SCARLATINA. 585 



nitrate of soda, although it will very rarely prevent any inflammatory 

 complications. Great care must be exercised in the employment of 

 tartar emetic, for violent vomiting and purging are injurious to measles 

 patients, and readily induce sudden collapse, even during so-called in- 

 flammatory measles. Laryngitis and pneumonia complicating measles 

 are to be treated in the same way as when they occur primarily, al- 

 though the prognosis is not so good ; the same is true of other com- 

 plications. In asthenic, typhous, and septic measles, quinine, mineral 

 acids, and stimulants, are most frequently given. I have not seen any 

 malignant measles recently ; but should it prove that they induce a 

 very high bodily temperature, from my experience in analogous forms 

 of other infectious diseases, I should not hesitate in such cases also to 

 wrap the patients up in cold, wet cloths, at short intervals, and to give 

 thorn large doses of quinine. 



CHAPTER II. 



SCARLET FEVER SCARLATINA. 



ETIOLOGY. Scarlatina is an infectious disease, as is shown by a 

 few cases of successful inoculation, and by many well-known instances 

 where the disease was carried from one place to another by scarlatina 

 patients. It is less clearly proved that contagion is the only mode of 

 propagating the disease, and that scarlatina never develops sponta- 

 neously. At least, epidemics have occurred in places where its exten- 

 sion could be readily observed without its being detected, or even being 

 probable that the disease had been imported. We know no more about 

 scarlatina poison than we do about that of measles. The infection of 

 persons who have been near scarlatina cases, without being immedi- 

 ately in contact with them, appears to show that the poison is con 

 tained in the exhalations of the patient, and is mingled with the atmos- 

 phere about them. Well-proved facts also render it probable that the 

 contagion may be carried by persons who are not themselves affected 

 by the disease. Past experience has not yet taught us whether the 

 blood and secretions are also means of conveyance. The period of in- 

 cubation appears to be shorter than in measles, and to last only eight 

 or nine days. But, from the difficulty of deciding the time when the 

 infection terminates, this point is not exactly determined ; and, for the 

 same reason, we cannot accurately answer the question, In what stage 

 is scarlatina infectious ? The predisposition to scarlatina is far less 

 common than that to measles ; there are not a few persons who never 

 nave it. One attack almost unexceptionally removes the liability to 

 another. Nursing children often escape during an epidemic; while 



