A sheet should be fastened outside the door of the sick-room, and this should be kept moist by a i in So Carbolic solution or a i in 200 of Chlorinated Lime or Chlorinated Soda, and a large vessel containing diluted Condy's Fluid should be kept on the landing for the immersion of all drinking and eating utensils.
Given a mild case of simple scarlatina without complications the less officious the physician and the nurse are the better. A milk diet at first, followed in a few days by light farinaceous foods, bread and butter, weak tea and thin soups are all that is required, fish and chicken being permitted as soon as the fever entirely subsides and the throat congestion has disappeared.
The temperature of the room may be kept about 6o° F., and though the freest ventilation and sunlight are desirable, when the patient is permitted to dress and sit, up (by the end of a week), he must, owing to the possi bilities of renal complications, be carefully protected from chills. Atten tion should he paid to the state of the bowels, and as a rule it will be desirable to give a mild saline at the commencement of treatment.
Bathing is undesirable in the early stages, and unless the temperature remains high, sponging of the entire surface of the body should be dis pensed with. Any simple diaphoretic mixture may be prescribed, and as rheumatic pains are sometimes experienced in the joints even in mild cases, the following may be ordered: R. Sodii Salicylatis piss.
Spirit. Mindereri Syrup. Aura Ht. Flor. Aquce ad 5iv. Misce.
Ft. mistura. Cpt. 3j. ter in die.
In the treatment of such a mild case of the disease as is under considera tion there will be no necessity to treat the throat locally; should, however, any pain in swallowing be experienced, a Carbolic Spray (s in too) may be freely employed. The use of this spray is urged as a routine antiseptic, and much stronger solutions are recommended by Milne and others with the view of diminishing the infectivity of the disease, and this is carried out in conjunction with the following: Intinctiun of the entire body with Eucalyptus Oil, including the hair and scalp, is started immediately the disease declares itself, the oil being applied twice a day for the first four clays and once a day for a week afterwards.
Milne claims for this routine that the severity of the disease is lessened and that the scarlatina patient may freely be permitted to dress and move about among healthy individuals by the end of to days from the onset though he be desquamating liberally. The results of this method are
challenged by Goodall and others.
By the end of 4 days after the temperature has become normal in the commonly met with mild cases of the disease the patient may be per mitted to dress and sit up; before doing so a warm bath should be ad ministered, and the writer's practice is to order the water to be deeply stained with Condy's Fluid. After careful drying before the fire in the sick-room an anointing oil consisting of r part Eucalyptus and 4 of Olive Oil may he rubbed over the skin. The bathing should be repeated daily and the feet and hands may be two or three times a day well scrubbed with a hair-brush and soap to hasten the removal of the dead epithelium. The child should be kept within doors for a month in severe winter weather, but in summer he may be permitted to go into the open air in about so days or sometimes less.
Scarlatina will require active measures both con stitutional and local. The pyrexia, if only moderately severe, may be met by small doses of the newer antipyretics as Antipyrine, etc., or full doses of Quinine; but as a rule the effect of these is very transient, and in all cases where the temperature reaches say 14' the only reliable method of reducing the fever heat is by assiduous Sponging, the Cold Bath or Cold Pack. Whilst cold sponging meets the ordinary severe form of this septic type of the disease, the cold pack should without hesitation be at once resorted to in all cases where the temperature reaches so5° or upwards. Owing to the youthful age of the patient the cold pack is easily applied. A large bath towel saturated with water at about 90° should be loosely wound round the patient's body and after the lapse of 5 minutes water at about 7o° may be made to trickle over this till the body heat falls to about 102'. The duration of the pack and its repetition will depend upon the effects produced as indicated by the thermometer used every 15 minutes; except in the severest cases, when the pyrexia falls to 102° in the pack it will continue to fall farther when the patient is taken out of it. Kerley does not hesitate to apply the pack continuously for 48 or even 72 hours, ice being applied to the head and the hot-water bottle to the feet in the presence of the high fever accompanying some of the complications of the disease. The pack nut only reduces the fever, but it is the best remedy for the intense restlessness, delirium or insomnia.