Determination of Scarlet Fever.—When beginning with vomiting, headache, high fever, and sore throat, and followed in twenty-four hours with a general scarlet rash, this is not difficult; but occasionally other diseases present rashes, as indigestion, grippe, and German measles, which puzzle the most acute physicians. Measles may be distinguished from scarlet fever in that measles appears first on the face, the rash is patchy or blotchy, and does not show for three to four days after the beginning of the sickness. The patient seems to have a bad cold, with cough, running at the nose, and sore eyes. German measles is mild, and while the rash may look something like that of scarlet fever, the patient does not seem generally ill, is hardly affected at all, though rarely troubled with slight catarrh of the nose. In no sickness are the services of a physician more necessary than in scarlet fever; first, to determine the existence of the disease, and then to prevent or combat the complications which often approach insidiously.
Outlook.—The average death rate of scarlet fever is about ten per cent. It is very fatal in children about a year old, and most of the deaths occur in those under the age of six. But the mortality varies greatly at different times and in different epidemics. In 1904–5, in many parts of the United States, the disease was very prevalent and correspondingly mild, and deaths were rare.
Duration of Contagion.—The disease is commonly considered contagious only so long as peeling of the skin lasts. But it seems probable that any catarrhal secretion from the nose, throat, or ear is capable of communicating the germs from a patient to another person for many days after other evidences of the disease are past. Scarlet fever patients should always be isolated for as long a period as six weeks—and better eight weeks—without regard to any shorter duration of peeling, and if peeling continues longer, so should the isolation.
Treatment.—In case a physician is unobtainable the patient must be put to bed in the most airy, sunshiny room, which should be heated to 70° F., and from which all the unnecessary movables should be taken out before the entrance of the patient. A flannel nightgown and light bed clothing are desirable. The fever is best overcome by cold sponging, which at the same time diminishes the nervous symptoms, such as restlessness and delirium. The body is sponged—part at a time—with water at the temperature of about 70° F., after placing a single thickness of old cotton or linen wet with ice or cold water (better an ice cap) over the forehead. The part is thoroughly dried as soon as sponged, and the process is repeated whenever the temperature is over 103° F. There need be no fear that the patient may catch cold if only a portion of the body is exposed at any one time. If there is any chilliness following sponging, a bag or bottle containing hot water may be placed at the feet. It is well that a rubber bag containing ice, or failing this a cold cloth, be kept continually on the head while fever lasts. The throat should be sprayed hourly with a solution of hydrogen peroxide (full strength) and the nose with the same, diluted with an equal amount of water, three times a day. The outside of the throat it is wise to surround with an ice bag, or lacking this, a cold cloth frequently wet and covered with a piece of oil silk (or rubber) and flannel.
The diet should consist of milk, broths, or thin gruels, and plenty of water should be allowed. Sweet oil or carbolized vaseline should be rubbed over the whole body night and morning during the entire sickness and convalescence. The bowels must be kept regular by injections or mild cathartics, and, after the fever subsides, vegetables, fruit, cereals, and milk may be permitted, together with meat or eggs once daily. It is imperative for the nurse and also the mother to wear a gown and cap over the outside clothes, to be slipped off in the hall at the door of the sick room when leaving the latter.
MEASLES.—Measles is a contagious disease, characterized by a preliminary stage of fever and catarrh of the eyes, nose, and throat, and followed by a general eruption on the skin. One attack practically protects a person from another, yet, on the other hand, second attacks occur with extreme rarity. It is more contagious than scarlet fever, and isolation of a patient in a house is of less service in preventing communication to other inmates, whereas in scarlet fever half the number of susceptible children may escape the disease through this precaution. The germs which cause measles perish rapidly, so that infected clothes or other objects merely require a thorough airing to be rendered safe, whereas in scarlet fever the danger of transmission of the contagion may lurk in infected clothing and other substances for weeks, unless they are subjected to proper disinfection. A patient with measles is capable of communicating the disorder from its onset, before the appearance of the rash, through the breath, discharges from the nose and eyes, tears and saliva and all the secretions. At the end of the third week of the disease the patient is usually incapable of giving the disease to others. Close contact with a patient is commonly necessary for one to acquire the disease, but it is frequently claimed that it is carried by a third person in the clothes, as by a nurse. It is infrequent in infants under six months, and most frequent between the second and sixth year. Adults are attacked by measles more often than by scarlet fever.
Development.—A period of from seven to sixteen days after exposure to measles elapses before the disease becomes apparent.
Symptoms.—The disease begins like a severe nasal catarrh with fever. The eyes are red and watery, the nose runs, and the throat is irritable, red, and sore, and there is some cough, with chilliness and muscular soreness. The fever, higher at night, varies from 102° to 104° F., and the pulse ranges from 100 to 120. There is often marked drowsiness for a day or two before the rash appears. Coated tongue, loss of appetite, occasional vomiting, and thirst are present during this period. The appearance of minute, whitish spots, surrounded by a red zone, may often be seen in the inside of the mouth opposite the back teeth for some days before the eruption occurs.
The preliminary period, when the patient seems to be suffering with a bad cold, lasts for four days usually, and on the evening of the fourth day the rash breaks out. It first appears on the face and then spreads to the chest, trunk, and limbs. Two days are generally required for the complete development of the rash; it remains thus in full bloom for about two days more, then begins to subside, fading completely in another two days—six days in all.
The rash appears as bright-red, slightly raised blotches on the face, which is generally somewhat swollen. The same rash extends to the abdomen, back, and limbs. Between the mottled, red rash may be seen the natural color of the skin. At this time the cough may be hoarse and incessant, and the eyes extremely sensitive to light. The fever and other symptoms abate when the rash subsides, and well-marked scaling of the skin occurs.