fever (or scarlatina) is, like measles, one of the commoner in fectious fevers of childhood. It usually occurs in epidemics which vary greatly in severity. One attack, in the large majority of cases, protects against a second, for it is a disease which very rarely occurs twice in the same person. A second attack may, however, occur. Some time ago I saw a little girl, aged seven years, who had a significant history of fever followed by desquamation and dropsy, which had attacked her when she was in perfect health two years before. The child was a patient in the East London Children's Hospital, suffering from general arnyloid disease dependent upon spinal caries which had followed the illness referred to. While she was in the hospital the girl again contracted scarlatina, and was sent away to the Fever Hospital, where she died.
Sometimes the disease appears in an abortive form in persons who are already protected by a previous attack. In every epidemic of scarlatina it is common to find cases of anomalous sore throat occurring in protected persons exposed to the infection. Such persons may communicate the perfect disease to others who are not protected.
Causation.—The fever is of a highly infectious nature, and is readily communicable from one individual to another. Sporadic cases are some times met with, but the illness generally occurs in epidemics. The infec tious principle is probably not at all volatile, for articles of clothing, flan nel, etc., have been known to retain their poisonous properties for long periods of time. It is a debated question whether the disease ever has a spontaneous origin. Some authorities hold that it may be generated de novo by cesspools and ill-ventilated drains. Different epidemics have dif ferent degrees of severity ; but apart from the special type of fever preva lent, the intensity of the disease is dependent more upon the constitu tional state and sanitary surroundings of the recipient than upon the severity of the disease in the person from whom the infection is conveyed. Scrofulous children, and those who are ill cared for, or are exposed for long periods to an impure atmosphere, are likely to take the disease badly. ,
During the first few days of the illness the patient is less dangerous as a source of infection than he afterwards becomes. The time of desquama tion is probably the period at which the complaint is most likely to be car ried away, for the particles of epithelium thrown off must be highly con tagious, and the patient's power of communicating the disease does not cease until the peeling of the skin is at an end.
Scarlatina is seen less frequently than measles during the first twelve months of life ; but between the first and second years the disease is a common one, and, according to the researches of Dr. Murchison, 64 per cent. of the cases occur before the completion of the fifth year. After the tenth year the disease again becomes less frequent, although it may occur during adult life or even in extreme old age.
Morbid death from scarlatina we usually find evi dence of the special complications which have determined the fatal issue. In addition the blood coagulates imperfectly, as a rule, although pale fibrinous clots may be found in the right ventricle.
The parts especially prone to suffer are the gastrointestinal mucous membrane and the glandular system. In fatal cases inflammatory swell ing is found in the lymphatic glands of the neck ; also in the follicles at. the base of the tongue, and in those of the pharynx, tonsils, and larynx. In the intestine the solitary glands and those of Peyer's patches are often enlarged, reddened, and softened. There may be also enlargement and softening of the spleen, liver and pancreas. In all these organs, according to Dr. Klein, there are changes in the small blood-vessels. A hyaline thickening is noticed in the arterioles, with a proliferation of the cells of the endothelium and of the nuclei in the muscular coat, together with an accumulation of lymphoid cells in the tissues around. In the gastro intestinal mucous membrane there is of the subepithelial layers, and great proliferation of cells which distend and obstruct the gastric tubules. Sometimes casts of these tubules may be detected in the matters ejected from the stomach.