TREATMENT

The patient should be kept in bed for three weeks and chilling of the skin prevented. This is important in even the mildest cases in order to avoid kidney complications.

Skillful management and careful nursing does much good in scarlet fever. In the acute stage when fever is high much relief is afforded by baths. Small children may be placed in a bath of warm water and left there for 15 to 20 minutes. The temperature of the water must not be below that which is comfortable to the child, but it may be gradually lowered by adding cold water. While in the bath the head should be kept cool with wet cloths. The bath lowers the fever, quiets the nervous symptoms and favors sleep. In older children and adults the same results may be secured by sponging the body and by packing in wet sheets. In any case the temperature of the water used should be adapted to the sensibility of the patient. He should not be chilled, and quite warm water is often most grateful and followed by the most beneficial results.

Throughout the disease liberal amounts of water should be taken. This is given cold. In young children this can be accomplished by giving small quantities at frequent intervals. Water increases the elimination of the poisons, and its administration is one of the most important measures in the management of the disease. If the stomach is disturbed with a tendency to vomit cold water, small amounts of weak tea, taken as hot as possible, will sometimes help settle the stomach.

The diet during the early period will be principally milk. As the fever falls and the appetite returns cereals, toast, fruits and vegetables may be added. Eggs and meats are best withheld until three weeks from the onset. In septic cases with prolonged course, liberal feeding with easily digested foods is of the greatest importance. The mouth and throat should be kept as clean as possible. In persons who are large enough frequent use of bland gargles are desirable. For this purpose a tablespoonful of table salt or baking soda to a pint of water is suitable. Rubber bags filled loosely with finely cracked ice and applied to the neck, relieve the soreness of the throat. They are specially useful when the neck is swollen, and tend to prevent the formation of abscesses in the glands of the neck.

Pain in the ear is treated by the application of heat. A few drops of warm glycerine, to which carbolic acid in the proportion of five to ten per cent is added when dropped into the ear is very useful in relieving pain and reducing inflammation. When a discharge from the ear occurs, it must be collected on gauze which is burned. The canal must be kept as clean as possible and secretion not allowed to accumulate. If it is thick and does not run out freely the ear may be gently washed out with a saturated solution of boric acid in water. The ear must not be plugged with cotton but drainage must be facilitated. As the discharge becomes less the ear should be cleansed with boric acid dissolved in alcohol and then dried carefully with small pledgets of absorbent cotton.

Pain and tenderness back of the ear always calls for expert advice. Such cases often come to operation which must not be too long deferred if results are to be satisfactory. Also when signs of kidney disease appear, such as swelling of the eyelids, vomiting, etc., medical advice should be sought as quickly as possible.

The painful joints which occur in some cases are usually relieved by hot applications.

Until recently the treatment of scarlet fever has been entirely symptomatic, and directed toward conserving the strength of the child and toward preventing complications until nature cured the disease. Natural recovery occurs when the individual who is sick makes his own antidote for the poisons of the disease. We may assist nature by injecting into the acutely sick person, some blood drawn from an individual recently recovered from the disease. The convalescent blood, containing the antidote or antitoxin, serves to destroy the poison in the blood of the acutely sick child, and so aids recovery. Marked improvement often follows the use of convalescent serum. Such serum is not always at hand, but if an older child or adult who has had scarlet fever is available, his blood may be drawn and injected into the sick child. There is reason to believe that we may soon have a scarlet fever antitoxin, produced from horses in a manner similar to that in use in making antitoxin for diphtheria.

The successful treatment of scarlet fever with its many complications demands great skill. There is no disease in which the outcome depends more on judicious medical management and careful persistent nursing than in scarlet fever.