BY J. H. P. FROST, M. D., BANGOR, ME.

This form of dropsy constitutes one of the most frequent and important of the sequelae of Scarlatina. Its first appearance is usually in from ten to twenty days after the subsidence of the original symptoms; but the patient cannot be said to have escaped all danger of this kind till a much later period. The swelling having been known to set in as late as the fifth week after the completion of the desquamation.

A very different liability to this disease doubtless exists in different persons. In some children it makes its appearance in spite of all ordinary precautions and without any apparent cause; while others, who have been less carefully treated and much more exposed, may escape entirely.

“The swelling is first observed in the face and upper part of the body to which it is sometimes confined, though more generally it extends over the whole body.” In severe cases the urine is thick, scanty, and dark colored; passed only at intervals, or almost entirely suppressed. There is more or less feverishness, especially at night, with great nocturnal restlessness. In mild cases the swelling may be the only obvious indication of disease, the change in the urine not being sufficiently marked to attract attention.

Scarlatina dropsy appears to be originally a pure anasarca or dropsy of the subcutaneous cellular tissue. In this primary stage, it readily yields to homoeopathic treatment; but if left to itself, it tends, after a certain time, to invade some noble organ. In the secondary stage, which is greatly aggravated by improper medication, there is seldom any possibility of saving the patient. For whether the effusion and accumulation be on the brain, in the chest, within the pericardium, or in the abdomen, the disease runs a course so rapid as to give little time for treatment. And where the kidneys are primarily or principally affected, the fatal termination may be still more sudden. As Dr. Laurie well remarks, “the extent of the anasarcous swelling does not always indicate the degree of danger.” And so insidious is the disease, that children are sometimes past all help before the parents are so much alarmed as to send for a physician.

Scarlatina dropsy may come on without any apparent cause, or it may result from premature exposure to cold; but whether spontaneous or not, it appears only in those cases in which the primary affection was not of a severe character. Such at least has been the case with those which have come under my observation. This, however, is denied by an allopathic author,* [“North American Journal of Horn.,” Vol. I., p.130] who remarks that he has observed dropsy to ensue more frequently after a severe attack of scarlatina, than when the symptoms were of more moderate character. But the weight of authority is against him. Dr. Phillips states “that the succeeding dropsy was very common in the mild epidemic which he witnessed.” Dr. Watson states “that this dropsy has an inverse relation to the violence and danger of the preceding exanthem; and that it is much more common after a mild than after a severe disease.” Dr. Tweedie states†[“Cyclopaedia of Practical Medicine”] that “this dropsy is remarked to succeed as often to the mild as to the more severe forms of this disease. Bat it has never been observed to supervene in cases of malignant scarlatina.”

In the more severe cases, which are less liable to be followed by dropsy, the subsequent desquamation is much more rapid, while the elimination of effete matters by means of abscesses, or otherwise, may greatly relieve the whole system in general, and consequently the kidneys in particular.

The question raised, in the article above referred to, respecting the presence of albumen in the urine of scarlatina patients, can have little interest for the homoeopathic practitioner, who does not expect to treat abnormal vital action on chemical principles.

Nor can the attempt to identify scarlatina dropsy with what is called “Bright's Disease” interest him further than as affording an illustration of the folly of treating diseases by name alone. For when it is attempted to show that albumen is present in the urine of scarlatina patients, authorities differ. Solon finds albumen in twenty-two out of twenty-three cases; while Phillipe states that in sixty cases of the disease in which he tested the urine for albumen, no trace of that principle could be found. So that considering the presence of albumen in the urine an essential characteristic of “Bright's Disease” the allopathic theorists are completely at a loss. Nor will the case be helped by the proof that we may have “Bright's Kidneys,” that is granular degeneration, without albuminous urine, on the one hand, and albuminous urine without “Brights Kidneys,” on the other.*[“American Journal Medical Science.” 1843, p. 452.]

In scarlatinal, as in every other form of dropsy, the kidneys are necessarily more or less affected. And the concentration of this dropsy, on these organs, is the most insidious and dangerous form in which it can terminate. And yet so long as it does locate in other vital organs, and prove fatal by effusion, as in the pericardium, it can never be properly considered identical with Bright's or any other disease of the kidneys. No good can result from attempting to imprison

the ever-varying forms of disease within the narrow limits of a fixed nomenclature. While by tracing the origin and development of the various forms of disease in accordance with the dynamic action, we may discover valuable means of prevention if not of cure.

Even in comparatively mild cases of scarlatina, the capillary system of the skin must be more or less congested and obstructed. And the same inflammatory action which renders the urine scanty, prevents perspiration. All this naturally tends to promote dropsical accumulations.*[“That the distended or overloaded state of the capillaries which occurs daring inflammation, may cause great and disproportionate increase in the fluid exhaled, is established by the phenomena of the inflammation of the filamentous tissues, especially of the serous membranes. In the former, edema and anasarca are results by no means unfrequent.

“The best examples of morbid increase of exhalation is conceived to be found in those of the serous membranes, giving rise to the disease termed dropsy. It is most frequent in the peritoneum, and in the general cellular membrane; less so in the pleura and pericardium, and in the arachnoid and its divisions” — Craigie's Path. Anat., p. 190.

“Dropsy after Scarlatina is of an acute or sub-acute kind; arising from increased action of the sanguiferous system, the consequence of this increased action is the effusion of serous fluid into the external tissues of the body, or where there is still greater vascular excitement, into one or other of these cavities” — Tweedie.]

As the scarlatina subsides desquamation sets in, and the urine becomes even more abundant than in health; but this desquamation, by preventing the return of the skin to the performance of its proper functions, perpetuates the evil influence exerted by the primary disease, and continues to impose a double duty upon the kidneys, — a burden evidently greater than they can long sustain. And so, when convalescence seems almost complete, dropsy ensues from the failure of the kidneys to carry off the unusual exhalation, while, at the same time, attempting to do their own work and that of the skin. Or where, from exposure to cold in this period, a still more serious impression is reflected from the tender skin upon the already over-burdened kidneys, they become congested and entirely obstructed, the uraemic poison, accumulating for a short time, and finding no outlet from the system, is suddenly re-absorbed, and coma, vomiting and convulsions close the scene.

In the mildest forms of scarlatina, the principal, if not the only indication of its presence, consists in the vomiting which announces its onset. Even these cases are sometimes followed by dropsy, and that too without the intervention of any exposure. There can be little doubt that in these cases, the primary fever or scarlatina virus, failing to develop itself on the skin, attacks the complementary organic structure of the kidneys. In such cases the anasarca may be regarded rather as the consequence than as the cause of the renal disease.

Thus it will be seen that there are two distinct forms of scarlatinal dropsy. One, in which the dropsy begins primarily from the state of the skin as disordered by scarlatina, and, perhaps, aggravated by exposure to cold; the other, in which the dropsy arises from disease of the kidneys themselves, consequent on the scarlatina virus settling upon them instead of being developed on the skin. And this we regard as a most important distinction, as well with respect to the course and termination of the disease which must be anticipated, as with respect to the treatment which must be pursued. Not but that the totality of the symptoms, in each case, must indicate the appropriate remedies, but the comparative value of the symptoms themselves must greatly differ in these different forms of disease.

The tendency of scarlatina dropsy to attack some noble organ has been already noticed. But this has relation to the first-mentioned or anasarcous form of the disease only. Here the age and constitutional peculiarities of the patient exert a predominant influence. Thus it is easy to see how readily this dropsy may assume the form of Hydrocephalus in children predisposed to this disease. So in cases complicated with hereditary debility or actual disease of the lungs, the same dropsy may as naturally assume the form of Hydrothorax. For similar reasons, no doubt, the heart is often attacked, though the indications of such a predisposition can seldom be pointed out in advance.

But, in what we have termed the second form of scarlatina dropsy, that in which the kidneys are the primary and principal seat of the disease, death may supervene from re-absorption before the edema has exerted any injurious influence in other parts of the body. The mode in which this form is usually developed, we have assumed to be by the original scarlatina virus attacking these organs instead of manifesting itself on the skin: but this renal disease may also be brought on by the combined influence of severe exposure and local, organic, and constitutional obstruction.

There is still another form of disease intimately connected with this subject. This is seen in the inflammation, shining, swelling and intense pains in the (wrist and ankle) joints, which sometimes appear as the eruption subsides and the desquamation commences. By allopathic writers this is termed scarlatinal rheumatism.* [“Braith. Retrospect.” No. 33, p. 30.]And it may be said to resemble simple, arthritic inflammation also in its disposition, so much greater in children than in adults, to metastasis to the heart. But it differs from all ordinary arthritic inflammation by an almost equally marked tendency to purulent effusion into the 'affected joints. This form of disease, though fortunately rather rare, is sometimes epidemic. Sometimes also it is complicated with great swelling in the neck, enlargement of the sub-maxillary glands and other indications of acute scrofulosis. Such a case I have seen baffle the utmost efforts of an eminent and skillful Homoeopath;†[The late Dr. F. Campos, Norfolk, Va.] and, under the ordinary treatment, these cases are usually, if not invariably fatal.

We subjoin brief notes of a few cases, illustrative of the views advanced in this paper, and of the action of some of the homoeopathic remedies.

Case I. — J. C, aged six years. Soon after recovering from a mild attack of scarlatina, in which he was attended by a homoeopathic physician, became dropsical. When first seen by me on the 10th instant, he “had been swollen about a week,” His face, hands, feet, chest and abdomen were much swollen; a complete case of anasarca which had succeeded the scarlatina without any apparent exposure. Much thirst, hut drinks hut little at a time; urine scanty and dark colored; feverish; pulse 100, small; drowsy by day, restless by night. Has been taking Aconite with some relief of the fever. Gave him Aconite.³ and Arsenic.⁴, in solution, alternately once in four hours.

12th inst. Less swollen; pulse 88; urine more copious; is cross and fractious; calls for food. Medicines continued, a dose once in five hours; under which he made a rapid and complete recovery.

Case II. — The same physician*[DR. E. MANTER, Winterport, Me.] soon after reported to me the case of a child, who from general dropsy after scarlatina, was so much swollen as to be “nearly if not quite as broad as he was long,” and who, in forty-eight hours, was restored to his natural size, and in a very short time after to entire health, under the influence of Cainca¹.

Case III. — C. N., aged nine years. October 3rd. Attacked by scarlatina tolerably severe, but from which, under homoeopathic treatment, he made a good recovery. He was a delicate child; and, perhaps, from exposure in going to the door, on the morning of the 23rd his mother noticed the swelling in his face.

24th. Considerable anasarca; dry, hacking cough; tongue covered with whitish coating; a slight eruption around the chin; nose bleeds at night; urine dark, thick and scanty; very restless at night. Apis in drop doses once in three hours.

25. No relief from the medicine. Feverish and very restless at night; cough dry and troublesome; other symptoms about the same. To take Arsenic. ⁴ in solution once in four hours.

26th. Rested much better last night; cough easier; face less swollen, but no diminution of the ascites; urine passed but twice in twenty-four hours, scanty, thick, dark colored, and smelling very offensively. Cainca¹ in two drop doses, once in four hours.

27th, p.m. The Cainca caused, this a.m., considerable discharge of urine so deep red as to greatly alarm the parents, who thought it blood. Rested better last night, and seems much improved in general appearance; nose bled freely in the night; scrotum still remains considerably swollen. Cainca ¹ and Arsenic.⁴, in alternation, a dose once in six hours.

28th. Passed a large quantity of dark red urine this morning. Scrotum still swollen, right side more than left; cough continues dry and troublesome. Rhus tox² and Cainca.² in alternation, every four hours; a dose of Arsenic⁴ at night.

29th. Patient improving; passes considerable very dark urine. Scrotum and and right testicle still swollen; no other dropsical appearance. Tonsils inflamed and enlarged; uvula elongated, causing dry, hacking cough. Merc. sol.⁴ and Rhus tox² alternate, every six hours.

31st. Dressed and runs about the room; scrotum a little swollen; urine copious and red as madder dye. Medicine continued.

November 2nd. Scrotum still swollen; tonsils enlarged and uvula elongated, but no cough. Bryonia³, p.m., and Merc. iod.⁴, a.m.

12th. Found only some enlargement of the tonsils, which disappeared under Baryta c.⁴ and ³⁰

It is possible that the Apis might have more rapidly relieved the persistent swelling of the scrotum and the throat symptoms. The severe nocturnal restlessness, due no doubt to incipient hydrothorax, was well controlled and finally removed by the Arsenicum.

Case IV. — H. T., aged four years, October 19th. Eruption of scarlet rash over the whole body except the face; not ill enough to be undressed; and the exanthem disappeared in the usual time. On the 24th, for the remaining sore-throat, he got Bell³ and Merc.⁴, morning and evening.

25th, p.m. Began to grow worse, and suffered all night with severe pain in the backs of his hands, of which he seemed to have lost the use. They could not be moved without making him scream; and were covered with perspiration. Considerable stiffness of the neck; but no general fever; much worse after sleeping.

26th. Saw him at nine, a.m. In addition to the above symptoms, he complains of pain in his head. Gave Lach.⁴ one dose, and ordered Acon. ², once in four hours. At three, p.m., found him quite comfortable, but feverish; pulse 120, and quick. Gave Acon. which relieved the fever, and he went to sleep. At five, p.m., he was much worse, as before, after sleeping. Intense pains “like a knife,” as he expressed it, in the temples and head, which make him scream. Pains worse on the least motion; considerable fever; neck stiff; constipated, during the night he had made two or three ineffectual attempts to relieve the bowels. Bell.², in solution, repeated every half hour greatly relieved him, so that his pulse came down to 100, before nine, p.m.

27th. Passed a comfortable night; some pain in the right ear, and in his head on rising; pupils dilated; temperature of body natural. Got Lach. ⁴ at eight, p.m., and injection per anum at nine, with no result. At four, p.m., his father becoming uneasy at his having had no stool for more than forty-eight hours, gave him a dose of oil. At seven, p.m., he raised himself up and cried with a return of the pain in his head, which was quickly relieved by a dose of Bell. Found him at nine, p.m., resting comfortably, with profuse perspiration on head, hands and feet.

28th. Had a very good night, passing at four, a.m., a very large, hard stool.

December 1st. The remaining stiffness of the neck was removed by Bryonia and Nux.

This child possesses a strong nervous sanguine constitution, from infancy suffered with hereditary and most obstinate constipation, with occasional severe attacks of inflammation and obstruction of the bowels; but, under homoeopathic treatment, he had for two years been almost entirely free from this difficulty. The symptoms of this case, as well as their prompt relief by the Bell., seem to indicate an attack of Cerebral (Meningeal) Tuberculosis.

Case V. — Miss E. G., aged nineteen years. Had what was thought to be the true scarlatina, in mild form. At the end of the second week was apparently in her usual health, when her brother, in whose house she lived, on his return from a journey, and knowing nothing of the nature of the disease, took her out sleigh riding. Such exposure could not fail to produce bad consequences. At the end of another week I saw her for the first time. Face considerably bloated, especially the right cheek, and of a dark purple color. From not having seen her before, and from her being of a (scrofulous) fleshy habit, I could not judge the degree of general swelling. Pulse slow and apparently obstructed; urine quite scanty,

Saturday. Gave Cainca^1.

Monday. She seemed about the same; medicine continued.

Tuesday. The bloating had considerably subsided; urine more free. Continued medicine.

Was prevented from seeing her till the following Saturday. She had been out of medicine two days.

Thursday. She began to relapse, having improved till then.

Friday evening she learned the dangerous illness of a dear sister at a distance; and her decease was announced to her on Saturday evening.

This (Saturday, p.m.,) I found her dressed and about the room as she had been all the week; her face bloated and purple as before, and she complained of swelling in the small of the back. She was evidently worse than when I first saw her that day week. Apprehensive of serious mischief in the kidneys, I gave her Merc.⁴, with little hope of benefit.

Sunday. She seemed quite as well as the day before, and retired to rest at night as usual. But at breakfast time, next morning, was found in convulsions, with dark blood gushing from her mouth. She was quite insensible, and remained comatose all day, with convulsions and vomiting of blood at intervals, till about midnight, when she died.

This was plainly a case of re-absorption of the uraemic poison; the fatal crisis having doubtless been hastened by the distressing news she had heard a few hours before.

Case VI. — Miss C. B., aged nine years, cousin to case three. Had a slight touch of scarlatina. No physician employed till a week after she began to swell from premature exposure out of doors; then took the usual allopathic remedies (?) ”Sal tartar“ principally, and in liberal doses. The powerful influence of this drug in thinning the blood is so well known to the homoeopathic physician, that he will not be surprised to learn that hydropericardium and hydrothorax became very rapidly developed.

About the latter part of the second week of the dropsy, I was called to see her early in the morning, and found her laboring under that indescribable distress, and difficulty of respiration, which indicate the near approach of death. Arsenic³⁰, alone, gave partial relief to the most distressing symptoms; but she died the same evening, the victim of parental and professional ignorance.

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