§ 108. Secondary diseases succeeding scarlatina.

In many cases Belladonna will prove useful, particularly for the following symptoms: bloatedness of the face, swelling of the hands and feet, lentescent evening-fever with shuddering, stiffness of the extremities, sensation as if the abdomen would become constricted on raising the trunk; creeping sensation in the dorsal spine as if gone to sleep, erysipelatous glandular inflammations, discharge of pus from the ears, ulceration of the corners of the mouth, drowsy appearance alternating with great precipitancy in talking or doing anything; tearing and aching pains in the head, sudden starting with cries, etc. For the dropsical swelling of the body, particularly of the extremities, provided no other characteristic symptoms are present, Rhus t, Hellebor. nig., Digit., Ars., or Dulc, all in repeated doses, deserve a preference over Bell, (likewise in hy-drothorax); Aurum fol. or mur. is the best remedy for the swelling of the Schneiderian membrane or of the nasal bones, or for the discharge of fetid pus from the nose. Mercurius is indicated for ulceration of the face, accompanied with ptyalism and swelling or suppuration of the submaxillary glands.

For the subsequent vascular excitement which is apt to recur at various periods, and is accompanied with a disturbed state of the cutaneous secretions, Aconite is the best remedy, which, in some cases, is appropriately followed by Bell., Dig., Chin., Ars., or Sulphur.

The subsequent swelling and inflammation of the parotid glands do not always terminate in suppuration, but are sometimes fatal. If attended to in time, this condition can be relieved by Baryta, Hep. s., Cale, carb., Silic, Dulc, Rhus t.

The angina sometimes extends to the rima glottidis, occasioning a croupy cough. The treatment for this state of things is the same as for membranous croup, except that the Aconite can frequently be dispensed with. Hepar s. is frequently the most suitable remedy, either alone or in alternation with Spongia or Iodium.

For the remaining tearing in the limbs, I have found Dulc. most suitable; for the asthmatic complaints, Puls.,Nux v., or Arsenic. The cerebral affections setting in after scarlatina require Aconite, Bellad., Mer-cur., Digit., Am., Rhus t. The affections of the scalp, falling off of the hair, etc., are controlled by Sulphur, 2 Baryt., Lyc, Calc. c, Graph., etc.; the moist eruption on the scalp by Rhus t.. Graph., Oleander, etc.; the dry eruption by Baryt., Merc, Sulph., Calc. carb.

For a morbid state of the skin, disposition to decomposition of the solids, ulceration, Cham., Graph., Hep. s., Petrol., Sep., will be found suitable. Chamom. is likewise useful in the subsequent suffocative cough, with flushes in the face which are sometimes accompanied with cold creepings over the extremities and back. For the latter symptom I have frequently given Ipec. and Hyoscyam.; but with still greater success Conium.

Other means for the cure of scarlatina are: kindly and encouraging persuasion, pleasant little presents, beverages and coverings suitable to the patient's taste; the feeling of the patient is a much safer guide than all dogmatic rules. The patient should, however, be warned against the too early and copious use of substantial nourishment during his recovery.

§ 109. On the means of preventing Scarlet-fever, and Scarlatina complicated with Purple-rash.

Belladonna is universally admitted to be a prophylactic against the genuine uncomplicated scarlatina. It is sufficient to give a small portion of a drop of the 30th attenuation every two or four days, or in robust individuals every day or every other day. In some cases, particularly when the epidemic is very violent, the lower attenuations have to be resorted to. Acids, wine and coffee have to be avoided during the use of Belladonna. By using small doses of Belladonna, the angina and fever, the ulceration of the corners of the mouth, the various eruptions, the affections of mind and body, the paralytic condition of the optic nerves, and all the other symptoms consequent on large doses of Belladonna, are avoided. These bad effects of large doses of Belladonna require, in the first place, a saturated solution of camphor, to be given in drop doses every half hour or hour, after which Coffea, Vinum, Puls., Merc, Hyoscyam., Opium, Aurum, Hepar s., etc., should be administered.

If scarlatina and purple-rash should exist combined-ly, both Bellad. and Aconite have to be used as antidotes, commencing with either medicine according as the symptoms of either disease are more or less predominant. Bellad. should be given 12 or 16 hours after Aconite, and the latter 48 hours after the former.

§ 110. Purple-rash, Miliaria purpurea, Purpura rubra, Scarlatina miliaris Hahnemanni.

Purple-rash attacks persons of every age. The eruption consists of purple-red circumscribed spots, which sometimes have a brownish or dark-red tinge, and remain unaltered under the pressure of the finger. The spots are dotted with dark-red miliary pimples, which are not so much raised above as deep-seated in the skin, and distinctly perceptible to the eye and finger. The eruption does not show itself on any particular place, is, however, most frequently perceived on the covered parts and in the bends of the joints. It is least frequent on the face, and is generally without swelling. The eruptive fever does not run a regular course; the rash is seen now here, then there, and does not disappear after a definite period. The sudden disappearance of the rash, which takes place at times, becomes frequently fatal in a short time. The danger is not proportionate to the quantity of the eruption upon the skin. The disease is sometimes most malignant when the eruption is trifling, whereas there is frequently very little danger when the eruption is fairly out. No sweat appears except on the dark-red spots. Dr. Trinks saw no sweat except on the parts which were free from all eruption; the parts covered by the eruption became turgescent. This rash may occur several times on the same person, even during the same epidemic. There is no angina except when there is no eruption; it is felt previous to the eruption coming out; there is no angina when the eruption is out fully, and it becomes very violent when the eruption recedes from the skin. The angina varies in different epidemics and sometimes resembles that of scarlatina. '