ACUTE INFECTIOUS DISEASES. 



and simple hypersemia of the kidneys. We shall first describe the 

 symptoms and course of this simple form (which is, however, quite a 

 serious disease), and subsequently shall speak briefly of the modifica- 

 tions caused partly by the asthenic character of the fever, probably 

 from the great increase of bodily temperature, partly by the extent 

 and variety of the local affections. 



During the stage of incubation, some patients complain of weari- 

 ness and depression, and an undefined feeling of sickness ; but most 

 of them feel quite well. 



The prodromal stage begins with repeated rigors, more rarely with 

 a single chill. This is followed by a feeling of burning heat, nausea, 

 or actual vomiting, severe headache, feeling of great relaxation, pain 

 in the limbs, and the series of symptoms that accompanies almost any 

 severe fever. Even at this time the pulse is often 120 to 130 beats a 

 minute, and the bodily temperature occasionally rises to 104 to 105, or 

 higher. Such an increase of the pulse and rise of temperature are not 

 often observed at the commencement of other diseases, even in inflam 

 mation of important organs, hence these symptoms alone should excite 

 the suspicion that we are dealing with the first stage of an infectious 

 disease. And, since, along with the fever, the subjective and objective 

 symptoms of pharyngitis usually occur, we may generally decide with 

 great probability, even at this time, that the case is one of commen- 

 cing scarlatina, and not of commencing measles, small-pox, or other in- 

 fectious disease. The patients complain of a feeling of dryness and 

 heat in the throat, and of pain, which is increased by swallowing. On 

 examining the throat, we find the mucous membrane of the tonsils and 

 soft palate dark rod and swollen. And in some cases the tongue is 

 already very red at the edges. Occasionally, the prodromal stage only 

 lasts a few hours, or the eruption may occur almost at the same time 

 with the fever, so that there is no real prodromal stage ; but in most 

 cases this stage lasts one or two days, and rarely longer. The inten- 

 sity as well as the duration of the prodromal stage varies in different 

 cases ; this is partly due to the individuality of the patient, partly to 

 unknown causes. Some patients are very much excited or delirious; 

 others lie benumbed and apathetic ; children not unfrequently have 

 convulsions, just as they do in other febrile diseases. Other patients 

 are less severely affected by the prodromal stage of scarlatina, and 

 have no serious symptoms. 



The stadium eruptionis almost always begins with an exacerbation 

 of the fever. The symptoms accompanying the fever, also the head- 

 ache, weakness, excitement, or apathy, increase, and it is at this time 

 that convulsions most frequently occur in children. The eruption does 

 not come first on the face, as that of measles does, but begins on the 



