We do not prescribe a pure milk diet. From the very beginning we allow, in addition to boiled milk, malt coffee and cocoa with milk, milk foods (farina, rice and flour in milk), flour foods (farina mush, milk toast, cooked rice), then water buns (semmeln), white bread and butter; pea soup, lentil soup and potato soup, cooked or stewed pears and apples.
If milk disagrees with the chill, causing nutritional disturbances. we do not hesitate to allow meat (cooked beef and ham) even when nephritis is present. We have never observed any unpleasant symptoms from such a diet.
Alcoholics are shunned, except for use as stimulants in the severe cases. They should never be prescribed for tonic purposes.
Thorough ventilation of the room and the maintenance of room temperature are important. The child should be bathed and its body and bed linen kept clean and fresh. There need be no fear that the child will be chilled.
Baths are not given for therapeutic purposes. The patient is bathed on admission to the hospital, and from four to six baths are given toward the end of the convalescent period. While the disease is running its course, the child is merely washed.
Antipyretics are never used. When the temperature rises beyond 39.5° C. 110:3° F.) cool packs are employed.
Half of a sheet is dipped into water of a temperature of 15° C. to 20° C. (60° to 70° F.), wrung out and rolled up, the wet half being upper most. The child is then placed on this sheet, the wet half next to the body, extending from the axilla to the crest of the ilium. Depending on the degree of temperature, this pack is renewed every hour or two, or less often, if necessary.
Another method to reduce the temperature is the following: The child is placed on a dry sheet ; a second, wet, sheet is folded so as to cover the chest and abdomen. The dry sheet is then placed over this. This method is a sort of compress and allows of changing the applications more easily.
In the severe cases the temperature and the color of the hands and feet, which must always be kept free for observation, are watched. If the extremities become cold or cyanotic, the cold pack must be removed at once, and if a normal color does not make its appearance promptly, the patient should be wrapped in a dry warm cover. A hot water bottle is placed at the feet, and, if necessary, all along the extremities.
Because of these sudden and extreme variations in the temperature, cool baths are avoided in the severe cases. Changes in temperature and in the extremities are not readily noted, and there is danger of a collapse occurring. Formerly we resorted freely to the use of cool baths and sprinkling the patient with cool water (20 degrees), but discontinued their use when we failed to note any favorable influence on the course of the disease or the condition of the patient.
No treatment need be directed to the eruption or the desquamation. The patient may be anointed with va-seline or vaseline and lanolin. Des quamation is hastened thereby, especially when the patient is first bathed in warm soap water. In the hospital we resort to anointing with fatty substances only when the skin is dry, when it itches or when there is a distinct tendency to eczema.
Symptomatic treating the angina, we must differen tiate between the mild and the severe cases. No attention need be given to simple redness and swelling and lacunar deposits. Cold compresses are placed around the neck. These compresses are changed every three hours during the day; at night they are not touched. Older children are given a gargle of any convenient antiseptic (1-2 per cent. hydrogen peroxide).
When the angina is severe, especially in the case of very young children, the mouth should be kept moist and free from mucus, of which there is always a considerable quantity, particularly when mouth breathing is necessitated because of obstruction of the naves. This is best accomplished by allowing the patient to drink often.
Lemonade, cold tea, tea with lemon juice, are most agreeable to the patient. When the fever is high, we give wine soup. It also serves the purpose of an alcoholic stimulant. It consists of equal parts of wine and water, sugar and the yolk of an egg.
Three or four times during the day the mouth is syringed with cold water. An ordinary ear syringe is used. The child usually objects to this procedure at first, but later the relief obtained overcomes this feeling. The syringing is best done by placing the child between the knees of the nurse, holding its hands and feet, and inclining its hca-d slightly forward.