Clinical and pathological papers .. . July 7, 1889 Digitized by Microsoft® PHILLIPS: SKIN RASHES IN TYPHOID FEVER O which there were hemorrhagic rose spots; this condition is not veryuncommon. The sixth case of purpura is so remarkable that Ishall give it in detail. This patient, a female, aged eighteen years,was admitted to Lakeside Hospital May 9, 1903, with a typical his-tory of typhoid fever, with rose spots, enlarged spleen, and a posi-tive Widal reaction. On the sixth and seventh days after admis-sion she had two copious intestinal hemorrhages. At the same timeseveral large purpuric spot
Clinical and pathological papers .. . July 7, 1889 Digitized by Microsoft® PHILLIPS: SKIN RASHES IN TYPHOID FEVER O which there were hemorrhagic rose spots; this condition is not veryuncommon. The sixth case of purpura is so remarkable that Ishall give it in detail. This patient, a female, aged eighteen years,was admitted to Lakeside Hospital May 9, 1903, with a typical his-tory of typhoid fever, with rose spots, enlarged spleen, and a posi-tive Widal reaction. On the sixth and seventh days after admis-sion she had two copious intestinal hemorrhages. At the same timeseveral large purpuric spots appeared on the abdomen—one justabove the pubis and another at the site of an old appendiceal scarbeing much larger than the others. There were also a few petechiseover the anterior surface of the left ankle, one over the second toeof the left foot and a small -ecchymosis over the great toe of the rightfoot. The patient complained of some burning in the ecchymoticareas of the abdomen. This was relieved by the application of hot. Fig. 1.—Showing the areas of ecchymoses on the abdomen. The darker areas representthe ulcers after sloughing. compresses. In the course of a few days the ecchymoses on theabdomen became much darker in color, and at the end of a week acentral slough had separated, leaving a ragged ulcer in the region ofMcBurneys point, and another just above the pubis (see Fig. 1).The patient died three weeks after admission from toxemia. Such superficial gangrene of the skin is very rare. Taupin33 men- 83 Jour, des Con. , 1839, No. 7 (quoted by Hare and Beardsley, p. 177). Digitized by Microsoft® 0 PHILLIPS: SKIN RASHES IN TYPHOID FEVER tions a case of sloughing of the thighs, sacral region, knees, elbows,and of the face, in a child with typhoid fever. The skin becameviolaceous in appearance, and mortified, and this was accompaniedby increase in the del irium. Hare and Beardsley34 have reported a casein which the gangrene developed on the inside of the
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