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Lymphadenitis 1

temperature, day, fever, sequel and normal

LYMPHADENITIS _1. sequel which does not affect the prognosis unfavorably is simple post-scarlat Ina! lymphadenit is.

Anna II., aged seven years. Moderately severe attack. Tempera ture normal on twelfth day. Lymph-nodes of jaw enlarged to size of almond.

Twenty-first day: Temperature normal in the morning; 39.2° C. (102.5° F.) in the after noon. Pain in both angles of jaw.

Twenty-second day: Lymph - nodes, size of almond; tender to pressure. Pain dis appears in course of day. General condition good.

Twenty-third day: Temperature normal. Lymph-nodes size of bean; not tender to pressure.

With slight eleva tion of temperature there appears a pain ful swelling at angle of jaw. As a rule, only one node is involved; it is non-elastic and hard. Subjectively, the prominent symptom is palpation tenderness. The temperature usually rises in the afternoon, seldom exceeding 39° to 40° C. (102°-104° F.). The following morning it falls to 35° C. (100° F.) or below. Further development is subject to individual variations. The general condition of the patient, as a rule, is in marked contrast to the fever. In only a few cases is the condition initiated by vomiting, which may recur. The facial aspect of the child is characterized by marked paleness and puffiness. There is loss of appetite; no restless ness at night. The suspicion of a possible nephritis is aroused, but the urine remains free from albumin.

The condition terminates, on the average, from the fourth to the eighth (lay (Fig. 56). The tenderness disappears first. This is an inch cation that the crisis has passed. There is recession in the size and con sistency of the swelling; the afternoon remissions in the temperature curve are less marked. The temperature falls by lysis and soon reaches normal. It is rare, indeed, that there is a recurrence, either early or late.

The swelling is seldom of severe grade, and the extensive infiltra tions seen in the primary disease never occur. Suppuration is the acme of the pathologic process. It occurred twice in seventy-one cases. It is advisable not to incise until fluctuation occurs.

This type of post-scarlatinal lymphadenitis was present in about ten per cent. of our cases. It occurs about as often as a sequel of scarlet fever as does nephritis. The two affections occur either simultaneously or the lymphadenitis precedes the nephritis. When the latter occurs, the otherwise absolutely favorable prognosis of lymphadenitis is made uncertain. It is a danger signal, indicating that the ordinarily smooth convalescence from the primary disease is disturbed, and that the course of the sequel is not such an one as would occur under usual circumstances.

The fact that a lymphadenitis has occurred as a sequel or otherwise is of diagnostic value in that it renders it possible to establish the fact that the patient did have scarlet fever. Whenever a child has a unilateral cervical lymphadenitis, without any pharyngeal disturbance, the possi bility of scarlet fever should suggest itself. Evidences of desquauiation should be sought for and the urine should be examined for albumin.

Leopold W., aged five and a half years. Has a severe lymph:nlenitis in the left subma,xillary region (6 by 9 cm.). Redness of skin over swelling. Examination discloses very fine desquamation on trunk. Careful inquiry elicits information that three weeks before child had fever and eruption.