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Symptoms.—In this disease the period between exposure to
infection and the appearance of the first symptoms (the incubation
period) varies from two to seven days. The earliest symptom in
children affected with this disease is usually that of vomiting, but in
very young children it may begin with convulsions. Fever also sets
in and rises very rapidly. The skin becomes dry and hot and the
face flushed. On the second day a rash appears on the body,
consisting at first of a number of red points. It appears first on the
neck and chest, and then spreads rapidly in most cases over the
entire skin, but in some it occurs only in patches. The rash lasts
two or three days and then fades away. The throat becomes at the
same time more or less affected, varying in different cases from
a slight redness to intense inflammation. With the disappearance
of the rash the fever falls and other symptoms improve. Some days
after the patient appears to have recovered from the fever a
characteristic symptom appears, that is the superficial layer of the
skin begins to peel off, or, as it is termed, " desquamate." This
process lasts from ten to twenty days, and the peeling may affect the
whole body. In some mild cases the early fever and rash are so
slight that they are not noticed, and the parents only begin to
suspect scarlet fever when the skin begins to peel. The above
description refers to an uncomplicated case of scarlet fever, but the
disease may be complicated by more serious symptoms, as indicated
above.
The infection of the patient lasts from the appearance of the
earliest symptoms until the peeling, or desquamation, of the skin has
ceased. It is considered that the period of sore throat and fever and
the early stage of peeling is more infectious than the later stage, but
it is safer at present to regard infection as lasting up to the end of
peeling, or until all discharges from the nose or ears have ceased.
From this account it will be seen that the preventive measures are
similar to those of other fevers affecting children.