sore throat with tenderness at the angles of the lower jaw, and stiffness at the back of the neck; vomiting is very common, and chiefly so in children; shivering and rigors come on, and occasionally convulsions in young children. The temperature rapidly rises and will go up to 104° or 105°; the pulse is very quick, the tongue is covered with a thin white fur; there is thirst and loss of appetite. This stage lasts from 12 to 30 hours, and then a rash comes out. Sometimes the earlier symptoms are so slight that the rash is the first thing noticed. This consists of small scarlet dots on a background of lighter red almost running together so as to give a flush all over the skin; the colour disappears on pressure, but rapidly reappears when the pressure is removed. It generally appears at first on the sides of the neck and upper part of the chest and in the bends of the joints; it then spreads downwards, and is found to come out last on the legs; it begins to fade on the fourth or fifth day, and is generally quite gone within a week. The sore throat is always present in some degree; there is redness and swelling of the tonsils and soft palate, so that it is often very painful to swallow, while the glands beneath the jaw also swell and are painful. The temperature is generally higher than in measles, and much higher than in diphtheria, but it rarely exceeds 105° F.; the temperature falls to normal during the second week of the illness, or seventh to tenth day of disease. In no fever is the pulse quicker than in this disorder, and it may be 140 or 160 in a minute. Moderate delirium and headache are often present in these cases. After the rash has gone the epidermis is dry and harsh, and about the ninth or tenth day it begins to peel, and is sometimes cast off in large flakes, and this desquemation or peeling may last a few days or occupy several weeks.
2. Malignant Scarlet Fever—is characterized by an increased severity of the above symptoms; there are great prostration, delirium and sleeplessness; the rash does not always come out well; the face may be livid, and stupor and coma come on and end in death; the throat is ulcerated, and there is much difficulty in swallowing.
3. Latent Scarlet Fever—is when the disease is so mild that until the sequelae appear one is not aware of having had scarlet fever. Sore throat may be the only symptom. There is no relation between the abundance of the rash and the danger to the patient. However mild the disease may be, the sequelae may come on with great severity; and the fever is just as likely to spread from a mild case as from a severe one.
4. Sequelae.—After the fever has passed, a train of symptoms may follow, which are very inconstant in their character and of much danger to the patient. The throat may continue to be affected, and the glands outside maybe inflamed and swell, so that the child's head seems encased in a collar; often these glands suppurate, and a large ulcerated surface is then seen. Deafness may supervene, and a discharge from the ear. Bronchitis and pneumonia are not so common
