scarlet-fever and have it in the mildest form, and vice versa. The character of the disease depends very much on the constitution, as I have said above. However, if the epidemy in general is of a malignant character (which may again depend, partly at least, on the constitution of the atmosphere), it will prove so in many individuals who are taken with it, and the precautions ought to be so much the more careful on that account.

28. DIAGNOSIS.

After what has been said about the symptoms of scarlatina, it cannot be difficult to distinguish it from similar eruptive diseases. However, as there is much resemblance between scarlatina and measles, at least in the milder form of the former, I shall give a few symptoms of each, to assist parents in making the distinction.

29. DIAGNOSIS FROM MEASLES.

In scarlatina the heat is much greater, and the pulse is much quicker than in measles.—In scarlatina the throat is inflamed, usually the brain affected, and the patient smells like salt-fish, old cheese or the cages of a menagerie; in measles, the eyes are affected, inflamed, and incapable of bearing the light; the organs of respiration likewise (thence coryza, sneezing, hoarseness, cough); the perspiration smells like the feathers of geese freshly plucked.—In scarlatina the period of incubation is a day less than in measles; namely, in scarlatina the rash appears on the second day after the first symptoms, in measles on the third.—The scarlet-rash consists of large, irregular, flat patches, which cover large spaces with a uniform scarlet-red, being brightest in those parts which are usually covered by the garments of the patient; in measles the spots are small, roundish or half-moon-like, with little grains upon them, and usually of a darker color; the measle-rash is thickest in such parts as are exposed to the air.—In scarlatina the symptoms of fever and the affection of the mucous membranes continue two days after the eruption has begun to make its appearance; in measles the eruption diminishes those symptoms at once.—The scarlet-rash stands out a day or two less than the measle-rash, and comes off in laminæ, whilst the latter comes off in small scales or scurfs.

30. THE PROGNOSIS,

under a well conducted course of hydriatic treatment is, in general, favorable. Much depends, however, on the season of the year (in damp and cold weather—partly owing to a lack of pure air in the sick-room—the disease is more dangerous than in summer); on the general health of the patient (not on his mere looks, for well-fed and stout children are subject to affections of the brain); on the age of the patient (adults are generally more in danger than children); on the form of the disease and the character of the fever (erethic or mild fever being the most favorable, whilst typhoid fever is the worst; a violent character of the fever is not very dangerous under hydriatic treatment, as we have plenty of means to limit its ravages without weakening the patient); on the eruption, the condition of the throat, the process of desquamation, &c.

31. FAVORABLE SYMPTOMS

are the following: Absence of internal inflammation; a bright florid rash; a regular, steady appearance, standing out, and disappearance of the latter; a regular and complete pealing off of the cuticle; a decrease of the pulse after the eruption of the rash; an easy and regular respiration; a natural expression of the features; a moist skin.

32. UNFAVORABLE SYMPTOMS

are: A fetid breath, with ulceration and sloughing of the throat and glands; a smarting and weakening diarrhœa; involuntary evacuations of the bowels; dizziness, deafness, coma, grinding of the teeth; retention of urine; petechiæ; a rapid decline of the patient's strength; a quick, small, weak pulse; rapid breathing; twitchings, tetanus, hiccough, &c.—Closing up of the nose frequently precedes a dangerous affection of the brain. A sudden disappearance of the rash, or of the inflammation of the throat, is a bad omen. With such symptoms as these, there is usually little or no rash, and the little there is, of a pale, livid color, and the skin, in general, inactive.

FOOTNOTES: