MALIGNANT SCARLATINA. 179 



made to move at all. As the disease proceeds, or takes on 

 more intensity, large blisters or vesicles appear upon the limbs 

 in the regions of the joints ; these vesicles burst, and discharge 

 a bright amber- coloured fluid, which is very corrosive in its 

 effects upon the skin. In other cases again, remote portions 

 of the organism, such as the ears, will suddenly present a 

 blanched appearance, and become hard and dry as though 

 frozen ; and in the course of a day or two, these blanched 

 portions snap off from the parts contiguous, leaving exposed a 

 raw surface, which speedily suppurates. The appetite entirely 

 disappears, and the secretions from the bowels become checked, 

 and what is denominated constipation ensues ; the urine also 

 becomes scanty, and of a thick yellow or brown colour. 



In the course of twenty or twenty-four hours from the 

 commencement (and in many cases even less), the scarlet spots 

 on the membrane of the nose enlarge, and pass into purple- 

 coloured patches, which slough, and leave a raw surface, from 

 which is secreted an abundance of purulent matter ; at the 

 same time a similar sloughing goes on around the joints where 

 the blisters or vesicles first appeared. If the disease goes on 

 favourably the fever will generally abate (in the milder states 

 at least) about the fourth or fifth day from the commencement 

 of the more acute stage ; while in the more malignant kinds it 

 is seldom that a change for the better occurs before the seventh 

 or eighth day. In its most severe forms, however. Purpura 

 Hsemorrhagica supervenes, and the patient becomes an emaci- 

 ated and loathsome looking object. 



Pathognomonic Symptoms. — The symptoms which are 

 pathognomonic of Scarlatina are the presence of scarlet spots 

 upon tTie membrane loiihin the nostrils, hlotchy elevations upon 

 the slcin, and the sudden swelling of the limbs. 



