SCARLATINA. 



587 



grated tissue and dirty sanies, are left. In many cases this process 

 advances through the fauces to the nares, inducing the notoriously 

 malignant scarlatina coryza. The diphtheritic inflammation also occa- 

 sionally extends to the mouth and lips, and particularly to the angle 

 of the mouth, while it rarely attacks the larynx. Lastly, in some 

 cases, scarlatinous pharyngitis runs its course as a parenchymatous 

 angina, inducing great swelling, and, after a time, suppuration of the 

 tonsils. 



Combined with the malignant pharyngitis, or even independent of 

 it, we often have inflammations of the parotids and lymphatic glands 

 and of the connective tissue of the neck ; these rarely end in resolu- 

 tion, but generally after a hard swelling of the inflamed parts has 

 lasted for a variable period, they terminate in suppuration or diffuse 



necrosis. 



Scarlatina is localized in the kidneys just as often as it is in the 

 skin or mucous membrane of the pharynx. The usual form of this 

 localization is an intense hypersemia and catarrh (throwing off of the 

 epithelium) by the uriniferous tubules ; but, in many cases, and in 

 some epidemics in almost all the cases, the scarlatina infection induces 

 orottpous inflammation of the uriniferous tubules instead of simple 

 nypersemia. "We should not consider either diphtheritic angina or mor- 

 bus Brightii among the complications of scarlatina ; or else we shall 

 have to regard the inflammation of the skin, catarrhal pharyngitis and 

 hyperaemia of the kidneys as complications and not symptoms of 

 scarlatina. 



Perhaps the same thing is true of inflammation of the joints, pleura, 

 pericardium, and also with that of the ear, cornea, and other rarer dis- 

 turbances of nutrition observed during the course of this disease ; at 

 all events, there is no proof that, in cases where these inflammations 

 have occurred in scarlatina patients, there has been any second cause, 

 besides the scarlatina infection, acting on the patient to excite these 

 diseases as complications. It is, at least, fully as probable that the 

 infection, which generally only induces palpable changes in the skin, 

 throat, and kidneys, decidedly modifies the nutrition of the entire body, 

 and, under some unknown circumstances, excites severe, and conse- 

 quently perceptible, changes in the organs above mentioned. 



Lastly, we may mention that, in the bodies of those who have died 

 ol scarlatina, the blood is generally poor in fibrin, thin and dark, and 

 occasionally the spleen and intestinal glands are tumefied. 



SYMPTOMS AND COURSE. It is customary to give the name sim- 

 ple, normal, or benign scarlet fever to those cases where the fever 

 maintains a synochal character, and where the perceptible localizations 

 of the disease are limited to the exanthema, severe catarrhal angina, 



