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to avoid the consequences of the measles, it is not the drawing off the morbific matter which we need to study, so much as the obviating and removing the inflammatory state of the system which had been induced by the disease. With this last view, indeed, purging may still be a proper remedy; but bleeding, in proportion to the symptoms of inflammatory disposition, is yet more so.
650. From our late experience of the benefit of cold air in the eruptive fever of the small-pox, some physicians have been of opinion, that the practice might be transferred to the measles : but we have not yet had trials sufficient to ascertain this. There is no doubt that external heat may be very hurtful in the measles, as in most other inflammatory diseases; and therefore the body ought to be kept in a moderate temperature during the whole course of the measles; but how far, at any period of the disease, cold air may be ap plied with safety, we are yet uncertain. Analogy, though so often the resource of physicians, is in general fallacious; and further, though the analogy with the small-pox might lead to the application of cold air during the eruptive fever of the measles, the analogy with catarrh seems to be against the practice. After the eruption had appeared upon the skin, we have had many instances of cold air making it disappear, and thereby producing much disorder in the system; and have al
so had frequent examples of such disorder being removed by restoring the heat of the body, and thereby again bringing forth the eruption.
OF THE SCARLET FEVER.
651. It may be doubted if the scarlet fever be a disease specifically different from the cynanche maligna above described. The latter is almost always attended with a scarlet eruption; and, in all the instances I have seen of what may be called the scarlet fever, the disease, in almost every person affected, has been attended with an ulcerous sore throat.
652. This view of the matter may create some doubt; but I am still of opinion, that there is a scarlet fever which is a disease specifically different from the cynanche maligna.
Dr. Sydenham has described a scarlet fever, which he had seen prevailing as an epidemic, with all the circumstances of the fever and eruption, without its being accompanied with any affection of the throat; at least he does not take notice of: any such affection, which such an accurate obm
server could not fail to have done, if any such symptom, as we have commonly seen making a principal part of the disease, had attended those cases which he had observed. Several other writers have described the scarlet fever in the same manner, and I know physicians who have seen the disease in that form; so that there can be no doubt of there being a scarlet fever not necessarily connected with an ulcerous sore throat, and therefore a disease different from the cynanche maligna.
653. But, further, although in all the instances of scarlet fever which I have seen, (and in the course of forty years I have seen it six or seven times prevailing as an epidemic in Scotland), the disease, in almost all the persons affected, was attended with an ulcerous sore throat, or was what Sauvages names the Scarlatina Anginosa ; and although, in some instances, the ulcers of the throat were of a putrid and gangrenous kind, and at the same time the disease in all its symptoms resembled very exactly the cynanche maligna ; yet I am still persuaded, that not only the scarlatina of Sydenham, but that even the scarlatina anginosa of Sauvages, is a different disease from the cynanche maligna ; and I have formed this opinion from the following considerations.
654. 1st, There is a scarlet fever entirely free from any affection of the throat, which sometimes prevails as an epidemic; and therefore there is a specific contagion producing a scarlet eruption with out any determination to the throat.
2dly, The Scarlatina, which, from its matter being generally determined to the throat, may be properly termed Anginosa, has, in many cases of the same epidemic, been without any affection of the throat; and therefore the contagion may be supposed to be more especially determined to produce the eruption only.
3dly, Though in all the epidemics that I could allege to be those of the scarlatina anginosa, there have been some cases which, in the nature of the ulcers, and in other circumstances, exactly re. sembled the cases of the cynanche maligna : yet I have as constantly remarked, that these cases have not been above one or two in a hundred, while the rest have all of them been with ulcers of a be. nign kind, and with circumstances hereafter to be described, somewhat different from those of the cynanche maligna.
Athly, On the other hand, as I have two or three times seen the cynanchè maligna epidemically prevailing; so, among the persons affected, I have seen instances of cases as mild as those of the scarlatina anginosa usually are: but here the proportion was reversed ; and these mild cases were not one fifth of the whole, while the rest were of the putrid and malignant kind.
Lastly, It applies to the same purpose to ob
serve, that, of the cynanche maligna, most of the instances terminate fatally, while, on the other hand, that is the event of very few of the cases of the scarlatina anginosa.
655. From these considerations, though it may appear that there is some affinity between the cynanche maligna and scarlatina anginosa, it will still remain probable, that the two diseases are specifi. cally different. I have been at some pains to establish this opinion: for, from all my experience, I find, that those two diseases require a different treatment; and I therefore now proceed to mention more particularly the circumstances of the scarlatina anginosa,
656. This disease commonly appears about the beginning of winter, and continues throughout the season. It comes on with some cold shivering, and other symptoms of the fever which usually introduces the other exanthemata. But here there is no cough, nor the other catarrhal symptoms which attend the measles; nor is there that anxiety and vomiting which commonly introduce the confluent small-pox, and which more certainly introduce the cynanche maligna.
Early in the disease, some uneasiness is felt in the throat; and frequently the deglutition is difficult, generally more so than in the cynanche maligna. Upon looking into the fauces, a redness