A
TREATISE	
ON THE
SCARLATINA ANGINOSA:
OR WHAT IS VULGARLY CALLED THE
SCARLET FEVER,
OR
CANKER-RASH.
REPLETE WITH EVERY THING NECESSARY TO THE
PATHOLOGY AND PRACTICE,
DEDUCED FROM ACTUAL
EXPERIENCE AND OBSERVATION.
BY CALVIN JONES,
PRACTITIONER OF PHYSIC.
CATSKILL: PRINTED BY M. CROSWELL & Co.
MDCCXCIV.
 




PREFACE.
OF the Scarlatina Angi-
nosa, now treated of,
notes were taken of every oc-
currence and circumstance
worthy of observation; of
which enough is here deliver-
ed, both to confirm the doc-
trines, and to distinguish the
disease; and the concurrence
of the whole, presupposed or
expressed, gave rise to, and
serves as an illustration and
confirmation of the Theory
and Practice.
In the prosecution of the
work, the principles of the
great Brown have been uni-
formly adopted; principles in
every respect most exquisite-

iv.
ly sublime, and which require
only to be better known, to
be universally received.
The Scarlatina Anginosa
is here considered differently
from what it has been by pre-
ceding writers. Cullen and
Sydenham, are vague and er-
roneous—our countryman,
Dr. Rush of Philadelphia, is
the most consistent on the
subject, but he is cursory in
his observations; and all have
erred in treating varieties of
it as distinct diseases.
It may not be amiss here to
remark, to those out of the
profession, that from the doc-
trines here delivered, it is evi-
dent that no one remedy, or
particular set of them, are 

v.
promiscuously to be employ-
ed in the cure of this disease;
which the author thought
proper to mention, as quacks,
ever ready to impose on the
credulity of the vulgar, to en-
hance the pretended merit of
their nostrums, have asserted.
But prescriptions must be
made answerable to the then
state and functions of the ani-
mal economy, as they de-
pend on the balance of the
excitement and excitability,
the exact knowledge of which
requires much discernment
and skill.
Convinced of the justness
of the reasoning and observa-
tions, and of the success with
which the proposed practice 

vi.
has been attended, inspires
the author with a degree of
confidence in presenting this
performance to the world;
and if it proves to be of pub-
lic utility, to the attainment
of which he has aspired, his
highest aim will be fully gra-
tified.
Freehold, County of Albany,
December 10, 1793. 


A
TREATISE, &c.
AS the Scarlatina Anginosa in dif-
ferent states of temperature puts on differ-
ent appearances, and as it first occurred to
my observation in the hot season (August
5, 1793.) I shall therefore first enumerate
the symptoms, as they then appeared, and
afterwards point out the deviations inci-
dent to the cold season, and the mild tem-
perature between those two extremes, and
from these may be selected the symptoms
common to all.
Soreness of the fauces and tonsils, al-
ways; at the same time, or soon after, an
affection of the stomach, with severe nau-
sea, and commonly vomiting, are the symp-
toms which usher in the disease. The vo-
miting, if violent, soon abates; but if mo-
derate, will be of longer continuance. The
nausea, if it does not proceed to vomiting,
continues for some days. The soreness of
the fauces and parotis continues and goes
on increasing for several days, generally 

8
to about the fifth or seventh. These parts
are sometimes affected with little swelling,
but it is often considerable, and in some ca-
ses, so great as almost to ostruct respira-
tion, and entirely deglutition. This swel-
ling is greater on one side of the neck than
the other, and to me it has appeared, affect-
ing the right side in preference to the other.
But whether this is pathognominic, or
merely accidental, I shall not at present
determine.
The breath is hot and of a cadaverous
smell, and the more so, the greater the de-
bility is. The tongue is for the most part
covered with slough. If the excitability
is abundant,* and the throat, in conse-
quence, much affected, with little or no
eruption, there will be a profuse salivation.
There is sometimes a headach, but it is al-
ways slight. A constant drowsiness and
aversion to exercise immediately succeeds to
the vomiting. The pulse is generally high
and quick, and if united with any con-
siderable degree of strength, the face will be
flushed, and the whole skin will appear flo-
rid, and an eruption may easily be discern-
ed, which is attended with violent itching.
This eruption commonly appears on the
second day; sometimes in a few hours af-
* Which always happens when the excitement is deficient;
for when the excitability mounts to any degree of the scale,
its cause, deficient excitement, has receded down in the same
proportion. 

9
ter the attack; and again in some cases, not
until about the fifth day. When the erup-
tion appears it remains apparent for several
days, unless checked by cold or some other
debilitating power: and after, or during
the recovery of the patient, at an uncertain
period, the skin suffers a desquammation
of the cuticle, more or less complete, ac-
cording as the eruption has been in degree.
This disease is sometimes followed by
anasarcous swellings, and often by ulcerated
sores, and not unfrequently both these cases
have been found concurring together.
The short duration of the extreme cold *
of the first days of November prevented
my making sufficient observations of the
effect that temperature would produce on
this disease. But considering the matter in
a philosophical light, we may with propri-
ety suppose its effects to be similar to an ex-
cessive degree of heat,† and the few cases
which I find in my notes seem further to
warrant the opinion.
For several days previous to the first
of November, and ever since the 5th, as
long as the disease continued, the weather
has been of a moderate temperature,* a-
dapted to have an agreeable effect on the
* It is to be regretted that no thermometrical observations
could be made.
† See Brown's Elements of Medicine.
B

10
senses, and consequently that suited to good
health, being a mean between two oppo-
site extremes, during which the disease oc-
curred less frequently, and much less vio-
lent. The eruption more certainly ap-
peared, vomiting or nausea seldom occurred,
but with the addition of what in warm
weather was a slight head-ach, is often at
this time very violent and the throat more
swelled: This, as shall presently be re-
marked, happened more especially to adults
The career of the Scarlatina Anginosa
was stopped about the 12th of November,
during a moderate temperature, which had
continued for six or seven days; but whe-
ther the disease was checked by the tem-
perature in which it disappeared, or by the
cold of the first days of November, and
whether the subjects in which the disease
last appeared were infected by the contagion
previous to those days, and remained latent
in the body until that time, cannot be as-
certainted, as we do not know how long
the contagion remains in the body, after
infection, before the disease makes its ap-
pearance; or whether it is alike in all sub-
jects.
The Scarlatina Anginosa is of a highly
contagious nature, which, in different pla-
ces, has prevailed in all seasons of the year,
and is propagated over the country very
slowly. It has two or three years since been 

11
within thirty miles to the eastward of this
place, and has been ever since progressively
advancing to the westward, and it is but
about five months since it first came to my
observation, since which its progress to the
westward has not exceeded a dozen miles.
This contagion has no effect on some
persons who are of an age most subject to
it, while I have seen it break out in a family
who had no intercourse with any other fa-
mily for twelve days, who lived half a mile
distant from any other person, and who
had never been within a mile of any diseas-
ed person; here the whole family was af-
fected and with violence.
Children are much more subject to this
disease than adults; not one tenth escaping
it in the boundaries over which the conta-
gion has spread, in warm weather, and not
one third in cold; and in both, not one
fourth, and perhaps not one eighth of a-
dults are affected; but in the several tem-
peratures, the proportion of adults to that
of children is in the same ratio reversed.
Subjects most liable to a mild disease, are
infants under 12 months old; above which
age, and below the age of puberty, they
are more liable to a violent disease; and
above which, until the middle of life, the
disease is less violent, but far from being
so moderate as in infants. 

12
This affection in those past the vigour
and in the decline of life has never occur-
red to my observation.
Of the Scarlatina Anginosa affecting
pregnant women, I have seen but one in-
stance: this was in an advanced state of it;
the disease was slight, and the recovery good.
When it terminates fatally, it is on the
fifth, or between the fifth and ninth, very
rarely afterwards, and never sooner * unless
the case has been mismanaged, or not ma-
naged at all: in the former, by the injudi-
ciality of the practitioner, in adding excite-
ment to a sthenic diathesis, already too
much encreased, or what is more com-
monly the fault of practitioners in allow-
ing it to run into a state of direct debility,
or increasing that disposition, for such is
its nature, as in the warm weather especi-
ally, to usher in the fatal event by inducing
a putrescent state of the fluids unless coun-
teracted by a large use of all the stimili.
Why children are more subject to this
disease in warm and hot weather than a-
dults, and in colder weather in a lesser pro-
portion, may merit enquiry: I will hazard
a few conjectures in the attempt.
* These remarks refer to my own observation: A lady
from New-York informed me, that a child at or near Powles
Hook died of this disease in a few hours after having left its
play. Dr. Rush has observed, that in Philadelphia there were
a few instances of adults who walked about, and even trans-
acted business until a few hours before they died. 

13
1. Not as a conjecture, but as a certainy,
I will assert that debility favors the opera-
tion of contagions.
2. To an exact and perfect use of all the
functions, a mean degree of every stimu-
lant, as heat, light, food, pure air, mental
exercise, &c. is required; the excessive or to-
tal diminution of either of these will induce
debility, and of such a nature, that the ad-
dition of the stimulant which caused debi-
lity by its deficiency, is requisite for a per-
fect restoration of health—and not any or
all the others, though stimulants, will effect
it.
Now to this purpose heat is a stimulant
which, applied in excess, will have a disa-
greeable affect on the senses, and thereby
induce debility, as well as by exceeding the
bounds of the sthenic diathesis, in the part
to which its intensity is immediately appli-
ed, which is the skin and lungs, as being
external surfaces (without much impairing
the functions of the whole) and by which
we suppose contagion to be introduced.—
Now to apply this doctrine to the case be-
fore us, we must observe, that the blood
circulates with greater celerity in children
than in adults, and consequently generates
more heat: this added to the external heat
operating on their abundant excitability,
which is easily overcome, will shew that
contagions operate more certainly in them

14
than in those whose excitement is now
come in balance with the excitability, and
will bear a greater degree of heat added,
there being less generated in the body; and
hence it is why children are more liable to
be affected by contagion in warm weather
than adults. And to explain the effects of
cold on both, all that has been said may
be applied with observing, that as adults
till bear that degree of heat which would
overcome the excitability of children, with
the effect only of increasing the energy of
their powers, so that what in children
would have the effect of producing the dis-
ease, would in adults have a contrary effect.
The violence of the Scarlatina Anginosa
usually depends on debility, where there is
no eruption, and with its danger is com-
monly united a putrescent state of the flu-
ids, and may depend on ultimately excessive
excitement; but I have never seen an in-
stance where death happened in consequence
of it, though I have seen it so great as to
produce morbid effect; but even this is
rare.
As in the most favorable cases there is
always an eruption, and vice versa, it may
merit inquiry whether eruption is necessary
to evacuate morbific matter from the blood,
or whether that degree of excitement which
produced eruption, throw off by the per-
spiratory pores all or a part of the morbid 

15
matter necessary to be evacuated. Or is it
from the stimulants, or to come nearer to
the case, the degree of excitement existing
during the eruption, that morbid affection
is chiefly removed, and the stimulants no
more necessary than in any other asthenic
affection, or is for the double purposes of
producing all these that stimulants in cases
of debility are required?
I Judge it to be from both.
The Scarlatina Anginosa, has, under its
different appearances, been distinguished as
different diseases, and been known by as
many appellations. But as these arise from
the contagion, they may more properly be
denominated the same disease. Although
the excitement may be various, and re-
quire a variety of treatment, yet, by attend-
ing to that circumstance, of such infinite
importance, viz. the degrees of excitement,
all difficulties may be obviated, and we shall
escape the many evils usually attendant on
nosological distinctions.*
* Before that blessed discovery lately made of the princi-
ples of excitement and excitability, where diseases of the same
nature have been widely separated; and those diametrically
different, agreeing only in some trifling circumstances, and
even those arising from different causes, have been placed to-
gether in the same class and order, has had a most baneful in-
fluence on the practice of physic.
That great master of the healing art, Dr. Cullen, too ser-
vile in imitation, was guilty of this fault. For what can be
more similar than the common catarrh and sthenic cynanche,
or more different than this latter affection and the cynanche
maligna, of his nosology—the first of which he has separated,

16
As the chief violence of the disease in
most cases, and in the cases which I have
seen, its danger always depended on a defici-
ency of tonic power. So the chief and im-
portant indication of cure is to restore the
tone of the system by all the means in our
power.
Notwithstanding the attending debility
and the vomiting which commonly ushers
in the disease, I have found emetics to be
in their use of important consequence. It
evacuates foul matter and vitiated bile,
which the spontaneous vomiting does not
effect; and which it is necessary should be
evacuated, from its being powerfully debi-
litating, and perhaps more so than the emet-
ic itself, and to put the system in proper
order to receive stimulants which might
otherwise be given without effect, if involv-
ed in the gelatinous contents of the prima
via.
from each other, and the two last joined together? This
great man was misled by a contractedness in reasoning, which
has ever been a reproach to the annals of medicine; and the
glory of discovering and establishing the science of medicine,
on demonstrated principles, was reserved for the elevated
foul of the illustrious Brown; who, by his astonishing genius,
reduced the (hitherto) conjectural art of medicine to a moral
certainty, and expunged the old practice, which was taking
a wide range of spreading death and destruction among man-
kind.
While science is studied, the name of Brown will be rever-
ed, and while the human heart is grateful, will be transmitted
to immortal memory; and physicians of posterity ages innu-
merable will esteem his day as the birth-day of their science.

17
If in children a salivation should come on,
and the saliva not be ejected but swallowed,
as sometimes happens, this circumstance, or
other of a similar nature, where morbid
matter may be supposed to be collected in
the stomach, will countenance the re-exhi-
bition of emetics.
To excite vomiting I prefer emetic tartar,
calomel, combined with ipecacuanha, I have
employed sundry times upon the authority
ot Dr. Rush, but in certain cases, presently
to be mentioned, it is inadmissible; there-
fore, on the whole, the former is best.
Of the stimulants, wine and bark are the
chief. Of the wines, Madeira nnd Sherry
are the best, and Teneriffe preferable to Port.
With these should a strong tincture be ex-
tracted from the bark and given in quantities
according to the defect of tonic power. In
cases of extreme debility, the red bark should
be used, and in very large quantities, joined
with the use of the most powerful of all the
diffusible stimili.
I have in one instance given upwards of a
quart of wine in a day, with a large pro-
portion of bark and the diffusible stimulus,
with good and successful effect.
In cases of any considerable debility, bark
alone, in substance, is not to be depended on:
from circumstances, I am disposed to think
it does not yield an equal degree of stimulus
in cases of great debility, as it does in lesser
C

18
ones: and if I am not mistaken in my ex-
perience, I have been disappointed in ex-
pectation of effects which were afterwards
produced by the extract, making allowances
for the stimulus of the menstruum when sti-
mulant. And what may be less liable to
exceptions, is, that bark, in those cases and
circumstances, given in any quantities, will
have no apparent effect on the system.
Does not the active powers of the bark
reside in its resinous part? Is it not neces-
sary that its resinous part should be extract-
ed by a menstruum of some kind or other,
previous to exhibition, or by the gastric flu-
id afterwards in order that it should pro-
duce tonic, or if you will, stimulant effect?
Is not a certain tone of the stomach neces-
sary to extract this resinous part? And last-
ly, is not the bark given in substance in
cases of extreme debility, a totally, or near-
ly inert substance with respect to the human
body?
But whether the bark given in cases of
great debility, yields the same quantity of
stimulant operation as it does in other cases
—I know for certain the more powerful the
more diffusible stimulants are requisite.
When wine is not at hand, I have made
use of ardent spirits conjoined with bark,
and succeeded in all that could be expected
from wine.

19
Wine or bark singly, will prove of them-
selves sufficient stimulants in cases of mo-
derate debility, and may safely be depended
on, where there is an eruption announced
by a violent itching, and where no parti-
cular contraindication prevails.
When the atony is great, and the throat
in consequence much affected with gan-
grenous sores; when there is no salivation,
or if it has been profuse & suddenly stopped,
then it is that calomel ought to be exhibit-
ed, which may be done in the quantities of
five or six grains in a day, for the double
purposes of stimulating the whole system,
now laboring under debility, and of pro-
moting the salivation; or if emergencies re-
quire a sudden flow of saliva, it may be pro-
moted by applying mercurials to the paroted
glands. But when the diathesis is at, or
approaching to sthenia, and the throat swel-
led with an inflamation, then calomel would
be improper, and from this circumstance it
is, that it has been objected to as an emetic;
for let it be evacuated ever so effectually,
still its only touching the mouth will be
sufficient to affect the salivary glands.
In those head-achs which appeared in
the mild temperature, and affected chiefly
adults, blisters applied under the ears will
most certainly cure them.* The cuticle
* From the obvious good effects of blistering in those cases,
I promised myself to make observations sufficient to remove

20
ought not to be taken off as a too free ac-
cession of air renders them liable to be af-
fected with canker.
In children blisters ought not to be ap-
plied but with great caution. As the head-
ach in them often proceeds to delirium*
and the irritation of the blistered places,
induces a desire in the patient of scratch-
* I have seen three cases in a degree of violent mania and
all of them fata!. A delirium when receding from the sleep-
ing to the watching state, or vice versa, is more common.
a doubt which ever pervaded my mind, with regard to the
class of remedies to which they belong, and which has been
equally so to all the profession; let their pretentions to cer-
tainty be ever so strong, yet we find their ignorance verefied
in their practice, prescribing blisters in both sthenic and as-
thenic cases—Hence Brown, in ridicule, has termed them
the extreme unction of the art. Those in whom head-achs
were relieved by blistering, appeared not to have the excite-
ment greatly deviated from the standard of health, but ap-
peared rather to labour under debility. Two of these pa-
tients I visited the same day, affected in the same manner,
were relieved from their morbid watching state by the use of
opium, after blistering had relieved their head-achs, and after
having previously made use of ardent spirits and bark. The
third, under the same circumstances and treatment, found an
aggravation of the morbid watching by the use of it, and re-
moved by sedative. These and other circumstances nearly
similar, have still left me uncertain as to the nature of their
effect. Whether in the last the excitement had suddenly
mounted up to a sthenic diathesis, or what peculiar circum-
stance had taken place in any of them, I could not fully de-
termine. If the future observation of such cases occur they
shall be attended to with the strictest scrutiny, in hopes that
better opportunities and further reflection may elucidate the
subject; at present we must be content with remarking, and
what indeed is of no small consequence, that we know for cer-
tain, blisters will relieve head-achs in the subjects and cir-
cumstances mentioned in the text. 

21
ing, who being diverted of judgment by
the delirium always gives way to, and grat-
ifies that propensity, and as constantly with
bad effect.* But in those circumstances
in children, or in adults, Glauber's salts
ought to be given, and repeated as occasion
may require.
When the throat is considerably swelled
(especially in adults) the volatile liniment
is to be applied—from the liberal use of
which, I have always experienced the most
salutary effects.
Their drinks ought to be of a stimulant
opening kind; The decoction of Seneca
snake-root is the best; that of the flowers
of camomile and orange-peel is good, and
may be sharpened and rendered more grate-
ful by the addition of wine, and wine and
water; or sage and hyssop may serve as a
substitute for either.
In malignant affections of the fauces, the
most detergent gargles ought to be used;
the solution of Saccharum saturni in water
is best; that of borax, vitr. alb. &c. may
be used. In children, where they might
be liable to swallow it, the milder ones
ought to be used, or the powerful ones ap-
plied carefully with a swab, and in lesser
quantities. After the patient is cured, and
yet in a state of convalescence, a purgative
exhibited will commonly prevent dropsical
* To wit, canker and great swelling.

22
swellings, which sometimes follow in con-
sequence of omission, and the more certain-
ly the more violent the disease has been.
For the swellings of the parotid glands
which sometimes follow the disease digest-
ive plasters must be applied, the abcess o-
pened, the pus evacuated, and the ulcer
treated according to art.
Sometimes ulcerous sores in various parts
of the body, more frequently of the face
and head, follow the disease without being
preceded by abcess—Goulard's extr. saturni
must be applied externally, and a cathartic
of sal. mir. glaub. exhibited—this never
failed curing.
If dropsical swellings occur, strong doses
of jalap and chrystals of tartar should be
given, and a tincture of guaiac.
An universal dropsy sometimes follows
this disease; I have never myself seen an
instance of it; but an intelligent practi-
tioner lately informed me that he had seen
several, the first of which proved fatal with-
out his knowing the disease, but taught by
dissection, he afterwards employed jalap
and calomel in large doses, frequently re-
peated, making use, at the same time, of
some powerful stimuli, which always prov-
ed successful.
The application of cold to valetudinari-
ans, by obstructing the perspiration, has
always a dangerous, and sometimes fatal

23
effect—this evil ought to be strictly guard-
ed against.