§ 105. Scarlet-fever, Scarlatina.

Scarlatina is a contagious epidemic, and in some cases sporadic disease, of changeable character; it generally attacks persons only once, is most common among children, and spreads very slowly. The genuine, uncomplicated scarlatina occurs very rarely now-a-days, and does not attack any one beyond the age of twelve years.

The eruption is of an erysipelatous, fiery, bright scarlet-red, or of the colour of boiled lobster, turning white under the pressure of the finger, but speedily resuming the original colour. The smooth, shining redness gradually loses itself in the surrounding white skin, and is never strictly limited; from time to time the redness either increases or diminishes in intensity, and is constantly seen either spreading or diminishing again in extent. The red skin is perfectly smooth and glossy, by which scarlatina is distinguished from every other kind of rash. The uncovered parts, or those which are but little covered, are generally first attacked by the disease, swelling up a little as far as the red-ness extends. The face, neck, chest, hands and feet are first attacked, whence the redness (in violent cases) spreads over the whole body. In every case of genuine scarlatina, the appearance of the redness is accompanied with fever, and in simple cases continues from three to four, in malignant cases about seven days, at the termination of which the eruption gradually grows paler and paler, until it disappears altogether. The redness never disappears suddenly during the fever. As the eruption disappears, the fever abates, and ceases entirely when the desquamation has commenced. The redness remains even after death; it then assumes a violet tinge. The more intense and general the redness, the more malignant the fever. In true scarlatina the red spots are perfectly dry; there is no moisture except on the parts which are not red. Sweat breaks out after the termination of the fever and the disappearance of the redness. The sweat is succeeded by the process of desquamation, but the disease may likewise disappear without sweat.

* Aconite is frequently more useful than any of the above-named remedies. - Hemptl.

Scarlatina runs the following course, distinguished into three stages.

The first stage is characterized by violent fever, sore throat and very quick pulse, which is peculiar to scarlatina, and is not met in any other eruptive disease. Scarlatina is distinguished from measles by the absence of all catarrhal symptoms. The fever and angina increase as the exanthem approaches the period of breaking out, and are sometimes attended with delirium and spasms.

In the second stage of the eruption, the spots first appear on the forearms and hands, afterwards on the rest of the body, but rarely in the face; they increase in size and redness, and new spots constantly supervene, the angina and fever continuing all the time. In this stage internal organs are liable to become inflamed, which may likewise take place in consequence of the eruption disappearing suddenly. This stage lasts from five to six days.

The stage of desquamation commences on the sixth.

and frequently on the ninth day, sometimes even later; the epidermis scales off in large patches. This stage lasts several days, and sometimes occurs several times in succession. The fever abates at the commencement of this stage, and terminates with critical phenomena.

Many authors speak of a fourth stage, the secondary or metastatic, or dropsical stage, which, in this disease more easily than in any other, is excited by a cold and terminates in acute dropsy, of which the swelling of the eyelids seems to be a precursor. Other metastatic diseases of scarlatina are: dangerous diseases of the eyes, ears, and nose, ulceration of glands, indurations, abscesses.

No disease is more insidious and deceitful than scarlatina; in some epidemics the disease is quite mild, without being fatal in a single case; whereas in other epidemics the disease, though apparently mild with a finely-formed eruption, frequently destroys life by metastasis to the brain. Scarlatina is met in conjunction with any kind of fever; the prevailing character of disease has generally a great influence on the nature of scarlatina.

§ 106. Belladonna is the specific remedy for the true, genuine scarlatina, whether it is just commencing or is already fully developed. Symptoms may however occur which do not correspond to Belladonna, and for which other remedies are required.

Ammonium carb. has been employed with great success by some physicians. It is not so much indicated by the eruption as by the accompanying symptoms, fever, state of the mind and sensorium, symptoms of the head. It does not seem to be suitable when the angina is very considerable.

If burning heat, soporous stupefaction, agonizing tossing about with vomiting, diarrhoea or costiveness, or convulsions, should be present, Opium is indicated.

Exacerbation of the fever towards evening, sleeplessness, complete loss of appetite, nausea, whining mood and ill-humour, moaning, indicate Ipec, after which Puls, is sometimes suitable.

The cases where the throat is inflamed without the skin being affected, are very dangerous. In mild cases the angina is of no great importance, even if it should be somewhat violent. The stinging-burning, the rigidity and dysphagia, the swelling of the tonsils, uvula and fauces, which look red, excoriated and spotted, and are dotted with small, inflamed papillae and covered with tenacious mucus and aphthae; all these symptoms generally yield to one dose of Belladonna, which, in bad cases, can be followed by a dose of Mercurius on the same day.

If such an angina should set in by metastasis, accompanied with typhoid symptoms and with a number of fetid-smelling little ulcers in the mouth and fauces, great prostration, dryness of the mouth and thirst, neither Belladonna nor Arsenic will prove of much avail, but Nux vomica will help, if help be possible. (See the chapter on angina faucium.) Baryta carb. (see. or third trit. every three or four hours) is an excellent remedy even in desperate cases, when the parotid glands, tonsils, and submaxillary glands are very much swollen, when the patients are affected with ptyalism, with an aching-stinging pain during deglutition, or when there is a sensation of swelling with dryness. Sulphur and Hepar s. should likewise be thought of, unless Acidum nitri should correspond more exactly to the symptoms.

In some cases of epidemic scarlatina neither eruption nor angina appear, in the place of which the patient is affected with the following symptoms: quiet lowness of spirits and despondency, faint and staring look, with widely-opened eyelids, obscuration of sight, coldness and paleness of the face, absence of thirst, extremely small and quick pulse, lameness and immobility of the extremities, impeded deglutition with stinging pains in the parotid glands, aching pain in the head, constrictive colic, chilliness and heat of single parts. These symptoms constitute a sort of masked scarlatina, and yield to Belladonna.