Scarlet fever (scarlatina)

-SMALL A. E.,
This disease, is generally believed to be of a contagious character, and is usually regarded as the most formidable of any of the eruptive fevers among children. There are three varieties of the disease, viz: the simple, anginose, and malignant.

The simple Scarlet Fever, is usually preceded by chilliness; weariness of the limbs; peevishness and fretfulness; pain in the head; nausea, or sickness at the stomach, and sometimes vomiting, after which, the eruption begins to appear in patches, covering the entire body with a bright, scarlet eruption; the breath appears foul; the tongue loaded with a white coating; inflammation of the tonsils, but without ulceration.
The ANGINOSE variety, makes its appearance with more violent symptoms; great acceleration of the pulse, and continual vomiting for hours, of green, bilious matter; when the vomiting subsides, there is an eruption of a paler appearance, that begins to manifest itself in patches; the tonsils become inflamed and swollen, and severely ulcerated; and the breath has in exceedingly offensive odor; and the tongue is loaded with a dirty, white coating, or appears red; and the papillae swollen; there is great prostration, and swelling of the parotid glands, and also the glands of the under jaw; the fever is intense, and the chest seems afflicted with catarrhal difficulty; and not unfrequently, there is a constant discharge of hot, acrid mucus from the nose; the tongue is dry and swollen.
The malignant form of the disease, manifests the most violent symptoms about the head, it is sudden in its appearance, and often terminates fatally, before the eruption has fully made its appearance; but when such is not the case, there is continual vomiting, violent pain in the head; stupor; eyes half closed; pale eruption in spots, of the color of brick-dust; and not unfrequently, thin, acrid, and burning discharges from the nose. These are the general characteristics of the three forms, but great variations in the symptoms, may be met with, that will call for corresponding treatment.

Scarlet fever rarely attacks persons of adult age; in general, it may be regarded a disease of childhood, though, in some cases, persons of mature age have been its subjects.
Treatment
The remedies employed in the treatment of scarlet fever in its various forms, are, Acon., Arsenicum, Belladonna, Bryonia, Calc. carb., Chamomilla, Digitalis, Dulcamara, Helleborus nig., Hepar sulph., Kali carb., Lycopodium, Mercurius, Nitric acid, Nux vom., Opium, Phosphorous, Phosph. acid, Pulsatilla, Rhus tox., Sulphur, Silicea.
Aconitum napellus
When the fever runs high in the first stage of simple scarlet fever, that has been preceded by chilliness, and there is throbbing of the temples, and vomiting of greenish matters.
DOSE. – Six globules, or one drop, in half a tumbler of water, a teaspoonful every hour, until the eruption is completely out, and then refer to Belladonna.
Arsenicum album
is indicated when there is a heavy, fetid odor from the mouth, with continual inclination to vomit; great heat about the head, and strongly marked indications of cerebral disturbance; a discharge of hot, acrid water from the nose; fetid ulceration of the throat; great prostration, and loss of consciousness; pulse rapid, full and tense; stupor and delirium. This remedy is suited to the malignant form of the disease.
DOSE. – One drop, or six globules, in half a tumbler of water, a teaspoonful every two hours, until mitigation or change.

Belladonna
is useful after Aconite, in simple inflammatory scarlet fever after the fever is somewhat subdued, and the throat appears to be seriously affected; tonsils swollen and red; the skin of a scarlet hue; the tongue coated, and red around the edges; the pulse quick and strong, and particularly, when the disease appears in its simple form, without any prominent febrile symptoms.
DOSE. – One drop of the dilution, or six globules, in four tablespoonfuls of water, a teaspoonful every three hours, until mitigation or change. It should be administered as soon as the throat and tongue become affected with dryness and burning, provided the other indications are present.
Bryonia alba
is indicated when there is vomiting of white glairy mucus, and the eruption is slow in making its appearance; it promotes the bringing out of the eruption after it has receded.
DOSE. – One drop of the dilution, or six globules, in four tablespoonfuls of water, a teaspoonful every three hours; this remedy may be followed by Belladonna, the same as directed for the use of this remedy.
Calcarea carbonica
is particularly indicated in the more malignant form of the disease, when complicated with scrofula, or the subject has been known previously to be affected with herpetic eruptions, that have been suppressed, and also by pale, sunken expression of the countenance; stupor; swelling of the parotid and submaxillary glands; red, glairy appearance of the tongue; disposition to sleep; pale color of the eruption and in patches.
DOSE. – One drop, or six globules, may be dissolved in four tablespoonfuls of water, and a tablespoonful may be given first, and Belladonna may be given if otherwise indicated three hours after; Calc. carb. should not be repeated oftener than once in two days; during the interval any remedy indicated by the acute symptoms may be given every three hours.
Chamomilla
is indicated when there is in the commencement great restlessness and inquietude, and also when there is pain in the stomach, preceding the appearance of the eruption; fretful, wheezing and moaning; the eruption red and distinct; slight indications of perspiration on some parts of the body, and particularly on the face and forehead; tossing about or throwing about the arms and legs, and also for rawness of the face.

DOSE. – This medicine may be given four globules at a time, every three hours, either in water or dry upon the tongue, or one drop of the dilution in four spoonfuls of water, a teaspoonful at a time, every three hours, until amelioration or change.
Digitalis purpurea
is particularly applicable in local affections arising from scarlet fever, such as dropsy of the chest; the symptoms which indicate its use are: small, quick, soft pulse; labored breathing, as if the patient were smothering; tumefaction of the countenance; pale, sickly appearance of the face; great debility and want of strength in the limbs; discharges of watery pus from the ears.
DOSE. – One drop, or six globules, in four spoonfuls of water, a teaspoonful every four hours; this remedy may be used in alternation with Arsenicum, or Helleborus, or Calcarea carb.
Dulcamara
may be used to obviate deafness after an attack of scarlet fever, attended with pains in the ears, when there still remains heat and dryness of the skin, or when the scarlet fever has appeared suddenly after a cold.
DOSE. – The same in all respects as for Digitalis.
Helleborus niger
is particularly indicated when general dropsy sets in, as an after effect of scarlet fever, and may be associated with Arsenicum, Bryonia and Rhus.
DOSE. – Of either remedy, one drop, or six globules, may be dissolved in four spoonfuls of water, and one spoonful may be given three times a day.
Hepar sulphur
is another remedy to be consulted in obstinate dropsical difficulties, or discharges from the ears, or stoppage in the nose, when they appear as the after effects of scarlet fever.

DOSE. – Four globules, or one drop of the dilution may be given twice a day, or Hepar. may be given at night, and Puls. in the morning.
Kalium carbonicum
is indicated when there is continued inflammation of the parotid glands, and catarrhal difficulties implicating the chest, or sore throat, remaining after the fever has disappeared.
DOSE. – The same in all respects as for Hep. Sulph.
Lycopodium clavatum
is suitable for internal inflammation of the ears, discharge of pus, and for obstinate dropsical difficulties, after the use of Helleborus.
DOSE. – One drop, or four globules, twice a day.
Mercurius solubilis
is a good remedy against soreness of the nose and face after the fever, with swelling of the sub-maxillary glands; it may be followed with Silicea or Sulphur.
DOSE. – One drop, or four globules, may be given twice a day; twenty four hours should elapse in all cases after the use of this remedy, before either of the others are employed.
Nitricum acidum
is a useful remedy in scarlet fever, when it assumes the typhoid form; when there is a kind of half sleep and stupor; severe and dangerous ulceration of the tonsils; snoring and difficult breathing; coldness of the lower limbs and feet.
DOSE. – One drop, or six globules, in four tablespoonfuls of water; a teaspoonful may be given every hour, until the vital energies appear to be aroused, or there is some amelioration or change.
Nux vomica
is particularly indicated during the fever, which there is a large quantity of viscid mucus secreted from the inflamed surface of the throat, which adheres so closely that it is difficult to expel, and that sometimes threatens suffocation; it may be used in alternation with Pulsatilla.
DOSE. – Of either. – One drop, or four globules, two or three times a day, or in alternation every four or six hours.
Opium
is a useful remedy to follow Belladonna when there is burning heat of the skin; drowsiness; stupor; snoring respiration; open mouth; eyes half closed; restlessness, with vomiting and convulsions; furious delirium; restlessness, and continual movements of the hands in the commencement of the disease.

DOSE. – One drop, or six globules, may be dissolved in four tablespoonfuls of water, and a teaspoonful may be given every two hours, until the system becomes aroused, or there is some mitigation or change.
Pulsatilla pratensis
is decidedly indicated when the face is pale, and bloated or red, and also when the stomach and digestive organs are deranged; when there is constipation of the bowels; or, on the other hand, looseness at night, and occasionally with pains in the bowels and shivering; disposition of a fretful, irritable, sensitive, melancholy character.
DOSE. – Of a solution of six globules, or one drop, in four tablespoonfuls of water, give a teaspoonful every two hours; when the patient is known to be of a scrofulous habit, one dose of four globules of sulphur may precede the use of pulsatilla.
Phosphorus
is an excellent remedy in the fever when there is dry and hard tongue, and lips covered with blackish scabs, loss of speech and hearing, difficulty of swallowing, inability to retain urine, excessive falling off of the hairs.
DOSE. – In all respects the same as directed for Pulsatilla.
Phosphoricum acidum
is useful in the after-effects of the fever, when there are boils, clusters of red, fine rash pimples, gouty affection of the joints, stitching in the ears, difficulty of hearing, intolerance of music and noise, tough phlegm in the throat, swelling of the parotid glands, and discharge of thin pus from the ears.
DOSE. – Of a solution of six globules, or one drop, in four tablespoonfuls of water, give a tablespoonful morning and evening, until a change.
Rhus toxicodendron
is particularly indicated if the eruption degenerates into a kind of vesicular erysipelas, with inclination to sleep; starting and agitation; stoppage of the urine, and violent thirst. It is also useful in the after-effects of the fever, when there is a tendency to general dropsy. It may be used alone or in alternation with Bryonia, Helleborus or Arsenicum, as the particular symptoms may indicate.

DOSE. – Rhus tox. may be given every three hours, four globules in a spoonful of water, or one drop may be dissolved in half a tumbler of water, and a teaspoonful may be given every three hours, or in alternation with either of the above named remedies every three hours.
Sulphur
may be employed in the commencement of an attack of scarlet fever, where there is any thing like a scrofulous habit, or where it is known that the patient has previously suffered from tetter or any herpetic eruption that has been suppressed, or where there is a head affection that will not yield to Belladonna, or lethargic sleep, starts, convulsions of the eyes or continued delirium; puffed and bright red face; obstruction of the nose; dry, cracked, red tongue, covered with brownish mucus; thirst and difficulty in swallowing, or in the after-affects when there is swelling of the glands; pains in the ears, and discharge of pus; or when there is loss of mind, or memory, or more positive indications of idiocy, it may be used in alternation with Phosphorus in this latter difficulty.
DOSE. – Sulphur when used in the commencement of the fever, may be repeated every six hours, one drop, or four globules; but in the after-effects it is sufficient to repeat a dose of one drop, or six globules, every twenty-four hours.
Silicea terra
is particularly useful in the after-affects, when there is swelling of the glands, discharge of thick pus from the ears, or chronic stoppage of the nose, inflammation of the parotid glands.
DOSE. – One drop, or six globules, every twenty-four hours.

Remark
There are other remedies that may be employed in the treatment of scarlet fever, but the above group embraces the principal remedies.
Sometimes in severe cases attended with heat in the head, cold water has been applied, but this is seldom to be recommended; but more rarely hot or warm water applied to the head under such circumstances may be attended with favorable results; cloths dipped in very warm water may be applied to the head, while internal remedies are being administered, but they should be removed when there appears to be any mitigation of the symptoms.
Diet and regimen
There is but little that can be taken of any kind of food during the raging of the fever; very thin rice gruel, or gruel made of arrowroot may be given in small quantities, when the mouth and throat are exceedingly dry or parched; a little warm milk and water may be given to moisten them; and also, when thick scales accumulate on the teeth and lips, or dry scabs, warm milk and water may be employed to cleanse the mouth and to moisten the scabs; after the fever has abated, and there begins to be a craving for food, great care should be exercised to avoid taxing the digestive organs; a single portion of food unsuited to the condition of the stomach may provoke a relapse, attended with all the dangerous sequels of the disease; swabbing the mouth in the morning with warm water, or milk and water, even after convalescence becomes established, is recommended; a little plain or milk toast may be allowed at regular intervals after the fever has disappeared and the appetite returns; when it is found that digestion goes regularly on, a small quantity of digestible meat may be allowed, with bread once a day, until the normal strength is regained; beef or mutton, or chicken boiled, are best; the two latter may be made into a soup, with rice or barley; vegetables should be avoided for some weeks after convalescence from a serious attack of scarlet fever.

-C.Hering

In scarlet fever the skin is of a bright red or yellowish-red color, or like that of a boiled lobster, though it may be of a dusky red or purplish color. The eruption fades in a few days and in about a week the skin begins to peel off.

The disease often commences with nausea and vomiting; slight chills or creepings, followed by great heat of skin and thirst, and occasionally headache, and more or less stupor or delirium. The eruption appears at first most on parts that are covered and later on other parts.

The fauces are also of a red color; the tongue is generally covered with a white coating, with enlarged red points.

The throat is usually considerably affected, these symptoms being often severe from the commencement. The tonsils may be swollen; the whole throat become covered with grey, yellowish, or white membrane; or it assumes a dark hue. The breath becomes offensive.

The faces have sometimes a dark red appearance, without much swelling; and ulceration or gangrene with extensive sloughing may speedily take place.

Sometimes an acrid discharge takes place from the nose, the eyes or ears; the glands about the jaws and of the neck become inflamed and swollen.

Scarlet fever sometimes occurs without any eruption on the skin; but instead, the mouth and fauces become affected.

Catarrhal inflammation of the kidneys, commonly known as acute Bright’s Disease, is a sequel of scarlatina which is somewhat common; as a consequence of this, dropsy occurs and the results are most serious unless proper treatment is observed. Another very common-result is inflammation of the middle ear, known as “gathering in the head.” Discharge of matter soon occurs and much destruction of the hearing apparatus may take place. Deafness frequently follows and in young children it is a not uncommon cause of deaf-mutism.

Aconitum may be administered in the very beginning, before the eruption makes its appearance, when the fever is high, pulse rapid, head hot, hands and feet cold, twitching of the fingers, and tossing about.

Belladonna, in the simple forms of scarlet fever when the eruption is bright red; it should also be given as soon as the throat and tongue become affected with dryness and burning, and there is excessive thirst, but inability to swallow; bright red appearance of the throat and tongue; swelling of the tonsils and stiffness of the jaws and neck, and delirium.

Mercurius after Belladonna, when the latter has failed to produce a favorable change, and there is ulceration of the tonsils, with increase of mucus, and swelling of the tongue, throat and tonsils. Bryonia, when the eruption does not come out well.

Rhus tox. If Belladonna has been given without effect and there is delirious talking, with dry tongue and picking at the lips.

Pulsatilla for great restlessness, jerking of the limbs, pains in hands and feet and sleeplessness.