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Sequel of Scarlet Fever

day, sequehe, week, nephritis and temperature

SEQUEL& OF SCARLET FEVER Unfortunately, the danger point in scarlet fever is not passed with the subsidence of the primary disease and its complications. There is now initiated the period of the sequehe, which may defer complete con valescence for weeks, and which, in some cases, may lead to death. In the severe cases, where the patient survives the fourth week of the disease. dangerous and fatal sequehe may complete the clinical picture of the case. It is a notable fact, however, that the mild cases of scarlet fever are most often followed by sequelze.

The time of appearance or onset of the sequelte is characteristic. There is more or less uniformity in this regard. They may appear as early as the txvelfth day, but not later than the sixth week after the subsidence of the primary disease. They appear most frequently during the third week (critical days are the nineteenth to the twenty-first).

At the Vienna Clinic, in 1901 and 1905, post-scarlatinous lymph adenitis and nephritis occurred as follows (counting from the beginning of the scarlet fever): Week. Lymphadenitis. Nephritis.

2 (12th to 14th day) 2 3 37 16 4 i 5 6 3 6 1 3 After the fourth week the frequency of the appearance of sequehe diminishes rapidly. It is not until the seventh week, however, that one may assume with certainty that no sequehe will manifest themselves. The latest time of onset of a lymphadenitis was the forty-first day of the disease.

A second characteristic of the onset of sequehe is the acuteness of the symptoms, the remittent type of the fever, and, as in the primary affection, its tendency to fall by lysis.

Oscar 13., aged eight years (Fig. 54). Eruption slight in degree. Lacunar angina; maximum temperature, 39.2° C. (102.5° F.); desqua mation. Normal temperature from the fifth to the seventeenth day. On the afternoon of the seventeenth day, 3S° C. (100° F.), on the next day, 3S.S° C. (101° F.). In the angle of the jaw on the right side, a bean sized lymph-node, tender to touch. No albumin in urine (nor at any subsequent time). Nineteenth day: Maximum temperature, 39.2° C. (102.5° F.). Lymph-node somewhat larger; in the afternoon, pain in the left ankle-joint, with swelling and redness of the skin in spots. T•enty-first day: Swelling of lymph-nodes lessening. Ankle-joint unchanged. Pain and fever subside on the twenty-second day, and the swelling on t he t went y-t bird.

In this case the affection of the lymph-node \•as accompanied with a joint involvement. It is apparent, then, that various may appear, either singly or in combination. Children in the same family may manifest the same temperature curve and still be suffering from different The sequehe which may make their appearance are, first, nephritis, and, second, conditions whose relationship to the nephritis as at one time not appreciated : Lymphadenitis, synovitis, endocarditis, simple fever without apparent cause, and recurrent. attack of scarlet fever.