In this fever, some of the very best results of cold bathing and packing have been obtained. In mild cases, tepid or cold sponging during the course of the disorder, and a few carbolized warm baths at the termination are all that is necessary. The warm baths during the period of desquamation help the process, and give much comfort to the patient, especially if followed by inunction of carbolized oil or glycerin. They also stimulate the action of the skin, and lessen renal congestion, or the risk of it, and also the chance of infecting other persons.
Dr. Vaudrey Lush, indeed, and some other physicians, have advocated the routine use of the warm bath from three to five minutes, at first three times a day, afterward less often, for every case of the malady (Lancet, ii., 1880); but without denying the advantages of this method, it is clearly often impracticable, and cannot be considered necessary.
• In very severe cases, however, when the temperature rises to 104°, 105°, or 106°, F., and there is delirium or stupor, the rash being dark and indistinct, and the urine scanty and albuminous, I have frequently seen, even in apparently hopeless conditions, the cold or hot wet pack bring out a vivid rash, and cause lowering of temperature and abatement of all severe symptoms.1 Dr. Edison has reported two illustrations of this, occurring in children, with delirium, etc., and both successfully treated by frequent bathing (Lancet, 1877); interesting cases treated by cold affusion, also valuable cautions on the subject may be found in Trousseau's "Clinical Lectures" (vol. ii.).
1 Although, as above stated, temperature is commonly reduced in the pack, I have known it rise 2° to 3° F. in five different patients in the cold pack, and in four others in the hot pack. At one time I thought such an occurrence to contra-indicate the treatment, but furhter experience has shown me that it does not do so, and I believe that even in the nine cases referred to, recovery was assisted by the treatment.
* I first used the hot pack in a case of suppressed scarlatina (where the prejudices of parents prevented the usual cold applications), and finding the results equally good, I have commonly adopted it. In the case of a boy whom I found convulsed, and with dusky purplish skin, on the third day of what was presumed to be scarlatina, the hot sheet acted admirably. The throat was much affected, albumen was in the urine, and consciousness was lost. Within half an hour of commencing the hot pack he was able to speak, perspired freely, and the rash came out a vivid red; he was afterward put in blankets, and went on perfectly well without the necessity of repeating the pack. In another still more severe case, the convulsions had lasted over two days, the child was quite blue, there was albumen in the urine, and his life was despaired of; but in the first pack consciousness returned, and recovery followed.
The vapor-bath is another mode of affecting the same results, and is especially applicable when renal congestion and albuminuria are marked, and in such cases compresses, poultices, or fomentations should be kept applied over the loins. The instances given will suffice to show the power of this treatment, although certainly there are cases of malignant scarlet fever which no art can save.
For the sore throat of scarlatina, compresses should be used externally. I find it best to have the throat bathed with water as hot as can be borne, for about five minutes every three or four hours, and directly afterward a bandage, wrung out of water at about 112° F., should be applied round the neck and covered with oiled silk. This should be con-tinued for three or four days as an adjunct to other treatment. Dr. H. Corson (U. S.) recommends a piece of ice, in gutta-percha, over each parotid gland. Warm water is a good gargle, or ice may be swallowed in small pieces with much advantage.
In Measles, Small-pox, and other eruptive disorders, similar treatment by bathing and packing is valuable.
On the other hand, there is much clinical evidence of the value of ammonia in this fever. De Witt, Peart (1802), Wilkinson, and Strahl have written specially in its praise, and many illustrations of its value have been given by Hillier, Camden, Graham, Sisson, Langdon Down, and others (Lancet, 1860, 1864, 1870; Medical Times, 1858, 1862, 1873, and "London Hospital Reports," vol. i.). From 3 to 6 gr. of carbonate, freely diluted, are to be given every one or two hours, until improvement occurs: it determines to the skin, and perhaps thus hastens elimination of the poison. I have found it especially useful in cases accompanied by malignant sore throat. Dr. Down refers to 192 cases occurring in one epidemic at Earlswood Asylum; 78 had severe angina, and 49 were malignant cases: all received 5 gr. of the carbonate every four hours, and were otherwise treated alike: alcoholic stimulants were used in moderation. Ten only died, and of these seven were tuberculous, and considering the low resisting power of imbeciles this result is good. He considered the remedy diminished febrile excitement and calmed the nervous system: it was taken readily without pain to the throat.
The small doses of hydrarg. c. creta just mentioned I have found equally useful in the severe specific sore throat of scarlatina, especially when the cervical glands and adjacent cellular tissue are inflamed and swollen, and when there is ulceration or even a tendency to gangrene.