215. Will you describe the symptoms of Scarlet Fever?
The patient is generally chilly, languid, drowsy, feverish, and poorly for two days before the eruption appears. At the end of the second day, the characteristic, bright scarlet efflorescence, somewhat similar to the color of a boiled lobster, usually first shows itself. The scarlet appearance is not confined to the skin; but the tongue, the throat, and the whites of the eyes put on the same appearance; with this only difference, that on the tongue and on the throat the scarlet is much darker; and, as Dr. Elliotson accurately describes it,—“the tongue looks as if it had been slightly sprinkled with Cayenne pepper.” The eruption usually declines on the fifth, and is generally indistinct on the sixth day; on the seventh it has completely faded away. There is usually, after the first few days, great itching on the surface of the body. The skin, at the end of the week, begins to peel and to dust off, making it look as though meal had been sprinkled upon it.
There are three forms of scarlet fever,—the one where the throat is little, if at all affected, and this is a mild form of the disease; the second, which is generally, especially at night, attended with delirium, where the throat is much affected, being often greatly inflamed and ulcerated; and the third (which is, except in certain unhealthy districts, comparatively rare, and which is VERY dangerous), the malignant form.
216. Would it be well to give a little cooling, opening physic as soon as a child begins to sicken for Scarlet Fever?
On no account whatever. Aperient medicines are, in my opinion, highly improper and dangerous both before and during the period of the eruption. It is my firm conviction that the administration of opening medicine, at such times, is one of the principal causes of scarlet fever being so frequently fatal. This is, of course, more applicable to the poor, and to those who are unable to procure a skillful medical man.
217. What constitutes the principal danger in Scarlet Fever?
The affection of the throat, the administration of opening medicine during the first ten days, and a peculiar disease of the kidneys ending in anasarca (dropsy), on which account, the medical man ought, when practicable, to be sent for at the onset, that no time may be lost in applying proper remedies.
218. 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 color 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 eruption of scarlatina a curious phenomenon, which serves to distinguish this eruption from that of measles, erythema, erysipelas, etc., 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.