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

first case.”
Malignant Diphtheria.—Some seasons the diphtheritic virus
possesses a virulence entirely unaccountable. The patient seems stricken
with such force that the resisting power of the system is unable to cope
with its unequal foe. The patient is dull and listless; the face is a dusky
hue; the tongue thick, flabby, and covered with a dirty, pasty coating,
or it is dry, brown, and parched; the fever is quite active, the
temperature reaching 103° to 104°, or even 105°. The pulse, however, is
small, though rapid, showing marked enfeeblement of the heart. In
nervous children, vomiting, followed by convulsions, may usher in the
disease. The urine is scanty and often loaded with albumen.
The local affection is seen very early; the tissues of the throat are dusky
and swollen; the tonsils enlarge, and, with the swollen and edematous
condition of the uvula, the throat is so occluded that swallowing is
exceedingly difficult, painful, and often impossible, the fluid returning
through the nose. To add to the gravity, a cellulitis develops, and the
deeper tissues of the neck are involved. The lymphatics of the neck
become hard and swollen, the nares become almost closed, causing
difficult respiration. The exudate soon appears on fauces, tonsils, and
uvula, frequently passing to the nares.
If the child lives long enough, the necrotic exudate gives way, leaving a
ragged and foul-looking ulcer. The odor is peculiarly offensive. From the
nares a bloody, sanious, excoriating discharge takes place. The
extremities become cold, the child becomes drowsy, the face becomes
more dusky, the heart beats feebly, and finally death relieves the
sufferings of the little patient. If convalescence takes place, recovery is
slow, the heart showing the effects of the poison in the feeble frequent
pulse.
Nasal Diphtheria.—While in a severe case of pharyngeal diphtheria
the membrane may extend to the nares, we are not to overlook the cases
where the exudate is primarily in the nares. In these cases we have all
the general symptoms of diphtheria, but the throat remains clear for the
first few days, though the exudate may ultimately extend to the
pharynx and neighboring structures.
The exudate is usually not so firm, though sufficient to obstruct the
nasal passage, and causes the child to breathe with the mouth open. An
offensive sanious discharge excoriates the end of the nose and lips, and
The Eclectic Practice of Medicine - PART I - Infectious Diseases - Page 159