by a plate). • This appearance has continued ten days, and in some cases longer, without much distress to the patient, and with no other symptoms of ferit than a quick pulse. and a slight degree of languor. P. 236. The mineral acids are of obvious advantage.

Dr. Willan affirms that he never saw the Rubeola vulgaris intermixed at an early period with petechiæ; and he has adduced several observations, which elucidate satisfactorily this iinportant circumstance in the history of measies. Since the publication of a paper, in the Medical Observations and Inquiries, vol. iv. written by Sir Wm. Watson, the existence of what were denominated Putrid Measles' has been generally.credited, and recorded by authors. But Dr. Willan states a sufficiency of evidence to shew that the disease, so denominated by Sir W. Watson, and which occurred in the Foundling. Hospital in 1763 and 1768, was Scarlatina. He observes that Sir Wm. W. himself refers the disease in question to the morbilli maligui, described by Dr. Morton: but Morton expressly maintained that this measles and scarlet fever were the same disease, standing in the same relation to each other as the distinct and confluent small-pox; and his description of the morbilli inaligni, inorbilli epidemii, &c. is obviously applicable only to the disease to wbich other writers have given the titles of Angina maligna, Angina epidemica, Scarlatina Anginosa, &c.

The nalure and essential character of Scarlatina were, in fact, at that time in a considerable degree undetermined. It is curious to observe the successive variation of the terms by which Dr. Watson designated these epidemics; and the implied unsettled state of his opinion with respect to their nature. In that of 1963, the first case (see Med. Obs. and Ing. p. 136,) is called ' Epidemic Yeasles;' but in the apothecary's book the same case is dene ninated 'Eruptive Fever. I wo other cases in the same month are called, the one' Eruptive Fever,' the father : Scarlet Fever. Fruta these sources, one hundred and eighty children were soos affected with the disease in question; but it was not all seven months afterwards that some cases are entered as Morbil- ' lous Fever.' In 1766 the term · Eruptive fever and Sorethroat," is used for an epidemic disorder among children. In 1970 the scarlatina and measles probably prevailed at the same time, and the nomenclature of Sir W. W.is as follows: • Measles' -' Measies and Sore-throat • Measles and ulcerated Sore-throat'-and measles with • Putrid Fever. The denomination of “Scarlet Fever and Sore-throat' first occurs in the reekly report Ist Sept. 1787

About the same time,' Dr. Willan adds, in the prescription book appropriated to the measles, a separate entry is made of Scarlatina; this generic title being at length applied, when the disease, after a dreadful ravage during two successive years, had fully impressed the inhabitants of London with a knowledge of its distinctive character, and peculiar virulence. P. 245.

Dr. Willan quotes some other contemporary authorities, to shew the unsettled state of Opinions and nomenclature respecting the Scarlatina till after the year 1780. This point is still more amply illustrated in the literary history of this disease, which Dr. W. has followed out with much ability under its proper head.

The subject of the measles is concluded with some observations on the accounts left by the original writers of the Saracenic school, who have created no small confusion, by describing the small-pox and measles as one and the same disease. This error was transmitted by medical authors for more than eight centuries -A circumstance which affords us a remarkable illustration of the bondage of the human intellect under the trammels of authority; and may serve to teach us the just value of original observation and unbiassed inquiry; in the exercise of which alone, true experience (that much abused name in the science of medicine) is to be attained.

Of the Scarlatina Dr. Willan gives the following brief character.

• The Scarlatina is characterised by a close efflorescence, of a scarlet colour, appearing on the surface of the body, or within the mouth and fauces, usually on the second day of a febrile disorder, and terminating in about five days, but without any certainty of a crisis to the fever.'

The generic term comprises three varieties, which he denominates Scarlatina simplex, consisting of the rash only; S. unginosa, in which there are superadded a swelling and redness of the internal fauces, often terminating in slight . ulcerations;--and S. maligna, in which symptoms of low

fever, with dark and livid ulcers of the throat, & c. also occur. Another variery, is afterwards mentioned, viz. the scarlet ulcerating sore-throat, without any efflorescence on the skin, which experience has decided to originate from the same contagion with the other forms of the disease. Some practitioners, indeed, have expressed an opinion, that the ulcerating sore throat might occur in individuals who had previ. ously undergone the scarlet eruption; but, among two thoupand patients, Dr. W. has not seen a recurrence of any one of the forms of the disease, after any of the other had existed. This accords with the statement of Dr. Withering in the second edition of his pamphlet.

The difficulty of distinguishing the Scarlatina from the measles, and the frequent mistakes which have been made, independently of considering thein as varieties of the same disease, has induced the author to recapitulate their diagnose tic characters; the perspicuity and accuracy of his detail, éspecially of the appearances of the two eruptions respectively, will render any apology for transcribing the greater part of it unnecessary.

Ist, The efflorescence in Scarlatina generally appears on the second day of fever; in the measles it is seldom visible till the fourth.

sally. It is much more full and spreading in the former disease than in the latter, and consists of innumerable points and specks under the cuticle, intermixed with minute papulæ, in some cases forming continuous, irregular patches; in others coalescing into an uniforın flush over a considerable extent of surface. In the measles the rash is composed of circular dots, partly distinct, partly set in small clusters or patches, and a little elevated, so as to give the sensation of roughness when a finger is passed over them. These puches are seldom confluent, but form a number of creşa cents or segments of circles, with large intervening portions of cuiicle, which retain their usual colour. The colour of the raska is also different in the two diseases, being a vivid red in Scarlatina, like that of a boiled lobster's shell ; but in the mcasles a dark red, with nearly the bue of a raspberry.

• 3dly. During the febrile staze, the incasles are distinguished by an obstinate barsh cough, forcing up, in repeated paroxysins, a tough acrimonious phlegm;' by an infiammation of ihe eyes and cyelids, with great sensibility to light; by an increased discharge fruin the lachrymal gland, sneezing, &c. The Scarlatina is fre. quently attended with a cough, also with redness of the eyes, from an extension of the rash to the tunica albuginea, circumstances which render the distinction between this complaint and measles particularly difficult, if other symptoms be not clear and decisive, On minate observation, however, it will be generally, perhaps always, found, that the cough in Scarlatina is short and irritating, with jut expectoration; that the redness of the eye is not attended with intolerance of light; that the ciliary glands are not affected; and that, although the eyes appear shining and watery, they never overflow. (P. 260-1.)

Dr. Willan has detailed at length the variety and the progress of the symptoms, which are considerably ditferent under the different forms of the disease; irregularities Cost. Rev. Vol. 7. February, 1806.


which hare, no doubt, contributed materially to the con. fusion which is to be found in its history. The lime and place of the origin

of Scarlatina, as well as of the measles, are unknown. Whether the,' pestilential ulcers of the throat,' described by Aretæus and Aëtius, as prevalent in Egypt avd Syria, were forms of this disease, Dr. W. does not attempt to decide: and the Arabian physicians have not left deseriptions sufficiently precise, to furnish any conclusion in regard to its existence among them. The author'thinks it probable that it was imported into this country from the Levant. It is first described in modern times by Ingrassia, a plıysician of Naples, where it was known before the year 1500, by the name of Rossalia. From this time its progress is satisfactorily traced by Dr. W. under the mask of varying appellations, through the dif. ferent countries of Europe, of which it constituted, for al least two centuries, the most malignant scourge.

A contagious sore-throat proved extremely fatal at Amsterdam in 1517, which, from the description of it given by Forestus, appears to have been a malignant Scarlatina; as well as a similar epidemic described by Wierus, which spread through Lower Germany, in 1564 and 65. The same disorder was epidemical at Paris a few years afterwards, according to Ballonius, who denominates it Rubiolæ, and in his description has detailed the leading symptoms of Scarlatina anginosa. It was fatal in a dreadful degree. The epidemic sore-throat, called by the Spaniards, Garrotillo, which succeeded the influenza of 1580, and spread in the course of forty years to all the sea-ports of Italy, Sicily, and Malta, carrying with it an almost incredible mortality, clearly appears to have been the Scarlatina, from the accounts of it left by Mercati, Francesco Nola, and others. At Naples, and otlier places, being considered as a new disease, it received a great number of new appellations, Abont the same time the milder forms of Scarlatina pre. vailed in different parts of Germany, where it was denominated Morbilli ignei, Rossalia, Erysipelata, Universal Erysi. pelas, &c. (Sce Sennertus and Doringius.) The latter writei first notices its termination in dropsical swellings; it was again described as a new disease, under the titles of Febris miliaris rubra,' and · Febris cocrinca,' when it occurred at Leipzig about the middle of tlie seventeenth century. It spread through Poland in 1665, and was well described by Schultzius under the denomination of Purpura epidemia maligna. During the remainder of the century it was frequently described by writers ou the continent, under various titles, some expressive of its extreme fatality, others denoting its affinity with measles, miliary eruptions, petechial fever, &c. as may be collected from the detail which Dr. Willan bas given,

The author pursues the historical view of the disease in this country, from the time of Sydenham and Morton, the first English writers who mention it, to the present period. And be observes, that all the descriptions of Scarlatina, occurring epidemically at different tiines, and in different climates, agree more nearly than might have been expected; and that they coincide with his own observations, so far as to justify the distinctions he has made.

This historical detail, developed with considerable learning and ability, of which we have been able to present but a slight sketch, stripped of the ample evidence on which it rests, is extremely satisfactory. It tends to simplify the records of medicine; it dispels a mist which hung over the history of epidemic diseases, bidding defiance to arrangement, and multiplying greatly the apparent varieties of human malady. And by teaching is the identity of the disease, which has been perpetually mistaken, and misnamed, it gives us the opportunity of deriving all the instruction which a comparison of the different remedies and expedients adopted for its cure can afford. The instruction is great, and the comparison highly in favour of modern medicine. It is indeed a lamentable truth, that two centuries of fatal experience were requisite to open the eyes of mankind to the falsity of their hypothetical principles, and to the obgervation of facts. But again we have to lament the bigotry of system and the power of prescriptive authority; when physicians, as Dr.W.observes of Mercati, seem to have chosen rather to err with Galen, than to trust to their own reason and sagacity.

We have dilated so amply on the more original parts of this treatise, that our limits compel us to conclude, with merely recommending an attention to the observations relative to the treatment of Scarlatina. The variations in the practice, which the different varietics of the disease require, are in general clearly pointed out. We regret that, with regard to some of the remedies, the author did not rather present us with observations collected from the store of his own experience, than with a full detail of the opinions of others. This part is concluded with some important considerations on the ineans of preventing and arresting the contagion of Scarlet Fever. It contains fire coloured en


« ElőzőTovább »