Scaling.—As the disease subsides the outer layer of the skin dries and peels off. The extent of this depends upon the severity of the attack. In some cases the scaling is hardly perceptible, and sometimes it appears only on certain parts, such as on the toes and inner parts of the thighs. There is always some scaling. This is called "desquamation." Generally speaking, scaling begins where the eruption first appeared on the upper part of the chest and neck. The scales may be fine and branny or as is most common, the skin peels in large particles. Some scaling is always present. The length of the scaling time is variable. It usually lasts from three to four weeks, but often longer. This stage is considered by many as the most contagious, as the fine scales fly in the air.
Complications. Nose.—The nose is affected at the same time if the "sore throat" is very severe. A membrane may also form in the nose.
Ear.—This may be affected in as high as one-fifth of the cases and needs careful watching and attention. Both ears may be diseased and deafness frequently results from it. Ten per cent of those who suffer from "deaf-mutism" can trace their affliction to scarlet fever. The ears usually become afflicted in the third week. The fever rises and there is pain in the ears or ear. The onset may not appear alarming and not be suspected until the discharge makes its appearance This is unfortunate; these complications are serious, as meningitis and abscess of the brain may result. The ear trouble (otitis) usually occurs during the scaling. The patient may be up and around. There is a rise of the temperature to 103 or 104 degrees, the patient begins to vomit food and has a headache. At night the child starts from its crib and cries as if in pain. They do not always locate the pain in the ear. The face and hands may twitch. The fever may fall to normal and rise sharply again. Such symptoms should call for a thorough examination.
Eye.—Inflammation of the (conjunctiva) red membrane of the eyes, often occurs.
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Kidneys.—There may be a mild form of inflammation in the earlier stages. The severe form comes, if at all, usually in the third week. It occurs in five to seven per cent of the cases. It may occur in the mildest case, as such cases are not so closely watched. The first symptom is a slight bloating of the eyes and face and spreads over the whole body. Sometimes the swelling is very slight; at other times it is extreme. The urine diminishes early and sometimes is wholly suppressed. It may be light colored, smoky or straw colored. This trouble usually runs for weeks. The patient may get uremia and result fatally.
Heart.—This also may be affected as the valves may become diseased.
Joints.—Rheumatism also may occur, and other complications.
Chorea.—Follows scarlet fever also, especially in girls from twelve to fifteen years.
Diagnosis.—In most cases it is easy to distinguish from other diseases.
Dermatitis, inflammation of the skin ("Itis" always means inflammation).
In dermatitis the throat symptoms and strawberry tongue are absent.