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

fourth or sixth day, when desquamation commences. As this progresses,
the surface becomes paler, the epidermis exfoliating in whitish scales, or
in large pieces where it is thick; sometimes desquamation is retarded for
two or three weeks.”
Scarlatina Maligna.—Some seasons, for reasons unaccountable,
scarlet fever appears in a malignant form. Such an epidemic occurred in
the winter of 1879 in the little village of Harrison, Ohio, nearly every
case resulting fatally, and this was my first introduction to scarlet fever.
So intense was it, and so fatal in its results, that I have ever had a
dread of this disease, and when scarlet fever appears, there rises before
me a picture of that epidemic of 1879.
We may divide this variety into two forms,—the nervous, and the
excessively toxic. In the first form the child is suddenly stricken; the chill
is short and the febrile reaction extreme. The skin is intensely hot, dry,
and pungent; the mouth is dry and parched; the eyes are brilliant and
burning; the face is turgid; the head is hot and painful; the throat
becomes dry, tumid, and swollen; the patient is restless and delirium
early ensues. There is nausea and vomiting of a persistent character;
convulsions are the rule.
Within twenty-four hours the intense excitement gives away to stupor.
The child lies with the eyes partly open, the pupils are dilated, the
surface seems dusky and swollen, the temperature reaches 104° to 105°,
the pulse ranges from 160 to 170 beats per minute, and within thirtysix
to forty-eight hours death ends the scene. In this case, if the
eruption appears, it is a dingy red, and appears slowly, though the
patient may succumb before it shows itself upon the surface.
In the second form, the disease is but little less fatal, though not so
rapid. There is great prostration from the beginning. The chill is greatly
prolonged, febrile reaction coming up slowly, the evidence of extreme
sepsis being seen from the beginning. The child is dull and stupid, and
the countenance vacant and besotted. The face is dusky or turgid and
the heat of the body pungent, though the extremities are inclined to be
cold. The tongue is broad and heavily coated, or dry and parched.
Nausea and vomiting frequently occur, and diarrhea is common. The
urine is highly albuminous.
The throat affection is characteristic; at first dry and tumid, it soon
shows a dirty, moist exudate, so that it is not infrequently taken for
The Eclectic Practice of Medicine - PART I - Infectious Diseases - Page 130