20 CLINICAL OBSERVATIONS 



mouth became dry and fissured in spite of constant care. 

 There was moderate reddening of the pillars of the fauces in 59 

 cases but never of such intensity as to suggest marked inflam- 

 mation. 



Labial herpes was present in but two cases. 



5. EKUPTION (Figs. 4, 5, 6, 7, and 8) 



All on admission showed an eruption characteristic of typhus 

 fever. This eruption is in its early stages composed of discrete, 

 rather sharply defined, pink macules, round, oval, or somewhat 

 irregular from 2 to 6 mm. in diameter, disappearing on pressure, 

 rarely palpable, distributed with more or less profusion (but 

 nearly always more numerously than the rose spots of typhoid 

 fever) on the chest, abdomen, back, neck, shoulders, arms and 

 legs, and dorsa of hands and feet, in other words over the 

 whole body with the exception of the face and head. In our 

 cases on first examination it was present on the trunk in 180, 

 one case having too extensive pigmentations and scratch 

 marks from pediculosis for recognition of the typhus rash ex- 

 cept on the extremities. One hundred and forty-two cases at 

 this stage had eruption on the extremities, 101 on the neck. 

 As curiosities 6 cases with profuse general eruptions had a few 

 lesions on the face, 2 had lesions on the palms, and 2 had red 

 spots probably typhus lesions on the soft palate. As the dis- 

 ease progresses the lesions become more numerous and larger, 

 and the color becomes first a brighter red, then purplish red to 

 dark purple. As the purplish color develops the lesions often 

 tend not to disappear on pressure, due to extravasation of 

 blood, but the hemorrhagic element in the eruption is com- 

 monly less than the color of the lesions would lead one to 

 suspect. Even the deepest purple lesions may disappear com- 

 pletely on pressure, and some of our patients who up to the 

 time of death had had extreme eruptions showed almost com- 

 plete disappearance of eruption after death. Among our cases 

 the rash as tested by disappearance on pressure was markedly 

 hemorrhagic in 52. In 14 some lesions were palpable. In some 

 cases somewhat after the beginning of the stage of eruption, 



