SCARLET FEVER

New Zealand Mail, 29 January 1902, Page 13

SCARLET FEVER

(By Dr Andrew Wilson.)

THE SYMPTOMS OF THE DISEASE

We have seen that when a person is attacked with scarlet fever the period of incubation, or that which intervenes between infection and the first appearance of the symptoms of the fever, is as a rule short. It may extend, as we have seen, to six days, but such cases are probably exceptional. On the other hand, the symptoms may declare themselves twenty-four hours after infection. We find blie usual run of symptoms when a child is sickening from this disease. It >'s fretful, restless, complains of nausea and sickness, suffers from headaches, and if its temperature be taken by the mother, that temperature is found to have risen, this rise taking place at night especially. Bear in mind that the natural temperature of the body is about 98.4 degrees Falir. When the child is sickening for this fever, the temperature will probably rise to over 100, and remain at 102 or 103 degrees. This steady rise of temperature and continuance thereof is, of course, one of the sure indications of the presence of the fever. Certain other symptoms stand out somewhat prominently. Every mother knows that a very important sign in this connection is the presence of sore throat. If the child’s throat be examined, the parts are found to be extremely red and inflamed, and likewise present a certain degree of swelling. The tongue also presents a fairly characteristic appearance. It is furred and white, and the little papillae or points on the tongue remaining' red in colour, and projecting through the pipe, give riso to the appearance to-which the name of strawberry tongue lias been applied.

THE RASH. Within two days at latest after the appearance of these preliminary symptoms, and sometimes at an earlier period the eruption or rash declares itself. The rash, which may be inconspicuous in, say, typhoid fever, is very marked in scarlet fever, and judged, the particular appearance of the rash has given this fever its name. It first appears in the upxier part of the chest, and extends to the neck and face. The separate particles of the rash, as it were, really appear as small, bright red specks on the skin, and, of course, all around the skin itself will bo seen to have acquired a strange redness. In about a day after its first appearance the rash will be found to be spread to the body and limbs. Jn three or four days later it will reach its highest development, and then by the seventh or eighth day of the fever it will fade and disappear. If the case is a simple one, the a'ctivc symptoms of tho fever will disappear when the rash fades away, but then comes the peeling and scaling of the skin, .which I have already referred to as one of the most frequent sources of infection. It would seem, indeed, as if this fever largely ended-its career by producing the particular skin symptoms to which I have alluded. We must, therefore, bear in mind that the scurf from the skin (sometimes the skin will peel off in large masses) is highly infectious, because it is charged with the germs of

the disease; and one important point further in tho case of a scarlet fever patient consists in the disinfection of all clothing, bed and body clothing alike, and in the prevention of the escape of skin particles from the patient’s room. It is on this ground that in the treatment of cases of scarlet fever many medical men, when the stage of skin peeling lias been arrived at, order tne skin to he anointed with some form of disinfecting ointment. In this way the drying of the scales and the flying off into the air is prevented. Remember that no case of scarlet fever can ever be pronounced cured and free from risk of infecting others until every trace of skin peeling lias disappeared.

THE TREATMENT. I have already shown the importance of a fever patient having constant s ttention and good nursing. If this can--1 not be procured in the home, where there must be many risks of infection being conveyed to others, the only safety for patient- and others alike is his or her treatment in a fever hospital. I have already referred to the risks which attend an attack of this fever, especially during the period cf convalescence, from chills and colds. There- . fore, this fact must he borne in mind, ■ and the patient must be guarded carefully against all such risks. It is probably more or less neglected cases of this kind which arc apt to terminate fatally through the oncoming of kidney troubles and other diseases. The home treat- ; ment of scarlet fever, therefore, first of | all includes precautions against infoc- • tion spreading. For the rest- that tireat- ; ment will he, as a rule, simple in cliar- ; actor. Such a case is eminently one | for the attendance of a medical man. if for no other reason than that he alone is able to detect if the disease is proj grossing favourably, and he alone is callable of recognising and at'once treat- ■ ing any complications which may occur. The room in which the patient is kept i must he cool, and it is very important | that the bowels should ho regulated. : Probably a dose of castor oil given at j the commencement of the fever will ! have a beneficial effect in somewhat lesj soiling it, while the very operation of the | bowels is a condition that certainly faj vours the course of the disease. The diet, | of course, will be extremely simple, and | will consist mostly of milk. If any ! additions be made to this diet it will j probably take the form of very light i milk pudding and similar fare. If the ' thirst- is great, and the throat especially painful, an excellent drink may be i made by dissolving CO grains of ehlori ate of potash in a pint of water, the I patient being allowed to drink as freely ! as is necessary. If the throat symptoms j aro very troublesome, hot poultices ! may require to be applied, and if the j case is assuming somewhat of a severe ! character, with great, weakness attend- ! ing thereon, stimulants will undoubtedly be ordered by the medical man. SOME OTHER HINTS. It will be seen in a case of this.kind that very little medicine is necessary or given for an ordinary case of this fever. One may remark that medical men rei cognise at least three varieties of it , the simple variety, in which the eruption disappears quickly, say about the fifth daya second variety, in which the fever is much more severe, and the , temperature early runs up to a liigh : degree, the eruption being delayed in I appearance till tho third or fourth day; ! : and finally, a variety called malignant j scarlet fever, where there is delirium, I great prostration, and irregular rash and collapse.- If a patient in such a case 'survives the seventh or eighth ; ■ day of the fever he is likely to recover. ; i The throat trouble should especially be : | watched, and the doctor warned ,es- ! : pecially of any enlargement of the ! I glands beneath the jaw, which is, on die ! whole, an unfavourable sign. With re- | gard to disinfection in this fever, those . in attendance on the case should remem- j ; her that all hod and body clothes, inline- ; | diately on being taken off the bed and patient, should be plunged into a tub i containing a solution of izal and water j in the proportion of one part of izal to 200 parts of water; allowed to steep in this solution for twenty-four .tours, | they may then bo rinsed and washed with safety. I have already spoken of the importance of anointing the body ! witlg-oil or some other sort of ointment, and unless there is some special reason indicated hv the doctor against this practice, it- should he followed. With j regard to the disinfection cf the room after the patient lias recovered, this may he best accomplished in a household way by closing up the chimney and apertures of windows and doors i with paper, and by lighting in the room sulphur to the amount of about ljlb for every 1000 ft of space the room ; contains. The sulphur should he burned on an iron shovel or tray set over a tub ] | containing water. The powerful f as ! ! given off by-./thc burning sulphur finds its way into corners and crevices, and ! destroys any germs which may remain, i This gas is so powerful that the moment ! tho sulphur is alight .the person who ■ - lights should leave the room at once, 1 ! shutting the door, otherwise suffocation j might he liable to occur. The -00111 j should be kept closed for'twenty-four hours, and then freely aired. It is’ v/ell 1 to repaint and paper tho room if possible, and I need hardly say the bedding should be purified and disinfected by steam. Previous to tho gas being lighted in ihe room, carpets will, of course, lie taken up and all unnecessary objects of furniture moved out therefrom. The walls, after disinfection with sul-

phur, may bo rubbed down with dry bread, the . crumbs being carefully collected and burned, and all woodwork should be washed with a strong disinfectant soap, such as izal soft soap, and hot water. I have devoted this article to the consideration of this disease because it. forms an admirable object lesson for • us in the treatment of all infectious diseases. It is only by attention being paid to the details I have noted that we, can ever hope to limit the spread of this modern plague, and reduce the death rate, which year by year it is the duty of health authorities to chronicle for us by way of warning.