COMPLICATIONS

Complications of scarlet fever are common and it is in these that most of the danger lies. In the throat ulcers may form on the tonsils and elsewhere resulting in extensive destruction of tissues. Secondary to such conditions the glands in the neck may become swollen and may break down with resulting abscesses. The inflammation in the throat may extend to the nose and nasal sinuses with associated purulent discharge from the nostrils. Extension of the inflammation from the throat along the Eustachian tubes to the middle ear is frequent, and occurs most often when the illness has lasted a week or so. Many times this causes only transient pain, but often there develops a discharge of purulent material from the external ear. Sometimes the destruction within the ear is so severe and extensive that deafness results. Scarlet fever is responsible for a considerable number of instances of acquired deaf-mutism. Inflammation in the ear is indicated by pain which may be severe. After a few hours or sometimes only after days perforation of the drumhead is followed by a discharge from the ear. At first this is watery, sometimes tinged with blood, and soon becomes thick and purulent. With healing it again becomes thinner and finally stops. Most of such ears, after recovery have the hearing but little dulled. Fever is apt to recur or become higher when the trouble in the ear starts, and when perforation occurs the pain stops and the fever falls. Mastoid disease may be caused by extension of the inflammation from the ear to the bone behind the ear. This is recognized by pain, tenderness and swelling back of the ear. This is always dangerous.

It is quite common for patients with scarlet fever to have joint pains about 4 to 10 days after being taken sick. A few or many joints are involved, and as the pain disappears from one joint it appears in another. After a few days this disturbance comes to an end without leaving any permanent damage. The poisons of scarlet fever circulating in the blood, sometimes cause severe and even fatal damage to the heart. Injury to the kidneys is common with resulting acute Bright’s disease. This develops early or late in scarlet fever. The late cases, which come after the child has been sick for about three weeks, are most characteristic. Attention is often directed to this condition by a high colored, smoky urine, and by a puffy swelling of the eyelids. Later the swelling, due to the accumulation of water, becomes more extensive and general dropsy may result. With the dropsy and scanty, highly-colored urine, there may be associated disturbances of sight, headaches, vomiting and convulsions. Under appropriate treatment recovery from nephritis usually occurs, but in a few instances death results. While usually the heart and kidneys apparently return to normal after recovery from scarlet fever, there is much evidence which indicates that heart and kidney diseases later in life may be dependent upon damage done during this disease.