44 DISEASES OF CHILDREN. 



cases this matter may be discharged by a series of openings either inside the throat 

 or outside. The condition of the throat may be so severe as to kill a patient, either 

 by exhaustion or by blood-poisoning. It is not at all uncommon to have the glands 

 of the neck inflamed and suppurating during the sore throat of scarlet fever. 

 Sometimes the nose is attacked as well as the throat, and the patient is troubled 

 with a discharge therefrom which may be very offensive. The ear also may be 

 attacked, and we sometimes get a discharge from the ear followed by a destruction 

 of the tympanum, or drum, and permanent deafness. The bones of the ear may be 

 damaged, and then there is occasionally a risk to the brain. 



The most serious and the most common consequence of scarlet fever is 

 undoubtedly disease of the kidneys, which usually comes on during the decline of the 

 fever, and while the desquamation of the cuticle is in progress. The early symptoms 

 of this trouble are only to be detected by means of a chemical examination of the 

 urine, which should be performed by the medical man at frequent intervals, in order 

 that no time may be lost in checking the symptoms should they appear. If the urine 

 becomes thick, smoky-looking, or bloody, the kidneys are certainly diseased ; or if the 

 legs swell, or the eyelids are puffed up in the morning, we shall generally be right in 

 coming to the same conclusion. The slightest appearance of disease of the kidneys 

 should not be treated lightly; for if this trouble be not skilfully subdued, it may go on 

 till it causes permanent dropsy and disease of the heart, and condemns the patient to 

 be a valetudinarian for the rest of his life. 



Lung disease is occasionally set up during scarlet fever, and patients may be 

 attacked with bronchitis, pneumonia, pleurisy, or consumption. 



Sometimes also, and especially during the persistence of the rheumatic symptoms, 

 disease of the covering membrane of the heart (pericarditis} is established. Thus it 

 will be seen that scarlet fever is not only a dangerous disease in itself, but that it is 

 beset with subsidiary dangers, into any of which the patient may fall if he be not 

 nursed and guarded with the greatest care. 



In the treatment of a case of scarlet fever we have not only to consider the safety 

 of the patient himself, but we have, as far as possible, to guard against his being a 

 source of danger to others. Directly the disease is detected, or, indeed, directly it is 

 suspected, the patient should be isolated. Except in the very mildest cases, he must 

 keep to his bed, and, no matter how mild the attack may be, it is absolutely neces- 

 sary that he keep to his room, from whence he must not think of stirring for three 

 weeks; for up to that time he cannot be considered as a safe companion for others, 

 nor can he himself be considered free from the risk of kidney disease or some other 

 consequence. Everything should be moved out of the room that is not absolutely neces- 

 sary for decent comfort. The carpet should be taken up, and window curtains be 

 taken down, and everything in the shape of a wardrobe or chest of drawers should be 

 removed ; for these articles can well be dispensed with, and if allowed to remain in 

 the room, they may one and all become lurking-places for contagious particles. It 

 must be borne in mind that every excretion of a scarlet-fever patient is probably 

 infectious. The breath expired through the ulcerating throat and nose is probably 

 loaded with germs of the disease. The urine and the evacuations from the bowels are 

 certainly contagious in the highest degree; and above all things it is to be remembered 



