274 PATHOLOGY. 
forenefs, chops, and even blifters. Thefe fymptoms are 
often accompanied by fevere diarrhoea, and by petechiae 
and vibices on the {kin, with haemorrhage from the 
mouth, throat, bowels, or other parts, which, of courfe, 
but too often lead to a fatal termination. This generally 
takes place in the fecond or third week ; but, in a few 
inftances, the patients have fuddenly funk as early as the 
fecond, third, or fourth, day, probably from the occur¬ 
rence of gangrene in the fauces, oefophagus, or other 
portions of the alimentary canal; and fometimes at a 
later period of the difeafe, when the fymptoms had been 
previoufly moderate, the malignant changes have fud¬ 
denly commenced, and proved rapidly fatal. Even thofe 
who efcape through thefe dangers, have often to ftruggle 
againft many diftreffing fymptoms, for a confiderable 
length of time; fuch as ulcerations fpreading from the 
throat to the contiguous parts, fuppuration of the glands, 
tedious cough and dyfpnoea, excoriations about the nates, 
&c. with hedic fever. 
This difeafe is not unfrequently followed by a date of 
great debility, under which children are affeded with 
various troublefome diforders. But there is one affec¬ 
tion peculiar to the decline of Rofalia, which occurs ef- 
pecially when the eruption has been extenfive; namely, 
anafarca of the face and extremities. This dropfical ef- 
fufion is commonly confined to thefe parts, and there¬ 
fore unattended with danger: it ufually appears in the 
fecond week after the declenfion of the raffi, and conti¬ 
nues for a fortnight or longer. But in a fmall number 
of cafes, when the anafarca had become pretty general, 
a fudden effufion has taken place into the cavity of the 
cheft, or into the ventricles of the brain, and occafioned 
the death of the patient. 
In tracing the fcarlet fever in its mildeft form, the 
interference of medicine is unneceffary, and in fad hurt¬ 
ful. If the bowels are much confined, a laxative may be 
given, and faline medicines may ferve to increafe the fe- 
curity of the patient ; but, further than this, medicine 
does harm. In the fecond variety, however, we have 
reafon to adopt more efficient meafures. Although 
blood-letting has been recommended by Morton, De 
Haen, and others, the experience of our later writers on 
this fubjed coincides in deeming it injurious. Dr. 
Willan fays, wherever it had been employed great de- 
preffion and faintnefs were the immediate confequences, 
the pulfe becoming more weak and frequent, and often 
irregular. And Dr. Withering difcountenances even 
local bleeding. “ Sometimes, where the fiery rednefs of 
the eyes and the ftate of delirium feemed to demand the 
application of leeches to the temples,” he obferves, “I 
have feen them applied, but never with any good effed.” 
Upon the whole, it is beft to confine bleeding in fcarlet 
fever to cafes in which the head or other vital part is 
gravely affeded, or in which the fymptoms lead us to 
infer that the difeafe will terminate in a malignant form. 
We have found leeches to the pit of the ftomach of effen- 
tial benefit when the attendant gaftritis has been ex¬ 
treme. 
Emetics have been much recommended; and in the 
early ftage of the difeafe, probably while the contagious 
materia is ftill in contad with the ftomach, they fome¬ 
times prevent the development of the exanthem : and 
many have advifed vomits to be continued, and in large 
and frequent dofes, during the continuance of the ma¬ 
lady, and under all its forms. The propriety of this prac¬ 
tice may reafonably be doubted. Naufeating medicines 
are neverthelefs ufeful; and fox-glove may be given in 
the early ftages of the difeafe. Gentle purgatives ffiould 
be regularly adminiftered ; but draftic cathartics ffiould 
be entirely proferibed. 
The application of cold is a remedy of the greateft 
avail in Rofalia, the fimple obfervation that the {kin is 
hot and dry being enough to guide us in its ufe. If the 
fooliffi prejudices of patients prevent us from ufing this 
important meafure, fponging the body, and efpecially the 
epigaftrium, may be reforted to. In the latter end of the 
difeafe, i. e. when it puts on the malignant form before 
deferibed, cold aft'ufion is improper. Leeches to the in¬ 
flamed throat, blifters in the vicinity of an inflamed organ, 
and gargles, are local applications of much ufe ; but of 
which plenty of formulae abound. Plate III. fig. 3, dif- 
plays the appearance of Rofalia parifthmitica in its moft 
advanced or malignant ftate. 
2. Enanthefis rubeola, meafles: raffi in c rim foil ftig- 
matifed dots, grouped in irregular circles or crefcents ; 
appearing about the fourth day, and terminating about 
the feventh; preceded by catarrh ; fever a cauma. Three 
varieties. 
«■ R. vulgaris : raffi {lightly prominent, extending over 
the mouth and fauces; harffi dry cough; inflamed 
watery eyes. Occurring only once in the courfe of a 
man’s life : contagious. See Plate IV. fig. 1. 
R. fpuria : the raffi running its regular courfe with 
little fever or catarrhal affe&ion ; affording no certain 
fecurity againft the common or regular difeafe. 
y. R. nigra: the raffi about the feventh or eighth day 
affuming fuddenly a black or livid hue, interfperfed with 
yellow; prolonged in its ftay; and accompanied with in- 
creafed languor and quicknefs of pulfe. See fig. 2. 
The two laft varieties are fufficiently deferibed in the 
above definition. It remains, however, to give a more 
detailed account of the fymptoms of meafles in general. 
R. vulgaris begins with fymptoms of fever; fluffiing 
of the cheeks; a fenlation of pain or weight acrofs the 
forehead and eyes, with difpofition to fleep ; flight fore¬ 
nefs of the throat, a white fur on the tongue, a frequent 
and fomewhat irregular pulfe. On the third and fourth 
days, the eyes become tender and inflamed, the eye-lids 
and tarfi a little turgid ; there are difeharges from the 
eyes and noftrils, and repeated fneezing; and afterwards 
a frequent dry cough, hoarfenefs, difficulty of breathing, 
and a fenfe of conftridtion acrofs the cheft. Thefe fymp¬ 
toms decline with the efflorefcence on the feventh day. 
A harffi founding cough often precedes the attack, in 
infants, feven, ten, fifteen, or twenty, days. The raffi 
appears in patients having a delicate Ikin, partially on 
the third day; in thofe having a dark or thickened {kin 
about the fifth ; but moft ufually on the fourth. It is 
firft vifible on the forehead, under the chin, about the 
throat, nofe, cheeks, and mouth ; it is formed on the 
neck and breaft, early on the fifth day, and is diffufed, 
towards night, round the trunk, and on the extremities; 
during this day it is moft full and vivid on the face, as 
reprelented on Plate IV. On the fixth day the effloref¬ 
cence on the face begins to decline ; that on the body is 
moft red and extended, and declines on the fucceeding 
day, leaving a roughnefs and itching of the Ikin, with the 
formation of feurf. The colour of the raffi is lefs vivid 
than in Rofeola 5 and, on its decline, affumes a yellow- 
iffi hue. It commences with diftintt red and nearly-cir- 
cular dots ; larger patches appear afterwards, approach 
to the form of a crefcent or femicircle, and are gently 
raifed under the finger. They confift of a number of 
the dots juft mentioned, with which they are alfo inter¬ 
fperfed, leaving, however, large interftices of the natural 
colour. Diftinft papulae are apt to appear on the face 
and hands in infants, and on the wrifts and hands in 
adults : miliary veficles alfo appear on the neck, breaft, 
and arms. On the fourth day, fmall dark-red patches, 
of the form deferibed, appear on the palate, uvula, tonfils, 
and velum pendulum palati; during the fucceeding day, 
they pafs into a general ftreaky rednefs. If the eruption 
be repelled by cold, delirium, dyfpncea, or diarrhoea, oc¬ 
curs, attended with confiderable danger. 
Dr. Willan thus recapitulates the diagnoftic chara&ers 
of Rubeola and Scarlatina, (our Rofalia.) “ 1. The 
efflorefcence in Scarlatina generally appears on the Jecond 
day of fever; in the meafles it is feldom vifible till the 
fourth. 2. It is much more full and fpreading in the 
former difeafe than in the latter, and confifts of innume- 
, rable 
