TREATMENT OF DISEASES. 257 



pieces of the skin come off, especially from the hands and feet. The swell- 

 ing and inflammation of the throat sometimes go off without any ulceration; 

 but at other times slight ulcerations form at the tonsils and at the back of the 

 mouth; and whitish specks are seen intermixed with the redness, from which 

 a tough phlegm is secreted, clogging the throat and very troublesome. This 

 kind of scarlet fever is not unfrequently followed by great debility, or the 

 occurrence of other diseases, as inflammation of the eyes, or dropsy, or an 

 inflammatory state of the whole system or water on the brain. 



Treatment. — It is in general, proper to begin with giving an emetic, 

 especially if we at all suspect the stomach to be loaded with undigested mat' 

 ter; and we are very soon after to exhibit laxative medicines which are truly 

 one of our most important remedies in this disease. A dangerous and exhaust' 

 ing looseness which takes place towards the fatal termination of an ill-man- 

 aged scarlet fever, for a long time excited great fears and prejudices against 

 the use of laxative medicines in this disease; but better observation has con- 

 ,inced us that so far from being detrimental, laxative medicines, early and 

 prudently begun have the best effect in mitigating the disease and in prevent- 

 ing the collection of that putrid and offending matter in the bowels which is 

 so sure to produce wasting diarrhoea when it is suffered to accumulate. To 

 lessen the burning heat of the skin, nothing is at all comparable in some cases 

 to the free affusion of cold water, which, when employed prudently and at the 

 proper time, cools the surface, and from a state of the most restless irritation, 

 brings the patient to comparative ease and tranquility. The cold affusion, 

 however, is not proper where there is much fullness of blood on one hand or 

 great debility on the other; and in the majority of cases we must trust to the 

 washing or sponging of the whole body with tepid water, or vinegar and 

 water; and till the heat of the body is reduced by these means, it is in vain 

 that we give internal medicines to procure perspiration or to allay restlessness 

 and induce sleep. After washing it is not at all unusual for fhe formerly 

 harassed patient to fall into a gentle and refreshing sleep, and a mild and 

 breathing sweat comes but over the whole body This supersedes the neces- 

 sity of sudorific and anod/he medicines; and provided we attend to the bowels, 

 keep away stimulant and nourishing food, give the drink' cold or acidulated, 

 and employ proper gargles for the mouth and throat, the drugs we iKiminister 

 may be very few indeed. 



The inflammatory state of the system which often follows scarlet fever is 

 not unfrequently accompanied with a swelling resembling dropsical swelling; 

 but we are not to regard this last as a sign of debility, or to be deterred from 

 the use of active remedies. Bleeding from the arm is seldom admissible, but 

 leeches behind the ears may be necessary if head symptoms come on; brisk 

 purgatives are to be freely administered, and the inflammatory and dropsical 

 tendency is to be combated by the use of foxglove and other diuretics When 

 the inflammatory action has subsided and the dropsy appears to be the prin- 

 cipal malady, we are to give tonic medicines and nourishing diet along with 

 such medicines as increase the flow of urine. 

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