When scarlet fever becomes epidemic among adults, children rarely fail of being attacked by it in great numbers, and very frequently sink under it. It is, indeed, rather a child’s disease, and is very contagious amongst children; but is not often communicated from them to adults. This disease begins with the common symptoms of fever, often with languor and disposition to fainting, shivering, sickness, a quick pulse, and pain in the head; there is frequently, very early in the disorder, a stiffness in the muscles of the neck, which is soon followed by some difficulty in swallowing. This affection of the neck should be carefully inquired into, especially in young children; the soreness of the throat being sometimes not complained of in the most severe attacks of the disease, until but little hope remains of any mode of treatment being attended with success. The fever generally increases in the evening, and is often accompanied with delirium; but some remission takes place towards morning, and perspirations come on. There is no complaint in which delirium is of so little consequence as in scarlatina. On the second or third day the efflorescence (or redness) appears on the skin, and generally first on the face, neck, and breast. Up to this period the disorder is sometimes supposed to be measles, as many of the premonitory symptoms are similar; but scarlatina is readily distinguished by the absence of that hoarse cough, frequent sneezing, and watery discharge from the nose and eyes, which are the constant attendants on the early stages of measles: in this latter complaint also, the skin is covered with a _distinct_ eruption, raised above the skin, leaving it clear and well-defined between the marks,—while in scarlatina, the redness is _on_ the skin, and its appearance seldom produces any remission of fever. When the complaint is to terminate in health, the fiery redness abates gradually, and is succeeded by a brown colour, when the skin, becoming rough, peels off in small scales, and health is generally restored. On the contrary, when it is to terminate fatally, the febrile symptoms run very high from the first attack, the skin is intensely hot and dry, the pulse is very frequent but small, great thirst prevails, the redness appears on the second day or earlier, and about the third or fourth is often interspersed with large livid spots, and the patient is cut off about the sixth or eighth day. Sometimes a severe purging comes on, which never fails to prove fatal. No complaint is more arbitrary in its attacks, and none on which, humanly speaking, you can reckon with so little certainty. To determine to the surface of the body, it will be right to give the simple saline, made as follows:— Take of Citric Acid 1½ drachm. Bi-carbonate of Potash 2 drachms. Water 7½ ounces. Simple Syrup ½ ounce. Spirits of Nitre 2 drachms.