The appetite of the little ones is not increased either by the baths or by antipyretics administered internally, but it returns when the fever naturally declines, because the infection has exhausted itself, the body has asserted its mastery, and the toxin which paralysed the digestive functions is formed and absorbed no more.
Above all and most emphatically, I would caution against the strict observance of such antipyretic measures as Brandt's or Vogl's, who have gained for themselves an unenviable remembrance. Such coarse methods (I cannot. find a milder designation for them) are apt to produce such disagreeable sensations that the patients do not crave for their repetition.
In case of severe disturbance of the nervous system, especially insomnia, a warm bath—about 35 to 36° C. (95°-97° F.) and given in the presence of the physician—may be serviceable, and if there be any stupor, water of the room temperature may be poured on the head. During the last few years I have, under such conditions when the heart action was good, prescribed small doses of pyramidon, 0.1 to at most 0.15 Gm. (l', to 2 gr.), administered once in the evening. The reduction of the temperature effected thereby is gradual, but lasting for a long time, and the soothing effect is undeniable.
Other than this I use only hydropathic compresses with slightly heated water, changing them every three hours and covering them with a dry cloth. In case they should give rise to any unpleasant sensations or excite the child I simply dispense with them. Apart from time fact that the little patients generally stand fever very well and often with a temperature of 39° C. (102° F.) and above, will sit. upright in their beds and play, they do not feel any better when their bodily temperature has been artificially reduced.
Nutrition is of importance and of course, during the whole period of fever the diet must be liquid and such as milk or in case of dislike of milk, coffee, tea, cocoa, soups, eggs, egg punch (on account of its alco holic contents indicated when the pulse is small). To increase their nutritive value, somatose, piasmon, tropon, Leuhe's meat solution, puro, and the like may be added. They should be given in small quantities and at frequent intervals as the patient will not take much—every one and a half, two to three hours—and also abundant. drink such as boiled sterilized water, lemonade, light natural acidulated waters, etc.
When there is vomiting or deep stupor makes the taking of food by mouth impossible, enemata may be tried, made of eggs, flour, milk, and salt, or in the form as recommended by A. Schmidt ready for use and
sterilized (made by Heyde') of Radebeul near Dresden).
Great loss of water as a result of profuse diarrhoea should be equal ized by subcutaneous infusions of common salt, and waning heart power strengthened by bold alcoholic administration in the form of mild dessert wines or champagne, injections of ether, camphor, and the like. Com plications involving the lungs require expectorants or inhalations of oxygen and the attempt may be made to check intestinal haemorrhages by injections of gelatin—two to five per cent., sterilized, in doses of 40 to SO c.c. (1A to 3 oz.) according to age. Intestinal perforation has recently been successfully operated upon by Stewart.
Frequent cleansing of the mouth to prevent or restrict secondary infections is very much to be recommended. This may be done either by washing out the mouth with a piece of gauze dipped in boric acid solution or by repeated rinsing and gargling. Good service is rendered also by menthol vaseline (0.5 to 1 per cent. with vaseline oil) instilled into the nose twice a day.
Scrupulous cleanliness, especially after each evacuation, is the best means for preventing decubitus; also a smooth firm mattress and fre quent change of position. There must be an ample supply of fresh air which can best be procured when conditions permit by having two rooms at the patient's disposal which can be alternately ventilated and occupied. If a mixed infection is present it must he treated locally; in case of pus foci, they should be opened and protected by bandages. The appetite may, with the defervescenee of the fever, recur with vigor, but its premature gratification by solid food should be sternly refused; the return of the appetite while undeniably welcome is under such con ditions rather perplexing. We must make a firm stand against soft hearted attendants and absolutely forbid all solid food such as soft rolls, meat hash, etc. Such food should be withheld until about a week after complete disappearance of the fever, or even somewhat longer in case the disease has been a severe one. After another week the children, who, in the meanwhile have been out of bed for three to four days, may be allowed out to drive when the weather permits. Where conditions are favorable, a stay in the country during convalescence is to be recommended. Return to school must not be permitted until after complete physical and mental recuperation.