SCARLET FEVER AND SCARLATINA. (Plate XXVII.) Scarlet Fever is extremely infectious, very •.omnion among children, and often more dangerous because of its consequences than on account of the actual fever.
The symptoms of an ordinary case are that the person complains of shivering, weariness, headache and sickness, and sore throat. In chil dren a convulsive fit, instead of shivering, not seldom begins the illness. There is great heat and dryness of the skin, and frequently the dulness and drowsiness of the patient are quite marked. Some amount of delirium is fre quently present. There is thirst, but no desire for food. The pulse is very fast. The appear ance of the tongue is peculiar. It is thinly coated with a white fur, but is red at the edges and tip, and numerous minute red points are seen standing out, giving an appearance indi cated by the phrase : "strawberry tongue" or "raspberry tongue." This, however, is not seen till the fourth or fifth day of the fever. The sides of the jaws are slightly swollen, stiff, and sore. On the second day of the fever the rash comes out. It comes out in fine red points so numerous and grouped so closely that the skin appears red all over. Appearing first on the face, sides of the neck, and breast, it is soon spread all over the body. It is most intense by the fourth day, and begins to fade on the fifth, disappearing before the end of the seventh. The intense redness of the skin may be shown, by contrast, by drawing the point of the finger firmly over it. A white mark is produced, to which the redness quickly returns. The soreness of the throat may be felt a day or two before the fever—it increases up to the time of the rash appearing,—the tonsils (p. 195) being very red and swollen, and in ordinary cases it diminishes when the eruption reaches its height. With the fading of the rash the pulse becomes less quick, the fever lessens, and all the symptoms improve, and in the course of a few more days the fever has departed.
With the disappearance of the rash another peculiarity of the disease presents itself, namely, desquaniation or shedding of the skin. The
scarf-skin begins to separate in fine or large scales, or in large flakes. It begins on the neck and chest, spreads to the other parts of the body, and to the hands and feet last. Some times the scarf-skin of the hand will separate all together as a glove, or that of the foot like a slipper. As a rule, desquamation is not com plete till after the sixth week from the begin ning of the fever.
The chief symptoms are the sore throat, the scarlet rash, and the shedding of the skin.
Scarlatlna.—The attack may be mild, ex hibiting the main symptoms but in a very slight degree, and often after the first day or two the patient is so little affected that he or she seri ously objects to the confinement. It is to this form the term scarlatina is applied. It means Merely a mild attack of scarlet fever. Practi cally, however, the mild attacks are often found to be more serious than the severer form just de scribed. Scarlatina is capable, by infection, of communicating the worst type of the disease, causing rapid death. Moreover, the evil con sequences, so common in the disease, as readily attend the mild as the severe form. In a mild case it is often difficult to impress the patient, or, in the case of a child, its parents or nurse, with a due sense of the risks. Less care is exercised, there is improper exposure, and dropsy or other symptoms of kidney disease speedily appear. The mildest case of scarlatina ought to be treated with the same watchful care as the most severe. There are even milder cases of scarlet fever than those noted. A child is feverish and unwell for a day or two, and apparently becomes quite well, though unusually pale and not strong. No rash has been noticed. But, in a week or ten days after, the glands at the side of the jaws swell, the ears become sore, perhaps the skin peels, or other symptoms lead to the con clusion that the child has suffered from scarlet fever.