The patient should be kept in bed for three weeks and chilling of the
skin prevented. This is important in even the mildest cases in order to
avoid kidney complications.
Skillful management and careful nursing does much good in scarlet
fever. In the acute stage when fever is high much relief is afforded
by baths. Small children may be placed in a bath of warm water and
left there for 15 to 20 minutes. The temperature of the water must
not be below that which is comfortable to the child, but it may be
gradually lowered by adding cold water. While in the bath the head
should be kept cool with wet cloths. The bath lowers the fever, quiets
the nervous symptoms and favors sleep. In older children and adults the
same results may be secured by sponging the body and by packing in wet
sheets. In any case the temperature of the water used should be adapted
to the sensibility of the patient. He should not be chilled, and quite
warm water is often most grateful and followed by the most beneficial
results.
Throughout the disease liberal amounts of water should be taken. This
is given cold. In young children this can be accomplished by giving
small quantities at frequent intervals. Water increases the elimination
of the poisons, and its administration is one of the most important
measures in the management of the disease. If the stomach is disturbed
with a tendency to vomit cold water, small amounts of weak tea, taken
as hot as possible, will sometimes help settle the stomach.
The diet during the early period will be principally milk. As the fever
falls and the appetite returns cereals, toast, fruits and vegetables
may be added. Eggs and meats are best withheld until three weeks from
the onset. In septic cases with prolonged course, liberal feeding
with easily digested foods is of the greatest importance. The mouth
and throat should be kept as clean as possible. In persons who are
large enough frequent use of bland gargles are desirable. For this
purpose a tablespoonful of table salt or baking soda to a pint of
water is suitable. Rubber bags filled loosely with finely cracked ice
and applied to the neck, relieve the soreness of the throat. They are
specially useful when the neck is swollen, and tend to prevent the
formation of abscesses in the glands of the neck.
Pain in the ear is treated by the application of heat. A few drops of
warm glycerine, to which carbolic acid in the proportion of five to ten
per cent is added when dropped into the ear is very useful in relieving
pain and reducing inflammation. When a discharge from the ear occurs,
it must be collected on gauze which is burned. The canal must be kept
as clean as possible and secretion not allowed to accumulate. If it
is thick and does not run out freely the ear may be gently washed out
with a saturated solution of boric acid in water. The ear must not be
plugged with cotton but drainage must be facilitated. As the discharge
becomes less the ear should be cleansed with boric acid dissolved in
alcohol and then dried carefully with small pledgets of absorbent
cotton.
Pain and tenderness back of the ear always calls for expert advice.
Such cases often come to operation which must not be too long deferred
if results are to be satisfactory. Also when signs of kidney disease
appear, such as swelling of the eyelids, vomiting, etc., medical
advice should be sought as quickly as possible.
The painful joints which occur in some cases are usually relieved by
hot applications.
Until recently the treatment of scarlet fever has been entirely
symptomatic, and directed toward conserving the strength of the child
and toward preventing complications until nature cured the disease.
Natural recovery occurs when the individual who is sick makes his
own antidote for the poisons of the disease. We may assist nature
by injecting into the acutely sick person, some blood drawn from an
individual recently recovered from the disease. The convalescent blood,
containing the antidote or antitoxin, serves to destroy the poison
in the blood of the acutely sick child, and so aids recovery. Marked
improvement often follows the use of convalescent serum. Such serum is
not always at hand, but if an older child or adult who has had scarlet
fever is available, his blood may be drawn and injected into the sick
child. There is reason to believe that we may soon have a scarlet fever
antitoxin, produced from horses in a manner similar to that in use in
making antitoxin for diphtheria.
The successful treatment of scarlet fever with its many complications
demands great skill. There is no disease in which the outcome depends
more on judicious medical management and careful persistent nursing
than in scarlet fever.