SCARLATINA, or SCARLET FEVER, is one of the group of diseases called exanthe mats (q.v.). In addition to the characters common to the group, scarlatina is almost always attended by sore throat, and the rash or eruption, which is of bright scarlet color, commonly appears as early as the second day after the manifestation of the febrile symp toms, ana ends in desqnamation of the cuticle on the sixth or seventh day. Most writers on medicine make three varieties of this disease—viz., scarlatina simplex, in which there are the fever and the rash, but scarcely any throat-affection ; anginasa, in which, in addition to the fever and the rash, the throat-affection is the most prominent symp tom; and scarlatina maligns, a name which is applied to certain cases of extreme vio lence, in which the system is at once overwhelmed by the force of the disease. or iu which the symptoms evince an extraordinary degree of weakness and want of vital power.
The disease begins with shivering, lassitude, headache, a frequent pulse, a hot dry skin, a flushed face, thirst, loss of appetite, and a furred tongue. Shortly after the appearance of the febrile symptoms, the throat begins to feel irritable, and, on examina tion, is found to he red, and often more or less swollen. This redness becomes diffused over the interior of the mouth and the tongue. The rash begins in the form of minute red points, which soon become so numerous that the surface appears of an almost uni form red. It first appears on the neck, face, and breast, whence it gradually spreads over the trunk and extremities. The reddened surface is smooth to time touch, and the color, temporarily disappears on pressure of the finger. Along with the true rash, minute vesicles, known as sudamina (q.v.), sometimes occur. The eruption, in ordinary cases, is persistent for three or four days, after which it gradually disappears, and is usually ' gone by the end of the seventh day. The cuticle then begins to scale off in small bran like scurf, or in flikes of varieus sizes. Specimens of an almost entire epidermic cover ing of the hand or foot, forming a natural glove or, slipper, are of common occurrence in our pathological museums; but it is comparatively seldom that such perfect molting takes place. Tile desquamative process is usually completed in a fortnight, or rather more, from the commencement of the disease. The fever does not abate on the appear ance of the rash, but continues in a more or less decided degree through the progress of the case; it often presents exacerbations toward the evening, and is occasionally attended with delirium, or even with comatose symptoms. If the urine be examined, both chemi cally and microscopically, a few days after desquamatiou has set in, it will be found to contain albumen, and to exhibit a large mount of epithelium from the uriniferous ducts of the kidneys (q.v.).
Malignant scarlatina is so terrible a disease that its characteristic symptoms require a brief special notice. The rash comes out late and imperfectly. timid sometimes is hardly perceptible; or, having appeared, it may suddenly recede; and sometimes it is inter mixed with livid spots. The pulse is feeble, the skin is cold. and there is extreme prostration of strength, In such a ease as this, death may occur (apparently from blood poisoning) in a few hours. Other eases rapidly assume it typhus-like character. "The pulse (says Dr. Watson) becomes frequent and feeble; the tongue dry, brown, and trem-s ulous; the debility extreme; the breath offensive; the throat is livid, swollen, ulcerated, and gangrenous; and the respiration is impeded by viscid mucus, which collects about the fauces. Over this variety of the clisea.4e medicine has comparatively little control." Even in scarlatina tinginosa there is very considerable danger. The disease may prove fatal (1) from inflammation or effusion within the head, or (2) from the throut-affeetion, which too often proceeds to disorganization and sloughing of the adjacent. parts. over, in parturient women even the mildest form of the disease is fraught with the greatest peril. Further, when the disease is apparently cured, the patient is exposed
to great hazard front its consequences or sequelx. Children who have suffered a severe attack of scarlet fever are liable (hi the words of the eminent physician to whom We have already referred) " to fall into a state of permanent bad health, and to become a prey to some of the many chronic forms of scrofula—boils, strumous 2rs, diseases of the scalp, sores behind the ear, scrofulous swellings of the cervical glands and of the upper lip, chronic inflammation of the eyes and eyelids. The above-named consequences not unfrequently follow small-pox and measles, but, in addition to these, scarlatina is often followed by the form of dropsy known as anasarca, or serous infiltration of the subcutaneous cellular tissue, frequently accompanied with dropsy of the larger serous cavities. Strange as it may at first sight appear, tins dropsy is much more common after a mild than after a severe form of the disease; but this apparent anomaly is probably due to the fact that less caution is observed in the former than in the latter cases dur ing the dangerous period of desquamation. If the patient (for example) is allowed to go out while new cuticle is still funning, the perspiratory power of the skin is checked by the cold, and the escape of the fever poison through the great cutaneous outlet is thus prevented. An excess of the poison is therefore driven to the kidneys, where it gives rise to. the form of renal disease known as " acute desquathative neph•itis." Scarlatina is a disease that=--like all the exanthemata—occurs in the epidemic form; and each epidemic presents its peculiar type, the disease being sometimes uniformly mild, and in others almost as uniformly severe. The treatment of this disease varies accord ing to the preponderating symptoms. In scarlatina simplex nothing is required except confinement to the house, a non-stimulating diet, and the due regulation of the bowels, which are apt. to be costive. In scarlatina anginosa, cold or tepid sponging gives much relief if the skin is hot. If there is much fever, and especially if delirium supervene; a few leeches should be applied behind the ears, or if the patient were previously in robust health, blood might be cautiously taken from the arm. If, however, no bad head symptoms are present, all that is necessary is to prescribe saline draughts, of which citrate of ammonia, with a slight excess of carbonate of ammonia, forms the best ingre dient, and to keep the bowels open once or twice a day by gentle laxatives. Iu scarlatina maligna there are two main sources of danger, which were first recognized as distinct by Dr. Watson, who describes them as follows: " The one arises from the primary impression of the contagious poison upon the body, and particularly upon the nervous system, which is overwhelmed by its influence. The patients sink often at a very early period, with but little affection either of the throat or skin. If we can save such patients at all, it must be by the liberal administration of wine and bark, to sustain the flagging powers until the deadly agency of the poison has in some measure passed away. But another source of danger arises from the gangrenous ulceration which is apt to ensue in the fauces, when the patient is not killed by the first violence of the contagion. The system is re-inoculated, I believe, with the poisonous matter from the throat. Now, under these circumstances also, quinia, or wine, and upon the whole, I should give the preference to wine, is to be diligently though watchfully given." In addition to these remedies, a weak solution of chloride of soda, of nitrate of silver, or of Candy's disin fectant fluid, should be used as a gargle; or if, as is too often the ease, the patient is incapable of gargling, the solution may he injected into the nostrils and against the fauces by means of a syringe or elastic bottle.