From the appearance of a specific local cedema or a typical has tened reaction, it may be confidently asserted that an injection has been given.
The differential diagnosis concerns only the exanthem. For a serum exanthem the points are: (1) the time of the eruption, seven to fourteen days after the injection; (2) first appearance of the efflorescence in the neighborhood of the site of injection; (3) enlargement of the re gional lymph-nodes; (4) total absence of mucous membrane involvement.
The general treatment consists especially of hygienic and dietetic measures. The patient. of course remains in bed, warmly, but. not too warmly, covered. The comfort of rest in bed is a necessity in this dis ease which uses up the strength so quickly. The air in the sick room is kept pure, best by removing the upper sash from a window. If the weather is so cold as to prevent this, then for one or two hours every day the window should be opened wide and the room flushed out with fresh air. If the patient is walking around at the onset of the disease, that. room should be chosen which is the most spacious, brightest and sunniest, and all furnishings that would catch dust and germs are to be removed. The room is to be provided with all the furniture necessary t.o the care of the sick one, in order to limit the intercourse with the rest of the house as much as possible. The air of the room must be kept. not only constantly fresh but moist, so as to hasten the loosening of the pseudomembrane. Water may be vaporized in any suitable way; sometimes large sheets may be hung up and wet with a warm, weak car bolic solution. Very good service is derived from a systematic steam treatment (see treatment of laryngeal diphtheria).
The diet must be bland and nutritious, and because of the anorexia, as varied as possible, only small appetizing portions being placed before the patient at a time. If the pain on swallowing is great, cold food and liquids are preferable. Two or three times a day cold milk foods with not too sweet fruit juices or cold stewed fruits; between these, two or three times a day, ice-cold, diluted and acidified milk (two-thirds milk, one-third water, 15 to 20 drops of nitrohydrochloric acid) which, when anorexia is complete, may serve, alternating at short intervals with fresh fruit juice, as the sole nourishment for some time. If desire for
warm food returns, in addition to milk and milk foods, cereal broths may be given, well cooked spinach, potato or carrot soup, and light farinaceous foods. If plain milk becomes distasteful, it may be mixed with malt-coffee or tea. Water may be given to drink, or toast and water with lemon juice; the addition of much sugar is not advisable. If there is fever, meat in any form, meat broths and eggs are to be ex cluded from the diet, but alcohol, coffee, tea, chocolate and cocoa may be allowed. Because the whole organism is depressed, digestion and assimilation are below par and care must be taken to avoid giving food too often or in too large amounts. Overloading the stomach as the appetite returns in convalescence may be dangerous.
Great care must be given to the skin. There should be a. full bath daily, to very sick patients, in bed, while a moderately sick one may have an indifferent soap-bath of 35° C. (95° F.). A refreshing measure is sponging off with alcohol or cologne-water after the bath; or, as the child sits in the bath, after the whole body has been soaped, one part at a time may be rinsed off with cool water.
The examination by the physician is to be carried out with the greatest quiet, every unnecessary disturbance of the patient being avoided, especially if the heart is weak. Care must be exercised not to arouse the patient too often nor to allow him to move around too much. For eating, drinking, defecating and urinating, he should be so placed as to use as little strength as possible.
The fever is only to be combated when it lasts too long or is too high. The usual hydrotherapy is sufficient.
The diet may be used to overcome the ordinary constipation which arises, by giving cooked fruit freely, as well as raw, grated or pressed fruit. Enemas may be necessary.