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tina poison. Eight had had attacks of the disease previously, and all these had the disease in a modified form. They had sorethroat, general malaise, no eruption, no desquamation. In one case acute nephritis followed the sorethroat, ending in dropsy, convulsions, and death in four months. In the one case in which there had been no previous attack of the disease, and in the case where this point is doubtful, the full course was observed, the eruption and desquamation being well marked. In the case of the boy there were symptoms in the course of the secondary fever which made me suspect the presence of typhoid as well, but the rapid recovery proved that this was not the case. There was secondary adenitis, with slight albuminuria, and congestion of the liver. All these disappeared rapidly under treatment. In the case of the adult the disease was exceedingly mild and free from complications.
The first question that arises in our minds is, To what extent does one attack of scarlatina protect a person from a future attack? For my part I do not entertain a doubt that one and the same agent, the scarlatina poison— whatever that may be—was the cause of the illness in all these cases. I have no doubt that in the case where nephritis came on and ended so unfortunately, the kidney affection was brought about through the same agency, in a subject, it may be, rendered peculiarly susceptible to that action of the poison through previous habits of life.
Of course, it is not an unknown thing for persons in an exceptional way to have scarlatina twice in the course of a lifetime. But here were eight persons in two households, all of whom had had the fever before, and all more or less affected by the infection on being exposed to it a second time. I have repeatedly seen nurses, as in the case of these two mothers, affected with sorethroat and general illness for a few days when nursing scarlatina patients.
In the light of these facts, it seems to me that we should answer the question I have propounded in this way. One attack of scarlatina does not destroy the susceptibility of a patient to the disease in future. It lessens that susceptibility; but wherever the infection becomes intense there will be a liability to take the disease in a modified form. This form of the disease, though generally unattended with danger, is not always so; the possibility of the sequelae of the fully developed form following the modified disease should be borne in mind and guarded against.
I cannot find anything in the facts I have narrated that will warrant me in drawing conclusions as to the infectiveness of the modified disease. Except that the freedom from desquamation does away with the danger of infection on that score, one would expect the modified disease to be as infective as the fully developed form so long as the fever and sorethroat lasted. The epidemic influence, however, was so strong and so wide-spread in this village that there was no possibility of saying how the infection was conveyed. In the case of the girl its operation was very rapid. The first symptoms showed themselves on the second day after her arrival home. This is not so rapid, however, as in one case mentioned by Trousseau, where the period of incubation was only twenty-four hours (Clinical Medicine, vol. ii, p. 166, Sydenham Society's translation). I did not then believe (as I have what I think to be good reason to do now), in the prophylactic power of Belladonna in this disease; and even if I had there was not much opportunity of giving it a trial in these instances, as the majority of the members of the two households had become infected before my services were called for.
There remains to be considered the question of treatment.
In the first case, that of the boy, the throat affection seemed to yield very satisfactorily to Bell, and Merc. bin. In the secondary fever with the gland and liver affection and typhoid symptoms, whilst Aeon, and Bell, did not seem to be of much service—though the gland lessened under their influence—the aspect of the case changed markedly for the better when he was put on Arsen. and Baptisia. The rheumatic symptoms also subsided quickly under these medicines; and a few intercurrent doses of Cantharis were sufficient to render the urine normal when it had become scanty and albuminous.
In the cases of the brother and sister, rapid improvement in the condition of the throat was noticed under the Sulphide of Calcium and Belladonna. I regret that in the brother's case, who appeared to be much the less severely affected of the two, and who recovered more quickly from the immediate effects, I did not give Arsenicum instead of China to help to complete his recovery. As regards the treatment of the nephritis I fear nothing very substantial can be claimed for any of the remedies employed. It was, however, marvellous how his general health and strength kept up in spite of the kidney lesion, and it was almost impossible to persuade the patient to believe that his condition was as grave as it was. In fact, it was impossible, and on one or two occasions it led to imprudence on his part, which apparently contributed to the result if they did not determine it. His diet consisted largely of milk which he took well. Arsenicum and the Liquor arsenicalis appeared to be the most serviceable of all the remedies given.
In the last case I did not give Belladonna at all. The dusky redness of the throat, the moisture of the skin, the tongue, and general condition appeared to me to indicate Mercurius, and I gave that medicine in alternation with Aconite. Under these two medicines the disease ran a very mild course, although the patient was not a very promising subject. Arsenic was the only other medicine given, and under this he convalesced satisfactorily.
A NOTE ON THE PREPARATION OF CARBO.
By P. Proctor, L.R.C.P.
The microscopical investigations into the divisibility of Carbo vegetabilis entered upon by our American confreres last year ended unsatisfactorily, it being left a matter of doubt whether the microscope left unrevealed as much as it revealed; but, as far as the revelations went, it was clear that an immense proportion of the triturated carbon remained in large microscopical masses. It is, therefore, evident that a finer and more uniform division of the substance is wanted, and I beg to suggest, for further investigation, a mode of preparation that commends itself as supplying this desideratum. Whether there is or can be any essential difference between Carbo veg. and Carbo anim. is doubtful, for if both are efficiently prepared the nature of the process ensures uniformity of result, for chemistry is very definite on this point. The substance we have to our hands is pure carbon, the other organic constituents having been got rid of by the most efficient of destructive agents, fire. The only supposable difference being in molecular cohesion. As both these forms of Carbo are open to the same objection of difficult division under the triturating process it occurred to me that we might obtain a better preparation in another way, viz. by volatilising our carbon, and so obtaining it first in that very pulverisable form. I selected Camphor as the purest form of hydro-carbon available, and after dissolving it in pure spirit burned it in a spirit lamp and collected the soot on a clean earthern plate. Three grains were collected, and as it was contaminated with the products of imperfect combustion it was submitted to a dull red heat in a testtube. This drove off these products in the form of yellowish vapour, and after a short time left the carbon in as pure a state as is known. The powder left behind was of a fine glossy black, inodorous, and tasteless, and extremely light and pulverulent.
Its ready divisability on an improved scale was evident on making the 1st centesimal trituration, which, after five minutes' trituration, gave a dark brownish-black result. On comparing it with the ordinary preparation it was fifty times deeper in colour, for one grain of this 1st trituration ground with fifty grains of Sac. lactis gave a tint equally dark to that of the 1st trituration of the ordinary preparation, so showing its greater minuteness of division. In mixing equal quantities in water the 1st trituration of the new preparation gave an inky darkness, whilst the old gave but a greyish one. Under the microscope with a quarterinch power the division appeared also to be much finer, and none of the lumps that we find in the old preparation were present. The whole substance appeared to be equally distributed. The 2nd and 3rd triturations I have not yet examined, but feel convinced they will equally show their superiority in this respect.
The first objection that will be made to this mode of preparation will naturally be that as Hahnemann made his provings with the drug prepared in his way we must follow in his steps to get the same result. To this it may be replied that we have not hesitated to use precipitated metals in place of those obtained by rubbing on a hone, &c. Indeed, the new preparation of Car bo, which I would designate Carbo sublimatus, is as nmch more finely divided as precipitated gold is over the triturated gold leaf, only instead of being precipitated it is sublimated. By such means we are justified in expecting we shall get a more efficient medicinal agent.
Another objection may be offered that fuligo is one thing and Carbo another. This is quite true, for fuligo contains along with carbon ammoniacal salts, pyroligneous acid, and other products of imperfect combustion, and it is to get rid of these that the carbon from the camphor is subsequently heated to a dull red heat in a glass tube or a crucible. The incandescent heat in this second stage does for the carbon what the fire does for the wood on the old method, viz. secure purity, whilst the volatilising of the carbon in the first place secures what we so much desire, a fine molecular state of division, and one that appears to be more favourable for subsequent treatment by our methods of preparation.
I regret that I have not the clinical illustrations ready in support of these anticipations, for the matter is but recent to me, but shall be disposed to apply the final test when opportunity offers. In the meantime the subject is offered respectfully for further inquiry in the microscopic and vital directions, accompanied by such recommendations as I have been able to mention.