It there be coryza, the saline solution may be injected into the nasal fossce, or the nose may be syringed once a day with a weal; solution di nitrate of silver (gr. v. to the ounce).
Abscesses forming in the neck must be opened directly fluctuation is detected, and be afterwards well poulticed. If haemorrhage occur, the wound must be stuffed with lint soaked in perchloride of iron. A post pharyngeal abscess must be also opened early with a large trocar and cannula.
If otorrhcea be noticed, the meatus must be syringed out frequently during the day with warm water. If the tympanic membrane be perfect, the discharge proceeding only from the external canal, a syringeful of some mild astringent lotion should be injected each time after complete cleansing. Glycerine of tannin (one drachm to the ounce of water) or a weak solution of sulphate of zinc (gr. iij. to the ounce) answer well for this purpose.
In the case of any of the above complications quinine in full closes (gr. iij. four times a day for a child five years old) should be given ; and a liberal diet should be allowed, due regard being had to the patient's powers of digestion. When the temperature has fallen in scarlet fever the child should have meat once a day, an egg or a little bacon for his breakfast, and should take plenty of milk. As long as the water con tinues clear we may be sure that he is not being overloaded with food ; but the appearance of a thick deposit of lithates should at once make us reconsider his dietary, and limit the quantity allowed at his meals.
When the throat affection is severe, iron seems more beneficial than quinine, if administered energetically. For a child of this age fifteen to twenty drops of the pernitrate of iron should be given with glycerine and water every three or four hours. At the same time brandy-and-egg mixt ure must be supplied in such quantities as seem desirable, according to the degree of prostration of the patient. In such cases children will take with benefit large quantities of the stimulant. Strong beef-tea, meat extract, etc., can also be given.
If the disease be ushered in with obstinate vomiting, the symptom is best relieved by sucking ice. If diarrhoea occur, oxide of zinc (five grains for a child of five years old) or bismuth (gr. xv.) and chalk mixture should be resorted to. If at the beginning of the diarrhoea the motions are lumpy, a mild aperient, such as a dose of castor-oil or a rhubarb and soda powder, should be administered.
In cases of malignant scarlet fever with violent nervous symptoms every kind of treatment will unfortunately be often found to fail. If the
temperature be high, it must be reduced by cold bathing. The child may either.be placed in a cool bath (temperature of 70° Fahr.), and kept there until his teeth begin to chatter ; or allusions with water of the same temperature may be practised, as recommended by Currie. I prefer the former method ; and there is no doubt that the immediate effect of the bath in lowering the pulse and temperature, dissipating the delirium, and relieving the agitation of the patient is very decided. When the temper ature rises again and delirium returns the process must be repeated. Unfortunately, although there is temporary relief to the symptoms, the patient is seldom ciu'ed by this means, and usually falls after a time into a state of prostration and collapse, in which he dies. A milder way of employing the same treatment is to wrap the child in a wetted sheet, and lay him upon a hard mattress, covering him merely with a thin blanket thrown loosely over him. When he shivers he should be released and returned to his bed. The milder practice is suitable in the less severe cases, and has a distinct effect in reducing the temperature. It must be remembered, however, with regard to this question of hyper-pyrexia, that children often bear high temperatures very well ; and it is difficult to lay down a broad rule as to the period at which it is necessary to intervene. It is better to be guided in this respect by the general symptoms than by the thermometer. If, as often happens, a child seems comfortable and composed, with a temperature of 105' or 106°, there is no occasion for any step more energetic than that of sponging the surface of the body with warm water ; but if with a lower temperature (103° or 104°) he is deliri ous, agitated, and distressed, the cold bath may be used with benefit. Wet packing is often useful in these cases ; but when thus enveloped in blankets the child's temperature must be carefully watched. If the skin be induced to act by this means, and the patient sweat profusely, the process is a beneficial one and the temperature will fall. If, on the other hand, the skin do not act, the effect of the packing is to cause- a further increase in the pyrexia. Therefore, if the temperature be found to rise instead of falling, the blankets should be at once removed. In all these cases the bath, of whatever kind it be, should be supplemented by energetic stimulation in order to counteract the tendency to sudden collapse.