If the child is from the first in a state of prostration, instead of the cold bath the hot mustard bath may be made use of ; but such cases are seldom benefited even temporarily.
If rheumatic pains are complained of and the joints swell, these parts should be wrapped in cotton wool and covered with a firmly applied flannel bandage ; and Dover's powder should be given at night if the pains inter fere with sleep. Attention must also be paid to the state of the bowels. Inflammation of the serous membranes must be treated upon ordinary principles.
If albuminous nephritis occur, energetic treatment must be adopted at once. A mere trace of albumen, such as is often met with in cases of scarlatina, is of little consequence, and requires merely tonic treatment ; but the appearance of copious albumen in a smoky urine shows the pres ence of acute Bright's disease, and is a very different matter. We should therefore at once proceed to sweat and purge the patient. There is, per haps, no condition in which the beneficial influence of free purgation is more striking than in this complication. A child of five years old should take every night a dose of compound jalap powder (gr. xxx.—xl.) alone, or mixed with five grains of compound scammony powder. Enough should be given to produce two or three watery stools. In the daytime he should be wrapped in a sheet wrung out of tepid water and be then well packed in blankets ; taking at the same time a draught containing a solution of acetate of ammonia ( 3 j.) and antimonial wine (rn, xx.) to insure the free action of the skin. His diet should be simple. As long as there is any pyrexia no solid food should be allowed ; and the patient should have noth ing but milk and broth with dry toast. Plenty of fluid is useful. If these measures be adopted, the albumen in the majority of cases will be found to disappear very quickly from the urine. Should it, however, persist, and the renal disorder seem to be passing into a chronic state, iron and ergot are indicated ; or three grains of the hydrate of chloral may be given (for a child of five years old) three times a day. In cases of urvemic convulsions purging and sweating carried out briskly are of equal service, and will usually quickly relieve the symptoms, especially if aided by a diuretic. The
following is a serviceable form : A good diuretic for children is digitalis ; and the drug is well borne in early life. Five drops of the tincture given three times a day with an equal quantity of spirits of juniper may be employed. Jaborandi and its alkaloid pilocarpine are useful in these cases ; and can be given either by the mouth or by subcutaneous injection. The most convenient way of admin istration is to make a fresh solution of the nitrate or hydrochlorate of pilocarpine in water of the strength of one grain to twenty-four minims. Of this solution three drops (one-eighth of a grain) can be injected sub cutaneously, and is a suitable dose for a child of five years of age. Children bear this remedy well. If the solution is freshly made, copious sweating follows the injection ; there is often profuse salivation ; and the secretion of urine is greatly augmented. The child should lie between blankets, so as to encourage the action of the skin. The close may be repeated every day, if necessary. It often excites nausea and vomiting, but this is imma terial.
During the stage of clesquamation measures should be taken to hasten the separation of the epithelium. The child should be oiled all over the body every night with carbolized oil (one part of the acid to twenty parts of olive-oil), and this should be well rubbed into the skin. Afterwards he should be thoroughly washed with soap in a warm bath. If this be carried out in a warm room, there is no fear of a chill.
Even in mild cases the child should keep his bed for three weeks, and his room for a month at least, from the beginning of his illness ; and until the peeling has quite ceased the patient is unfit to associate with healthy persons. It must be remembered that desquamation may linger long about the wrists and ankles, the fingers and the toes ; and that a considerable time may elapse before the mucous membrane of the throat has completely recovered its normal state. When the child is finally pronounced to be well, it is advisable to send him to the sea-side for change of air before he resumes his ordinary habits and mode of life.