340 THE DISEASES AND DISOEDEES OE THE OX. 



and accumulation of lymphoid cells in the surrounding tissues, 

 besides which in the epidermis swelling and proliferation of the 

 cells of the rete mucosum with serous effusion and migration of 

 leucocytes between them, and tendency to detachment of the 

 borny layer ; in the various epithelia (including those of the 

 renal tubules) changes resembling those in the skin ; and in 

 the interior of lymphatic glands, especially those of the neck, 

 disappearance of the lymphoid cells, and development in their 

 stead of many-nucleated giant-cells, which at last become 

 fibrous. 



. In regard to the treatment of patients suffering from scarla- 

 tina, a great deal of judgment is always requisite. The remedies 

 which have been employed are very numerous. As we have 

 said above, scarlet fever varies very considerably in its intensity. 

 On the one hand, if no complications occur, the malady may 

 terminate favourably within about a week or a little more from 

 its commencement. On the other hand, it must be borne in 

 mind (as Dr. Gee points out) that however favourable may be 

 the progress of a scarlatinal patient, confinement to bed should 

 be insisted upon for a period of three weeks from the outset of 

 the disease. Then the patient may be allowed to get up, but not 

 to leave the room for another week. Even after four weeks have 

 elapsed, the patient cannot be said to be free from all danger of 

 albuminuria. Especially, of course, if the disease is of a malig- 

 nant type, and also if any unfavourable pre-existing condition 

 such as the puerperal state is present, must the greatest care be 

 exercised. 



The patient should at once be isolated, placed in a suitable 

 room on the top floor of the house, which should be set apart 

 exclusively for the patient. The usual measures should be taken 

 in regard to nursing, ventilation, disinfection, cleanliness, and 

 removal of surplus furniture. Carpets and porous materials 

 should be removed. The bedroom should be well ventilated, in 

 part by an open fire. The whole surface of the body should be 

 sponged with tepid water in which a little of the salt, perman- 

 ganate of potassium, has been dissolved, once or twice a day. 

 The skin may be subsequently greased with mutton suet. The 

 diet should consist of milk, beef-tea, eggs (one or two daily), 

 light puddings, and farinaceous diet. Drink should be freely 

 supplied. It should be remembered that purgation is to be 



