Another complication to be dreaded is the extension of the otitis to the mastoid and from here to the meninges. Marked tenderness on pressure over the mastoid region is the first symptom to direct attention to such extension. The overlying skin is red and swollen. Increase in the degree of swelling causes crowding away of the ear.
Olga Sehw., two and a half years old. Severe case of scarlet fever; infectious manifestations on sixth day. Left tympanum slightly red dened on seventh day; otorrhcea on ninth day. Right tympanum red dened on tenth day; otorrhcea on fourteenth day; bilateral. Fifteenth day: Skin behind right ear reddened; ear protruding. Sixteenth day: Incision of subperiosteal abscess. Seventeenth day: Complete right facial paralysis. Restlessness increased in the course of the next few days; condition of patient becoming progressively worse. Twenty-first day: Tremor of hands; gnashing of teeth; unconsciousness at noon; general convulsions, beginning in the left upper extremity. Death. Necropsy showed purulent meningitis. Microscopically, the exudate was seen to contain streptococci and a Grain positive bacillus, resembling the bacillus influenzzc.
A radical operation on the mastoid will often prove effective in preventing extension of the inflammation to the meninges. A brain
abscess may develop and, if possible, surgical intervention should be resorted to at once in such cases.
I saw a three-year-old child die eighteen months after the com mencement of a scarlet fever otitis, which had resulted in a brain abscess without any clinical manifestations.
It must be borne in mind that in the case of a so-called extra buccal scarlatina the necrotic inflammation, which ordinarily is seen in the pharynx, may reach its development at the infection atrium. The surgical wound, or other injury—in puerperal scarlatina, the trauma of the genitals—has the appearance of an infected wound. Its edges are infiltrated, the secretion covering the wound resembling macroscopically and microscopically the condition ordinarily seen in the pharynx, necrotic masses of connective tissue are seen in the depth of the wound, and the regional lymph-nodes are enlarged. Streptococci are always found in the wound secretions.
If the infection extends from one or more papules, marked inflam matory changes are here also evident,. In cases of extrabuccal scarlet fever the skin eruption is, as a rule, most intense in the vicinity of the infection atrium. The mucous membrane of the mouth and pharynx does not show the usual eruption; it is merely reddened and swollen.