594: ACUTE INFECTIOUS DISEASES. 



an enema of tepid water, avoiding active purges, except in case of 

 necessity. It is an old custom to keep scarlatina patients in bed till 

 the stage of desquamation is over, and it is well to keep up this cus- 

 tom, undeterred by the fact that patients neglecting this rule do not, 

 by any means, always suffer for so doing. Even after desquamation is 

 completed, the patient should be protected from cold, and in winter 

 should be kept in his room for at least a fortnight. During this time 

 he should take several baths in lukewarm water. In simple, mild 

 cases of scarlatina this expectant plan is sufficient, and should be pre- 

 ferred to any medicinal, hydropathic, or other treatment. 



But, during scarlatina, changes often arise which urgently demand 

 therapeutic interference, and which are sometimes successfully com- 

 bated by energetic treatment. Chief among these changes are exces- 

 sive increase of the bodily temperature and consequent occurrence of 

 symptoms of adynamia and threatening paralysis. Formerly, in such 

 cases, general stimulants were employed, occasionally with the effect 

 of arresting the impending paralysis, as it seemed ; but most of the 

 patients died, in spite of the carbonate of ammonia, which was given 

 as a specific in scarlatina maligna. Recently, the knowledge that the 

 hydropaths treat scarlatina very successfully by wrapping the patient 

 in wet sheets, and by cold douches, has greatly increased the popular- 

 ity of this treatment, which had already been extensively used by 

 Currie, and other physicians, in the treatment of asthenic or typhoid 

 cases. And this is the most important therapeutic remedy in malig- 

 nant scarlatina ; and, in cases where there is no dangerous local disease, 

 it often has a surprising effect. The employment of wet sheets and 

 cold douches cannot be replaced by Schneemanrts treatment of smear- 

 ing the whole body with grease twice daily during the first three 

 weeks, once daily during the fourth week, although this operation 

 renders the patient more comfortable. I shall not attempt to say 

 whether placing the patient in an empty tub and pouring cold water 

 over him, or wrapping the naked body in wet sheets, deserves the 

 preference ; but we should abstract heat by one method or the other 

 every time the temperature of the body becomes excessive, and the 

 symptoms of adynamia reappear. The wet sheets should be reapplied 

 from three to six times, at intervals of ten or fifteen minutes ; the pa- 

 tient should then be placed in bed, and left quiet till it is necessary to 

 repeat the process. As even the laity are tolerably familiar with the 

 success of the hydropaths, we rarely meet any great objection to the 

 above treatment, even in private practice. If we should find this ob- 

 jection, large doses of quinine should be given, although I cannot 

 speak of its benefits from personal experience, as I can of those from 

 the energetic abstraction of heat. In desperate cases, where the 



