. The diseases of children : medical and surgical. re not other cases the rash is patchy on the limbs, and when this is so, the casemay simulate measles ; the patches consist of clusters of fine papules or pointswith much surrounding erythema, while normal skin is present between the 252 The Specific Fevers patches. Sometimes the rash is haemorrhagic, minute extravasations ofblood taking place into the skin ; this may occur in mild cases. It is, how-ever, much more common in malignant cases. Purpuric patches are notuncommonly found after death that were not present during life. Tow
. The diseases of children : medical and surgical. re not other cases the rash is patchy on the limbs, and when this is so, the casemay simulate measles ; the patches consist of clusters of fine papules or pointswith much surrounding erythema, while normal skin is present between the 252 The Specific Fevers patches. Sometimes the rash is haemorrhagic, minute extravasations ofblood taking place into the skin ; this may occur in mild cases. It is, how-ever, much more common in malignant cases. Purpuric patches are notuncommonly found after death that were not present during life. Towardsthe end of the first week the rash, which has been fading for several days, issucceeded by desquamation, which is free or slight according to the intensityof the rash. This exfoliation of the epidermis generally goes on for manyweeks, being present longer about the hands and feet. The tonsils are red,swollen, and covered with an excess of mucoid secretion, yellow pointscorresponding to the tonsillar crypts are usually present, sometimes there. Fig. 49.—Temperature Chart of a case of Scarlet Fever, medium attack. , aged. 13 years *, Rash present. are patches of yellow exudation ; the soft palate, uvula, and pharynx are moreor less congested. The nasal mucous membrane is frequently involved, sothat there is much discharge from the nose. The deep cervical glands atthe angles of the jaw are usually enlarged. The tongue is coated with athick white fur ; not infrequently there is a dry glazed central band on thedorsum ; in the course of a few days the tongue cleans, leaving a red cleanglazed tongue with prominent fungiform papillae— the strawberry eyes are often suffused and the conjunctivae injected, and with this thereis often sleeplessness or delirium, no doubt due to a congested state of themembranes of the brain. In rare cases the delirium is severe and thepatient violent. Scarlet Fever 253 The pulse is quick, varying from 120 to 150, often faster than
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