ONSET 19 



remainder retaining their appetite, some to a degree unusual in 

 fevers. Insomnia was complained of in 88 cases. 



Most of our patients were not admitted to our Division until 

 on or after the sixth day of illness. Through poverty, igno- 

 rance, and other difficulties in securing medical attention they 

 had as a rule remained some days sick at home before they were 

 seen and sent to the hospital by a district health officer of the 

 city. It was usually on the day following their admission to the 

 hospital that they were selected for transfer to our service. 

 Most commonly the eruption was present in its earlier stages 

 on admission to the hospital. An unquestionable eruption was 

 required by us in all cases accepted for transfer. Diagnosis by 

 the eruption was ordinarily clear and simple with the exception 

 that the lesions were in not a few cases complicated and ob- 

 scured by those of chronic pediculosis and impetigo. Some 

 cases undoubtedly having typhus fever were rejected on this 

 account. 



All cases entering our Division did so when they were febrile 

 and had eruptions of the types described below. On entering 

 70 patients showed outspoken mental disturbance, 45 had 

 delirium of the excited type, and 25 mental dullness; the re- 

 mainder did not show obvious mental symptoms, but many of 

 them developed delirium later, often on the first evening. 



The facies on admission was noted as " tense" in 49 cases, 

 corresponding commonly with excitement, and "lax" in 23, 

 corresponding with dullness or stupor. The face was markedly 

 flushed in 73. 



Conjunctival injection was noted on admission in 157; in 83 

 cases moderate, in 68 marked, and in 6 extreme. The con- 

 junctival injection, like the delirium, tended to increase with 

 the progress of the eruptive stage until the beginning of 

 defervescence. 



The tongue was noted as coated but moist in 86, coated and 

 somewhat dry in 48, and very dry in 26. Dryness of the tongue 

 was regarded by the Polish physicians as one of the most reli- 

 able criteria of the severity of a case, and our experience taught 

 us to concur in this opinion. In all severe cases the tongue and 



