Vomiting is the rule at the onset of the malady, but is rarely troublesome afterward. During the few days of fever, cool drinks - water, lemonade, Seltzer, etc. - should be given freely. The food must be liquid. Milk is the best. It can be varied by gruels, oranges, stewed or baked apples, and stewed prunes. But while the fever ranges high, it is best to use only milk or gruels. These ought to be given every hour, in doses of from three to five ounces.

When the throat is intensely sore, swallowing may become so distressing as to cause children to refuse food. Then rectal alimentation must be resorted to. Care should especially be taken that enough fluid is administered by rectum or hypo-dermically to maintain good elimination by the kidneys. Ice-cream can often be swallowed with comfort when fluids give pain.

Such a diet should be prescribed as will avert nephritis. The latter occurs more frequently in scarlet fever than in any other eruptive disease. It usually shows itself in the second or third week of the malady. During the period of maximum pyrexia, albuminuria is common. It is rare, however, that nephritis develops at this time. Exposure to cold during the period of desquamation is a cause of nephritis, but it is probable that the complication is more frequently due to overeating or to unsuitable food. Jaccoud maintains that scarlatinal nephritis can almost always be averted by a rigorous milk diet, persevered in until after the third week. The kidneys are commonly in a pathologic state during pyrexia, but true nephritis generally dates from the period of desquamation, because the skin can then perform its functions so imperfectly. If at this time the diet contains a small amount of fluid and considerable albuminous food, nephritis should be expected, because the substances to be eliminated by the kidneys will come to them in a concentrated form and be voided in concentration. Highly nitrogenous food will impose still more work upon the kidneys. It is, therefore, not surprising that nephritis develops. Moreover, eating mixed foods heartily during fever, leads to their imperfect digestion and to their fermentation in the gastrointestinal tract, which produces abnormal products to be absorbed and eliminated by the kidneys and at the same time to irritate them. Milk, of all foods, is least likely to produce these irritating substances. Salt is also irritating to the kidneys. Therefore, it should not be added to food generously and foods containing much of it should not be eaten. The bowels must be emptied regularly and perfectly to prevent harmful fermentation in them. Since nephritis appears almost as often after mild scarlatina as after severe cases, great care in regard to diet must be taken in all cases during the first three weeks of the illness.

Milk is the best food during this time. Kumiss, matzoon, ice-cream, and gruels may be employed for variety if a strict milk diet can not be maintained. Fruit and fruit juices also are permissable in moderation, but the soreness of the throat sometimes does not tolerate them. When convalescence is established, there may be added to the milk diet, oatmeal, soft-boiled rice, puddings of corn-starch, farina, and sago, with cream, milk-toast, cream toast, baked potato, stale bread with butter, or fruit jellies, baked apples, stewed apples, stewed prunes, and oranges. After the third week, fish, such as creamed codfish, oysters, or oyster or clam broth, squabs, and breast of chicken, and, later, the red meats, may successively be tried. A greater variety of simply cooked vegetables may also be used. Adults may have tea, coffee, and cocoa.

During the first days of convalescence care must be taken that too much food and food of too varied character, be not taken. Children become extremely hungry, but their desire for quantity and variety cannot safely be satisfied.

When, in spite of such care, inflammation of the kidney develops, the regimen must be that of nephritis rather than of scarlet fever. (See p. 353.)