ONSET 21 



especially in young subjects with clear skins running high tem- 

 peratures, the eruption, particularly on the neck, chest, and 

 upper arms, is complicated by a mottled or blotchy erythema 

 which may continue for several days but disappears earlier 

 than the lesions of the typical eruption. This was observed in 

 23 of our cases. 



On direct examination of the skin of a typhus patient with 

 a microscope magnifying 40 diameters, first rubbing on petro- 

 latum to increase transparency, each lesion is seen to consist of 

 a tangle of dark red blood vessels. 



6. LUNGS AND HEART 



Among our cases evidence of tracheobronchitis was so preva- 

 lent as to lead us to believe it characteristic of the disease as 

 with measles. On transfer to our service nearly all cases had 

 cough, either dry and slightly barking or loose with obvious 

 excess of bronchial secretion. In 55 this cough was present on 

 admission without abnormal signs in the lungs. Fifty-five 

 showed musical rales in varying numbers throughout. Seventy- 

 three showed crepitant rales at one or both bases. 



The heart showed no evidence of endocarditis in any in- 

 stance. In 8 cases the heart was absolutely irregular without 

 visible auricular venous pulse in the neck as from auricular 

 fibrillation. In the 4 of these cases that recovered the heart 

 resumed normal rhythm with convalescence; the remaining 4 

 died, but without symptoms or signs of cardiac insufficiency. 



7. THE SPLEEN 

 The spleen was palpable on admission in 48 cases. 



8. BLOOD 



White counts were done by Dr. Stella Naparalska on the day 

 following admission in 179 cases. The results are shown in the 

 following table (Table II). 



Certain cases with high leucocytoses, however, recovered 

 without at any time in their course showing signs of a severe 

 type of typhus infection or of complications. 



