334 THE DISEASES AND DISORDERS OF THE OX. 



owing to the two facts, firstly, that the skin of the face is 

 naturally full of blood, and, secondly, that the scarlatina rash 

 is much more uniform than most rashes are, and is consequently 

 not so easily observed. The rash occurs also on the scalp, on 

 the oral and faucial mucous membranes, probably also on the 

 nasal mucous membrane, as is shown by the constant thick 

 stream of discharge so frequently seen flowing from both nostrils 

 in infants and children, also on the conjunctiva, in the external 

 auditory meatus of the ear; probably also in the middle ear 

 and eustachian tube. These latter points lead us to the recol- 

 lection that the mucous membranes of the fauces, eustachian 

 tube, middle ear and external ear are originally derived from the 

 lining of one cleft, the tympano-eustachian, the representative 

 of the permanently open spiracle of the Selachii. Observations 

 of a similar nature are to be made in regard to the two 

 diseases, measles and small-pox. 



While the rash is attaining its full development, the other 

 symptoms are all becoming intensified. The temperature rises, 

 and the pulse and respirations become more rapid. The tongue, 

 which at first was covered, with the exception of the tip and 

 edges, with a thickish whitey-brown fur, becomes more thickly 

 coated. At a later time the coating falls off", and the tongue 

 becomes in about four and a half days from the outset of the 

 malady red, clean, and moist, with swollen papillse, and shows 

 that remarkable strawberry-like appearance which is so charac- 

 teristic of this disease. In severer cases the tongue quickly 

 becomes dry. The soreness of the throat increases, and a more 

 or less vivid or dusky redness and swelling of the pillars of the 

 fauces, soft palate, uvula, and tonsils, are apparent. The 

 tonsils generally enlarge, and here and there on their surface 

 specks of inspissated secretion may be seen. With the faucial 

 swelling and inflammation, there are generally associated pain 

 and diflBculty in swallowing, fulness and tenderness behind the 

 angles of the jaw, and some enlargement of the lymphatic glands 

 of this part. There is much weakness, the limbs may be 

 tremulous, and the patient may become delirious and look dull 

 and stupid or restless, and be persistently so until death super- 

 venes. The vomiting generally subsides at quite an early 

 time; but in malignant cases it is severe, and may be almost 

 continuous. The bowels are variable in regard to their action. 



