As a Prophylactic in Scarlatina.</span>

BY H. L. CHASE, M. D., CAMBRIDGE, MASS.

Hahnemann says: *[Hahnemann's Organon]“Previously to the year 1801, the genuine Scarlet fever of Sydenham prevailed epidemically among children, and attacked all without exception, who had not escaped the disease in a former epidemic: whereas, every child who was exposed to one of the kind which came under my observation in Konigslutur, remained exempt from this highly infectious disease, if it had timely taken a very small dose of Belladonna.” The first question which naturally arises in the consideration of this subject is, what is the genuine Scarlet fever of Sydenham ? In answer to the question, thinking it would be interesting, I have transcribed Willis' translation, which is as follows:

Ҡ[Works of Thos. Sydenham translated by Geo. Willis, 1788.] Though the Scarlet fever may occur at any time, yet it generally comes on at the close of summer, when it seizes whole families, but especially children. A chilliness and shivering come on at the beginning, as in other fevers, but without great sickness; afterwards the whole skin is covered with small red spots, which are more numerous, redder but not so uniform as those which constitute measles; they continue two or three days, and after they are vanished, and the skin is scaled oft, there remains a kind of branny scales, dispersed over the body, which fall off and come on again twice or thrice successively.

As this disease seems to me to be nothing more than a moderate effervesence of the blood occasioned by the heat of the preceding summer, or some other way, I do nothing which may prevent the despumation of the blood and the expulsion of the prevent matter through the pores, which is quickly enough performed. Accordingly I refrain from bleeding and the use of enemata, which make a revulsion, whereby I conceive the noxious particles are more intimately mixed with the blood, and the motion which is more agreeable to nature is checked. On the other hand, I forbear cardiacs, by the heat of which the blood may perhaps be put into a more violent motion, than so gentle and mild a separation as effects a cure require, and besides, by this means a high fever may be occasioned. I judge it sufficient for the patient to refrain wholly from meat and spirituous liquors, and to keep his room without lying always in bed. When the skin is entirely peeled off and. the symptoms vanished, it is proper to give a gentle purge suited to the age and strength of the patient. By this plain and manifestly natural method,*[Hoc morbi nomen (vix enim altius assurgit.)] this disease in name only, for it is little more, is easily cured without trouble or danger; whereas on the contrary, if we add to the patients evils, by treating him too learnedly, either. by confining him continually in bed, or exhibiting abundance of cardiacs, and other superfluous remedies, the disease is immediately increased, and he frequently falls a victim to the over-officiousness of the physician. But it should here be observed that when epileptic convulsions, or a coma arise in this disease at the beginning of the eruption, which sometimes happen to children and young persons, it is highly proper to apply a large and strong blister to the neck, and immediately exhibit a paregoric of syrup of white poppies, which is to be repeated every evening during his illness, and he must be directed to make use of milk, boiled with thrice its quantity of water, for his ordinary drink, and to refrain from meat.”

This is “the genuine Scarlet fever of Sydenham,” but the epidemic which Hahnemann saw, and in which he recommended Belladonna as a prophylactic, although resembling this, was of a more severe character; with his masterly account of the disease we all are familiar. I think I am safe in saying that we have now no disease which corresponds to this description; the disease called Scarlet fever at the present day is a very different affair. Hundreds die yearly, and in its severe form it is alike the terror of physicians and laymen. Now if it can be shown that this disease differs greatly from that described either by Sydenham or Hahnemann, then the theory of Belladonna being prophylactic now, as far as Hahnemann is concerned falls to the ground and must be abandoned. Some of these points of difference I have arranged in a tabular form.

SYDENHAM.

Rigent horrentque sub initis ut in aliis febribus, qui hac assiciuntur. neque vehementer admodum oegrotant;

postea cutis universa maculis pavis rubris interstingiuntur, crebrioribus certe et multo latioribus, magisque rubentibus, at non perinde unifornibus, ac sunt Mae quoe Morbiliios constituent.

HAHNEMANN.

All at once there occurred timidity and fearfulness, rigor with general coldness, especially of the face, hands and feet. Pressure in the hypochondria-very unexpected attack of violent vomiting, which recurs at intervals of 12 or 24 hours. After rigors which last from 12 to 24 hours, the body becomes excessively hot, accompanied with itching and burning. The head, neck, hands and feet are hottest, and swollen so as to present a shining appearance, which last to the end of the disease. Almost every paroxysm of heat terminates in profuse sweat, which, however only affects the rest of the body, but not the head, hands or feet.

On these swollen parts but first in the pit of the throat, then on the arms and legs, there appear about the second day, variously shaped and sized, cinnabar colored, spots, that readily grow pale on a slight chill, and are always accompanied with smarting, itching and burning; as the disease advances they spread out into a connected, but less vivid redness.

PRESENT SCARLATINA.

Rigors and chills are very rarely met with in the commencement, and when they do occur never last 12 hours.

Vomiting is frequent. The body is immediately very hot, the pulse being usually over 100; but there is no itching of the skin at this stage.

These parts are no hotter, and but slightly if at all swollen.

Sweating is rare; if it occurs it is profuse on the head and face, gentle on the rest of the body.

Occasionally we see this spotted appearance, but generally the eruption is in the form of minute red points, which in 24 hours are to be seen over the whole body, more particularly in the fiexures of the joints; as the points multiply by the third day, the eruption is more of a diffuse efflorescence, the points still being distinct and communicating to the hand a slight feeling of roughness; the color not being so bright as is here represented; itching of the skin is frequent on the subsidence of the eruption.

I might remark on many other points of difference; as of the fever, desquamation, &c. &c, but I think I have shown enough to convince us that the disease of the present time, is not the Scarlet fever either of Sydenham, or of Hahnemann; it seems to me that in prescribing Belladonna, either as curative or prophylactic, we have fallen into that error against which Hahnemann so often warned his followers, of prescribing for the name of a disease, instead of the total assemblage of symptoms. The word has gone out, without qualification, that Belladonna is prophylactic to Scarlatina, and what is the result? articles without number have been published in the journals, showing its decided failure, and while in some instances, those children who have taken it, have escaped the disease, (and the same is true of those who have taken nothing) in many more, not only has it not prevented the disease, but to the minds of many physicians it has seemed to be a positive injury-in this way the cause of Homoeopathy has been greatly injured. I need not detain the reader with a recital of the accounts of the failure of Belladonna, which might be done almost indefinitely, nor with a comparison of the symptoms of this drug with the disease in question, for with those symptoms all are conversant, and all know how beautifully they agree with the genuine disease.

The conclusion to which we have arrived is, that Belladonna not being homoeopathic, is therefore, not prophylactic to the Scarlet fever known to physicians of the present day; but should an epidemic arise, similar in character to that described by Hahnemann, there would be good reason for expecting that it would act as a preventive.