SCARLATINA. 593 



lent belief that the dropsy and renal disease are due to cold, tc 

 which the patient has been exposed during the height of the exan- 

 thema or during the desquamative stage. The fact that albuminuria 

 and dropsy are very rarely seen in some epidemics, while they occur in 

 almost every case in others, sufficiently proves the error of this hypoth- 

 esis, although we cannot explain the causes of the difference in fre- 

 quency of nephritis, angina maligna, and other local affections in dif- 

 ferent epidemics. We have already (Vol. II., p. 12) fully described the 

 symptoms and course of croupous nephritis, and we can now refer to 

 that description the more readily, because most of the cases of croup- 

 ous nephritis, which formed the basis of that description, occurred in 

 children in the desquamative stage of scarlatina. While part of the 

 patients affected with hydrops scarlatinosum, which is a symptom of 

 acute inflammation of the kidney, recover and another part die with 

 the symptoms of ursemic intoxication, and still more of pneumonia, 

 pleurisy, pericarditis, etc., the second form of scarlatinous dropsy, not 

 accompanied with albuminuria, is a sequel of scarlatina as free from 

 danger as it is inexplicable. It generally develops gradually, may be- 

 come very extensive, is not limited to the subcutaneous connective 

 tissue, and rarely extends to the serous cavities. In some cases of very 

 extensive scarlatinous dropsy without albuminuria, recovery takes place 

 in a remarkably short time, as I know from my own observation. 



TREATMENT. Prophylaxis requires the isolation of healthy persons 

 from those affected with the disease and from those who have inter- 

 course with such patients. This is the only rule that promises any 

 good results ; hence it should be urgently recommended during malig- 

 nant epidemics. Belladonna (extract belladonnas gr. iij, aq. dest. f j ; 

 give daily twice as many drops are there are years in the patient's 

 age) is regarded as a prophylactic by some physicians as well as by 

 the homoeopaths ; but experience has shown that, even when continued 

 for weeks, this remedy affords no protection against scarlatina. The 

 same is true of all other medicines, either internal or external, that 

 have been recommended as prophylactics. The same rules apply to 

 the treatment of scarlatina as we gave for that of measles. Before 

 asking ourselves what we shall prescribe, we should decide whether 

 it is necessary or even admissible to interfere actively with the regular 

 course of the disease. We should keep the sick-chamber at an even 

 temperature, not exceeding 55 to 65, not allow the patient to be cov- 

 ered with heavy bedclothes, freshen the air of the room occasionally 

 by opening the window, and have the patient carefully washed daily. 

 The best drink is pure cold water or lemonade ; as nourishment, we 

 may at first give water-soup, bread, stewed fruit, etc. ; later, we may 

 give meat-broths, milk, etc. If there be constipation, we may order 



