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vious period. Indeed she was reduced to a state of constant danger and distress. I advised an operation, which was made by dividing the upper portion of the tumour with a scalpel about five inches, encircling the prominent portion of integuments within two elliptical incisions. Twenty-two ounces of fluid were discharged, carrying the appearance of the purest alcohol. On standing till cold, it had no appearance of serum or lymph, but was more like distilled water. These incisions, and the removal of parts, exposed the interior and bottom of the tumour. It was lined with the dura mater distended and enlarged with the fluid mentioned, two of the lower spinous processes were wanting; a cavity was presented, and the spinal cord, in its natural position, and covered with the pia mater, was perceptible.
The divided parts were brought together by adhesive strips, and compresses being laid on a bandage was applied. She suffered but little by the operation, except the former symptoms from concussion; these were great for a few minutes. There was a constant secretion and discharge of fluid, from the parts for the first five days, with neuralgic symptoms, and increased arterial excitement, which were mitigated by large doses of morphia and warm fomentations, over the spine. The suppurative process took place freely about the tenth day, and a union of the parts followed, with a mitigation of all the symptoms. A sound state of the parts, with a depression of the integuments over the deranged portion of the spine, followed, and she has enjoyed good health up to this time, which is eight years. This tumour carried with it from the birth of the individual the appearance of those which I have described as curable. If my conclusions are correct, these "cysts,” as “D.” terms them, have secreting surfaces, and would not be
likely to unite with a coagulum, or fibrine, deposited within the
Would the coagulum adhere, without inflammation, to the surrounding tissues ?
Painsville, Ohio, July, 1840.
Art. 11.--Remarks on Scarlet Fever, as it occurred in Callo
way Co., Ky., in 1838. By Dr. W. Scott LAWRIE, of Ky.
In the following article I shall not attempt a labored dissertation on scarlet fever, but shall endeavor briefly to describe the symptoms and mode of treatment pursued during its prevalence in the county of Calloway, Kentucky, in the spring and early part of the summer of 1838. The winter had been unusually severe, and it was early in the spring that this formidable disease commenced its ravages. Its appearance created much alarm, the general impression that it was contagious pervading almost every family; and in some instances so great was the dread of spreading it, that the assistance so necessary among neighbors in times of sickness, was most inhumanly withheld, and a case or two occurred where barely sufficient force could be mustered to pay the last sad offices to the dead.
No disease with which I am conversant, is more appropriately named than “Scarlet Fever,” a solitary symptom serving at once to develope its character. Its presence was variously intimated, at times being ushered in by rigors or slight chills, with redness of the eyes, pain in the head, heat, redness, and dryness of the skin, and difficulty of respiration;
, while again the rash itself, though not generally appearing until between the third and fifth day, was the first symptom manifested. In some other cases, soreness of throat was the symptom first complained of; and again, fever, redness of the eyes, the peculiar appearance and elevation of the papillæ of the tongue, resembling the seed of the strawberry, (a diagnostic in the cases of both black and white patients,) cough, wheezing, with a rattling of mucus in the throat, and redness and swelling of the fauces, were the symptoms which presented, in others.
These are the symptoms which usually came under my notice. The indications which they suggest are, first to abate the violence of the fever, and, secondly, to promote the cutaneous afflux or centrifugal tendency, scarlet fever, like all other eruptive diseases, being safest when it comes fully out upon the skin. Upon being called to a case in the commencement of an attack, and finding the usual symptoms attendant, particularly heat and redness of skin, with headache and difficult respiration, I endeavored to meet the first indication by abstracting blood freely from the arm, and in such a quantity as to satisfy me, that an impression had been made
the symptoms manifested. Bloodletting as a remedy in scarlatina, I am aware, is not sanctioned by some of the profession, while by others it is as much extolled. Dr. McIntosh states, that for a good while he was opposed to it, but that upon find- . ing so many of his cases snatched from an untimely grave, by a spontaneous bleeding from the nose, he determined upon a change of treatment; and at the time of his death he was an advocate for v. s. in this disease. So clear an indication of nature was not lost upon such a man as Dr. McIntosh.
The soreness and rattling in the throat, and the hurried and laborious respiration, would at once proclaim the propriety and necessity of an emetic, and, more particularly, should the cutaneous affilux be tardy in its appearance. Emetics, from their peculiar mode of operation, having a direct tendency to the skin, are very essential in the treatment of scarlatina, while cathartics, in their nature, are the reverse. An emetic in the onset, according to my experience, is the most effectual step towards cutting short the disease, and I am inclined to give the preference to tartar emetic over all the other articles of this class. In all the cases which have fallen under my care, I have used this remedy, and in only two have I seen it run off by the bowels, the objection urged against it, and in these, it failed to vomit altogether. In one instance only have I administered ipecac, and then, combined with calomel, it answered remarkably well. In the same family in which I gave it, I had six other patients all of whom took the antimonial and recovered.
To an abuse of any medicine I am opposed, and to none more than that of calomel as a purgative in scarlatina. Cathartics, I have stated, have no cutaneous tendency, and calomel least of all, being a permanent irritant of the mucous membrane of the alimentary canal, and reducing during the time of its operation the functions of the skin, which are in an inverse ratio to the peristaltic action. In this disease the bowels are frequently sluggish and torpid, and that they should be opened, there can be no doubt; but that they should be moved by calomel is by no means certain. A majority of cases, in my opinion, will be as well, if not better managed without calomel, Epsom salts, and calcined magnesia, or rhubarb and magnesia, having with me done admirably well.
When the heat and dryness of skin continue after the stomach and bowels have been operated on, and the eruption is still tardy, or appears but partially, I have been much aided by the warm bath, either by immersion, or by pouring water from a vessel upon the body. Even sponging the body with warm water is of much benefit. The bath better than almost any other measure allays that restlessness so often attendant, and puts an end to the irritation of the skin, while at the same time it reduces the excessive temperature, promotes perspiration, and adds much to the comfort of the sufferer.
Cataplasms have also aided me much in the management of scarlet fever. A poultice of light-bread and milk, with the addition of cayenne pepper, has been usually employed. The temperature of the body is in many cases very unequally distributed, that of the abdomen being often preternatural, and in such instances a poultice covering the entire bowels will be found highly beneficial.
The testimony concerning vesication in this disease is conflicting. My own experience is favorable to it. In three or four cases, at least, I am confident that I obtained much advantage from the use of blisters; and I am not sure, that to them alone three of my patients are not indebted for their lives. In two of them, deglutition seemed impossible, and any liquid taken into the mouth was at once ejected through the nostrils. To the first I was called in much haste about 10 o'clock, P. M. The subject was a remarkably stout and healthy young woman, who had been for a few days convalescent, and had on that day been unfortunately exposed to a light shower of rain. I found her in extreme distress; her pulse full and bounding, skin hot and dry; much disturbance about the head, throat painful, and a good deal swollen. My efforts at v. s. failed entirely- the light was a bad one, and
, the patient being very fleshy, after two or three ineffectual attempts I abandoned it. Tartar emetic was forthwith administered, half a grain every fifteen minutes, but failed to induce emesis, the irritability of the bowels being such that