CONTAGIOUS DISEASES OF CHILDREN. 251 



eruption looks uniform, but a closer examination discloses innumerable 

 round points, some of which are more pointed and higher than their 

 neighbors, and often run into minute bladders about the size of a pin's- 

 head. 



Sometimes the disease is singularly mild ; sometimes exceedingly 

 virulent. Sometimes it is so fugacious that its presence is not suspect- 

 ed until the skin begins to peel, a process notably observed on the 

 hands and feet. Frequently the joints, particularly the wrists, suffer 

 pains analogous to those of rheumatism. Scarlet fever is an extremely 

 contagious disease; and while, after ten days' isolation and the use of a 

 bath at the close, a child convalescent from measles may be allowed to 

 associate with others, not less than six weeks' isolation is required to 

 exhaust the communicability of a case of scarlet fever. 



Mumps may come on suddenly, or else be preceded by a few days 

 of general indisposition, which now and then amounts to high fever. 

 A feeling of stiffness about the jaws is soon followed by swelling, often 

 very bulky, and more or less tense. The swelling is apt to extend 

 either at the back of the lower jaw or underneath it. The swelling 

 contains no fluid : dental pain is absent. Generally first one side of 

 the jaw is attacked and then the other; it is rare for both sides to suf- 

 fer simultaneously. Not uncommonly similiar swellings burst out in 

 other localities of the body, the genital organs being most liable to 

 seizure. 



Ulcerative stomatitis is a contagious disease. Its invasion may be 

 preceded by general indisposition, usually unattended with fever. Gray- 

 ish bleeding ulcers, tending to spread in extent and depth, attack the 

 edge of the gums, the inner side of the cheeks and lips, and the roof 

 of the hard and soft palates, accompanied with an extremely fetid 

 breath. 



Diphtheritic sore-throat or croup is eminently contagious. Its ap- 

 proach is insidious, often commencing with some difficulty in swallow- 

 ing and slight hoarseness. Possibly the glands at the back of the 

 angle of the jaw swell, which in serious cases extends to the neighbor- 

 ing structures of the neck. At other times these symptoms occur sub- 

 sequent to a swelling about the nostrils, with more or less copious dis- 

 charge, indicating that the nasal membranes have been seized prior to 

 those in the throat. Cough, if any, is faint and muffled ; the voice is 

 hoarse and smothered. 



With a spoon press down the child's tongue, and note if there be 

 any appearance about the tonsils and the soft palate of a skin or leather- 

 like membrane, which may be grayish or whitish, or even blackened 

 by vitiated blood. This false membrane, which characterizes the dis- 

 ease, is prone to spread over the neighboring parts, notably reaching 

 downward into the windpipe. This diphtheritic croup must not be 

 confounded with false or spasmodic croup. 



In false croup the child has generally been perfectly well during 



