The month of September was cool and dry, and the scarlatina anginosa became epidemic among adults as well as young people. In most of the patients who were affected by it, it came on with a chilliness and a sickness at the stomach, or a vomiting; which last was so invariably present, that it was with me a pathognomonic sign of the disease. The matter discharged from the stomach was always bile. The swelling of the throat was in some instances so great, as to produce a difficulty of speaking, swallowing, and breathing. In a few instances, the speech was accompanied by a squeaking voice, resembling that which attends the cynanche trachealis. The ulcers on the tonsils were deep, and covered with white, and, in some instances, with black sloughs. In several cases, there was a discharge of a thick mucus from the nose, from the beginning, but it oftener occurred in the decline of the disease, which most frequently happened on the fifth day. Sometimes the subsiding of the swelling of the throat was followed by a swelling behind the ears. An eruption on the skin generally attended the symptoms which have been described. But this symptom appeared with considerable variety. In some people it preceded, and in others it followed the ulcers and swelling of the throat. In some, it appeared only on the outside of the throat, and on the breast; in others, it appeared chiefly on the limbs. In a few it appeared on the second or third day of the disease, and never returned afterwards. I saw two cases of eruption without a single symptom of sore throat. The face of one of those patients was swelled, as in the erisypelas. In the other, a young girl of seven years old, there was only a slight redness on the skin. She was seized with a vomiting, and died delirious in fifty-four hours. Soon after her death, a livid colour appeared on the outside of her throat. The bowels, in this degree of the disease, were in general regular. I can recollect but few cases which were attended by a diarrh[oe]a. The fever which accompanied the disease was generally the typhus mitior of Doctor Cullen. In a few cases it assumed symptoms of great malignity. The disease frequently went off with a swelling of the hands and feet. I saw one instance in a gentlewoman, in whom this swelling was absent, who complained of very acute pains in her limbs, resembling those of the rheumatism. In two cases which terminated fatally, there were large abscesses; the one on the outside, and the other on the inside of the throat. The first of these cases was accompanied by troublesome sores on the ends of the fingers. One of these patients lived twenty-eight, and the other above thirty days, and both appeared to die from the discharge which followed the opening of their abscesses. Between the degrees of the disease which I have described, there were many intermediate degrees of indisposition which belonged to this disease.