If there is severe headache or sleeplessness or delirium, a powder of— Bromide of potassium 10 grains, Antipyrin 7 grains, Citrate of caffein 1 grain, may be given twice or thrice daily, well diluted with water, the last dose at night.
A great many applications to the inflamed skin have been suggested. The progress of the inflammation may often be arrested by paint ing the skin with a saturated solution in water of picric acid, if this is done early enough. To do this properly and effectually the affected skin should be thoroughly cleansed of dirt and grease. Tepid water should be used and soft soap. A small flannel bag should be made about 2 inches long and 1 inch broad ; this should be tilled with soft soap and the open and then sewn tight. Everything should be got ready, and neatly arranged.
1. A washhand - basin with tepid water; dropped in it the bag of soft soap.
2. A second basin with clean tepid water.
3. A small bowl containing about a dozen pieces 2 inch square of absorbent wool, the prepared kind called gamgee, or plain-lint.
4. A cup or wine-glass with a little methyl ated spirit of wine.
5. A tea-cup with the solution of picric acid, and a camel-hair pencil.
The patient should be laid on the bed in the most convenient position for the nurse, a bath towel under head and shoulders, and clothing slipped down out of the way. The nurse having previously thoroughly washed her own hands, and been girt with an apron, goes over the affected part freely and lightly with the soap bag and tepid water, specially thoroughly any hairy part involved or near the affected skin; the soapy water is then douched off with the fresh water, and then the skin and hair is care fully dried with the pieces of wool. Each piece, as it is soiled, should be tossed into a bucket ready for the purpose. A piece of wool is then taken, dipped in the spirit, and lightly passed over the skin, the eyes being carefully protected. A dry piece of wool mops off the spirit. Then the picric acid is painted on, a broad line being first painted all round the inflamed part, and fully 1 inch outside of it. The inflamed area within this line is thoroughly painted with the solution, running being prevented by the nurse with a piece of wool in the free hand. If the washing has been properly done, and the spirit dried off properly, the solution should not run, and, quickly drying on, should show by the yel low stain that the solution has been thoroughly applied. Any unstained piece of skin in the marked-off area should be gone over again. The patient should then be tidied, dishes, &c. removed, care being taken immediately to wash all vessels, to burn all pieces of soiled wool, and to put into a wash-tub towels, &c., used in the
process. This having been done, an ointment, of which the recipe is given should be smeared thickly all over the affected akin, which should then be lightly covered with a layer of wool, thin or thick according to the outside tem perature. If it is winter, the layer should be sufficient to keep the skin comfortably protected from cold ; if it is summer, the patient's comfort may require that no wool be applied at all- the ointment being sufficient protection. If it is the face and head that are affected, a large piece of gamgee should be cut to shape of a large mask, with holes for eyes, and one for the month and nose. This can be very neatly made by binding with thin tape, and it is secured by tapes. A fresh mask need not be frequently made if the same side be always put next the face. Twice a day the nurse should remove the wool mask, and carefully examine the edges of the yellow stain. If the inflammation is spreading anywhere, it will appear as a pink blush beyond the yellow area. Any such little bit appearing should be washed, with soap and water and then spirit, none of the rest of the area being touched, and then the picric solution applied. Over all a fresh layer of the ointment should be daily spread. If this method is properly followed, and care ful watch kept, the disease will in a great majority of cases cease, and in four or five days will be quite clearly over. Meanwhile it will take all the nurse's deftness and cleanli ness to keep the patient tidy in spite of the greasy application. A piece of jaconet stitched ou to the pillow will keep it from being stained. It can be regularly sponged. If the disease has ceased to spread after two or three days, the affected parts may be again cleansed. This can be done with pure vaseline, or with olive-oil containing 30 grains menthol to each 6 ounces. A little of this is poured on to the grease-coated skin, and worked into a lather by the tips of the nurse's fingers, well washed for the purpose in hot water and soap and then dried. A little bit is done at a time, and the lather is wiped off with pieces of gamgee. Bit by bit every particle of the layers of ointment may thus in time be removed, and the skin and hair appear as fresh and clean as if they had been washed. The parts should then be very lightly smeared with the fresh menthol oil. In a few days the yellow-stained cuticle will come off, and the fresh healthy skin appear below un stained.