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July 22, 1939


Author Affiliations

College Park, Ga.

JAMA. 1939;113(4):294. doi:10.1001/jama.1939.72800290001007

March 1, 1939, a middle-aged woman suffered chills, followed by fever, nausea, vomiting and headache. When seen by me the next day she exhibited mild prostration, with a temperature of 103 F. A small ulcer was noted on the medial surface of the proximal phalanx of the right middle finger, but there was no redness or swelling of the hand or forearm; epitrochlear and axillary nodes were not palpable. As a mild epidemic of influenza was prevailing at the time, symptomatic treatment was prescribed.

Her condition grew steadily worse: to the general symptoms were added mild pain in the right arm and more severe pains over the anterolateral aspect of the chest and right upper quadrant of the abdomen; she became weaker and somewhat irrational. The afternoon temperature averaged 104.

March 14 the lesion on the middle finger had become a slightly irregular ulcer about 1.5 cm. in diameter; along

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