–An infectious or zymotic fever like measles, characterised by a bright red rash covering the body, and making it the colour of boiled lobster; sore throat, high fever, with delirium, and ending in peeling off of the cuticle or scarf- skin. The disease commences to show itself on the parts covered by the clothes, and soon spreads over the whole body. This is one of the marks which distinguish it from measles, which appears first on the face. Then in scarlatina there are no cold symptoms, which are so marked in measles, and the skin is dry and free from the peculiar “mousey” odour which the bodies of measles patients emit.
About a day before the rash appears the scarlatina patient feels ill, vomits his food, and, if a child, possibly has a convulsion; fever sets in, sore throat is complained of, and when looked at the throat is seen to be red. When the disease runs a favourable course, the eruption fades in a few days, the fever declines, the throat gets better, and in a week the skin begins to peel.
The dangerous complications to be feared are the sore throat becoming diphtheritic, when there will be an acrid offensive discharge from the nose (but this does not come on at the very beginning of the disease, as is the case with nose-running in measles); spreading of the inflammation to the ears through the throat, and inflammation of the glands of the neck; and inflammation of the kidneys and dropsy. All these are dangerous conditions, and demand skilled medical attention.
It must be borne in mind that scarlatina may sometimes exist and run its course without any rash. There is generally sore throat, followed by peeling of the skin, and at times inflammation of the kidneys. When scarlatina breaks out in a house, where some members of the family have had it before, the latter may take it in this modified form, if they do not take measures to escape it.
Scarlatina is infectious from first to last–from the time that the fever sets in until the peeling stage is complete. It is this that makes it such a tedious disease to treat. The patient must be put in quarantine the whole time, which is generally six weeks.
For Diagnosis. see MEASLES.
General Treatment.–By way of prophylaxis, when scarlatina breaks out in a house, all those who have not had the disease should take a dose of Belladonna 3, night and morning. This will almost certainly prevent the disease spreading.
The usual treatment for fever patients must be adopted. A well- aired, well-warmed room from which all carpets and superfluous furniture have been removed,is the first requisite. A sheet hung over the door outside, moistened from time to time with some disinfectant, is a useful precaution, and serves as a warning to passers. When the eruption comes out, the patient should be sponged three times daily with vinegar and hot water (one pint of vinegar to four of hot water).
After the fever is over the greatest care must be taken to guard against chills. The patient should be rubbed all over with salad oil at bed-time, and sponged with warm water in the morning. The clothing should be warm. So long as there is peeling he should not go into the open air.
The diet must be gruel, barley-water, water, beef-tea, and milk. No solid food must be given so long as there is any fever.
The poison of scarlatina is very difficult to get rid of, and the most careful measures of disinfection are required. The bedding used by the patient should be either burnt or baked. The linen must be soaked in a strong solution of carbolic acid before being sent to the wash. In the room he has occupied sulphur must be burnt, with doors and windows securely closed. The room should be left so for twenty-four hours, and then the windows opened wide till the smell of sulphur has gone. It may then be washed. Toys and books should be burnt or baked. Disinfection should be carried out by professional sanitary authorities when available.
Medicines.–(Every hour when the symptoms are very acute, and less often when not so urgent.)
–Before the eruption appears; high fever, restlessness, anxiety, tossing about, head hot, hands and feet cold.
–Eruption bright red and smooth; throat and tongue dry and burning; great thirst, with difficulty in swallowing; throat bright red, jaws stiff; delirium. (Belladonna is the chief remedy in typical cases of the disease.)
–After Belladonna, when the latter does not seem to act. Ulceration of the tonsils, increase of mucus, and swelling of tongue, throat, and tonsils.
–When the eruption does not come out well.
Rheumatic symptoms worse by movement.
Rhus. t. 3.
–After Belladonna, when there is delirious talking, with dry tongue and pricking of the lips. Rheumatism and restlessness. After the fever, when the neck begins to swell.
–Children very cross; eruption dark in colour and scanty; diphtheritic membrane on throat.
–Great prostration; eruption pale, scanty; ulcers of the throat turn livid about the edges and emit an offensive odour. Arsen. may follow Rhus,if insufficient, when the glands of the neck swell; also when dropsy follows taking cold.