can only be had recourse to at the onset of the fever, when it may be considered only of an inflammatory kind, and in plethoric habits, which then may probably put a complete stop to its progress, or at least render it milder during its continuance. I speak cautiously of venesection, not having practised it sufficiently to give a decided opinion: but I can decide more positively concerning the use of emetics when given at the beginning of the attack. The remedies on which I chiefly rely, and may say, generally have administered with a very good effect, are frequent purges of a mercurial kind, and the saline mixture in the state of effervescence; I generally find it necessary to use some astringent gargle, and have usually prescribed the following-R. Cort. Cinchon, contus. 3ss. Fol. rosæ rubr.3ss. Coque in aq. font. bss. per min. xv. cola et. adde. Acid. sulph. dil. gtt. LX. Sacch. alb. 3ss. ft. garg. sæpe utend. When nothing but debility remains I begin the tonic plan, and first give bark with the saline mixture, still in the state of effervescence. I remain, Gentlemen, T. F. R. London, Feb. 19, 1811. To the Editors of the Medical and Physical Journal. GENTLEMEN, As it is hardly possible to receive too much evidence in support of any eligible practice that is not generally adopted, I venture to send the following remarks for insertion in your valuable Journal. Since the beginning of the last spring I have spent some time with two extensive and worthy medical practitioners in Suffolk and Norfolk, and I have had an opportunity of witnessing their method of treating Scarlatina Anginosa, a disease which for several months nearly superseded every other. A plan calculated to counteract every inflammatory symp tom was invariably recommended and persevered in; repeatedly purging with calomel, &c. spunging the body with a cold fluid, and in the warm weather freely exposing it to the air, low regimen, scarification of the fauces, and, in short, all the antiphlogistic remedies enumerated by Mr., Hamilton Hamilton (page 102) except phlebotomy. This was performed only in a few cases (adults) none of which terminated fatally. Effervescing draughts with carbonate of soda and tartaric acid were constantly given. This treatment was succeeded by the most happy result; and whenever any occasion occurred of comparing its effects, in similar circumstances, with those of an opposite treatment, where wine and nourishing diet were allowed from the commencement, its superiority was frequently evinced by the absence of danger and a more speedy recovery. That so varying a disease as Scarlatina, which sometimes assumes the most formidable appearances, should be wholly disarmed by the most simple means, is not to be expected. Many have died, under my observation, of the remote con sequences of the disease, two or three weeks, or even months from its first attacking them, of abscess, dropsy, mortification, consumption, &c. I have, however, neither seen nor been informed of a single instance, where the antiphlogistic system had been embraced early and adhered to strictly, that ended mortally in a few days; although I have known many patients, in the same neighbourhood, and almost on the same spot, who, after every stimulating tonic and antiseptic means * In 1788, the scarlet fever was unusually prevalent in some part of Norfolk. An experienced medical man, who was in the midst of it, sent me the subsequent account which I relate in his own words. " Insatiable thirst at the beginning of the disease, pulse very quick, soreness of the throat so as to prevent deglutition, delirium after a few days, and then scarlet eruption. They who had the eruption earlier became easier, and mended sooner, and their pulse were lessened to eighty, yet the tongue and fauces were still lined with a matter of a yellow appearance. The vis vite shewed great signs of assisting itself by the eruption, by diarrhoea and profuse sweatings, and the younger subjects were always relieved by these. The aged mostly sunk under the disease, their pulse becoming thready and not above thirty. In all their speech was remarkably affected; they could scarcely articulate a word. Bleeding at the nose gave great relief, and those who applied early were blooded and emetic tartar given, until the stomach was well emptied. As soon as the inflammatory symptoms decreased we began with antiseptics, ordering port wine, bark, and a liquid diet consisting of strong broths." He adds, "All those who underwent blood-letting in the beginning of the disease recovered." The tartaric acid is perhaps as good as the citric in its effects, and to be preferred on account of being less expensive. Every person who is at all acquainted with chemistry, knows why that acid should be mixed with carbonate of soda rather than of potass: a small quantity only of the compound formed by the latter mixture being soluble in water, chief of it subsides to the bottom. ♦L had had been tried, died in the manner related by Mr. Goodwin, on the 5th or 6th day, or sooner. The only case that I have seen of this kind, was a healthy strong man, above thirty years of age, who called in no medical assistance until the third day, when he was in a hopeless and most dreadful state, low delirium, pulse scarcely perceptible, a glossy eye, tongue brown and hard, inability of articulation, skin of a dry burning heat, and all over of a dark copper colour, the whole body furnishing a most noxious fœtor. His throat could not be examined: he died in six or eight hours. This poor man's symptoms for the first thirty hours had, as far as I can learn, nothing in them of peculiar malignancy. After walking a few miles and drinking a little, he was taken in the evening with a cold chill and head-ache; was afterwards very hot; throat stiff, not very sore; and he thought himself but slightly unwell all the next day. I know not why we may not be allowed an opinion, that the active and timely exhibition of proper remedies would have saved him from so quick and shocking an end. It would greatly assist us in estimating the value of Mr. Hamilton's paper on Scarlatina, to be informed whether he has met with any fatal instances from the immediate effects of the disease, or whether the cases he has given us should be regarded as comprising a summary of his whole experience on that head, and as warranting a conclusion, that his practice. has been attended with universal success. I believe there are not a great many people, at the present time, who do not think the antiphlogistic plan of treatment as successful, in most cases of Scarlatina Anginosa, as what is called the stimulating and antiseptic; and I am convinced there are none who, after a fair trial, will hesitate to pronounce it, in the first stage of every case, far preferable. If such a trial should, in the least degree, be furthered by the recommendation here given, it will be highly gratifying to the wishes of, Gentlemen, Your most humble and obedient Servant, February 12, 1811. To the Editors of the Medical and Physical Journal: GENTLEMEN, As you have been pleased to notice, in your last number, my communication to Mr. Brooks of a very rare occurrence, viz. the serum of the blood of the colour and consistence of milk, I thought a few particulars of the case would be also acceptable to you. The subject of this singular appearance in the blood, is a labourer in the Ordnance department at this place, aged thirty-five, of a thin spare habit of body, and sallow complexion; addicted in the early part of his life to spirituous liquors; latterly to ale or porter. He first complained of a pain in his left side on the 14th of June, 1810, which, appearing more of a spasmodic than an inflammatory nature, was treated with aperients, fomenta tions, and volatile liniment; which it yielded to in a few days. Since that, he informs me, he had been subject to loose stools, and transient pains of the same side; but never had recourse to any medicine for these complaints. From his description, the stools must have been of the dysenterie kind. He was not bled for this first attack. Nov. 24, 1810. In the morning, he came to my house complaining of a return of the pain of his left side. Recollecting the former treatment, I ordered him immediately an aperient draught of the pulv. jalap, comp. the fotus com. and liniment ammon. which he used. In the evening I was sent for to his lodgings. The draught had operated, the fo mentation and liniment had been applied. He was rather worse. The pain was very severe, chiefly scated in the middle of the left hypochondrium, extending from that, forward, as far as the cartilago ensiformis, and backward, to the vertebræ. There was little or no tension of the part, but the pain was increased by pressure made along the edges of the costa spuriæ. He was obliged to bend, himself forward to ease the pain, by relaxing the abdominal muscles, and could only lie on his right side, suffering greatly by any attempt made to alter this position. From his first attack in June, he has never been able to lie easy on his left side. He. had neither nausea, nor vomiting, nor pain of stomach; no dyspnea, cough, or any pulmonic affection; and the right hypochondrium was free from any uneasiness. Symptoma tic fever had taken place. I could not discover any enlarge ment of the spleen, but all the symptoms were evidently referred to the region of that viscus. The pulse was rather small, or contracted, quick and frequent; tongue whitish, but moist; skin dry, but not very hot. He was immediately bled to the extent of fourteen or sixteen ounces, and the pulse rose accordingly. The stream of blood was full and florid, but on reaching the bason I was surprised to observe a whitish appearance forming, like a cloud, on the surface of the blood, which made me suppose that there had been some milk in in the bason; but I was soon satisfied to the contrary. The bleeding gave relief. He was ordered pulv. antim. with nitre and digitalis in powder, the saline mixture and an anodyne at bed time, the fomentation and liniment to be repeated. Before I left his chamber, I was surprised to see the serum like so much milk, with the crassamentum floating in it. Nov. 25.-This morning 1 found the blood as I had left it, the crassamentum floating in serum of the colour and consistence of milk. The crassamentum, on its upper surface, was cupped and sizy, on its under, of a black red colour, and loose in its texture. He took some pills of rhubarb and calomel, and continued the other medicines; and, as the pain was still very severe, he was bled again to the same extent, and with exactly the same appearance. A blister was now ordered. In the evening I was obliged to bleed him the third time, and to the same effect. Each of these successive bleedings exhibited the same phenomena. Nov. 26. This day he was so much better as not to require bleeding, and the blister had taken full effect. Continued. 27.-Having some return of pain he was bled the fourth time, to about ten or twelve ounces. The blood had now assumed a very different aspect, the serum was of the natural colour and consistence, the crassamentum was, however, still cupped and sizy, but more florid. Continued. 28.-The pain not being entirely gone he was bled the fifth time, to about eight ounces. The blood was now natural, and the crassamentum neither cupped nor sizy. Contin. med. pro re nata. After this he continued to mend gradually, and as soon as all the inflammatory symptoms had subsided I put him upon a general course of calomel. He has now returned to duty and seems to be better than before his indisposition. I sent a vial of the serum to Mr. Brooks, of Blenheim Street; and have some still in my possession, which is thicker than it was at first, and emits but very little foetor. I here beg leave to correct a mistake in my communication to Mr. Brooks. I there stated that the splenitis was the consequence of frequent attacks of intermittent fever." But on more particular enquiry I do not find that to be the case. His complaints have been rather of the dysenteric kind, which are, in this place, sometimes attended with a symptomatic fever of the intermittent type. The situation of Sheerness being low and marshy causes intermittents to be endemic bere |