2. The second form of the disease (scarlatina typhodes) presents a striking contrast to the first: it is one of the most highly dangerous diseases which the practitioner in this country is ever called to witness. It is invariably attended with the symptoms which have been described as proper to typhus gravior. And these symptoms may consist either of those which belong to the first form of typhus gravior, and which have been already described,[26] or they may be those which characterize the second, or the congestive form.[27] The former is the most frequent, but the latter is not uncommon. The most exquisite specimens of congestive fever which it has happened to me to witness, have been those afforded by scarlatina: and there is no disease incident to this climate which is more alarming, more beyond the reach of remedies, or more rapidly fatal. Though fortunately several years may sometimes elapse without the occurrence of a single case of it, yet occasionally seasons return in which many cases happen. I have witnessed two such seasons in London, and all the persons I remember to have seen affected with it were near the age of puberty and not beyond that of thirty. For examples of it the reader is referred to the pathology. * * * * * Before bringing to a close this account of the general phenomena of fever, it is necessary briefly to notice some events which, because they occasionally occur in the progress of the disease, but are not constant, may be considered as accidental. 1. It is not very common, but there sometimes takes place an extreme degree of tenderness over the entire surface of the body. The sensibility is so much increased that the patient cannot bear, without pain, the slightest pressure. Several cases have occurred in which the entire skin was as tender to the touch as the abdomen in some of the abdominal cases. Whenever this preternatural sensibility occurs, it is always in connexion with an exceedingly severe form of the disease. 2. One of the most common occurrences in severe and protracted cases is excoriation of the skin, and the subsequent formation of a sloughing sore. In bad and long-continued cases of fever the powers of life are so much exhausted, and the sources of nourishment are so completely vitiated, that the skin and the subjacent parts have not vitality sufficient to bear even the pressure occasioned by the weight of the body. The most common seats of these sores are the back, the sacrum, and the hips. They often spread far and eat deep; they are additional sources of irritation and exhaustion to a frame already reduced to the last extremity of feebleness, and the scale which seemed to be equally balanced between life and death, they often turn on the side of death.