The reports of the Registrar-General for 1858 and 1859 show the mortality in London from scarlatina as compared with other forms of zymotic disease :— Scarlet fever visits certain districts as an epidemic, and that whilst in some years it falls down to a level with other diseases of the same general nature, or even below them, it rises at others far above them. During the years 1857, 58, 59, and 60, scarlet fever has-prevailed in London as an epidemic, and has carried off little short of 1'2,000 persons. During these years it has been associated with the disease called diphtheria, but they are distinct diseases and not in any manner produced by the same causes. [DIPUTHERIA.] Scarlatina is often followed by other forms of disease. One of the most frequent of these is anasarca, which frequently terminates fatally.
This disease arises from the morbid oondition of the kidneys. In a large number of CAMs of scarlatina the kidneys are primarily affected, and the urine presents a low specific gravity, and contains albumen. In the anaisarea which comes on after the febrile symptoms have passed away, there is invariably present albuminurie. Tide condition of the svetem often terminates fatally by dropsical effusions occurring in tht the pericardium, or the unembraues of the brain. it sometimes 'mew that an attack of scarlet fever may not obviously produce the tumid skin and throat symptoms, but expend all its force on the internal orgasms especially the kidneys. Under these circumstances anasaras may come on and lead to a fatal result.
Amongst other sequebe or results of the action of the scarlatina] poison is an extension of the inflammation of the throat into the enata.chian tube, and the internal ear. In this way the bones of the oar are destroyed, and ulceration of the tympanum and its destruction follow. Foetid discharges take place, and the whole of the internal ear not I:Infrequently be-comes involved, producing, should the inflammation not extend to the brain and destroy the patient, permanent deafness.
In other capes an affection of the joints, not unlike rheuinatisin, comes on during the attack of scarlet fever. This affection of the joints continues sometimes a long while after the active symptoms of the fever have disappeared.
Scarlatina is an example of a contagious and infectious disease. In the majority of cases the origin of the disease can be traced to exposure to the poison arising from a previous case. The intensity of the poison Weems greater than even that of small pox or typhus. Dr. Watson says," it lurks about an apartment, or clings to furniture and clothes, for a very long time, even after some care has been taken to purify them. Uf this I have known several remarkable example& You will be asked at what period the danger of imparting the disease on the one hand, or of catching it on the other, is over ; and I would recom mend you to answer that you do not know. I am sure I do not." Many persons go through life without catching this disease, and it is most desirable that all should. The only certain way of avoidiug it. is the strictest quarantine. Any thing which has been near the patient, or handled by persons attendipg upon the patient, may com municate the disease. The only certain prevention of its spread in familiea is either the removal of the sick or those liable to take the disease. The spread of the scarlatina] poison is not dependent on dirt and squalor, and other circumstances injurious to health, although the fatality of the disease is greatly increased by these circumstances. The
disease is generated and spread by the poison alone. It is on this account that the greatest attention should be paid in nursing this disease to prevent infected things from passing out of the paticnt'e bedroom. All linen or clothes worn by the patient should be imme diately after they are used placed in boiling water. All vessels used in the bedroom ehonld be immediately emptied after they are used, chlorinated lime or soda, or the permanganate of soda, being added to their contents. The vessels should also be washed and rinsed out with solutions of these substances. After the patient has recovered, every thing in the room that can be placed in boiling water should be submitted to its action, and books, papers, and things which will not bear water, should be placed in an oven. The room should be fumi gated with chlorine, and the walls and ceiling whitewashed.
In the treatment of scarlatina it should be remembered that in the milder cases little or no medicine is required. The patient passes through all stages with little derangement of the system, and the only thing required is to prevent exposure to cold, and to watch for the accession of any of the symptoms of the secludes above mentioned. When the symptoms are more severe an alkaline treatmemt may be recommended. Dr. Watson especially recommends the chlorate of potash with hydrochloric acid. When the throat symptoms are severe in adults, leeches to the throat. or cupping at the nape of the neck have been strongly recommended. Some practitioners recommend, in cases of a low type, small and often repeated doses of sulphate of quinine. Where the pulse is rapid and the tongue becomes dark, the administration of wine is indicated, and where wine fails to stimulate sufficiently, brandy has been given with advantage. The sesquicarbo nate of ammonia, in cased with low symptoms, has been vaunted as a specific : it may be given with advantage in cases in which wine is indicated. Purgatives and saline diapharetics may be administered as the symptoms indicate. The throat demands especial attention where the tonsils are merely swollen a gargle of alum or powdered alum may be applied. When it is ulcerated the tileere may be touched with nitrate of silver or a lotion applied. The chlorate of potash, with nitrohydrochloric acid, may be used as a gargle. Where the ulcerations are fcrtid, syringing the throat with a lotion of chlorinated lime or soda will greatly contribute to the comfort of the patient. There is no one system of treatment that is adapted for all cases, and those writers who advocate one system can have had but little experience of the great variety of forms which the disease presents.
The treatment of the smarm and other sequehe will depend on the symptoms present. When dropsical effusion comes on, the patient will bear more active treatment than in the primary and secondary stages of the disease. Cupping or leeches to the loins is of service, and active purgatives. Thu chlorate of potash may be con tinued in this forte of the disease, and when the more formidable symptoms are subdued, the salts of iron may be administered.
.(Bennett, Principles of Medicine ; Hood, On the Fatal Diseases of Children ; Watson, Lectures on the Practice of Physic; Aitken, The Scirove and Art of Medicine.)