Should putrid symptoms make their appearance (21), I would strongly advise the acid in full and repeated doses, as well as the frequent repetition of the packs. In putrid cases, not only the syrup, but also the gargle will do good service. Gargling is so much the more advisable as the putrid matter should be frequently removed. If nothing else can be had, pure water or water and vinegar may be used. The temperature of the gargle should be about 70°-75° Fahrenheit. For the same purpose, the aqua chlorina, and the chloride of soda have been strongly recommended.[34] A few drops of the solution may be used, also, on the compress outside.

In affections of the nervous centres, the brain, the cerebellum, and the spine (see 17-19), the danger which threatens the patient's life is principally averted by the sitz-bath. The nervous system needs support, and the circulation must be regulated. In every case where the packs do not relieve the symptoms in the head and spine, the sitz-bath is probably the only remedy to remove the danger. It should be about 70°, and the patient should stay in it till relieved, which will probably be in half an hour or there about. After the sitz-bath, if the patient feels quite easy and inclined to sleep, he may be put to bed; if he continues restless and still complains of pain, he should be put in a wet pack of about 65°. There he should stay till he complains of more pain, when he should take his bath and repeat the sitz-bath. Thus he should alternate till he becomes entirely relieved.

95. CASES.

During an epidemic of scarlatina in 1836 two of my children were attacked by the disease, a boy of about eight, and another of five years, the younger one two days after the older one. I ordered them to be packed, and all seemed to go well, when, during my absence from the city (of Freiberg) a medical friend, who called, persuaded my wife to desist from continuing the hydriatic treatment, and use some remedies of his instead. On my return, I found the elder boy (the other began only to show some slight symptoms) in a very bad state: the cerebellum and spine were distinctly affected by the contagious poison; the patient complained of insupportable pain in the back of his head, the spine and all over his body, so that no one dared to touch him. The fact of the packs having been discontinued during twenty-four hours being concealed from me, and the boy being subject to herpes and inclined to scrofula, I began to fear that the treatment would not be applicable in such cases, and became really alarmed about my child. I was then almost a novice in Priessnitz's practice, at least in the treatment of acute diseases, which seldom occurred at Græfenberg, and, had I had more confidence in blood-letting and drugs, I would probably have resorted to them. For a while I was doubtful about the course I should pursue, when Dr. B., my medical friend, made his appearance and I learned what had happened during my absence. Instead, however, of giving way to his earnest solicitations to rely on the old practice, I at once became encouraged by his confession, and declared I would persevere in my own practice, which was quite new to him, and in which no physician of the place as yet believed. He assured me, from the symptoms, that the boy could not live twenty-four hours, unless he be bled, and that even then he would not answer for his life. Having lost six children before under allopathic treatment, and having never had much confidence in drugs during the time I had been connected myself with the practice, I firmly refused to allow either bleeding or drugging, and expressed my resolution to see what water could do, resigning myself to the possibility of a bad issue of the case. I need scarcely assure my readers, that my feelings were far from agreeable, and that my resolution required all the reminiscence of the bad success of allopathic treatment of former cases in my family, and the confidence I had in Priessnitz and his system, to support it. I tried the pack again, which did little or no good. Judging from the effects of the sitz-bath in cases of affection of the brain during continued fevers, that it might be of service also in the present case (Priessnitz's directions did not go so far, nor had I treated a similar case since my return from Græfenberg), I put my boy with great care into a sitz-bath of 70° F. and left him there for a little over half an hour, when he felt greatly relieved. He was taken to his bed and allowed to become warm, when he began to complain again. I then packed him, seemingly without much effect; therefore the sitz-bath was repeated and proved quite successful. I then packed the patient immediately after the sitz-bath and left him two hours in the pack, where he slept almost all the time. When he awoke, he complained again of pain in his head, which partly yielded to the half-bath. About three hours after the bath, he complained more of the pain in his head and spine, and I repeated the sitz-bath and the pack. He slept in the pack for about three hours, and when I took him out, he was covered with red spots. Feeling pretty well, he was dressed and permitted to stay up. In the forenoon, my friend called to see whether our patient were still living, and could hardly believe his own eyes when, on cautiously putting his head in at the door, he saw the boy walking up and down the room to warm his feet. In the afternoon, the pain returned and the rash faded. I repeated the pack, and the pain not yielding entirely, I gave him one more sitz-bath in the evening and a pack after it, in which he stayed asleep almost all the time, nearly four hours, upon which the rash stood out finely and never disappeared until desquamation set in. I managed to keep him in bed after the relapse mentioned, till desquamation was over. I need scarcely say that I continued to pack him (twice a day) till after desquamation, when the packs were given once a day for about a week longer. On the seventeenth day (which was the fifteenth with the younger boy, who had the fever in a very mild form, and was treated accordingly) the two scarlet-convalescents were seen playing in the street, throwing snowballs at each other; a fact, which increased not a little the sensation caused by this miraculous cure. Although my friend was not converted to the new method, this case had a very decided encouraging influence upon myself, and, I am convinced, became the means of salvation for many hundred lives afterwards, treated partly by myself directly, partly by other physicians, or the parents of the patients, after my prescriptions. I felt the importance of my success in this difficult case of scarlatina, and warmly thanked Providence for having assisted me in saving my child for the benefit of many others.[35]

96. The circumstance that, at the same time my two boys were taken sick with scarlatina, a servant of mine became afflicted with small-pox, my daughter with varioloids, and my mother and wife with influenza, afforded me an ample opportunity of trying the effects of the water-cure and my own courage and skill in the new method. The servant was cured, chiefly by long packs, in twelve days, so that she was able to resume her household duties, and though she had been covered with pocks all over, not the slightest mark remained on her body; my little girl was out of doors in a fortnight, and a few days were sufficient to rid the ladies of influenza. The complete success I had in the treatment of all these cases, contributed not a little to encourage me to employ the method upon others, with whom I have ever since been equally successful, with one single exception, which I shall mention hereafter.

97. One of the last cases of affection of the brain in torpid scarlatina I treated, was that of a scrofulous little boy of six years, from Williamsburgh, N. Y., who was at my establishment, with his mother and sisters, taking treatment for scrofulous ulceration of the parotid glands, and other symptoms of that dangerous disease. The reaction was torpid, and the brain became affected almost from the commencement. There was a little rash coming out, but in small dark purple spots, looking much more like measles than scarlet-fever. The delirium increased during the period of efflorescence, instead of giving way. The spine evidently sympathized in the suffering of the brain and cerebellum. Homœopathic remedies, which were earnestly asked for by the mother, had no effect whatever; acids only produced a slight relief of the inflammation of the throat; the packs increased the symptoms in the head and spine. The appearance of the tongue, the peculiar kind of delirium, the small quick pulse, &c. showed, that the case was going to take a typhoid turn; when I ordered a sitz-bath, which almost immediately relieved the head and improved the pulse, I then, proceeded in about the same manner as described above in my son's case, with the difference, that I allowed longer intervals. The patient, according to the severity of the symptoms, took one or two packs a day, and the same number of sitz-baths, had wet compresses on his ears and throat, and was kept in bed with very few exceptions, when the nurse would take him on her knees, wrapt in a blanket. The good effect of the sitz-bath was so obvious, that the child's father, who had been informed by telegraph of the critical condition of his son, asked himself for a repetition of it, when he found that neither medicines nor packs produced the slightest change. The child always became quiet and slept after the bath. Not only was his life saved, but he also escaped all the dreaded consequences of the disease. I am confident, that under any other kind of treatment, he would have lost his life, or at least he would have lost his hearing. But, far from increasing, the affection of his ears was rather improved when he left, and his general health a great deal better than when he was first placed under my care. I had a great deal of trouble with that little patient, not only because he did not allow me a night's rest for a week, and the case produced quite an estampeda in the establishment,[36] but also, and chiefly, because of the interference of a half-bred Irish woman, who had brought him up, and who, on account of the mother's bad health, acted in the double quality of a nurse and a governess towards the children. This woman, being averse to the treatment and the place, which gave her little pleasure, and to the rules of which she would not submit, procured all sort of dainties and excited the child by her foolish remonstrances against any application I found necessary, making at the same time an unfavorable impression on the simple minds of the family, by telling lies and tales, thereby not only placing difficulties in my way, in a case which was difficult in itself, but even preventing the parents from acknowledging by one word of thanks the sacrifices of time and health I had cheerfully made. What a blessing it would be for physicians and patients, could unnecessary and unreasonable people be kept away from persons afflicted with painful and dangerous diseases!—

98. IMPOSSIBILITY OF ANSWERING FOR THE ISSUE OF EVERY TYPHOID CASE.

Although a typhoid character of scarlatina will rarely set in, when the patient has been subject to the packs from the beginning of the disease, there will be cases when water-treatment can neither prevent such an event or even save the life of the patient afflicted by scarlet-fever. There will be a case, now and then, to baffle any mode of treatment, and the physician must not be blamed for losing a patient of scarlatina occasionally, but it is not necessary that people should continue to die of this disease in such numbers, as they have been destroyed till now.

99. Any case, where typhoid symptoms set in (16-25), is dangerous, and the physician and his mode of treatment deserve commendation, if the patient is saved by it; and it is in such cases, also, that the hydriatic physician requires the most skill, experience and courage.

102. The temperature of the baths should be in proportion to the reactive power of the body; i. e. the longer the patient has been sick, and the weaker he is, the higher should be the temperature of the water, but never so high as to have rather a weakening than a strengthening effect upon the nervous system. The highest temperature which may be used should not exceed 75° F.

103. When the delirium is active, the patient restless, almost raging, the water should be used colder; when the delirium is more passive, the patient weak, muttering, the water should be warmer: in the former case, the water may be between 50 and 60°, in the latter, between 60 and 70°.

104. When the skin is hot and dry, a wet-sheet pack will produce relief, and assist in bringing out the rash. After the pack, a half-bath should be given, the duration of which must be regulated by the condition of the brain. If the delirium continues, the bath should be prolonged.

105. The patient should not leave the bath before his head is clearer. It may be necessary for the patient to stay in the bath for more than half an hour.

106. In a low condition, with passive delirium, the packs should not be continued very long, as they will be apt to increase the bad condition of the brain. In that case they should be used only to prepare the body for the bath following it.

107. When the skin is cool and moist, neither a bath nor a pack is indicated. When the skin is rather cool and dry, an affusion of cold water and frictions with the bare hands should be used, and the patient packed afterwards in a dry blanket, to assist in producing a reaction. In such cases I have found very cold water to be of more service than water of a warmer temperature. When the patient has not been too much weakened already, a rash is likely to be produced by the proceeding, and in consequence of repeated baths, the nervous system to be relieved and a healthier reaction to be obtained.

108. Should putrid symptoms appear, I would advise the use of mineral acids and chloride of lime, in addition to hydriatic treatment.

109. In no case would I advise a hydriatic practitioner to overdo, either in regard to the temperature or to the quantity of the baths. The state of the brain and of the skin should always guide him. The increase of delirium will require a bath, and the dryness and heat of the skin a pack. If both symptoms exist, the bath is to be preferred, as the condition of the nervous system should always command the principal attention of the physician. When the nervous system is supported, the whole of the organism is, and the condition of the skin usually improves with the former.

In the winter of 1845-46, during an epidemic, which ravaged the city of Dresden and the neighboring villages, I was called to see a child, belonging to a tradesman, blessed with a large family, but without sufficient means to support them. I found the whole family crammed together in a room of moderate size, the patient lying in a bed near the window. There was a large fire in a sheet-iron stove, upon which the mother was preparing the scanty dinner of the family. The air was filled with the exhalations of the living, beside the smell from the potatoes and sourkrout, which was undergoing the cooking process, the sundry boots and shoes lying around or being under repair in the hands of the father, and a few pieces of linen hanging behind the stove for the purpose of drying. In an adjoining alcove lay the body of a little boy, who had expired the day before, a victim of scarlet-fever.

I found the patient, a fair-haired little girl of about eight years, in a state of sopor, which had lasted a day and a half; there had been delirium for two or three days, during which time the child had never had a clear moment. There was a purple rash all over the body. The temperature of the body I found 112 F., on placing my pocket-thermometer under the pit of the arm; the pulse was small, but exceedingly quick. There was considerable inflammation of the throat and swelling of the face; the breath was very bad. There was a blister on the throat and a mustard plaster on each of the soles of the feet.

I sent for a large wash-tub and water, which I mixed with some warm water, so as to make it about 65°. I had the child undressed, and placed in the empty tub, after removing the blister and mustard; then I poured the water slowly over her head, shoulders and the rest of the body. The second pail brought her to consciousness, but only for a moment. As the delirium returned, I continued to pour water over her; till the tub was filled about nine inches, when I used the water from the bath. In fifteen minutes, I found the heat of the body diminished about five degrees. Soon after, the child became conscious, and its mind cleared off more and more, as she continued in the bath. In thirty minutes, the heat was 103, and the pulse, which first could not be counted, 135, when I removed her from the bath and put her in a wet-sheet pack, where she fell asleep. The pulse continuing slower, coming down to 126, and the heat not increasing, I left her in the pack for an hour and three quarters, when I observed an increase of heat, a quickening of the pulse and a return of delirium.

The water of the first bath still standing in the room, but having become warmer, and it being found troublesome to carry much water up-stairs to a fifth story; I sent for a pail more of fresh water, lowering the temperature of the bath to 71°, and, placing the child in the bath, threw water over it, as I had done before. This time the bath produced a beneficial effect much sooner, and I removed the patient from it in about twelve minutes. The heat of the body had gone down to 101, the pulse was 118, and the patient was perfectly conscious, complaining a good deal of her throat. I placed a wet compress on the throat and chest and had her put to bed, but ordered the bed to be removed further from the window, and the latter partly to be kept open. I need scarcely say, that I had opened it soon after entering the room.

When I returned in about five hours, I found the patient covered with a thick feather-bed, the window closed, the air of the room as bad as before; the patient was delirious, the heat 110, the pulse upwards of 150.

I repeated the bath as before, but continued only twenty minutes; then I packed her again, placed a wet compress on her head, opened the window entirely, and left, promising to be back in an hour.

This time, on my return, I found the window open, the air better, the child conscious in her pack. I left her a quarter of an hour longer; then placed her in a bath of fresh water, of 70°, kept her there five minutes, and put her back to bed. It being late in the evening, I recommended changing the compress on the throat and placing another on the stomach, and in case of renewed delirium, a cold compress on the head, to be changed frequently.

When I called in the morning, I found the patient again in delirium, the heat 110°, the pulse 140.

The bath was repeated for twenty-five minutes, when the heat went down to 100°, and the pulse to 120. The patient being conscious, I had her packed again and left her about two hours in the pack. When I returned, I found her head almost clear; the bath of 70° for ten minutes brightened her very much. Her throat continued very troublesome, one of the submaxillary glands was very much swollen, and broke afterwards, on the fifth day of my treatment, discharging fetid matter. Also the parotid gland on the same side became seriously affected, swoll considerably and looked as if the ear might be endangered. The patient developing heat enough, I used nothing but wet compresses, and water and vinegar for a gargle.

The heat and delirium returning, the patient was bathed and packed twice more the same day; the pack lasting only an hour to an hour and a quarter. The night was pretty good; there was little delirium.

The third day, the patient was packed twice, and had four baths, and the bowels being costive, an injection of tepid water in the evening.

The fourth day, the rash having disappeared, and the heat being down to 98, whilst the pulse continued weak and quick, and the patient still had some delirium, I gave her a pack in the forenoon, without a bath previous, of an hour and a half, and a short bath after it; and in the afternoon, the patient having more delirium, the half-bath of 70° was repeated, and the patient kept in it for twenty minutes.

On the fifth day the ulcerating gland burst outside and the parotid gland became relieved. Pack and baths as the day before. In the evening the patient complaining of pain in the bowels, a sitz-bath of 70° for twenty minutes was administered, and an injection after it, which relieved her.

The rest of the time, one pack and bath in the morning, and a bath in the afternoon were deemed sufficient. On the eighteenth day of my treatment the patient left the house for the first time, and continued improving from day to day, the packs being continued for about two weeks longer on account of the broken gland, which continued to discharge. I tried to persuade the parents to continue the packs till the gland was healed, but they found it too much trouble.

The patient drank a good deal of water during the whole of the treatment, ate very little and only light food, principally water-soup or panada, and gruel, and kept in bed almost entirely the first ten or twelve days. Her deceased little brother had the same symptoms, and I am confident, she would have followed him, had she not come under hydriatic treatment.

111. A later case, to which I have alluded before, was the following: The driver of a lady, who was under my care in Florence, attending to one of the lady's maids, who was sick with typhoid scarlatina, was taken ill. Like most uneducated people, he could not understand how water could do any good for diseases, and went to the village-store to buy some patent medicine, which he took. The remedy producing no good effect, he bought some other medicine—purgative pills, as I understood—and took it. Some friends of the village, which, like other villages, especially in America, was full of doctors—brought him nostrums and popular remedies, which he took for some days, till he could not leave the bed any more, delirium set in, and I was at last applied for. I found him with all the symptoms of typhus, and scarcely any of scarlatina, except the tongue, which seemed to struggle between a typhoid and scarlatinous appearance, but soon took all the form and color of the former. There was no rash, not much of a sore-throat, but constant delirium and rapid sinking of the strength of the patient.

Under these circumstances, I believed I must treat him more for typhus than for scarlatina, and used cold baths; in which course I was encouraged by the fine reaction ensuing after every bath, and the slight clearing off of his mind for a few minutes. Internally, I used the muriatic-acid in the forms mentioned above (39), and the solution of chloride of lime, which was also used for a wash and sprinkled about the room. In order to draw the eruption towards the skin—provided there be any of the scarlatinous poison in his system,—I tried a few packs, but without avail. He grew weaker and weaker, though his skin continued to become red after every bath, and on the sixth day early in the morning, when we were about changing his linen, and I was holding him sitting up in bed, he expired in my arms. This is the only case of scarlet-fever, I lost under hydriatic treatment; and it is yet doubtful whether it can be considered as belonging to that disease. I have always considered it, and continue to do so now, a case of typhus, partly communicated by the typhoid exhalations of the other servant, and partly created in his own body, as he complained for more than a fortnight before, of nervous and feverish symptoms, which indicated a serious disease threatening him. The contagion of scarlatina may have made the case more dangerous by complicating it; but, be this as it may, it is certain that the symptoms were such from the beginning that a cure must have appeared most improbable at first sight to any physician of any school; and if there was a possibility of saving his life, it could only be done by the course I took; a course which had proved successful in several cases of typhus I had treated before, and which looked about as bad, and even worse than that of poor William McNought.

112. The young woman, who apparently communicated the typhoid contagion to William, was in quite as critical a condition as her fellow-servant; and for a while I doubted of her recovery. She continued delirious for more than a fortnight, and there were distinct putrid symptoms, her throat and glands ulcerating, and breaking in two places outside. For longer than a week she had not a lucid moment, became extenuated and powerless. We had to lift her into the baths and out; involuntary discharges from the bowels and the bladder took place; petechiæ appeared, and every thing indicated a steady decay. Neither acids nor chloride of lime seemed to have any effect; the only thing, which revived her, was the tepid half-bath, of 70°, which she took twice a day for about twenty minutes. She was usually carried into the bath-room near by, and was commonly able to walk back assisted by the nurses. She took a pack occasionally for an hour or an hour and a half, as long as a few spots of the rash made their appearance. Her skin peeled off but imperfectly (there was not an appearance of desquamation on the driver's person, although he died about the tenth day after the disease had manifested itself). The patient not producing much heat, I used a poultice of hemlock-leaves and bran on her glands, the gargle of muriatic-acid, and ablutions of water and vinegar externally, when the skin was not prepared for a bath. Although of a weak, scrofulous habit, and having always been sickly, not only her life was saved, but her health became afterwards stronger, and her looks much better than they ever were before. The gland kept discharging for three or four months longer, and I have no doubt, to her great benefit.

With this patient, I never found the heat to exceed 100° Fahr. and the delirium never had a very active character. For the greater part of the time, her skin was more cool than warm, and sometimes even clammy.

FOOTNOTES: