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 a.s.sist 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 quant.i.ty should be adapted to the age and const.i.tution 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 a.s.sist 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 h.o.m.oeopathic 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 POTa.s.s--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 repet.i.tion 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 70-75 Fahrenheit. For the same purpose, the _aqua chlorina_, and the _chloride of soda_ have been strongly recommended.[34] 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 princ.i.p.ally 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, 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. 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 a.s.sured 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 a.s.sure 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 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 s...o...b..a.l.l.s 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 a.s.sisted me in saving my child for the benefit of many others.[35]

96. The circ.u.mstance 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. h.o.m.oeopathic 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 son's 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 child's father, who had been informed by telegraph of the critical condition of his son, asked himself for a repet.i.tion 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 night's rest for a week, and the case produced quite an estampeda in the establishment,[36] 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 mother's 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 princ.i.p.al 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 F.

103. When the delirium is active, the patient restless, almost raging, the water should be used colder; when the delirium is more pa.s.sive, the patient weak, muttering, the water should be warmer: in the former case, the water may be between 50 and 60, in the latter, between 60 and 70.

104. When the skin is hot and dry, a wet-sheet pack will produce relief, and a.s.sist 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 pa.s.sive 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 a.s.sist 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.