ORDINARY TYPE. — The invasion is usually sudden, and is marked by vomit ing. fever, sore throat, and rapid pulse. Occasionally a short period of malaise precedes the onset of definite symptoms. In older children a chill is sometimes the first symptom; in younger children a convulsion. The vomiting is usually repeated several times, and is not accom panied by nausea. When it occurs late in the disease it is a far more able symptom than at the outset. The intensity of the period of invasion is usu ally indicative of the severity of the at tack, though this is a rule subject to many exceptions.
A clinical phenomenon in scarlatina iu the most characteristic instances con sists in a paresis of the extremities, the patient complaining that he cannot move the hands or feet. This degree of disturbance, however, is very excep tional. Most frequently there is only a numbness of the hands, with sensations of tingling or fornication. Numbness may be absent, and then the patient ex periences pricking sensations localized in the extremities of the fingers or in the palm of the hands. Disturbances in the feet are of rarer occurrence; they may be noticed alone or in conjunction with those described in the hands.
This sign appears during the period of eruption, exceptionally before it. Its duration is very variable; it may be experienced for only a few minutes, and not be felt again. In the majority of cases it is more durable, appearing sev eral hours or a day after the beginning of the eruption and persisting for two or three days, ordinarily with interrup tions. It may even be delayed in its ap pearance until the third, fourth, or fifth day of the eruption. It is accompanied by no painful sensation. Some patients experience this disturbance only when they wish to use the hands; others at the moment of leaving the cold bath or when the hands are dipped into water.
This sign is very constant.
This sign in other eruptive diseases has not been encountered. Meyer (Presse p. 119, '9S).
The temperature is frequently found to be 103° F. at the first visit and may reach 104° or 105° on the first day.
A temperature on the first day above 104 indicates a severe attack; below 102° a mild attack. The highest point is commonly reached at the height of the eruption. It then begins to subside and becomes normal at a varying period, rang ing from the ninth to the fifteenth day. The fever is frequently remittent and in mild cases almost intermittent in acter. There is no typical temperature range. The febrile stage, even in quite severe cases, may be limited to six or seven days, or it may be prolonged to fourteen or fifteen days without obvious cause.
A pulse abnormally rapid as compared with the height of the temperature is quite characteristic of scarlet fever. It is often 150 on the first day, and con tinues rapid through the disease.
One of the earliest symptoms is sore throat. The fauces, tonsils, and pharynx are of a uniform bright-red color, and on the hard palate numerous dark-red ules may be seen. In mild cases the throat symptoms may be very slight; in more severe cases the tonsils may be studded with follicular spots or smeared over with a tenacious exudate closely sembling a pseudomembrane. There is frequently a discharge from the nose, which may consist of clear, tenacious mucus or muco-pus. The glands at the angle of the jaw frequently become en- , larged.
In scarlet fever there is a general in tense redness of the whole throat, includ ing the hard palate. The entire mucous membrane is affected, and the small dots, which in connection with the hyperemic condition of the skin represent the con dition of a punctate erythema, from be ing localized on the moistened mucous membrane, have a little darker appear ance than the adjacent reddened tissue. In measles, on the contrary, the mucous membrane of the throat has a blotchy appearance, and is of a darker red than is seen in scarlet fever, while the mucous membrane between these blotches is but slightly congested in comparison with that of scarlet fever. T. Rotch (Boston Med. and Surg. Jour., May 27, '97).