Treatment. Whatever may be the precise cause of petechial fever it is largely connected with and maintained by an unhealthy condition of the blood, and especially with the presence of toxins and waste products in that liquid. The first consideration is to secure for the patient the best possible sanitary conditions. A roomy loose box, dry, clean, well lighted and well aired, nourishing, easily digested food—green food, carrots, turnips, or mashes—and pure water are desiderata. A sunny exposure is desirable especially in winter, and everything like chill should be guarded against. Blanketing may be called for in cold weather, but the circingle like the halter should be avoided as being calculated to cause indentation, cracking or sloughing of the swellings.
A moderate action of the bowels should be secured by the nature of the food (linseed meal or tea), or by small doses of saline laxatives (sodium sulphate) or calomel. Suppression of the urine too, must be counteracted by diuretics (saltpeter, oil of turpentine) when necessary.
Further internal medication has been aimed to correct the dilatation of the capillaries, and to prove antidotal to or to eliminate the poisons present in the blood.
As vaso-motor stimulants have been employed ergot, belladonna, tannic, sulphuric and hydrochloric acids, oil of turpentine, iron sulphate, potassium bichromate and chlorate, quinia sulphate, and strychnia sulphate and arsenate. The value of any one of these is dependent on its early employment, the slight character of the lesions and the remissions that so often occur even in severe attacks. None are of much account in a violent attack at its worst.
In the slighter cases ergotin, 5 grains daily in two doses, has been apparently useful. An objection is that its continued action on the nerve centres and digestive organs is liable to prove depressing and injurious. Of the acids, tannic is liable to engender constipation, locking up the injurious products to which, however, it acts to some extent as an antiseptic. Sulphuric and hydrochloric acids have a tonic effect, and the latter is a stomachic under ordinary conditions. The same may be said of the iron salts and to some extent of oil of turpentine, which have both proved useful in favorable cases. Cadeac condemns ol. terebinth as calculated to abolish kidney secretions. The potash salts, bichromate and chlorate, and quinia sulphate are decided antiseptics and though the admissible dose would not ensure the destruction of bacteria, yet, acting in the system, with leucocytes and leucomaines, they may serve by keeping them in check. The chlorate of potash is given to the extent of an ounce the first day, and of half an ounce on succeeding days. The quinine salt is given in half ounce doses once or twice daily. In combination with bitters they seem to be of material value. Nux vomica (1 dram) or strychnia sulphate or arsenate (2 grains) given twice daily has seemed to be among the most promising agents of this class. As a potent vaso-motor stimulant, a bitter tonic and stomachic, strychnia has seemed at times to rouse the vitality and enable the system to throw off the load of poison that depresses it. The wonderful power of adrenalin chloride as a vaso-motor stimulant more than warrants its use both locally and generally. In using any one of these agents, we should not neglect concurrent attention to the bowels and kidneys, to antisepsis internally and externally, to hygienic and tonic measures generally.
Antiseptic agents have been given by the alimentary canal, the skin, the subcutis, and the air passages.
By the stomach the following have proved more or less useful in checking gastro-intestinal fermentations, and perhaps in hindering absorption of toxins from the specific lesions on this track: phenic acid, creolin, lysol, ichthyol, boric acid, salicylic acid, sodium salicylate and hyposulphite, and calomel.
To the superficial swellings, fissures and sores the same agents may be freely applied, alone, or combined with astringents, such as alum, lead acetate, aluminum acetate. In the hot season they may be applied cold, whereas in the cold weather hot applications are often preferable. Aruch claims excellent results from covering the engorged head with a woolen cloth and irrigating it with cold water.
The question of drainage of the worst cutaneous swellings by scarification, has been variously dealt with, Dieckerhoff advocating deep incisions, while Friedberger and others forbid them as encreasing the tendency to necrotic infection and sloughing. In the slighter cases it can well be omitted, but in extensive swellings the disintegrating and debilitating action on the tissues is so great as to well warrant its prevention by incisions and drainage. It is well to first give the surface a soapy wash, then apply a mercuric chloride or carbolic acid lotion and lance it in the prominent and tense portions. As a further precaution against septic infection it may then be covered by cotton soaked in one of the above lotions and covered with a bandage. For swellings beneath the abdomen or chest this may be held in place by loose circingles. Scarifying becomes imperative in case of paraphymosis arresting the flow of urine. Deep fissures and sores following sloughing may be treated with mercuric chloride solution, (1:1000), creolin or phenic acid (2:100), iodoform, dermatin, naphthalin or salol.
Disinfection of the nasal passages has been attempted by pervading the air with carbolic acid, creolin, cresyl, lysol, or naphthalin, by hanging saturated cloths in the stall, or spreading them on the floor. Perhaps a better method is to flush out the nose, by injecting each chamber in turn with a piece of rubber tubing, one end of which is introduced into the nose, and the other raised four feet and furnished with a funnel. The injection may be 1 dram creolin to 2 quarts water, or carbolic acid or alum may be substituted or alternated.