Other measures are not resorted to, no insulation of powder into the throat, no painting and no irrigation of the nose.
Ice compresses are not indicated in the mild cases, and in the severe they often are responsible for chilling; therefore, we no longer resort. to their use as a means to reduce the fever. Neither is the patient given any ice to suck. When the lips are dry, cracked, bloody and painful, apply a 3 per cent. boric-lanolin-vaseline ointment. The same ointment is applied to the rhagades at the angle of the mouth. In the severe cases these rhagades may be coated. The nostrils may also be smeared with this ointment in cases of rhinitis. This will usually prevent irrita tion by the nasal secretion. The ointment may be introduced into the nose by means of an applicator, if the child is not excited thereby.
Never try to do too much; avoid polypragmaty. When the child is asleep, do not disturb it, because sleep is as important as any thera peutic measure.
Karl Sch., eleven years old. Severe case of scarlet fever; treated at home. Death resulted because through a misunderstanding of the physician's orders the child was bothered day and night by something or other being done. First, the neck compress was changed; then the car was irrigated, the mouth cleaned, the cold pack renewed and the child forced to drink, despite its vigorous protests. Next the medicine was given, and in the meantime the time had arrived to change the neck compress.
If the scarlet fever is complicated by diphtheria, diphtheritic anti toxin should be injected promptly. It is advisable to inject a sufficiently large quantity (3000 units).
If there exist redness and swelling of the tympanum, to be confirmed by examination with the head-mirror, a few drops of a five per cent. carbolglycerin mixture are instilled into the external auditory canal, two or three times daily, and hot or cold compresses (use liquor Burowii), the decision is left with the child, are applied to the external ear. If the
tympanum is very red and bulging, and there is pain and high fever, resort to paracentesis. When otorrhcea supervenes, instil a three per cent. hydrogen peroxide solution into the external auditory canal twice daily. If possible, secure the services of a specialist ; his assistance is especially needed in cases of mastoiditis.
Swelling of the lymph-nodes is best treated by means of cold com presses. They are efficient, and also relieve the pain of the angina. If the swelling increases in extent or severity, apply a compress saturated with liquor Burowii, paint with five per cent. iodovasogen or apply a ten per cent. ichthyol ointment. Hot applications or compresses (bread and milk or linseed) will hasten the progress of the lymphadenitis to sup puration. Incision is to be resorted to only when there is evident fluc tuation, the overlying skin red and thinned out. Inasmuch as the operation is exceedingly painful, it should be done under light ether narcosis. We wish to caution against too early incision. The tissues are infiltrated and secondary infection is exceedingly liable to occur.
The rheumatoid complications do not demand any internal medicine, although aspirin or sodium salicylate may be given. The swollen joints are immobilized and wrapped in cloths saturated with liquor Burowii.
In the severe cases, when the heart is weak, stimulants should be given; internally, digitalis or digalen, black coffee, alcohol (wine soup, tea and cognac, Malaga). Stimulation in these cases is of the greatest importance. Cardiac myasthenia and endocarditis arc treated in the usual manner. As a rule, rest in bed is sufficient.
Finally, I wish to emphasize the importance of keeping the bowels well open. I prefer to use for this purpose aqua laxativa viennensis or oleum ricini-syrupus mann., aa. 10. An enema may be given.