lids and face, and of the feet, ankles, and hands,
together with lessened secretion of urine--which often becomes of a
dark and smoky hue--may denote the onset of this complication. The
disease of the kidneys usually results in recovery, but occasionally
in death or in chronic Bright's disease of these organs. Inflammation
of the middle ear with abscess, discharge of matter from the ear
externally, and--as the final outcome--deafness, is not uncommon. This
complication may be prevented to a considerable extent by spraying the
nose and throat frequently and by the patient's use of a nightcap with
earlaps, if the room is not sufficiently warm. Inflammation of the
eyelids is an occasional complication. The heart is sometimes attacked
by the toxins of the disease, and permanent damage to the organ, in
the form of valvular trouble, may result. Blindness and nervous
disorders are among the rarer sequels including paralyses and St.
Vitus's dance.

=Determination of Scarlet Fever.=--When beginning with vomiting,
headache, high fever, and sore throat, and followed in twenty-four
hours with a general scarlet rash, this is not difficult; but
occasionally other diseases present rashes, as indigestion, _grippe_,
and German measles, which puzzle the most acute physicians. Measles
may be distinguished from scarlet fever in that measles appears first
on the face, the rash is patchy or blotchy, and does not show for
three to four days after the beginning of the sickness. The patient
seems to have a bad cold, with cough, running at the nose, and sore
eyes. German measles is mild, and while the rash may look something
like that of scarlet fever, the patient does not seem generally ill,
is hardly affected at all, though rarely troubled with slight catarrh
of the nose. In no sickness are the services of a physician more
necessary than in scarlet fever; first, to determine the existence of
the disease, and then to prevent or combat the complications which
often approach insidiously.

=Outlook.=--The average death rate of scarlet fever is about ten per
cent. It is very fatal in children about a year old, and most of the
deaths occur in those under the age of six. But the mortality varies
greatly at different times and in different epidemics. In 1904-5, in
many parts of the United States, the disease was very prevalent and
correspondingly mild, and deaths were rare.

=Duration of Contagion.=--The disease is commonly considered
contagious o