[Reprinted from the Philadelphia Hospital Reports for 1892.'] 
NOTE ON THE LOCAL USE OF THE SALICYLATES 
IN THE TREATMENT OF SCARLET FEVER. 
By JULIUS L. SALINGER, M.D. 
Having observed the beneficial action of the salicylate of soda 
and salicylic acid applied locally in ointment, in eczema and other 
inflammatory conditions of the skin, it occurred to me to try their 
efficacy in the most pronounced type of inflammation of the skin, 
namely, scarlet fever. Accordingly, the salicylates were used in 
ointment, and no other medicament employed, the dose varying 
with the age of the child; but no stronger ointment being used 
than twenty grains to the ounce of oxide of zinc ointment. 
Mostly weaker ointments were used, and the salicylate of soda 
being preferred. It may be well, here, to detail a case as an illus- 
tration : 
Herbert S., aged four, was attacked with typical scarlatina, 
beginning with a chill, vomiting, and high fever. Pulse, one hun- 
dred and fifty per minute, thready and weak. Early in the course 
of the second day the rash appeared, which was of the ordinary 
scarlet (boiled lobster) color. Involvement of the throat and glands 
at the angle of the jaw were also among the early manifestations. 
The temperature ran very high, ranging between 104° and 106° F. 
The child was delirious the greater part of the time, and when 
not so complained of great itching and burning of the skin. He 
did not take medicine or food, and rectal alimentation had to 
be resorted to. In this condition an ointment was used, con- 
taining twenty grains of salicylate of soda to the ounce of oxide 
of zinc ointment. This ointment was well rubbed into the 
inflamed skin every four hours. It was observed that after several 
inunctions of the ointment the color of the rash began to fade in 
spots, and that soon after desquamation set in. The temperature 
fell about one and a half degrees after the second inunction. The 2 
SALICYLATES IN THE TREATMENT OF SCARLET FEVER. 
child subsequently recovered, with marked otitis media as a sequel, 
which up to this time, although nearly three years have elapsed, 
is not entirely well, having resisted treatment by the best special- 
ists both in Philadelphia and New York. 
In eight other cases in which I have tried this treatment, and 
in three other cases which have been placed at my disposal by 
medical friends, this treatment has proved very beneficial. It is 
certain that the marked itching and burning of the skin is almost 
instantly relieved, and the period of desquamation is ushered in 
sooner than in cases not so treated, and the temperature is lowered. 
In the cases observed by me desquamation usually began on the 
fourth day after the appearance of the eruption, which is certainly 
sooner than in cases not so treated. Of the fact that the salicylates 
are speedily absorbed, there can be no doubt, as the patients have 
often complained of marked ringing of the ears (tinnitus aurium) 
soon after a somewhat copious inunction. A notable fact, and 
one that will warrant further investigation, is that in none of the 
cases investigated (eleven in all) was there any sign of albuminuria. 
Careful and constant testing failed to show even a trace of albu- 
men. Nor were there any other signs of kidney affection present. 
Whether this was mere coincidence, or whether it be due to the 
salicylates, I am at present not prepared to state; I only note the 
fact. Shakhovsky, in Keating’s “ Cyclopaedia of Diseases of Chil- 
dren,” Yol. I., page 574, goes so far as to state that: “ salicylic acid 
will prevent all complications, such as uraemia, dropsy, diphtheria, 
anginas, and lymphadenitis, and will remove them when present.” 
That it will not prevent or in any way favorably influence the 
disease of the middle ear, I have had ample opportunity of test- 
ing. While by no means claiming for the salicylates used Ideally 
the place of a specific remedy, yet I hold that their judicious use 
favorably influences the disease, in as far as the eruption fades 
sooner, the itching and irritation of the skin are removed, the 
temperature lowered, and possibly the kidney complication pre- 
vented.