The Mother's Manual of Children's Diseases

by Charles West

The resemblance of German measles to scarlet fever is, however, extremely slight, and is almost entirely limited to the existence of a slight sore-throat, unaccompanied with glandular swelling. The rash in no respect resembles the uniform redness of the scarlatinal eruption, and there is no peeling of the skin, nor even any roughness of the surface left behind.

Slight feverishness sometimes precedes the appearance of the rash for twenty-four hours; but the cough, and sneezing, and running at the eyes and nose, which usher in measles are entirely absent. The rash usually appears in the course of twenty-four hours, is never postponed beyond the second day; it begins, like that of measles, on the face, and, like it, travels downwards, but always disappears on the third day, while that of measles is not entirely gone before the eighth or ninth. The rash itself also has a different character. It consists of small, slightly elevated, round red spots which now and then coalesce into small patches, but never have the somewhat crescentic arrangement observed in the rash of measles. The colour of the spots is somewhat darker than that of the eruption of measles, while the skin between them remains pale, and does not assume the flush of measles. As it disappears it simply fades, and does not at all change its tint as that of measles does, and it leaves the skin unroughened.

Now and then German measles are severe, and are attended with a good deal of fever for a day or two, and even with symptoms of bronchitis. These cases are, however, very unusual, are seen only at times when the disease prevails epidemically; and even then the symptoms of the affection are sufficiently marked to preserve from error all but those who wish to be deceived, and to flatter themselves that their child is henceforth protected from scarlatina.

Scarlatina, or Scarlet Fever, for the two names mean the same thing, the former being only the Latin term, and not implying any greater mildness of the disease, is one of the most formidable ailments of childhood, and especially of early childhood, since the highest mortality from it takes place during the third year of life.

It is more dreaded in a household, and justly so, than any other disease of childhood, though, indeed, it is not limited in its occurrence to early life, and instances are familiar to us all in which the mother, devoting herself to the care of her little ones, has herself fallen a victim to the poison.

I do not think it so directly contagious, from person to person, as small-pox, chicken-pox, or measles, but its infection appears to be specially abiding in its character, and to cling longer to the clothes, the bedding, and even the room of a scarlet fever patient, than that of the other eruptive fevers, except perhaps small-pox.

It is an object of special dread also for two other reasons. One of these reasons is the extreme and causeless variations in its severity; so that I have known more than one or two children in the same family to have it so slightly as scarcely to be ill, two to have their lives placed in jeopardy, and two to die. The other reason for special dread is that the mildness of the disease at its outset affords but a slight guarantee against the occurrence of serious complications in its course, and still slighter against secondary diseases which may follow in its train, and either destroy life directly, or leave behind some irremediable mischief.

Scarlatina has been divided by medical men into three classes, according to its different degrees of severity; the mild—that accompanied with bad sore-throat—and the malignant variety.

We have specially to do with the first of the three; for it is in it only that there is danger of the disease being overlooked, or mistaken.

The symptoms of scarlatina usually appear within three days after exposure to its contagion, and there is very good authority for believing that the interval never exceeds six days. I should not, however, feel quite secure until after the lapse of ten days, and during this time the child ought to be isolated from his brothers and sisters. In the mildest form of the disease the appearance of the rash upon the surface, usually with, but sometimes even without slight sore-throat and feverishness, may be the first indication of an affection which is sometimes so deadly. In the majority of cases, however, it is ushered in by vomiting once or oftener, accompanied by headache, heaviness, of head, great heat of skin, and some measure of sore-throat. The brain is easily disturbed in children, as has already been said, and delirium at night during the first twenty-four hours of an attack of scarlet fever need not excite anxiety, for it then often passes away, and the disease runs a perfectly favourable course. The continuance of delirium later is an attendant only on the graver forms of scarlet fever.