109. In no case would I advise a hydriatic pract.i.tioner to overdo, either in regard to the temperature or to the quant.i.ty 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 princ.i.p.al 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. ILl.u.s.tRATIONS.

I shall give a couple of ill.u.s.trations:

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. 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, 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, 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, the pulse 140.

The bath was repeated for twenty-five minutes, when the heat went down to 100, 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 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 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 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, princ.i.p.ally 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 circ.u.mstances, 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, 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 a.s.sisted 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 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.

FOOTNOTES:

[7] Elements of Medicine, Vol. I. London, 1836.

[8] J. Armstrong, Practical Ill.u.s.trations of the scarlet-fever, measles, &c. London, 1818.

[9] W. Withering. An account of the scarlet-fever, &c. London, 1779.

[10] Hamilton, in Edinburgh Journal.

[11] F. Jahn, in Hufeland's Journal, 1829.

[12] J. Wendt, das Wesen, die Bedeutung und aerztl. Behandl. des Scharlachs. Breslau, 1819.

[13] F. A. G. Berndt, D. Scharlachepidemie im Kustriner Kreise, 1817-19, &c. Berlin, 1820.--The same, Bemerk. uber das Scharlachfieber, &c. Greifswalde, 1827.

[14] Peart, Practical informations on malignant scarlet-fever and sore-throat, in which a new mode of treatment is freely communicated.

London, 1802.

[15] J. B. Brown, On scarlatina, and its successful treatment by the Acidum-acetic.u.m-dilutum of the Pharmacopaeia. London, 1846.

[16] The forms in which I have given this acid are the following:

Take three ounces of raspberry syrup and fifteen drops of muriatic acid.

Rub the whole of the acid with two or three spoonfuls of syrup in a porcelain mortar (or, if there is none, in a soup-plate with the foot of a wine-gla.s.s, or a tumbler) for a minute or two; then add some more of the syrup and rub again, and thus continue till the acid is well divided and mixed up with the syrup. Of this mixture give the patient a teaspoonful every hour or two, or oftener, according to the symptoms.

An other form for a gargle is this:

Take a cup of coa.r.s.e pearl-barley (or of rice), roast it till yellow; then boil it with one quart of water for ten minutes; add one teaspoonful of muriatic-acid, and four or six tablespoonfuls of honey; mix it well and use it for a gargle, tepid. The decoction should be pa.s.sed through some linen, or a sieve, before the acid and honey are added, to keep back the barley or rice-grains.

The syrup should be used for inflammation of the tonsils; the gargle for inflammation of the fauces or pharynx.

[17] Schnitzlein, das Scharlachfieber, seine Geschichte, Erkenntniss und Heilung: Munchen, 1851.

[18] Schneemann, die sichere Heilung der Scharlachkrankheit durch eine neue, vollig gefahrlose Heilmethode. Hannover, 1848.

[19] Lindsley, Boston Med. and Surg. Journal, May, 1850.

[20] C. A. W. Richter, das Wa.s.serbuch. Berlin, 1856.

[21] Berend, Oppenheimer Zeitschrift. April, 1848.

[22] Hauner, Deutsche Klinik, 1850, No. 41.

[23] Hufeland, Hedenus, Burdach, Berndt, Cramer, Maclure, Feron, &c.

[24] Lehmann, Harnier, Wagner, Vogel, Steimmig, Schwartze, c.o.c.k, Pfaff, Baumgartner, Belitz, &c.

[25] Currie, on the effects of cold and tepid water. London.