Again, there is a malignant form of the dis ease, in which there are great brain disturbance. convulsions, and low muttering delirium. The tongue is dry, the throat dark-red, ulcerated, and sloughing. The rash comes out late, and speedily disappears. Death may occur before the rash has time to appear.
Scarlet fever occurring at or immediately after childbirth assumes very fatal characters.
The results of scarlet fever are many. Ab scesses may form in the throat or in the glands at the sides of the jaw ; suppuration may occur in the nostrils and in the eustachian tube (p. 464) leading to the ear. Disease of the ear, accompanied by discharge and ending in deaf ness, is common. Various affections of the membrane surrounding the heart (pericardium, p. 318) and lung (pleura, p. 359) may arise. Rheumatism is apt to follow. The commonest result is inflammation of the kidneys (p. 399). Inflammations of the eyes are not infrequent.
The infection of scarlet fever is undoubtedly at its worst during the shedding of the skin, but not at this period only. It is very probable that the sore throat is also infectious, and that therefore the disease is " catching " from its commencement to its termination. • Treatment —Disinfection should be practised from the beginning in the manner advised on p. 616. At the beginning of the disease nothing is more valuable than the warm lysol bath (see p. 508), which should be daily repeated.
If the fever runs high, the cold sponge (p. 510) should be substituted. The patient should be kept strictly to bed in a well-ventilated room, in which a fire is kept burning. For food,
milk, to 3 pints, according to age, every 24 hours, is the best, given every hour diluted with barley-water, soda-water, or aerated water. To encourage the action of the skin and kidneys the ammonia and ether mixture is valuable (p. 511), and the treatment detailed on these pages is applicable. Inhaling the steam of boil ing water or sipping warm milk relieves the throat. A warm application over the throat may also be used if the pain is severe. Some times nothing is so soothing as allowing a piece of ice to melt in the mouth, and with children giving a tea-spoonful of iced milk or water now and again. When the skin begins to separate, the body, after the bath or sponging, should be rubbed all over with carbolic or camphorated oil. This prevents the scales of the skin being scattered through the air. This should be re peated daily till all the skin has separated. The patient should not be permitted to leave his room or mix with others till all the skin has been shed, and then only after proper disinfec tion. See pp. 516, 517.
Milk should be the exclusive diet till the fever has ceased, and after that, milk with bread, and bread and butter, and milk puddings made without egg, should be the diet for other three weeks.
All cases should be in the care of a physician. Discharge from the ear should, from the very first appearance of it, be treated as advised for that affection on p. 490.
If the kidneys become involved, the hot bath should be given (p. 509), followed by a dry pack, or the hot pack only may be given and repeated once or twice daily.