cent, the general
disturbance of health very slight, and the fever and accompanying rise
of temperature small. The risk in such circumstances of the disease
being altogether overlooked is even greater than that of its being
confounded with some other eruptive fever. The rash of measles cannot be
confounded with that of scarlatina, and the distinctly spotty character
of the rash of German measles ought, apart even from other differences,
to render mistake impossible.

Perhaps the best rule that can be laid down is that every diffused red
rash, not obviously formed by distinct spots, even though it be not
uniform but appears in patches on the neck, breast, back, or inside of
the thighs, and persists for more than twelve hours, is scarlatinal.
Further, that in any instance in which even very slight feverishness, or
very slight sore-throat, have preceded or accompanied the rash, the
nature of the ailment is stamped beyond the possibility of doubt.
Mistakes are made from want of careful observation, much more than from
any insuperable difficulty in distinguishing one disease from the other.
When the least hesitation is felt as to the nature of any rash which
may appear on a child, with, or without previous illness, the question
should be at once referred to a medical man. People are too apt in these
circumstances to wait for a few days, and then to appeal to the doctor
when all traces of rash have disappeared, and when the grounds no longer
exist on which he could base a positive opinion.

I need not describe the symptoms of severe and dangerous scarlatina, for
long before symptoms become really formidable, the patients will have
been placed under medical care. It may suffice to say that the danger is
almost always in proportion to the severity of the throat-affection and
swelling of the glands, and not at all in proportion to the abundance of
the rash. Though severe cases usually set in with severe symptoms, yet
this is not invariably the case, and medical watching is all the more
necessary from the very commencement, since until the end of the first
week it is impossible to calculate on the subsequent course of the
disease. In malignant scarlatina happily of infrequent occurrence, the
child is struck down, as though its blood were poisoned, from the very
first; and death takes place often within forty-eight hours, the rash
appearing just sufficiently to stamp the nature of the pestilence which
has proved so deadly.

It