64. In case of some trouble resulting from early and imprudent exposure, which is about as apt to occur in the house as out of it, a pack or two will usually be sufficient to restore order again. As long as the patient moves about, warmly dressed, there is no danger of his taking cold after a pack, and provided packing be continued long enough, and the patient be forbidden to sit down or stand still in cool places, or expose himself to a draught, there is nothing to be apprehended.
65. I have no objection to homœopathic remedies being used at the same time, nor would I consider acids, as mentioned above (39, note), to be objectionable in cases of severe sore throat; but I must caution my readers against the use of any other remedies, especially aperients, except in cases, which I shall mention hereafter (72). In a couple of cases, where I acted as consulting physician, I have observed dropsical symptoms proceeding from laxatives and the early discontinuation of the packs during convalescence. Let the bowels alone as long as you can: there is more danger in irritating them than in a little constipation. As for the rest we have injections, which will do the business without drugs, of which I confess I am no friend, especially in eruptive fevers.
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 coarse 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.