The urine becomes scanty and high colored during the febrile stage, and fre quently contains a slight amount of albu min and sometimes blood and hyaline casts. Except in the more severe forms. suppression is rare and dropsy still more so. These symptoms usually subside as the fever falls. The kidney symptoms at this stage rarely prove serious. They may, however, do so, and always demand I attention. The more serious kidney symptoms occur later and will be con sidered as a complication.
The following is the result of personal observations made as to the occurrence of peptonuria in scarlet fever. 1. The urine in scarlet fever very frequently contains peptones; they are usually present in a moderate degree, and are rarely abundant. 2. Peptonuria is not.
necessarily associated with albuminuria; both may be present at the same time, but the conditions are independent. 3. In cases complicated with pneumonia peptones were seldom found in the urine, and, if present, their appearance was noted on the third day of illness, and they entirely disappeared as soon as the crisis ensued. 4. The severity of the dis ease has no bearing whatever upon the occurrence of peptonuria. Hence the prognostic value of peptonuria is doubt ful. 5. In all the cases there was con• stantly present inflammation of the inner ear and the lymphatic glands, with tendency to pus-formation. O. Eryant's test (potassic mercuric iodide) often failed to produce the characteristic pre. cipitation where peptones were proved to be present in the urine by other tests; on the other hand, it formed a precipitate when peptones could not be detected. 7. Schulter's statement that the produc tion of peptonuria is greatly influenced by high temperature is discredited. No such relation between high temperature and peptonuria could be made out. M. Hemser (Veatch, No. 1, '99).
Searlatinal nephritis is a disease 8111 generis: a. diffuse nephritis, developing. as a rule, about the third week, and ac companied by general anasarea. The urine contains a large quantity of albu min and numerous casts of all varieties. Often the first indication of the onset is a sudden fall in the specific gravity of the urine, followed in a short time by a sudden rise in specific gravity, as sociated with a diminution in the total quantity of the excretion. Engorgement
of the renal vessels has then occurred. and no time should be lost in instituting active treatment. Frequently before the appearance of albuminuria there may be a marked increase in urates. Kemp (Ar chives of Pediatrics, July, 1900).
—Scarlet fever is some times so mild as to render diagnosis very difficult. The symptoms may be so slight that medical aid is not sought. As a rule, however, there is an onset of vom iting, fever, and sore throat, as in the ordinary type, but none of the symptoms are urgent. The vomiting is not per sistent, the temperature does not rise above 102° or 103° F., and the throat presents only the symptoms of mild pharyngitis. I have seen an undoubted case in which the temperature never rose to 101°. It may become normal on the fourth or sixth day. The eruption is often very faint, and may not appear on the face. It may, however, be bright and distinctive for twenty-four hours and then fade away so rapidly as to have disappeared by the fifth day. In rare instances it is an evanescent rash which disappears entirely within twenty-four hours. Nephritis may be a sequel, due in many cases to exposure and lack of care: the natural results of so mild an illness. Owing to this lack of care and isolation, the patient may become very dangerous to others. It is by these mild cases that the disease is sometimes sown broadcast. A mild attack in one child may produce a malignant one in another.
The appearance of a punctate eruption in the armpits and in the groins, to gether with the congestion of the tonsils and a punctate eruption in the roof of the mouth, no matter whether there is any eruption elsewhere or not, are posi tive proofs of scarlet fever. The most characteristic feature of the disease is the enlargement of the papillas of the tongue: It appeared as the one constant symptom in each of 1000 cases examined. It is often important to make a diagnosis of scarlet fever after the rash has subsided, in order to prevent infection during the period of desquamation. Here the exist ence of a white line at the junction of the pulp of the finger with the nail is of great assistance. J. II. McCollom (Phila. Med. Jour., June 3, '99).