SCARLATINA. 589 



neck, and thence extends over the body. Even in twenty-four cir thirty- 

 six hours the whole surface is usually covered with a scarlet color. In 

 the face, the cheeks only are generally red ; hence the exanthema is 

 less readily recognized here than elsewhere. The deepest redness is 

 usually on the neck, outside of the limbs, joints, hands, and feet. The 

 exhalations of the patient are said to smell like mouldy cheese, or 

 caged wild beasts in menageries. When the eruption appears, the 

 throat troubles increase, the fauces become more intensely red, the 

 tongue is of a dark raspberry redness, not only at the edges, but also 

 on its dorsum, from which the previous coating is thrown off; the 

 swollen and erect papillae give the surface of the tongue a rough ap- 

 pearance (cat's tongue). During the stage of eruption there are varia- 

 tions from the above symptoms, which have no material effect on the 

 course of the disease. For instance, in some cases the exanthema 

 spreads over the surface with uncommon rapidity ; sometimes the red- 

 ness is brighter, at others much darker ; in other cases the exanthema 

 presents the characters of scarlatina miliaris. In the same way che 

 throat troubles are sometimes very severe, again very slight ; they are 

 rarely accompanied by catarrh of the larynx, trachea, and bronchi. 



In the stadium florescentice, which usually lasts four or five da^s, 

 the fever at first increases, reaching its height about the second day. 

 At the same time the eruption is in its bloom, and the threat trouble 

 has reached its height. The urine contains quantities of detached 

 epithelium, and often, traces of albumen ; the general health of the 

 patient is also most affected at this time. Then all the symptoms 

 usually begin to decrease, the frequency of the pulse and the tempera- 

 ture go down, the exanthema fades, the difficulty of swallowing grows 

 less, the general health improves. In this stage also, besides the mate- 

 rial deviations due to increase of the fever, or extensive and unusual 

 local affections, different cases do not agree in all respects ; occasion- 

 ally, the exanthema remains out longer, or it fades and disappears 

 earlier; the same is true of the changes in the pharyngeal mucous 

 membrane, and of the fever symptoms. 



The stadium desquamationis usually begins on the fifth day after 

 the appearance of the eruption. While the eruption continues to some 

 extent in the extremities, especially about the joints, it disappears 

 about the neck, and here we first notice that the skin is rough and 

 dry, the epidermis is raised, and falls off in small shreds. A few days 

 later the redness usually disappears from the extremities also, and 

 desquamation begins. This does not occur in the extremities as it 

 does in the neck, with a detachment of small scales, but large flakes 

 come off, particularly from the hands, and they are not unfrequentl} 

 peeled off by the patient. During the stage of desquamation, which 



