A Treatise on Fever

by Southwood Smith

Of Scarlatina. Characters by which it is distinguished from Continued Fever, without an Eruption. Division into Scarlatina Synochodes and Typhodes. Events which occasionally occur in Fever, but which form no essential Part of it.

The only kind of continued fever attended with an eruption, which it falls within the compass of the present work to notice, is that of scarlatina, and, even in relation to this, after the full account which has been given of the other forms of fever, it will be necessary to state only the peculiarities by which it is distinguished.

1. The depression of the nervous system so characteristic of synochus and typhus, is much less in degree in scarlatina. Neither the physical nor the mental debility is as great. In the whole attitude and manner of the patient, as well as in his own sensations, there is less prostration. The disease is more nearly allied to a pure inflammatory affection than either of the preceding forms of fever.

2. Accordingly, the circulation is not only more rapid, but it is also more strong. It is not uncommon for the pulse to be 140 in a minute; in severe cases it is seldom below 120. Without being hard, it is more full and strong and less easily compressed than in the other forms of fever.

3. Corresponding with the activity and energy of the circulation is the increase of the temperature; the heat over the whole surface of the body is often intense and pungent. In this fever, the temperature, as indicated by the thermometer, rises several degrees higher than in any other.

4. The capillary vessels of the external skin, as is shewn by the bright and vivid colour of its characteristic eruption, are filled with blood. Often from the crown of the head to the sole of the foot, the external covering of the body is in a state of inflammation, and this inflammation constantly terminates in the death of the cuticle, whence it is thrown off by the process of desquamation. It is not improbable that the large quantity of blood which is thus spent upon the surface of the body, and which is thereby diverted from the internal organs, is one reason why the latter are not so much oppressed as in the other forms of fever.

5. Much as the external skin is loaded with blood, the capillary vessels of the internal skin appear to be equally turgid with it. This is indicated by the bright and vivid redness of the mucous membrane covering the mouth, the tongue, the fauces and the throat. That this redness extends beyond these external parts into the internal organs there is abundant evidence, because, although we cannot follow it with the eye, we can trace it by the signs of disordered function which arise.

6. Certain parts of the internal skin, as it covers particular organs, is peculiarly apt to pass into inflammation, and to terminate, like ordinary inflammation, in ulceration. The principal seats of inflammation are the throat and the larynx; but that, on the one hand, the inflammation extends from the throat into the stomach, is evident from the peculiar tenderness of the epigastrium, which is almost constant in scarlatina, and which is more acute than in ordinary fever; and that, on the other hand, it extends from the larynx into the bronchi and their ramifications, is evident from the symptoms of thoracic affection, which are at once more prominent and more constant than in the other forms of fever. The larynx, the cartilages of which are apt to be destroyed by ulceration, in the severe and mortal cases, is now and then attacked with a peculiar kind of laryngitis, to be further noticed in the pathology, which is almost uniformly and most rapidly fatal.

7. From the preceding observations, the new symptoms which are added to the febrile train in scarlatina, and which arise out of the modification of the fever by its complication with an inflammatory condition of the external and internal skin, are easily understood. They are the following: namely,

Scarlet eruption on the skin; vivid and peculiar redness of the mouth, tongue, fauces and throat: the presence of the disease may usually be discovered by this peculiar and specific redness of the tongue and throat alone, although every other characteristic symptom were absent: pain in the throat, difficult deglutition, huskiness and hoarseness of the voice. To these must be added other symptoms, which, though they are sometimes present in ordinary fever, are both more constant and more severe in scarlatina than in the latter, namely, pain in the chest, cough, difficult and hurried respiration, duskiness, in severe cases lividness of the cheek, often, especially in the commencement of the attack, nausea and vomiting.