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

the inflamed condition of the tissues results in the discharge of a
purulent material. The deeper tissues are infiltrated, and frequently
extensive sloughing follows the removal of the exudate.
The pseudo-membrane is composed of fibrin, necrosed epithelium, pus,
broken-down leukocytes, blood-disks, and bacilli of various kinds, of
which the Klebs-Loemer predominate. The blood-vessels beneath the
membrane are congested, and the lymph channels are dilated and filled
with fibrous fluid.
The necrosis may be confined to the epithelium, in which case there is
but little tissue change: but if the deeper connective tissues are
involved, there may be extensive destruction of tissue, including bloodvessels.
When the membrane in the larynx and bronchi is thick and
tenacious, complete casts may be expelled.
Heart.—Among the most important lesions in severe diphtheria are
those that affect the heart. There may be parenchymatous degeneration
in the less severe form, while fatty degeneration occurs in the
severe case. One or both ventricles may be dilated. The walls of the
heart are often flabby, while interstitial myocarditis is not uncommon; a
rarer lesion is endocarditis and pericarditis.
Kidneys.—In the severer cases of diphtheria there is nearly always more
or less acute nephritis, and a cut surface reveals the process of
degeneration. The kidneys are usually enlarged. The urine is generally
rich in albumen, casts, epithelium, and leukocytes.
Spleen.—In most diseases where there is toxemia, we find enlargement
of the spleen, and this disease is no exception. There is also
degeneration of its tissues. The lymphatic glands of the neck are
frequently swollen and more rarely hemorrhagic, while suppuration
may take place, though not common.
Nervous System.—J. G. Thomas reported in the Boston Medical Journal,
February, 1898, the lesions produced by diphtheritic toxin, as follows: 1.
A parenchymatous degeneration of the peripheral nerves, and at times
an interstitial process is added to the degenerative one, accompanied by
hyperemia and hemorrhages. 2. Acute parenchymatous and interstitial
degeneration in the muscles, especially the heart muscles. 3. Only slight
changes in the nerve cells. 4. In rare cases a hyperemia, infiltration or
hemorrhage into the brain or cord sufficient to produce permanent
The Eclectic Practice of Medicine - PART I - Infectious Diseases - Page 156