SCARLATINA MALIGNA. 35 



third, and fourth days, symptoms of gastro-enteritis are present; 

 the tongue is of a bright red colour ; there is nausea, vomiting, 

 diarrhoea, or constipation, dry cough, quick and vibrating pulse, and 

 occasionally epistaxis. The eruption, which appears on the third 

 day, is not so generally or equally distributed as in the former 

 affection. It also sometimes disappears suddenly, frequently on the 

 day after its appearance, and returns again after an uncertain period 

 of time. The entire duration of this form is longer than in simple 

 scarlet fever, and its order of appearance, and that of its desquama- 

 tion, are not so regular. 



SCARLATINA MALIGNA. 



Symptoms. — This form comes on like the scarlatina anginosa, 

 except that the symptoms are of a graver type even on the first 

 accession. Sometimes, in fact, the patient is stricken dead by the 

 poison in a very few hours before any eruption or local symptoms 

 come on. The eruption does not present a scarlet appearance, but 

 is more of a livid hue, and frequently interspersed with petechias. 

 It is irregular in its first appearance, and it may disappear and 

 reappear several times. In this form of scarlatina, the pulse is 

 small and irregular, the teeth and tongue are covered with brown or 

 black incrustations, the eyes are much injected, and the vision is 

 confused ; the respiration is laborious, and the breath is foetid ; the 

 pharynx is covered with thick, viscid mucosity, and there is often 

 sloughing of the surface of the amygdalse. Convulsions and coma 

 are frequent concomitants of this afTection in children, while delirium 

 and deafness attend this form in the adult. 



The appearance of numerous petechise, of abundant diarrhoea, of 

 difficult respiration, or of persistent coma, announce the approach of 

 death. 



The sequela of scarlatina are, anasarca, ophthalmia, otitis, bron- 

 chitis, enteritis, orchitis, and cynanche parotidea, in adults ; affec- 

 tions of the sub-maxillary and inguinal glands, &c., in children. 



Treatment. — In scarlatina sitn'plex., when the bowels are con- 

 stipated, mild purges may be employed. Rest in bed, spare diet, 

 cooling acidulous drinks, and, where the surface of the body is ex- 

 tremely hot and burning, cold sponging, are the means principally 

 to be relied on. 



In scarlatina anginosa, and 7naligna, the treatment must be the 

 same in its nature as that of continued fever, but be varied to meet 

 the symptoms. If there is violent cerebral excitement, or inflamma- 

 tion of the throat, a few leeches may be applied ; but if the powers 

 of life are low, it may be necessary to give wine, beef-tea, &c., 

 from the very commencement. The throat always requires great 

 attention. Therefore the patient, if able, should assiduously use a 

 gargle containing muriatic acid, or chloride of soda, and should 



