Selected monographs.

Date:: 1888

Credit: Selected monographs. Source: Wellcome Collection.

224/440 (page 206)

$typhoid fover, will naturally suggest tliemselves to every mind. 3. It is beyond a doubt tliat there is no relation between the eruption and the severity of the cases. I confess that I long felt inclined to believe that the more plentiful the •ernption the less serious the case. I was particularly led to think so by the total absence or extreme scantiness of the eruption (though carefully sought for) in the Glasgow epidemic of 1836, which was very deadly, and by afterwards finding it more or less copious in sporadic cases presenting a much less intense form of the affection. After further inquiry, I find, that though in its fullest sense the opinion is incorrect, it is to a certain extent true. Prom a careful perusal of the valuable work of Chomel, I find that a large proportion of the worst cases, and of those who died, had either a scanty eruption or none at all; and it appears from the lucid state- ments of Louis,^ that it was wanting in g out of 35 fatal cases, and that it was scanty {en petit nomhre) in 18, or three fourths of the remaining 26, some of them presenting only five or six spots; a number reckoned by Chomel (p. 18) of no value, fifteen or twenty being necessary, according to him, to characterise the typhoid affection. Fifty-four of fifty-seven patients who had severe attacks, but recovered, had the eruption, and of the remaining three, two came to the hospital on the 14th and 40th days of the disease. ^'In some cases, he adds, there was only a small number of spots. In twelve the eruption^was very abundant. It was present in all the cases where the affection was slight, whence he infers, that its cause is special, or specific, and that it is not like other secondary phenomena, proportioned to the gravity of the disease and the febrile movement. Hence we may at least conclude, that in severe attacks of typhoid fever, the eruption is less frequent, and generally less plentiful than in those that are less serious. Does any one object that these reasonings prove not the difference of the eruptions, but merely a different determi- nation of one and the same eruption, in the one case to the skin, in the other to the mucous surface, which has been called the inverted skin?—I reply that, according to this ' Louis, vol. ii, 231, et seq.$

Selected monographs.

Licence and re-use

Contents