338 THE DISEASES AND DISOEDERS OF THE OX. 



may come on early in the disease ; but they are rarer than at 

 the beginning of measles or small-pox. 



There is no disease which varies more than scarlet fever does. 

 On the one hand, it may be one of the very mildest ; or on the 

 other, one of the most terrible, of diseases. Sometimes patients 

 scarcely know that they have been ill, while at other times it 

 may happen that not one of a household in which the fever breaks 

 out lives through it. Indeed, the malady may be of so deadly a 

 nature that a patient stricken down vrith it may die within the 

 first three days, or even, it is said, during the very first day of 

 attack, before the rash has appeared or the throat has become 

 at all markedly sore. Again, while some epidemics of scarlet 

 fever scatter death far and wide, others are of such a mild 

 character that scarcely a single death results. Frequently the 

 fever spreads rapidly through a village or town or over a large 

 extent of country in so mild a form that hardly any fatal cases 

 occur, while at other times an epidemic may be characterised by 

 great malignancy, and a terrible mortality may ensue from its 

 ravages. Some mild cases may be spoken of as examples of 

 latent scarlet fever, and some would scarcely be recognised as 

 scarlet fever at all but for the facts that they occur while that 

 fever is prevalent, or that they impart scarlet fever, or that 

 desquamation, with or without albuminuria, supervenes. Further, 

 of cases of medium intensity, some may show severe sore throat 

 and but a mild eruption, while in others there may be but little 

 aff'ection of the throat. 



Another variety of scarlet fever is that in which the throat 

 affection may be serious from the first ; but more frequently it 

 undergoes aggravation either at the height of the fever or during 

 the subsidence of the rash, or even after its disappearance. 

 There may, perhaps, be abscess of the tonsil, or marked ulcera- 

 tion, or gangrene, with oedema of the surrounding tissues, and, 

 supervening thereon, the glands in the neck may inflame and 

 suppurate, and sinuses may form. If so, the patient may fall 

 into a typhoid condition and die, or may be carried ofi" by oedema 

 of the glottis, perforation of an artery, or pyaemia. Scarlet fever 

 occurring at or just after parturition is said to be very fatal, and 

 is regarded by some as a grave form of "puerperal fever." 

 However, it does not appear to be especially dangerous during 

 pregnancy or to lead to abortion. 



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