SCARLET KKVKK. 43 



spreads from the chest over the face and trunk, and over the arms and legs also. It 

 reaches its maximum decree of intensity in three or four days, and then begins 

 to fade, and usually ly the eighth or ninth day it has completely disappeared. In 

 favourable cases the other symptoms subside with the eruption ; the temperature 

 falls, the pulse sinks to its normal rate, the tongue cleans, and the patient begins to 

 feel tolerably well again. 



At this period the skin begins to scale, or, in other words, the desquamation of 

 commences, and this may be looked upon as quite as characteristic of the 

 disease as any of the other phenomena we have enumerated. The amount of scaling 

 is proportional to the amount of eruption, and varies from a slight scurfiness of the 

 skin to the downright }>eeliiig off of solid flakes, which are most pronounced usually 

 on the soles of the feet and the palms of the hands. These are the spots where 

 evidence of scarlet fever lingers longest, and whenever a child is seen with its 

 palms or soles in a peeling condition, that child is to be regarded with suspicion, as 

 it is probably infectious. The duration of the peeling period is very variable. 

 Occasionally several weeks elapse before the skin is perfectly free from any sign 

 of it. 



About the time that the skin begins to peel, the patient is very liable to have an 

 attack of so-called rheumatism, accompanied by swelling of the joints. The knees, 

 elbows, and hips are usually affected. The temperature rises again, and it occa- 

 sionally happens that a genuine relapse takes place, and all the phenomena of the 

 fever are repeated. In a favourable case the peeling will have ceased and the 

 patient will be convalescent at the end of three weeks. 



All these symptoms, as we have said, vary very much in severity. There may be 

 but little eruption, and no sore throat worth speaking of, and then the case is spoken 

 of as one of simple scarlatina, or scarlatina simplex. When the throat symptoms 

 are very bad it is called scarlatina anginosa, and when all the symptoms except 

 tJie eruption are present it is spoken of as scarlatina without eruption ; and it is 

 important to remember that such cases are recognised as occurring. It is supposed 

 by some that there is a difference between scarlet fever and scarlatina, and we not 

 unfrequently hear people say that " So and so has not got scarlet fever, but only 

 scarlatina." It is right that people should thoroughly understand that the two 

 diseases are actually the same, although the word " scarlatina " is usually applied to 

 the milder cases. We would impress very strongly on the reader, however, that the 

 mildest possible cases are capable of producing by their contagion the severest cases 

 in others, and that no matter how mild the actual fever may be, the sequelae or conse- 

 quences of that fever may be of the most serious and dangerous nature possible. This 

 leads us on to speak of the complications and sequelre of scarlet fever. The condition 

 of the throat may be so bad from the first as almost completely to overshadow the 

 other symptoms of the disease. The throat may be immensely swollen internally, 

 and the tonsils may lie so much enlarged as completely to block the passage of the 

 throat, and to threaten the patient with suffocation. The throat condition may persist 

 long after the other symptoms have subsided. There may be deep-seated inflamma- 

 tion all round the throat, so that the skin feels hard, tender, and puffy, like one large 

 carbuncle surrounding the neck. Matter may be formed beneath the skin, and in bad 



