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SCARLET FEVER. Definition
Category: Infectious Diseases
Scarlet fever is an acute infectious disease,
with a characteristic eruption.
Modes of Conveying. The nearer a person is to a patient the more likely
one is to take or convey the disease. Clothing, bedding, etc., may retain
the poison for months. Scales from the skin of a patient, dried
secretions, the urine if inflammation of the kidneys (nephritis) exists,
the discharges (feces) from the bowels, are all means of infection. The
longer a person remains near the patient the more likely he is to convey
the disease. Foods handled by those sick of the disease, or by those who
may have been near patients may convey the disease. This is especially
true of milk. Epidemics of scarlet fever have been started by dairy-men
who had scarlet fever in their family. I once attended a family where the
only known cause for it in that family was a long-haired dog of a neighbor
who had scarlet fever in the family. The dog was in the room with the sick
ones, and visited the neighbor's family and played with the children who
afterwards came down with the fever. Discharges from the ear, caused by
scarlet fever, are said to be capable of giving it.
Remains in the Room, how long?--It may remain for months in a room, and
extend over two years as recorded by Murchison. We do not yet know how the
poison obtains entrance to the body. Hence, the need for thorough
Age, Occurrence, Susceptibility. All children exposed to the disease do
not contract the disease. It is less contagious than measles. A person who
is exposed once, and does not take it, may take it at a future exposure.
It occurs at any age and in all countries. It occurs oftener in autumn
(September) and winter (February). Isolated cases occur, and then it is
called sporadic. This disease attacks nursing children less frequently
than older children. It is not often seen during the first year of life.
How Often?--As a rule, it attacks a person only once; yet there are
recorded cases of well observed second and third attacks, but fortunately
these are very rare. I once attended a family where they had it and
claimed to have had it before, but very lightly.
Incubation. The vast majority of cases develop within three to five days
after exposure. If eleven days elapse without the appearance of symptoms
we may reasonably expect that the danger is past, at least in the great
majority of cases exposed.
Contagiousness. There is danger of catching the disease during the stages
of incubation, eruption and scaling. It is most contagious in the last two
Onset. Sometimes the onset is sudden; there may be a convulsion, preceded
by a sharp rise in the temperature. An examination in such cases may
reveal a marked sore throat or a membranous deposit on the tonsils
preceding the eruption, and nothing more. A chill followed by fever and
vomiting ushers in a large number of cases. These may be mild or severe.
The severity of these symptoms usually indicates the gravity of the
Rash. The rash or eruption appears from twelve to thirty-six hours after
the onset, usually on the second day, and looks like a very severe heat
rash, but is finer and thicker. It consists of a very finely pointed
rose-colored rash. In mild cases it is hardly noticeable. Usually it first
appears on the upper part of the chest around the collar bones, spreads
over the chest and around upon the back. Also it is now seen on the neck,
beneath the jaw, behind the ears and on the temples, thence spreads over
the body. There is a paleness about the mouth and wings of the nose, while
the cheeks are flushed with a flame-like redness. There is much itching if
the rash is severe. It attains the full development at the end of two or
three days, and then gradually declines. In some cases the rash is seen
only twenty-four hours.
Fever. The fever rises rapidly in the first few hours to 104 or 105-8/10
degrees. It remains high except in the morning, until the eruption reaches
its full development and falls with the fading eruption, and in
uncomplicated and typical cases, within six days becomes normal.
Sore Throat. This we find on the pillars of the fauces, uvula, tonsils,
and pharynx, reddened and inflamed. Sometimes it is very severe, and a
membrane comes on one or both tonsils and pillars of the fauces. There is,
generally a severe sore throat, and this makes swallowing difficult.
Tongue. The tongue is covered with a coating at the onset, and may
present a slightly reddened appearance at the borders and tip. The
papillae are prominent and covered and look like a strawberry sometimes,
or like the tongue of a cat. In fatal poisonous cases it becomes dry and
Scaling. As the disease subsides the outer layer of the skin dries and
peels off. The extent of this depends upon the severity of the attack. In
some cases the scaling is hardly perceptible, and sometimes it appears
only on certain parts, such as on the toes and inner parts of the thighs.
There is always some scaling. This is called "desquamation." Generally
speaking, scaling begins where the eruption first appeared on the upper
part of the chest and neck. The scales may be fine and branny or as is
most common, the skin peels in large particles. Some scaling is always
present. The length of the scaling time is variable. It usually lasts from
three to four weeks, but often longer. This stage is considered by many as
the most contagious, as the fine scales fly in the air.
Complications. Nose. The nose is affected at the same time if the "sore
throat" is very severe. A membrane may also form in the nose.
Ear. This may be affected in as high as one-fifth of the cases and needs
careful watching and attention. Both ears may be diseased and deafness
frequently results from it. Ten per cent of those who suffer from
"deaf-mutism" can trace their affliction to scarlet fever. The ears
usually become afflicted in the third week. The fever rises and there is
pain in the ears or ear. The onset may not appear alarming and not be
suspected until the discharge makes its appearance This is unfortunate;
these complications are serious, as meningitis and abscess of the brain
may result. The ear trouble (otitis) usually occurs during the scaling.
The patient may be up and around. There is a rise of the temperature to
103 or 104 degrees, the patient begins to vomit food and has a headache.
At night the child starts from its crib and cries as if in pain. They do
not always locate the pain in the ear. The face and hands may twitch. The
fever may fall to normal and rise sharply again. Such symptoms should call
for a thorough examination.
Eye. Inflammation of the (conjunctiva) red membrane of the eyes, often
Kidneys. There may be a mild form of inflammation in the earlier stages.
The severe form comes, if at all, usually in the third week. It occurs in
five to seven per cent of the cases. It may occur in the mildest case, as
such cases are not so closely watched. The first symptom is a slight
bloating of the eyes and face and spreads over the whole body. Sometimes
the swelling is very slight; at other times it is extreme. The urine
diminishes early and sometimes is wholly suppressed. It may be light
colored, smoky or straw colored. This trouble usually runs for weeks. The
patient may get uremia and result fatally.
Heart. This also may be affected as the valves may become diseased.
Joints. Rheumatism also may occur, and other complications.
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