-_putrid symptoms_ present a good deal of danger, although
they give the organism and the physician more time to act.

22. CONDITION OF THE THROAT, AND OTHER INTERNAL ORGANS.

The condition of the _throat_ requires the most constant attention. From
a highly inflamed state, it often passes into a foul and sloughy
condition; the breath of the patient becomes extremely fetid; the
nostrils, the parotid and submaxillary glands swell enormously, so that
swallowing and breathing become very difficult. There is an acrid
discharge from the nose; the gangrenous matter affects the alimentary
canal, causing pain in the stomach, the bowels, the kidneys and the
bladder; a smarting diarrhoea with excoriation of the anus, and
inflammatory symptoms of the vulva. Also the bronchia, lungs, pleura and
pericardium become affected, as sneezing, cough (the so-called
scarlet-cough) and the pain across the chest and in the region of the
heart indicate.

23. OTHER BAD SYMPTOMS.

These symptoms may present themselves with the rash standing out; but
most frequently they occur when there is little or no eruption, or when
it fades, becomes livid, or disappears altogether. A sudden
disappearance of the rash, before the sixth day, commonly increases the
typhoid symptoms, and must be considered a bad omen. Also the invasion
of the larynx, which is happily of rare occurrence, is commonly fatal.

24. DESTRUCTION OF THE ORGAN OF HEARING.

When the glands pass into a sloughing state, the parts connected with
them are frequently damaged. Thus the ulceration of the parotid gland
often causes deafness, by the gangrenous matter communicating to the
eustachian tube and the inner ear, where it destroys the membrane of the
drum and the little bones belonging thereto, or by closing up the tube.
When the discharge from the outer ear is observed, the destruction has
already taken place, and it is too late to obviate the injury.

25. OTHER SEQUELS, DROPSY, &C.

Beside the ulceration of glands and deafness, some of the sequels of
scarlatina are white swelling of one or more of the joints, usually the
knee, chronic inflammation of the eyes and eyelids, and partial
paralysis. These chiefly occur in scrofulous subjects. Dropsy, which I
have mentioned before, is one of the sequels that frequently prove
fatal.

26. THE CONTAGION OF SCARLATINA VERY ACTIVE.

The _contagion_ of scarlatina is very active, and adheres for a long
time to the sick-room, bedd