SCARLET FEVER. SCARLATINA.
Scarlet fever is an acute, contagious disease. It begins abruptly. The child may have a severe attack and be quite sick from the beginning, or he may have a mild attack and not be very sick. Usually the fever rises rapidly, the child vomits and complains of a sore throat. If the attack is very mild the throat symptoms may not cause any distress. Frequently, about the third day, there are patches on the tonsils. Prostration may be profound if the fever is very high. Convulsions and diarrhea are sometimes present in very young patients. It takes from two to six days to develop scarlet fever from the time the child is exposed to it. The disease may be caught at any time, but it is most contagious during the time the patient is scaling. It is not as contagious as measles. Some children seem to escape even though directly exposed to it. It is more frequent in the fall and during the winter, and it is more severe during the latter months.
Eruption.—The eruption appears at any time after twelve hours. It may not, however, appear before the third or fourth day. It lasts from three to seven days, and only takes a few hours to cover the whole body after it is first seen. The rash is first seen on the neck or chest; it appears as a red, uniform blush, but, when examined closely, small reddish spots may be seen all over it. If the rash is very faint and of a doubtful character a hot bath may bring it out. A bright red, well-developed rash is a sign of good heart action. In the event of heart failure, the rash fades quickly. Itching is a constant symptom after the rash is fully out.
About the eighth day the rash begins to scale or desquamate. It begins on the neck and chest. It takes from one to three weeks to scale completely, from the time it begins to peel. The hands and feet are the last spots to scale.
It must always be kept in mind that mild cases are just as contagious as severe cases, and that a mild case may cause in another person a very severe attack.
The throat may be mildly affected or it may be the most troublesome feature of the case. It is red and swollen and the child complains of pain during the act of swallowing. Patches may be seen on the tonsils on the third day. There is usually a discharge from the nose and this discharge may be contagious. While the fever is high, the child is restless, complains of thirst, and may be slightly delirious.
One attack is usually all a child has during life, though there are exceptions to this rule. Complications are quite frequent with scarlet fever. Inflammation of the ears and kidneys is most often met.
Measures to be Taken to Prevent Spread of Disease.—Every case, no matter how mild, should be isolated for four weeks. Many cases must be isolated longer,—until scaling is complete. Children should not play or sleep with other children for three or four weeks after all symptoms have been absent. Other children in the family, who have not been exposed, should be sent away. All clothing should be changed and washed in soap and water and then boiled in a carbolic solution. The nurse should not mix freely with other members of the family. The sick room should be kept clean, and well aired. It should be dusted with a wet cloth, and this should afterwards be burned. There should be no furniture, or hangings, or pictures in the room other than are absolutely necessary. The room should not be used after the case is over until it is thoroughly and completely disinfected.
During the period of scaling the patient should be rubbed all over with carbolated vaseline. This allays itching and prevents the scales flying around. The bed sheet can be taken off daily with the scales in it, and immediately put in carbolic water and boiled.
Treatment.—Inasmuch as scarlet fever is one of the most dangerous and one of the most treacherous diseases of childhood, we cannot afford to take any chances with it. Every child with scarlet fever should be put in bed, and kept there during the entire illness,—that is, from four to six weeks. Light, and the free circulation of fresh air are absolutely necessary for the proper care of a scarlet fever case. The child should be clothed only with the usual night gown and a light undershirt. No extra wraps or blankets are required.
The diet should be reduced in quantity and strength. The bowels should move daily. If anything is necessary to accomplish this, citrate of magnesia is quite satisfactory. There is no special medicine for the treatment of this disease. Often it is not necessary to give any. Good nursing is more essential, and with proper attention to the bowels, diet, fresh air, clothing, sleep, and quiet, all will, as a rule, result favorably. Quiet is essential. Consequently, two persons at a time should never be allowed in the room with the little patient.
The family physician will prescribe whatever medicine is necessary in his judgment, and will meet any complication as it arises.