Read PART I - DESCRIPTION OF SCARLET-FEVER of Hydriatic treatment of Scarlet Fever in its Different Forms , free online book, by Charles Munde, on ReadCentral.com.

DESCRIPTION OF SCARLET-FEVER

1. SCARLET-FEVER, OR SCARLATINA.

Is an eruptive fever, produced by a peculiar contagious poison, and distinguished by extreme heat, a rapid pulse, a severe affection of the mucous membranes, especially those of the mouth and throat, and by a burning scarlet eruption on the skin.

2. DIVISION OF THE PROCESS OF THE DISEASE INTO PERIODS.

Its course is commonly divided into four distinct periods, viz.: the period of incubation, the period of eruption, the period of efflorescence, and the period of desquamation; to which may be added: the period of convalescence.

3. PERIOD OF INCUBATION, OR HATCHING.

The time which passes between the reception of the contagious poison into the system and the appearance of the rash, is called the period of incubation; incubation or incubus meaning, properly, the sitting of birds on their nests, and figuratively, the hatching or concoction of the poison within the body, until prepared for its elimination. There is no certainty about the time necessary for that purpose, as the contagion, after the patient has come in contact with it, may be lurking a longer or a shorter time about his person, or in his clothes and furniture.

As in almost all eruptive fevers, so in scarlatina, the patient begins with complaining of shivering, pain in the thighs, lassitude, and rapidly augmenting debility; frequently also of headache, which, when severe, is accompanied with delirium, nausea and vomiting. The fever soon becomes very high, the pulse increasing to upwards of 120 to 130 strokes in a minute, and more; the heat is extreme, raising the natural temperature of the body from 98 to 110-112 degrees Fahrenheit, being intenser internally than on the surface of the body. The patient complains of severe pain in the throat, the organs of deglutition located there becoming inflamed, and swelling to such a degree that swallowing is extremely difficult, and even breathing is impeded. The tongue is covered with a white creamy coat, through which the points of the elongated papillae project. Gradually the white coat disappears, commencing at the end and the edges of the organ, and leaves the same in a clean, raw, inflamed state, looking much like a huge strawberry. This is called the strawberry tongue of scarlet-fever, and is one of the characteristic symptoms of that disease. There is a peculiar smell about the person of the patient, reminding one of salt fish, old cheese, or the cages of a menagerie.

4. PERIOD OF ERUPTION, OR APPEARING OF THE RASH.

Commonly, on the second day, towards evening, sometimes on the third, and only in very bad cases later, the rash begins to make its appearance, under an increase of the above symptoms, especially of the fever and delirium, and continues to come out for about twelve hours. Usually the eruption commences in the face, on the throat and chest; thence it spreads over the rest of the trunk, and finally it extends to the extremities. The minute red points, which appear at first, soon spread into large, flat, irregular patches, which again coalesce and cover the greater part, if not the whole, of the surface, being densest on the upper part of the body, particularly in front, in the face, on the neck, the inner side of the arms, the loins, and the bend of the joints. The scarlet color of the rash disappears under the pressure of the finger, but reappears immediately on the latter being removed. Sometimes the eruption takes place with a profuse warm sweat, which prognosticates a mild course and a favorable issue of the disorder. Together with the appearance of the rash, the disease develops itself also more internally: the inflammation of the mouth and throat increases; the tonsils and fauces swell to a high degree; the eyes become suffused and sensitive to the light; the mucous membranes of the nose and bronchia become also affected, the patient sneezes and coughs, and all the symptoms denote the intense struggle, in which the whole organism is engaged, to rid itself of the enemy which has taken possession of it.

5. PERIOD OF EFFLORESCENCE, OR STANDING OUT OF THE RASH.

During the first day or two of the period of efflorescence, which lasts three or four days, the above symptoms usually continue to increase. Sometimes, however, the patient is alleviated at once on the rash being formed. This alleviation always takes place when the rash comes with perspiration, and also under a proper course of water-treatment. If the rash continues to stand out steadily, the symptoms decrease on the third day; the patient becomes more quiet, the pulse slower (going down to 90 and even to 80 strokes per minute); the rash, then, gradually and steadily fades, and finally disappears altogether. -- Sometimes the rash fades or disappears too early, in which cases, usually, the internal symptoms increase, the brain and spine become affected, and the situation of the patient becomes critical.

6. PERIOD OF DESQUAMATION, OR PEELING-OFF.

About the sixth or seventh day, the epidermis, or cuticle of the skin begins to peal off, commencing in those places which first became the seat of the rash, and gradually continuing all over the body. In such parts as are covered with a thin delicate cuticle (as the face, breast, &c.) the cuticle comes off in small dry scurfs; in such parts as are covered with a thicker epidermis, in large flakes. There have been instances of almost complete gloves and slippers coming away from patients’ hands and feet. -- The fever subsides entirely, and so does the inflammation of the throat and mouth, which become moist again. Also the epithelia, or the delicate cuticles of the mucous membranes, which have been affected by the disease, peal off and are coughed up with the tough thick mucus covering the throat, or they are evacuated with the faeces and the urine, forming a sediment in the latter. -- Desquamation is usually completed in from three to five days; sometimes it requires a longer time; under hydriatic treatment it seldom lasts more than a few days. Whilst desquamation is taking place, a new cuticle forms itself, which, being exceedingly thin at first, gives the patient a redder color than usual for some time, and requires him to be cautious, in order to prevent bad consequences from exposure. --

Thus the disease makes its regular course in about ten days, and, under a course of hydriatic treatment, which not only assists the organism in throwing off the morbid poison and keeps the patient in good condition, but also protects him from the influence of the atmosphere, the patient may consider himself out of danger and leave the sick-room under proper caution, of which we shall speak hereafter.

7. THE PERIOD OF CONVALESCENCE,

under the usual drug-treatment, is, however, usually protracted to twice or thrice the duration of the disease, the patient being compelled to keep the house for five or six weeks, especially from fear of anasarca, or dropsy of the skin, frequently extending to the inner cavities of the body, and proving fatal. This dangerous complaint has been more frequently observed after mild cases of scarlet-fever than after malignant cases, probably from the fact that in mild cases the patient is more apt to expose himself, than when the danger is more obvious and all possible care is taken. -- Sometimes also severe rheumatic pain, or rather neuralgia, in the joints, swelling of the glands, and other sequels prolong his sickness. I never observed a case of dropsy, or of neuralgia, after a course of water-treatment.

8. VARIETIES OF FORMS OF SCARLATINA.

The above is the description of scarlet-fever, as it most frequently occurs. But far from taking always that regular course, the constitution of the patient, the intensity of the epidemy and the virulence of the poison, the treatment and other circumstances influencing the development of the disease, cause several anomalies, from scarlatina simplex to scarlatina maligna, which too often baffles all the resources of the Medical Art.

9. SCARLATINA SIMPLEX, OR SIMPLE SCARLET-FEVER.

In the mildest form of the disease, called scarlatina simplex, or simple scarlet-fever, there is no inflammation of the throat, the fever is moderate, and the patient suffers very little. Unfortunately this form is so rare, that many experienced physicians never saw a case. Probably, it was a case belonging to this class, which was mentioned a number of years ago by one of the writers on Priessnitz’s practice, when a lady with scarlet-fever joined a dancing party at Graefenberg, a case for reporting which the author has been ridiculed by the opponents of the Water-Cure, but which by no means belongs to impossibilities; for scarlatina simplex having been declared by eminent physicians (not of Priessnitz’s school) to be “scarcely a disease," becoming fatal only through the officiousness of the doctor, and other physicians of note recommending cold rooms and open air through the whole course of the disease, or at least towards the latter part of it; I do not see why a patient under water-treatment should not be safer in producing perspiration by dancing than in sitting in a cold room or in walking in the open street. The fact, of course, is unusual, and I do not exactly recommend its practice, but it is not at all impossible, and ridiculing the reporter of it shows either ignorance of the disease or a bad will towards the new curative system, to which those are most opposed who know the least of it.

10. SCARLATINA ANGINOSA, OR SORE-THROAT SCARLET-FEVER.

Wherever the throat is affected, which is almost always the case, the disease is called scarlatina anginosa, or sore-throat scarlet-fever. This is the form described at the commencement of this article. There are several varieties, however, of scarlatina anginosa.

In any case, the organism, invaded by the contagious poison, will try to rid itself of its enemy. The reaction is necessarily in proportion to the violence of the miasma and to the quantity of organic power struggling against it.

11. MILD REACTION (ERETHIC).

If the poison is not virulent, and the body of the patient in a favorable condition, the reaction is mild, and the poison is eliminated without any violent efforts on the part of the organism. This is the case in scarlatina simplex, and in mild forms of scarlatina anginosa.

12. VIOLENT REACTION (STHENIC).

If both, the contagious poison and the organism, are very strong, a violent reaction will take place, and the safety of the patient will be endangered by the very violence of the struggle, by which internal organs may be more or less affected.

13. TORPID REACTION (ASTHENIC).

The more violent the contagious poison, and the weaker the organic power, the less decidedly and the less successfully will the organism combat against the poison, and the more inroad will the latter make upon the system, affecting vital organs and paralyzing the efforts of the nervous system by attacking it in its centres. In such cases of torpid reaction, the patient frequently passes at once into a typhoid state. This is what we call scarlatina maligna, or malignant scarlet-fever.

14. SCARLATINA MILIARIS

Sometimes the red patches of the rash are covered with small vesicles of the size of mustard-seed, which either dry up or discharge a watery liquid, leaving thin white scurfs, that come away with the cuticle during desquamation. Although this form, called scarlatina miliaris, being the result of exudation from the capillary vessels, shows an intensely inflamed state of the skin, its course is usually mild and its issue favorable; because the morbid poison comes readily to the surface.

15. SCARLATINA SINE EXANTHEMATE.

There are also mild cases of scarlet-fever, when little or no rash appears, and the throat is very little affected. These are the result of a particularly mild character of the epidemy, together with a peculiar condition of the skin, the desquamation of which shows that the poison went to the surface without producing the usual state of inflammation, or the rash peculiar to the disease. This form, called scarlatina sine exanthemate, is extremely rare.

16. THE MALIGNANT FORMS OF SCARLET-FEVER

are caused by the character of the epidemy, but, perhaps, more frequently by the weak and sickly constitution of the patient and the external circumstances affecting it. Thus, persons of scrofulous habit, being naturally of a low organization, without much power of resistance, are much more liable to experience the destructive effects of scarlatina than those whose organism possesses sufficient energy to resist the action of the morbid poison, and to expel it before it can do any serious harm inside the body.

17. SUDDEN INVASION OF THE NERVOUS CENTRES.

Of the different forms of scarlatina maligna the most dangerous is the sudden invasion of the nervous system, particularly the brain, the cerebellum and the spine, by which the patient’s life is sometimes extinguished in a few hours. In other cases the symptoms deepen more gradually, and death ensues on the third, fifth or seventh day.

18. AFFECTION OF THE BRAIN.

When the brain is affected, the patient suddenly complains of violent headache, vomits repeatedly, loses his eye-sight, has furious delirium, or coma (a state of sleep from which it is difficult to rouse the patient); his pupils dilate; the pulse becomes small, intermits; sometimes the skin becomes cold; there is dyspnoea (difficulty of breathing), fainting, paralysis, convulsions, and finally death; or, sometimes, the paroxysm passes suddenly by with bleeding from the nose or with a profuse perspiration.

19. AFFECTION OF THE CEREBELLUM AND SPINE.

In affections of the cerebellum and spinal marrow, the patient complains of violent pain in the back of the head and neck, in the spine, and frequently in the whole body. These also frequently terminate with the destruction of life.

20. During all these invasions of the nervous centres there is little or no rash, and what appears is of a pale, livid hue.

21. PUTRID SYMPTOMS.

Next to those most dangerous forms most dangerous, because the organic power (the vis medicatrix naturae), from which the restoration of health must be expected, and without which no physician can remove the slightest symptom of disease, becomes partly paralyzed from the beginning putrid symptoms present a good deal of danger, although they give the organism and the physician more time to act.

22. CONDITION OF THE THROAT, AND OTHER INTERNAL ORGANS.

The condition of the throat requires the most constant attention. From a highly inflamed state, it often passes into a foul and sloughy condition; the breath of the patient becomes extremely fetid; the nostrils, the parotid and submaxillary glands swell enormously, so that swallowing and breathing become very difficult. There is an acrid discharge from the nose; the gangrenous matter affects the alimentary canal, causing pain in the stomach, the bowels, the kidneys and the bladder; a smarting diarrhoea with excoriation of the anus, and inflammatory symptoms of the vulva. Also the bronchia, lungs, pleura and pericardium become affected, as sneezing, cough (the so-called scarlet-cough) and the pain across the chest and in the region of the heart indicate.

23. OTHER BAD SYMPTOMS.

These symptoms may present themselves with the rash standing out; but most frequently they occur when there is little or no eruption, or when it fades, becomes livid, or disappears altogether. A sudden disappearance of the rash, before the sixth day, commonly increases the typhoid symptoms, and must be considered a bad omen. Also the invasion of the larynx, which is happily of rare occurrence, is commonly fatal.

24. DESTRUCTION OF THE ORGAN OF HEARING.

When the glands pass into a sloughing state, the parts connected with them are frequently damaged. Thus the ulceration of the parotid gland often causes deafness, by the gangrenous matter communicating to the eustachian tube and the inner ear, where it destroys the membrane of the drum and the little bones belonging thereto, or by closing up the tube. When the discharge from the outer ear is observed, the destruction has already taken place, and it is too late to obviate the injury.

25. OTHER SEQUELS, DROPSY, &C.

Beside the ulceration of glands and deafness, some of the sequels of scarlatina are white swelling of one or more of the joints, usually the knee, chronic inflammation of the eyes and eyelids, and partial paralysis. These chiefly occur in scrofulous subjects. Dropsy, which I have mentioned before, is one of the sequels that frequently prove fatal.

26. THE CONTAGION OF SCARLATINA VERY ACTIVE.

The contagion of scarlatina is very active, and adheres for a long time to the sick-room, bedding, clothes and furniture. The best means to destroy it, is plenty of air. It is difficult to say when the contagion is over, as much depends on the season of the year and the care with which the house is aired. Physicians and visitors at the sick-room are very apt to carry it about, unless they be exceedingly careful in changing their clothes and washing themselves, hair and all, before entering other rooms inhabited by persons who had not had the disorder before. It is astonishing how easily such persons are taken by it; and it even sometimes happens that such as have gone through it, take it again in after years. I am authorized by experience, that the idea as if patients under water-treatment, or even such as take a cold bath every morning, were inaccessible to the contagion, is erroneous. I have had patients under treatment for chronic diseases, who had had scarlatina several years before, and neither this nor the water-cure protected them from taking it again. With some of them, however, the throat only became affected and no desquamation took place, whilst the character of the complaint with the rest was rather mild. I have been astonished to read that in a meeting of a medical society of this country, which took place a very short time ago, some members could have raised the question whether scarlatina was really contagious. I admit that the profession in general has not made great progress in the cure of the complaint, but it does not require great study and long experience to know that scarlet-fever is contagious!

27. The form of the disorder in one patient does not imply the necessity of another who caught it from him having it in the same form. A person can take the contagion from one who dies of malignant scarlet-fever and have it in the mildest form, and vice versa. The character of the disease depends very much on the constitution, as I have said above. However, if the epidemy in general is of a malignant character (which may again depend, partly at least, on the constitution of the atmosphere), it will prove so in many individuals who are taken with it, and the precautions ought to be so much the more careful on that account.

28. DIAGNOSIS.

After what has been said about the symptoms of scarlatina, it cannot be difficult to distinguish it from similar eruptive diseases. However, as there is much resemblance between scarlatina and measles, at least in the milder form of the former, I shall give a few symptoms of each, to assist parents in making the distinction.

29. DIAGNOSIS FROM MEASLES.

In scarlatina the heat is much greater, and the pulse is much quicker than in measles. -- In scarlatina the throat is inflamed, usually the brain affected, and the patient smells like salt-fish, old cheese or the cages of a menagerie; in measles, the eyes are affected, inflamed, and incapable of bearing the light; the organs of respiration likewise (thence coryza, sneezing, hoarseness, cough); the perspiration smells like the feathers of geese freshly plucked. -- In scarlatina the period of incubation is a day less than in measles; namely, in scarlatina the rash appears on the second day after the first symptoms, in measles on the third. -- The scarlet-rash consists of large, irregular, flat patches, which cover large spaces with a uniform scarlet-red, being brightest in those parts which are usually covered by the garments of the patient; in measles the spots are small, roundish or half-moon-like, with little grains upon them, and usually of a darker color; the measle-rash is thickest in such parts as are exposed to the air. -- In scarlatina the symptoms of fever and the affection of the mucous membranes continue two days after the eruption has begun to make its appearance; in measles the eruption diminishes those symptoms at once. -- The scarlet-rash stands out a day or two less than the measle-rash, and comes off in laminae, whilst the latter comes off in small scales or scurfs.

30. THE PROGNOSIS,

under a well conducted course of hydriatic treatment is, in general, favorable. Much depends, however, on the season of the year (in damp and cold weather partly owing to a lack of pure air in the sick-room the disease is more dangerous than in summer); on the general health of the patient (not on his mere looks, for well-fed and stout children are subject to affections of the brain); on the age of the patient (adults are generally more in danger than children); on the form of the disease and the character of the fever (erethic or mild fever being the most favorable, whilst typhoid fever is the worst; a violent character of the fever is not very dangerous under hydriatic treatment, as we have plenty of means to limit its ravages without weakening the patient); on the eruption, the condition of the throat, the process of desquamation, &c.

31. FAVORABLE SYMPTOMS

are the following: Absence of internal inflammation; a bright florid rash; a regular, steady appearance, standing out, and disappearance of the latter; a regular and complete pealing off of the cuticle; a decrease of the pulse after the eruption of the rash; an easy and regular respiration; a natural expression of the features; a moist skin.

32. UNFAVORABLE SYMPTOMS

are: A fetid breath, with ulceration and sloughing of the throat and glands; a smarting and weakening diarrhoea; involuntary evacuations of the bowels; dizziness, deafness, coma, grinding of the teeth; retention of urine; petechiae; a rapid decline of the patient’s strength; a quick, small, weak pulse; rapid breathing; twitchings, tetanus, hiccough, &c. -- Closing up of the nose frequently precedes a dangerous affection of the brain. A sudden disappearance of the rash, or of the inflammation of the throat, is a bad omen. With such symptoms as these, there is usually little or no rash, and the little there is, of a pale, livid color, and the skin, in general, inactive.