A common infectious disease, scarlet fever, or scarlatina, owes its name to the vividness of its rash. Epidemics occur from time to time and children are more commonly the subjects of the disease. The specific cause seems to be a variety of streptococcus which generally enters the body through the nose and throat; moreover, the infection is most often communicated by the secretions from those parts. Those usually infected are therefore susceptible persons who come into close personal contact with others suffering from the disease or carrying the germs in the throat or nose.
Other discharges caused by the disease, such as a running from the ear, may be infective, and also scales thrown off from the patient’s body during desquamation. In some instances infection appears to be conveyed by fomites, that is, things handled by the patient or which have otherwise been in close contact with the patient’s body. Epidemics have sometimes been caused by milk.
The incubation period is usually about three or four days, but may be only one day or as many as eight. Then the patient becomes fevered and suffers from sore throat and probably vomiting, especially if it is a child. On the second day the rash appears, first on the neck and chest but in the course of a day or two usually covering the whole body, with the exception of the skin around the mouth. The contrast between the flushed face and this region of what is called circumoral pallor is often very striking.
The rash consists of tiny red spots, each being surrounded by an areola of pink, the general appearance of redness being caused by the enormous assemblage of such spots. The rash disappears temporarily on pressure and the skin which has been pressed looks yellowish. The mouth and throat have also a vivid scarlet color. Often there is much enlargement of the tonsils and perhaps one or more white or yellowish spots on their surface.
The tongue is furred at the beginning of the fever and may have the appearance described as the white strawberry-tongue. In this the surface is covered with white fur but is dotted over with red spots, due to swollen papillae projecting through the fur. Later on the fur is thrown off, leaving a clean red surface, but the redness of the papillae is of a different shade and they are still conspicuous; this is called the red strawberry-tongue.
With the appearance of the rash the temperature rises further, reaching 102° to 103° F. or more, and when a hand is placed on the patient’s skin it may feel what is called biting hot. The pulse-rate and breathing are increased more or less correspondingly. There is great thirst but vomiting does not usually persist.
Peeling that follows the rash:
The rash lasts for three or four days and then fades, the temperature also gradually declining. About seven days after the appearance of the rash peeling begins, and this usually goes on for two or three weeks at least. Its appearance has procured for it the name of pin-hole desquamation, but the small bare areas so described gradually enlarge and, as the skin peels off in flakes, a lace-like pattern is produced.
The description of scarlet fever which has been given above is that of a case of moderate severity. In rare instances the toxemia, or poisoning, may be so severe as to cause death in a day or two. In a proportion of cases, not so large as it was some years ago, what is called the septic type of scarlet fever occurs. There is severe inflammation in the throat and probably ulceration of the tonsils. The glands in the neck, which are usually enlarged to some extent in any case of the disease, are much enlarged in the septic type and probably suppurate. There is commonly a muco-purulent discharge from the nose. Fever is more pronounced and there is some degree of prostration.
This type of the disease may be the predominant one in an epidemic occurring in a community which has previously been free from the disease. In the United States and Great Britain a considerable proportion of cases are now of a slight nature. Sometimes there is but little fever and there may be so little rash that it is overlooked. Several very important complications may occur in scarlet fever. There may be inflammation of the kidneys, or nephritis. The urine becomes scanty and contains albumin and often blood, while there is edema of the feet, ankles and face or even more generally. In view of this risk the urine should be tested periodically during the course of the disease.
Another complication is otitis media, or inflammation of the middle ear. Infection passes up the Eustachian tubes from the nose and throat and commonly causes a suppurative discharge from the ear. Possibly the infection may pass backward and cause mastoid disease. A third complication is acute rheumatism, the larger joints being involved, and sometimes there is inflammation of the heart, or the pericardium. The general treatment of scarlet fever is that of infectious disease.
Application and treatment:
Treat as infectious disease, treat symptoms as listed. Expect rapid and complete recovery. If there is any question about contamination of food or milk, boiling or treating as in a session will destroy bacteria and viruses, 5 to 10 minutes at moderate output is required for decontamination of liquids up to 1 quart.