Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

223/440 (page 205)

de Claubiy, Montault), and my own experience leads me to assert it, that it appears later than the exanthema of typhus, bnt that is a point of very minor importance; tho main question is, are its characters the same ? According to all the best authors on the subject (Chomel, Rayer, Biett, Rochoux, &c.) it is distinguished from the morbilKform eruption of typhus by being distinct, rounded, slightly elevated above the skin, and of nearly uniform size. In only one case (which I saw in the Hotel Dieu last winter) have I noticed anything like an approach to the irregular, and very often confluent, rash of typhus, which is generally level with tbe skin, or if raised, is very slightly so, and that only during the stage of excitement. In all the other cases of typhoid fever in which I have seen the eruption I should say that it appeared in small spots, rounded, and almost papular in form, being considerably elevated in the centre. Dr. Perry, of Glasgow, was the first whom I heard maintain the complete difference of the two eruptions, and I am now fully satisfied of the accuracy of that opinion, for the following reasons : 1. The typhoid eruption is not permanent. 'That the typhous exanthema is so, has, I think, been shown by abundant eviden6e ; but it is generally agreed that the rash in typhoid fever is composed of several successive erup- tions,^ that its duration varies from three to seventeen days, the mean duration being seven and a half, and that each rosy spot is not commonly visible for more than three or four days, and sometimes less. I have often been able to verify this remark. 2. I have never seen a single case in which tho typhoid eruption became petechial or even dark, and no author I have consulted pretends that it does. On the contrary, it always retains the same characters, the last crops (and I have seen them appear the day before death, in cases where there was the most complete prostration) being as florid as the first. Reflections on the necessary relation between the state of the blood and the appearance of the ei'uption, which I cannot now develop, but which are strongly confirmed by the frequent occurrence of a buffy coat, and a pretty firm coagulum, in ' Clioincl, 'Lc9ons,' &e., p. 19 ; also Louis, vol. ii, p. 232, 241, ' Cliomcl and Loiiis.