as in measles. Sometimes convalescence is retarded by abscesses forming in various parts of the body; at other times there is a painful affection of the joints which much resembles rheumatic fever. Renal dropsy is also one of the most usual sequelae, but it frequently varies in different epidemics. Its onset is associated with a rise of temperature, headache, and often sickness and vomiting; the face and loose parts of the skin are very pale and puffy, which is best seen under the eyes and on the insteps; the urine is scanty, and dark from containing blood; loss of appetite is common, and convulsions sometimes occur, Renal dropsy often comes on 2 or 3 weeks after the first appearance of the rash.
Treatment.—Most cases recover in a fortnight, except the malignant ones, or where the sufferer is at the same time pregnant (this condition much increases the danger, and hence women should then be extremely careful not to go near a case of scarlet fever). Even the mild cases must be nursed, for there is no remedy which will cut short an attack. The patient must be put to bed and administered a milk diet. Hot flannels or cotton wool, or spongio-piline, should be wrapped round the throat, and steam may be inhaled by the mouth when the throat is sore. If dropsy supervenes it is a symptom that the kidneys are affected, and the patient must be put to bed again if he has been up previously, and the diet still consist chiefly of milk. A hot bath and purgatives must be given to remedy the kidney affection, which is a serious development.
Exposure to cold too soon after an attack of scarlet fever often causes dropsy, so that great care should be taken to keep the patient in the house for at least three weeks after the rash and until the peeling has quite finished. During the stage of peeling, baths containing an antiseptic, such as Sanitas, should be occasionally given, care being taken to see that the water is as warm as the patient can comfortably bear it, and that a warm bottle is placed in the bed, or other precaution used, to ensure freedom from chill. When there is great prostration ammonia may require to be given. The throat may be thoroughly syringed with chlorine water by means of a 4 oz. ball syringe. During convalescence tonics should be administered, for which purpose quinine and iron are probably the best. For the disinfecting measures to be used the reader is referred to the remarks in the earlier part of this section.
Enteric, or Typhoid Fever.—Typhoid or enteric fever is a continuous and infectious fever, caused chiefly by the contamination of drinking water with sewage containing the bacillus of this disease, lasting an uncertain period of from four to six weeks, and sometimes followed by a relapse. It is also known by the names of low, gastric, and drain fever. It seems to have been known from the earliest times. It is always endemic in the British Isles, but is perhaps most common in England.
Causes.—Among the predisposing causes are age, mode of prevalence, months and seasons, temperature and moisture, idiosyncrasy, residence in an infected locality, overcrowding, deficient ventilation, and bad