696 ACUTE INFECTIOUS DISEASES. 



soft ; the liver filled with blood ; the general appearance corresponds 

 with that usually revealed upon the autopsy of an exanthematoua 

 patient. 



SYMPTOMS AND COUBSE. In a few instances the disease is pre- 

 ceded by languor, headache, soreness of the limbs, loss of appetite, 

 indigestion, and other premonitory but non-characteristic symptoms. 



Much more commonly the disorder breaks out suddenly, without 

 any precursory signs whatever. The patient goes to bed feeling per- 

 fectly well, and awakes in the night bathed in sweat, the flow of which 

 in a few cases is preceded by a slight chill. He complains of a painful 

 sense of constriction about the precordium, and of an indescribable ter- 

 ror and restlessness. The countenance is reddened, the skin hot, pulse 

 frequent, and urine scanty and concentrated ; strange to say, thirst is 

 not always much augmented. Most patients further complain of head- 

 ache, of a feeling of stiffness and tension about the nucha ; many also 

 suffer from mental confusion, dizziness, roaring in the ears, palpita- 

 tion of the heart, and painful spasms of the extremities, like those of 

 cholera. These are accompanied by a more characteristic symptom, a 

 sense of numbness and pricking of the skin, particularly in the fingers 

 and over the regions where the eruption afterward breaks out most 

 profusely. The sweating is so copious as to saturate the clothing and 

 bedding, and sometimes even the mattress. A peculiar odor has been 

 ascribed to this perspiration by some, who compare it to the smell of 

 rotten straw or musty vinegar ; but more probably the odor proceeds 

 from decomposition of the sweat which soaks the bedding. 



At the end of about three or four days, the eruption appears, pre- 

 ceded by an aggravation of all the above symptoms, but particularly 

 by an increase of the perspiration, and the prickling of the skin. 

 Scattered here and there among the spots of the eruption, solitary 

 sudamina appear limpid vesicles filled with sweat, beneath which 

 the skin seems so normal that one might mistake them for drops of 

 water.* The greater part of the eruption, however, is of the miliary 

 form and should rank with the eczemas, since the elevation of the 

 cuticle is not the result of mere perspiration, but of an inflammatory 

 effusion. The vesicles at first are tolerably transparent, but soon be- 

 come pearly and turbid ; and according as they are or are not surround- 

 ed by an intensely reddened areola they are described as miliaria 

 rubra or miliaria alba. Sometimes the effusion accompanying the 

 hyperaemia of the sudoriparous glands in miliaria rubra is so slight 

 that there are apparently no distinct vesicles, but merely solid nodules 



* To guard against misunderstanding, the term miliaria crystallina should be 

 disused. 



