CHARACTER OF SCARLET FEVER COMPARED WITH THAT OF MEASLES.—It will be seldom difficult to distinguish this disease from other acute eruptive disorders. The one to which it bears the greatest resemblance is the measles; but from this it is readily distinguished by the absence of the cough, the inflamed and watery eye, running at the nose and sneezing, which are the predominant symptoms in the early stage of the measles; but which do not usually attend on scarlet fever—at least, in any high degree. In measles, also, there is an absence of that restlessness, anxiety, and depression of spirits, by which scarlet fever is peculiarly distinguished.—The rash, too, in measles, does not appear till two or three days later than that of scarlet fever. It also differs in its characters. In scarlet fever, the eruption consists of innumerable minute dots or points, diffused in patches with uneven edges of various sizes and forms; and gives to those portions of the skin on which it appears, a diffused bright red colour. In measles, the rash comes out in irregular semi-lunar or crescentic shaped patches, distinctly elevated; the spots being of a deeper red in the centre than in the circumference, and leaving intervening spaces in which the skin retains its natural pale colour.
MATERNAL MANAGEMENT.—The chief points to which the parent's attention must be directed, irrespective of a strict attention to the more immediate medical treatment directed by the physician, are the following:—
VENTILATION OF THE BED-ROOM.—Even in the mildest cases, the child must be kept in bed from the first accession of the fever. He must not be loaded, however, as was formerly the practice, with a quantity of bed-clothes, in order to encourage the fever and increase the quantity of eruption. A moderate quantity of clothing is all that is required, adapted to the heat of skin and feelings of the patient.
The bed-room must be kept cool and well ventilated. This is of importance in the mildest cases; but in the more severe forms of this disease, in which the throat is much affected, the constant and free admission of pure air will have a most decided and marked good effect upon the symptoms. The air should be renewed, therefore, from time to time. The linen, both of the bed and the patient, should also be frequently changed daily,—if practicable.
However mild the symptoms of this disease may be at the commencement, the child must always be carefully and vigilantly watched by the parent, as inflammation of some internal organ may suddenly arise (which is generally indicated by symptoms sufficiently obvious), and thus change an apparently mild form of this disease into one of an alarming character.
COLD SPONGING.—Whenever the skin is pungently hot and dry, the whole surface of the body should be sponged with cold water, or with vinegar and water. The heat is by this means rapidly abstracted, and the child refreshed; and this may again and again be resorted to, as the heat again returns. By this application alone, "the pulse has been diminished in frequency, the thirst has abated, the tongue has become moist, a general free per spiration has broken forth, the skin has become soft and cool, and the eyes have brightened; and these indications of relief have been speedily followed by a calm and refreshing sleep. In all these respects, the condition of the patient presented a complete contrast to that which preceded the cold washing; and his languor was exchanged for a considerable share of vigour. The morbid heat, it is true, when thus removed, is liable to return, and with it the distressing symptoms; but a repetition of the remedy is followed by the same beneficial effects as at first."[FN#40]
[FN#40] Bateman's Practical Synopsis of Cutaneous Diseases.
GARGLES AND THE INHALATION OF WARM WATER.—When the throat is affected, gargles are sometimes ordered; but the pain and inconvenience which their employment gives rise to, frequently precludes their use: and children seldom understand how to employ them, even if the state of the throat permitted it. Under these circumstances, the inhalation of the steam of hot water, or hot vinegar and water, may be substituted, and with decided benefit. Mudge's inhaler is a good contrivance to effect this.
When the throat is found by the mother to be early affected, an immediate application to the medical adviser is especially important. For, if he be called upon to treat this form of scarlet fever at its very commencement, by judicious treatment, the duration and violence of the disease may be both shortened and greatly mitigated.
REGIMEN.—Cooling drinks, as plain water, toast and water, barley water flavoured with lemon peel, fresh whey, lemonade, and thin gruel, may all be resorted to in their turn. The child may also be allowed oranges, grapes, or lemons sweetened with sugar, particularly when the mouth is foul and dry; but care must be taken that neither the pulp nor the stones are swallowed. These will both refresh and feed the patient as much as is necessary until the decline of the disease. The parent must strictly forbid the attendants in the sick chamber giving, at this period, any heating or stimulating fluid, as also animal food; and this injunction must be strictly regarded, even in the mildest form of the disease.