SWEATING SICKNESS. 697 



(eczema papulatum). The eruption then bears a great resemblance 

 to measles. WLen the effusion is very profuse beneath the cuticle 

 the vesicles become so large as to suggest a varicella. The first ap- 

 pearance of the exanthema is upon the sides of the neck and the upper 

 part and front of the chest. Thence it spreads to the belly, back, 

 arms, and legs ; it rarely attacks the face or hairy scalp. The erup- 

 tion breaks out either all at once, the whole body becoming cov- 

 ered with vesicles within a few hours ; or else it comes out in crops, 

 one part of the body after another being assailed. The latter is a very 

 common form of the eruption. The fresh outcroppings of the rash 

 are always preceded by an aggravation of the other symptoms, espe- 

 cially of the sweating and pricking of the skin. 



Sometimes there is no eruption at all. Such instances are not 

 to be regarded as analogous to the rare cases of scarlatina with- 

 out exanthema and of abdominal typhus without intestinal lesion. 

 Here the rash seems to depend upon mere sweating; and the 

 latter is the real pathognomonic sign of sudor anglicus. Whether 

 or not there be also a miliary eruption depends a good deal upon 

 the degree of susceptibility of the skin of the individual, just as in 

 cases of sun-burn or of mercurial inunction, it depends in part 

 upon the activity of the irritant and in part upon the sensitiveness 

 of the skin whether or not an eczema solare or eczema mercuriale 

 shall ensue. 



When the disease takes a favorable type, the fever and other 

 symptoms assume a remittent and sometimes even an intermittent 

 form, and about the sixth to the tenth day the sweating begins to 

 abate, and no more fresh crops of the vesicles arise. The restlessness 

 also ceases, as well as the headache, prickling, and loss of appetite ; 

 the fever subsides, sleep is tranquil, urine copious, the vesicles dry up, 

 and convalescence is established; during which the macerated and 

 loosened cuticle exfoliates, sometimes in large sheets, sometimes in 

 bran-like scales. 



Occasionally a relapse interrupts convalescence, and runs a course 

 like that of the original seizure. The malady may thus drag on for 

 weeks, and greatly exhaust the patient, rendering his recovery very 

 slow. 



While in many epidemics the favorable type is so much the rule, 

 that the majority or even all patients recover, yet there are others in 

 which the sudor anglicus, without especial complication, makes many 

 victims. It may terminate fatally at any period, death taking place 

 suddenly and without warning, either with symptoms of excessive 

 dyspnoea, or else of cerebral and cardiac palsy. Sometimes the end 

 is preceded by a cessation of the sweating and a fading of the exan- 



