The fever, as a rule, is notably higher than in other eruptive fevers. The attack may begin with a chill, nausea and vomiting and headache. There is also bleeding from the nose in a certain proportion of cases. The most constant sign is redness and more or less swelling of the throat, either with or without a sense of soreness and pain in the act of swallowing. The stage of development lasts in the average twenty-four hours, although exceptionally it may appear in a few hours after the first symptoms of the disease have appeared. The eruption often begins on the back first, and from there rapidly spreads over the entire body in twenty-four hours. It greatly differs from the eruption in measles in not allowing any healthy or white skin to intervene between the red specks, but the entire skin has a reddish blush. This has given rise to the expression boiled lobster appearance in scarlatina, and indeed nothing could illustrate the color of the skin better than by comparing the one with the other. The eruption is sometimes accompanied with a great deal of itching and burning and reaches its fullest development on the third day after its first appearance; it lasts from four to six days.
The extent and redness of the eruption varies greatly in different individuals, in some it is very slight and transient while in others there is not a spot as large as a dime which is not covered. Yet a very light attack in one patient when communicated to another individual may develop in that one a most malignant form. One attack secures against a recurrence.
The throat affection seems to modify the eruption of the skin for in some instances in which the throat is very bad, the skin eruption is comparatively slight. There may be simply a little redness over the tonsils, extending more or less over the soft palate, or on the other hand, the disease in the throat may become in every respect equal to if not identical with the worst type of diphtheria. Some writers consider the sore throat of scarlatina and that of diphtheria identical, and from a practical point of view there is certainly no difference, and the very best results are obtained when all severe sore throats of scarlatina are treated precisely as if they were diphtheria; this has always been my practice.
The tongue is quite distinctive of the affection; early in the development of the disease it is generally furred, but later the coating peels off in patches, and these spots present the appearance of a ripe strawberry; sometimes the entire surface of the tongue looks as if cayenne pepper or red sand had been sprinkled on it.
The fever generally increases during the eruptive stage, and the skin becomes very dry and hot. The pulse may run up to 130 to 140 per minute, while the temperature runs up as high as 106° Fahrenheit; this state of affairs places the patient in imminent danger, he now may become restless and even delirious. In a certain proportion of cases the kidneys become involved and albuminuria is a result, but this usually passes off with the improvement and recovery of the patient.
In the third stage the cuticle begins to exfoliate in the form of branny scales. In the absence of serious complications this stage marks the beginning of convalescence; the fever subsides, the appetite returns, and the soreness and redness of the throat disappear.
The treatment of this affection always depends upon the nature of the case. Simple scarlatina requires no medical treatment; the precaution and intelligence which are comprised in good nursing supply everything that is required. There is not the same danger of the eruption striking in with scarlatina as there is with measles, and the patient need not be kept so warmly covered. When the fever runs very high, sponging the surface with cool water is very grateful and reduces the temperature. After the eruption has thoroughly developed, the water for sponging off may be very cold without the least danger, and this may be repeated as often as comfort or the high temperature demands. To relieve the burning and itching of the skin, the entire body should be rubbed over with glycerine night and morning; this relieves the system and makes the skin moist and supple. If the throat is only reddened, a teaspoonful of chlorate of potash dissolved in a cupful of hot water and when cold used as a gargle and a teaspoonful of the solution swallowed at the same time every two hours is all that is necessary. The diphtheritic scarlatina is treated precisely similar to and according to the instructions laid down for diphtheria in another part of this work. Move the bowels freely with the Femina laxative syrup.
(m) Chickenpox has neither distressing symptoms nor is it significant as regards danger. It is an eruptive fever which occasionally affects adults, but for the most part children. The eruption is generally preceded by a slight fever and nausea, and appears first on the body and afterwards on the scalp where it is usually more abundant. There always remains healthy white skin between the vesicles, which at first contain a transparent liquid, hence called by the Germans waterpox, which afterward becomes cloudy or opaline. The eruption begins to dry up from the fifth to the seventh day forming granular crusts that are sometimes followed by pitting. The disease is contagious and develops twelve to seventeen days after the exposure. Chickenpox claims no treatment; its only point of interest is its resemblance to varioloid, but as a successful vaccination guarantees against the latter, and as the vesicles of varioloid have a central depression while those of chickenpox have not, the individuality of the affection is readily established.