very young children sometimes convulsions), sore throat, fever,
chilliness, and headache. The tongue is furred. The patient is often
stupid; or may be restless and delirious. Within twenty-four hours or
so the rash appears--first on the neck, chest, or lower part of
back--and rapidly spreads over the trunk, and by the end of
forty-eight hours covers the legs and entire body excepting the face,
which may be simply flushed. The rash appears as fine, scarlet pin
points scattered over a background of flushed skin. At its fullest
development, at the end of the second or third day, the whole body may
present the color of a boiled lobster. After this time the rash
generally fades away and disappears within five to seven days. It is
likely to vary much in intensity while it lasts. As the rash fades,
scaling of the skin begins in large flakes and continues from ten days
to as many weeks, usually terminating by the end of the sixth to
eighth week. One of the notable features is the appearance of the
tongue, at first showing red points through a white coating, and after
this has cleared away, in presenting a raspberry-like aspect. The
throat is generally deep red, and the tonsils may be dotted over with
white spots (see Tonsilitis) or covered with a whitish or gray
membrane suggesting diphtheria, which occasionally complicates scarlet
fever. The fever usually is high (103 deg. to 107 deg. F), and the pulse
ranges from 120 to 150; both declining after the rash is fully
developed, generally by the fourth day. The urine is scanty and dark.
There is, however, great variation in the symptoms as to their
presence or absence, intensity, and time of occurrence and
disappearance.

=Complications and Sequels.=--These are frequent and make scarlet
fever the most dreaded of the eruptive diseases, except smallpox.
Enlarged glands under the jaw and at the sides of the neck are common,
and appear as lumps in these sites. Usually not serious, they may
enlarge and threaten life. Pain and swelling in the joints, especially
of the elbows and knees, are not rare, and may be the precursors of
serious inflammation of these parts. One of the most frequent and
serious complications of scarlet fever is inflammation of the kidneys,
occurring more often toward the end of the second week of the disease.
Examination of the urine by the attending physician at frequent
intervals throughout the course of the disorder is essential, although
puffiness of the eye