Scarlet Fever-- Scarlatina.

- RUDDOCK.E.H,

(A popular idea exists that when the disease is severe it is termed Scarlet Fever, but when mild, Scarlatina; the terms, however, are strictly synonymous.)

Like Measles, Scarlet fever is infectious and contagious, but it is much more to be dreaded. It chiefly affects children, and usually occurs but once in the same person. During the epidemic in London (1869-70), however, instances were comparatively numerous in which the disease occurred a second time in the same person. The second, third, fourth, and fifth years of life are those in which it is most prevalent; after the tenth year its frequency rapidly declines. The opinion that the disease does not attack children under two years of age is erroneous, for in 1887 the deaths from this disease in England and Wales were 7,859; and out of this number 5,111 were children under five years of age, 435 of these being under twelve months old. in 1910 the deaths were 2,370, and above 2,000 of these were in patients under six years of age. Infancy, then, offers no exemption from severe attacks of Scarlatina; but the most fatal age is generally between five and six.

Tongue in scarlet fever.

As in Measles and in Small-pox , Homoeopathic treatment has been highly successful. All Homoeopathic practitioners have loudly demanded pure air and plenty of it, pure water and careful drainage; and as these matters have been gradually acceded, so has disease abated. Even as it is, the number of deaths is nearly twice as large as need be. Looking back at the Registrar- General's Reports, there is much to be thankful for. We no longer see the number of deaths given as 30,000, 29,000, 30,000, as in former years; the deaths were 14,275, in 1881, in 1895, 4,532, and in 1916, 1,381. In the year 1886 not more than 5,986 were registered, and 6,974 in 1890. In the year 1863 an excessively high rate of mortality prevailed in London, Manchester, Leeds, and many other large towns during that year, ranging from 100 to 120 deaths a week for many weeks, and in the autumn of 1870 the rate of mortality from this disease ion London alone was 108 per week. This high mortality led Professor Huxley, in his address to the british Association for the Advancement of Science, in September, 1870, to remark-- Looking back no further than ten years, it is possible to select three (1863, '64, and '69) in which the total number of deaths from Scarlet fever alone amounted to ninety thousand. This is the return of the killed, the maimed and disabled being left out of sight. Without doubt, the nature and cause of this courage will one day be well understood, and the long-suffered massacre of our innocents come to an end; and thus mankind will have one more admonition that the people perish for lack of knowledge.'. The drop to a rate of 2,370 in 1910 with a larger population speaks well for the work of the Public Health officers since 1870.

VARIETIES.-- There are three varieties, or, more properly speaking, degrees of intensity. it is important to remember that though it be convenient to speak of S. simplex, S. anginosa, and S. maligna, they are not different diseases, but one disease, developing itself more or less perfectly, with greater or less intensity, according to the constitutional condition of its victim and the amount of resistance which the constitution possesses. The nervous system, the skin, the mucous lining of the throat, stomach, bowels, and kidneys, and the function of the circulation, exhibit disturbance in every case, although the degree of that disturbance may vary widely. Again, exposure to the contagion of S. simplex may give rise to an attack of S. anginosa, or S. maligna; and the contrary. Finally, in proof of the identify of the different modes of the fever, the same sequelae are observable after each degree of the disease. It is convenient, however, to describe the fever according to the different degrees of its intensity, viz.-- I. S. simplex.- A scarlet rash, with redness of the throat, but without ulceration. It may be expected to terminate quite favourable under proper treatment. 2. S. anginosa.-- a more severe form of the disease, with redness and ulceration of the throat, and a tendency to the formation of abscesses on the neck. The temperature is high and the disturbance of the circulatory system great. This has many points of danger, and in several ways may jeopardize the patient's life. The throat complication is more likely to be more severe and fatal in winter than in summer. 3. S. maligna-- extreme depression of the vital strength, and great cerebral disturbance, are superadded to the affection of the throat and skin, the fever soon assuming a malignant character. The tongue is brown; there is low delirium; the throat is dark, livid, or even sloughy; the eruption comes out imperfectly or irregularly, or alternately appears and disappears, and is dark rather than scarlet. This from of the disease is always one of extreme danger.


Child with scarlet fever.

GENERAL SYMPTOMS.-- Scarlatina usually commences suddenly, with the ordinary precursors of fever-- chills and shivering succeeded by hot skin, nausea, sometimes vomiting, rapid pulse, thirst, frontal headache, and sore throat. The last-named, symptoms-- sore-throat-- is generally the earliest complained of by the patient. in about forty-eight hours after the occurrence of these symptoms, the characteristics rash is perceptible, first on the breast, from whence it gradually extends to the neck, face, trunk, over the great joints and limbs, till the whole body is covered with it. The eruption is bright scarlet, and consists of innumerable red points or spots, which have been compared to a boiled lobster-shell. These spots either run together, and diffuse themselves uniformity over the skin, or else appear in large irregular patches in different parts of the body. The colour of the skin disappears on pressure, but returns on its removal. The appearance of the tongue is characteristic; it is first coated, the tips and edges are red, the papillae are red and raised; afterwards the tongue becomes clean and raw-looking. A diffused redness, sometimes of a dark claret-colour, covers the mouth, fauces, etc., which disappears as the febrile symptoms and rash subside., On about the fifth day the efflorescence generally begins to decline, and entirely disappears by about the eighth or ninth day, leaving the patient in a weak condition. The subsequent process of desquamation of the cuticle is variable in its duration; it takes place in the form of scurf, from the face and trunk; but from the hands and feet large flakes are separated, sometimes coming away entire like a glove or slipper.
It is not always,. however,that the disease pursues this uniform course. Sometimes the disease occurs without any rash or throat being observed; or the eruption is livid and partial, and attended with prostration so extreme that the patient sinks in a few hours under its virulence.

DISTINCTIVE FEATURES.-- (I) The scarlet rash, already described.-- (2) The high temperature of the body. The thermometer placed in the axilla rises from 98 degree F.-- the natural standard.- to 105 degree, or even 106 degree. -- (3) The papillae of the tongue are red and prominent, and may be first seen projecting through a white fur, or, as this fur clears away, on a red ground,m and this has been termed the strawberry tongue,-- (4) The sore-throat. The throat is congested and swollen round the soft palate and tonsils, and the mucous membranes of the mouth and nostrils are generally involved.

SCARLET FEVER AND OTHER DISEASES.-- For the chief differences between it and Measles, see page 130. In Roseola the eruption is generally irregular, limited to the chest, and the throat symptoms and fever are slighter. The early eruption in Small-pox sometimes resembles that of Scarlet-fever; but the subsequent papular character of the former, and the previous pain of the back, sufficiently distinguish them.

CAUSE AND MODES OF PROPAGATION.-- The poison of Scarlet-fever is of a subtle nature. Streptococci are always associated with it,. and undoubtedly play a large part in producing sequelae. It is doubtful if any streptococcus however can be regarded as the prime cause of Scarlet fever. Its earliest source is distinctly traceable to Arabia, but it has now spread over the whole world. owing to the insanitary condition of their dwellings, it spreads extensively, and with great fatality, among the poor. It may be transmitted by fomites-- in the clothes, bedding, carpets, etc.; this is proved by the fact that medical men have often carried the disease to their own families. The poison may be destroyed by a temperature 205 degree F., or by disinfection and ventilation. The infecting power probably commences with the primary fever, and diminishes as the fever subsides. The danger from desquamation has probably been exaggerated.