No. 11.] LONDON, SATURDAY, JUNE 18, 1825.

LECTURESON THE

PRINCIPLES AND PRACTICEOF PHYSIC,

BY DR. ARMSTRONG.

Theatre of Anatomy, Webb Street.

LECTURE 29.

THE subject of this Lecture will bethreefold, viz. :-

Scarlatina, Measles, and HoopingCough,

all of which arise from specific con-tagions, as the two following factscombinedly show :-

1. If a patient he affected by scarla-tina, measles, or hoeping-cough, andif that patient be visited by a certainnumber of persons who have never hadscarlatina, measles, or hooping cough,some of them would be attacked byone or other of these distempers towhich they chanced to be exposed.It might, however, be said, that thisalone does not prove the presenceand influence of a specific contagion,becanse there might be a local taiut ofatmosphere, atising independently ofsuch patients, in or about the house inwhich they had been confined andvisited. Is there then any otherproof? There is, and that seems tobe conclnsive. If yon remove a pa.fient labouring under scarlatina, mea-sles, or hooping cough, into a perfectlyiresh atmosphere, each of them iscapable of propagating itself, inde.finitely, to second and third personswho never have been the subjects ofthe specific affection before. Whereis the man bold enongh to say-aye,and to prove this of typhus fever ?

The contagion of scarlatina, mea-sles, and hooping cough, like that ofsmall pox, sometimes produce a con-gestive form of fever ; at least I have,occasionally, seen individuals attack-ed by this form of fever in houseswhere these affections prevailed,-andas I could not trace the congestion toa common cause, I inferred that itwas the product of a peculiar causedepressing the vital energy. But al-though ’the doctrine of congestivefever is applicable to the influence ofthe peculiar as well as of the commoncauses, yet, generally speaking, theoperation of the contagion of scarla.tina, measles, and hooping congh, issucceeded by the stage of excitementimproperly called re-action. In thefirst instance, all these peculiar agents,for the most part, diminish the heart’saction and the animal heat on the sur-

face of the body, but in the end thiscongestive stage is followed by anincrease of both. Sometimes, how-ever, these peculiar agents operate atonce as stimulants. To give you anexample of this : I have known achild affected by the contagion ofscarlatina, in which there was no coldstage at all, the hot one ushering inthe attack ; but, as in other febrileaccessions, there is most frequentlypaleness, languor, and lassitude inthe commencement.

Symptoms of Scarlatina.Scarlatina, or scarlet fever, is an

affection which sometime3 arises veryrapidly, within about four days afterexposure to contagion, and usually,I would say, within eight, nine, orten days. The precursory symptomsare generally these, a pale skin, apulse weaker than natural, and someuneasiness about the head, back, orstomach ; and there is often some

stiffness about the neck, or sorenessabout the throat. The pulse becomesafterwards quick, and the skin hot

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and dry. The efflorescence comesout at various periods after the de-velopment of the fever; it oftencomes out in twenty-four hours, some-times in 36 or 48 hours, sometimeson the third day, but rarely as lateas the fourth. I mention these facts,because the accounts which we havein systematic works on scarlatina arenot correct, the efflorescence gene-rally coming out at an earlier pe-riod than they have stated. SYDEN-HAM, the only great practical phy-sician which London has produced- with reference to past times—SYDEN-HAM, I repeat, has described one

modification of scarlet fever, whichoccurs without any sore-throat, andthough this be the rarest form of thedisorder now, I have occasionally metwith it, very clearly, unquestionablydefined. For instance, fourteen chil-dren were sentinto the Hospital hav-ing scarlet fever, and thirteen ofthem had no sore throat. This form

might be called simple scarlet fever,with respect to the internal and ex-ternal pathology, for though the or-gans are excited, none are positivelyinflamed. How would you distinguishthis efflorescence to be that of scarla-tina? In the simple cases, the colourand appearance of the skin more

Dearly resemble the skin of a boiledlobster than any thing else to which Icould compare it. The efflorescenceis diffused in broad patches ot a brightred ; but if you examine them moreminutely, you will find that they aremade up of minute points running intoeach other, and thus making the sur-face flot id, especially about the joints.The conjnnctiva is more red than na-2taral; and the tongue very often so,particularly near the extremity, withthe papillæ red and raised there. Thepulse generally ranges from 100 to110 in young children. The heat ofthe skin, as indicated by the thermo-meter, is of’ten about 99 or 100°, yetyou have not the combined marks of-either an external or internal inflam-mation. This, then, is the simple, orthe first form of scarlatina.

. Thete is a second modification of’scarlatina which is the inflammatory.This nosologists call scarlatina angi-nosa when- the fever is fully deve-loped. It occurs, in many instances,with a remarkably hot skin, a very

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quick pulse, great thirst, moist furredtongue, red at the tip ; in short, at firstwith an open and ardent form of fe.ver, such as I described to be an at-tendant sometimes of typhus, andsometime of small pox. In this highlychatacterised form of scarlet fever,the throat is inflamed; if yon look atthe tonsils they appear red and swol-len, the inflammation being diffusedover the adjacent mucous membraneof the fances. The fever passes onoften under this high character forsome days, and after a time specksform in the throat, about the tonsils,But recollect that there are sometimes

spots of coagulable lymph, which youmust distinguish from slough; theformer will be removed by gargling

whilst the latter remain after garg.,,ling; and if you then throw a stronglight into the throat, by the reflectionof a good candle on a small mirror,

you can discover that they are deepand distinct sioughs of an ash or greycoiour. Now after a time this openand ardent fever undergoes a change,the heat falling upon the surface ofthe body, the pulse becoming sub-

dued, the efflorescence of the skinlosing its florid colonr, and assuminga dull red or copperish hue. The in-flammation has then extended downthe air passages, it is in fact the su-

pervention of an intense bronchial af-fectionwhich has caused the protractedcase to put on this peculiar character,this smothered or subdued forln of

The older authors confined their at-tention exclasively to the throat.Their pathology extended no further;but what they lacked of real informa-tion, they made up, according to thegood old custom, by an abundance ofcrude conjectures. When the throatbecame very bad, and when the ef-florescence put on a copper cast, theycalled it not scarlatina anginosa butscarlatina maligna, and pretended thatit was then a highly putrid affection.But whenever the efflorescence be-comes of a copper hue, It dependsupon an intense bronchial inflamma-tion, which sometimes occurs at the

beginning and then the fever at oncehas a masked and smothered charac-ter, in which the tongue becomesglazed, in which the heat of the skinis reduced, in which the pulse be-

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tomes weak, in which the voice is

feeble, and in which the patient de-monstrates great loss of muscular

power, whatever local disturbances

may exist. This form of fever, as Ibefore explained, borrows its pccttliaities from the bronchial lining beingnot only overloaded with blood, batbesmeared with an adhesive secretionwhich prevents the inspired air from

coming freely in contact with theblood. The more intense the hron-chial affection, the less is the feverdeveloped. Study this special bron-cial affection well, trace it through allthe disorders in which it appears, andwhich it modifies, if you wish to avoidthe fatuity of a conjectural pathologyaU1 an empirical practice in specificfevers.

There arc then two leading forms ofscarlet fever, the simple and inflam-matory. The second might be againsubdivided into the highly inflamma-tory and the congesto inflammatory,in the first of which inflammation ofthe fauces and bronchial lining takesplace with an open and ardent fever,in the last of which with a maskedand smothered fever at the beginning.In both the brain and lining of the in-testines may become affected. Re-collect not to confine your attention

merely to the lining of the air pas-sages, but examine into the state ofall the internal organs, connecting thesymptoms with the patliological con-ditions, the effects with their causes.

There is an affection which some-times arises in the progress ofscarta-tina important to be borne in mind-an inflammation which spreads fromthe throat along tlio eustachiau tubeinto the internal ear. It is especiallyapt to happen when the inflammationof the throat arises early in the pro-gress of the scarlet fever; and in mis-managed cases the inflammation some-times remains in the internal ear whenthe inflammation in the throat hassubsided. The bones of the ear maythen become carious; the petronsportion of the temporal bone may bepenetrated by caries, and the duramater become inflamed, nay, ulti-timately the brain itself, as I haveoccasionally seen. But this rarely,very rarely, happens in rightly treatedcases, More evils perhaps spring

from ignorance than can be remediedbv wisdom. .

There is another circumstance to beattended to in scarlet fever: patientsare sometimes attacked by pains likethose of rheumatism, and 1 believe thatexactly the same structures are at-

tacked, and in the same manner, as inrheumatism. The pains are seatedabout the joints and shoot atong themuscles. A man was brought into thehospital labouring under scar!et fever,and this affection in his aiicies. He

put his feet out of bed one night andexposed them to the cold. The affec-tion left the ancles, aiid the pericar-dium became inflamed, so that it un-dergoes transfers like the commonrheumatism arising from cold.

A circnmstance has been not:ced bycontinental writers. Little miliarypoints, small portions of raised cltticle,appear here and there, of a whitishcolour, and on this acconnt they havecalled this form the scarlatina mitiaria.They are accustomed to make veryminute distinctions from sneh appear-ances, but this mode of proceeding isnot attended with any practical bene-fit. It ought to be voted frivolous andvexatious. These miliary points arenot uncommon, and arise from the ex-cessive heat of the surface.

Treatment.

If yon were called to a patient af.fected with the simpie form of scarletfever, what would you do? The best

thing at tirst, when the skin has be-come uniformly hot is to wash thepatient all oyer with tepid water; ;procare a large shallow tub, a com-

mon washing t!tb, and let the patientsit on a three legged stool in the mid-dle of it, the feet being covered by-warm water ; sponge the skin witltwarm water, then wipe it perfectlydry, and put him to bed between cleansheets. Give about two grains of ca-lomel with a little rhubarb, and a doseof cold drawn castor oil a few hoursafterwards. Let the diet be then arrow-root, and the drink cold wate-r; pur-sue this plan in a cool airy apartmentfor three or fonr days, and the patientwill generally be convalescent. Becareful not to expose him to coM then,as he might become dropsical. Our

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systematic writers have made dropsyalmost a necessary consequence of

scallatina, but this is not the fact. Ihave ,een, within the last six years, atleast four hundred cases of scarletfever, and I have only seen a singlecase in which dropsy occurred, whichwas owing to my directions being dis-regarded. The patient crammed him-self with new bread, and cold er cram-ming at its usual causes. Dropsy, sofar as I have observed suhseqnent toscarlet fever, arises often from inat tention on the part of the patient, andoccasionally from ignorance on thepart of the practitioner.The treatinent of the inflammatory

scarlet fever must be regulated ac-cording to its form. If you are calledt. a patient in whom the fever is ar-dently developed, and the throat muchinflamed, apply eight or ten leeclies tothe part; sponge the surface of thebody in the way 1 have mentioned,or pour about two gallons of tepidwater at once over the whole surface.In the next place, give a brisk ape-rient, as a combination of calonnel andrhubarb or jalap, followed np hyaninfii,,ion of senua with sulphate ofmagnesia. Use a gargle also com-

posed of diluted sulphuric acid witha little syrnp; keep the patient at restin the recumbent posture, and keephim very cool, and on a very sparediet. This is the plan that I usuallyadopt. Some cases require a more

active treatment than this, if the brainor bowels be inflamed, the heat high,and the pulse expanded or hard. Ina word, you must bleed, generally orlocally, according to the degree of thefever and inflammation, being guidedby those principlea which I beforelaid down respecting the removal ofthe inflammation, which is the main

object in such cases. Presei ve thevital organs from derangement, andthe recovery will be certain, in the ar-dent foam.

With regard to the masked form,in which the bronchial inflammationis intense, attended by a copuer-co-loured efflorescence, a soft compress-ible pulse, a glazed tongue ; the sub-dued heat, and a weak respiration,with slonghs abont the throat, yonmust be cautious as to evacuations. If

you were to treat it as actively as theother, you would almost iuvariahly be

unsuccessful. You must manage it

mildly; put on a few leeches, s;iyfonr or five, to the throat, aud if thepulse rises you may repeat them, ifthe inflammation should require them;but if the pulse sink on a very smallloss of blood, do not apply themagain. If the skill be cool, lay tltepatient between blankets, and put ahotttf of warm water to the feet. Re.gulate the temperatnre of the room bythe thermometer; let it be kept about64° in snch cases, the ventilation beingfree. Give mild doses of calonietjoined with small ones of rhubarb, fol-lowi-d np bv a little cold drawn castoroil; and let the diet be bland. But besure to avoid all extraordinary de-mands upon the strength. About ndrachm of the solution of chlorinemay frequently be given with advan.tage in this masked form, in thecourse of twenty-tour lours, mixedwith about six ounces of distiliedwater. Where it irritates the mu-

cons membrane of the intestines, le-men juice may be substituted, asprinkling of which, being added tothe common drink, is often refreshingand grateful. In the advanced stages,the sub-car bonate of ammonia is some-times useful by detet mining to the stir-tace, and when the pulse falters, alittle wine may be now and then al-lowed. This masked form of fever ismost common in delicate children andadults, and certainly requires a veryguarded tteatment, particularly inLondon. But if vou have distinctlycomprehended the pathological andpractical principles which I laid downin typhus fever, ou will be at no lossto apply them here. Scarlet fever,however, under its ordinary chane.ters is a milder affection than typhusfever, running a ahorter course, andleaving far less prostration. Batingthe masked and --mothered form, notone case in a hundred aught to befatal.

Measles.

The first symptoms that appear tousher in an attatk of meastesarewatery eyes, a running nose, occasion-al sneezing and some degree of cough,These precursory sypmtoms continnefor three or four davs before theeruption comes out. But I have seenmeasles occur without being preceded

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by any of the catarrhal symptoms ;during the last summer, I saw severalcases of this kind.. There is one thingthat you ought to he aware of, namely,patients are sometimes attacked byinflammation of the tarynx, before therash comes out, and they would be indanger of dying froni suff cation, ifyon were to wait until the rash ap-peared. Sometimes, al,o, the brainbecomes inflamed, before the appear-ance of the rash; I remember in par-ticutar the case of a boy where this

happened. You cannot be surprisedat this, when you recoliect that the ex-citement is fully developed for two orthree days before the rash. The rash ofmeasles generally appears first on theneck, chiu, and flice, and then gra-dually spreads to other parts of thebody. It has been said that the rashof measles is darker than the efflor-escence of scarlet fever, and it is sogenerally, but not universally. It istrue, generally, because the affectionof the mucous membrane of the airpassages is usually more fully deve-loped in the measles.

Diagnosis.

How would you distinguish measles,from scarlatina ’ The first thing to re-member is the appearance of the ca-tarrhal symptoms in measles, beforethe eruption. 2. The rash appears in

smaller points than in scarlatina, beingmore like millet seeds, just raised aibovethelevel ot tlre skin, and of a dusky Lme.3. The rash of measles differs also

matetiatly from the efflorescence ofscarlet fever ipon the face, it is dif-fused in broad tithes in the latter,whilst it is invariably in stnall distinctdevations in the former. 4. In mea-

sles, if you look under the throat attten-tiveiy, you will find stnall raised redspots npon the soft palate, but in scar-let fever there is a diffused efflores-cence over the whole throat, in whichsuch spots are not at all perceptible.3, There is a peculiar smell in measles,which is not present in scarlet fever.

Pathology.With respect to the pathology of

measles, it is similar, generally, to thatwhich I have described in scarlatina.The fever attending lucasles generally

puts on the inflammatory character,and the inflammation is generallyseated about the air passages, especial-ly if the patient he kept hot. I sawseveral cases sometime ago, where thepatients were nearly dying from beingkept too hot ; the windows were shut,the curtains drawn, and the door neverallowed to remain long open. Thesecases were all evidently developed inthe fir-t instance, hut they becametyphoid from want of fresh air. Thenyou will recollect, that what I havesaid about the ardent, or open form offever, and the smothered or masked

form, is applicable to the measles, aswell as to scarlatina. The rash of

measles usually goes away in three orfour days, but it continues longer if thefever be protracted, and this is thecase likewise witlt the efflorescence of! scarlatina.

Treatment.

With respect to the medical treat-ment of measles, I have l.ttle to say.If yon see a child running about the

! house who has a slight running at thenose, and a little cough, with scarcelyany degree of fever, if you give him a.laxative, avoid cold, and adopt a sparediet, he will generally do well withoutany other means. But if yon find thesigns of any internal inflammation yonmust be upon your gnard, and treat itaccording to those rules which I bstoreso repeatedly prescribed, when I spokeof particular inflammations. When

the skin is fre quently hot and dry, andthe pulse round or resisting, bloodmust be draw and the patient mustbe kept upon a strictly antiphlogisticdiet. Bnt if yon see a patient labour-

ing under the masked form of fever,keep him in bed, surround him with afresh atmosphere, move his bowels

mildly, and be cautious about blood-letting. In such examples those meanswhich at the same time act gently onthe bowels and sk:n are the most ef-ficacious. In measles, as well as inscailet fever, sometimes the lining ofthe intestines is fnflamed. But do notsuppose that this is tlw case wheneverthe tongue is red, for that redness isoften a part of the effloresence in the’one and the rash in the other. Remem-ber what I before remarked,—do nottrust so much to any single symptom,as to a combination of several sy mp-

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toms, in for ming an opinion of the seatand nature of the affections.As a general rule, a nentral tempe-

rature is best in the measles, I mean ione by which the surface of the bo-dy is neither chilled nor heated.But when the skin is universallymoist, you should be mindful againstcurrents of cool air, for tiey are liableto create serious inflammation; on theother hand, when the skin is uniformlyhot and dry, a cool atmosphere is de-lightfully refreshing, and even benefi-cial by diminishing the excitemeLtAgain and again in most examples ofthe latter, I have seen the most agree-able changes induced by lessening thetemperature of the sick-chamber, andby abstracting a little blood. Duringconvalescence be very careful in mea-

sles, about preserving the naturalwarmth of the sldn, chillness of whichoften tends to pulmonic affections,acute or chronic.

Hooping Cough.Hooping cough comes on in general

like a common catarrh, except thatthere is seldom a running at the nose.After the lapse commonly of a tewdays, the cough comes on in fits, anda child, if standing at a distance froma table or chair, will run to them andcatch hold to prepare himself for thestruggle, as ifhe has a warning of thefit. There is then a sudden and strangesensation about the larynx ; the facebecomes turgid, the eyes swollen andred, and the cough is by severatrapid expirations in snccession, fal-lowed by a long and deep inspiration,accompanied by a peculiar nose callelthe hoop.’ These fits of coughing, orhoop, terminate in two ways, eitherby mucous expectoration, or vomiting,or both. One attack is succeeded byanother, and terminates in the sameway. This affection is rather alarm-ing when it attacks very young andvery delicate children, for such arevery liable, likewise, to irritation of

the mucous membrane of the intes-tines, and subsequently to convulsionsfrom a sympathetic affection of thebrain. In examining the bodies infatal cases, I have always foundtraces of inflammation about the mu-cons membrane of the larynx, as anintelligent friend has stated in an ex-cellent paper which he has pnblished

on the subject; but I have frequentlyfound proofs of inflammation of themucons lining of the small or largeintestines of children, and often aaoverloaded condition of the pia mater,with some opacity of the arachnoid,and effusiun between these mem-

branes, or into the ventricles. Theirritation appears to commence firstabout the larynx, and .often spreaddown the trachea and bronchia; it nextattacks the mucous membrane of thebowels, and lastly the brain becomesaffected, at least this is the orderwhich I have most frequently observ.ed. Hooping cough is harrily evera aserious disorder where fever and

dyspnœa, or difficulty of breathing,are absent; but it is frequently a se-rious disorder, especially in infants,or very delicate children, where feverand dyspnœa are present. Hoopingcough is far more fatal in Londonthan in the country, if I might forman opinion on the subject from myown observation. This, I believe,much depends upon the greater

general delicacy of the children, bywhich the mucous irritations are aptto be more urgent; but I cannot helpsuspecting, that it principally dependsupon the more active treatment thatis generally adopted in the BritishMetropolis. A very common plan isto sicken children, two; three, or

more e times in the day by ipecacuan: or antimony; and I have in manycases distinctly traced the origin ofthe irritation of the mucous memhrane

of the bowels to the effect of one or

, other of these medicines, or to small! doses of the prussic acid and gene-

rally the affection of the brain hassucceeded, apparently as a conse.

quence. I do not mention thesefacts as matter of personal censure;men do what they believe is the best;they act according to the rules of re-ceived authorities, and such errors ofjudgment ought to be -tenderly re-g"rded in an individual point of view.No man has practised physic withoutcommitting many mistakes, and oneprofessional brother should make thelawful allowance for another, whomay he as superior in one depart-ment as he is inferior in some otherto the practitioner who may chance todetect a mistake. My business as ateacher is to warn you against syste-

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matic errors, and therefore let mestrongly warn yon against the corn-mon one of giving daily nani-eating oremetic doses of antimony or ipeca-cuan in hooping cough. Generallyspeaking, if you put the little patientson a bland diet, if in cold weather youplace them in a regulated temperatureof from about 5S° to 64°, if you givethem a little mild aperient medicineif necessary, and prevent acidity by alittle carbonate of potash or soda, thecomplaint will leave them in a fewweeks. It is often as important toknow theextentof onr ignorance as ofour information. Hooping cough has asort of determinate dutation. If mildweather it lasts about six weeks ortwo months, but longer in cold wea-ther, unless the children be kept in anartificial kind of warm climate. Allattempts to shorten its dmation by-violent measures are not only fiuit-less, but comnsonly vel y ponicious.Where, however, fever and dyspnœaarise, you must apply the appropriateremedies for the removal of the cause ;and when the complaiut assumes a

chronic character, a change into a

fresh and bland air is otten attendedwith the happiest efferts. But Bherethat cannot be accomplished, a mildand simple diet, a gentle aperient oc-casionally, a little carbonate of po-tash, witli a few drcps of the tinctureofhy-oscyamus, and the occasional em-ployment ot the tepid bath, often an-swer an excellent purpose. If yonwish to shorten a chronic hoopingcongh, keep the timcticns of’ the skmright, and avoid irritating the mu-cous membrane of the alimentarycanal.For want of time I have been com-

pelled to put these impor tant subjectsinto one lecture, and have thereforegiven yon an imperfect view of eachof them; but in my next course oflectures I shall, if possible, devote aseparate lectare to each ot these spe-cific affections.

ERRATUM.In Dr. ARMSTRONG’S last Lecture,

p.294, for-‘° the eruption is moreregular as to its time," read, the erup-tiou is more irregular as to its time.

LECTURESON

PHRENOLOGY,BY

DR. SPURZHEIM.

LECTURE 9.

LADIES AND GENTLEMEN,I COME to-day to a very important

application of phrenology, namely, toEducation.Look at man in general, and see

what a wretched Etate he is in, herequires to be treated almost as a

child, and yet writers have told us,that the world wishes for education.Many books have been written on

edncation,-whole libraries hdve beencompiled, various institutions esta-blished, yet very little improvementhas taken place. Can man be per-fected by education, or can he not?It is certain that the improvement isnot proportionate to the trouble whichsome individua’s have taken. There-fore I repeat, can man he perfectedor not? Or shall he lemain eternallywhat he is? In speaking of the perofection of man, I do not mean to saythat man can, by any power whatever,acquire any one of the fundamentalpowers of the mind, because the num-ber of them is determinate; but thequestion is, whether these powers canbecome more or less active, and whe-ther they can be dii ected in awaylikelv to be most useful to the indivi-dual ? Commonly, in speaking ofedu-cation, it is divided into two parts, phy-sical and moral. Since we admit thatthe moral part of man, or, in other

words, the mental part, depends uponthe organization, and since we do notadmit of any influence independent ofthe cerebral orgavaization, I do notlike this division, and thelefore shallnot speak of it.

However, I shall speak of educa-tion under two heads. I shall firstexamine hew tar it M possible to

give more or less activity to thefundamental powers with which man