220. How would you distinguish between Scarlet Fever and Measles?
Measles commences with symptoms of a common cold, scarlet fever does not. Measles has a peculiar hoarse cough, scarlet fever has not. The eruption of measles is in patches of a half moon shape, and is slightly raised above the skin, the eruption of scarlet fever is not raised above the skin at all, and is one continued mass. The colour of the eruption is much more vivid in scarlet fever than in measles. The chest is the part principally affected in measles, and the throat in scarlet fever.
There is an excellent method of determining, for a certainty, whether the eruption be that of scarlatina or otherwise. I myself have, in several instances, ascertained the truth of it—"For several years M Bouchut has remarked in the eruptions of scarlatina a curious phenomenon, which serves to distinguish this eruption from that of measles, erythema, erysipelas &c., a phenomenon essentially vital, and which is connected with the excessive contractability of the capillaries. The phenomenon in question is a white line, which can be produced at pleasure by drawing the back of the nail along the skin where the eruption, is situated. On drawing the nail, or the extremity of a hard body (such as a pen-holder), along the eruption, the skin is observed to grow pale, and to present a white trace, which remains for one or two minutes, or longer, and then disappears. In this way the diagnosis of the disease may be very distinctly written on the skin; the word 'Scarlatina' disappears as the eruption regains its uniform tint."—Edinburgh Medical Journal.
221. Is it of so much importance, then, to distinguish between Scarlet fever and Measles?
It is of great importance, as in measles the patient ought to be kept moderately warm, and the drinks should be given with the chill off; while in scarlet fever the patient ought to be kept cool—indeed, for the first few days, cold—and the beverages, such as spring-water, toast and water, &c., should be administered quite cold.
222. Do you believe in "Hybrid" Scarlet Fever—that is to say, in a cross between Scarlet Fever and Measles?
I never in my life saw a case of "hybrid" scarlet fever—nor do I believe in it. Scarlet fever and measles are both blood poisons, each one being perfectly separate and distinct from the other. "Hybrid" Scarlet fever is, in my opinion, an utter impossibility. In olden times, when the symptoms of diseases were not so well and carefully distinguished as now, scarlet fever and measles were constantly confounded one with the other, and was frequently said to be "hybrid"—a cross between measles and scarlet fever—to the patient's great detriment and danger, the two diseases being as distinct and separate as their treatment-and management ought to be.
223. What is the treatment of Scarlet Fever? [Footnote: On the 4th of March 1856, I had the honour to read a Paper on the Treatment of Scarlet Fever before the members of Queens College Medico-Chirugical Society, Birmingham—which Paper was afterwards published in the Association Journal (March 15 1856) and in Braithwaite's Retrospect of Medicine (January—June, 1856) and in Rankings Half Yearly Abstract of the Medical Sciences (July—December, 1856), besides in other publications. Moreover the Paper was translated into German, and published in Canstatts Jahresbericht, iv 456, 1859]
What to do—Pray pay attention to my rules, and carry out my directions to the letter—I can then promise, that if the scarlet fever be neither malignant nor complicated with diphtheria, the plan I am about to advise will, with God's blessing, be usually successful.
What is the first thing to be done? Send the child to bed, throw open the windows, be it winter or summer, and have a thorough ventilation, for the bedroom must be kept cool, I may say cold. Do not be afraid of fresh air, for fresh air, for the first few days, is essential to recovery. Fresh air, and plenty of it, in scarlet fever, is the best doctor a child can have let these words be written legibly on your mind. [Footnote: In the Times of Sept 4, 1863, is the following copied from the Bridgewater Mercury—