Part 4 (1/2)

66.--2. TREATMENT OF THE VIOLENT, OR STHENIC FORM OF SCARLATINA ANGINOSA.

The _violent_, or _sthenic form_ of scarlatina anginosa becomes dangerous only through the excess of reaction, when the heat is extreme (upwards of 105 Fahrenheit, sometimes 112 to 114), the pulse can scarcely be counted, as it hammers away full and hard in a raging manner, the throat being inflamed and swollen to suffocation, and the patient in a high state of delirium; but it need not frighten the physician or parent acquainted with the use of water. We have the means of subduing that violence without weakening the patient. It is in this form of scarlatina that the greatest mistakes are committed by physicians unacquainted with the virtues of water, and that our hydriatic method shows itself in all its glory; for where there is an abundance of heat, water cannot only be safely applied, but it is also sure to bring relief. It is in this form of the disease that the cold affusions recommended by Currie and his followers, have shown themselves so beneficial, and that the wet-sheet, used properly and perseveringly, is almost infallible.

67. TEMPERATURE OF THE WATER--DOUBLE SHEET--CHANGING SHEET.

The water for the wet-sheet pack, in this violent form, ought to be cold; in summer it should be iced down to 46-48 Fahr. The sheet ought to be coa.r.s.e or doubled, in order that it should retain more water, and it should not be wrung out very tight. In a thick wet-sheet the patient will be better cooled than in a thin sheet, and he will be able to stay longer in it before changing. It may be advisable, however, with very young and rather delicate persons, not to double the sheet about the feet, as they might be apt to remain cold, which would send the blood more to the head. But, although the patient will feel easier in the pack for a while, the heat and fever will soon increase again, and, in proportion as the sheet grows warmer, he will become more and more restless, and the changing of the sheet will become indispensable. When the symptoms increase again, in the second pack, the sheet is changed a second time, and so on till the patient perspires and becomes relieved for a couple of hours or longer; which usually happens in the third or fourth sheet. After the first, every following sheet is wrung out tighter and tighter, and the last one may be taken single, or doubled only at its upper end.

68. LENGTH OF PACK--PERSPIRATION.

To make quite sure of the reaction, the single sheet may be tried first, except in exceedingly violent cases, and the double sheet may be resorted to, if the single sheet prove inefficient. Or, should there be any doubt, the double sheet may be dipped in water of a higher temperature than that given above, say 55 to 60. With young and delicate children I prefer this course, especially if they be very excitable, and the shock of very cold water may be expected to be too much for their nerves. In these matters some discrimination should be used: it is always better we should keep on the safe side, and rather give a pack more than frighten the little patients out of their wits.

Proceed safely, but firmly and try to obtain your object in the mildest manner possible.

69. Before perspiration comes on, there is a little more excitement for a few minutes (41), which must not induce the friends of the patient to take him out of the pack; only when it continues to increase, instead of the perspiration breaking out and relieving the patient, it will be necessary to change the sheet, another time, as in that case the organism is not fully prepared for perspiration. After the breaking out of the latter, the patient invariably feels easier, and continues so for some time. When the feverish symptoms increase, during perspiration, which can be ascertained by feeling the pulse on the temples and by the thermometer, it is time to remove the patient from the pack, to give him his bath. Half an hour's perspiration is commonly sufficient; if the patient feel easy, however, and can be prevailed upon to stay an hour, or longer, till a good thorough perspiration brings permanent relief, it will be better. It would be unwise to let the patient stay too long and get him in a state of over-excitement; but, on the other hand, parents ought to remember that very few children _like_ to be packed, and that a patient in high fever is a bad judge of his own case. I have always found those children the best patients, who had been brought up in strict obedience to their patients' dictates, before they were sick, and this, as well as the daily habit of taking baths, and the quiet and firm behavior of the physician and friends of the patient under treatment generally remove all difficulty.

70. LENGTH OF BATH.

Although the temperature, in sthenic cases, should be a little lower than in erethic cases, it is not advisable to use the water very cold, as this would cause too strong a reaction, and consequently new excitement. The safer way is to let the temperature of the bath be between 70 and 65, according to the age and const.i.tution of the patient (the younger and more delicate the patient, the higher the temperature), and to let him stay long enough in the bath to become perfectly cool all over, which can be ascertained by placing the hand or the thermometer under the arm-pits, which usually retain the warmth longest. I understand, in advising such a temperate bath of several minutes, duration, that the patient be hot and the rash standing out full and bright on coming from the pack; or else the bath must be colder and shorter, not exceeding a minute or two.

71. CAUTION.

After the bath, the patient is rubbed dry, and either taken to his bed, or, if he feels well enough, dressed and induced to walk about the room, or placed in a snug corner (not near the fire, however), till he feels tired and wishes to go to bed. During his stay out of bed, the rash ought to be an object of constant attention for his friends; for as soon as it becomes pale, the patient ought to be sent to bed immediately and covered well, or should then the rash continue to become paler and paler, the pack should be renewed, and the patient kept in bed ever after, till desquamation is over.

72. THE WET COMPRESS.

In bed, a wet compress is put on the throat, and another on the stomach, which, beside the direct influence it has on that organ, acts as a derivative upon the throat and head, and as a diaph.o.r.etic upon the skin, a.s.sisting in allaying the fever and heat. This compress on the stomach is an excellent remedy with small children and infants in a restless, feverish condition. I often use it, even with infants scarce a week old, and always with perfect success. I wish, mothers could be made to subst.i.tute it for paregoric and the like stupefying stuff, to procure their crying infants relief and themselves rest. There is more power in the compress than any one who is not familiar with its use, can imagine.

At the same time it has a very good effect on the bowels, which should be kept regular, either with the a.s.sistance of tepid injections, or, if they fail to operate, with a moderate dose of castor oil. If possible, however, avoid the irritation of the digestive apparatus through medicines, which are apt to counteract the external applications, whose object is to draw the morbid poison as early and as completely as possible to the skin.

73. HIGHLY INFLAMED THROAT--CROUP.

If the _throat_ is in a highly inflamed condition, repeated packing is the surest means of allaying the inflammation and preventing _croup_.

Although I have had very bad cases under my hands, I never saw a case of scarlet-croup under water-treatment. All you have to do is, to pack your patient early enough and often enough to keep the inflammation down, to keep a wet compress on his throat and chest, and, in general, treat him as I have prescribed. The condition of the throat will improve in proportion to your perseverance in packing.

74. NECESSITY OF ALLAYING THE HEAT.

The packs and baths should be continued, even when the patient cannot be prevailed upon to stay long enough in the packs to perspire. The heat of the skin and the general inflammatory condition of the whole organism _must_ be allayed, especially, when there is much _delirium_. In that case, the patient ought to be kept long enough in the bath to clear off the head, and care ought to be taken, that he should never stay in the pack to become much excited.

75. THE HALF-BATH--THE SITZ- OR HIP-BATH.

Should the half-bath or shallow-bath (which are technical terms for the bath described above), not be sufficient to relieve the head, the patient must be placed in a _sitz-_ or _hip-bath_ of 65 to 70 and stay there, with his body covered by a blanket or two, till the head is easy.

During and after the sitz-bath, the parts exposed to the water, as well as the lower extremities, should be rubbed repeatedly, to favor the circulation of the blood. The head should be covered with a compress, dipped in cold water and but slightly wrung out, to be changed every time it becomes warm. The time required will vary according to the condition of the patient, from half an hour to one hour and a half.