Four cases of miliary scarlet fever showing that a. miliary eruption may be present in a mild ease, with a slight rash and without extensive peeling. The de velopment of miliaria probably due to some peeuliarity of the cutaneous tissues. J. P. C. Griffith (Jacobi's Festschrift; Phila. Med. Jour., May 12, 1900).
— Not only are the symptoms of this type severe, but the various stages are prolonged. The fever may continue for three weeks or more, and the stage of desquamation for even a longer time. A fatal termination is common, death occurring usually during the second week. The chief peculiarity which distinguishes this from the ordi nary type is the presence of septic symp toms due to streptococcic infection. The type might, therefore, with propriety be called the complicated type. The throat is usually the first to show the evidence of streptococcic invasion. On the third day and in some cases on the first or second day a membranous exudate ap pears on the tonsils and soon invades the pharynx and naso-pharynx. A pu rulent nasal discharge appears, and the lymphatic glands at the angle of the jaw begin to swell, the cellular tissues being so involved as to often cause immense enlargement. The Eustachian tubes are involved, and purulent otitis media fol lows; but the larynx commonly escapes. The urine contains albumin and perhaps blood-cells and hyaline and epithelial casts. Symptoms of general septic infec tion rapidly supervene. There is low delirium or stupor; the child refuses nourishment and may die from exhaus tion; but sudden death is not uncom mon. Others, after overcoming one com
plication after another, slowly recover after a tedious convalescence.
Study of 2G00 cases of scarlet fever. There were 62 cases of arthritis, the wrists, knees, phalanges, and the elbows being most frequently involved in the order given. Occasionally there was a functional bruit over the heart, hut in no case was this endocarditis. The 62 cases of arthritis believed to be septi ccemic and due either to the germ of scarlet fever or to cocci which had fol lowed them. Six cases with affected joints presented some form of heart le sion. J. G. McNaughton (Edinburgh 71led. Jour., Aug., 1900).
—Though very rare, malignant scarlet fever does some times occur. It begins with convulsions and hyperpyrexia. The scarlatinal poi soning may be so intense as to cause death within twenty-four hours. More commonly, death does not occur before the third or fourth day, the patient be ing comatose or delirious. The nervous symptoms are so marked that some writers have given to this type the name of cerebral scarlet fever. In a case of my own the initial symptoms were con vulsions, hyperpyrexia, and hinaturia.
True scarlatina maligna is now com paratively rare, and in consequence scar let fever is no longer the dreaded and fatal disease it once used to be. Out of an experience of over 5000 cases, only 3 undoubted cases in children under four months of age seen. C. K. Millard (Brit. Med. Jour., Jan. 15, '98).