Scarlatina Maligna, or Malignant Scarlet Fever.

Under this name is designated an affection which oftentimes
exhibits none of the features of scarlet fever, but is recognized as
such by its occurrence among children during an epidemic of the
disease. The patient seems simply overwhelmed by some acute
poisoning ; lies prostrate, perhaps unconscious, with cold extremi­
ties. There is usually no fever ; death commonly occurs in a few
hours, before the appearance of an eruption or other characteristic
features of scarlet fever.

Then, again, there are cases in which the throat affection and
the general appearance and history of the patient indicate that the
disease is scarlet fever, although the characteristic rash may not
appear ; and there are­ still others in which the rash may be insig­
nificant in quantity, while the skin is reddened in patches by the
escape of blood into its structure.

One characteristic feature of scarlet fever, as distinguished from
all other eruptive diseases, is the rash ; after this has been seen a
few times it is usually easy of recognition subsequently. Scarlet
fever is especially apt to be mistaken for measles ; several points of
distinction will be mentioned subsequently, and it will suffice here to
call attention to a few items: the brevity of the stage of invasion (one
or two days prior to the appearance of the eruption); the intensity of
the fever ; the appearance of the throat difficulty before the rash on
the skin becomes visible, and the persistence of the fever after the rash
has appeared. The difficulties in recognizing the disease occur in
those mild cases in which the eruption is very slight without any
soreness of the throat; also in those instances (scarlatina anginosa)
in which there is little or no eruption, but severe affection of the
throat. In some of these cases even the experienced physician may
be compelled to decide by the surroundings of the patient — the
prevalence of an epidemic of scarlet fever, for instance.

Treatment.— With our present means we have no power to
cut short scarlet fever any more than the other infectious diseases.
The remark made as to the treatment of one holds good for them
all : that the object is to support and guard the patient from the
ravages of the disease. In ordinary mild cases of scarlet fever no
formal treatment is necessary ; the child should be sponged or 
immersed in a hot bath several times daily, half a teaspoonful of
sweet spirits of nitre may be given every four hours (if the child
be three or more years old) ; if there be constipation a saline
laxative may be given.

One of the troublesome features is the management of the
throat affection. Fortunately, this feature is absent in many cases
except in a slight degree ; for these the old remedy of muriatic acid
and honey in equal parts as a gargle (diluted with water) may suf­
fice. In severer cases it becomes necessary to cleanse the throat
several times a day with camel’s hair brushes or similar instruments.
After gargling with water or with a solution of carbolic acid (one
part to twenty of water) the brush may be swrept over the grayish
or brown surfaces, removing any particles that may be easily
detached ; after this a clean brush is dipped into a solution of
nitrate of silver (twrenty grains to the ounce of water) and the
ulcerated parts of the throat are penciled with this. These throat
cases, too, are often benefited by the application of cold cloths, fre­
quently changed, to the neck.

If the fever be very high and mental symptoms prominent, great
advantage will often be derived from the wet pack. For this pur­
pose a sheet may be wrung out of water having a temperature of
70 degrees F. The patient, divested of all clothing, is wrapped in
this sheet, and covered with several blankets. In the course of half
an hour or so, the individual is usually perspiring freely, and feels
greatly refreshed, and often enjoys tranquilizing sleep. This
measure may be executed two or three times daily ; there is no
danger of “ driving in the rash,” according to the popular prejudice.
In the severer cases, whether complicated by affections of the
throat or not, an important feature of the treatment is the administra­
tion of light and nutritious food. Theusualfare^milk, eggs and broth
—must be in such cases supplemented by alcoholics in some form,
Qgg nog or milk punch. To the same end it is advisable to admin­
ister quinine regularly ; for a child of three years the dose may be
one-half to one grain four times a day.

Another indication for treatment in scarlet fever is the itching
which so often annoys the patient. A popular, though not espe­
cially desirable, remedy consists in lubricating the skin with lard ; a
preferable substitute is a solution of glycerine, either in simple water
or in rose or cologne water—one part of glycerine to four of rose
water.
 
In cases of mental disturbance—stupor, delirium and convul­
sions—the source of the difficulty is often the failure of the kidneys
to discharge their functions properly. In such instances the greatest
hope of relief lies in brisk purging and in the wet pack.
There are cases, too, in which there is no evidence of inflam­
mation of the kidneys until after the peeling off—desquamation—has
begun, so that dropsy may become apparent a week or two after the
crisis of the disease has passed. This must not, however, be con­
sidered as an indication that the patient has taken “ a fresh cold,”
for it is usually a portion of the disease itself.

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