SIGNIFICANCE OF PHENOMENON 369 



ciples and the corresj)()ii(liii^ antil)()dies may be recoxered as a 

 result ot spontaneous infections. 



Stolyhwo drew attention to the hemorrhagic and necrotic de- 

 cubital skin lesions which coidd be frequently seen in severe 

 cases of typhoid and paratyphoid fever. These lesions had a sud- 

 den onset and developed rapidly in the superficial layers of the 

 skin. Some of the lesions appeared in the form of small skin 

 hemorrhages whilst others became necrotic assimiing a black 

 violet coloration demarcated by peripheral hemorrhagic zones. 

 They usually occtnred in the sacral region and less frecjuently on 

 the back and extremities of the patient. The skin lesions ap- 

 peared ordinarily in the first half of the second ^veek and also 

 between the third to the seventh day following the onset of a 

 relapse in prostrated, as well as restless, typhoid patients. They 

 were definiteiy incidental to manifestations of a general toxemia. 

 Inasmuch as most of the cases ^vith the lesions described ^vere 

 fatal, a possibility was afforded to study the histological appear- 

 ance of the skin invohed. In these studies, Stolyh^vo Avas im- 

 pressed by histological similarity with the lesions of the phenom- 

 enon of local skin reactivity (necrosis, hemorrhage, thrombosis 

 of small blood vessels, etc.) . In some cases similar hemorrhagic 

 lesions ^vere observed in the kidneys (without infarct) , mucosa 

 of small intestine and also once in the gastric mucosa. Inasmuch 

 as also necrotic and hemorrhagic reactions Avithout infarct were 

 occasionally observed in the kidneys, it occiuTed to this author 

 that the toxic substances responsible for these manifestations may 

 be secreted by the kidneys. 



The mine of typhoid patients at various stages of the disease 

 was collected by means of a catheter, as follo^vs: 



1. Patient \V. J. During the fourth week of a severe toxit case of typhoid 

 fever, Avhen a rehtpse began and became complicated by hemorrhagic and 

 necrotic spots on tlie skin. 



2. Patient T. T. During the thirteentli day of rehipse complicated tlie 

 following day by severe hemorrhagic and necrotic lesions at the back and 

 btittocks. 



3. Patient D. W. During the end of the second ^veek of the disease at the 

 period of severe toxic manifestations. 



4. Patient G. J. During the fourth week of the disease at the beginning 

 of lytic defervescence. 



5. Patient Z. E. During the fifth Aveek of typhoid fever with a normal 

 temperature during con\alescence. 



6. Patient R. A. During the third Aveek of a moderately severe case of 

 typhoid. 



