The throat and tonsils should be painted inside with the following: Nitrate of silver, 20 grains; dissolved in distilled water, i ounce. The best way of painting or mop- ping this on the throat, is to tie a small piece of sponge very tightly on the end of a piece of whalebone, taking care to touch the tonsils at each application. The diet should be light. Free ventilation is an essential point in the treatment of scarlet fever. It must be secured so as not to expose the patient to sudden cold or chill. Disinfection should be carefully attended to. Scarlet fever sometimes assumes a malignant form. From the very beginning there is a depression of nervous power, the eruption is dusky, and the ulceration of the throat very acute. In this case, stimulants must be given, as wine or brandy and water; but in other forms of the disease, these are seldom needed. Small-pox. Variola. — Character. — This is an infectious eruptive fever, having, in its natural form, a definite course from the moment of infection to its termination. We shall in 36^ MEDICINAL. the first place describe the disease as unmodified, in which its course is divisible into the several phases, or stages, of incuba- tion, invasion, eruption, decline. Incubation. — The stage of incubation, or period during which the disease is being developed in the system, covers a lapse of twelve days from the date of infection, and passes usually without any manifest sign of disease. Invasion. — At the end of twelve days, the symptoms of invasion make their appearance in indefinite febrile illness, principally marked by pain in the back, and at the pit of the stomach. These premonitory symptoms last for forty-eight hours, and vary greatly in degrees of severity — some cases assuming the character of very severe illness, the exact nature of which is not clear. The use of the clinical thermometer will here be found a help in diagnosis. If the temperature of the body be as high as loo degrees, or above that, there will be no room for doubt that a fever is impending. Other circum- stances, such as possibility of infection, etc., will further assist in arriving at an opinion. The severity of the premonitory symptoms has usually a direct relation to the severity of the subsequent eruptive fever. Stage of Eruption. — The premonitory illness having existed for forty-eight hours, begins to decline simultaneously with the outbreak of the eruption, in the shape of minute, red pimples, which feel like millet-seeds beneath tlie skin. They appear first on the upper parts of the body, and last on the legs and feet. In from twenty to thirty hours the eruption is nearly as fully out as it will be. Varieties. — The number and character of the pimples give rise to varieties, which have been recognized and designated as: I. Distinct, or discrete; the spots not being very numerous, and clear spaces of skin being left among them. The fever is slight in these cases. 2. Confluent: in many cases the eruption is more copious, the pimples running together and forming large clusters. In this form the fever runs high, and the dan- ger is greater in proportion to the number of pustules. There may be an intermediate variety. 3. The semi-confluent, in which the clusters occur in patches, leaving other portions of skin free from the eruption. The febrile symptoms are neither so mild, nor so severe, as iii the above varieties.

AI-modernized reading of the original text

The throat and tonsils should be painted inside with the following: Nitrate of silver, 20 grains; dissolved in distilled water, i ounce. The best way of painting or mopping this on the throat, is to tie a small piece of sponge very tightly on the end of a piece of whalebone, taking care to touch the tonsils at each application. The diet should be light. Free ventilation is an essential point in the treatment of scarlet fever. It must be secured so as not to expose the patient to sudden cold or chill. Disinfection should be carefully attended to. Scarlet fever sometimes assumes a malignant form. From the very beginning there is a depression of nervous power, the eruption is dusky, and the ulceration of the throat very acute. In this case, stimulants must be given, as wine or brandy and water; but in other forms of the disease, these are seldom needed. Small-pox. Variola. — Character. — This is an infectious eruptive fever, having, in its natural form, a definite course from the moment of infection to its termination. We shall in the first place describe the disease as unmodified, in which its course is divisible into the several phases, or stages, of incubation, invasion, eruption, decline. Incubation. — The stage of incubation, or period during which the disease is being developed in the system, covers a lapse of twelve days from the date of infection, and passes usually without any manifest sign of disease. Invasion. — At the end of twelve days, the symptoms of invasion make their appearance in indefinite febrile illness, principally marked by pain in the back, and at the pit of the stomach. These premonitory symptoms last for forty-eight hours, and vary greatly in degrees of severity — some cases assuming the character of very severe illness, the exact nature of which is not clear. The use of the clinical thermometer will here be found a help in diagnosis. If the temperature of the body be as high as loo degrees, or above that, there will be no room for doubt that a fever is impending. Other circumstances, such as possibility of infection, etc., will further assist in arriving at an opinion. The severity of the premonitory symptoms has usually a direct relation to the severity of the subsequent eruptive fever. Stage of Eruption. — The premonitory illness having existed for forty-eight hours, begins to decline simultaneously with the outbreak of the eruption, in the shape of minute, red pimples, which feel like millet-seeds beneath the skin. They appear first on the upper parts of the body, and last on the legs and feet. In from twenty to thirty hours the eruption is nearly as fully out as it will be. Varieties. — The number and character of the pimples give rise to varieties, which have been recognized and designated as: I. Distinct, or discrete; the spots not being very numerous, and clear spaces of skin being left among them. The fever is slight in these cases. 2. Confluent: in many cases the eruption is more copious, the pimples running together and forming large clusters. In this form the fever runs high, and the danger is greater in proportion to the number of pustules. There may be an intermediate variety. 3. The semi-confluent, in which the clusters occur in patches, leaving other portions of skin free from the eruption. The febrile symptoms are neither so mild, nor so severe, as iii the above varieties.

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