Examinations of 100 cases with refer ence to the enlargement of the lymphatic glands. The inguinal glands were en larged in 100 per cent., the axillary in 96 per cent., the Maxillary in 95 per cent., the posterior cervical in 77 per cent., the anterior cervical in 44 per cent., the submaxillary in 36 per cent., the epitrochlear in 26 per cent., and the sublingual in 25 per cent. The enlarge ment seemed to correspond with the in tensity of the toxemia. The main value lies in recognizing scarlet fever from scarlatiniform eruptions due to various toxins or drugs. In these the glands are not so universally enlarged. J. F. Schamberg (Annals of Gynme. and Peed., vol. xiii, No. 3, '99).
As the disease progresses, the tongue, which is at first coated, often assumes the so-called strawberry appearance. Much confusion exists as to what the strawberry tongue really is. It is not a white tongue with red papillae; such a tongue is seen in various conditions. The true straw berry tongue was originally described by Flint as follows: "The tongue in the first days is usually coated. In the prog ress of the disease the tongue usually foliates, leaving the surface clean and reddened and the papilla: enlarged. The appearance is strikingly like that of a ripe strawberry. The strawberry-like tongue is a pathognomonic symptom; it is peculiar to this disease. It is often, but not uniformly, present." The term should be applied to the red, clean tongue with prominent papillae which follows a coated tongue.
All agree that during the first three or four days of scarlet fever the tongue is white-coated, with the papilla promi nent, sticking out through the white fur, as if the tongue had been sprinkled with red pepper. After the fourth day this coating disappears, sometimes gradually, sometimes quickly, leaving the tongue of a bright, shiny red, and very prominent The first conditions, while common in scarlet fever, and while the redness of the papilla is more marked in that dis ease than in any other, do not occur in many febrile affections, especially where there is irritation of the digestive tract. Therefore. it cannot be in itself charac teristic of scarlet fever. The more or less sadden desquamation of the tongue. it bright red and rough, with prominent papilhe, does not occur in any other disease, and is therefore char acteristic of scarlet fever. If the term strawberry is to be applied at all, it should be to the rough, bright-red tongue with prominent papillre. M. II. Fussell (Univ. Med. Mag., May, '97).
An early and constant symptom in scarlet fever is a rash which appears on the soles of the feet and palms of the hands after twenty-four or thirty-six hours of the stage of invasion. It is
bright red, not mottled, and accompa nied by swelling. The whole of the sole of the foot is not affected, as toward the centre near the highest part of the plantar arch an elliptical pa tell of skin retains its normal color. Sometimes the redness extends along the heel and around the sides of the foot. This rash lasts sometimes only a few hours, but generally it persists for a couple of days; then the color changes to violet. About the fourth day it becomes duller, of an earthy or brownish hue. On the fifth and sixth days it disappears. Stoupy (Archie de Mid. et de Pharm.
July, 1901).
The eruption usually appears within twenty-four hours after the initial vom iting. It is not infrequently seen after twelve hours, and is sometimes delayed for thirty-six hours and in rare cases to the fourth or fifth day. There is fre quently intense itching or burning of the skin. The rash is usually well developed during the second day of its appearance. It then continues from four to six days, when it gradually subsides. It usually appears first over the front of the neck and upper part of the chest. It consists of minute points of bright-scarlet color closely grouped together on a slightly reddened skin. They become confluent in places, forming bright-scarlet patches, but over the most of the surface they remain discrete throughout. Being hy peraemic in nature, the rash disappears on pressure, leaving, for a perceptible time, a white spot. An eruption of very fine vesicles is seen in rare instances, and occasionally a blotchy eruption appears early on the face, but subsides as the typical rash develops.
One of the most characteristic symp toms of scarlet fever is the desquamation. It rarely begins before the sixth day, and is frequently delayed until the second week. It appears first on the neck and between the fingers. It begins as fine, branny scales, but soon changes to large lamellar scales. Sometimes the skin can be peeled off in strips. It continues from ten to thirty days, and is most persistent where the skin is thickest. It frequently continues about the fingers and nails after other portions of the body are clear, which explains the readiness with which the disease is conveyed by letters. When the skin has received careful attention, the desquamation is sometimes almost imperceptible. In rare instances a second desquamation occurs.