CHAPTER I
ACUTE SPECIFIC DISEASES
15. Scarlet Fever (Febris Rubra) – Scarlatina.
THE mortality of Scarlet fever is very large, the disease destroying every year in this country the lives of some twenty thousand persons. During the same time it more or less completely disables, often for a long period, a hundred thousand others. Yet, judging by the results and have been effected by disinfection, separation, and preventive treatment, by far the larger amount of this waste of life and costly sickness might be averted.
Scarlet fever is chiefly prevalent in children, especially from the second to the fifth year of life. It is by no means infrequent during the second year, and even occurs before the end of the first, although infants a few months old seem to enjoy a special immunity. We have often attended families in which all the children have been suffering from the disease except the baby, who, crowing and smiling all the time, was the only one unaffected. After the tenth year the susceptibility rapidly diminishes. The common notion that Scarlatina is a mild, and Scarlet fever a severe form of the disease, is incorrect, for the terms are synonymous.
VARIETIES.- There are three varieties, or, more correctly, degrees of intensity; for though it is convenient to speak of Scarlatina simplex, S. Anginosa, and S. maligna, they are but one disease, manifesting different degrees of severity. Exposure to the infection of S. simplex may give rise to an attach of S. maligna and the reverse. The same organs are affected, the same functions are disturbed, and organs are same secondary diseases follow in each case. The characteristics of each variety are as follows :- 1. S. simplex. A scarlet rash with moderate fever and slightly enlarged and inflamed tonsils. 2. S. anginosa, those of S. simplex of the throat, and swelling of the submaxillary glands. 3. S. Maligna. The rash is of a dark-red colour, often haemorrhagic, and comes out later than in the other varieties, and often imperfectly or irregularly; there is no ulceration of the throat or glandular enlargement, but profound toxaemia, shown by a very high temperature, very rapid and feeble pulse, restlessness and delirium soon giving place to come. Death may occur within thirty-six hours.
MODE OF PROPAGATION.- Although we are ignorant of the origin of Scarlet fever, we know that it spreads by infection, and that most rapidly and persistently. It is by no means necessary to have direct contact with a patient, or to imbibe or touch anything that has been directly contaminated by him – it is not even necessary to be in the same room, in order to take the disease. The poison rapidly diffuses itself throughout the whole house unless stringent preventive disinfecting measures are adopted, and no inmate can be said to be safe unless he has previously had the disease, and even then he is not absolutely had the disease, and even then be is not absolutely so. The poison may be conveyed in milk. The unseen germs, which no microscope can detect, are not only very rapid and fatal in their action, they are also very tenacious. They lurk in all kinds of places, and cling to everything. The clothes of attendants as well as of the patient, the bedding, furniture, and walls of the rooms, persistently retain the poison. and they have been known to communicate the disease after an interval of one or two years.
GENERAL SYMPTOMS.- Scarlatina has an incubation period of two to five days. It commences with the ordinary symptoms of fever – chills, shivering, hot skin, frontal headache, rapid pulse, nausea, vomiting, thirst, and sore throat. The last-named symptom is generally the first complained of by the patient.
After a short time the pulse becomes very quick, often in children 120 to 140 in the minute. In about forty-eight hours after the occurrence of these symptoms, the rash comes out, first on the breast, then on the neck, face, body, and cover the great joints and limbs, till the whole body is covered with it.
The eruption usually fades away in the same order. Its appearance is a bright-scarlet efflorescence, consisting of innumerable smooth spots, not raised above the skin, having the colour and semblance of a boiled lobster-shell. The colour disappears on pressure, but immediately returns on its removal.
The tongue at first is coated with a creamy fur, the tip and the edges are red, the papillae are red and raised, giving it a peculiar strawberry-like appearance. This is always exhibited in the course of the disorder, and not infrequently at its commencement. The tongue afterwards becomes preternaturally clean and raw looking. A diffused redness, sometimes of a dark claret colour, covers the mouth, fauces, etc., which disappears as the febrile symptoms and rash subside. On above the fifth day the efflorescence generally begins to decline, and by about the eight or ninth entirely disappears, leaving the patient prostrate.
During a period of uncertain length, the outer skin comes off as scurf, or moulded masses are thrown off, especially from the hands and feet. The disease does not, however, always pursue this uniform course. In the exceedingly dangerous form we have described, the eruption is either entirely wanting, or livid and partial. In the anginose variety the mucous membranes are threatened with gangrene, the glands and even the cellular tissue of the neck are very much swollen, membranous exudation as in Diphtheria may form in the pharynx and spread up into the nose, constitutional disturbance is profound and the child may quickly die. Short of this there may be extensive suppuration and sloughing in the tissue of the neck.
TREATMENT.- At the commencement of the illness, of before its true nature is recognised, the febrile symptoms may be modified by a dose of Aconite every two for three hours. When the characteristic redness of the skin or throat shows itself, Belladonna should be administered in a similar manner; or if the fever continue high, the two medicines may be given alternately, at intervals of two hours. If the case be one of S. simplex no other medicine will probably be needed, until it is on the decline, when Sulph. should be taken night and morning for two or three days. In S. anginosa, Aconite will hardly be needed, Apis or Mercurius will have to take the place of Belladonna, and, if the heat of skin or restlessness be considerable, in alternation with Gelsemium. In S. maligna, Ailan, or Ammonium-Carb.will be more especially called for.
Difference between MEASLES
1. Rash comes out on the fourth day
2. Catarrhal symptoms are prominent watery discharge from the eyes and nose, sneezing, harsh cough etc.
3. The rash begins near the roots of the hair
4. The rash is of a pinkish-red of raspberry colour. The white streak produced by the back of the nail is not uniform, and lasts a shorter time than in Scarlet fever.
5. The eruption is somewhat rough, so as to be felt by passing the hand over the skin, and is crescentic groups, with natural skin between.
6. Liquid, tender, watery eye 7. The cuticle is thrown off in minute portions, like fine scale of bran 8 The most common sequelae are diseases of the lungs, eyes, ears and skin.
SCARLET FEVER
1. Rash appears on the second day.
2. Catarrhal symptoms are usually absent, but there is great heat of the skin, sore throat, and sometimes delirium.
3. The rash begins on the neck and face.
4. The eruption is of a bright scarlet colour, and by drawing the back of the nail over the skin a white streak is produced, which lasts two or three minutes.
5. The rash usually presents no inequalities to sight or touch, and is so minute and closely crowded as to give the skin a uniformly red appearance.
6. A peculiar brilliant stare, as if the eyes were glazed.
7. Desquamation of the cuticle is usually in large patches, especially from the hands and feet.
8. The most frequent sequelae are dropsy, especially after milk cases, and glandular swellings.
DANGERS.- Pneumonia, Bronchitis, Diphtheria, and inflammation of the larynx may arise during the course of the disease. Phthisis, Diphtheria, disease of the glands and bones, Chronic Ophthalmia, Otorrhoea, and skin diseases may follow the attack.
TREATMENT.- In the early stage Aconite should be given every two or three hours to subdue the fever. As soon as the symptoms peculiar to the disease manifest themselves, Pulsatilla must be administered alone every two or three hours, or, if necessary, in alternation with the Aconite at intervals of two hours. The cough almost invariably attendant upon the disease may be mitigated by a dose or two Belladonna or Hyoscyamus If the eye-symptoms are very troublesome, great smarting and intolerance of light, they should be bathed every few hours with a lotion of Euphrasia, in the proportion of a teaspoonful to a teacupful of water.
INDICATIONS FOR THE ABOVE AND OTHER REMEDIES.
REMEDIES.- Aconitum – Febrile symptoms at the outset or during the process of the disease. A dose every third or fourth hour.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."