In the scarlatina anginosa, the principal force of the disease seems to be expended in the throat; hence all the throat symptoms are rendered much more intense and painfully severe than in the simpler and more common form of scarlet fever. The general fever, and especially the eruption upon the skin, are much less strongly marked. “Almost from the commencement of the attack, soreness of the throat is experienced, attended with difficulty of deglutition, and often with considerable stiffness of the neck, and pain and difficulty in moving the lower jaw, due in part to the swelling of the submaxillary glands. On examining the throat, it is seen to be intensely red, and the tonsils are red and swollen. The swelling of the tonsils increases rapidly, until they almost block up the entrance of the pharynx, and thereby render the attempt to swallow so difficult, that fluids are often returned by the nose. An adhesive mucus collects about the back of the throat, and often seems to cause great annoyance to the patient, and specks or patches of lymph form upon the tonsils, and look like sloughs covering ulcers. In some of the severest cases, a very troublesome coryza comes on, and an adhesive yellowish matter is secreted in abundance by the mucous membrane of the nares, whence it runs down upon the upper lip, excoriating the skin over which it passes, and causing still more serious suffering by the obstacle that it presents to free respiration. West.
In addition to these symptoms, the ears also become affected, from the extension of the severe inflammation along the course of the Eustachian tubes; there is very great deafness, followed by copious and acrid discharge from the external meatus. Even the mastoid process of the temporal bone becomes carious.
When the throat thus becomes the principal seat of the disease, the eruption does not appear so regularly or so seasonably upon the external surface. It is often delayed till the third or fourth day, and generally comes out in scattered patches on the chest and arms. In some cases it is wholly confined to the back of the hands and wrists, and sometimes entirely vanishes the day after its appearance and reappears partially and at uncertain times. About the fifth or sixth day if begins to decline, following the same order in its decline which it had previously observed in its appearance; subsiding first on those parts which it had primarily occupied. Desquamation of the cuticle follows the disappearance of the rash; unless the latter has been very slight. And the fever and inflammation of the throat begin to abate with the fading of the eruption, though sometimes the sore throat and some degree of fever continue for a week or ten days after the rash has entirely disappeared. All these symptoms, in their severity and persistence, are capable of being very much modified by the use of the appropriate Homoeopathic remedy; our object here is simply to portray the natural order and the progress of the disease, when not inferred with; and yet it must be remembered that they naturally present a very great variety, in different persons, as regards their severity and their mode of combination.
In scarlatina maligna, all the symptoms may be said, in general terms, to be simply much more severe than in the milder forms of the disease. The principal distinction being rather of degree than of kind. Still a brief account of such cases may be useful. The rash is extremely irregular, both in the time of its appearance and in its duration; and also in its extent. It often comes out at a later period of the disease; disappears after a few hours, or suddenly vanishes to be again and again renewed in the course of the disorder. Its color may be pale, than in milder cases, or in irregular patches it may assume a livid hue; in the course of the disease in its worst varieties, petechiae may also appear on the skin. Soon after its first onset “the fever assumes a typhoid form, the heat of the skin is less intense, and there is great disorder of the functions of the sensorium, with small, frequent and often irregular pulse. There is at the same time a dull redness of the eyes, with a dark-red flush on the cheeks; the patient is restless, fretful, and at times delirious; the delirium is sometimes violent, but more generally it is of a low, muttering kind. The tongue quickly becomes dry and brown, or red, dry and glazed, and often so tender and chapped that a slight touch causes it to bleed; the teeth and lips are covered with sordes, and the odor of the breath is extremely fetid. The throat has a dusky red appearance; there is not much swelling, but dark incrustations from on the velum, uvula and tonsils, which are not, as has been generally supposed, sloughs, but merely exudations of lymph, or false membranes. In some cases however, there is a gangrenous inflammation of these parts, which are destroyed by the sloughing which succeeds. There is at the same time acrid, excoriating discharge from the nostrils, and a viscid secretion from the fauces, impeding respiration and producing a rattling noise. In severe cases the inflammation extends to the posterior pharynx, which, though not much swollen, is so irritable, that on attempting to swallow fluids, they are rejected through the nostrils. The inside of the lips and cheeks is frequently covered with aphthae; and the cervical and submaxillary glands become inflamed, abscesses occasionally forming in them and in the surrounding cellular tissue. In many cases of this malignant form, a fatal termination comes on the third or fourth day; the little sufferers appearing to sink under the general malignant influence. Scarlet fever without the eruption, in which the entire force of the disorder is expended upon the mouth and fauces, is of no uncommon occurrence; some instances have been known in which those who have thus had the throat affection without the eruption have subsequently had the scarlet fever eruption, without the throat affection, the same poisonous influence appearing capable of developing either the one or the other affection exclusively, or both together, according to the state of the patient’s system. But in this as in the other forms or varieties of this disorder, the true physician will seek to adapt the individual remedy to the particular condition of each individual patient.
Treatment. Select the remedy to meet the condition of each individual patient, according to the indications given below; and compare also the medicines subsequently indicated under the various Sequelae.
Aconite. When there is much distress, restlessness, heat, thirst and sleeplessness, the rash is not smooth. Aconite relieves the excitement of the system, both nervous and sanguineous, and at the same time promotes the development of the eruption.
Ammonium carb. When the rash continues out longer than the ordinary period; and there is tendency to gangrenous ulceration.
Arnica. In typhoid states, with epistaxis; or haemoptysis, aggravated by coughing;or when ecchymoses of various colors appear on different parts of the body; or even small boils.
Arsenicum. The eruption has disappeared too quickly, and there is rapid prostration and sinking; or the throat becomes putrid, with the same circumstances as under Aconite.
Arum tri. The lips, corners of the mouth and perhaps the nostrils are raw and bloody; and there is an apparent tendency for this state of things to increase in depth and circumference. There may also be a profuse (acrid) discharge from the nose. The throat becomes extremely sore, and excessively putrid, and the fever very persistent. In such cases (of scarlatina maligna) the Arum is the only remedy.
Aurum. Fetid discharge of mucus from the nose; or for otorrhoea of a similar nature, especially if bones comes from the ear.
Baryta c. Where the sore throat is pale instead of having the bright redness of Belladonna; the submaxillary and parotid glands are swollen and tender; the breath is putrid; the child scrofulous and dwarfish.
Belladonna. In the true Sydenham scarlet fever, where the eruption is perfectly smooth and truly scarlet. Eyeballs red and injected; the skin is so hot that it imparts a burning sensation to the hand.
Bryonia. The rash does not come out fully, it seems pale; there are frequent attacks of dyspnoea; nausea on sitting up; constipation; parched lips.
Calcarea c. In those chronic forms or protracted cases of scarlatina, where the temperament is leucophlegmatic, the nose sore and obstructed; the glands of the neck are swollen; slow fever, especially worse in the evening; the child appears pale and languid, does not seem to convalescence after the regular recession of the eruption.
Camphor. Extremities cold and blue; rattling in the throat; hot breath; hot sweat on the forehead, and the child refuses to be covered.
Carbo veget. This remedy should be considered when the soreness of the throat continues after the disappearance of the eruption. Putrid sore throat; sloughing away of some of the swollen parts in the fauces.
