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Scarlatina Scarlet

fever, disease, rash, patient, usually and acute

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SCARLATINA (SCARLET FEVER).—An acute, infectious, febrile disease, by a diffused scarlet rash on the skin, followed by scaling off of the cuticle. It is a very contagious and dangerous disease, usually occurring in epidemics, and often being communicated from child to child in schools and kindergartens. Direct contact with a scarlatina patient is not necessary for the transmission of the disease, for contagion may be acquired by simply staving in the sick-room. Even healthy persons who have been in contact with the patient may, without acquiring the disease themselves, convey contagion to others. Children under ten years of age are most susceptible ; but older children, and even adults, often acquire the disease. Recovery from scarlatina usually protects from a second infection, although cases are known of persons who have been attacked repeatedly.

The onset of the disease is usually acute, beginning with vomiting, lassi tude, headache, and nose-bleeding ; rarely with a violent chill, or general spasms. The temperature of the body soon rises to a considerable height (104° to io6° F.), the fever being accompanied with the development of the scarlet rash. This rash first appears about the throat and chest, is usually uniformly distributed, and consists of many small, red dots. After two days the entire body, except the chin and the upper lip, may be covered with the rash. Pain in the throat and difficulty of swallowing also appear at the onset of the affection. These symptoms are due to swelling and red ness of the palate, tonsils, and uvula, which in some patients may show a dirty grey, smeary layer (scarlatinal diphtheria). The infection causes the glands in the throat and lower jaw to swell, often to the size of walnuts.

In cases which run a favourable course, the symptoms begin to disappear at the end of the first week. The fever subsides, and the rash fades. The swollen glands, however, require a longer time to diminish in size. In the second week the scaling-off process peculiar to scarlet fever commences, the cuticle being thrown. off in large flake-like patches. Not until after the

termination of this desquamation may the patient be considered to be well, and all danger of infection passed. In some instances this process may last up to six weeks ; and during this period the hands and feet must be examined with especial care, because it is often difficult to determine whether the rash has actually disappeared from these parts.

Scarlet fever does not always run as simple and favourable a course as that described in the foregoing. In many patients the eruption may be limited to certain parts of the body ; in others, small white vesicles may develop on a red ground (simple scarlatina) ; and in still others, bluish-red spots (suggilations) may appear. The appearance of these suggilations usually indicates a severe infection. There are also cases of scarlatina which run an exceedingly rapid and Mild course, the disease appearing without any eruption, and being suggestive of scarlet fever only because of the affection of the throat.

Complications are common in scarlet fever. If a second increase in temperature occur after the fever of acute onset had abated, and the patient apparently was recovering, it is probab:e that one of the many dreaded complicating affections is starting. The most important of these compli cations are : purulent inflammation of the middle car ; acute inflammation of the kidneys ; acute bronchopneumonia ; and symptoms of brain involve ment. In very young patients the onset of an inflammation of the ear may be suspected when the little patient is very restless, and frequently raises his hands to the ears. Older patients complain of pain in the ear, and of buzzing and singing noises. If the face or the limbs commence to swell, showing doughy pittings on pressure, and if the urine becomes red and thick, an inflammation of the kidneys is developing. An increase in hoarseness, and a dry, painful cough, are indicative of involvement of the bronchi.

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