Part 4 (2/2)

There is no danger of his taking cold, provided the body be covered sufficiently. The room ought not to be too warm, as a hot room will increase the tendency of the blood to the head; 65 to 70 is perfectly warm enough. I would rather have it between 60 and 65.

76. The _sitz-bath_ may be taken in a small wash-tub, if there is no proper sitz-bath-tub at hand. It should be large enough to allow the water to come up to the navel of the patient, and to permit rubbing. Too large a tub would not allow the patient to sit in it comfortably. If there is no tub to fit, a common bathing-tub may be raised on one end, by putting a piece of wood under it, so as to keep the water all in the other end, allowing the feet of the patient to be kept out of the water.

This latter practice is more convenient with very small children, with whom, however, the sitz-bath will scarcely be required, a half-bath of sufficient duration being almost always efficient. It is not advisable for persons little acquainted with the use of water as a curative, to let the patient stay very long in the sitz-bath, it being safer to pack the patient again, and to repeat the sitz-bath after the pack, if his delirium is not removed, or not lessened in half an hour or three-quarters of an hour. This alternating with the pack and sitz-bath should be repeated, till the head becomes clear.

77. In excessive heat and continuous delirium, a half-bath may be given, also, every time the packing sheet is changed. The rule is that _we_ ought not to yield, but the _symptoms must_; and they will, if the treatment is persevered in. Only go at it with courage and confidence.

There is nothing to be apprehended from the treatment: where there is too much heat, there is no danger of a lack of reaction, and consequently no occasion for fears that the rash might be ”driven in.” A physician afraid of using water freely in violent cases of scarlet-fever, would resemble a fireman afraid of using his engine, for fear of spoiling the house on fire.

78. ACTION OF THE SITZ-BATH EXPLAINED.

The _sitz-bath_ acts in a direct manner upon the abdominal organs and the spine, and through the latter on the brain. Indirectly, it helps in removing the inflammatory and congestive symptoms in the throat and head, by cooling the blood, which circulates through the parts immersed in the water, and by doing so cools also the upper parts of the body, equalizes the temperature, and diminishes the volume of the ma.s.s of the blood, thus making its circulation easier, _whilst it has no tendency to impede the action of the skin_. Besides, the abstraction of electricity, by the sitz-bath, should be taken in account of its action. After the sitz-bath, the reaction takes place in those parts which were immersed in the water, thereby making the relief of the upper parts more lasting.

79. RELAXATION OF TREATMENT TOWARDS THE END OF THE THIRD PERIOD--CONTINUATION OF PACKS DURING AND AFTER DESQUAMATION.

When the patient is through the first part of the period of efflorescence the symptoms decrease, and he will be easier. Under the treatment prescribed, the time when the excitement is highest, is much abridged, and usually the treatment can be relaxed in less than twenty-four hours. When the patient is easier, the treatment may be given as in the milder form of scarlatina anginosa, with due regard to the state of the throat. In proportion as the heat abates, the packs should not be repeated so often, the sheet not changed; the patient should stay longer in the packs, and the baths should be shorter. The sitz-bath would then be out of season. The packing should be repeated whenever the symptoms increase again; but even if they should not, one pack and bath a day are necessary.

80. During and after desquamation, the treatment should be continued as indicated in milder cases, except the throat continue troublesome, when more packs should be used. If the throat is well, the patient may leave his room by the sixteenth day, under the precautions given above.

81.--3. TREATMENT OF TORPID FORMS OF SCARLATINA--DIFFERENCE IN THE TREATMENT POINTED OUT.

When the _reaction_ is _torpid_, the pulse small, weak, quick, the skin dry, the rash slow to appear, and when it appears in small, pale, livid spots, instead of bright scarlet patches (16-25); the treatment ought to be calculated to produce a short, but powerful, stimulus upon the surface of the body, after which a long pack should a.s.sist the organism in producing a slow, continuous and increasing reaction. If in violent reaction a repet.i.tion of short packs and long cooling baths is indicated,--in torpid reaction, cold and short tonic baths or affusions and long packs are required, in proportion to the degree of the reactive power of the patient. Therefore the packing sheet should be very cold, but thin and well wrung out, so as to make a strong, but transitory, impression, soon overcome by the reaction it calls forth, upon which all our success depends. The patient stays in the pack till he becomes quite warm and tired. Perspiration is seldom produced; if it is, it may be considered a favorable symptom. I have had patients stay in the pack for four, five, six and seven hours, and almost always, when I took them out, their skin was covered with eruption. The only phenomenon, which should induce the physician to relieve the patient of the pack before he becomes perfectly warm, is increased delirium, which in torpid reaction, indicates a tendency to a typhoid character of the disease, when the warm and moist atmosphere of the long pack would be more favorable to the disease than to the patient, by weakening the nerves still more. In that case, a long half-or sitz-bath is required, the former, under constant rubbing, from 15 to 20 minutes, the latter from 30 to 40 minutes; the temperature of either from 65 to 70.

82. LENGTH OF PACK.

Usually it is time for the patient to come out from his pack, when the pulse becomes fuller and stronger, the face begins to flush and the head to be affected. Frequently he sleeps till awakened by the increasing heat. A drink of cold water will quiet him for a while, which may be administered by means of a gla.s.s tube (julep-tube), in order not to disarrange the pack by lifting him up. As long as the head is not affected, there is no danger of his staying too long. The longer he can stay, the surer the eruption will appear.

83. COLD AFFUSIONS AND RUBBING.

After the pack, the patient is placed in an empty bathing or wash-tub, and cold water (of 65-60 Fahr., only with very young and delicate children a little higher, with adults rather lower) is thrown over him in quick succession by means of a dipper, whilst he is well rubbed all over his body, especially the extremities. Not too much water should be poured over the head; however, the head should be always wetted first.

This process should not last longer than a minute or two, except the patient continue very warm during it, in which case it should be prolonged, as the perfect cooling of the body is necessary to prevent the fever from coming on soon after and the patient continuing weak.

After the bath, he should be rubbed dry, first with the bare hands of the attendants, and then with a dry sheet, and put to bed again, or, if he feel inclined to stay up, dressed warmly and be induced to walk about as long as he can.

84. ICE-WATER AND SNOW-BATH IN MALIGNANT CASES.

If no rash appear during the first pack, which will scarcely fail, the proceeding should be repeated, and the patient stay longer in the pack than the first time. In very bad cases, when the patient fails at once under the action of the poison (malignant scarlet-fever) iced water or snow may be resorted too. I know several instances of patients, having been given up by their physicians, reviving again under the influence of a snow-bath, which produced a healthy reaction, when nothing else was of avail. I have never had occasion myself to resort to such extremes, cold water having always answered my purposes; but I would not hesitate a minute to use snow and ice in a case where I could think it useful and necessary. Such proceedings _look_ cruel; but it _is_ decidedly more cruel to let the patient's life be destroyed from want of timely a.s.sistance. I distinctly remember a case, which occurred in Ca.s.sel, when the physician objected to ”tormenting the poor boy,” and wanted the father to ”let him die in peace.” But the father,[33] who had some knowledge of, and a great deal of confidence in hydriatics, put the little patient, a boy of 8 or 9 years, into a bathing-tub filled for the greater part with snow, covered him over with the cold material, and left him there till he became conscious; then he was rubbed all over, placed in a dry pack (without a sheet), and left to perspire, which ensued and brought out the rash. The patient was out of danger in four hours' time, and Dr. S., on calling again in the evening, was quite astounded at seeing him alive, out of bed, and covered with a tolerably bright eruption.

85. WINE AND WATER, IF NO REACTION CAN BE OBTAINED.

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