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

Predisposing causes are, poor hygienic surroundings, which in former
times were the cause of so much erysipelas in hospitals, and following
confinements. Age also predisposes to this lesion, those being the most
susceptible who are between the ages of twenty and thirty. Previous
attacks also render one more susceptible, thus being different from all
other contagious diseases.
Pathology.—Erysipelas is a true dermatitis, involving the skin,
subcutaneous, and mucous surfaces. The blood-vessels are dilated and
distended with blood, and cell-infiltration may extend into the deeper
tissues, where suppuration is apt to take place. The cocci are found in
the lymph spaces of the affected area, while beyond this they are found
in the lymph vessels, where the battle is fought and won by the
leukocytes (phagocytes).
Aside from the local affection, the toxin in severe cases causes granular
degeneration of the heart, kidneys, spleen, and liver. According to Osier,
some of the worst cases of malignant endocarditis are secondary to
erysipelas.
Symptoms.—The period of incubation is variable, it being from three
to ten days after the entrance of the infection before the development of
the disease. The prodromal symptoms are common to inflammations
generally; viz., headache, loss of appetite, furred tongue, partial arrest
of the secretions. These terminate in the chill in the adult, or more likely
in a convulsion, if the patient be a child. Following the chill, reaction
occurs, with rapid rise in temperature, the thermometer registering-
103° the first day, 104° the second, and 105° to 106° by the third or
fourth day, usually the days of greatest intensity. The pulse is full and
bounding, the tongue is coated with a dirty fur, or it is brown and dry.
The skin is dry and more or less constricted, the urine is scanty and
high colored, and the bowels are constipated.
The local affection begins with a bright-red spot, slightly raised, more or
less edematous, and with a tendency to spread rapidly. The part is hot,
swollen, and painful, and often slight blisters form upon the affected
part. If that part be the face, the favorite seat of the disease, the
swelling extends to the eyes, which it soon closes; then involves the ears,
which become enormously enlarged; and finally, when at its height, the
features of the patient are so obliterated as to render him
unrecognizable by his nearest friends.
The Eclectic Practice of Medicine - PART I - Infectious Diseases - Page 169