A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck.
- Date:
- 1887
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
74/1022 page 42
![and is especially to be recommended if the skin be harsh and dry after the erup- tion has faded. [From the moment that the disease is declared the patient should be thoroughly anointed daily with carbolized vaseline, lard, or the like; and this should be kept up until desquamation has ceased. Not only is the comfort of the patient pro- moted, but the danger of the spread of the infection is thereby greatly lessened.] A more vigorous treatment is demanded whenever there is considerable sore throat. Larger children may use a gargle (two-per-cent, solution of chlorate of potash, one- or two-per-cent, solution of carbolic acid). Inhalation of carbolic-acid spray is also to be recommended where practicable. If there is prostration, or if the child be young or willful, we must cleanse the mouth and throat at short inter- vals, by means of a spray-apparatus, with disinfectants, such as carbolic acid or permanganate of potash in solution. Sometimes it is a good plan to let the patient swallow slowly a half-teaspoonful of a solution of potassic chlorate (about 1 to 40) every half-horn- or oftener, with the object of contributing to the local disin- fection of the throat. Abscess of the tonsils may often be lanced. The diphtheria of scarlet fever is to be treated in the same way as is the genuine variety {vide infra). If the nose be likewise affected, the chief thing to do is frequent cleansing and syringing while the head is bent forward. We should be on the watch for the possible occurrence of otitis. In this particular the physician is often guilty of sins of omission. Much harm may be averted by a prompt cleansing of the ears, or, if need be, by insufflation of air into the middle ear, or paracentesis of the membrana tympani. Inflammation of the glands in the neck, if severe, is prone to pass on to sup- puration, and must then be treated surgically. When the swelling has just begun, or is still moderate, we may try to cure it by rubbing in iodoform ointment (1 to 15) two or three times a day. Ice is generally not so well borne as warm applica- tions (poultices or warm bran-cushions). If there be continuous high fever, accompanied by rather severe constitutional symptoms, a moderate employment of the cold-water treatment is strongly to be recommended. The baths seldom need to be cooler than 81° to 88° (22°-25° R.), and are to be employed two or three times daily, or oftener in severe cases. If the nervous disturbance be serious, or if the respiration be impaired, the patient should be douched with cold water during the bath. At the same time wine or strong coffee is to be given as a stimulant, or, if cardiac failure and signs of collapse appear, the best remedy is subcutaneous injections of camphor. We are convinced that internal antipyretics, such as quinine or antipyrine, may usually be dispensed with. If it is desirable to prescribe something, we can write for an acid mixture or for decoction of cinchona. If the pulse is abnormally rapid, and there is danger of cardiac failure, we can employ, beside stimulants, an ice-bag placed over the heart. Digitalis may also be tried cautiously. The scarlatinal inflammation of the joints is sometimes improved by salicylate of soda (forty-five to sixty grains, grm. 3 to 4, in one dose [!]). Sometimes, how- ever, this remedy has failed us. We know of no means to avert the nephritis. In justice to himself, the physi- cian must always at the start point out the possibility of its occurrence, and must avoid as far as possible errors in diet or exposure to cold on the part of his patient. He may thus escape blame. For the treatment of the nephritis and its results see the section on renal diseases. We must likewise refer the reader to the appropri- ate chapters for the treatment of other possible complications of scarlet fever. The patient must, as a rule, keep his bed three to four weeks, even if convales- cence be uninterrupted.](https://iiif.wellcomecollection.org/image/b21981565_0074.jp2/full/800%2C/0/default.jpg)
