SYMPTOMS. 295 



to move, will show stiffness from the swelling which exists over 

 the limb. On passing the hand over these swellings we may, 

 in certain situations where the skin is thin and vascular, and 

 where the swelling is of a patchy character, detect a certain 

 amount of moisture distributed in a dew-like fashion over the 

 skin ; or if this exuded serosity is becoming dry, the sensation 

 imparted to the fingers is similar to what is felt on passing 

 them over a mildly vesicated surface. Very careful examina- 

 tion may detect the vesicles before they rupture and discharge 

 the serous fluid. More carefully examining the face and head, 

 to which we are led by the swollen eyelids, there will in all 

 likelihood be noticed several blotches there and over the region 

 of the throat, which, although they may not feel dry or rough 

 to the touch, are yet to the eye rough-looking, from the open 

 condition of the hair. In many cases there may be very few 

 or no elevated patches on either body or limbs, nothing save 

 some amount of oedema ; the only diagnostic symptoms being 

 those connected with the membrane of the mouth and nose. 

 When the elevated, exuding, or roughened cutaneous patches 

 are present, the nasal and oral lesions are rarely absent ; these 

 consist of numerous bright red dots or spots scattered over the 

 membrane both of the nose and mouth. These blood-spots are 

 most readily observed on the membrane covering the nasal 

 septum and on the inner surface of the lips ; they are variable 

 in size and form, as also in intensity or depth of colour, not 

 only in different cases, but in the same case on different days, 

 or even at different periods of the same day : their size, num- 

 ber, and intensity of colour seem to bear a direct relation to 

 the severity of the fever, and its advance or defervescence. At 

 times there is coalescence of these spots, or a connection of 

 one with another by rays stretching between them. The 

 general appearance of the membrane upon which the punc- 

 tated blood-marldngs are situated is not in the . simple form 

 much changed in colour. Many of the circumscribed elevations 

 of the cuticular surface, when of a light colour, and denuded 

 of hair, show the petechial markings very distinctly, exactly 

 like those which exist on the nasal and buccal membrane. 

 If the affection to which this scarlatina has succeeded has not 

 been accompanied with soreness of the throat, such will most 

 probably now manifest itself, either accompanying the rash or 



