Household Medicine, Surgery, Sick-room Management and Diet for Invalids ©1854
Scarlatina is popularly supposed to be a different disease from scarlet fever. This is an error, scarlet fever being merely the technical name of scarlatina. The most severe and the mildest cases are termed by medical men, indifferently, scarlatina, or scarlet fever.
Scarlet fever is comparatively unfrequent after childhood; the cause of this appears to be, not that adults, as such, are insusceptible to the disease, hut that the majority of persons have been affected by it in childhood.
Like most of the other specific diseases, scarlet fever varies greatly in severity,—sometimes it is a disease so malignant as to kill in a few hours, at other times its symptoms are so mild that the patient is almost unconscious that he is ill.
The first symptom of scarlatina in an adult is usually considerable stiffness and soreness of the throat; this is quickly followed by shivering or chilliness, heat of skin, headache, thirst, and frequent pulse. In children these latter symptoms ordinarily precede complaints of sore throat. Among the symptoms less constantly present on the first day of disease are vomiting, and, in children, convulsions.
The rash from which the disease derives its name appears on the second day of illness—i.e.,supposing the child to have sickened on Monday, the rash may be looked for on Tuesday. The rash breaks out first on the throat and chest, it then affects the face and trunk, and extends in two or three days to the legs and arms. When first visible it consists of minute scarlet points; these soon grow so numerous as to unite and tint the skin generally of a scarlet hue. The colour is sometimes as vivid as that of the shell of the boiled lobster; at others, it is only a faint scarlet blush. AVhen the rash is fully out, the face is a good deal swollen, the skin is very hot, the pulse is very rapid; the patient's mind may wander at night; the tongue is intensely red or white, with red points projecting through it, and the throat red and swollen ; there is often, too, at this time, more or less swelling externally, about the angle of the lower jaw on either side. On looking down the throat ulceration of tho tonsils is sometimes visible, but more commonly what at the first moment appears to be an ulcer, is only a patch of adherent secretion. The rash of scarlet fever attains its maximum extent and intensity on about the fifth day.
From this date all the symptoms of the disease quickly subside, and in three or four days may altogether disappear. On or about the fifteenth day—sometimes, however, at a much earlier period—the skin begins to desquamate in small bran-like scales from the surface generally, but from the hands and feet the separation of the cuticle takes place in large flakes.
In a considerable proportion of cases, a fortnight or three weeks after the rash has faded the face is observed to be fuller than natural; and if the feet be examined thoy are found to be swollen; the patient has scarlatinal dropsy; the urine is at the same time small in quantity and of dark colour. Under these circumstances he may be suddenly seized with convulsions.
There are no remedies which can directly cure a ease of scarlet fever. The room in which the patient lies should be carefully kept cool, and freely ventilated ; his bed should be very lightly covered, and all his flannel clothing removed. Cold sponging of the whole surface, when the skin is very hot and the patient does not feel chilly after, affords considerable relief. The bowels should be kept moderately lax. No other medicines are needed in mild cases. In severe cases the treatment varies according to the intensity of the disease. Sometimes danger is occasioned by the occurrence of local inflammation, and at others by extreme debility. In the latter case brandy and ammonia may be demanded; in the former, blood-letting may be required. During the period of desquamation great care must be taken that there be no exposure to cold, as such exposure is generally supposed to favour the occurrence of dropsy. Warm baths are, during convalescence, of considerable advantage; and, should dropsy supervene, confinement to a warm room is essential for recovery.