SCAELET FEVEE. 43 



urinary bladder. Urethritis and orchitis, which occasionally occur 

 in typhoid fever, are possibly to be explained as direct secondary 

 infection, via the urethra, and vas deferens, or as descending 

 typhoid infections from the kidney ; but the orchitis is possibly 

 a blood-borne infection. 



SCARLET FEVER. 



Although the virus of scarlet fever may obtain access to the 

 body through wounds, burns, or the raw surfaces left as the 

 result of recent childbirth, yet the common portal of entry is the 

 lymphoid tissue of the faucial and naso-pharyngeal tonsils. 

 When the resulting inflammation is considerable, the swollen 

 pharyngeal tonsil tends to block up the posterior nares, and to 

 obstruct nasal breathing. The secretions escaping by the nose 

 appear in the form of an irritating rhinorrhcea, which excoriates the 

 skin of the upper lip. At the same time the swollen faucial tonsils 

 interfere with deglutition and mouth breathing. Intense inflam- 

 mation may culminate in widespread local destruction of tissue. 



Early enlargement of the lymphatic glands in connection with 

 the fauces and nasopharynx may be expected. This primary 

 adenitis is due to infection, conveyed by lymphatics, and appears 

 in the form of tender submandibular swellings. The glandular 

 infection may be of mixed character, since the buccal, nasal and 

 pharyngeal cavities are liable to become centres of secondary 

 infection by reason of their exposure. The virulence of the 

 infection from the throat may be such that a periadenitis, and 

 even diffuse suppuration in the connective tissue planes of the 

 neck may result. When such extension occurs thin-walled veins 

 may be opened by ulceration, but the arteries, protected by their 

 thickness, usually escape. The oedema of the eyelids, which 

 often accompanies the adenitis, is explained by the fact that 

 their lymphatics traverse glands of the affected groups. 



The scarlatinal rash is a manifestation of vascular infection, 

 and is due to distension of small blood-vessels in the true skin. 

 The rash is at first minutely papular and discrete. This punctate 

 arrangement does not appear to be determined by the presence 



