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.