Scarlet fever (scarlatina)

- Benson.A.R,

Scarlet fever

Scarlet fever is an acute infectious disease, the specific cause of which has not yet been determined. It resembles tonsillitis and diphtheria in its onset. The temperature is high (104° - 1041/2°). There is nearly always vomiting at first, and the pulse is rapid. The child feels very sick and complains of a sore throat, and the skin is hot and dry. The throat when examined appears to be bright red, and often fine pin-points spots, slightly darker than the surrounding mucous membrane, may be detected. These spots are the same as those which later appear on the surface of the skin.
The skin eruption is usually seen in 48 hours after the onset of the disease. It appears first on the face and spreads rapidly over the whole body. The rash, however, sometimes disappears so rapidly from the face that it will not be detected, and it is always wise to examine the body carefully. The rash consists of bright red dots on the skin, so close together that they are scarcely distinguishable, and a few away the skin presents an appearance of bright redness. The child is often described as looking like a "boiled lobster." The face presents a characteristic appearance which is unmistakable. The lips and skin around the mouth are free from eruption. In consequence, although the rest of the face appears brightly flushed, the region around the mouth seems abnormally pale.
The tongue is thickly coated, but by the time the eruption appears, the upper layers of this coating become rubbed off, and the redness of the mucous membrane shows through in spots. This is often described as a strawberry tongue.
The acute stage of the disease lasts from two days to a week. The rash fades rapidly in the same order in which it came, disappearing from the face first, and last from the feet. It is followed by a long period of desquamation (peeling) in which the outer layer of the skin comes off in fine or large flakes. The skin on the palms and soles, on account of its thickness, is the last to peel.
The disease is contagious from the onset until desquamation is complete. The small particles of skin are frequent carriers of the disease and great care must be used to prevent infection from them.
The after effects of scarlet fever are of great importance. Frequently it is accompanied or followed by acute nephritis, and heart complications are common. The eyes and ears often suffer, sometimes to the extent of total blindness or deafness.
Nursing : In general, the same care must be used in nursing scarlet fever as in other acute infectious diseases. Cool water and milk may be given freely. If there is troublesome itching of the skin it may be relieved by anointing the body with white vaseline or any other simple oil. The skin should not be bathed unless under a physician's direction, but cool applications may be used on the head if there is high fever, heat and restlessness.
The mouth and throat may be carefully cleansed with hot salt solution (1/2 teaspoonful of salt to a glass of water). During the period of peeling, the body should also be anointed, not only to hasten this process, but to prevent the spreading of the particles of skin. Soap and water and a scrub brush may be used on the hands and feet during the latter part of the convalescence.
belladonna, a teaspoonful every half hour, may be administered if there is delay in procuring the services of a physician. The same remedy may be given to other children in the family, 8 pellets night and morning, as a preventive measure. The disease is a serious one, however, and no time should be lost in securing a physician. More than one attack of scarlet fever in the same individual is very unusual.