THE measles appeared in Europe about the same time with the small-pox, and have a great affinity to that disease. They both came from the same quarter of the world, are both infectious, and seldom attack the same person more than once. The measles are most common in the spring season, and generally disappear in summer. The disease itself, when properly managed, seldom proves fatal but its consequences are often very troublesome.
CAUSE - This disease, like the small-pox, proceeds from infection, and is more or less dangerous according to the constitution of the patient, the season of the year, the climate, &c.
SYMPTOMS - The measles, like other fevers, are preceded by alternate fits of heat and cold, with sickness, and loss of appetite. The tongue is white, but generally moist. There is a short cough, a heaviness of the head and eyes, drowsiness, and a running at the nose. Sometimes indeed the cough does not come before the eruption has appeared. There is an inflammation and heat in the eyes, accompanied with a defluxion of sharp tears, and great acuteness of sensation, so that they cannot bear the light without pain. The eye-lids frequently swell so as to occasion blindness. The patient generally complains of his throat; and a vomiting or looseness often precedes the eruption. The stools in children are commonly greenish; they complain of an itching of the skin, and are remarkably peevish. Bleeding at the nose is common, both before and in the progress of the disease.
ABOUT the fourth day, small spots, resembling flea-bites, appear, first upon the face, then upon the breast, and afterwards on the extremities: These may be distinguished from the small-pox by their scarcely rising above the skin. The fever, cough, and difficulty of breathing, instead of being removed by the eruption as in the small-pox, are rather increased; but the vomiting generally ceases.
ABOUT the sixth or seventh day from the time of sickening, the measles begin to turn pale on the face, and afterwards upon the body; so that by the ninth day they entirely disappear. The fever, however, and difficulty of breathing, often continue, especially if the patient has been kept upon too hot a regimen. Petechiae, or purple spots, may likewise be occasioned by this error.
A VIOLENT looseness sometimes succeeds the measles; in which case the patient's life is in imminent danger.
SUCH as die of the measles generally expire about fhe ninth day from the invasion, and are commonly carried off by a peripneumony, or inflammation of the lungs.
THE most favourable symptoms are, a moderate loosness, a moist skin, and a plentiful discharge of urine.
WHEN the eruption suddenly falls in, and the patient is seized with a delirium, he is in the greatest danger. If the measles turn too soon of a pale colour, it is an unfavourable symptom, as are also great weakness, vomiting, restlessness, and difficulty of swallowing. Purple or black spots appearing among the measles are very unfavourable. When a continual cough, with hoarseness, succeeds the disease, there is no reason to suspect an approaching consumption of the lungs.
OUR business in this disease is to assist nature by proper cordials, in throwing out the morbific matter, if her efforts be too languid; but when they are too violent they must be restrained by evacuations, and cool diluting liquors, &c. We ought likewise to endeavour to appease the most urgent symptoms, as the cough, restlessness and difficulty of breathing.
REGIMEN. - The cool regimen is necessary here as well as in the small-pox. The food too must be light and the drink diluting. Acids, however do not answer so well in the measles as in the small-pox, as they tend to exasperate the cough. Small beer likewise, though a good drink in the small-pox, is here improper. The most suitable liquors are decoctions of liquorice with marsh-mallow roots and sarsaparilla, infusions of linseed, or of the flowers of elder, balm-tea, clarified whey, barley-water, and such like. These, if the patient be costive, may be sweetened with honey; or, if that should disagree with the stomach, a little manna may occasionally be added to them.
MEDICINE. - The measles being an inflammatory disease, without any critical discharge of matter, as in the small-pox, bleeding is commonly necessary, especially when the fever runs high, with difficulty of breathing, and great opression of the breast. But if the disease be of a mild kind, bleeding may be omitted. I do not know any disease wherein bleeding is more necessary than in the measles, especially when the fever runs high; in this case I have always found it relieve the patient.
BATHING the feet and legs frequently in lukewarm water both tends to abate the violence of the fever, and to promote the eruption.
THE patient is often greatly relieved by vomiting. When there is a tendency this way, it ought to be promoted by drinking lukewarm water, or weak camomile-tea.
WHEN the cough is very troublesome, with dryness of the throat, and difficulty of breathing, the patient may hold his head over the steam of warm water, and draw the steam into his lungs.
HE may likewise lick a little sperma ceti and sugar-candy pounded together; or take now and then a spoonful of the oil of sweet almonds, with sugar-candy dissolved in it. These will soften the throat, and relieve the tickling cough.
IF at the turn of the disease the fever assumes new vigour, and there appears great danger of suffocation, the patient must be bled according to his strength, and blistering-plasters applied, with a view to prevent the load from being thrown on the lungs, where if an inflammation should fix itself, the patient's life will be in imminent danger.
IN case the measles should suddenly disappear, it will be necessary to pursue the same method which we have recommended when the small-pox recede. The patient must be supported with wine and cordials. Blistering-plasters must be applied to the legs and arms, and the body rubbed all over with warm flannels. Warm poultices may likewise be applied to the feet and palms of the hands.
WHEN purple or black spots appear, the patients drink should be sharpened with spirits of vitriol; and if the putrid symptoms increase, the Peruvian bark must be administered in the same manner as directed in the small-pox.
OPIATES are sometimes necessary, but should never be given except in cases of extreme restlessness, a violent looseness, or when the cough is very troublesome. For children, the syrup of poppies is sufficient. A tea-spoonful or two may occasionally be given, according to the patient's age, or the violence of the symptoms.
AFTER the measles are gone off, the patient ought to be purged. This may be conducted in the same manner as directed in the small-pox.
IF a violent looseness succeeds the measles, it may be checked by taking for some days a gentle dose of rhubarb in the morning, and an opiate over night; but if these do not remove it, bleeding will seldom fail to have that effect.
PATIENTS recovering after the measles should be careful what they eat or drink. Their food, for some time, ought to be light, and in small quantities, and their drink diluting, and rather of an opening nature; as butter-milk, whey, and such like. They ought also to beware of exposing themselves too soon to the cold air, lest a suffocating catarrh, an asthma, or a consumption of the lungs should ensue.
SHOULD a cough, with difficulty of breathing, and other symptoms of a consumption, remain after the measles, small quantities of blood may be frequently let at proper intervals, as the patient's strength and constitution will permlt. He ought likewise to drink asses milk, to remove to a free air, if in a large town, and to ride daily on horseback. He must keep close to a diet consisting of milk and vegetables; and lastly, if these do not succeed, let him remove to a warmer climate. Attempts have been made to communicate the measles, as well as the small-pox, by inoculation, and we make no doubt but in time the practice may succeed. Dr. Home of Edinburgh says, he communicated the disease by the blood. Others have tried this method, and have not found it succeed. Some think the disease would be more certainly communicated by rubbing the skin of a patient who has the measles with cotton, and afterwards applying the cotton to a wound, as in the small-pox; while others recommend a bit of flannel which had been applied to the patient's skin, all the time of the disease, to be afterwards laid upon the arm or leg of the person to whom the infection is to be communicated. There is no doubt but this disease, as well as the small-pox, may be communicated various ways; the most probable, however, is either from cotton rubbed upon the skin, as mentioned above, or by introducing a little of the sharp humour which distils from the eyes of the patient into the blood. It is agreed on all hands that such patients as have been inoculated had the disease very mildly; we therefore wish the practice were more general, as the measles have of late become very fatal.
THE scarlet fever is so called from the colour of the patient's skin, which appears as if it were tinged with red wine. It happens at any season of the year, but is most common towards the end of summer; at which time it often seizes whole families; children and young persons are most subject to it.
IT begins like other fevers, with coldness and shivering, without any violent sickness. Afterwards the skin is covered with red spots, which are broader, more florid, and less uniform than the measles. They continue two or three days, and then disappear after which the cuticle, or scarf-skin, falls off.
THERE is seldom any occasion for medicine in this disease. The patient ought however to keep within doors, to abstain from flesh, strong liquors, and cordials, and to drink freely of cool diluting liquors. If the fever runs high, the body must be kept gently open by emollient clysters, or small doses of nitre and rhubarb. A scruple of the former, with five grains of the latter, may be taken thrice a-day, or oftener, if necessary.
CHILDREN and young persons are sometimes seized, at the beginning of this disease, with a kind of stupor and epileptic fits. In this case the feet and legs should be bathed in warm water, a large blisterIng-plaster applied to the neck, and a dose of the syrup of poppies given every night till the patient recovers.
THE scarlet fever, however, is not always of so mild a nature. It is sometimes attended with putrid or malignant symptoms, in which case it is always dangerous. In the malignant scarlet fever the patient is not only affected with coldness and shivering, but with languor, sickness, and great oppression; to these succeed excessive heat, nausea and vomiting, with a soreness of the throat; the pulse is extremely quick, but small and depressed; the breathing frequent and laborious; the skin hot, but not quite dry; the tongue moist, and covered with a whitish mucus; the tonsils inflamed and ulcerated. When the eruption appears, it brings no relief: on the contrary, the symptoms generally grow worse, and fresh ones come on, as purging, delirium, &c.
WHEN this disease is mistaken for a simple inflammation, and treated with repeated bleedings, purging and cooling medicines, it generally proves fatal. The only medicines that can be depended on in this case are cordials and antiseptics, as the Peruvian bark, wine, snake root, and the like. The treatment must be in general similar to that of the putrid fever, or of the malignant ulcerous sore throat. In the year 1774, during winter, a very bad species of this fever prevailed in Edinburgh. It raged chiefly among young people. The eruption was generally accompanied with a quinsey, and the inflammatory symptoms were so blended with others of a putrid nature, as to render the treatment of the disease very difficult. Many of the patients, towards the decline of the fever, were afflicted with large swellings of the submaxillary glands, and not a few had a suppuration in one or both ears.
WHEN a continual, remitting, or intermitting fever is accompanied with a frequent or copious evacuation of bile, either by vomit or stool, the fever is denominated bilious. In Britain the bilious fever generally makes its appearance about the end of summer, and ceases towards the approach of winter. It is most frequent and fatal in warm countries, especially where the soil is marshy, and when great rains are succeeded by sultry heats. Persons who work without doors, lie in camps, or who are exposed to the night air, are most liable to this kind of fever.
IF there are symptoms of inflammation at the beginning or this fever, it will be necessary to bleed, and to put the patient upon the cool diluting regimen recommended in the inflammatory fever. The saline draught may likewise be frequently administered, and the patient's body kept open by clysters or mild purgatives. But if the fever should remit or intermit, bleeding will seldom be necessary. In this case a vomit may be administered, and, if the body be bound, a gentle purge; after which the Peruvian bark will generally complete the cure.
IN case of a violent looseness, the patient must be supported with chicken broth, jellies of hartshorn, and the like; and he may use the white decoction for his ordinary drink. See Appendix, White Decoction. If a bloody-flux should accompany this fever, it must be treated in the manner recommended under the article Dysentery.
WHEN there is a burning heat, and the patient does not sweat, that evacuation may be promoted by giving him, three or four times a-day, a table-spoonful of Mindererus's spirit mixed in a cup of his ordinary drink. See Appendix, Spirit of Mindererus.
IF the bilious fever be attended with the nervous, malignant, or putrid symptoms, which is sometimes the case, the patient must be treated in the same manner as directed under these diseases.
AFTER this fever, proper care is necessary to prevent a relapse. For this purpose the patient, especially towards the end of autumn, ought to continue the use of the Peruvian bark for some time after he is well. He should likewise abstain from all trashy fruits, new liquors, and every kind of flatulent aliment.