On Scarlatina. By COLUMBUS W. SMITH, M. D., of Jonesborough, Georgia.

In attempting to write upon this subject, I am fully aware how difficult a task it is. Many learned and experienced men have endeavored to present it in its true light, and yet scarcely any two agree. It is my design to present the disease as it has recently appeared under my own observation.

The simple form of this disease, termed Scarlatina Simplex, was generally ushered in with chill, pain in the head and back, followed by fever; some slight stiffness about the neck and lower jaw. The tongue was very variable in its appearance: it was generally furred white, with papillæ of a red cast showing themselves through the fur, more or less numerous; in a few cases it was a bilious or brown fur, with red edges and without the pimples; but when it had this appearance it was always attended with vomiting of a bilious character, and it assumed more of a general redness after the vomiting had subsided. In some cases the patients were attacked with vomiting and diarrhoea, one or both at the same time. The fauces were invariably red, inflamed and tender, and at times pain was experienced during deglutition, but by no means very acute. No catarrhal symptoms were present; the pulse was generally full and frequent, and the skin hot and dry, although a perspiration would come on once in 24 hours, and last a longer or shorter time; frequently this would occur in the night, after which

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the fever would be somewhat moderated. The appetite was occasionally impaired; at other times it seemed as good as in health. In some individuals an eruption would make its appearance, of a red or scarlet color, with innumerable pimples or small elevations over the skin. This took place usually within the first forty-eight hours: it commenced on the thighs and body, and extended over the whole trunk. By rubbing the finger over the eruption it would feel rough, and by depressing the skin with the finger, a white spot would appear and the red would immediately return. The face was somewhat swollen. This eruption is very irregular in its duration; it generally continues growing thicker and redder until the fourth day, and then gradually declines until the seventh or eighth, when it entirely disappears with desquammation of the cuticle. About the fourth day the fever and inflammatory symptoms begin to decline; but the eruption did not show itself in half the cases we saw, and when there was no eruption there was no desquammation; the fauces would at times be red and tumid previous to the attack in either variety of the disease.

SCARLATINA ANGINOSA.-This variety of the disease might be described in a very concise manner, for in truth it seems to be nothing more than an increased or aggravated degree or form of the preceding; but we will try and lay it down more particularly.. It was most frequently brought on with chill, high fever, headache, pain in the back, loins, &c. The pulse was rapid, and much more feeble than in the preceding variety; the temperature of the surface was much higher; fauces and adjacent parts were much more inflamed and tumid. There was also considerable difficulty in deglutition; hoarse voice; a tough mucus was secreted or thrown off by the tissues, which appeared to impede respiration more or less-in fact, where the tonsils were much swollen and prostration very great, some seemed to sink from suffocation.

The prostration in this variety was much greater than in the preceding. The tongue was generally furred white, and the papillæ were very manifest upon it. The fur soon left the tongue, and at once it became red and dry, and continued so until an abatement of the symptoms supervened; it then grew moist and paler until it lost its florid hue. Ulcers were formed on the tonsils, on the tongue, inside and at the corners of the mouth; in a few instances, two-thirds of the tongue were covered with a scurf

or scab which yielded to mild astringent gargles. The catarrhal symptoms were absent in every case-occasionally vomiting and diarrhoea were present in the beginning; in others the diarrhoea did not set in until the latter stage. It was then beyond the reach of remedies, and dissolution soon took place. In the latter part of the disease, when fatal, the patients became very restless, rolling and tossing about on the bed; in many of the cases which recov ered, the cervical and other glands about the lower jaw became enlarged, suppurated and discharged a large quantity of pus. In those who died, the glands did not become swollen, from which cir cumstance we were at first led to think it a favorable symptom. It was always six days before any abatement took place, and more frequently not until the eighth, but always on the tenth an abate. ment was manifest, perspiration came on, and a subsidence of the more distressing symptoms was obvious. One of the most remarkable things connected with it was, in several cases, no loss of appetite occurred through the course of the attack.

The eruption was more irregular and uncertain than in S. simplex; some recovered with the eruption, others recovered without, while others died, with their skin as red as flannel. Delirium was present in a majority of the cases.

SCARLATINA MALIGNA.-This grade of the disease differs from the others, and is indeed what its name indicates, malignant, in eve. ry respect. It usually appears with chill, followed by fever, headache, pain in the back, loins and extremities, with stiffness in the neck and lower jaw; the pulse is feeble; the reaction is not very great; the heat of the skin is not very high-it is lower than in S. simplex or in S. anginosa. The tongue was red from the beginning, and also the fauces and adjacent parts were highly inflamed and swollen; a mucus was secreted which interfered with respiration, and the parts were so tender and tumid, that deglutition was performed with difficulty. Ulcers were early formed on the tonsils, of rather white appearance, which soon gave way to others of a dark brown color, and altogether more malignant. The tongue and roof of the mouth became very dark and extremely dry; the lips also put on a very dark, dry, parched appearance. The nose ran a watery mucus, and the breath bore a very offensive odor. The rash or efflorescence was so variable that it is unnecessary to speak of it: it was frequently absent, and