Scarlatina, or SCARLET FEVER, is one of the group of diseases called Exanthemata (q.v.). In addition to the characters common to the group, scarlatina is almost always attended by sore throat, and the rash or eruption, which is of bright scarlet colour, commonly appears as early as the second day after the manifestation of the febrile symptoms, and is followed by very distinct desquamation of the cuticle. The period of incubation (see MEASLES) is very rarely more than a week; sometimes as little as twenty-four hours. Most writers on medicine make three varieties of this disease—viz. S. simplex, in which there are the fever and the rash, but only slight throat affection; S. anginosa, in which, in addition to the fever and the rash, the throat affection is the most prominent symptom; and S. maligna, a name which is applied to certain cases of extreme virulence, in which the system is at once overwhelmed by the force of the disease, or in which the symptoms disclose an extraordinary degree of weakness and want of vital power.
The disease begins with shivering, lassitude, headache, a frequent pulse, a hot dry skin, a flushed face, thirst, loss of appetite, and a furred tongue. Shortly after the appearance of the febrile symptoms the throat begins to feel irritable, and, on examination, is found to be red, and often more or less swollen. This redness becomes diffused over the interior of the mouth and the tongue. The rash on the skin begins in the form of minute red points, which soon become so numerous that the surface appears almost of a uniform red. It first appears on the neck and breast, whence it gradually spreads over the trunk and extremities. The reddened surface is smooth to the touch, and the colour temporarily disappears on pressure of the finger. The eruption, in ordinary cases, is persistent for three or four days, after which it gradually disappears, and is usually gone by the end of the seventh day. The cuticle then begins to scale off in small bran-like scurf, or in flakes of various sizes. Specimens of an almost entire epidemic covering of the hand or foot, forming a natural glove or slipper, are of common occurrence in our pathological museums; but it is comparatively seldom that such perfect moulting takes place. The desquamative process is hardly ever completed till at least five weeks from the commencement of the disease, and may last considerably longer. The fever does not abate on the appearance of the rash, but continues in a more or less decided degree till that has faded; it is often attended by delirium.
Scarlatina anginosa presents in addition to the symptoms above described much more severe affection of the throat, with great pain and swelling. The inflammation is very apt to spread from the throat to the nose and ears: to the latter it is very destructive, life-long deafness often resulting in the case of those who recover from the fever. Sometimes a form of inflammation resembling, if not identical with, diphtheria supervenes; in other cases inflammation and suppuration invade the glands or other tissues in the neck.
Malignant Scarlatina is so terrible a disease that its characteristic symptoms require a brief special notice. The rash comes out late and imperfectly, and sometimes is hardly perceptible; or, having appeared, it may suddenly recede; and sometimes it is intermixed with livid spots. The pulse is feeble, the skin is cold, and there is extreme prostration of strength. In such a case as this death may occur (apparently from blood-poisoning) in a few hours. Other cases rapidly assume a typhus-like character.
Besides the dangers connected with the severity of the fever, and the results of the throat affection, the chief risk arises from inflammation of the kidneys. It is uncertain whether they become affected in all cases; in many there is no evidence that they are. But there are none in which the risk of this complication is absent; and it frequently supervenes in the mildest forms of the disease, if it has been unrecognised, or if due precautions have not been taken. It is essentially similar to catarrhal nephritis arising from other causes (see KIDNEYS), and may arise at any period till desquamation is completed, but most frequently in the second or third week of the disease. Rheumatic fever not unfrequently follows closely upon scarlet fever. Scarlet fever is rare in infancy and after thirty, most common between two and fifteen. But it is very apt to attack persons suffering from wounds and lying-in women exposed to the infection. It is common in Europe, whence it has been introduced into America and Australasia; but is rare in Asia, except Asia Minor, and Africa, except Algiers. In the tropical parts of these continents it is almost unknown; but in tropical America severe epidemics have often occurred.
Like all the exanthemata, scarlet fever occurs in epidemics; and nothing is more remarkable in the history of the disease than the extreme variations in severity in different outbreaks. Sometimes the mortality is almost nil; sometimes as many as 30 and 40 per cent. of those attacked succumb. It is undoubtedly caused by a micro-organism (see GERM THEORY); but the nature of the organism has not yet been conclusively demonstrated. It is very contagious; as, however, the contagium is given off chiefly in the desquamated cuticle it is generally possible, if the patient can be isolated as soon as the disease is recognised, to prevent or greatly to limit its extension to others. On the other hand, the contagium retains its vitality with great persistence, and can be conveyed by letters, clothes, &c. Cases are on record where it has lain dormant in clothes for at least a year. Milk is a frequent vehicle for the disease; and it seems certain that in some epidemics it has acquired its infectious properties not from scarlet fever in man, but from a form of disease affecting milch cows.
Treatment.—No specific is known which can cut short the disease; the feverish state must be treated on general principles, by rest in bed, diluents, &c.; and in simple cases little more is necessary. Severe local symptoms or complications must be met as they arise; bad sore throat by application of Condy's fluid, boracic acid, or some other antiseptic with a brush or as a gargle, by chlorate of potash lozenges, by poultices applied externally, &c. A severe case of scarlatina anginosa will test to the utmost the patience and resource of both nurse and doctor; while scarlatina maligna usually defies all their efforts. In ordinary cases it is of the greatest importance to guard against chills. The patient should be confined to bed for at least a fortnight, and to his room till desquamation is completed. The application of carbolic oil, one to thirty, all over the body, is valuable for neutralising the poison in the skin, and preventing its diffusion; it is moreover generally soothing to the patient. Tonics, especially quinine and iron, are useful during convalescence. Strict isolation during the progress of the case, and careful disinfection afterwards, are of course essential.
In the early stage, before the appearance of the rash, scarlatina may be readily mistaken for several other febrile diseases; after the appearance of the rash the only disease with which it is likely to be confounded is measles, and we must refer to the article on that disease for a notice of the distinctive characters of the two affections. There is no complaint in which the final result is more uncertain than this, and the physician should give a very guarded opinion as to how any special case may terminate.
The popular delusion that scarlatina is a mild and diminutive form of scarlet fever should always be corrected, as the error, if uncorrected, may do much harm by leading to a disregard of those precautions which are always necessary in this disease.