About the sixth or seventh day, the epidermis, or cuticle of the skin begins to peal off, commencing in those places which first became the seat of the rash, and gradually continuing all over the body. In such parts as are covered with a thin delicate cuticle (as the face, breast, &c.) the cuticle comes off in small dry scurfs; in such parts as are covered with a thicker epidermis, in large flakes. There have been instances of almost complete gloves and slippers coming away from patients' hands and feet.—The fever subsides entirely, and so does the inflammation of the throat and mouth, which become moist again. Also the epithelia, or the delicate cuticles of the mucous membranes, which have been affected by the disease, peal off and are coughed up with the tough thick mucus covering the throat, or they are evacuated with the fæces and the urine, forming a sediment in the latter.—Desquamation is usually completed in from three to five days; sometimes it requires a longer time; under hydriatic treatment it seldom lasts more than a few days. Whilst desquamation is taking place, a new cuticle forms itself, which, being exceedingly thin at first, gives the patient a redder color than usual for some time, and requires him to be cautious, in order to prevent bad consequences from exposure.—
Thus the disease makes its regular course in about ten days, and, under a course of hydriatic treatment, which not only assists the organism in throwing off the morbid poison and keeps the patient in good condition, but also protects him from the influence of the atmosphere, the patient may consider himself out of danger and leave the sick-room under proper caution, of which we shall speak hereafter.
7. THE PERIOD OF CONVALESCENCE,
under the usual drug-treatment, is, however, usually protracted to twice or thrice the duration of the disease, the patient being compelled to keep the house for five or six weeks, especially from fear of anasarca, or dropsy of the skin, frequently extending to the inner cavities of the body, and proving fatal. This dangerous complaint has been more frequently observed after mild cases of scarlet-fever than after malignant cases, probably from the fact that in mild cases the patient is more apt to expose himself, than when the danger is more obvious and all possible care is taken.—Sometimes also severe rheumatic pain, or rather neuralgia, in the joints, swelling of the glands, and other sequels prolong his sickness. I never observed a case of dropsy, or of neuralgia, after a course of water-treatment.
8. VARIETIES OF FORMS OF SCARLATINA.
The above is the description of scarlet-fever, as it most frequently occurs. But far from taking always that regular course, the constitution of the patient, the intensity of the epidemy and the virulence of the poison, the treatment and other circumstances influencing the development of the disease, cause several anomalies, from scarlatina simplex to scarlatina maligna, which too often baffles all the resources of the Medical Art.