SYMPTOMS

The period of incubation, i.e., the time between exposure or infection and the appearance of signs of illness—is very short in scarlet fever. It may be only a day or two and is almost always less than a week. The onset is very sudden. A child goes to school as usual in the morning and during the day becomes acutely sick, or he goes to bed at night in apparent health and by morning is virulently ill. At the beginning there is fever, which may quickly rise very high, sore throat and often vomiting. The throat is so sore that the patient usually complains very much of it, and acute pain is caused by swallowing. Vomiting once or several times in the early part of the disease is very common. Whenever a child is suddenly taken with fever, a sore throat and vomiting, scarlet fever should be suspected. Soon the eruption appears. This usually is present within 24 hours, but may be delayed 2 or 3 days in rare instances. It is first seen upon the neck and chest, rapidly extends to the body, then to the arms and legs. It is absent on the face. The skin about the mouth is paler than natural. The rash consists of very small red points closely set upon the skin which shows a uniform bright red flush. The skin looks much like that seen after severe sunburn. The color is bright scarlet. If one looks at the throat it is bright red, and often small white spots are seen upon the swollen tonsils. The tongue is coated white through which bright red points may project giving the appearance spoken of as “strawberry tongue.” At the sides of the neck the glands are swollen and tender. In size they may correspond to a marble, or may attain the size of a hen’s egg or larger. While the eruption is coming out, the throat remains very sore, and the fever is high. Especially at night, children in this acute stage of scarlet fever are apt to show delirium and may try to get out of bed. After two to four days the fever begins to fall, the throat becomes less sore, and the rash fades. As the rash fades the skin is roughened and peels in small flakes. About three weeks from the onset the thick skin of the palms of the hands and soles of the feet peels off. The detached pieces may be large, or only small delicate pieces may come from the fingers and toes. This late peeling is very characteristic. The case to which the preceding description applies is one of average severity. Many mild cases have little fever and slight rashes which last but a few hours. The sore throat is constant even in mild cases.