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6
fig. 1.
The post-mortem examination revealed the following macroscopic and microscopic
changes:—
(1.) Subcutaneous haemorrhages lower limbs, feet, buttocks, left mastoid area, left side
of neck, right upper eyelid. Haemorrhage and slight acute inflammatory infiltration of skin and
subcutaneous tissue.
(2.) Tonsils enlarged, pale anaemic, chronic tonsillitis.
(3.) Heart pale, petechial haemorrhages into endocardium.
(4.) Liver—pale, enlarged, hydropic degeneration.
(5.) Spleen—large, cedematous subacute toxic condition with degeneration of centres of
Malphigian bodies.
(6.) Kidneys enlarged, haemorrhage in and around pelvis of left kidney.
(7.) Retroperitoneal haemorrhage in perinephric area.
(8.) Haemorrhage into bladder wall. Slight inflammatory changes in wall of bladder.
(9.) Haemorrhage into right testis.
(10.) Small luemorrhage into dura just deep to anterior fontanelle.
(11.) Sinus catarrh of lumbar lymphatic glands which were enlarged.
(12.) Chronic inflammation with areas of necrosis in left cervical gland.
(13.) Considerable haemorrhage into whole of abdominal and thoracic walls.
(14.) Bone marrow of femur normal.
As has previously been noted, the occurrence of purpura at a distance of three
to four weeks from a fleeting rash, coupled with sufficient malaise to have necessitated
liis being kept in bed for ten days, suggest very strongly that this is a case of scarlet
fever. It is true that there was no history of either a primary or secondary sore
throat (which is of interest in view of the suggestion that such purpuras are allergic
in origin), but the presence of the tonsillar lymphadenitis, which was of the streptococcal
type, is not readily explicable on any other basis. Furthermore, the presence
of islands of normal skin throughout the purpuric areas surrounded by zones of
hyperemia, as manifested in this case, has already been described as being in a
measure peculiar to the purpura of scarlet fever.1
Clinically, the case is interesting from several points of view. The course was
extremely rapid—five days in all from admission to the fatal termination. At no
time was there any fever, although the lesions on the toes looked gangrenous and