As regards the use of drugs internally to destroy the causal micro organisms or their toxins, no chemical substance is known which can be regarded as possessing any specific action. Illingworth's treatment by Biniodide of Mercury introduced with this intention has not stood the test of experience, and the same may be said of Chlorate of Potassium, Carbonate of Ammonia, Oxygen, Benzoates, Salicylates, and Sulpho carbolates.
Serum Therapy and Vaccine Treatment.—The results of injections of a Polyvalent Antistreptococcic Serum prepared by injecting different strains of the coccus into the horse cannot be regarded as very satis factory. Given in the usual dose of so c.c.. the serum, however, cannot do harm, and may favourably affect general nutrition. The intravenous injection of so-too c.c. of the blood serum from convalescing scarlatina patients has been successfuV tried by several physicians: this method of treatment is obviously only indicated in serious tuxic cases.
There cannot be a doubt about the value of an autogenous vaccine in the treatment of some of the grave complications, and whilst such is being prepared from the secretion of the patient's ear or throat lesion, a stock Streptococcus conglemeratus vaccine should be injected in doses of at least 25 millions. Great diversity of opinion still exists about the value of routine Antistreptococcic vaccine treatment in scarlatina, and the weight of evidence appears to be certainly against it.
Local Treatment.—In all forms of the anginose type of scarlatina the application of local antiseptic solutions should be assiduously employed from the start, since these may prevent or minimise suppurative cellulitis and other grave complications; moreover, by destroying the virus at the seat of its rapid production constitutional toxremia may be diminished, since the throat secretions are being continually swallowed by children.
As a routine the following spray may be frequently used: R. Glycerini Ac. Carbolici 3v.
Glycerini Ac. Borici Aqua Rosa ad 5xij. Alisce.
By older children this when diluted with half its volume of water may be used as a gargle. Stronger solutions (I in 20) of Carbolic Acid or even the Glycerin of this drug may be carefully applied as a swab occasionally.
When the secretion is foul and profuse, sprays should not be entirely depended upon, but the throat and nasal passages should be syringed twice a day with a r in 3o solution of Carbolic Acid, r in i,000 Perchloride of Mercury or r in so Permanganate of Potassium solution. Warm saturated Boric Acid solution is an efficient cleanser, and a i in 4 solution of Argyrol or r in 20 Collargol may be used as a swab, after cleansing with the boric-acid solution, carbolic spray or i in 4 Hydrogen Peroxide solution.
Chlorine is one of the most reliable of antiseptics, and Caiger's method of preparing a solution of the free gas for irrigating the throat and nares is convenient. He pours ioo mins. strong Hydrochloric Acid on 3 drs. Potassium Chlorate in an empty pint phial, and after evolution ceases water is added at short intervals till the bottle is filled up. This solution may be used as a nasal douche and throat wash every 2 or 3 hours. Iodine (3 drs. weak tincture to 20 uz. water) may be used in a similar manner, and 2 drs. Carbolic Acid may be added to this for a spray.
To the swelling in the neck cold or iced compresses and warm antiseptic poultices should be applied according to the amount of comfort derived from either class of application, but when deep fluctuation appears a warm boric compress under oiled silk should be employed, and as the pus approaches the surface a free incision should be made and the abscess cavity thoroughly irrigated by warm Boric solution or Hydrogen Peroxide. Abscesses in the tonsil should be opened early. When brawny swelling in the neck appears, the pressure on the trachea must be relieved promptly by free incisions without waiting for pointing.
Laryngeal symptoms are an indication for the use of the steam-spray, bronchitis kettle, and the agents useful in the treatment of diphtheria; suffocative signs may demand the prompt opening of the trachea. The appearance of a diphtheritic membrane on the tonsils or fauces is a clear indication for the injection of the Antidiphtheritic Serum, and this should be employed in all cases of doubtful nature, since no harm can possibly follow from its use.