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26
A number of the eases admitted to hospital have a definite
train of signs and symptoms. The earliest symptom is usually a
sore throat, accompanied by a temperature which frequently reaches
103, 104 and 105 degrees. The throat is congested and the softr
palate may be uniformly injected or it may have the appearance
of a punctate rash, which may be regarded as the enanthem of the
disease. The tongue, at first furred, afterwards assumes the typical
strawberry appearance.
The rash appears about 24 hours from the onset of the disease
and consists of closely set minute points, usually of a brilliant red
colour. The rash is general on the trunk and limbs, but does not
invade the face.
When these signs and symptoms are present there is no difficulty
in the diagnosis, but the conditions may be modified to an
extraordinary degree. The temperature may not be above the
normal; the throat symptoms may be very mild ; the appearance of
the tongue may be quite indefinite, and the rash so evanescent as
to have disappeared before admission to hospital. So that although
most of the cases are easy, others are difficult, and some are impossible
to diagnose correctly at the stage in which they are admitted
to hospital.
If we admit that Scarlet Fever is not a specific disease, the
difficulty of diagnosis is fundamental, and not due to want of skill
The conditions are so variable as to warrant the assumption thaf
the disease we call Scarlet Fever is not a specific entity but caused
by different strains of the Streptococcus. The conditions are to
variable to be explained by different degrees of virulence in the
same strain.
Bacteriologically, the Scarlet Fever reaction may result from
infection of numerous kinds of streptococci which are not identical.
In the majority of the cases of Scarlet Fever, the organism found
is a haemolytic streptococcus belonging to one of four types. In
some epidemics scarlatinal types 1, 2, 3 and 4 represent over 75 per
cent of the strains isolated, and it is confidently stated in some
quarters that the severity or mildness of the disease depends on
the type of streptococcus present in the epidemic. But although
the assumption of the causation of the disease by different strains
of streptococci may explain some of the clinical manifestations of
Scarlet Fever, it leaves certain phenomena obscure. For instance,
we should on this assumption expect that a fair proportion of the
cases admitted to hospital would develop secondary attacks during
their stay in the hospital. But if a definite diagnosis of Scarlet
Fever has been made on admission, secondary rashes and throats