On the Epidemics of 1852-8. 461 
The scarlet fever of 1842 was ushered in by a better state 
of general health; the disease, though very common—and 
more so than the Returns show—yet never was either so 
common or fatal as it has been this year. 
Tt is not necessary that I should enter into an explanation 
of the general symptoms of Scarlatina; they are so well 
understood by the profession, and of so little interest to 
those out of it, that the shorter time I occupy in referring 
to them the better. 
The present epidemic fully bears out the remark of Dr. 
Graves, that in both acute and chronic diseases a constitu- 
tional affection may display its existence by only one or two 
of the numerous symptoms which usually characterize it. 
Had this correct view been more generally entertained, there 
would have been less confusion in separating the different 
kinds of attacks of one and the same disease, and calling by 
distinct names the affection, according to the severity of the 
attack or the prominence of particular symptoms. 
At all periods of this epidemic mild and severe cases have 
been seen at one and the same time, often in the same 
house. The throat symptoms at the early part of the 
epidemic exhibited more of an inflammatory type and the 
tonsils chiefly were enlarged, whereas afterwards the throat 
affection was less prominent and there was more a diffused 
redness, extending over a large surface and passing down 
into the esophagus, or, more unfortunately, in some cases 
into the larynx. This state of throat was less easily 
brought under the effect of treatment than the other; and 
while there was often little pain, there was frequently great 
difficulty of swallowing—sometimes from the epiglottis being 
affected, at others apparently from the swelling of the parts, 
by infiltration into the submucous cellular tissues. 
Among the fatal cases were some which were early car- 
