The Maternal Management Of Children, In Health And Disease Part 18

Mild scarlet fever;

Scarlet fever, with sore throat.

MILD SCARLET FEVER.--In this form of the disease there is only the rash with fever.

SYMPTOMS.--The antic.i.p.ating symptoms are those of fever: they precede the eruption. The degree of fever, however, is variable; for the symptoms are sometimes so moderate as scarcely to attract attention, slight and irregular s.h.i.+vering, nausea, perhaps vomiting, thirst, and heat of skin; whilst, at others, there is considerable const.i.tutional disturbance, indicated by pungent heat of skin, flus.h.i.+ng of the face, suffusion of the eyes, pain in the head, great anxiety and restlessness, and occasionally slight delirium.

These symptoms are followed on the second day (in the majority of instances) by the rash. This first appears in numerous specks or minute patches of a vivid red colour on the face, neck, and chest. In about four-and-twenty hours it becomes gradually diffused over the whole trunk. On the following day (the third) it extends to the upper and lower extremities, so that at this period the whole surface of the body is of a bright red colour, hot and dry. The efflorescence, too, is not always confined to the skin, but occasionally tinges the inside of the lips, cheeks, palate, throat, nostrils, and even the internal surface of the eyelids. Sometimes the efflorescence is continuous and universal; but more generally on the trunk of the body there are intervals of a natural hue between the patches, with papulous dots scattered over them, the colour being most deep on the loins and neighbouring parts, at the flexure of the joints, and upon those parts of the body which are subjected to pressure. It is also generally most vivid in the evening, gradually becoming paler towards morning.

The eruption is at its height on the fourth day;--it begins to decline on the fifth, when the interstices widen, and the florid hue fades;--on the sixth, the rash is very indistinct; and on the eighth day it is wholly gone.

The various symptoms with which the eruption is accompanied, gradually disappear with the efflorescence; but the tongue still remains morbidly red and clean. The peeling off of the cuticle (the outer layer of the skin), which begins about the end of the fifth day on the parts on which the eruption first appeared, proceeds; so that about the eighth or ninth, portions of the cuticle are thrown off, the thickest and largest being those detached from the skin of the hands and feet.

SCARLET FEVER, WITH SORE THROAT.--In this form of the disease, the fever and rash are accompanied with inflammation of the throat.

SYMPTOMS.--The symptoms are more severe than in the mild form of this disease, and, in the majority of instances, the inflammation of the throat appears with the eruption, and goes through its progress of increase and decline with the cutaneous eruption. Sometimes, however, it precedes the fever; whilst at others it does not appear until the rash is at its height.

It is generally in the course of the second day that the child complains of considerable stiffness in the muscles of the neck, extending to the lower jaw, and under the ears;--of a roughness of the throat, and difficulty in swallowing;--and some degree of hoa.r.s.eness will be noticed: all so many indications that the throat is affected.

Very shortly, an increased secretion of the mucus of these parts occurs, and, collecting about the tonsils, aggravates the child's sufferings, from the frequent and ineffectual efforts made to expel it.

If the inflammatory action be more severe, exudations of lymph will also be poured out, and intermingling with the mucus, greatly augment the difficulty of swallowing. At this time the lining membrane of the mouth, as also the tongue, a.s.sume a florid red colour; the red points of the latter becoming much elongated.

The febrile symptoms are severe from the first; amongst others, there will be headach, sometimes accompanied by slight delirium, nausea, intense heat of skin, languor, and considerable inquietude and anxiety: and as the inflammation approaches its height, the fever increases, the pulse rises, the breathing becomes oppressed, the skin becomes more pungently hot and dry, and the thirst urgent. All these symptoms being increased towards evening, when the febrile restlessness is often succeeded by delirium.

The rash is seldom perceptible before the third day, and then comes out in irregular patches on various parts of the body, particularly about the elbows and wrists; thus differing as to the time and mode of its appearance, from the mild form of the disease. It frequently recedes, or entirely vanishes, the day after it first comes out, and then reappears partially, and at uncertain times. This generally protracts the duration of the disorder, without, however, producing any perceptible change in the other symptoms. On the fifth or sixth day of the disease, the fever and inflammation of the throat begin to abate; at the same time the rash declines, and the peeling off of the cuticle soon follows.

This is the ordinary course of scarlet fever with sore throat; but in many cases the symptoms run still higher, and the disease is alarmingly dangerous from its commencement. In some instances, there is an acrid discharge from the nostrils or ears, often accompanied with deafness; as also enlargements of the glands in the neck, followed by the formation of abscesses in their immediate neighbourhood. It is unnecessary, however, to follow out the symptoms of scarlet fever more fully; as all that has been attempted here, has been so to sketch out the more prominent symptoms of this disease, that the directions upon the parental management may be readily comprehended: they will be very brief, but a strict attention thereto will be found all-important to the well-doing and comfort of the child.

CHARACTER OF SCARLET FEVER COMPARED WITH THAT OF MEASLES.--It will be seldom difficult to distinguish this disease from other acute eruptive disorders. The one to which it bears the greatest resemblance is the measles; but from this it is readily distinguished by the absence of the cough, the inflamed and watery eye, running at the nose and sneezing, which are the predominant symptoms in the early stage of the measles; but which do not usually attend on scarlet fever--at least, in any high degree. In measles, also, there is an absence of that restlessness, anxiety, and depression of spirits, by which scarlet fever is peculiarly distinguished.--The rash, too, in measles, does not appear till two or three days later than that of scarlet fever. It also differs in its characters. In scarlet fever, the eruption consists of innumerable minute dots or points, diffused in patches with uneven edges of various sizes and forms; and gives to those portions of the skin on which it appears, a diffused bright red colour. In measles, the rash comes out in irregular semi-lunar or crescentic shaped patches, distinctly elevated; the spots being of a deeper red in the centre than in the circ.u.mference, and leaving intervening s.p.a.ces in which the skin retains its natural pale colour.

MATERNAL MANAGEMENT.--The chief points to which the parent's attention must be directed, irrespective of a strict attention to the more immediate medical treatment directed by the physician, are the following:--

VENTILATION OF THE BED-ROOM.--Even in the mildest cases, the child must be kept in bed from the first accession of the fever. He must not be loaded, however, as was formerly the practice, with a quant.i.ty of bed-clothes, in order to encourage the fever and increase the quant.i.ty of eruption. A moderate quant.i.ty of clothing is all that is required, adapted to the heat of skin and feelings of the patient.

The bed-room must be kept cool and well ventilated. This is of importance in the mildest cases; but in the more severe forms of this disease, in which the throat is much affected, the constant and free admission of pure air will have a most decided and marked good effect upon the symptoms. The air should be renewed, therefore, from time to time. The linen, both of the bed and the patient, should also be frequently changed daily,--if practicable.

However mild the symptoms of this disease may be at the commencement, the child must always be carefully and vigilantly watched by the parent, as inflammation of some internal organ may suddenly arise (which is generally indicated by symptoms sufficiently obvious), and thus change an apparently mild form of this disease into one of an alarming character.

COLD SPONGING.--Whenever the skin is pungently hot and dry, the whole surface of the body should be sponged with cold water, or with vinegar and water. The heat is by this means rapidly abstracted, and the child refreshed; and this may again and again be resorted to, as the heat again returns. By this application alone, "the pulse has been diminished in frequency, the thirst has abated, the tongue has become moist, a general free per spiration has broken forth, the skin has become soft and cool, and the eyes have brightened; and these indications of relief have been speedily followed by a calm and refres.h.i.+ng sleep. In all these respects, the condition of the patient presented a complete contrast to that which preceded the cold was.h.i.+ng; and his languor was exchanged for a considerable share of vigour. The morbid heat, it is true, when thus removed, is liable to return, and with it the distressing symptoms; but a repet.i.tion of the remedy is followed by the same beneficial effects as at first."[FN#40]

[FN#40] Bateman's Practical Synopsis of Cutaneous Diseases.

GARGLES AND THE INHALATION OF WARM WATER.--When the throat is affected, gargles are sometimes ordered; but the pain and inconvenience which their employment gives rise to, frequently precludes their use: and children seldom understand how to employ them, even if the state of the throat permitted it. Under these circ.u.mstances, the inhalation of the steam of hot water, or hot vinegar and water, may be subst.i.tuted, and with decided benefit. Mudge's inhaler is a good contrivance to effect this.

When the throat is found by the mother to be early affected, an immediate application to the medical adviser is especially important.

For, if he be called upon to treat this form of scarlet fever at its very commencement, by judicious treatment, the duration and violence of the disease may be both shortened and greatly mitigated.

REGIMEN.--Cooling drinks, as plain water, toast and water, barley water flavoured with lemon peel, fresh whey, lemonade, and thin gruel, may all be resorted to in their turn. The child may also be allowed oranges, grapes, or lemons sweetened with sugar, particularly when the mouth is foul and dry; but care must be taken that neither the pulp nor the stones are swallowed. These will both refresh and feed the patient as much as is necessary until the decline of the disease. The parent must strictly forbid the attendants in the sick chamber giving, at this period, any heating or stimulating fluid, as also animal food; and this injunction must be strictly regarded, even in the mildest form of the disease.

When the child is convalescent, mild nourishment will be required, such as arrow-root, tapioca, chicken or mutton broth, beef tea, jellies, and roasted apples; and by and by a mutton chop. Wine is seldom necessary, except under circ.u.mstances of unusual debility after a protracted illness, when its moderate use tends much to a.s.sist the convalescence; but, if given unadvisedly, there will be great hazard of exciting internal inflammatory disease.

Relapses are sometimes caused by the child getting about too soon, and by indulgence of the appet.i.te, particularly for food: a proper degree of restraint, therefore, must be placed upon the child by the parent, who cannot too strictly carry out the directions of the medical attendant upon the diet and regimen during this period.

Great attention must still be paid to the state of the bowels, and, indeed, to all the secretions and excretions.

PEELING OFF OF THE CUTICLE, AND FALLING OFF OF THE HAIR.--To promote the more easy separation of the cuticle from the surface of the body, a warm or tepid bath may be usefully employed at the close of the disease. It will, moreover, greatly contribute to the comfort of the child, and induce a more healthy condition of the skin. Occasionally the cuticle of the whole hand and fingers will peel off unbroken, when it will resemble precisely a glove in shape.

As is the case in all fevers, more or less, so particularly after scarlet fever, there is a great tendency to the falling off of the hair. It will be always well, therefore, to shave the head at this time, and exhibit daily a tepid shower bath, as early as the strength of the child will permit.

CAUTIONS, ETC.--The contagious character of this disease requires the separation of the invalid from the rest of the family; and, when it is practicable, the children should be removed to a distance. This measure is imperatively called for, when the form of the disease is very severe in its character.

Great caution must also be exercised, after the convalescence of the patient, that the other children are not brought into too early contact with him: for infection may be thus produced, though several weeks may have elapsed from the period of the peeling off of the skin.

The period at which the disease shows itself after the exposure of an individual to sources of contagion, is exceedingly various. One child will be seized within a few hours; another, not for some days; and now and then (though rarely), five or six weeks have intervened between the period of exposure and the manifestation of the disease.

When this disease is rife in a family, it will frequently affect the individuals composing it very differently. Some escape altogether;-- others have the mild form of the complaint;--others the severe;--and, again, the attendant in the sick room may be attacked with the sore throat and fever only, both of which may subside without any appearance of a rash.

In conclusion, this disease is a complaint of infancy and childhood, rather than of adult age; generally affects the same individual but once during his life; and, though examples of a second attack have occurred, such a circ.u.mstance is extremely rare.

Sect. VI.--MEASLES.

Measles consists of a fever, in which the mucous lining of the air- pa.s.sages is princ.i.p.ally affected, and which, after about three days'

duration, results in an eruption of a red rash over the surface.

It depends upon a specific contagion;--occurs most frequently during childhood and adolescence, though no age is exempt from it;--and affects the system but once; a peculiarity to which an exception is very rare, proved by the few instances of the kind which have been recorded.

The period at which the disease manifests itself after infection is various,--generally about the ninth day; it has, however, been delayed until the sixteenth.