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tend to the causation of the types of the disorder, the symptoms being mild in those in whom the fermentable substance is in small quantity, severe in those in whom the fermentable matter is present in a greater quantity.
In closing this section, I have for a moment to recur to the origin of the propagating poison of scarlet fever, the poison which passes from one subject to another. There can be no doubt that on the circumstance of every case of scarlet fever producing an identical poison, rests the common idea that this poison is the sustaining cause of the individual symptoms. I read the question in a different way. I look on the transmissible organic poison as the product of a modified chemistry in the affected subject, as excrementitious in its nature, and as a necessary antecedent to the symptoms, but not as the diffused irritant on which the symptoms immediately depend.
I believe, indeed, that organic chemistry will at some time be able to prove that the organic poisons, by which the various diseases of epidemic type are propagated, can be produced in the laboratory by a synthetical process of research conducted on blood; that these poisons will be put into our hands as substantive things, and labelled in our museums as prussic acid and the alkaloids are now presented. But this subject, so profoundly interesting to the whole of mankind, as constituting the very foundation of scientific medicine, I must reserve for a future work.
THE TREATMENT OF SCARLET FEVER. · I knew some time ago a gentleman, who for many years was proprietor of one of the largest schools for youths in the neighbourhood of the metropolis, who had a novel way of treating scarlet fever. The treatment may be called heroic, but it was heroically successful. Whenever any one of his pupils was seized with scarlet fever, he had the youth out into the playground, and, covering him well, walked him about until the perspiration streamed from every pore. This effected, the sufferer was taken indoors, put into a warm bed, charged with warm fluids, and made still to perspire. The patient usually fell into a gentle sleep, and in nearly every case was virtually cured at once. In many cases it would be impossible to carry out literally this plan of treatment; but in all cases the same purpose might be easily effected by the hot air bath. In either way, the essence of the treatment of scarlet fever in its early stages is effected, for the essence of treatment is to produce that which nature is aiming at, profuse excretion by the skin; in other words, to expedite as quickly as possible the expulsion of the products of a malchemistry from the blood.
In cases where it is practicable, the true hot air bath, so-called Turkish, would be used with most efficiency. Where this is not obtainable, the plan, which has long been in use in this country, of making the bed a warm air bath, may be resorted to with immense advantage. For this purpose a cradle is placed over the patient, the bed-clothes are thrown over the cradle, and made to meet tightly round the patient's throat, so that he may breathe the outer air freely. A current of warm air is then driven by a long funnel-tube, made of tin, beneath the upper bedclothes into the bed. Another very simple and convenient plan is to put a couple of heated bricks into a common warming pan, and to place the pan thus heated in the bed, at a little distance from the patient, keeping it in gentle motion to prevent any scorching of the clothes. By this means there is no risk of breathing carbonic acid, the head of the patient need not be specially excluded, and the cradle for raising the bedclothes may be dispensed with. For hospitals, a simply constructed hot air couchbath is almost a necessary convenience.
Whatever means of this kind be employed, the object is the same—the production of a free diaphoresis; and this end achieved, the majority of the cases of scarlet fever would, in the presence of a pure air for respiratory purposes, recover naturally: but we must never forget that there is another element in the disorder, which may prove the fatal element, I mean the deposition of fibrine in the right cavities of the heart.
To meet this tendency to deposition, to prevent its occurrence, two remedies seem to me to be most reliable. The one is ammonia, as first recommended by Dr. Peart, and more recently by Dr. Witt; the other is acetic acid, as recommended by Mr. Isaac Baker Brown. I have often put these remedies into
use, in practice, and I am bound to say that they are both most effectual. It would be difficult to decide which is the best.
The action of these remedies at first sight may seem contradictory, but it is not so. Both acetic acid and ammonia have one property in common, that of holding the fibrine of the blood in solution. Both medicines also tend to eliminate carbonic acid; for ammonia, when freely administered, escapes from the skin, the breath, and perhaps the urine, in the form of carbonate; and acetic acid is decomposed entirely, escaping from the urine as carbonic acid in combination with a base. Further, by keeping the blood fluid, they favour elimination from every excreting surface. I have used with equally good effects a combination of these two remedies with an excess of ammonia, as in doses of two fluid-drachms of the liquor ammoniæ acetatis, with from three to five drops of liquor ammoniæ, in a liberal quantity of distilled water.
It is of importance in these exhibitions to administer the agent in small and frequently repeated doses, so that the blood may always contain the remedy; for, if the doses be given with intervals of three or four hours apart, the decomposition and elimination of the substance is over so quickly, that the system is left free of the effects during the greater part of the period between each dose. In a word, the secret of administration consists in putting aside the idea of a medicinal dose altogether, and in offering the remedy as a pleasant drink, rather than as a nauseous draught.
· If the ammonia treatment be selected, there are two points particularly to be observed. The doses must be followed up until the agent is very distinctly presented in the breath. This presence may be determined by the holding of a glass rod, moistened with hydrochloric acid for the patient to exhale on; when, if much ammonia be expired, the white characteristic fumes will be developed. This test, however, is not very satisfactory. It is better to place a drop of pure hydrochloric acid on a microscope slide, and allow the patient to exhale some twenty or thirty times over the acid surface. Then, the glass slide being gently dried before the fire, or near a spiritlamp, there will be left a crystalline deposit, which on microscopical examination will present the characters depicted in plate II, figure 1.
To effect this examination of the breath, Mr. Toogood, of Mount Street, has constructed, under my direction, a very simple pocket-tube, delineated in figure 2 of plate 11. · The tube is in fact a strong test-tube, with a neck holding a stopper perforated in two places. One of the openings is armed with a mouth-piece, and the whole is covered in with a well fitted glass cap. When the tube is prepared for use, a microscope slide is moistened at one or two points with a minim of pure hydrochloric acid, and is inserted in the tube; the stopper and glass cap are then adjusted, and the whole may be carried in the pocket safely. When it is to be applied, the glass cap is removed, and the patient is made to expire gently