If the skin is hot and dry and urmmic symptoms (usually represented by anti ria, somnolence, arnblyopia, and head ache) are present, we may resort to the hot pack, either wet or dry. The child should be wrapped in a blanket and placed directly in a tub containing water at a temperature of from 105° to 110° F. The child should be kept in the water fifteen or twenty minutes, or even longer if necessary, and should then be taken from the wet blanket, enveloped in hot, dry blankets, and kept in them until the skin has become moist and reaction has taken place. While the child is iu the bath milk may be given to it, and stimulants if they are indicated by a weak or an intermittent pulse.
In addition to this treatment, hydro chloride of pilocarpine, in doses of grain, should be given by the mouth to a child of two years, and subcutaneously if desired to a child five years of age. In these eases of threatened ummia con vulsions sometimes appear quite sud denly. Under these circumstances ene mata of hydrate of chloral, from 5 to 10 grains dissolved in water, are of value in controlling the nervous phenomena. The author prefers, however, to use a combination of bromide of potassium and hydrate of chloral.
Where the ascites is extreme, para eentesis abdominis is often of great value, not only in relieving the pressure, but also in increasing the action of the diuretic, which perhaps before was not acting freely. Digitalis is a valuable remedy, especially adapted to the treat ment of the nephritis of scarlet fever and to that of the cardiac changes which result from it. By the administration of this drug the flow of urine is increased. It is best given in the form of a freshly prepared infusion, in teaspoonful doses every four hours, to a child five years old. Diuretin, 5 grains dissolved in water and given two or three times in the twenty-four hours, has proved of considerable value. Nitroglycerin is valuable where the action of the heart suddenly becomes feeble and irregular. T. Botch (Boston Aled. and Surg. Jour., Nay 27, '97).
Acetanilid is useful for relieving the severe headache and the joint pains, but phenacetin is better when much muscu lar pain is present. If the pulse denotes high arterial tension, antipyrine should be prescribed; no harmful effects from it have been noted, even in the youngest infants, if given in doses of grain. To relieve internal congestion, particu larly of the kidneys, a decoction of sco paris, and also such cholagogues as cas cara and sodium phosphate, are of value.
Solomon (Phila. Med. Jour., July 1, '99).
The methodical use of intestinal irri gation with physiological saline solution is an important adjunct. It increases diuresis and militates against or prevents urcemic symptoms. Wertheimher (Klin isch-therap. Wadi., No. 11, 1900).
The use of oxygen-gas advocated in searlatinal nephritis. Besides being a good cardiac stimulant, it materially as sists in eliminating toxins. Another use ful measure is cuteroclysis, using a saline solution at a temperature of 110° to 120° F. for fifteen to twenty minutes at a time, three or four times a day. As a rule, from three to five times as much urine is secreted as the quantity of saline solution introduced. R. C. Kemp (Archives of Pediatrics, July, 1900).
To ward off nephritis, an absolute milk diet should be given for ten or twelve clays. During the eruptive period the child should be bathed in tepid water; and after desqua illation has begun inunetions of antiseptics are in dicated. The ichthyolized vaselin, rec ommended by Seibert, of New York, is excellent.
Boricated or resoreinatcd vaselin should be applied to the anterior nasal chambers, while spraying mentholized oil into the nasal passages is of impor tance. The should be kept clean by copious lavage with boiled water, rendered alkaline and antiseptic by boric acid, resorcin, etc. After the lay age the throat should be brushed by stronger applications of the same anti septics.
Calomel and salol are or value to dis infect the gastro-enteric canal. For the adynamia saline solution, ether, or cam phor should be injected. Aviragnet (Le Bull. Mild., Mar. 23, 1001).
According to the researches of the Pasteur 'institute, the saliva possesses the greatest toxilytic power of all the secretions and is poured out in the local ity where the scarlatina toxins are formed. Hence pilocarpine is the most valuable single agent against scarlatina and its associated affections. It should not be given in immediate conjunction with the coal-tar antipyretics, and each dose is better preceded by bathing. Chloral is nearly always indicated in small, frequently repeated doses. In ease of disagreeable effects from pilo carpine, a hypodermic of atropine, the "physiological antidote." will protect the patient. Toleration is rapidly estab lished. A great gain is in the prevention of parched mouth and lips. E. W. Saun ders (Archives of Pied., Feb., 1903).