Page:The New International Encyclopædia 1st ed. v. 17.djvu/691

SCARLATTI. 623 SCARLET FEVER. 1703 ami 1700 he was niacsiro tli capelln at Santa Maria .Mafj^'ioio at Koine ; he then returned to Xaples. and in 1715 pruihicccl II Tiyranc. His uni>ieal works eoniprise 117 operas, several ora- torios, and a j,'reat deal of chureh nuisie, besides various niadrijjals and other clianiher music. He was the founder of the Xeapolitan sehoul, in wliieh were trained most of the j;reat musieians of the ci^litecnth century. His modulations, often un- (■|i«'ctcd. are never har>-li. and ncvi'r ilillicnlt for llie voice. He is supposed to have l)ecn tlic lirst comiwser or musician to divide the strings into four parts. His instrumentation is hoth bold and skillful; and his orchestration shows that he had a knowledge and appreciation of the art of i;rouping instruments of dillcriii!,' tindu<> which was remarkable for his time. SCARLET (OF. escarlnte, Fr. icarlate, from ML. srarliitiini, scarlet, scarlet cloth, from Pers. muidliH. shjah'it, niKilfit, scarlet cloth). A vivid red color, inclining toward orange. It was formerly obtained exclusively from the cochineal (q.v.) insect, treated with zinc chloride and cream of tartar, but it is also now derived from coal-tar (q.v.). It is frequently used in the fine arts and in dyeing, and. like purple, was esteemed a color particularly suitable for costly attire. SCARLET FEVER, or Scarlatina. One of the exanthemata or eruptive fevers. It is a con- tagiuus disease and is characterized by fever, sore throat, a bright red eruption, and a tendency to acute inflammation of the kidneys. Children are chiefly afTccted, and one attack protects against another. This explains its rarity in adult life, fsearlrtina is extremely infectious and contagious, and the contariiuin has been carried by books, papers, and clothing for long distances. Three varieties of the malady are usually described, viz.: The ordinary form, scurhitiiia simplex, in which the rash and fever are present, with but few throat s.ymptoms; scarlatina aiiyinusa. in which, in addition to the rash and fever, the throat is severely alTected; and scarlatina ma- liynu, in which the attack is violent and the system is rapidly overwhelmed with the in- fection. This form is usually fatal in two or three days. Scarlet fever begins as a rule suddenly, after an incubation period of from 4 to 6 days, with a chill, vomiting, headaclie. languor, pains in the back and limbs, and loss of appetite. The temperature rises rapidly to 10.3° or 10,5° F.. and remains high during the course of the disease. The rash appears from 12 to .36 hours after the first symptoms, first on the chest and neck, but spreading over the entire body in a few hours. It consists of minute red spots set closely to- gether, so that the skin is covered with a bright red (lusli. About the fifth day the rasli begins to fade and is followed by desquamation or shed- ding of the superficial layers of the skin. This occurs in the form of white branny scales; in some eases the epidermis peels off in large flakes or, more rarely, complete molds of the hands, fingers, or toes are cast otT. During the des- quamative stage the disease is believed to be most contagions. The throat and tonsils are dark red and swollen, the latter sometimes cov- ered with a yellowish secretion. The tongue is at first thickly covered with white fur, but this soon disappears, leaving a bright red, raw sur- face, studded with prominent papillie, giving rise to the appearance known as 'strawberry tongue.' About the liflli day of the fever the disea.se begins to abate; the temi)crature falls, the rash fades, and convalescence is gradually established. In severe cases, however, the mental faculties are dulled, delirium is frequent, particularly toward night, and drowsiness, deepening to coma, super- venes. Death may occur at this |)oint from ex- haustion, or it nuiy occur later from various complications. The princi]ial of these are nephri- tis anil otitis media (q.v.). The latter is set up by extension of the inflammation from the throat, and a resulting abscess of the middle ear, with rupture of the drum mendjrane and chronic otorrlnea. is set up. Both ears niay be all'ccted sinuiltaneously, and in a yimng child permanent deafness or deafnnitisni may result. In violent inllanunations of the middle ear the mastoid cells may be involved, and meningitis, abscess of the brain, or |)ya'mia from throndmsis of the lateral sinus leads to a fatal termination. Nephiili~ is usually first recognized iluring conva- lescence, while desquannition is going on. -Some swelling of the face and feet may be noticed, and the urine is found to be scanty, high-colored, and albuminous. Dro])sy ma}' become general and death supervene. The mortality in scarlatina may be low in mild epidemics, but in others rises to 30 or 40 per cent. Scarlet fever presents very little characteristic pathology, hile, from its course, symptoms, and pathologv', unquestionably an infectious dis- ease, it has as yet bafHcd all attempts to deter- mine its specific micro-organism. The most char- acteristic lesion is that of the skin. This is ;i simple dermatitis. As a result of this dcrnuititis there is an infiltration of the papilhr and layer just beneath with leucocytes. In some eases hem- orrhages occur into the skin. This acute inflam- mation stimulates the proliferation of <q)ithelium. and the more than normally rapid casting oil of the surface cells constitutes the 'peeling' or des- quamation so characteristic of the later stages of the disease. This appearance of the skin, while quite characteristic during life, is often very in- distinct after death. Inflammations of the mu- cous membranes of the pharynx, larynx, tonsils, and bronchi are of almost constant occurrence. This inflammation may be simply catarrhal in character or. more rarely, is diphtheritic. Still more rarely it is of a gangrenous nature. Acute inflammation of the lymph nodes sometimes oc- curs. This may be of the nature of a simple hyperplasia with or without exudation, or the ghmds may go on to suppuration. The spleen is usnallv* enlarged. Acute inflammation of the kidney is common, vvliile inflammations of the pericardium and endocardium and of the lungs are not infrequent conqilications or sequelhe. W'hatevcr the specific organism of scarlet fever, it certainly has the cfTcct upon the body tissues of rendering them much more susceptible than they normally are to infection by other patho- genic micro-organisms. The most, common is a streptococcus infection causing croupous inflam- mations of the mouth and ujiper res])irat(U'y tract. It is probable that tlu; inllammations of lyniiih nodes, the suppurative conditions which frequently occur, the pneumonia, pericarditis, endocarditis, etc., are usually the result of a secondary infection by pyogenic micro-organisms. The Klebs-Loefller bacillus or bacillus of true diphtheria is sometimes present in scarlet fever.