Cure and prevention of scarlet fever

(published as a pamphlet by Hahnemann in 1801)

Preface

Had I compiled a large book upon scarlet fever, I should have obtained, through the usual channels of publication, at least as much in the way of honorarium as by the subscription for this little book. But as, according to Callimachus, a great book is a great evil, and is soon laid aside, one of my chief aims, to wit, to excite a great interest in a subject of so much importance to humanity as this is, in order clearly to ascertain the truth, by bringing the observations of many to bear upon it-could not have been fulfilled so well by the large book as by the mode I have adopted.: 

Up to this period it is impossible that the corroboration of my assertion could be complete. The extract of belladonna, which I caused to be delivered to my subscribers, might have lost its power by the great distances it was sent, and by the long period it had been kept. Occasionally it fell into the hands of some who had neither the ability nor the good will to administer its solution in an appropriate manner. The precautions laid down in this book could not all be enumerated in a small paper of directions, where on account of the danger of misusing the medicine, it was necessary to direct that only the very smallest dose should be administered. Moreover it is probable, that the thorough admixture of the few drops with a sufficient quantity of the fluid in which it should be taken, was generally neglected; a circumstance the neglect of which makes this and every other medicine many hundred times less powerful than they would be were they properly combined with the diluting fluid. The hurry and inaccuracy of young doctors of the present day are well known, and we know also how little dependence we can place on our private patients.: 

In addition, very inclement weather, and in general what is understood a chill (which I have forgotten to allude to in the text), present obstacles by no means slight to the power of belladonna as a preventative of scarlet-fever. Children should be carefully preserved from it, without however completely excluding them from the open air, and if this precaution be neglected, the dose of the remedy should at all events be increased.: 

There may also be many other circumstances unknown to me to diminish the power of belladonna. The philanthropic physician ought to endeavour to discover and to avoid them.: 

It is only in accordance with my well known maxim (the new principle) that small-pox, to give one example from among many, has an important prophylactic in the cow-pox, which is an exanthematous disease, whose pustules break out after the sixth day of innoculation, with pain and swelling of the axillary glands, pain in the back and loins, and fever, and surrounded by an erythematous inflammation-that is to say, constituting altogether a disease very similar to variola. And, in like manner, a medicine which causes symptoms so similar to those of the invasion of scarlet-fever, as belladonna does, must be one of the best preventive remedies for this children’s pestilence. It should however be put to the test with candour, carefulness and impartiality-not cursorily or hurriedly, not with the design of depreciating the originator of it at the expense of truth.

But if its efficacious prophylactic power has incurred and may still incur opposition from prejudiced, ill-disposed, weak-minded and cursory observers, I may be allowed to appeal against their conduct to the more matured investigation of the clear-sighted, dispassionate portion of the public, and to trust to time for a just verdict. I should esteem myself happy if I should see, some years hence, this scourge of mankind in any measure diminished by my labours.

At the commencement of the year 1799 small-pox came from the neighbourhood of Helmstadt to Königslutter which spread slowly around, and though not mild in character, the eruption was small, warty looking, and accompanied with serious symptoms, especially of an atonic kind. In the village it came from, the scarlet fever was prevalent at the same time, and, mixed up with the latter, the small-pox made its appearance in Königslutter. About the middle of the year the small-pox ceased almost entirely, and the scarlet-fever then commenced to appear alone and more frequently.

In its main symptoms this epidemic of scarlet-fever resembled the scarlatina of Plenciz. In some families the disease was of a mild form, but generally it was of a bad kind.

When it occurred in the mild form it generally remained mild in the whole family living together. There occurred a slight feeling of weariness, a kind of faint-heartedness, some difficulty of swallowing, some fever, red face and hot hands. There then appeared, usually the very first day, alone with slight itching, the spots of various shape, and sometimes paler, sometimes redder, on the neck, the chest, the arms, andc., which disappeared again in from three to four days, and the desquamation that followed was scarcely observable on the fingers, and almost nowhere else. Towards evening only the patients laid down in bed for a short time, but the rest of the day they went about. The sleep was pretty tranquil, the bowels usually somewhat less open than when in health, the appetite usually not much diminished.

Very different was the course, of the bad form of scarlet-fever that prevailed in most families. Generally the seventh day after the infection had been communicated it broke out suddenly and unexpectedly, without any previous feeling of illness seldom was it that horrible dreams on the previous night served as a prelude to it. All at once there occurred an unusual timidity and fearfulness, rigour with general coldness, especially in the face, the hands and the feet, violent pressive headache, especially in the forehead, above the orbits. Pressure in the hypochondria, chiefly in the region of the stomach; in most cases there occurs a very unexpected attack of violent vomiting, first of mucus, then of bile, then of water recurring at intervals of from twelve to twenty-four hours, accompanied by an ever increasing weakness and anxiety, with trembling. The parotid and sub-maxilliary glands swell and become hard and painful, swallowing becomes very difficult, with shooting pains. After rigours that last from twelve to twenty-four hours, the body becomes excessively hot, accompanied with itching burning, the head, neck, hands (forearms) and feet (legs) are hottest, and swollen so as to present a shining appearance, which lasts 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 and 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 cinnabar coloured spots of various sizes that readily grow pale on any slight chill; these spots are scarcely raised above the level of the skin, and are always accompanied by smarting, itching, burning; as the disease advances they spread-out into a connected, but less vivid redness. On the outburst of the eruption, the fever does not diminish; on the contrary, the greater the redness the more violent is the fever. In the meantime the sore-throat increases, swallowing becomes very painful, in the worst cases almost impossible. The interior of the mouth, the tongue and the palate are inflamed, very painful, raw, and as if ulcerated all over. In very bad cases the swelling of the cervical glands almost closes the jaws, and from between the teeth, which can be but slightly separated, there flows almost incessantly a very viscid and very fetid saliva, which can scarcely be expelled from the mouth in consequence of the tongue being so painful. In like manner, in the worst cases the lining membrane of the nose is ulcerated. At this period the voice becomes weak, suppressed and unintelligible, and respiration difficult. The taste in the mouth is putrid; the stools, which are usually rarely passed, have the odour of assafoetida. A drawing pain in the back and cutting bellyache are characteristic symptoms, which, together with pressive headache, in bad cases persist in alternation day and night, but in less dangerous cases only recur in the evening after sunset, along with increase of anxiety and timidity. In the very worst cases there are alternate paroxyms of agonising tossing about, raving, groaning, grinding of the teeth, floccitations, general or partial convulsions and comatose stupefaction or sopor, with half-shut eyes and head bent backwards. The urine, which is light-coloured, and the faeces, are passed involuntarily, and the patient sinks down to the bottom of the bed. The grumbling, complaining disposition increases from day to day. The smallest quantity of food, even in the slighter cases, perceptibly and immediately increases the anxiety, more than in any other disease.

From the fourth to the seventh day, if death do not ensue, the skin rises up, or rather the pores of the skin on the reddest places become elevated, especially about the neck and the arms, in small, close, pointed miliary vesicles (somewhat resembling goose’s skin), which at first, as the redness of the rest of the skin declines, appear extremely red, but afterwards, or when cold is applied, grow pale and at length quite white; they are however empty, and contain no fluid.

Neither the greater intensity nor the more general extension of the redness of the skin, nor yet the occurrence of these empty miliary vesicles, diminish the fever after the manner of a critical eruption; the former indeed is rather a sign of an increased intensity of fever which can only subside as this redness decreases.

The bad form of scarlatina lasts from nine to fourteen days, and the disgust at food lasts about the same time. As the appetite returns, the patient first wishes for fruit, then meat, he generally prefers pork.

During the fever, blood-red spots now and then appeared on the sclerotic; in some the cornea of one or both eyes was completely obscured; others (probably badly treated patients) were rendered imbecile.

At length the epidermis gradually peels off on the places where the redness appeared, and even where there was only burning itching without subsequent redness; on the hands and feet it comes off in large pieces, like pieces of a torn glove, but on the other parts only in larger or smaller scales. In one case the nails of the fingers and toes also fell off. The falling off of the hair only commenced some weeks or months after the fever; in one case it went the length of total baldness.

Among the after-sufferings the following were prominent: long-continued debility, a very disagreeable feeling in the back, as if it were asleep (narcosis), pressive headache, a painful sensation of constriction in the abdomen only felt on bending backwards, abscesses in the interior of the ear, ulceration of the lining membrane of the nose, ulcerated angles of the mouth, other spreading ulcers in the face and other parts of the body, and generally a great tendency of the whole skin to ulceration (unhealthy skin as it is termed). In addition to the above, a great hurriedness in speaking and acting, fits of sleepiness by day, crying out in sleep, shuddering in the evening, puffiness and earthy colour of the countenance, swelling of the hands, feet and loins, andc.

Any one who chooses may read for himself in the works of the various authors the infinity of medicines and modes of treatment invented for this disease (from blood-letting and leeches to bark, from gargles and clysters to blisters, from antispasmodic, derivative, antiseptic to refrigerant, resolvent, purgative, involvent, humectant, alexiteric, incitant, asthenic, and God knows what other ingenious modes of treatment) intended to meet the thousand imaginary indications. Here we often see the ne plus ultra of the grossest empiricism: for each single symptom a particular remedy in the motley, mixed, and repeated prescriptions; a sight that cannot fail to inspire the unprejudiced observer with feelings at once of pity and indignation!

For my own part, when summoned to cases of the fully developed disease (where there was no question of prevention or suppressing its commencement), I found I had to combat two different states of body that sometimes rapidly alternated with one another, each of which was composed of a convolute of symptoms.

The first: the burning heat, the drowsy stupefaction, the agonising tossing about with vomiting, diarrhoea, and even convulsions, was subdued in a very short time (at most an hour) by a very small quantity of opium, either externally by means of a piece of paper (according to the size of the child, from a half to a whole inch in length and breath) moistened with strong tincture of opium, laid upon the pit of the stomach and left there until it dries; or if there is no vomiting, internally, by giving a small quantity of a solution of opium.

For external use I employed a tincture formed by adding one part of finely pulverised crude opium to twenty parts of weak alcohol, letting it stand in a cool place for a week, and shaking it occasionally to promote the solution. For internal use, I take a drop of this tincture and mix it intimately with 500 drops of diluted alcohol, and one drop of this mixture likewise with other 500 drops of diluted alcohol, shaking the whole well. Of this diluted tincture of opium (which contains in every drop one five-millionth part of a grain of opium) one drop given internally was amply sufficient in the case of a child of four years of age, and two drops in that of a child of ten years, to remove the above state. It is unnecessary to repeat these doses oftener than every four or eight hours, in some cases not more than every twenty-four hours, and that sometimes only a couple of times throughout the whole fever, for which the more frequent or more rare occurrence of these symptoms must be our guide.

Where also, during the further progress of the disease, the same symptoms appeared accompanied by constipation of the bowels, opium so applied externally, or given internally in such doses, never failed to produce the desired effect. The result, by no means of a transient character, appeared at most in an hour, sometimes within a quarter of an hour, and just as rapidly from the external application as from the internal administration.

Larger doses than the above, occasion raving, hiccough, unappeasable peevishness, weeping, andc.-an array of factitious symptoms which, when they are not severe, disappear spontaneously in a few hours, or may be more speedily removed by smelling at a solution of camphor.

The second morbid condition that occurs in the course of this disease: the increase of fever towards evening, the sleeplessness, the total loss of appetite, the nausea, the intolerable lachrymose peevishness, the groaning, that is, the state where opium does and must do harm,-this state was removed in a few quarters of an hour by ipecacuanha.

For this end, immediately on the occurrence of this state, or during its persistence, I gave, according to the age of the child, ipecacuanha, either in substance in the dose of a tenth to half a grain in fine powder; or I employed the tincture prepared by digesting in the cold for some days one part of the powder with twenty parts of alcohol, of this one drop was mixed with a hundred drops of weak alcohol, and to the youngest children a drop of this last was given, but to the oldest ones ten drops were given for a dose.

I found these two remedies as indispensable as they were generally completely sufficient not only to ward off the fatal termination, but also to shorten, diminish and alleviate the scarlet-fever. I cannot imagine a more suitable mode of treatment, so rapid and certain in its results I found it.

As regards moral and physical accessory dietetic means in the treatment of a fully developed case of scarlet-fever, I would advise that we should try to dispel all fear by means of kind and cheering words, by nice little presents, by holding out hopes of a speedy recovery-and on the other hand, we should allow the patient a free choice of all kinds of drinks, and warmer or cooler coverings to suit his feelings. The patient’s own feelings are a much surer guide than all the maxims of the schools. We must only take care kindly to keep the patient from taking solid nutriment too soon, or in too great quantity during his convalescence.

But even under the most appropriate and certain medical treatment of developed scarlatina of a bad type there is always risk of death, of the most miserable death, and the amount of the countless sufferings of the patients is not unfrequently so great that a philanthropist must wish that a means could be discovered by which those in health might be protected from this murderous children’s pestilence, and be rendered secure from it, more especially as the virus is so extremely communicable that it inevitably penetrates to the most carefully guarded children of the great ones of the earth. Who can deny that the perfect prevention of infection from this devastating scourge, and the discovery of a means whereby this divine aim may be surely attained, would offer infinite advantages over any mode of treatment, be it of the most incomparable kind soever?

The remedy capable of maintaining the healthy uninfectable by the miasm of scarlatina, I was so fortunate as to discover. I found also that the same remedy given at the period when the symptoms indicative of the invasion of the disease occurs, stifles the fever in its very birth; and, moreover, is more efficacious than other known medicaments in removing the greater part of the after-sufferings following scarlatina that has run its natural course, which are often worse than the disease itself.

I shall now relate the mode in which I made the discovery of this specific preservative remedy.

The mother of a large family, at the commencement of July, 1799, when the scarlet-fever was most prevalent and fatal, had got a new counterpane made up by a semptress, who (without the knowledge of the former) had in her small chamber a boy just recovering of scarlet-fever. The first mentioned woman on receiving it, examined it and smelt it in order to ascertain whether it might not have a bad smell that would render it necessary to hang it in the open air, but as she could detect nothing of the sort, she laid it beside her on the pillow of the sofa, on which some hours later she lay down for her afternoon’s nap.-She had unconsciously, in this way only (for the family had no other near or remote connexion with scarlatina patients), imbibed this miasm.-A week subsequently she suddenly fell ill of a bad quinsy, with the characteristic shooting pains in the throat, which could only be subdued after four days of threatening symptoms.

Several days thereafter, her daughter, ten years of age, infected most probably by the morbific exhalations of the mother or by the emanations from the counterpane, was attacked in the evening by severe pressive pain in the abdomen, with biting itching on the body and head, and rigour over the head and arms, and with paralytic stiffness of the joints. She slept very restlessly during the night, with frightful dreams and perspiration all over the body, excepting the head. I found her in the morning with pressive headache, dimness of vision, slimy tongue, some ptyalism, the submaxillary glands hard, swollen, painful to the touch, shooting pains in the throat on swallowing and at other times. She had not the slightest thirst, her pulse was quick and small, breathing hurried and anxious; though she was very pale, she felt hot to the touch, yet complained of horripilation over the face and hairy scalp; she sat leaning somewhat forwards in order to avoid the shooting in the abdomen which she felt most acutely when stretching or bending back the body; she complained of a paralytic stiffness of the limbs with an air of the most dejected pusillanimity, and shunned all conversation; “she felt,” she said, “as if she could only speak in a whisper.” Her look was dull and yet staring, the eyelids inordinately wide open, the face pale, features sunk.

Now I knew only too well that the ordinary favourite remedies, as in many other cases, so also in scarlatina, in the most favourable cases leave everything unchanged, and therefore I resolved in this case of scarlet-fever just in the act of breaking out, not to act as usual in reference to individual symptoms, but if possible (in accordance with my new synthetical principle) to obtain a remedy whose peculiar mode of action was calculated to produce in the healthy body most of the morbid symptoms which I observed combined in this disease. My memory and my written collection of the peculiar effects of some medicines, furnished me with no remedy so capable of producing a counterpart of the symptoms here present, as belladonna.

It alone could fulfil most of the indications of this disease, seeing that in its primary action it has, according to my observations, a tendency to excite even in healthy persons great dejected pusillanimity, dull staring (stupid) look, with inordinately opened eyelids, obscuration of vision, coldness and paleness of the face, want of thirst, excessively small, rapid pulse, paralytic immobility of the limbs, obstructed swallowing, with shooting pains in the parotid gland, pressive headache, constrictive pains in the abdomen, which become intolerable in any other posture of the body besides bending forwards, rigour and heat of certain parts to the exclusion of others, e. g., of the head alone, of the arms alone, andc. If, thought I, this was a case of approaching scarlet-fever, as I considered was most probable, the subsequent effects peculiar to this plant-its power to produce synochus, with erysipelatous spots on the skin, sopor, swollen, hot face, andc.-could not fail to be extremely appropriate to the symptoms of fully developed scarlatina.

I now earnestly desired to be able if possible to preserve the other five children of the family perfectly free from infection. Their removal was impossible and would have been too late.

I reasoned thus: a remedy that is capable of quickly checking a disease in its onset, must be its best preventive; and the following occurrence strengthened me in the correctness of this conclusion. Some weeks previously, three children of another family lay ill of a very bad scarlet-fever; the eldest daughter alone, who, up to that period, had been taking belladonna internally for an external affection on the joints of her fingers, to my great astonishment did not catch the fever, although during the prevalence of other epidemics she had always been the first to take them.

This circumstance completely confirmed my idea. I now hesitated not to administer to the other five children of this numerous family this divine remedy, as a preservative, in very small doses, and, as the peculiar action of this plant does not last above three days, I repeated the dose every 72 hours, and they all remained perfectly well without the slightest symptoms throughout the whole course of the epidemic, and amid the most virulent scarlatina emanations from their sisters who lay ill with the disease.

In the mean time I was called in to attend in another family, where the eldest son was ill of scarlet-fever. I found him in the height of the fever, and with the eruption on the chest and arms. He was seriously ill, and the time was consequently past to give him the specific prophylactic remedy. But I wished to keep the other three children free from this malignant disease; one of them was nine months, another two years, and the third four years of age. The parents did what I ordered, gave each of the children the requisite quantity of belladonna every three days, and had the happiness to preserve these three children free from the pestilential disease, free from all its symptoms, although they had unrestricted intercourse with their sick brother.

And a number of other opportunities presented themselves to me where this specific preventive remedy never failed.

In order to prepare this remedy for preventing the infection of scarlet-fever, we take a handful of the fresh leaves of the wild belladonna (atropa belladonna, Linn.) at the season when the flowers are not yet blown; these we bruise in a mortar to a pap, and press the juice through linen, and immediately (without any previous purification) spread it out scarcely as thick as the back of a knife, on flat porcelain plates, and expose it to a draught of dry air, where it will be evaporated in the course of a few hours. We stir it about and spread it again with the spatula, so that it may harden in a uniform manner until it becomes so dry that it may be pulverized. The powder is to be kept in a well stopped and warmed bottle.

If we now wish to prepare from this the prophylactic remedy, we dissolve a grain of this powder (prepared from well preserved belladonna extract evaporated at an ordinary temperature) in one hundred drops of common distilled water, by rubbing it up in a small mortar; we pour the thick solution into a one-ounce bottle, and rinse the mortar and the pestle with three hundred drops of diluted alcohol (five parts of water to one of spirit), and we then add this to the solution, and render the union perfect, by diligently shaking the liquid. We label the bottle strong solution of belladonna. One drop of this is intimately mixed with three hundred drops of diluted alcohol by shaking it for a minute, and this is marked medium solution of belladonna. Of this second mixture one drop is mixed with two hundred drops of the diluted alcohol, by shaking for a minute, and marked weak solution of belladonna; and this is our prophylactic remedy for scarlet-fever, each drop of which contains the twenty-four millionth part of a grain of the dry belladonna juice.

Of this weak solution of belladonna we give to those not affected with scarlet-fever, with the intention to make them uninfectable by the disease,-to a child one year old, two drops (to a younger child one drop), to one two years old, three-to one three years old, four-to a child four years old (according to the strength of his constitution), from five to six,-to a five years old child, from six to seven,-to a six years old child, from seven to eight,-to a seven years old child, from nine to ten,-to an eight years old child, from eleven to thirteen,-to a nine years old child, from fourteen to sixteen drops; and with each successive year up to the twentieth, two drops more (from the twentieth to the thirtieth, not above forty drops)-a dose every seventy-two hours (well stirred for a minute with a teaspoon in any kind of drink) as long as the epidemic lasts, and four (to five) weeks thereafter.

Should the epidemic be very violent, it would be safer, if the children could bear it, to let the second dose be taken twenty-four hours after the first, the third dose thirty-six hours after the second, the fourth forty-eight hours after the third, and thereafter to let the subsequent doses be taken every seventy-two hours until the end, in order that the system may not at first be taken by surprise by the miasm.

This course of medicine does not disturb the health of the children. They may and indeed ought to follow the mode of life of healthy individuals, and keep to their usual drinks, food, and ordinary recreation and exercise in the open air, but they must take care to avoid excess in any of these things.

The only thing I must prohibit is the use of too much vegetable acid, of sour fruits, of vinegar, andc. The action of belladonna is thereby enormously increased, as my experience (contrary to the assertions of ancient writers) has taught me.

In case of the occurrence of such a case of the injurious and too violent action of belladonna (from this or any other cause), we should make use of its peculiar (according to my observations specific) antidote, opium, externally or internally, in doses similar to those I have above indicated, for the external or internal treatment of natural scarlatina.

There are, however, cases in which we are forced to give the above doses of belladonna oftener than every seventy-two hours. A delicate girl, three years of age, who was successfully using the belladonna as a preservative, in the above dose, beside her sister who had scarlet-fever, bruised her hand severely one day with the door of the room, and thereby fell into a mental and bodily condition so favourable to the reception of the infection, that, notwithstanding that she had taken the prophylactic the day before, she presented in a few hours all the signs of approaching scarlet-fever; but two drops of the weak solution of belladonna given immediately removed these symptoms just as quickly, without any further effects. From that time forward she took the medicine only every three days (as previously), and she remained quite free from the scarlet-fever and well.

We would therefore do well in the event of such sudden accession of violent mental depressions, occasionally, when requisite, to give one or two extra doses. We will also sometimes meet with children who possess naturally such timorous, tranquil dispositions, that in them the dose above indicated for children of their age will not suffice to protect them from scarlet-fever; the physician may therefore be allowed to increase it somewhat, and to stir the drops up with somewhat more fluid, and for a minute longer. I may observe, that it is scarcely credible how much this and every other medicine loses in power (so as even to be unserviceable for protecting from scarlet-fever), if we allow it to be licked simply and unmixed with anything from a spoon, or give it only on sugar, or, though dropping it into a fluid, administer it without stirring it well up with it. It is only by stirring, by brisk, long-continued stirring, that a liquid medicine obtains the largest number of points of contact for the living fibre, thereby alone does it become right powerful. But the well stirred dose should not be allowed to stand for several hours before it is administered. Water, beer, milk, and all such excipient fluids, when allowed to stand, undergo some decomposition, and thereby weaken the vegetable medicinal agent mixed with them, or even destroy it completely.

I would, moreover, advise that the medicine bottle should be locked up after every time of using it. I once saw a little girl of four years old fill up a medicine bottle with brandy, whence, as she confessed to me, she had previously drunk out all the medicine, which was also made with spirit and colourless. She had mounted on the table, had taken the bottle down from a high cupboard in the wall, and was about to fill it up with what she supposed to be a similar fluid, in order that her parents might not discover what she had done, when I entered the room.

Although a practitioner will seldom be so fortunate as to accomplish this extinction of the fever in question in its birth by means of belladonna, because it is not usual to send for him at the very beginning when the miasm attempts its first partial onslaught, and when uneasy dreams, paralytic stiffness of the limbs, pressive headache, rigour over one or other limb and over the head, constitute almost the only symptoms of the still feeble reaction of the system, yet it is a real fact, and, according to my by no means small experience, beyond all doubt, that it is capable of extinguishing the approaching fever with all its concomitant symptoms in the course of from twenty-four to forty-eight hours, and of restoring the previous state of health without the slightest bad consequences. To accomplish this object I found it best in this case to administer the half of the dose recommended above as a preventative every three hours, until all the symptoms had disappeared, and then to continue giving a full dose only every seventy-two hours in order to protect the patient from all further infection.I have, indeed, even in cases where there was already shooting pain and swelling of the cervical glands and increased heat of skin, that is, when a more considerable degree of natural reaction against the miasm was present, always succeeded in attaining my object by similar doses given at similar intervals of time, but I cannot recommend this practice to any practitioner who is not a most accurate observer, because should he chance to overlook symptoms of a more advanced stage that may be present, it must always remain a doubtful matter, whether, in such a case, by the addition of a new and powerful agent, the advanced disease would be suppressed and extinguished, or a tumultuous commotion be excited in the diseased system without any good result.

But least of all is it probable that our object would be attained by giving belladonna, and it is certainly not advisable to attempt it, if there are present greater heat, redness of face, great thirst, inability to leave the bed, vomiting and cinnabar-coloured eruption, in other words, fully developed scarlatina. It does not seem suited for administration in the height of the fever, just as Peruvian bark cannot be given in the middle of the hot stage of a paroxysm of intermittent fever with advantage or without producing a bad effect on the system.

On the other hand, belladonna displays a valuable and specific power in removing the after-sufferings remaining from scarlet-fever-an object that our forefathers, as we know, vainly strove to attain. Most medical men have hitherto regarded the consequences of scarlatina as at least as dangerous as the fever itself, and there have been many epidemics, where more died of the after-affections than of the fever.

The puffiness of the face, the swelling of the hands and feet, andc., the cachexy, the slow evening fever with shuddering, the stiffness of the limbs, the sense of constriction of the abdomen on holding the body erect, the formication and sleeping (narcosis) in the spine, the inflammation of the glands, the suppuration inside the ears, the ulcers on the face, on the lining membrane of the nose, at the angles of the mouth, andc., the extraordinary debility of the whole body, the sleepy, dull disposition, alternating with excessive hurry in talking and acting, the calling out in sleep, the pressive headaches, andc., will be specifically and rapidly removed by the same doses of this remedy as suffice (v. supra) for prophylactic purposes, or accordingly as the practitioner judges expedient by smaller or larger doses of it. Sometimes all that is required is to give the doses somewhat more frequently.

It is only in some particular cases, where the original disease was very violent, and advice has been sought for the after-sufferings too late, that I have witnessed what is termed the unhealthy skin, that is, the tendency to a solution of continuity in the solid parts, to ulceration, sometimes to such a degree, that belladonna is no longer of service. In such and other similar cases the most excellent remedy was the inspissated juice of the matricaria chamomilla, dried at a natural temperature in the air-of this a grain was first of all dissolved in 500 drops of water and mixed intimately with 500 drops of alcohol, and of this solution one drop was mixed with 800 drops of diluted alcohol-of this last diluted solution one drop (1/800000th of a grain of the inspissated juice) was given every day to a child of a few years old, two drops to one of ten years of age, and so forth; the medicine being well mixed with any liquid, and in a few days all tendency to ulceration of the skin was removed, the so-called unhealthy skin was cured-a disease in every case much dreaded by every medical man who does not know of this excellent but very heroic remedy.

The suffocating cough that sometimes follows the disease is also removed by chamomilla, especially if there is at the same time a tendency to flushing of the face, accompanied by horipilation over the limbs or back.

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