TREATMENT OF 
SCAELET EEYEE 
AND 
ITS COMPLICATIONS. 
BY 
J. HENRY FRUITNIGHT, M.D., 
NEW YORK. 
[Reprinted from the Archives of Pediatrics, December, 1S89. ] TREATMENT OF 
SCARLET FEm AND ITS COMPLICATIONS. 
Because the subject of this paper is a broad one, and its 
discussion can be extended to an undefined limit, I shall invite 
attention more particularly to certain points, such as the treat- 
ment of the fever, the angina, and the specific complicating 
nephritis, otitis, and cervical cellulo-adenitis. Others will be 
cursorily touched upon. It is not anticipated that anything 
new or startling will be offered you in this article. What I 
have to say is based upon my clinical observations, made upon 
nearly one thousand cases of the disease occurring in my own 
practice during the last fourteen and a half years. These cases 
naturally have ranged in severity from those of scarcely a 
week’s duration to those which have dragged their length into 
weary months. The collation and comparison of the clinical 
experiences of many practitioners ought to be both profitable 
and instructive. This last-expressed idea is therefore the motif 
of the present essay. 
Fever of a higher or lower grade, and pharyngeal irritation 
more or less severe, are the pathological factors which will be 
met with in every case of scarlet fever. In every case of the 
disease, therefore, measures must be adopted to combat these 
conditions. I will discuss the treatment of the fever first. 
It has been quite firmly established that the human organism 
can be subjected to a high degree of temperature and not suc- 
cumb. Though this be true, it does not follow that a laisser 
faire policy must be pursued as regards the fever; for in my 
opinion, if the fever can be reduced by art, the patient is made 
correspondingly more comfortable, and whatever tends to 
increase the comfort of the patient assists in directing the 
attack of illness, as a whole, to a favorable termination. 
Before the introduction of the recently-discovered antipyretics, 2 
Treatment of Scarlet Fever and its Complications. 
it had been my custom to treat the fever with aconite. The 
preparation which I employed was the ordinary tincture of 
the root of the plant of the United States Pharmacopoeia. I 
administered it in doses of one-half drop to one drop, according 
to the age of the patient, every hour in the beginning of the 
attack. When the fever had been reduced inconsequence of its 
absorption, I prolonged the interval to every two or three hours, 
according to the register of the thermometer. Aconite is a 
remedy “ which/’ as Dr. Charles S. Wood once aptly said in a 
discussion before the Northwestern Medical and Surgical 
Society of New York City on the use of this remedy in the 
treatment of pneumonia, “should go hand in hand with the 
thermometer.” When the child is less than three years old I 
use the smaller dose, which is increased proportionally with 
older ones. When the temperature is very high, as 105° or 
106°, I have employed with benefit the mode of administration 
of the remedy so highly recommended by Sidney Ringer, of 
London,—that is, one drop of the medicine is given every 
fifteen minutes for one hour, thereafter hourly two or three 
times, after which the interval is prolonged, and its further 
administration is to be decided by the thermometric record. 
Concerning the modus operandi of the drug I shall not speak, 
merely recalling the fact that it is classified as a cardiac sedative. 
Because of this depressing effect upon the heart, its use has been 
condemned by some able and celebrated physicians. I, how- 
ever, have never had any bad results from its use. In the milder 
cases of the disease, and in cases occurring in robust patients, 
the system was enabled to tolerate the medication. In cases of 
an adynamic type, stimulating treatment was also very soon 
inaugurated, which pari passu helped to mitigate, if not to pre- 
vent, any deleterious effect of the remedy on the heart’s action. 
The reduction of the temperature was always quite speedy. 
Without entering upon a detailed history, I will quote from 
my case-book the daily temperatures of several cases. 
First 
Second 
Third 
Fourth 
Fifth 
Sixth 
Day. 
Day. 
Day. 
Day. 
Day. 
Day. 
Cask I 
103° 
101 *° 
101° 
100° 
98|° 
98*° 
Case II 
102° 
101*° 
100° 
o 
00 
05 
98*° 
o 
00 
05 
Case III 
103° 
101° 
100*° 
100° 
99*° 
98*° 
Case IV 
o 
© 
100*° 
100° 
100° 
100° 
99*° Treatment of Scarlet Fever and its Complications. 
3 
Many more could be cited to show the gradual daily decline of 
the fever under the use of the aconite in the doses mentioned, 
but I must forbear, lest the tedium of their recital should 
become wearisome. 
When the phenic series of antipyretics were introduced, I 
abandoned the use of aconite, and employed the former in the 
treatment of scarlet fever. My experience both with di- 
methyloxyquinizine (antipyrin) and acetanilide were not so 
favorable as with aconite. True, the fever was diminished, 
but mv cases did not appear to do so well generally. It 
seemed to me that the reduction of the fever was accomplished 
at the expense of the vitality and general well-being of the 
patient. My patients seemed to suffer more discomfort and 
prostration, while at the same time the respiratory centres 
seemed to be unfavorably affected, as evidenced by palpable 
signs of anxious dyspnoea. Cardiac syncope was also threat- 
ened in a number of cases. The doses were not large, aver- 
aging from two and a half to five grains. I am not prejudiced 
against these remedies, for it is my impression that I was the 
first physician in this country to use antipyrin for fever, and in 
the first public report here in America on its action, which was 
made by me on October 15, 1884, before the Northwestern 
Medical and Surgical Society of New York City, I spoke very 
enthusiastically about it, though it was derided by the late Pro- 
fessor Austin Flint at that very meeting.* But for the reasons 
alluded to I soon forsook the treatment with these newer 
antipyretics, and resumed that with aconite. My later ex- 
perience with this remedy only corroborated my former ob- 
servations, and strengthened me in my belief that aconite was 
the best febrifuge to be employed in the treatment of scarlet 
fever. 
With the hydropathic treatment of scarlet fever I have had 
no experience, since none of my cases have exhibited extreme 
hyperpyrexia, and the medicinal agents have always been 
able to reduce the temperature sufficiently in other cases. In 
the average case of the disease, however, I would hesitate 
* New York Medical Record, vol. xxviii. p. 364, and vol. xxix. p. 
648. 4 
Treatment of Scarlet Fever and its Complications. 
very much before applying this method of treatment, because 
I think that other remedies are preferable. Only when the 
case had become desperate, and death from hyperpyrexia 
stared the patient in the face, could I be induced to resort 
to it. 
During the recent epidemic of scarlet fever last winter and 
spring in New York City, of sixty-three cases of the disease 
treated by me with aconite, only three died, all of which were 
caused by severe cerebral complications, terminating fatally 
within the first three or four days of the attack. 
When moderate hypersemia of the throat exists, very little 
treatment is necessary, yet it is neither safe nor judicious ever 
to ignore even a mild angina. Small doses of chlorate of 
potash, from one-half grain to three grains, proportioned to 
the years of the child, either dissolved in water or placed dry 
on the tongue, will suffice. If the anginose condition be more 
severe, the addition of a few drops of the tincture of chloride 
of iron to the first-named medicine will be beneficial. If the 
pharyngeal inflammation be of a severer grade still, larger 
doses of the martial tincture should be given, even to the 
extent of twenty drops per dose, in combination with the 
chlorate of potash. 
The chlorate of potash must, however, always be used with 
circumspection in children, for they are much more susceptible 
to its toxic action than adults, lest, if too large doses be per- 
mitted, serious nephritic lesions may be produced. In my 
opinion a child should never receive more than three grains 
at a dose. 
If follicular deposits appear in the crypts of the tonsils, I 
ordinarily prescribe the hyposulphite of soda, in doses vary- 
ing from two to five grains, dissolved in a teaspoonful of some 
aromatic water. When extensive exudations of a diphtheritic 
character are present, I have been induced to use, because of 
the good results obtained with the remedy in the treatment of 
diphtheria and diphtheritic croup, the bichloride of mercury ; 
and in the treatment of scarlatinal exudative angina, I must 
confess that equally satisfactory results have been obtained. 
When these remedies seem tardy in their action in the cases 
in which the throat is severely involved, I have supplemented D'eatment of Scarlet Fever and its Complications. 
5 
their use with local treatment, applied by means of the spray 
atomizer. For its solvent action I use trypsin in the presence 
of an alkaline solution, and for its disinfectant and deodorant 
effect, Lugol’s solution in the atomizer, alternately. In all 
cases accompanied by fetor of the breath I use either the 
Lugol solution or a solution of carbolic acid as a spray for its 
correction, whether the case be mild or grave. The treat- 
ment of the exterior of the throat will be considered in 
another connection later in this paper. 
In the course of any case, simple as well as severe, of scarlet 
fever, one must not be astonished to be suddenly confronted 
with any variety of complication, for the specific cause of the 
disease is of such virulence that the point of weakest resist- 
ance in the patient’s organism will most likely be called upon 
to withstand its assaults. The most usual complications are 
acute nephritis with dropsical effusions and albuminuria, acute 
otitis media, and cervical adeno-cellulitis. I have named 
them in the order of frequency in which they have fallen 
under my observation. 
In the treatment of the renal complication, which has 
occurred in about six per cent, of my cases, I insist upon the 
observance of three cardinal principles,—namely, rest in bed, 
warmth of the surface of the body, and an unrestricted milk 
diet. 
When the urinary excretion is diminished and oedema coex- 
ist, I administer a diuretic, preferably the acetate of potash, in 
the usual doses, combined with the tincture of digitalis. At 
the same time free catharsis is procured by the administration, 
at frequent intervals, of small doses of the solution of citrate 
of magnesia in younger children, and the compound jalap 
powder in combination with an additional quantity of calomel 
for older ones. When hsematuria is present, which I have 
seen quite frequently, I have sometimes given, with benefit, 
gallic acid, in three-grain doses, repeated every three hours. 
At other times five drops of the colorless hydrastis in a tea- 
spoonful of water every three hours has been efficacious to 
arrest the bleeding. I also order a daily counter-irritation of 
the region of the kidneys by means of sinapisms. When 
there is great general anasarca and abdominal ascites, threaten- 6 
Treatment of Scarlet Fever and its Complications. 
ing interference with respiration and circulation, in addition 
to the free purgative, hot vapor-baths are prescribed. These 
hot baths are applied in the following manner. The patient, 
stark naked, is laid upon a blanket, and immediately one or 
two bricks, which have been in the mean time thoroughly 
heated by immersion in pails of hot water, and then enveloped 
in flannel cloths, are placed both at either shoulder and at the 
feet, care being taken that they are not put too near the body, 
lest the patient be scorched. Another blanket is then thrown 
over the patient and the bricks. The upper corners of the 
superimposed blanket are brought over and tucked under the 
opposite shoulders, while the other end of that blanket, with 
the lower end of the underlying one, are lapped together 
under the heels of the patient, and the head alone is left to 
protrude from this improvised sack. The patient is retained 
in this hot pack for at least twenty minutes. It is resorted to 
once or twice daily, according to the urgency of the symptoms. 
Profuse diaphoresis directly occurs when the patient is sub- 
mitted to this treatment, always resulting in a marvellous 
amelioration of the alarming and distressing symptoms ac- 
companying dropsical effusions. The patients and their 
friends are apt to complain loudly of this heroic treatment, 
but I can recollect several instances where the child’s life was 
saved from imminent death by it. This hot bath will often 
accomplish the end sought when all other measures have failed, 
and this knowledge is the justification for its employment, in 
spite of such protestations. 
As an able adjunct to this diaphoretic treatment, pilocarpine 
muriate hypodermically and the fluid extract of jaborandi per 
orem have been employed by me. 
The occurrence of symptoms expressive of uraemic intoxica- 
tion demands the remedies appropriate thereto. The convul- 
sions I treat preferably by means of rectal injections of chloral 
hydrate, of the strength of five grains to a drachm of water. 
This dose is thrown into the rectum every fifteen minutes 
until the convulsions shall have ceased. Coma I have always 
combated by speedy and active purgation, by the administra- 
tion of a fraction of a drop of croton oil suspended in a 
blander oil, which is placed far back on the tongue. At the JYeatment of Scarlet Fever and its Complications. 
7 
same time the patient is subjected to the vapor-bath previously 
described. 
Finally, when the more acute symptoms of the renal com- 
plication have abated, I without delay put the patient upon 
some chalybeate preparation, which is to be continued for a 
considerable period of time. I always begin with the muriated 
tincture of iron, and later follow it with the compound citric 
acid preparations of iron with ammonia, quinine, or strychnia, 
according to the special indications of each individual case. 
Occasionally the patient will not tolerate the tincture of the 
chloride; then I substitute for it the acetic tincture of iron of 
the German Pharmacopoeia, with better results. With this 
line of treatment I have lost but three cases of scarlatinal 
nephritis since I have been actively engaged in practice, which 
is a mortality of extremely low per cent, for that complication. 
Though it be the opinion of many that a scarlatinal otitis 
will take care of itself, yet the numerous individuals with 
impaired hearing, traced back to an attack of scarlet fever, 
whom we meet, demonstrate how fallacious this view is. Even 
slight attacks of ear-disease occurring in the course of scarlet 
fever must not be disregarded. The aural complications may 
be varied in nature and location. The most usual one, how- 
ever, is an otitis media, either catarrhal or purulent, and occa- 
sionally diphtheritic. When tenderness and pain are complained 
of in the region of the ear, and symptoms of inflammation 
are developing, I make use of warm fomentations to the part, 
in the form of flannel cloths wrung out of either plain hot 
water or out of a decoction of either poppy-heads, chamomile, 
or hops. In the auditory canal a solution of warm salt-water 
is instilled, to which I have sometimes added a few drops of 
some opiate, or of a twenty-per-cent, solution of muriate of 
cocaine, the amount to be graduated to the acuteness of the 
pain. When the mastoid process of the temporal bone be- 
comes involved, and is hot, tender, and swollen, I apply a 
leech to the part, which soon relieves the tension and con- 
gestion. If the pain should be referred to the tragus, the leech 
should be used there also. By filling the meatus with cotton, 
the leech cannot slip into the ear. If the patient have hsemo- 
philic tendencies, the bleeding from the leech-bite may give rise 8 
Treatment of Scarlet Fever' and its Complications. 
to difficulty in its arrest. I met with such an example a few 
months ago, in which for nearly two hours I was unable to 
stop the flow of blood. 
If by inspection in severe cases we can satisfy ourselves 
that the tympanum is projecting and is highly congested, 
presenting the appearance as though pus was accumulating 
behind it, the membrane should be incised, to liberate the im- 
prisoned matter. This procedure will be followed by a great 
alleviation of the patient’s symptoms. Even if no pus be 
present, but an intense hypenemia only, paracentesis tympani 
should also be done, because by the release of the blood the 
patient’s symptoms will greatly improve. When otorrhcea is 
profuse, whether of offensive odor or not, it is necessary to 
keep the auditory canal clean and free. In the simpler cases 
lukewarm saline solutions are indicated, and when fetor is 
present the addition of a disinfectant and deodorizer, such as 
boric acid, carbolic acid, Labarraque’s solution, or permanganate 
of potash, in sufficient strength, should be added. I have 
used all of them at various times. This washing-out of the 
canal I advise to be done several times daily. After its com- 
pletion the ear is gently wiped out with absorbent cotton, plain 
or medicated. Insufflation of the dry powders I do not use, 
because- I think they would interfere with the free drainage 
and outflow of the discharges, and thus, perlxips, favor a 
possible extension of the inflammation to deeper structures, 
and even to the meninges. 
After all acute symptoms have passed by I make use of 
astringent solutions to arrest the residual otorrhcea, usually 
a solution of the nitrate of silver of five or ten grains to the 
ounce of water. Of this solution a drachm is added to a pint 
of lukewarm water, the whole of which quantity is used at 
one sitting, and the operation is repeated three times daily. 
After the syringing has been done and the canal wiped dry, I 
instil in the ear three to five drops of sweet almond-oil, which 
has been gently warmed in the following way. A teaspoon is 
dipped in warm water; the drops of oil are poured into the 
spoon thus warmed, and from it let fall into the ear. I forbid 
the introduction of cotton pledgets into the ear, but at the 
same time caution strongly against the exposure of the affected Treatment of Scarlet Fever and its Complications. 
9 
side to direct currents of cold air. The course of treatment 
thus conducted has always given me the best results and the 
greatest satisfaction in the management of aural complications. 
In the treatment of disease one can do too much oftener 
than too little. This reflection applies with great force to the 
treatment of cervical cellulo-adenitis. When the laity ob- 
serve the swelling and the oedema on the exterior of the neck, 
the temptation is to do a great deal and a great variety of 
things to relieve it. But what is the result ? By their rude 
and energetic, though well-meant, manipulations, the inflamed 
structures are bruised and further irritated, the inflammatory 
action is increased, and the very result follows, in consequence 
of their active maltreatment, which they had hoped thereby 
to prevent, or at least to dissipate. When there is simple en- 
largement of the glands of the neck, with but moderate in- 
filtration into the surrounding cellular tissue, I tell my patients 
to let it be, to do nothing, for nature will probably be able to 
cause absorption of the diseased products by the time that the 
attack of illness shall have run its course. Usually my pre- 
diction is verified. When the inflammation is of a severer 
type, I prescribe an ointment composed of slightly carbolized 
lanoline or vaseline, which is to be gently stroked with the 
finger-tips, but not rubbed, over the swelled tissues. The 
ointment should be heated a little. I emphasize the injunc- 
tion that it must not be rubbed, lest by such pressure irritation 
should be produced, which should be avoided. If, however, 
appearances indicate that absorption will not take place, and 
suppuration threatens, then I order hot flax-seed and slippery- 
elm poultices to encourage it. As soon as fluctuation is palpa- 
ble a free incision should be made and the pus thoroughly 
evacuated. The resulting wound and cavity are then irrigated 
with a phenated solution of the strength of one to a thousand, 
after which the poultices are continued for a short period. 
When it is evident that suppuration has terminated, basilicon 
ointment, impregnated with a few grains of iodoform, is ap- 
plied to the wound until it shall have healed. The disinfect- 
ant irrigations are also repeated at intervals until the final 
closure of the incision. It is interesting in this connection to 
refer to the case of a little girl, five years old, who came under 10 
Treatment of Scarlet Fever and its Complications. 
my care with an attack of scarlet fever during April last. 
She suffered with a bilateral cervical adenitis. On the right 
side the oedema extended up over the angle and ramus of the 
jaw, over the cheek and molar bone to the upper eyelid, 
causing the eye to close. Much to my surprise, suppuration 
did not occur, but with the gentle treatment outlined above 
the exudation was by degrees entirely though slowly absorbed. 
On the other hand, on the opposite side, which was not so 
highly inflamed, the tissues took on suppurative action, re- 
quiring incision for its cure. Though this patient subsequently 
also developed nephritic and rheumatic complications, she is 
to-day entirely well, having successfully recovered from the 
entire train of dangerous lesions. Though it may be a 
digression, I cannot forbear at this juncture to speak of the 
most formidable case of cervical adeno-cellulitis which has 
ever come under my observation. The patient was seen by 
Dr. J. Lewis Smith and myself in consultation. He was be- 
tween three and four years old, and had passed through several 
weeks of an attack of scarlet fever, during which time he had 
been treated by another physician. We found that he had had 
an extensive cervical cellulitis on the right side, which had been 
accompanied by such profuse suppuration and deep ulceration 
and sloughing, that a cavity large enough to hold an egg 
had been excavated. At the bottom of the cavity the pul- 
sating carotid artery lay exposed to our gaze, and its coats also 
were already quite deeply involved in the gangrenous process. 
We knew of nothing to hinder the fatal issue; ligation would 
have been a delusion and a snare. Early on the following day 
the vessel opened, and in a moment death claimed his own. I 
do not know whether a parallel case is on record, and its rarity 
has induced me to relate it at some length. 
As already intimated, any form of complication may be 
expected in scarlet fever ; among the less rare is acute articular 
rheumatism, for it is met with quite often. Its treatment 
does not vary at all from that suitable in cases of the regular 
idiopathic form of the disease. The salicylates have given 
the best results in my hands, especially when alternated with 
alkalies. The tendency of the rheumatism to involve the 
cardiac muscle and its sac in its embrace is not increased, Treatment of Scarlet Fever and its Complications. 
11 
because it assumes the role of a complication of scarlet fever. 
Certainly, one must be on the alert to forestall as far as possible 
any such trend of the rheumatic poison by watching the heart, 
and, on the slightest suspicion that such a contingency is to 
take place, treatment proper to oppose it must be at once 
inaugurated. 
As regards the chorea, which not infrequently follows this 
combination of scarlet fever, rheumatism, and heart difficulty, 
I would state that I have followed up the treatment just 
alluded to with the administration of arsenic and iron for the 
choreic condition, and of the bromides, sometimes reinforced 
with chloral hydrate, to control the excessive nervous excitation. 
The most formidable and most fatal complication of scarlet 
fever which we are called upon to face, is, in my opinion, 
acute cerebral meningitis, or encephalitis. The symptoms of 
this complication are in the majority of cases developed early 
in the course of the disease, and always with great intensity. 
The prognosis is always much more grave and unfavorable 
than when the cerebral affection is primary. Whether the 
aggressive character of the complication is due to a profound 
saturation of the patient’s system with the specific disease, 
entity of scarlet fever, or to this particular localization of 
inflammatory action in the course of the fever, I am not pre- 
pared to say. True, hyperpyrexia is commonly present in 
these cases, but I do not think the usually severe course and 
fatal result are to be attributed to this factor. Treatment of 
this complication is very unsatisfactory, and I regret to say 
almost always without avail. Iced applications to the head, 
the bromides, chloral, and opium in guarded doses, to control 
the congestion and restlessness, in conjunction with the routine 
treatment of the fever, constitute the measures which I have 
employed. 
Several cases of acute pleurisy with effusion have also come 
under my notice as a complication of scarlet fever, indepen- 
dent of serous effusions attending renal disease. They termi- 
nated favorably, the effused liquid having been reabsorbed in 
consequence of a tonic treatment, aided by the exhibition of 
diuretics, mild cathartics, and counter-irritation to the chest. 
I have had very few complications of the eye, indeed, and 12 
Treatment of Scarlet Fever and its Complications. 
none at all of a serious character. In these mild cases the 
treatment was not modified in any way, but carried out as 
though the eye affection was a primary disease. 
The vomiting, which is usually the initial symptom of 
scarlet fever, does not call for any special treatment, for it 
will cease spontaneously as soon as the stomach shall have 
been emptied of its contents. In a few cases anorexia per- 
sisted, but it was finally controlled with ice-pills, bismuth, and 
lacto-peptine, and carbonated drinks. 
Diarrhoea is more apt to complicate the disease than consti- 
pation. In a number of cases I have witnessed an almost 
intractable dysentery, which required very energetic treatment 
before it was checked. I can recollect one case last winter in 
which the dysenteric discharges continued for nearly three 
weeks. In simple diarrhoea the milder astringents and corri- 
gents, as chalk mixture, bismuth, acetate of lead, with par- 
egoric, have always been efficacious. In the graver forms of 
dysentery, I have obtained the best results from the adminis- 
tration of the elixir of coto bark, in doses ranging from ten 
or twelve drops to half a drachm in a teaspoonful of water, 
repeated hourly. When pain and tenesmus are prominent 
symptoms, I add to the coto from one-half to two drops of 
Squibb’s liquor opii compositus, which is discontinued as soon 
as those symptoms have disappeared. The opium is given 
every two or three hours as the urgency of the symptoms 
indicate. If the patient betray any symptom of narcosis, or 
undue susceptibility to the action of opium, careful watching 
is necessary, and it must be abandoned before its dangerous 
effects should ensue. 
For the constipation any of the milder cathartics will do, 
but what I have used with satisfaction are the suppositories of 
glycerin, which have been lately brought into use. 
Whatever other complications, and to which I have not 
alluded, may occur, they must be treated in accordance with 
those principles which their symptoms and location may de- 
termine ; for, as this paper is founded on my own experiences 
in the treatment of this disease, I have treated chiefly of those 
complications which actually fell under my care. 
It yet remains to consider certain general principles of Treatment of Scarlet Fever and its Complications. 
13 
treatment applicable to the management of the disease. Iso- 
lation of the infected individual is the only prophylactic treat- 
ment of which I know. This quarantine must be an honest 
one, and must be maintained until the period of desquamation 
shall have been fully completed. The attendants are also to 
observe certain obvious restrictions as regards intercourse with 
the outside world, clothing, and other minutiae, with which 
we are all familiar. The sick-room must be properly and 
sufficiently ventilated, and not so hot as the patient’s family 
are prone to have it for fear that the patient may “ take cold.” 
Scrupulous cleanliness about the body-linen and bed-clothing 
is to be strictly enjoined. The diet should be a liquid and 
easily-digestible one, suitable to the age and the condition of 
the patient. If the attack be a mild one, stimulation can be 
dispensed with; but when it threatens to be severe or pro- 
longed, I do not wait until my patient is debilitated before 
resorting to stimulants, but I at once begin with them, in 
order to counteract any such tendencies, and continue their 
use, until convalescence has been firmly established. I employ 
alcohol, preferably in the form of whiskey or champagne, and 
augment its action by the exhibition of digitalis and sparteine 
sulphate. These two last-named remedies I often combine in 
the same menstruum, allowing from two to five drops of the 
tincture of digitalis and from one-sixty-fourth to one-tenth 
grain of the sulphate of sparteine, for instance, in a drachm 
of camphor-water every three or four hours. Sometimes, 
when great prostration is imminent, I prescribe the aromatic 
spirits of ammonia, in addition to the other cardiac stimulants, 
in doses of from three to twelve drops in a teaspoonful of 
water, every fifteen minutes, until the patient shall have re- 
vived. In such cases the food is also administered in as con- 
centrated a form as possible. 
The ordinary disturbances of the nervous system dependent 
upon the presence of fever, the common antispasmodics, as 
the bromides and the like, will control. 
To allay the itching of the skin I have at times employed 
inunctions of feebly-carbolized white vaseline. But it has 
often been a question with me whether it did not interfere 
with desquamation and retard the necessary activity of the 14 
Treatment of Scarlet Fever and its Complications. 
skin. I have therefore often substituted for them, when 
desquamation began, a course of mildly antiseptic tepid baths, 
either carbolated or sublimated, which seemed to me to hasten 
the desquamative process, and to produce a healthier action of 
the skin. 
When the eruption is faint or tardy in its appearance, or 
when it shows a tendency to fade away, in the vernacular “ to 
strike in,” I have resorted to warm baths, to which mustard 
has been added, and to the application of sinapisms to the 
various portions of the body which appear to be the palest; 
besides which, ammonia is administered internally. In the 
majority of cases the eruption then resumes its brilliancy. 
The patient must be confined to the house, even in the very 
mildest type of scarlet fever, and must be protected against all 
exposure to the vicissitudes of the weather. 
The general management of the patient, after having passed 
through the attack, will, from the nature of the consist 
mainly of tonic and sustaining measures, coupled with a 
proper observance of hygienic principles. ARCHIVES OF PEDIATRICS 
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DISEASES OF INFANCY AND CHILDHOOD. 
EDITED BY 
WM. PERRY WATSON, A.M., M.D., 
Attending Physician to St. Francis’s Hospital and to the Central Dispensary (Department of Pediatrics); 
Consulting Physician to St. Michael’s Orphan Asylum, etc., Jersey City, N. J. 
THE ONLY MEDICAL JOURNAL IN THE ENGLISH LANGUAGE DEVOTED 
EXCLUSIVELY TO THE DISEASES OF INFANTS AND 
YOUNG CHILDREN. 
Containing nearly loco large octavo pages per annum. 
The contents of each number will be arranged as follows, viz.: three or four scien- 
tific articles by the ablest teachers of pediatrics in this country and in Europe. The remaining 
space will be devoted to a brief, practical resume of the current pediatrical literature of the 
world, distributed in the following departments, viz.: I. Hygiene and Therapeutics. 2. 
Medicine. 3. Surgery. The publishers are pleased to announce that the very interesting 
and valuable series of articles on the 
THERAPEUTICS OF INFANCY AND CHILDHOOD, 
By A. JACOBI, M.D., 
Clinical Professor of Diseases of Children in the College of Physicians and Surgeons, 
President of the New York Academy of Medicine, etc., 
which began in the January number, 1888, will be continued during 1889. The plan and 
scope of these articles are given in the following extract from Prof. Jacobi’s letter to our 
editor: 
“ I will prepare an essay of ten or twelve pages for every monthly issue of your journal. 
The subjects will be therapeutical. The first paper will probably contain general principle* 
in their application to the disorders of early age. The following will treat of the thera- 
peutics of the diseases of the newly-born, of developmental and infectious diseases, those of 
the organs of circulation and respiration, genito-urinary organs, stomach, and other ab- 
dominal viscera, muscles and bones, skin, nervous system, etc. Other subjects which will 
be treated of afterwards are certain classes of remedies, such as anaesthetics, narcotics, 
anti-febriles, purgatives, absorbents, roborants and stimulants, etc. If there be time and 
room, the most interesting diseases, such as epilepsy, chorea, whooping-cough, and growths, 
may become the subjects of special papers.” 
The series of practical articles on the 
MEDICAL DISEASES OF THE MOUTH IN CHILDREN 
By F. FORCHHEIMER, M.D., 
Professor of Physiology and Diseases of Children, etc. (Medical College of Ohio), 
Cincinnati, O., 
which began in the September number, 1888, will be concluded during 1889. 
It is the intention of the writers of these articles to complete a subdivision of their 
respective subjects in every number of the Archives, so that each issue will contain the 
mature observations of these distinguished authors and teachers upon their respective special 
subjects. 
Subscription Price, $3.00 per Year. 
The volume begins with the January number, but subscriptions may begin at any time. 
J. B. LIPPINCOTT COMPANY, Publishers, 
71a anil 717 Slarhet Street, Philadelphia,