Scarlatina

On the second day of illness the rash appears on the neck and face, and is made up of small red dots, which crowd together, forming patches of various sizes and extent; after a while the whole surface becomes of an uniform hue; on the third day, the eruption is seen on the body generally, the upper extremities, and the mucous sur­faces visible to the eye; on the fourth day, the lower limbs are scarlet, whilst the surface is hot, dry, and harsh. The eruption, which may be called a general efflorescence of boiled lobster color, is most marked about the third or the fourth day, and it is generally more intense in color towards evening, especially in the loins and flexures of joints. On the trunk it is often "patchy." The eruption fades on the fifth day - first on the face; desquamation follows about the eighth or ninth day.The diagnosis between scarlatina and rubeola is the only one that requires notice.

In scarlatina the rash appears on the second, in measles on the fourth day after the first onset of symptoms. In scarlatina the rash is bright red (boiled lobster color); it is not crescentic, and it is uniform or not patchy, or asso­ciated with intervals of normal integument. In measles the rash is of dull red color, and it take:-: the form of little crescentic patches, with intermediate lines of healthy skin. The skin in scarlatina is very dry, harsh, and pungent. In measles this is not so marked, nor is the subsequent desquamation so distinct or characteristic.

In measles the changes in the mucous membranes are accompanied by secretion; there are coryza, suffusion of conjunctivae - in scarlatina, the mucous surfaces are red, dry, ulcerated; there is also sore throat of marked kind, but this is absent in rubeola. The aspect of the tongue is characteristic in scarlatina, and the pulse is very rapid and irritable.