Additional Observations UPON THE Scarlatina Anginosa.
THIS disease has prevailed in Philadelphia, at dif|ferent seasons, ever since the year 1783. It has blended itself occasionally with all our epidemics. Many cases have come under my notice since its first appearance, in which dropsical swellings have succeed|ed the fever. In some instances there appeared to be effusions of water not only in the limbs and abdomen, but in the thorax. They yielded, in every case that I attended, to purges of calomel and jalap. Where these swellings were neglected, they sometimes proved fatal.
IN the winter of 1786, 7, the scarlatina anginosa was blended with the cynanche parotidea, and in one instance with a typhus mitior. The last was in a young girl of nine years of age. She was seized with a vomit|ing of bile and an efflorescence on her breast, but disco|vered no other symptoms of the scarlatina anginosa till the sixteenth day of her fever, when a swelling appear|ed on the outside of her throat; and after her recovery, a pain and swelling in one of her knees.
IN the month of July 1787, a number of people were affected by sudden swellings of their lips and eyelids. These swellings generally came on in the night, were attended with little or no pain, and went off in two Page 110 or three days. I met with only one case in which there was a different issue to these symptoms. It was in a patient in the Pennsylvania hospital, in whom a swelling in the lips ended in a suppuration, which, notwithstanding the liberal use of bark and wine, proved fatal in the course of twelve days.
IN the months of June and July 1788, a number of people were affected by sudden swellings, not only of the upper and lower lips, but of the cheeks and throat. At the same time many persons were affected by an inflammation of the eyes. The swellings were attended with more pain than they were the year be|fore, and some of them required one or two purges to remove them; but in general they went off without medicine, in two or three days.
Is it proper to refer these complaints to the same contagion which produces the scarlatina anginosa?
THE prevalence of the scarlatina anginosa at the same time in the city; its disposition to produce swel|lings in different parts of the body; and the analogy of the intermitting fever, which often conceals itself under symptoms that are foreign to its usual type; all seem to render this conjecture probable. In one of the cases of an inflammation of the eye, which came under my notice, the patient was affected by a vomiting ua few hors before the inflammation appeared, and com|plained of a sickness at his stomach for two or three days afterwards. Now a vomiting and nausea appear to be pathognomonic symptoms of the scarlatina anginosa.
IN the autumn of 1788, the scarlatina anginosa ap|peared with different degrees of violence in many parts of the city. In two instances it appeared with an ob|stinate Page 111 diarrhoea; but it was in young subjects, and not in adults, as described by Doctor Withering. In both cases, the disease proved fatal; the one on the third, the other on the fifth day.
IN the month of December of the same year, I saw one case in which a running from one of the ears and a deafness came on, on the fifth day, immediately after the discharge of mucus from the nose had ceased. This case terminated favourably on the ninth day, but was succeeded for several days afterwards by a trouble|some cough.
I SHALL conclude this essay by the following re|marks.
1. CAMPHOR has often been suspended in a bag from the neck, as a preservative against this disease. Repeated observations have taught me, that it possesses little or no efficacy for this purpose. I have had rea|son to entertain a more favourable opinion of the be|nefit of washing the hands and face with vinegar, and of rinsing the mouth and throat with vinegar and water every morning, as a means of preventing this disorder.
2. WHENEVER I have been called to a patient where the scarlatina appeared to be in a forming state, a vomit of ipecacuana, or tartar emetic, mixed with a few grains of calomel, has never failed of completely checking the disorder, or of so far mitigating its violence, as to dis|pose it to a favourable issue in a few days; and if these observations should serve no other purpose, than to a|waken the early attention of patients and physicians to this speedy and effectual remedy, they will not have been recorded in vain.