Medical inquiries and observations. By Benjamin Rush, M.D. professor of chemistry in the University of Pennsylvania.
Rush, Benjamin, 1746-1813., Redman, John, 1722-1808, dedicatee., Rush, Benjamin, 1746-1813. Appendix: containing, the new method of inoculating for the small pox.
Page  101

AN ACCOUNT OF THE Scarlatina Anginosa, AS IT APPEARED IN PHILADELPHIA, IN THE YEARS 1783 AND 1784.

THE beginning of the month of July was unusu|ally cool; insomuch that the mercury in Fa|renheit's thermometer stood at 61° in the day time, and fires were very comfortable, especially in the even|ing. In the last week but one, of this month, the weather suddenly became so warm, that the mercury rose to 94 1/2°, at which it remained for three days. As this heat was accompanied by no breeze from any quarter, the sense of it was extremely distressing to many people. Upwards of twenty persons died in the course of these three days, from the excess of the heat, and from drinking cold water. Three old people died suddenly within this space of time. This extreme heat was succeeded by cool weather, the mercury hav|ing fallen to 63°, and the month closed with produc|ing a few intermitting and remitting fevers, together with several cases of inflammatory angina.

THE weather in the month of August was extremely variable. The mercury, after standing for several days Page  102 at 92°, suddenly fell so low, as not only to render fires necessary, but in many places, to produce frost.

EVERY genus of fever made its appearance in this month. The synocha was so acute, in several cases, as to require from three to four bleedings. The remitting fever was accompanied by an uncommon de|gree of nausea and faintiness. Several people died, after a few days illness, of the typhus gravior, of Doctor Cullen. The intermittents had nothing pecu|liar in them, either as to their symptoms or method of cure.

TOWARDS the close of the month, the scarlatina anginosa made its appearance, chiefly among children.

THE month of September was cool and dry, and the scarlatina anginosa became epidemic among adults as well as young people. In most of the patients who were affected by it, it came on with a chilliness and a sickness at the stomach, or a vomiting; which last was so invariably present, that it was with me a pa|thognomonic sign of the disease. The matter discharged from the stomach was always bile. The swelling of the throat was, in some instances, so great, as to pro|duce a difficulty of speaking, swallowing, and breath|ing. In a few instances, the speech was accompanied by a squeaking voice, resembling that which attends the cynanche trachealis. The ulcers on the tonsils were deep, and covered with white, and in some instances, with black sloughs. In several cases there was a dis|charge of a thick mucus from the nose, from the be|ginning, but it oftener occurred in the decline of the disease, which most frequently happened on the fifth day. Sometimes the subsiding of the swelling of the throat was followed by a swelling behind the ears.

Page  103 AN eruption on the skin generally attended the symptoms which have been described. But this symp|tom appeared with considerable variety. In some peo|ple it preceded, and in others followed the ulcers and swelling of the throat. In some, it appeared only on the outside of the throat and on the breast; in others, it appeared chiefly on the limbs. In a few, it appear|ed on the second or third day of the disorder, and never returned afterwards. I saw two cases of erup|tion without a single symptom of the sore throat. The face of one of those patients was swelled, as in the erysipelas. In the other, a young girl of seven years old, there was only a slight redness on the skin. She was seized with a vomiting, and died delirious in fifty-four hours. Soon after her death, a livid color appear|ed on the outside of her throat.

THE bowels, in this degree of the disorder, were in general, regular. I can recollect but few cases which were attended by a diarrhoea.

THE fever which accompanied the disorder was generally the typhus mitior of Doctor Cullen. In a few cases it assumed the symptoms of the typhus gravior.

THE disease frequently went off with a swelling of the hands and feet. I saw one instance in a gentle|woman, in whom this swelling was absent, who com|plained of very acute pains, in her limbs, resembling those of the rheumatism.

IN two cases which terminated fatally, there were large abscesses; the one on the outside, and the other on the inside of the throat. The first of these cases was accompanied by troublesome sores on the ends of Page  104 the fingers. One of these patients lived twenty-eight, and the other above thirty days, and both appeared to die from the discharge which followed the opening of their abscesses.

BETWEEN the degrees of the disease which I have described, there were many intermediate degrees of indisposition which belonged to this disorder.

I SAW in several cases a discharge from behind the ears, and from the nose, with a slight eruption, and no sore throat. All these patients were able to sit up and walk about.

I SAW one instance of a discharge from the inside of one of the ears in a child, who had ulcers in his throat and the squeaking voice.

IN some, a pain in the jaw, with swellings behind the ears and a slight fever, constituted the whole of the disease.

IN one case, the disease came on with a coma, and in several patients it went off with this symptom.

A FEW instances occurred of adults, who walked about, and even transacted business until a few hours before they died.

THE intermitting fever, which made its appearance in August, was not lost during this month. It con|tinued to prevail, but with several peculiar symptoms. In many persons it was accompanied by an eruption on the skin, and a swelling of the hands and feet. In some, it was attended by a sore throat and pains be|hind Page  105 the ears. Indeed, such was the prevalence of the contagion which produced the scarlatina anginosa, that many hundred people complained of sore throats without any other symptom of indisposition. The slightest occasional or exciting cause, and particularly cold, seldom failed of producing the disorder.

THE month of October was much cooler than Sep|tember, and the disease continued, but with less alarm|ing symptoms. In several adults, who were seized with it, the hardness of the pulse indicated blood-let|ting. The blood, in one case, was covered with a buffy coat, but beneath its surface it was dissolved.

IN the month of November the disease assumed several inflammatory symptoms, and was attended with much less danger than formerly. I visited one pati|ent, whose symptoms were so inflammatory as to re|quire two bleedings. During the decline of the dis|ease, many people complained of troublesome sores on the ends of their fingers. A number of children like|wise had sore throats and fever, with eruptions on their skins, which resembled the chicken-pox. I am disposed to suspect that this eruption was the effect of the contagion of the scarlatina anginosa, as several in|stances occurred of patients who had all the symptoms of this disease, in whom an eruption of white blisters succeeded their recovery. This form of the disease has been called by Sauvage, the scarlatina variolosa.

I SAW one case of sore throat, which was succeed|ed not only by swellings in the abdomen and limbs, but by a catarrh, which brought on a fatal consump|tion.

Page  106 A CONSIDERABLE shock of an earthquake was felt on the 29th of this month, at ten o'clock at night, in the city of Philadelphia; but no change was per|ceived in the disease, in consequence of it.

IN December, January, and February, the weather was intensely cold. There was a thaw for a few days in January, which broke the ice of the Delaware, but it was followed by cold so excessive as to close the river till the beginning of March. The mercury on the 28th and 29th of February, stood below 0 in Faren|heit's thermometer.

FOR a few weeks in the beginning of December the disease disappeared in the circle of my patients, but it broke out with great violence the latter end of that month, and in the January following. Some of the worst cases that I met with, (three of which proved fatal) were in those two months.

THE disease disappeared in the spring, but it spread afterwards through the neighbouring states of New-Jersey, Delaware and Maryland.

I SHALL now add an account of the remedies which I administered in this disorder.

IN every case that I was called to, I began the cure by giving a vomit joined with calomel. The vomit was either tartar emetic or ipecacuana, according to the prejudices, habits, or constitutions of my patients. A quantity of bile was generally discharged by this medicine. Besides evacuating the contents of the stomach, it cleansed the throat in its passage down|wards. To ensure this effect from the calomel, I al|ways Page  107 directed it to be given mixed with syrup or sugar and water, so as to diffuse it generally over every part of the throat. The calomel seldom failed to produce two or three stools. In several cases I was obliged, by the continuance of nausea, to repeat the emetics, and always with immediate and obvious advantage. I gave the calomel in moderate doses in every stage of the disorder. To restrain its purgative effects, I add|ed to it a small quantity of opium.

DURING the whole course of the disorder, where the calomel failed of opening the bowels, I gave leni|ent purges, when a disposition to costiveness required them.

THE throat was kept clean by detergent gargles. In several instances I saw evident advantages from add|ing a few grains of calomel to them. In cases of great difficulty of swallowing or breathing, the patients found relief from receiving the steams of warm water mixed with a little vinegar, through a funnel into the throat.

A PERSPIRATION kept up by gentle doses of an|timonials, and diluting drinks, impregnated with wine, always gave relief.

IN every case which did not yield to the above re|medies on the third day, I applied a blister behind each ear, or one to the neck, and I think, always with good effects.

I MET with no cases in which the bark appeared to be indicated as an antiseptic, except the three in which the disease proved fatal. Where the sore throat Page  108 was blended with the intermitting fever, the bark was given with advantage. But in common cases it was unnecessary. Subsequent observations have led me to believe, with Doctor Withering, that it is sometimes hurtful in this disorder.

THIS disease proved fatal in many parts of the country, upon its first appearance; but wherever the mode of treatment here delivered, was adopted, its mortality was soon checked. The calomel was used very generally in New-Jersey and New-York. In the Delaware state, a physician of character made it a prac|tice not only to give calomel, but to anoint the out|side of the throat with mercurial ointment.