Mann, of Denver, has communicated to me personally cases of embolus of the femoral artery with resulting gangrene as sequels of diphtheria, as well as instances of true diphtheria of the penis, established by bacteriological diagnosis.
MUMPS.
The infectious character of this disease is not questioned, although not definitely established. Orchitis, ovaritis, stomatitis, enlargement of the tonsils and spleen, and albuminuria are frequent accompaniments of the disease, while articular and peri-articular complications have been noted. Bursal abscesses and pyarthroses have also been reported. These surgical complications have been regarded as rheumatoid or rheumatic, their essential significance not being recognized until recently.
VARIOLA.
The writers of the earlier part of this century allude frequently to the rheumatoid complications of smallpox, among which pyarthrosis seemed the most common and most serious. The various arthropathies are the most interesting of the surgical complications of this disease. The joints become swollen, red, and painful, one joint after another being involved.
INFECTIOUS ENDOCARDITIS.
The individuality of this condition has been recognized only within the last thirty years. That it deserves the characterization of “malignant” often given to it is well known. It is an infectious disease with a special localization in the heart, the term cardiac typhus being very expressive. Although so apparently spontaneous, it is usually a secondary lesion, sometimes a primary infection. The arthritic manifestations often assume a pyemic character, and even at the beginning of the affection, as Trousseau pointed out, there are frequently severe joint pains.
DENTAL CARIES.
Nearly one hundred species of microörganisms from the mouth have been studied and identified by W. D. Miller, who has clearly established that dental caries is due to the specific action of some of these parasites, which, gaining entrance into the dental tubules, determine fermentation and acid production, with erosion of the dental structure of the teeth and an increase in softening and destruction. In this way the teeth, as already indicated in Chapter IV, become paths of infection for germs which may travel but a short distance, causing only local disturbance, or which may be carried to other points about the head, producing disturbance in the antrum, in the neighboring bones, in the middle ear, and not infrequently in the brain. Abscess in the brain has been distinctly traced to caries of the teeth. Tuberculous infection is also common through this channel, and its most common expression is probably the invasion of the cervical lymphatics, superficial and deep, constituting those lymphatic tumors of the neck, formerly known as scrofulous, with their disastrous train of adhesions, suppuration, erosion, etc.