170 FEVERS fulfilled better the therapeutical indications. It was observed that in places where the dis- ease prevailed cases of puerperal fever were also prevalent. It was the general opinion among physicians that the fever was commu- nicable. A fever accompanied by pharyngi- tis or inflammation of the throat prevailed in the winter and spring of 1857 in the western part of the state of New York, in the adjacent parts of Pennsylvania, and in Canada. Its usual duration was from three to six days, and it terminated uniformly in recovery. A simi- lar fever prevailed in 1866 among the United States troops stationed at Hart 1 s island, in Long Island sound. It is probable that this fever has occurred at other times and places with- out having been described by medical writers. The disease as yet has no name. It differs from acute pharyngitis in that it is manifestly an essential fever ; that is, the febrile state is not symptomatic of the local affection, but the latter is secondary to or a complication of the fever. It is analogous to the epidemic erysipel- atous fever in the constancy of the pharyngeal affection. III. ERUPTIVE FEVERS. 8. Scarlet Fever, or Scarlatina. This is distinguished from other eruptive fevers by the fact of the eruption being an exanthema, an efflorescence, or a rash, these terms not being strictly ap- plicable to vesicles and pustules. The disease sometimes commences with a chill, and in most cases vomiting is a primary symptom, es- pecially in children. The fever which at once occurs is usually intense, the axillary tempera- ture often rising to 105, or even higher. The pulse in general is correspondingly frequent. The surface of the body often gives to the touch a burning sensation. The rash appears in about 24 hours after the date of the invasion, and with very few exceptions breaks out first on the face and neck, being diffused over the body in the course of 24 hours. The color of the rash is scarlet, whence the name. The rash in some cases is equally diffused over the whole skin, giving rise to an appearance like that of a boiled lobster. In other cases it is limited to patches varying in number and size, with irregular or serrated margins. The skin is somewhat swollen, and the rash oc- casions a burning sensation, with in some cases intense itching. Very generally the erup- tion takes place in the throat, more or less redness being apparent here, simultaneously with or before the appearance of the rash on the skin. Generally with the redness there is more or less swelling of the tonsils. Some cases are characterized by severe inflammation of the throat, accompanied by either an ash- colored product or an exudation resembling that which takes place in diphtheria ; and with this affection of the throat the glands of the neck become inflamed and sometimes suppu- rate. When the throat affection is severe the disease has been called scarlatina anginosa. The inflammation in some rare cases extends from the throat into the middle ear, giving rise to perforation of the tympanum, with perhaps loss of the ossicles, and resulting in more or less impairment of the sense of hearing. The cutaneous eruption continues from four to six days. Then follows the stage of desquamation. The cuticle generally in this stage exfoliates, and is separated either in the form of branny scales, or in large flakes or patches. In some instances the cuticle of the hands is separated intact, and may be stripped off like a glove. The itching in this stage is sometimes extreme- ly annoying. In favorable cases the duration of this stage may be reckoned to be five or six days, when convalescence is established. Fre- quently, however, this stage is much protract- ed. Aside from variations in respect of gravity and danger incident to the throat affection, scarlet fever differs greatly in the intensity of the fever and constitutional symptoms. The disease in a certain proportion of cases is ex- tremely mild, the patient perhaps not being confined to the bed. In other cases it is ex- tremely severe, and it may prove fatal within a few days or even hours. In no other disease are the two extremes more widely separated. Death sometimes takes place before the erup- tion appears. An affection of the kidneys, namely, inflammation of the membrane lining the uriniferous tubes (desquamative or tubal nephritis), is occasionally a concomitant, but oftener a sequel, of scarlet fever. This local affection may interfere with the excretory function of the kidneys so as to occasion re- tention of urinary principles in the blood, con- stituting the morbid condition called urasmia ; and this condition may prove serious, giving rise to coma and convulsions. Occurring as a sequel of scarlet fever, this affection of the kidneys leads to general dropsy. From, this the patient recovers, provided fatal effects of uremia do not take place. Scarlet fever is highly contagious, and it may be communicated by means of fomites. The infectious material remains for a long time in garments, &c., pre- serving its power of producing the disease. The time which elapses from the reception of the infection before the manifestation of the disease, that is, the period of incubation, is short, sometimes not more than 24 hours, and rarely exceeding a week. As a rule the disease is experienced but once, but exceptions are not very rare. Children are much more susceptible to the special cause than adults. After 40 years of age the susceptibility generally ceases. Children under two years rarely contract the disease. The treatment in mild cases of scarlet fever is very simple. Active medication is not indicated. It suffices to diminish the animal heat by sponging the body and giving cooling drinks, with such palliative remedies as par- ticular symptoms may denote, observing proper hygienic precautions. In severe cases the use of the cold bath or the wet pack is highly beneficial, not merely as affording relief but diminishing danger. The value in this disease of the direct abstraction of heat by these means
