Haemorrhagic Non-Pustular Small-Pox

Abstract

of liver extract was given. These injections were repeated two and fouir days latelr respectively.On Marchl 15tlh the condition of-the clhild showed definite btit slight improvement. 'easpoonifuil doses of liver extract were tried by the moutlh, and wer-e retained. Two more injections of spleen and liver were given at two-day intervals; and then the injection of liver extriact was stopped, but the iniectioiis of spleen were conitnued at f6ur-day initer vals untLil teni had been given. The dose of tlhe liver extract given by the mounth was graduially increased, until two teaspoonfuls of the liquiid extract were being taken tlhr ee tinmes a day. The child conitiniued to rmiake rapid anid uininl ertrupte (l l) The uterus contained an apparently normal eight months foetus.The stomach showed large. oval dark-red haenmorrhages, on the greater curvature clhiefly. There were also marked petechial haemorrhages on both the pericardium atnd epicardium, most marked within two inches of the apex. The lungs-were only congested, and the larynx and pharyvax were injected, without any evidence of diphtheria or other infection-. On tha gums there were petecliial haemorrhages, n-o blue line, and nio dental caries. The brain and meninges were injected, but 'tthere was no evidence of cerebro-spinal meningitis or of any other brain or cord conitimn.The breasts were well developed, and contained lacteal fluid; in the fatty areolar tissue there were petechial haemnorrhages. Tl-e joints showed -no evidenice of -fhaemor-rhlaes, 'nor of any abnormality. The pupils were.dilaited, slightly red-dened, and beginning to " sink." The blood vessels were thickened. There was a diffuse purplish 'rash over the whole of the face, neck, trunk, and part of the upper extremities, but it onily extended for two inches below the groin, where it could be 'distinctly seen to end in a' fraying-out of petechial haemorrhages, wlhich penetrated into the subcutaneous tissues. At first sight the distribution on tlhe thighs was like that in scarlet fever. In the parncrea's was foullnd ani abscess 1 inch in'diameter, oval in shape, anid well encapsulated; no other abnorrnality was noted. DIFFERENTIAL DIAGNOSIS.The following alternative diagnoses were considered: haemorrhagic small-pox (the purpuric non-pustular type of Tidy)-; purpura haemorrhagica,' and puirpura fulminans; severe typhoid fever (no typhoid spleen nor Peyer's patches were evident); Henoch's pulpura (age usually 5 to 20 years only); lead poisoning (the macroscopic signs .were not pl)esent, but there was an appearance resembling bilateral foot-drop; mechanical purpura (possibly caused by' venous stasis due to pressure of the foetus); acute leukaemia (ilo glhnds were enlarged as would. be expected); chloroma (sliull examin&d, -but' no evidence of greeii marrow); cer-ebro-spinal meningitis (the pathology -was negative); infective endocaliditis-'With secondary sep'ticaenmia; certain forms of toxic nepliritis of pr-gnancy (there was a i marked conjuinctivitis wbhichb r-equired otlher diagnosis for expl...