SCARLET FEVER. Synonyms.—Scarlatina; Scarlet Rash. Definition ...

the voice becomes hoarse, and may finally disappear. The hair on the
face, such as the eyelashes and eyebrows, drop out, the patient
presenting a horrible appearance. Sometimes these infiltrated patches
fail to develop into tubercular nodules, but gradually change to smooth,
white patches—lepra alba.
The tubercular nodules, after developing gradually for years, undergo
retrogressive changes, the tumors gradually melting away, leaving in
their place dark, pigmented patches. In this way, bone and cartilage
may be destroyed without ulceration.
Generally, however, indolent ulcers develop, which result in great
destruction of tissue; the nose, fingers, toes, and sometimes an entire
limb, are amputated by this method. Tubercles may develop on the
cornea and iris, destroying the sight, and the patient, blind and with
face horribly distorted, with nose, fingers, and toes rotting off, presents
a condition unequaled in any other disease.
Anesthetic Form.—So different in character is this form of leprosy, that
it is difficult to realize that it arises from the same specific cause.
The first evidence of the disease is the appearance, usually, of a local
erythema, though in rare cases its first appearance is in the form of
bullæ; so constant are the macules in this variety that Hansen proposed
the term “macular leprosy” for that of anesthetic leprosy.
This variety is characterized by nerve lesions and trophic changes in the
skin. With the appearance of the macules, which may be of a coppery
hue or a pale yellow, there is a stinging, burning, or painful sensation.
These appear on the shoulders, back, buttocks, knees, face, and arms,
and vary in size from a dime to quite a large patch.
At first painful, it soon loses its sensibility, which is characteristic of this
form. The nerve trunks affected, if superficial, can be readily felt as
hard, nodular substances. Bullæ occasionally appear, leaving anesthetic
patches behind; with these changes, go atrophy and contraction of the
muscles.
The hands become clawed, there is wrist-drop, the face is deformed, the
eyelids and mouth can not be closed, and the tears and saliva flow
away; the nails split, change color, and fall off; the hair loses its gloss,
and falls out; the strength gradually fails, and, after many long years,
The Eclectic Practice of Medicine - PART I - Infectious Diseases - Page 236