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

although inspection reveals an alarming condition. There is usually
dryness, the patient swallowing frequently to moisten the throat. On
inspection we note that the mucous surface of the fauces, tonsils, and
pharynx are reddened and swollen, upon which the characteristic ashen
gray exudate appears. Sometimes the throat presents a livid
appearance, revealing the malignant character of the attack.
The exudate first appears in small patches about the size of a wheat
kernel, but soon coalesces into one or more large patches or mass. The
exudate, at first superficial, soon dips into the deeper tissues, and
presents a characteristic appearance, embedded like the crystal in a
watch; the exudate can not be wiped off like an ulcerated surface, but
firmly adheres, and, when forcibly removed, leaves a raw and bleeding
surface.
“For two or three days, in the majority of cases, the throat is dry;
sometimes, indeed, during the entire progress of the disease. Then
secretion is established from the mucous follicles, and, some patches of
exudation being removed, there is a free secretion from the denuded
surface. The salivary glands also become more active, and the saliva is
thick, tenacious, and ropy; and altogether the secretion is large, and
requires frequent efforts at removal. Occasionally cases present
themselves in which this seems to be the most unpleasant symptom.
“In the latter stages of the disease we may distinguish two classes of
cases. In the first the dryness continues, and the parts become stiff and
immobile, so that, after a time, deglutition becomes almost impossible,
and respiration is rendered very difficult and labored. Extending
upward to the posterior nares and nasal cavities, these are closed by the
swelling; and descending to the inferior portion of the pharynx and
epiglottis, these and associated parts are swollen and rendered
incapable of motion, and the patient dies, partly from want of food and
drink, and partly from imperfect aeration of the blood.
“In the second class of cases, secretion commences about the second or
third day. By the fifth day it is quite free, some portions of the
exudation are being detached, and the exposed surface secretes pus. In
very severe cases this ulceration progresses in every direction, but is
mostly superficial. The tissues seem to have lost their vitality, and the
muscles their power of contraction, and they hang feeble and
pendulous, and infiltrated with serum where the connective tissue is
loose. Thus we have paralysis of the throat in the second as well as the
The Eclectic Practice of Medicine - PART I - Infectious Diseases - Page 158