SYMPTOMS. 297 



membrano and amongst tlie connective-tissue. Very rarely 

 have I seen this organ presenting the peculiar strawberry 

 appearance so characteristic of scarlatina in the human 

 subject. 



The chief distinguishing symptoms, however, of scarlatina 

 anginosa are such as connect it with morbid conditions of the 

 glands and gland-structures, and other organs and tissues in 

 the upper part of the air-passages. There is difficulty in 

 swallowing, a short painful cough, snuffling or embarrassed 

 breathing, a generally swollen, infiltrated, and painful condi- 

 tion of the glands and structures in the region of the larynx 

 and pharynx. 



The pulse in these severe cases is characterized by great fre- 

 quency, is small in volume, and occasionally jarring, while the 

 respirations are much accelerated. Both pulsations and respi- 

 rations vary in accordance with the advance or subsidence of 

 the general febrile disturbance, which again is in direct relation 

 to the severity of the anginal symptoms, and to the extent of 

 the peculiar blood-spots or markings over the membranes, and 

 the depth of their colouring. 



At varying periods during the course of this morbid action 

 oedematous swellings, not diagnostic, but remarkable for the 

 suddenness of their appearance, their extent and persistency, 

 are very apt to occur over the inferior parts of the chest and 

 abdomen. In most cases there is a discharge from the 

 nostrils, usually watery, seldom coloured, and rarely if ever 

 bloody. During the continuance of these symptoms the appe- 

 tite is very capricious, and the condition of the bowels irregular, 

 rather inclined to be confined. 



Course and Termination. — In those forms where angina is not 

 particularly severe, where there are no arthritic complications, 

 and where the general health has not been hopelessly broken 

 down by the inroad of the primary affection, of which this is 

 but the sequel, the distinctive features after repeated subsi- 

 dence and renewal will have culminated and shown evidence 

 of decline in six or eight days. It is seldom that the symptoms 

 disappear suddenly and at once, or even steadily and gradually; 

 the usual course they take is that of decline by oscillation — a 

 considerable improvement to be followed shortly by a renewal 

 of previous symptoms, these on renewal not being so severe as 



