or Scarlatina Anginosa is a more se vere form, particularly as regards the throat symptoms. The rash may be well marked or not, but it is often slow in developing and in subsiding. There is intense inflammation of the throat, the tonsils, uvula and soft palate being swollen and ulcerated, or bear ing membranous patches not unlike those of diphtheria, while the lymphatic glands in the neck are enlarged and indurated and often suppurate. This form of the disease is marked by great exhaustion and the gradual development of acute septicaemia, with sweating, albuminuria, delirium and septic rash. Some of these cases bac teriologically show the presence of B. diphtheria.
this form the gravity of the condition is due to intense poisoning. The at tack sets in with great violence and the patient sinks from the very first. The rash either does not come out at all or is of the slightest amount and of livid rather than scarlet appearance, while the throat symptoms are often not prominent. A further example of a malignant form is occasionally observed in cases where the rash, which had previously been well developed, suddenly recedes, and convulsions or other nervous phenomena and rapid death supervene.
The complications and effects of scarlet fever are among the most important features in this disease, although their occurrence is exceptional. The most serious is inflammation of the kidneys, which is specially apt to appear during convalescence. In a large number of instances it comes on insidiously. One of the most prominent symptoms is swelling of the eyelids. The urine is diminished in quantity, smoky or red from the presence of blood and contains a large quantity of albumen and casts. Muco purulent rhinorrhoea and rheumatism are other complications. One of the commonest is suppuration of the ears due to extension of the inflammatory process from the throat along the Eustachian tube into the middle ear. This often leads to permanent ear
discharge, with deafness from the disease affecting the inner ear and temporal bone ; the condition is dangerous from its prox imity to the brain. Other maladies affecting the heart, lungs, pleura, etc., occasionally arise in connection with scarlet fever, but are of less occurrence than those previously mentioned.
In the treatment of scarlet fever, one of the first requirements is isolation of the case, to limit spread of the disease. In convalescence, inunction of the body with carbolized oil (1 in 4o) and the frequent use of a bath containing soda, are to be recommended. It is seldom that a patient who has suffered from scarlet fever can safely go about before the expiry of eight weeks, while the period may be considerably prolonged, should any nasal or aural discharge continue. As to general management in favourable cases little is required beyond careful nursing and feeding. The treatment of kidney complications is that of acute Bright's disease. A hot-air bath or wet pack is often useful. When otorrhoea is present the canal must be kept as aseptic as possible. The ears should be carefully syringed every four hours with an antiseptic solution and dried, and a little iodoform inserted into the meatus. Complications such as mastoid disease require special treatment.
Dr. Besredka prepared a serum from the blood of fatal cases, and in the serum prepared at the Pasteur Institute some twenty separate strains of streptococci are used. In using serums, early and large dosage is necessary. Palmirski and Zebrowski prepared a serum from the streptococcus con glomerulatus, which was used with success in the children's hos pital at Warsaw. For the Dick method of intradermal inoculation see MEDICAL RESEARCH.