Scarlet Fever was long confounded with Measles, and, even when found to be a distinct disease, was believed to be merely a variety of Measles. Dr. Withering has the credit amongst British physicians of being the first who clearly and fully pointed out the difference between the two diseases. Most authors describe three varieties of Scarlet Fever, the simple, the anginose and the malignant. But the fact is, that though cases are not unfrequently observed in which the characters of each variety are tolerably well marked, yet it very often happens that they are blended together, so that it would be quite impossible to determine to which of them a particular case might belong. The disease is essentially the same in all its varieties, and produced by the same cause.

Scarlet Fever is highly contagious, and, when severe, is a most dangerous disease. It usually commences with headache, sore throat, redness of the eyes, sometimes with a feeling of languor and weariness, with frequent pulse, hot, dry skin, followed by thirst. Sometimes, also, at the commencement, there are nausea and vomiting. In different cases there is every variety in the severity of the symptoms, from a mildness hardly amounting to disease, to the highest point of danger. On examining the throat in most cases, it will be found inflamed, and frequently swollen, and the tongue is also frequently red and inflamed. The rash makes its appearance usually on the second day of the fever, but sometimes it is the first symptom noticed. It generally appears first upon the neck, face and breast, and from thence it spreads over the whole body.

The fever does not abate upon the appearance of the rash, but continues with various degrees of violence throughout its progress. The pulse is usually very frequent, much more so than in febrile diseases generally of the same degree of violence. It is often 120 or 130 in a minute, and sometimes more frequent still. The skin is burning hot. The bowels are frequently confined, but sometimes diarrhoea occurs in the advanced stage. Sometimes, also, the stomach is irritable, but this is not a common symptom.

The affection of the throat, in some cases, never exceeds that already noticed as occurring before the appearance of the eruption, but very often it becomes the most prominent and distressing symptom, being attended with swelling within and without, painful swallowing, and sometimes shortness of breath. The complaint usually attains its height from the fifth to the ninth day, when, in favourable cases, all the symptoms begin to decline. The rash fades, the heat of the skin diminishes, the pulse becomes slower and fuller, the soreness of the throat abates, and the tongue becomes clean, frequently, however, remaining reddish for a time. Sometimes the amendment is accompanied by a profuse perspiration, or by diarrhoea, but both of these are frequently absent. But the course of the complaint is often much less favourable. From the beginning to the close it is not free from danger. Death sometimes takes place in the first stage, from the overwhelming force of the shock upon the nervous system, and at any subsequent period, the patient is liable to the same result from coma or other cerebral affection. Inflammation occasionally attacks some vital part, especially one of the serous membrances, with fatal effect. Disease of the stomach and bowels sometimes carries off the patient, and sometimes affections of the throat have been the cause of death. The patient may also sink from debility consequent upon the malignant character of the disease, or the occurrence of gangrene of the throat. Even after the patient has seemed to recover completely from the complaint, when the only symptom remaining is a little weakness, the feet will sometimes suddenly begin to swell, general dropsy will rapidly set in, and in forty-eight hours the case will frequently terminate fatally.

It is certain that cases of fever with sore throat sometimes occur during the prevalence of Scarlet Fever, having all the symptoms, and running the exact course of that disease, with the single exception that the eruption is wanting. It is even stated that such cases are capable of imparting Scarlet Fever.

Few diseases leave a longer train of evils behind them than Scarlet Fever. Among the most common and troublesome, are the abscesses which form in the vicinity of the glands of the throat and at the angles of the jaws; sometimes the discharge of pus from these sources is more than the weakened system of the patient can bear, and, after having survived the fever, he dies of hectic. At the best, they greatly protract convalescence, and the constitution is long in recovering its usual strength.

Damp, badly drained neighbourhoods are those generally in which the worst cases of Scarlet Fever are found. The disease attacks all ages, but young people are most liable to suffer. As a general rule, a person only takes the disease once in his lifetime, although in rare instances, it may be otherwise. There is no complaint in which the result is more uncertain than in this. Cases apparently of the mildest character sometimes assume a most malignant appearance, and patients die suddenly when supposed to be quite free from danger; while, on the other hand, cases apparently desperate sometimes end favourably. The disease is generally dangerous in pregnancy.

Treatment

If there is much pain in the head and throbbing of the temples, with sore throat, great relief will be derived from putting a few leeches on each temple, and also on the throat, the number to be regulated by the intensity of the complaint and the age of the patient. This may be followed by a mild aperient, and the patient had better go to bed. If in winter or cold weather a little tire may be kept in the room, to cause a draught, and keep the air purified; and if in warm weather the window may be kept open. The patient should only be lightly covered with bed clothes, and should be sponged, several times a day, with vinegar and water; one part of vinegar to eight or ten of water. Bags dipped in the same may be laid over the forehead and head, and changed frequently. If the patient is feverish, cooling drinks of barley-water, flavoured with a little lemon, will be relished; and the following mixture may be taken: say two table-spoonsful every three or four hours; Diluted Sulphuric Acid, one dram; Sugar, one ounce; Infusion of Roses, half-a-pint. Should it not be convenient to get the Roses the acid may be given in Mint Tea.

Should the throat be troublesome, the following gargle may be used: Infusion of Roses or Mint Tea, half-a-pint; Nitre, two drams; or Sage Tea half-a-pint; Nitre, two drams. The throat may be gargled several times a day, if necessary. Some persons are fond of giving emetics on all occasions, and at all times and seasons. Sometimes they are useful, but as they reverse the natural action of the stomach, the less they are indulged in the better. It is usually bolter when there is any nausea at the stomach, to take frequent small effervescing draughts (say ten grains of Carbonate of Soda and six grains of Tartaric Acid, dissolved in a wineglassful of water), which will soon settle the stomach. The bowels should be kept gently open when required.

In cases where the system has been depressed, Ammonia has been found useful as a stimulant. Acting upon this idea, Professor Williamson, of Owen's College, Manchester, England, has for some years treated all his cases of Scarlet Fever with Champagne, and that from the very commencement of the disease. The moment he has been certain that the case was one of scarlatina, he has given the Champagne regularly and freely. The more severe the febrile symptoms, being convinced that they arose from a want of tone rather than an opposite state, the more bold has been his administration of the stimulant. He states that the success of this treatment has been almost uniform, the rash having always come well out, and not one single example of malignant sore throat having occurred in his practice. In a case which threatened to be bad and typhoid in character, as much as one full-sized bottle of Champagne was given every twenty-four hours, for the first four days. The malignant character of the throat affection passed off completely. No signs of intoxication or excitement appeared.

He adds: "Two points alone have I found requiring to be watched in connection with this plan. These are the possibility of sickness and diarrhoea. Occasionally I have found it necessary to suspend the Champagne for a few hours, falling back during the interval upon the old Port wine, but such cases have been rare. The fact that a young child of seven or eight years old can take an entire bottle of Champagne within twenty-four hours, not only without intoxication, but without any signs of excitement, is in itself significant of the atonic condition (want of tone) in the nervous system, and of the necessity for upholding it from the beginning."

The diet, while the patient is feverish, should consist of oatmeal gruel, barley-water, arrowroot, rice, corn starch, and bread puddings. As the patient improves, chicken and mutten broth may be added, changing gradually to beef tea, boiled chicken, and boiled mutton.