SCARLATINA (originally written Scarlattina, from scarlatts, a red-coloured cloth), Scarlet fever. This disease was not distinguished by the ancients from any of the other eruptive fevers; they contented themselves with classing together all these fevers as pestilential, and they attributed the variety of eruptions that accompanied them to different combinations of the humours. Small-pox, measles, and scarlatina were described by the Arabians, but they looked upon them merely as varieties of the same disease, and even to the close of the 18th century the two last-named maladies were confounded. Dr. Withering, in a second edition of an essay which be published on scarlet fever, in the year 1793,_first pointed out its distinctive characters.
Scarlatina, like small-pox and measles, may appear as an epidemic, or it may be propagated by a specific contagion; as an epidemic, it most usually appears at the latter end of the summer and the beginning of autumn ; sporadically, it is met with at all seasons ; it further resembles the diseases we have just named in rarely attacking twice the same individual Scarlatina varies much in severity, from the mild febrile disturbance which has been pronounced by Sydenham be fatal only through the officiousness of the doctor, to that grave form of the disease which has received the appellation of malignant. This difference has given rise to its division into three species, the Scarlatina simplex, S. anginose, and S. maligns. Scarlatina is ushered in by rigors, followed by increased heat of the body, thirst, loss of appetite, and all the symptoms of inflammatory fever. On the second day of this fever, or somewhat later in the severer forms of the disease, patches of a scarlet-coloured efflorescence begin to appear on the face and neck, which extend downwards, and, coalescing, soon spread over the whole body. On the trunk, however, the rash is seldom uniform, but is distributed into diffuse irregular patches, the scarlet hue being most vivid about the flexures of the joints and on the loins ; occa sionally minute vesicles are visible, and Sauvages has considered this circumstance sufficient to constitute a distinct species, which ho calls S. rariolotles. On the third and fourth days the eruption is at its height ; even the mouth and fauces are not free from it, the papillae of the tongue are unusually red and elongated, and the face is generally more or less swollen. On the fifth day it begins to decline, disappearing by interstices, so that the patches reappear as at the com mencement, and it is generally gone before the end of the seventh. 'Between the eighth and twelfth days the cuticle comes off in the form of a scurfy desquamation, and the fever has spbsided. This is the course of Scarlatina simplex. At those periods of the disease when the eruption is in patches, scarlatina is apt to be mistaken for measles, but it may readily be distinguished from the last-named disease by the following signs :—In measles, the patches are of a rosy hue, of a crescentic form, and elevated above the surrounding skin ; in scarlatina they resemble more the colour of boiled lobster, want the crescentic shape, and the hand passed over them detects minute asperities, but no elevated patches. It is further distinguished from measles by the
greater heat of skin, the temperature being sometimes as high as 108° or 112* of Fahr., by the absence of catarrhal symptoms, and by the state of the papillae of the tongue.
Roseola is the name of an affection which is characterised by an eruption bearing some resemblance to scarlatina ; but it is of a more crimson colour, pursues its course in a direction contrary to that of scarlatina,—namely, from the extremities and trunk to the neck and face,—and is attended with less constitutional disturbance.
Scarlatina accompanied with sore throat—S. anginosa, or cynanchica, as it is termed—is a much more frequent and severe form of the disease than that which we have just described. Not only are the precursory febrile symptoms more violent, but the whole course of the malady is protracted ; the eruption is seldom so universal as in the simple variety, but is in scattered patches, which frequently vanish and reappear ; the interior of the mouth and fauces is of a high red colour, tumefied and painful ; superficial ulcerations not unfrequently form on the tonsils, uvula, and soft palate ; and the throat is much clogged up with a tough viscid phlegm. In S. maligns the fever is of a typhoid character ; the pulse is small and feeble ; the tongue and lips dry, and encrusted with a brown fur ; there is delirium alternating with coma, and the rash is faint and continually coming and going ; the ulcers in the throat are covered with dark-coloured sloughs, and a Large quantity of viscid mucus clogs up the fauces and impedes respira tion and deglutition. These symptoms are often accompanied by diarrhcca, and by petechke on the skin, with hmmorrhage from the nose, throat, bowels, or ether parts, which generally lead to a fatal termination : this may occur on the third or fourth day of the disease, or the patient may linger to the second or third week ; if recovery take place, it is exceedingly tedious. It has been observed that during the prevalence of scarlatina adults are not unfrequently affected with the efflorescence in the mouth and throat, without the skin participating in the affection. For this class of eases Dr: Tweedy has proposed the name of S. fascism. All the varieties of scarlatina that we have mentioned may be observed during the prevalence of the same epi demic, and even among members of the same family ; but it is no less true that each epidemic has generally a certain character or type, which it is important to ascertain in order to regulate the treatment This circumstance renders it difficult to come to any just conclusion as. to the mortality from this disease.