It is generally in the course of the second day that the child complains of considerable stiffness in the muscles of the neck, extending to the lower jaw, and under the ears;—­of a roughness of the throat, and difficulty in swallowing;—­and some degree of hoarseness will be noticed:  all so many indications that the throat is affected.  Very shortly, an increased secretion of the mucus of these parts occurs, and, collecting about the tonsils, aggravates the child’s sufferings, from the frequent and ineffectual efforts made to expel it.  If the inflammatory action be more severe, exudations of lymph will also be poured out, and intermingling with the mucus, greatly augment the difficulty of swallowing.  At this time the lining membrane of the mouth, as also the tongue, assume a florid red colour; the red points of the latter becoming much elongated.

The febrile symptoms are severe from the first; amongst others, there will be headach, sometimes accompanied by slight delirium, nausea, intense heat of skin, languor, and considerable inquietude and anxiety:  and as the inflammation approaches its height, the fever increases, the pulse rises, the breathing becomes oppressed, the skin becomes more pungently hot and dry, and the thirst urgent.  All these symptoms being increased towards evening, when the febrile restlessness is often succeeded by delirium.

The rash is seldom perceptible before the third day, and then comes out in irregular patches on various parts of the body, particularly about the elbows and wrists; thus differing as to the time and mode of its appearance, from the mild form of the disease.  It frequently recedes, or entirely vanishes, the day after it first comes out, and then reappears partially, and at uncertain times.  This generally protracts the duration of the disorder, without, however, producing any perceptible change in the other symptoms.  On the fifth or sixth day of the disease, the fever and inflammation of the throat begin to abate; at the same time the rash declines, and the peeling off of the cuticle soon follows.

This is the ordinary course of scarlet fever with sore throat; but in many cases the symptoms run still higher, and the disease is alarmingly dangerous from its commencement.  In some instances, there is an acrid discharge from the nostrils or ears, often accompanied with deafness; as also enlargements of the glands in the neck, followed by the formation of abscesses in their immediate neighbourhood.  It is unnecessary, however, to follow out the symptoms of scarlet fever more fully; as all that has been attempted here, has been so to sketch out the more prominent symptoms of this disease, that the directions upon the parental management may be readily comprehended:  they will be very brief, but a strict attention thereto will be found all-important to the well-doing and comfort of the child.