48 CLINICAL APPLIED ANATOMY. 



glands in question. It is well to bear in mind that lymphatic 

 glands are so intimately related to the parotid and submandibular 

 salivary glands that they may almost be said to be embedded in 

 them, and clinically it may be very difficult to distinguish 

 lymphatic glandular from salivary glandular swellings. 



The albuminuria and neuritis of diphtheria are probably both 

 the results of toxins, carried by the blood stream. 



MEASLES. 



This highly infectious disease chiefly manifests itself in the 

 respiratory tract and the skin. The appearance of Koplik's spots 

 on the buccal mucous membrane affords the earliest evidence of 

 the infection. The distribution of these spots is in some way 

 influenced by position, for they usually occur on that part of the 

 buccal mucous membrane which is in contact with the teeth, and 

 so are best seen by drawing the cheek away from the molar teeth 

 and by everting the lips. 



Catarrh of the mucous membrane of the nose inducing sneezing, 

 and of the eyes causing photophobia, appears quite early. This 

 catarrhal condition rapidly extends locally ; by invasion of the 

 frontal sinuses it causes frontal headache, by spreading to the 

 fauces and mouth it gives rise to a patchy redness, which is 

 followed by congestion and swelling of the tonsils, soft palate, 

 uvula and pharynx. Further extension involves the larynx, 

 trachea, bronchi, bronchioles and even the alveoli of the lung. 

 In some cases the brunt of the catarrhal affection falls upon the 

 larynx in the early stages, and coryza is insignificant. Laryngeal 

 diphtheria is then closely simulated. 



The Eustachian tube being in direct continuity with the naso- 

 pharynx provides a path for the extension of the catarrh to the 

 tympanum. Deafness, earache and suppuration may result, and 

 the foundation thus laid for more serious complications such as 

 mastoid disease, sinus thrombosis, pyaemia, meningitis or 

 intracranial abscess. 



The primary involvement of the respiratory mucous membrane 

 explains the great infectivity of measles in its early stages. 



