Treatment of Scarlatina. By G. W. Brown, of Port Carbon,
Pennsylvania.
To the Editor of the Medical Examiner.
I send you a few notes of my practice in scarlet fever, as it
prevailed in this neighborhood in the fall, spring and winter of
1847-’48. I have notes of 126 cases, 21 of which proved fatal.
Of the fatal cases, eight died of hydrocephalus; one of hydro-
cephalus with laryngitis ; one of general congestion of the whole
venous system; one of ophthalmia, with inflammation of the
bowels ; one of inflammation of the throat and bronchii; one of
abscess of the neck, by which the jugular vein was divided ; and
three of pericarditis, with general dropsy. One died on the first
day, two on the third day, eight on the fourth day, three on the
sixth day, one on the tenth day, two on the eleventh day, one on
the thirteenth day, one on the fourteenth day, and one on the
twenty-second day. Of the secondary affections, dropsy followed
in fifteen cases, pericarditis accompanying in six, three of which
proved fatal. Rheumatism occurred in six cases, and abscesses in
sixteen cases. Four of the cases were adults, and all recovered.
Convulsions ushered in a number of cases, but one in particular,
in which they lasted for twelve hours, occurring every twenty or
thirty minutes. I did not find those cases in which convulsions
occurred at the commencement, any more severe or intractable
than the others. Those cases in which complete desquamation of
cuticle took place recovered most rapidly, and were least fre-
quently followed by secondary affections. Dropsy occurred in
the mildest cases ; some of them requiring scarce any treatment at
all, except an occasional cathartic. In those cases, the affection
of the skin being apparently insufficient to eliminate the morbid
poison from the system, it fell upon some other organ or tissue of
the body. In the commencement of the epidemic I adopted the
treatment usually recommended in the books, viz.: an emetic fol-
lowed by calomel, pepper gargles, laxatives, diaphoretics, tepid
sponging and counter-irritation to the throat ; but this I soon
found to be lamentably deficient, for I lost fully one-half of my
cases. About that time, in conversation with Dr. J. S. Carpenter,
of Pottsville, I was speaking of the fatal nature of the epidemic,
and of the inefficiency of our present mode of treatment, when he
suggested a strong solution of the nitrate of silver to the throat in-
ternally by means of probang. I adopted it immediately, with the
most happy results, in all of my cases. Of the last fifty cases
treated by it, I scarce lost a patient. I sometimes used a strong
solution of the sulphate of copper, especially where I desired to vomit
the patient at the same time, as was often the case where the throat
was filled with shreds of membrane, foetid matter, &c.; but I think
the nit argent, preferable in all cases. The strength of the solu-
tion was 9i. to the 5 of water. I applied the nit. arg. in all my
cases as soon as I was called, whether there was ulceration or not,
and repeated it once or twice daily till the patient was convales-
cent. In malignant cases I also used the chloride of soda inter-
nally, besides using it as a gargle, and I thought w’ith decided
benefit. Blisters, with few exceptions, did no good, but, on the
contrary, I thought they did harm by increasing irritation. Lini
ments, particularly of iodine, answered better, especially where
there was enlargement of the absorbent glands. My treatment
then consisted in an emetic at the commencement, followed by
calomel in doses of two or three grains every two hours till the
bowels were freely moved ; then laxatives, to keep up a gentle
action on the bowyels, sufficient to remove morbid secretions. A
mixture of equal parts of the syrup of ipecac, and spir. nit. dulc.,
to keep a gentle action on the surface, and at any time that it
was indicated, pushed sufficiently to produce full vomiting. Nit.
arg. to the throat internally, once or twice daily, with gargles of
the chloride of soda, and internal administration of the same,
when indicated by malignant symptoms. Liniments to the neck,
and tepid affusion to the whole body. Cool air and cold applica-
tions to the head in the shape of evaporating lotions, so long as
the fever continued. I sometimes made use of venesection with
decided benefit, but only in vigorous constitutions, and in the
very early stage of the disease. Dropsy was treated by bleeding
freely and purging, with diuretics and counter-irritation in the
latter stages. Pericarditis was treated by the same means as the
dropsical effusion, only more promptly. Squill, nitre, digitalis
and calomel, in combination, I found to be almost a specific in
the second stage of pericarditis, especially if it purged freely.