Scarlet Fever. Scarlatina.
This is likewise an acute inflammation of the entire covering of the body, both external and internal connected with fever which is infectious and contagious.
Symptoms. The fever comes on somewhere between the second and tenth day after exposure. On the second day of the fever, the eruption comes out in the form of very small points and pimples, which appear either in patches, or constitute a general redness, of a bright scarlet color. In PLATE 1, Fig. 2, the artist has given a fine picture of the disease.
The disease begins with languor, pains in the head, back, and limbs, with drowsiness, nausea, and chills; and these are followed by heat, thirst, etc. When the redness appears, the pulse is quick, and the patient is anxious, restless, and sometimes delirious. The eyes are red, the face swollen, the tongue covered in the middle with white mucus, and is studded with elevated points of extreme redness. The tonsils are swelled, and the throat red. The greatest degree of redness is reached on the evening of the third or fourth day from its beginning, when a gentle moisture appears, the disease begins to decline, with itching, and the scarf skin falls off in branny scales.
A swelling or puffiness of the flesh, which spreads out the fingers in a singular manner, seems to be peculiar to scarlet fever.
In the first stage of the complaint, the tongue, as stated above, is covered with a fur; but as it advances, the tongue often becomes suddenly clean, and presents a glossy, fiery red surface, which is sometimes, with the whole lining of the mouth, raw and tender.
It is peculiar in this complaint, that the inflammation of the throat always runs into a state of ulceration. As far as can be seen, on pressing down the tongue, the throat is swollen and of a deep, florid red; and on the tonsils may be seen white or gray ulcers. This makes swallowing very difficult, and aggravates the sufferings of the patient. The great amount of mucus in these parts causes also a continual rattling in the throat.
In quite a large number of cases of this disease the usual ulceration of the throat is replaced by an attack of true diphtheria, which, if at all severe, will require the giving of antitoxin of diphtheria in addition to the treatment recommended for scarlet fever.
The Eustachian tube, which extends up to the ear, is apt to get involved in the inflammation, and cause swelling and pain in that region. The glands under the ear and jaw sometimes inflame, and after a time they occasionally break. Abscesses formed in the ear frequently produce some deafness which is not easily cured.
In the cell dropsy, which sometimes appears after scarlet fever, the crystals of urate of ammonia may often be found in the urine with the microscope (Fig. 72).
This disease resembles measles, but may be distinguished from it by the absence of cough; by the eruption being finer, and of a more scarlet color (see plate) ; by the rash coming out on the second day instead of the fourth; and by the ulceration in the throat.
Treatment. In ordinary cases, the treatment should be very simple. The apartment should be kept cool, and the bed covering light. The whole body should be sponged with cool water as often as it i8 hot and dry, and the patient be permitted to take cooling drinks. Besides this, in many cases, very little is needed, except to give a few drops of the tincture of belladonna, night and morning.
The cold stage having passed, and the fever set in, warm water may be used without the mustard, etc. If the head be affected, put mustard drafts upon the feet. Should the bowels be costive, they may be gently opened by some very mild physic.
No solid food should be allowed; but after the first shock of the disease is passed, drinks, in reasonable quantities, will be advisable, such as cold water, lemonade, barberry and tamarind water, rice water, balm or flax seed tea, and some thin water gruel.
To promote the action of the skin, the spirits of nitre, with other articles (125), adapting the dose to a child, will be found useful.
Muriatic acid, forty five drops in a tumbler filled with water, and sweetened, and given to a child in teaspoonful doses, is a good remedy.
In very violent attacks, the system sometimes inclines to sink immediately; typhoid symptoms show themselves; there is great prostration; the eruption strikes in; the skin changes to a purple or mahogany color; the tongue is of a deep red, or has a dark brown fur upon it, and the ulcers in the throat become putrid. This is called scarlatina maligna; but it is only a severer form of the same disease.
The treatment of this form must be different from that recommended above. It must be tonic. Quinia (65) must be freely given. Wine whey, mixed with toast water, will be useful. Tincture of cayenne, in sweetened water, may be given often in small doses. Ammonia (135) may likewise be given as a stimulus. Gargles (245) (244) (243) are also required.
A dropsical affection is one of the most frequent results of scarlet fever. It is believed that this seldom occurs, if the warm bath is daily used, as soon as the skin begins to peel off. After the dropsy has set in, give the warm bath twice a week, and encourage perspiration by the compound tincture of Virginia snake root, and similar articles.
In young children, also in severe cases of fever or where the kidneys are not working properly as shown by swelling of the face, abdomen and extremities, milk should be the only article of diet allowed until these symptoms have quieted down. Should the stomach reject the milk, you may add lime water, a teaspoonful to a tumbler of. milk. From one pint to two quarts of milk according to age will maintain the nourishment of anyone over days and weeks at a time and gradually the different broths, as chicken or lamb and beef tea, may be added, and later bread and butter, boiled custard, rice and tapioca puddings.
Anointing the skin with Vaseline at night and washing off in the morning with suds removes the poisonous scales, and lessens the danger of contagion, as well as improves the activity of the skin. Nasal and aural catarrhal diseases are commonly observed to follow scarlet fever and need attention of a physician. Rheumatism likewise is a frequent sequela, while nephritis or inflammation of the kidneys is often a sad reminder of the disease. These two complications are to be treated as directed elsewhere.
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