"On Scarlet Fever"
There are many fevers listed as the cause of death in early modern England that do not translate well into modern diseases (worm, spotted, pining, nervous) but scarlet fever is still with us. The Puritan Dr. Thomas Sydenham (1624-89) is often referred to as the "English Hippocrates" because of his emphasis on the need to observe the course of diseases and not just theorize about them. His two major works, Methodis Curandis Febres (1666) and Observationes Medicae (1676), are thought to have been written in English and translated by a Latin scholar for publication. From sitting at the bedsides of his patients Sydenham argued, controversially at the time, that fevers were connected to the weather and the seasons and occurred in cycles. Here he describes scarlet fever as a summer disease that especially affects infants. Sydenham believes that the cause of the disease may be overheated blood from the hot summer weather. He recommends keeping patients indoors out of the sun, not giving them meat (a hot substance), using a mild laxative, and if the child has fits from the fever to use a hot iron to blister the skin on the back of the neck and give opium. The idea was that the blister would allow bad fluids to drain from the body. Sydenham probably advised blistering the neck as it was close to the skull, and physicians believed fits were caused by too much fluid/humor in the brain.
Scarlet Fever may appear at any season. Nevertheless, it oftenest breaks out towards the end of summer, when it attacks whole families at once, and more especially the infant part of them. The patients feel rigors and shiverings, just as they do in other fevers. The symptoms, however, are moderate. Afterwards, however, the whole skin become, covered with small red maculae, thicker than those of measles, as well as broader, redder, and less uniform. These last for two or three days, and then disappear. The cuticle peels off; and branny scales, remain, lying upon the surface like meal. They appear and disappear two or three times.
As the disease is, in my mind, neither more nor less than a moderate effervescence of the blood, arising from the heat of the preceding summer, or from some other exciting cause, I leave the blood as much as possible to its own despumation, [fermenting] and to the elimination of the peccant [bitter] materials through the pores of the skin. With this view, I am chary [careful] both of bloodletting and of clysters [enemas]. . . I hold it, then, sufficient for the patient to abstain wholly from animal food and from fermented liquors; to keep always indoors, and not to keep always in his bed. When the desquamation [the skin peels] is complete, and when the symptoms are departing, I consider it proper to purge the patient with some mild laxative, accommodated to his age and strength . . .
This, however, must be borne in mind. If there occur at the beginning of the eruption either epileptic fits, or coma--as they often do occur with children or young patients--a large blister must be placed at the back of the neck, and a paregoric draught of syrup of poppies must be administered at once. This last must be repeated every night until he recover.
Annotated by Lynda Payne.