74 IMMUNITY IN HEALTH 



the following complaints : — scarlatina, diphtheria, acute 

 anterior poliomyelitis, rheumatic fever, measles (Ger- 

 man measles rarely), typhoid fever, infantile enteritis 

 and pertussis. Flexner and Clark, and also Land- 

 sfeiner, Levaditi and Pastra have shown that the 

 tonsils from fatal cases of acute anterior poliomy- 

 elitis contain the virus, and Trethowan describes a 

 painful enlargement of the tonsils as a frequent early 

 sign of the disease. These signs of activity are most 

 developed in the initial stages of these diseases. Cer- 

 tainly the subepithelial lymphatic glands bear the brunt 

 of the attack in faucial and intestinal infections. 

 The lesions of scarlatina, typhoid fever and appendi- 

 citis illustrate this statement. Although the subepi- 

 thelial lymphatic glands seem almost to invite disease, 

 they yet seem better able to overcome it. Thus 

 diphtheria — a localised infection — is less serious when 

 limited to the tonsils than when it occurs elsewhere 

 (Jacobi, quoted by Mackenzie). 



The absence of the subepithelial lymphatic reaction 

 usually signifies a very virulent type of infection or a 

 lowered resistance, and presages a fulminating and often 

 fatal attack. Dr. Palmer relates a typical case of a lad 

 of 14j years of age struck down by malignant scarlet 

 fever. "The throat was normal. There was no glandu- 

 lar enlargement." Death occurred thirty hours after 

 the patient felt ill enough to consult a doctor, or three 

 days after the earliest feeling of malaise. The diagno- 

 sis seems fairly reliable — the patient had not had 

 scarlet fever previously ; the onset was marked by 

 vomiting and an unusually dusky scarlet fever rash 

 appeared on the second day ; a neighbour who had been 

 with him developed scarlet fever of a mild character 

 a few days later; a post-mortem examination helped 

 to exclude the possibility of other disease being present. 



The subepithelial glands concerned enlarge as a 



