590 ACUTE INFECTIOUS DISEASES. 



lasts from eight to fourteen days, the last traces of fever and angina 

 disappear, and, when the disease runs a favorable course, it ends in 

 perfect recovery during the third or fourth week. 



Scarlatina sine exanthemata and scarlatina sine angina belong to 

 the simple, or, at all events, to the benign cases. The former is only 

 to be distinguished from simple angina by its occurrence during an 

 epidemic of scarlatina, by the high fever, by the great constitutional 

 disturbance, and by a marked prodromal stage. In scarlatina sine 

 angina, the fever symptoms and the exanthema are characteristic ; but 

 localization of the scarlatina process on the pharyngeal mucous mem- 

 brane either cannot be found, or is limited to slight pain in swallow- 

 ing, or to faint redness of the fauces We should be very careful 

 about diagnosing scarlatina sine angina, particularly if it cannot be 

 proved that the patient has been near scarlet-fever patients ; from the 

 great similarity of the eruption, scarlatina sine angina can occasionally 

 only be diagnosed from some forms of roseola, especially roseola ab 

 ingestis, by considering the causes. Like measles, scarlatina may 

 prove very injurious, without any dangerous local symptoms ; the pa- 

 tients may even die of the disease before the customary local symp- 

 toms have appeared on the skin or pharyngeal mucous membrane. In 

 such cases the patients die of paralysis of the heart, which is preceded 

 by the symptoms of excessive adynamia. Here, as in the case of malig- 

 nant measles, we shall not attempt to say whether the alteration of 

 the blood has a directly paralyzing effect on the nervous system, and 

 especially on the nerves of the heart, or whether the injurious effect be 

 due to the high grade of the fever, that is, to the excessive increase of 

 bodily temperature. But since, even in simple benign scarlatina, 

 the temperature is usually very high, and since, as we have before 

 shown, a still further increase destroys life, as is proved by physiologi- 

 cal and pathological experiments, we regard it as very probable that 

 the excessive increase of bodily temperature in malignant, asthenic, or 

 typhoid scarlatina, induces the paralysis. The symptoms of asthenic 

 or typhous scarlatina closely resemble those of asthenic or typhous 

 measles and the same forms of other diseases, especially infectious dis- 

 eases. Even in the prodromal stage, the patients are very much de- 

 pressed ; they lie in a state of apathy, cannot collect their thoughts, 

 scarcely answer any questions, and finally become perfectly comatose 

 The pupils are usually dilated Slight twitchings of the muscles, and. 

 in children, general convulsions, not unfrequently occur ; the tongue 

 becomes dry, the pulse small, and scarcely to be counted ; the body is 

 often burning hot, while the extremities are cool. Even before the 

 eruption appears, the patient may die with the symptoms of excessive 

 collapse, and oedema of the lungs. The scarlatinous sore throat, which 



