of the thighs. Its colour is a very
bright red, due in part to a general flush of the skin, in part to the
presence of innumerable red dots or spots, which do not communicate any
sense of roughness to the hand, though now and then extremely minute red
pimples are interspersed. For three days the rash usually continues to
become of a deeper colour, and more generally diffused over the whole
surface; it then slowly declines, but does not wholly disappear until
the seventh or eighth day of the disease. As the rash subsides the skin
is left rough, and by degrees scales off, often in large flakes from the
hands and feet, but elsewhere in a sort of branny scales. Sometimes this
process is over in five or six days, while in other cases the skin peels
and is reproduced several times in succession, so that it is protracted
for three or four weeks or even longer. The degree of this peeling also
varies as well as its duration. It is usually most considerable where
the rash has been most abundant, while where the rash has been scanty,
it is sometimes scarcely apparent except at the tips of the fingers and
toes and just around the insertion of the nails.

Besides the rash there are commonly other symptoms not less
characteristic of scarlatina, and among them the sore-throat is one of
the most invariable. Even in mild cases, it is very rarely absent, and
if not present at the beginning, it comes on on the second or third day.
The palate and tonsils, in these circumstances are red, and the latter
are usually more or less swollen, while swallowing is attended with
pain, or at any rate with discomfort. The redness of the palate, which
extends also to the back of the throat, is a finely spotted redness
closely resembling the rash on the surface. The tongue is coated with a
thick white or yellowish coating, through which project numerous bright
red points, papillae as they are called, and this appearance of the
tongue is as distinctive of scarlatina as the rash itself. Later, as the
rash begins to fade, the coating separates from the tongue, which is
left of a bright red colour, looking raw and shining, with the little
raised red points projecting beyond its surface, and constituting what
has been called in medical language, the strawberry tongue.

When all these symptoms are present, no one can doubt but that the case
is one of scarlatina. But the decision is far less easy in mild cases,
for in them the rash is sometimes extremely evanes