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the kidneys or any demonstrable disease, these discharged
Scarlet Fever patients become temporarily actively infective
to others. Thus certain individuals, some with and some
without antecedent Scarlatina appear to be Scarlet Fever Carriers
and to be subject to waves of infectivity associated with
dormant periods of harmlessness.
Sometimes operation for mastoid abscess in sequence to
disease of the middle ear disturbs the concealed poison and
infects with Scarlatina the nurses and attendants. That, at
least, has been our recent experience at the Queen's Hospital
for Children, and it is a method of infection that merits close
attention.
There is no doubt that the crypts of the tonsils, the nasal
passages and sinuses, the eustachian tubes, the middle ear
and the accessory cavities, and the mucuous, lymphatic and
other glands in relation to these anatomical areas are apt to
harbour the materies morbi. Exactly where these disease
particles hide it is impossible to say, for as yet the germ of
Scarlet Fever has defied detection. But the dissemination
of the disease in sequence to inflammatory disturbances in
these areas, e.g.: sore throat, colds in the head, discharges
from the nose and ear and from the back of the nose, make it
highly probable that these regions are its common habitation.
Of all these situations the back of the nose, the nasopharyngeal
cavity of young and other children theoretically
affords the most favourable site. To find a really healthy
mucous membrane in that situation is quite uncommon. In
this region there is, together with a rudimentary third tonsil
(Lushka's tonsil) a plentiful formation of separate lymph
follicles. On inspection of these parts more or less hypertrophy
of the contained glands (Adenoids), and a catarrhal
and swollen condition of the mucous membrane there, accompanied
by muco-purulent discharge which constantly trickles
down the back of the throat is quite a common feature. These
children are liable to colds in the head, they frequently present
enlarged glands in the neck, and often in addition have diseased
tonsils. It is possible, and indeed not unlikely, that
some of these children act as Scarlatina Carriers, in any case