Precursory symptoms are: alternation of chilliness and heat, cloudiness and heaviness of the head, the heat soon predominates, is attended with congestion of blood to the head, vertigo, aching-stinging pain in the forehead, catarrhal and gastric symptoms. These precursory symptoms do not last long.

The eruption, accompanied with fever, generally first appears in the face, on the neck, back and chest, and lastly on the extremities. The rash-vesicles are sometimes so close together that they fall off in crusts, whereas they generally scale off. The desquamation continues for many days and even weeks, on several parts, two or three times in succession. When the eruption is very distinct, the eyes are slightly red, sensitive to the light, with profuse lachrymation, exhibiting a group of symptoms like the measles, from which they are distinguished by the eruption. The uneasiness and anxiety increase with the eruption, and the fever does not abate until the desquamation is nearly over. The alvine evacuations are generally suppressed; the urine, which is very dark, is passed in very small quantity. The lips, tongue and mouth become dry, and the thirst is excessive. There is tossing about, sleeplessness, starting from sleep, and exacerbation of the fever several times during 24 hours.

Purple-rash is just as dangerous and insidious a disease as scarlatina. There is danger of a metastasis to the brain or heart, which cannot be foreseen or prevented, and destroys the patient by nervous paralysis.

§ 3. The specific remedy for purple-rash is Aconite, which should be repeated every two, four or six hours, according as the disease is more or less violent. For the excessive pains and the whining mood, a dose of Coffea cruda is sometimes required. In some cases Coffea cr. and Aconite require to be given in alternation.

In some cases the fever is not very violent, and the eruption comes out very slowly, causing anxiety and restlessness, tossing about, moaning. For these symptoms a few doses of Ipec. should be interposed, and, when they are accompanied by symptoms of internal inflammation, Bryonia is required.

I have seen cases where the eruption remained almost suppressed, causing by metastasis a dangerous angina faucium, which yielded to Mercurius, or sometimes to Aconite followed by Belladonna. When the disease is of a malignant nature, the treatment indicated for malignant scarlatina has to be pursued.

Aconite is the specific when the eruption does not appear upon the skin, and an inflammatory fever with the following symptoms sets in: slight chills through the whole body suddenly alternating with redness and paleness of the face, full and quick pulse, slight dul-ness of the head, with nocturnal loss of consciousness, stupefaction and even delirium; dryness of the mouth and lips, with thirst; redness of the eyes; oppression of breathing; short cough with reddish expectoration, occasioning a stinging pain under the short ribs. When these symptoms occur, Aconite should be given in repeated doses.

Dr. Gross has furnished the following description of epidemic purpura miliaris which prevailed in his district: "After more or less striking precursory symptoms, the disease commenced with pains in the head and feet. These symptoms were soon followed by vomiting and delirium. Many patients died in the first days of inflammation of the brain, many died afterwards of angina. At times the palate and fauces were inflamed alone, at times the larynx, in which case the patients were affected with a croupy cough; in other cases two considerable, tight, pad-shaped swellings descended from the parotid gland, which, on being opened, discharged a thin, badly-colored, fetid ichor. In the last epidemic this disorganization was not observed: the children died before it set in.

"In some cases the exanthem resembled the Syden-hamian scarlatina; in most cases, however, it looked like a bright-red rash. Neither Bell, nor Aconite seemed to be of much use in this epidemic. The subsequent leucophlegmasia seemed to yield to Rhus t."

Dr. Wislicenus employed Dulcamara with great success in the epidemic of 1831. Dr. Gross used it with great benefit for acute cutaneous eruptions, when the angina was not very considerable, and the children complained of violent rheumatic pains in the limbs, not allowing them to be moved, and accompanied with slight glandular swellings. These symptoms generally yielded in 24 hours, after which the skin began to scale off.

Purple-rash may co-exist with other diseases, such as variola and measles. When complicated with variola, the rash set in at the time when the pustules began to inflame, causing an increase of the sy-nochal fever. The pustules remained stationary after the appearance of the rash, and continued their course as soon as the rash had run its course. The treatment was the same as in purple-rash. When measles and purple-rash co-exist in the same patient, it is exceedingly difficult to distinguish one from the other. Aconite is, in such cases, the chief remedy, although a dose of Bell, or Merc, sometimes requires to be given for the angina, and the supervening typhoid symptoms require the use of the remedies indicated for typhoid fevers.

In the scarlatina epidemic of 1842, Dr. Schroen derived no benefit whatsoever from the usual remedies, Bell., Aconit., Acid, phosph., Bryon., Merc, sol., Rhus t., Sulphur. He employed with the best success Amm. carb., in large doses, from half a scruple to a scruple with two ounces of water, with ordinary white sugar, half a tablespoonful or a whole tablespoonful every two hours; and if this failed, the patients were wrapt up in sheets soaked with cold water.

According to Dr. Schroen, the smell of scarlatina patients resembles that of musty bread. Dr. Hering has furnished the following remarks on epidemic scarlatina. According to him, the smell of such patients is like that of drying funguses, or, in bad cases, like that of funguses in a state of decay.

In cases where the vomiting, which is generally the first striking symptom of the disease, is followed by sopor, the Solaneae or Opium, or, at other times, Bryonia and Sulphur are useful, according to the symptoms.

If the patients should be red all over, even in scrofulous subjects, who are generally the worst kinds of scarlatina-patients, the third trituration of Sulphur, with intermediate doses of Aconite for the dry skin, restlessness, etc., will generally be found sufficient. The remedies may be given every two or six hours, and are to be followed by Puls., Calc. c, Baryt., carb., etc.

In doubtful cases, when the eruption was diminishing, Senega proved serviceable if indicated by the throat-symptoms. Calc. carb. was indicated by the swelling of the parotid glands, particularly on the right side, and by the desire for boiled eggs, which, however, the child is unable to chew or swallow. Calc. c. was likewise indicated by great ill-humour, occurring in the morning, and by other symptoms.

Kali carb. was indicated by swelling of the parotid glands, particularly on the right side, and by restlessness, moaning, tossing about between two and three o'clock in the morning, the children having been quiet the first part of the night.

Several children who were already rattling, with warm sweat on the forehead, cold and bluish limbs, hot breath, were cured by Camphora.

In the scarlatina epidemic of 1845, Dr. Elb, of Dresden, employed principally Calc. carb., particularly when symptoms of paralysis of the lungs and affections of the chest were present; and Zincum when the brain was affected and symptoms of paralysis of the brain were setting in. For the other symptoms, we refer the reader to Hahnemann's Materia Medica.

The diseases which generally follow purple-rash, are like those succeeding scarlatina, and require to be treated with the same remedies.