscious; then
he was rubbed all over, placed in a dry pack (without
a sheet), and left to perspire, which ensued and brought
out the rash. The patient was out of danger in
four hours’ time, and Dr. S., on calling again
in the evening, was quite astounded at seeing him
alive, out of bed, and covered with a tolerably bright
eruption.
85. WINE AND WATER, IF NO REACTION CAN BE OBTAINED.
Should the patient remain cold in
his pack for longer than an hour, a case,
which will seldom occur, a little wine and
water may be given him to assist the organism in producing
a reaction; and, in case of need, the dose may be
repeated once or twice in intervals of half an hour.
The quantity should be adapted to the age and constitution
of the patient, and by no means sufficient to affect
the head. Instead of water, it may also be mixed
with warm broth or tea, or hot water and sugar, to
make it agreeable to the little patient.
86. ABLUTIONS AND RUBBING WITH ICED WATER OR
SNOW.
In a few very obstinate cases, when
no rash would appear after two or three long packs,
I have succeeded by washing the patient with ice-water
or snow, rubbing him dry with my bare hands, and then
packing him in a dry blanket. After staying there
for several hours, more or less eruption always appeared.
87. WET COMPRESS.
The wet compress on the throat in
torpid cases should not be changed often, but left
till it becomes almost dry. Should the feet of
the patient be cold, a bottle filled with hot water
and wrapped in a piece of blanket or a sheet should
be placed near them, either within the pack, or out
of it, when the patient is lying in bed. The feet
should always be kept warm.
88. VENTILATION ALL-IMPORTANT.
If the circulation of air is necessary
in any other form of scarlet-fever, it is all-important
in torpid reaction, especially when it inclines to
a typhoid type. We should never forget that it
is the oxygen of the air that nourishes the process
of combustion going on in every living body, and that
in the same manner as no fire can burn bright without
a sufficient supply of air, the combustion within the
patient will be slower in proportion as there is less
pure air in the sick-room, and consequently his reaction
will be weaker, and vice versa. A sick-room,
filled with a number of people, and with a large fire
in it, or fed with the corrupted air of a furnace,
without the access of pure air, will always prove
a dangerous place for a patient in torpid fever, the
fire and every living soul in it absorbing the oxygen
indispensable to his recovery. And if the case
become typhoid, there is little hope of saving the
patient’s life without plenty of pure air.
89. CONTINUATION OF PACKS--CONVALESCENCE.
Whether the eruption appear or not,
the packs should be continued during the whole course
of the disorder, and as long as the throat continues
troublesome; and one pack and bath a day should be
given during some ten or twelve days, after every
symptom has disappeared. The patient, during
convalescence should not go out, except after his bath
and in fine sunny weather, till he feels quite well.
However, he should not be kept unnecessarily too long
in-doors either, as exercise in the open air will
assist him in regaining his strength. If the weather
is clear and bright, the low temperature of the air
need not be minded. I never saw any one take
cold after a pack and bath that walked out warmly dressed
in clear and cold weather.
90. MINERAL ACIDS, IN CASE OF SEVERE SORE-THROAT.
In case the throat be very troublesome,
there cannot be any objection to using the mineral
acid, as I have indicated above (35), except homoeopathic
remedies should be thought preferable and found to
afford sufficient relief. Some good may, and
no harm can be done by either.
91. PUTRID SYMPTOMS--GARGLE--SOLUTION
OF CHLORIDE OF SODA--DRINK: CHLORATE
OF POTASS--LIQUOR CALCII-CHLORIDI.
Should putrid symptoms make
their appearance (21), I would strongly advise the
acid in full and repeated doses, as well as the frequent
repetition of the packs. In putrid cases, not
only the syrup, but also the gargle will do good service.
Gargling is so much the more advisable as the putrid
matter should be frequently removed. If nothing
else can be had, pure water or water and vinegar may
be used. The temperature of the gargle should
be about 70 deg.-75 deg. Fahrenheit.
For the same purpose, the aqua chlorina, and
the chloride of soda have been strongly recommended.
A few drops of the solution may be used, also, on the
compress outside.
92. TREATMENT OF AFFECTIONS OF THE NERVOUS CENTRES.
In affections of the nervous centres,
the brain, the cerebellum, and the spine
(see 17-19), the danger which threatens the patient’s
life is principally averted by the sitz-bath.
The nervous system needs support, and the circulation
must be regulated. In every case where the packs
do not relieve the symptoms in the head and spine,
the sitz-bath is probably the only remedy to remove
the danger. It should be about 70 deg.,
and the patient should stay in it till relieved, which
will probably be in half an hour or there about.
After the sitz-bath, if the patient feel quite easy
and inclined to sleep, he may be put to bed; if he
continues restless and still complains of pain, he
should be put in a wet pack of about 65 deg..
There he should stay till he complains of more pain,
when he should take his bath and repeat the sitz-bath.
Thus he should alternate till he becomes entirely
relieved.
93. SITZ-BATH, ANCHOR OF SAFETY.
If there be much delirium, the sitz-bath
may be required longer, and the pack shorter, as indicated
above (81). In all such cases the packs and sitz-baths,
alternately, ought to be continued, till the nervous
symptoms disappear altogether, and should they make
their appearance again, the treatment must be resumed
without delay.
94. I repeat that in such cases,
the sitz-bath is the only anchor of safety I know
of. I have tried to remove these dangerous symptoms
by packs, affusions, baths, but almost always
in vain; whilst the sitz-bath has never failed to
insure success. As I am the only writer on hydriatic
treatment of scarlatina (as far as I know), who mentions
the virtue of the sitz-bath in those cases, and as
I am probably the first who ventured to use it, with
one of my own children, in 1836, when all seemed to
fail, I shall corroborate my advice by a couple of
cases.
95. CASES.
During an epidemic of scarlatina in
1836 two of my children were attacked by the disease,
a boy of about eight, and another of five years, the
younger one two days after the older one. I ordered
them to be packed, and all seemed to go well, when,
during my absence from the city (of Freiberg) a medical
friend, who called, persuaded my wife to desist from
continuing the hydriatic treatment, and use some remedies
of his instead. On my return, I found the elder
boy (the other began only to show some slight symptoms)
in a very bad state: the cerebellum and spine
were distinctly affected by the contagious poison;
the patient complained of insupportable pain in the
back of his head, the spine and all over his body,
so that no one dared to touch him. The fact of
the packs having been discontinued during twenty-four
hours being concealed from me, and the boy being subject
to herpes and inclined to scrofula, I began to fear
that the treatment would not be applicable in such
cases, and became really alarmed about my child.
I was then almost a novice in Priessnitz’s practice,
at least in the treatment of acute diseases, which
seldom occurred at Graefenberg, and, had I had more
confidence in blood-letting and drugs, I would probably
have resorted to them. For a while I was doubtful
about the course I should pursue, when Dr. B., my
medical friend, made his appearance and I learned what
had happened during my absence. Instead, however,
of giving way to his earnest solicitations to rely
on the old practice, I at once became encouraged by
his confession, and declared I would persevere in my
own practice, which was quite new to him, and in which
no physician of the place as yet believed. He
assured me, from the symptoms, that the boy could not
live twenty-four hours, unless he be bled, and that
even then he would not answer for his life. Having
lost six children before under allopathic treatment,
and having never had much confidence in drugs during
the time I had been connected myself with the practice,
I firmly refused to allow either bleeding or drugging,
and expressed my resolution to see what water could
do, resigning myself to the possibility of a bad issue
of the case. I need scarcely assure my readers,
that my feelings were far from agreeable, and that
my resolution required all the reminiscence of the
bad success of allopathic treatment of former cases
in my family, and the confidence I had in Priessnitz
and his system, to support it. I tried the pack
again, which did little or no good. Judging from
the effects of the sitz-bath in cases of affection
of the brain during continued fevers, that it might
be of service also in the present case (Priessnitz’s
directions did not go so far, nor had I treated a
similar case since my return from Graefenberg), I
put my boy with great care into a sitz-bath of 70 deg.
F. and left him there for a little over half an hour,
when he felt greatly relieved. He was taken to
his bed and allowed to become warm, when he began
to complain again. I then packed him, seemingly
without much effect; therefore the sitz-bath was repeated
and proved quite successful. I then packed the
patient immediately after the sitz-bath and left him
two hours in the pack, where he slept almost all the
time. When he awoke, he complained again of pain
in his head, which partly yielded to the half-bath.
About three hours after the bath, he complained more
of the pain in his head and spine, and I repeated the
sitz-bath and the pack. He slept in the pack for
about three hours, and when I took him out, he was
covered with red spots. Feeling pretty well,
he was dressed and permitted to stay up. In the
forenoon, my friend called to see whether our patient
were still living, and could hardly believe his own
eyes when, on cautiously putting his head in at the
door, he saw the boy walking up and down the room to
warm his feet. In the afternoon, the pain returned
and the rash faded. I repeated the pack, and
the pain not yielding entirely, I gave him one more
sitz-bath in the evening and a pack after it, in which
he stayed asleep almost all the time, nearly four
hours, upon which the rash stood out finely and never
disappeared until desquamation set in.
I managed to keep him in bed after the relapse mentioned,
till desquamation was over. I need scarcely
say that I continued to pack him (twice a day) till
after desquamation, when the packs were given
once a day for about a week longer. On the seventeenth
day (which was the fifteenth with the younger boy,
who had the fever in a very mild form, and was treated
accordingly) the two scarlet-convalescents were seen
playing in the street, throwing snowballs at each
other; a fact, which increased not a little the sensation
caused by this miraculous cure. Although my friend
was not converted to the new method, this case had
a very decided encouraging influence upon myself,
and, I am convinced, became the means of salvation
for many hundred lives afterwards, treated partly by
myself directly, partly by other physicians, or the
parents of the patients, after my prescriptions.
I felt the importance of my success in this difficult
case of scarlatina, and warmly thanked Providence for
having assisted me in saving my child for the benefit
of many others.
96. The circumstance that, at
the same time my two boys were taken sick with scarlatina,
a servant of mine became afflicted with small-pox,
my daughter with varioloids, and my mother
and wife with influenza, afforded me an ample
opportunity of trying the effects of the water-cure
and my own courage and skill in the new method.
The servant was cured, chiefly by long packs, in twelve
days, so that she was able to resume her household
duties, and though she had been covered with pocks
all over, not the slightest mark remained on her body;
my little girl was out of doors in a fortnight, and
a few days were sufficient to rid the ladies of influenza.
The complete success I had in the treatment of all
these cases, contributed not a little to encourage
me to employ the method upon others, with whom I have
ever since been equally successful, with one single
exception, which I shall mention hereafter.
97. One of the last cases of affection of the brain in torpid
scarlatina I treated, was that of a scrofulous little boy of six years, from
Williamsburgh, N. Y., who was at my establishment, with his mother and sisters,
taking treatment for scrofulous ulceration of the parotid glands, and other
symptoms of that dangerous disease. The reaction was torpid, and the brain
became affected almost from the commencement. There was a little rash
coming out, but in small dark purple spots, looking much more like measles than
scarlet-fever. The delirium increased during the period of efflorescence,
instead of giving way. The spine evidently sympathized in the suffering of
the brain and cerebellum. Homoeopathic remedies, which were earnestly
asked for by the mother, had no effect whatever; acids only produced a slight
relief of the inflammation of the throat; the packs increased the symptoms in
the head and spine. The appearance of the tongue, the peculiar kind of
delirium, the small quick pulse, &c. showed, that the case was going to take a
typhoid turn; when I ordered a sitz-bath, which almost immediately relieved the
head and improved the pulse, I then, proceeded in about the same manner as
described above in my sons case, with the difference, that I allowed longer
intervals. The patient, according to the severity of the symptoms, took
one or two packs a day, and the same number of sitz-baths, had wet compresses on
his ears and throat, and was kept in bed with very few exceptions, when the
nurse would take him on her knees, wrapt in a blanket. The good effect of
the sitz-bath was so obvious, that the childs father, who had been informed by
telegraph of the critical condition of his son, asked himself for a repetition
of it, when he found that neither medicines nor packs produced the slightest
change. The child always became quiet and slept after the bath. Not
only was his life saved, but he also escaped all the dreaded consequences of the
disease. I am confident, that under any other kind of treatment, he would
have lost his life, or at least he would have lost his hearing. But, far
from increasing, the affection of his ears was rather improved when he left, and
his general health a great deal better than when he was first placed under my
care. I had a great deal of trouble with that little patient, not only
because he did not allow me a nights rest for a week, and the case produced
quite an estampeda in the establishment, but also, and chiefly, because of
the interference of a half-bred Irish woman, who had brought him up, and who, on
account of the mothers bad health, acted in the double quality of a nurse and a
governess towards the children. This woman, being averse to the treatment
and the place, which gave her little pleasure, and to the rules of which she
would not submit, procured all sort of dainties and excited the child by her
foolish remonstrances against any application I found necessary, making at the
same time an unfavorable impression on the simple minds of the family, by
telling lies and tales, thereby not only placing difficulties in my way, in a
case which was difficult in itself, but even preventing the parents from
acknowledging by one word of thanks the sacrifices of time and health I had
cheerfully made. What a blessing it would be for physicians and patients,
could unnecessary and unreasonable people be kept away from persons afflicted
with painful and dangerous diseases!
98. IMPOSSIBILITY OF ANSWERING
FOR THE ISSUE OF EVERY TYPHOID CASE.
Although a typhoid character
of scarlatina will rarely set in, when the patient
has been subject to the packs from the beginning of
the disease, there will be cases when water-treatment
can neither prevent such an event or even save the
life of the patient afflicted by scarlet-fever.
There will be a case, now and then, to baffle
any mode of treatment, and the physician must not
be blamed for losing a patient of scarlatina occasionally,
but it is not necessary that people should continue
to die of this disease in such numbers, as they have
been destroyed till now.
99. Any case, where typhoid symptoms
set in (16-25), is dangerous, and the physician and
his mode of treatment deserve commendation, if the
patient is saved by it; and it is in such cases, also,
that the hydriatic physician requires the most skill,
experience and courage.
100. IS WATER APPLICABLE IN ALL TYPHOID CASES?
The question has been raised, whether
in typhoid cases, and in cases of torpid reaction
in general, water is at all applicable? I can
answer the question only in the affirmative; but I
must add, that the treatment of such cases requires
more than confidence and courage: it requires
a nice discrimination to know the exact moment, when
water may be applied, what should be its temperature,
how long the bath should last, what kind of baths
should be given, whether the pack will be of service,
&c.
101. RULES FOR THE APPLICATION OF WATER IN TYPHOID
CASES.
As a general rule, in typhoid cases,
bathing should form one of the principal features
of the treatment; i. e. the patient should have more
baths than packs in proportion to the treatment of
other cases.
102. The temperature of the baths
should be in proportion to the reactive power of the
body; i. e. the longer the patient has been sick,
and the weaker he is, the higher should be the temperature
of the water, but never so high as to have rather
a weakening than a strengthening effect upon the nervous
system. The highest temperature which may be
used should not exceed 75 deg. F.
103. When the delirium is active,
the patient restless, almost raging, the water should
be used colder; when the delirium is more passive,
the patient weak, muttering, the water should be warmer:
in the former case, the water may be between 50 and
60 deg., in the latter, between 60 and 70 deg..
104. When the skin is hot and
dry, a wet-sheet pack will produce relief, and assist
in bringing out the rash. After the pack, a half-bath
should be given, the duration of which must be regulated
by the condition of the brain. If the delirium
continues, the bath should be prolonged.
105. The patient should not leave
the bath before his head is clearer. It may be
necessary for the patient to stay in the bath for more
than half an hour.
106. In a low condition, with
passive delirium, the packs should not be continued
very long, as they will be apt to increase the bad
condition of the brain. In that case they should
be used only to prepare the body for the bath following
it.
107. When the skin is cool and
moist, neither a bath nor a pack is indicated.
When the skin is rather cool and dry, an affusion of
cold water and frictions with the bare hands should
be used, and the patient packed afterwards in a dry
blanket, to assist in producing a reaction. In
such cases I have found very cold water to be of more
service than water of a warmer temperature. When
the patient has not been too much weakened already,
a rash is likely to be produced by the proceeding,
and in consequence of repeated baths, the nervous
system to be relieved and a healthier reaction to
be obtained.
108. Should putrid symptoms appear,
I would advise the use of mineral acids and chloride
of lime, in addition to hydriatic treatment.
109. In no case would I advise
a hydriatic practitioner to overdo, either in regard
to the temperature or to the quantity of the baths.
The state of the brain and of the skin should always
guide him. The increase of delirium will require
a bath, and the dryness and heat of the skin a pack.
If both symptoms exist, the bath is to be preferred,
as the condition of the nervous system should always
command the principal attention of the physician.
When the nervous system is supported, the whole of
the organism is, and the condition of the skin usually
improves with the former.
110. ILLUSTRATIONS.
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 150.
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 relieved her.
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
treatment.
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.