Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

221/440 (page 203)

brown colour, wliilo the spots of purpura, besides having^ abrupt aucl very clearly defined margins, present a decided shade of blue, which, as Dr. Staberph remarks, renders the name applied to them very appropriate. Vibices appeared upon the chest in one case on the loth day, amid a pale- eruption, that became afterwards more marked, while the ecchymoses grew paler. The pulse, on the 9th day 124, had fallen to 112; the state of the patient improved rapidly, and convalescence took place on the i8th day. In another, tha vibices were pretty numerous, large, and very irregular in form, and appeared on the 12th day, amid livid and petechial eruption; the pulse fell from 132, the number of pulsations on the day before, to 122, and convalescence was complete on the 2oth day. From these details it appears clearly that purpura and vibices are of rare occurrence in typhus,, are quite distinct from the typhous eruption, and that, instead of being attended with peculiar danger, they would actually appear to be critical. We may also conclude that if, as Dr. Copland insists, the petechial affection is not in any senso of the word an eruption—the exanthematous eruption is not only often associated with petechite, but is often itself petechial. I now proceed to my second proposition. Dr. West (loc. cit., p. 141) says, that in the cases he observed the abun- dance or scarcity of the eruption was not at all in proportion to the severity or mildness of the diiierent cases. He considers petechia) not to be particularly ill omened (an opinion somewhat borne out by the facts stated above), and certainly by no means so much to be dreaded as the dark and livid hue of the eruption, a,nd of the skin generally, which is sometimes observed. To the first assertion, so vague and so general, I oppose his own words (at p. 290 of the 'Edinburgh Journal' for this year), where, speaking of Willis's account of the epidemic that broke out in the spring^ of 1643 among the troops near Oxford, and was for some time unaccompanied by eruption, he says, About midsummer the disease increased in fatality, and then goes on to give the description of the eruption already refei'red to. I oppose to it also the general fact that the eruption is seen in its greatest perfection in extensive epidemics, during which the