the constitutional powers, with delirium, Between the comparatively mild form first described, so mild indeed at times as scarcely to constitute a perceptible disease, and the malignant, scarlatina is met with in every degree of severity. As a general rule, the severity or mildness of the attacks of scarlet fever depend greatly upon the type of the prevailing epidemic, which at one time may be so favourable, that almost every case does well, whilst at another, the greatest fatality attends it, and sorrowing parents see their children carried off one after another with fearful rapidity.

The great variation in the severity of the attacks of scarlet fever must render the variation in the treatment equally great. When the form of the prevailing epidemic is extremely mild, little if any treatment is required, and many cases get none at all, not even confinement to the house, and certainly not to bed. This is not well even for the sake of others, and should the weather be ungenial, or should cold be taken, a mild affection may be at once converted into a dangerous disease. A moderately smart attack of scarlet fever requires, certainly, confinement to bed, in as well ventilated a room as possible, kept at an average tem.. perature of 60° Fahr.; the diet should be kept low, and should consist of milk, farinaceous articles, &c., and the thirst may be freely indulged with diluent drinks; the patient must not be covered with bed-clothes, which will keep up feverish heat. If the heat of skin is great, and indeed in most cases of this disease, sponging the surface of the body with tepid water, with or without the addition of a little vinegar, is at once most beneficial and grateful to the patient. A gentle aperient should be repeated once or twice in the course of the disease, a table-spoonful of castor-oil, a dose of magnesia and rhubarb, or from half to a whole seidlitz powder, may be required, or in fuller habits or where fever runs high, a more active purgative still, of calomel and scammony, or in an adult, calomel or blue pill, and colocynth.

The common effervescing soda powders are often liked, and may be permitted in moderation to all; but more freely-and, indeed the salines generally-to persons of full habit. From five to ten grains-according to age-of chlorate of potash given every six or eight hours, in a little sugar and water, is one of the most appropriate cooling salines in this disease.

If the feverish symptoms run high, of course the lowering and cooling remedies must be more actively enforced. In most cases much relief is afforded to the throat

by the frequent use of warm gargles, made either with simple gruel, or with gruel with one or two table-spoonfuls of vinegar to each half-pint. Externally, hot bran poultices, frequently renewed, are also of much service to the throat. When the throat is very much swollen, leeches may be requisite, but so much caution is called for in the abstraction of blood in scarlet fever, that this should only be done under medical sanction. Great enlargement of the glands around the jaw, and in the neck, must always be seriously regarded. When a case of scarlet fever presents symptoms of malignancy, every method of supporting the strength by wine, broths, &c., must be used, and the preparations of chlorine employed both internally, and as washes and gargles, to the nose, mouth, tonsils, &c. The chlorate of potash in from five to ten grain doses, must be given every three or four hours; or muriatic acid in five drop doses in sweetened water. Two drachms of the solution of chloride of soda, in the half-pint of water, will make a convenient wash, to be used with a syringe, if the child or person is unable to gargle.

Although the above directions are given for circumstances which might render them useful, it is not with the idea that any one in their senses would have recourse to them, if medical aid could in any way be procured. The fearful rapidity of a fatal case of malignant scarlet fever, calls for the most energetic exertion of the highest skill, which is too often of no avail. After the eruption has faded, the person may sit up, and gradually return to fuller diet, such as pudding, broth, fish, &c., the bowels being kept free, but not purged, and close attention given to the state of the urine as to quantity and appearance. At this stage, too, much comfort and benefit will accrue from the use of two or three warm baths. These relieve greatly the discomfort arising from the harsh and dry state of the peeling skin, and what is more important, encourage and keep active its ordinary perspiratory functions, which are apt to be impaired or impeded, and thus to give rise to one of the most serious incidents connected with the disease in question, that is, to a dropsical condition connected with a disordered state of the kidneys. The occurrence of dropsy after scarlet fever is always a serious matter, and the possibility of it, a cogent argument for guarding against all those influences which, by interfering with the perspiratory function of the-for the time-morbidly susceptible skin, tend to induce it. It is observed, that the attacks of dropsy after scarlet fever, are by no means in accordance

with the severity of the attack itself, and this is supposed to be, because those who have had only a mild attack, are more careless as to after-exposure than those who have suffered a severe one. However this may be, it is certain, that many who have passed safely through the disease itself, fall victims to the subsequent dropsy, purely as the result of carelessness on their own parts, or on that of others. The attacks of dropsy are most likely to occur from the end of the first fortnight to the end of the fourth week after the decline of the eruption. Its symptoms are generally those of languor and oppression, with headache, and it may be vomiting, the swelling coming on simultaneously. Usually, the face, the eyelids especially, is first affected, and the dropsical swelling may go no further, but generally the feet and legs, the hands, arms, chest, &c., become filled. Concomitant with these symptoms, the urine is scanty, high coloured, or "smoky" in tinge; it presents, moreover, peculiar chemical changes.

Little has hitherto been said about medical attendance in a case of scarlet fever. Although mild cases may be, and every day are, carried safely through with simple nursing, should the case be at all a smart one, it ought to be visited by a medical man; if it is severe, his presence is indispensable, equally so, whatever the case may have been, if the least symptoms of the afterdropsy show themselves. Should this last contingency occur, warm baths ought to be used to restore, if possible, the functions of the skin, hot bran poultices applied to the body, and if there is pain about the kidneys, blood taken by leeches or cupping. The bowels should be well cleared, or rather purged, by the calomel and rhubarb, or calomel and colocynth pill, or better still, by calomel and compound powder of jalap; at the same time a draught consisting of a drachm of nitrous ether, half an ounce of spirit of mindererus, and ten or fifteen drops of ipecacuanha wine, in a wine-glassful of water, may be given every four or five hours. These measures ought to be sufficient till medical assistance is procured; if, as sometimes occurs, convulsions or delirium come on, they are to be treated as directed in the articles on those disorders. Besides dropsy, scarlet fever is liable to be followed by other affections, particularly in those of weak or scrofulous constitution. If the affection of the throat has extended to the ears by the eustachian tubes, the structure of the organs of hearing may be materially damaged, and deafness, total or partial, be the result. Frequently, runnings from the external ears, from the nose or eyes, continue for

long after the subsidence of scarlet fever, and if the attack has been a severe one, a permanent state of impaired health may be the consequence. Of course, if a patient, after an attack of scarlet fever, remains weak, tonic medicines, quinine, or iron, with wine and good nourishment will be required, also warm clothing.

The question of contagion in scarlet fever is an important one. Few diseases perhaps are more eminently contagious, and few retain the power of propagation longer; indeed, it is difficult to say when this totally ceases, at least for some weeks. Probably, when the peeling stage is complete, the risk of contagion is gone, or nearly so. The fomites-see Fomites-from scarlet fever are very persistent, and unless the rooms which have been occupied by patients, and indeed everything which has been about them, are very freely cleansed, aired, or fumigated, there is always some risk for a considerable time. The power of belladonna, in acting as a prophylactic, that is, in protecting individuals against the contagion of scarlet fever, has been much discussed. It has been used extensively in Germany, and also in this country, and with apparent success; indeed, the author believes he has found it efficient for the purpose; at all events, the evidence is sufficient to make it worth a trial during the prevalence of a very severe or malignant form of scarlet fever. See Belladonna. Scarlet fever is generally a disease of childhood, and is usually passed through once in a life-time; but adults who have escaped it in early life, are liable to be affected. Second attacks are rare. Although, however, those around persons suffering from scarlet fever may not have the disease, they are very liable to suffer from sore-throat, often in a severe form. It is a serious thing for women to be exposed to the contagion of scarlet fever soon after child-birth; every means, therefore, should be used to guard against such a contingency.

Scarlet fever has sometimes been confounded with measles; a comparison of the described symptoms of the two diseases will point out the complete difference. SCAPULA.-THE SHOULDER BLADE.See Shoulder.

SCIATICA is neuralgia or nervous rheumatism, affecting the great or "sciatic” nerve of the lower extremity. This nerve, the largest in the body, passes down the back of the thigh to the ham, a little above which it divides into two main branches. The nerve sometimes becomes the seat of severe neuralgic pain, felt down its entire course, or perhaps in the hip only, or some

times in the foot and ankle only; the pain comes on in paroxysms, and is generally increased by exercise; in some cases, pressure upon the course of the nerve causes pain. Sciatica is often attended with so much suering, that it affects the general health to a considerable degree; moreover, it is frequently most difficult to get rid of. For these reasons, the case should be under medical superintendence. Leeches and cupping, in the first instance, down the course of the nerve, especially in plethoric subjects, followed by blisters, are useful; or heat and moisture may be used with advantage, in the form of the bran poultice, followed twice or three times a day by an embrocation composed of one part of turpentine and two of soap and opium liniment. A couple of drachms of this should be rubbed in for ten minutes at a time. The bowels being cleared by a purgative, if there is no tendency to fever, drachm-doses of carbonate of iron, given three times in the twenty-four hours, often cures quickly; or turpentine, in doses of fifteen drops, given in milk, three times a day, may be tried; or quinine, in two grain doses, every eight hours. There is considerable uncertainty in the effect of remedies in sciatica, even in skilful hands. In obstinate cases, the author has found much benefit from the use of the warm saline baths, such as those of Moira, or of Ashby-de-la-Zouch. Acupuncture is often of service in this disease, and is, perhaps, not so much had recourse to as it might. In all cases of sciatica, perfect rest of the limb is essential. Again, it is repeated, the obstinacy of the disease, the uncertainty of remedies, and the possibility of its being symptomatic of irritation in the kidney, make it the safer and wiser plan to have the case treated by a medical man at

once.

Refer to-Neuralgia.

SCHOOL.-It too often happens, that in consequence either of ignorance or of carelessness, the health of young people suffers irretrievable injury during the years of instruction. In day-schools, the chief source of injury is from deficient ventilation. The consequences of this, and the remedies, are sufficiently entered into under such articles as Air and Atmosphere-Bed-room-Ventilation, &c.—and require no further comment here; suffice it to remark, that the effect of breathing an atmosphere deteriorated by the carbonic acid exhaled from the lungs of a number of children into a small or badly ventilated room, must be to produce drow. siness and languor, and consequently to neutralize in some degree the exertions of the teacher.

In boarding-schools, the health of the pupils is of course subject to those general conditions and laws of health, which are commented on in the various sanitary articles; and parents would do well to assure themselves that due attention is paid to these, ere they commit the daily life of their children to influences over which they have no control. It is to be hoped, that there are few seminaries for the young in this kingdom, in which actual deficiency of food occurs; but it is possible, that in the selection and preparation of the food, there may be defects, which to strong constitutioned children are of comparatively little moment, but which are of the greatest importance to the delicate. The point should not be overlooked. It is impossible in the limited space of this work to enter into particulars, but the reader is referred to the various articles on Food - Digestion-and the principles of Nutriment. Equally important with quantity and quality of food, is the permission of sufficient time for meals, not only for the mere eating, but for rest after, before school work is resumed. The author is induced to notice this point especially, from having recently had his attention drawn to the regulations of a large educational institution, in which the time allowed for meals is so short, that the meal itself must be a scramble, independent of the injury which may result from the resumption of head-work immediately after taking food.-See Digestion and Indigestion. It does seem to be the case with some, that in seeking to cultivate the mind they forget the body, forget how dependent the activity of the instrument they seek to form, is, upon the well-being of its material clothing. There are many other points connected with school-hygienics, which are important, but, as before said, they fall under the heads of sanitary information generally, as already given in other parts of this work, and which space forbids to be reiterated.

Refer to-Air, &c.-Bed-room-Education -Ventilation, &c. &c.

-

SCIRRHUS-a form of cancer characterized by its peculiar hardness in the incipient stage of the disease.-See Cancer.

SCLEROTIC.-The outer thick coat of the globe of the eye.-See Eye.

SCREAMING-of infants, if continued, and if increased on particular movements of the body, should not be neglected. Intermittent screaming may be indicative of painful affection of the chest or abdomen, which incites the child to scream; whilst, on the other hand, the aggravation of the pain thus induced, compels it again to desist, thus giving the intermittent character.

SCROFULA-is the name rather of a constitutional tendency, or "Diathesis," than of a disease, although cases of scrofulous disease alone do occur, where the tendency is strong. That many persons may be tainted with scrofula, and nevertheless be free from those external signs which are usually considered to indicate the tendency, is unquestionable, but generally, if the scrofulous diathesis is at all strongly marked, its evidences are sufficiently apparent, and often strikingly so. The following description of the signs of scrofula by Dr. Phillips, one of the highest authorities on the subject, is peculiarly truthful. "In the form of the body there is usually observable a want of muscular development; but even this is often absent. There is often an appearance of plumpness and roundness, which is the result not of muscular development, but simply of an infiltrated condition of the cellular tissue, and which rapidly disappears under fatiguing exercise, privation, or disease. Commonly, there is a general paleness and coldness of the surface of the body, which is owing to a feeble circulating apparatus; but in a large number of cases, that paleness does not extend to the face. The colour of the hair is very variable, but for the most part it inclines to a dark tint. Of nearly nine thousand scrofulous children examined, a little over thirty-two per cent., had light hair and eyes. The abdomen is commonly tumid-discharges from the nose, the eye, and the ear are common-the tongue has commonly a dirty whitish coating; the tonsils are usually enlarged, and they are often so tumid as to impress a disagreeable and frequently husky character upon the voice, and to cause snoring when the patient is asleep. The stomach and bowels are frequently disordered, and digestion is ill

performed. Sometimes the evacuations are clay coloured, very offensive, and of varying consistency, at others having a redundancy of bile. The skin though often dry and hard is often the seat of a considerable greasy exhalation, sometimes it is found to be fetid and sour. The scalp and other parts of the cutaneous integument are often the seat of eruptive affections. The absence of vascular and muscular energy, often causes the child to lie and sit about much, and indisposes him to enter into the enerintellectual development claimed for scrofulous persons, that is usually wanting. That many scrofulous children present that character is quite true; but the result of very careful observation," says Dr. Phillips, "has convinced me that the overwhelming majority are without those superior intellectual qualities, which have been pointed out as their ordinary characters." Moreover, if the intellectual powers are forced, as too often happens," and the nervous and intellectual systems have the vital actions concentrated on them too intensely, the sufferer loses flesh, the general health languishes, and the intellectual faculties may give way, destroyed by an opposite, but not less sure, method than that which breaks down the poor man's child."

As noticed above, the very common idea that scrofula is usually associated with light hair and complexion, is far from being correct, the larger proportion of scrofulous subjects have dark hair and eyes, with a dingy complexion, and some are ruddy, and to the common observer look robust; others with delicate skin, inclined to freckle, have red hair.

Of the causes of scrofula, there can be no doubt that hereditary predisposition is the cause above all others; the fact is beyond dispute, and there are few families in this kingdom, who have not. indirectly at least, practical connexion with the fact. It is to be observed, however, that the predisposition is strengthened, if a parent, adds to the taint an acquired state of bad health, or if in a father the bodily powers are impaired by age; probably the reverse holds good, that whatever conduces to health and vigour, even in parents tainted with scrofula, tends to improve the constitution of offspring as regards the predisposition. Further, it is undoubted, that whatever hereditary tendencies children may possess, they are greatly retarded or strengthened by the external conditions to which such children are exposed. If the climate in which they reside is dry and bracing, if they are so placed that healthy habitations,

good clothing, and nourishing food, are provided for them, and especially if their parents and guardians are awake to the importance of these things, of being on the watch for any tendency to failing health, or to disease, the chances of health and life, are far greater, than they are for children of even originally better constitution, who are exposed to a damp cold climate, and to the unhealthy influences attendant upon the circumstances of poverty. These in fact of themselves, especially cold, damp, and privation of food, particularly if accompanied with depression of mind, may even engender scrofula in a constitution comparatively untainted by it. It ought always to be an object in those predisposed to scrofulous disease, to maintain the highest possible condition of health.

In children, the glands, those of the neck, chest, and belly, are the most usual seat of scrofulous disease, though few if any other of the tissues are free from the liability. In adults, the lungs most generally suffer. Whatever disease affects a scrofulous person, whether it be, like enlargement of the glands, distinctly traceable to the scrofula itself, or some other ailment, it is apt to be modified in its course and appearances by the existing tendency. Purely scrofulous inflammation is slow in its progress, and unattended in any marked degree by the usual phenomena of inflammation. When suppuration ensues, the matter is not "healthy pus," but more like whey or serum; if ulceration results, it is indolent, and the discharge is also of the thin whey like character. The formation of tubercles or of tubercular matter is another characteristic of scrofula. These bodies so common in the lungs, may also occur throughout the body; consisting of cheesy looking substance, they excite inflammation, and formation of matter in the adjacent parts of the tissue, in which they are deposited. When this occurs in the lungs, the tubercles become as it were softened down in the surrounding matter, and the fluid or semi-fluid mass is discharged by cough.

Under the head of causes, sufficient has been said to indicate the general course to be followed when a tendency to scrofula exists; when the disease actually breaks out, the same measures must be continued, and new ones of a more direct medicinal character adopted. These to be thoroughly carried out require the superintendence of a medical Iodine in its various preparations, especially that of the iodide of iron, also iron itself, with tonics generally, and above all the use of cod liver oil, are the principal remedies; and change of air, when obtainable,

man.

to the sea, or to a dry bracing air is always advisable. Season, as might be expected, exerts considerable influence over the scrofulous constitution; the early spring months being the most unfavourable. In some countries there is considerable importance attached to the contagiousness of scrofula. It cannot be considered contagious in the ordinary acceptation of the word, but it must be always advisable, especially for those predisposed to the disease, to avoid close contact with the affected. The scrofulous is often spoken of as the "strumous diathesis."

SCURF-See Dandriff.

SCURVY. This disease so well known and so fatal in times past to voyagers and others, has within the last few years, been again brought prominently into notice, in consequence of its prevalence in this country during the year 1847, when, in consequence of the failure of the potato crop, numbers of the population were compelled to do altogether without a vegetable substitute. It is requisite here to explain, that what is meant by scurvy in this article, is a very different disease from that meant in the popular acceptation of the term, which is applied to undefined cutaneous disorders especially of a scaly character. The error has probably arisen from the dry scurfy appearance of the skin, which often precedes an attack of the real scurvy. True scurvy is a severe disease, unquestionably owing to deterioration of the blood, as a result of inappropriate nourishment, espe cially of nourishment unvaried by the admixture of fresh vegetables, milk, &c. Scurvy commences with languor and signs of general debility, and great depression of spirits, the gums become swollen, and spongy, red or purple looking, project over the teeth, and bleed easily, this tendency to the exudation of blood extending to the various mucous surfaces within the body, in bad cases, and shewing itself in the discoloured patches of effused blood beneath the skin. The lower extremities become first stiff, then swollen and hard, the skin being as it were glued down to the parts beneath, and covered more or less with brownish or purple patches. If the case goes on unchecked, blood is passed from the various outlets of the body, and the patient sinks. Fortunately, for this formidable malady, we possess the well known and almost certain cure of lemon juice, but although this is the most strikingly speedy, and most certain curative agent, it is by no means the only one; as the deprivation of fresh vegetables or of milk, seems to be one chief cause of the disease, so a return to the