I have previously emphasized the fact that variations in the tem perature curve accompany the occurrence of all complications in primary cases of scarlet fever. It is by no means uncommon to have a continued elevation of temperature even when there has been complete recession of all symptoms. And no explanation can be found for this. Often lysis does not occur in these cases until the end of the third week. It is customary to designate this a secondary fever (Fiirbringer), and to as sume that it is caused by some local infection which has either escaped or defied detection. Careful and thorough investigation of these cases will diminish their number considerably. Special attention should be paid to the pharynx, nose, middle ear, and the lymph-nodes.
A comparatively rare complication of primary scarlet fever is pneumonia.
If this complication sets in at the height of the disease—and here usually only small children are concerned—the prognosis becomes con siderably more grave, because almost invariably it leads to infection of the pleura, which, in turn, is followed by an empymna, very often fatal, with a thin fluid pus containing streptococci.
In the case of a child, twenty-two months old (the pneumonia appearing on the first day, and death occurring on the fourth day), there was a Inumorrhagic pneumonia, septic in character, in the left lower lobe (streptococci in exudate), and a pleurisy in the vicinity of the part of lung affected.
In the case of a boy, and a half years old (pneumonia beginning on second day, empyema on the fifth and death occurring on the ninth day), there appeared symptoms indicative of a pneumonic involvement of the lower half of the left upper lobe, with central necrosis.
In both cases the pharyngeal picture remained unchanged, so that one might have believed that the lung was the infection atrium.
Other complications referable to the respiratory tract are usually the result of a mixed infection, most often influenza. I recall very dis tinctly that among ten children lodged on one floor of the scarlet fever pavilion, four (five to eight years old) suffered from a complicating influenza! pneumonia, fortunately terminating in recovery.