The temperature may require attention from the outset, but it should not be for gotten that a high temperature is nor mal to scarlet fever. It may be allowed to run, therefore, without interference, to a somewhat higher point than in most other diseases. Hyperpyrexia, or a tem perature continuously above 104°, de mands treatment. It is best reduced by means of the cold bath; but this, for obvious reasons, is less practical in pri vate than in hospital practice. The cold pack or cold sponging are more available. An effective method of applying cold adopted at the Willard Parker Hospital is thus described by Northrup: "The tendency in all cooling processes is for the feet to become cold. To obviate this the patient is placed upon blankets, but the legs, feet, arms, and hands are wrapped in warm, dry blankets, and hot bottles are inclosed in the wrappings. An ice-bag is applied to the head. The face and trunk are freely sponged in warm water and alcohol, evaporation be ing hastened by fanning, so long as it cools the patient, clears the cerebrum, gives force and improved rhythm to the heart, and leaves the patient to a quiet sleep." Great caution should be exer cised in the use of antipyretic drugs. The coal-tar antipyretics are capable of doing much harm if injudiciously admin istered.
Coal-tar products should not be used in reducing temperature in scarlatina. Digitalis seems better than strophan thus in heart-complication, and copious draughts of water are best for flushing out the kidneys. Hot packs are better than pilocarpine in suppression of urine. Paraeentesis of the membrana tympani should not be delayed if there is any bulging. The period for isolation of scar let fever, in order to be effectual, should be continued for at least fifty days. J. H. MeCollom (Phila. Med. Jour., June 3, '99).
When there is high temperature in the early part of the disease and severe nerv ous symptoms, an excellent method con sists in putting the child in water at 90° F., sufficient to cover the body and extremities. A large wash-boiler or tub will generally suffice and has generally been used in personal cases. The child should be constantly rubbed while in the water. The patient is to remain in the bath about eight minutes, dried quickly, and put to bed without taking time to put on a night-gown or other clothing. D. S. Hanson (Columbus Med. Jour., Aug. 5, '99).
A 5- to 10-per-cent. ointment of ich thyol in lanolin in scarlatina since 1SS4. The ointment is applied once or twice daily, in such a manner that the whole body is covered and the iehthyol is rubbed into the skin until hardly any ointment remains on the surface. The skin of the patient assumes a brownish hue after the inunction, which is made with the tips of the fingers.
The swelling of the skin is reduced after the first inunetion. The pruritus, which is excited by the ichthyol, disap , pears quickly. The occurrence of ulcera tion and phlegmonous and erysipelatous infiltrations in the skin is prevented. A. Seibert (Jahrb. f. Kinderheilk., Mar., 1900).
Temperatures of 103° to 106° F. in scarlatina and measles decline promptly by one or more degrees from an injection of a pint or more of cool water contain ing 2 to 10 grains, according to age of patient, of sulphoearbolate of soda per rectum. In the same conditions and even in the same cases the cold bath has not acted with so much or so happy effect. When the enema has been ejected without accomplishing a move ment of the upper bowel, melioration of temperature has nevertheless been noted.
High post-eruptive temperatures are often and have been repeatedly trace able to infelicities of ingestion and di gestion, and are more effectively relieved by prompt and sufficient enemas than by any other treatment.
These high post-eruptive temperatures repeatedly rising in the same individual have been accompanied synchronously by sensible increase of submaxillary swelling and tenderness, followed by the quick abatement of these lymphatic swellings, along with the reduction of temperature from cooling antiseptic enemas. Arthur de Voe (Pediatrics,
Aug. 1, 1901).
Antistreptococcic serum has recently been proposed as rational treatment for scarlet fever, and some very favorable results have been reported from its use. At the present writing, however, very little is actually known of the treatment, and no expression of opinion is possible. As the more serious symptoms are due to streptococcic infection, the theory un derlying this treatment is not irrational.
Antitoxin used in 25 cases, some of them very severe, as curative agent, and also as immunizant for the children in other families where the disease oc curred. None of the immunized children had the disease, and not a single death occurred among the patients. A num ber of cases that were running a severe course at once assumed a mild form after one or more hypodermic injections of antitoxin. C. U. Dalton (Merck's Archives, May, 1901).
Streptococci in the throats of 690 out of 701 children examined. In 100 cadav ers examined after death from scarlet fever streptococci were found in the organs, blood, marrow, etc., in all cases. Personal belief, therefore, that strepto cocci are the cause of scarlet fever, Marmorek's serum tried, but found use less. A serum was employed which had to be prepared by utilizing cocci ob tained from the bone-marrow of patients who had died from scarlatina. The serum conferred protection upon mice from virulent cultures, while the control mice and those pre-treated with Mar morek's serum succumbed. The ease mortality in a series of 58 patients treated with the serum was slightly lower than in another group of 63 pa tients treated in the usual way. Tin pressicm obtained that the serum wa, beneficial. The temperature fell slowly after the injections and did not rise again. The affection of the fames gen erally disappeared rapidly, and, although a fair number of complications occurred. this could be fairly attributed to the se verity of the attacks. The serum did not appear to have the powerful action which is seen in diphtheria antitoxin, but has an action which, although slow. is lasting and continuous. The serum prepared by Aronson is worthy of a careful trial. A. Baginsky (Berliner klin. Wochen.. Dec. 1 and 8, 1902).
A great deal has been said of late about the serum-treatment of scarlet fever, and much of what has been said has been indicative of confidence in the actual or rapidly approaching achieve ment of success with the treatment. Of all the recent publications on the sub ject, those of l'rof. Adolf Baginsky, of Berlin, have probably attracted most at tention. A letter from Dr. Baginsky, re cently received by the Journal state that he is not at present prepared to make any stronger statement than he has already published. In this letter he cutpho,izes t he fact that the credit of preparing the serum must. recently and promisingly used by him is due solely to .Aronson. While there are very encour aging indications that we are in a fair way to posses, an efficient scarlet-fever antitoxin before long. it would still he premature to proclaim its actual exist ence. Editorial New York Med. Jour.. March 14. Ittld As emaciation and anminia are fre quent results of scarlet fever, active tonic treatment should be instituted during the convalescence, the chief reliance being placed upon iron. Basham's mixture is especially indicated. The patient should be particularly protected from cold, for exposure not infrequently seems to pre cipitate nephritis long after its usual period of occurrence.
Compulsory notification, accompanied by hospital treatment. has lowered the mortality of scarlet fever and altered the type of the disease. Epidemics are now characterized by a want of symp toms and signs. The bright-red rash is seldom seen, and it often disappears be fore the arrival of the medical at tendant. The throat signs. too, may be transitory. It is these mild cases, how ever, that kindle into flame the big epi demics in large towns. William Robert son (Brit. Med. Jour., Apr. 6, 1901).