﻿140 ASHBURN AND CRAIG. 



Intercostal pain is very unusual and pain in the abdominal muscles 

 is even less so; Guiteras and Cartaya likened the latter to the sensation 

 produced by pressing a large iron on the abdomen. This description we 

 have elicited a few times. 



Skin eruption. — As previously stated, tbe face is usually deeply flushed 

 and the eyes injected and watery at the onset of the disease. This 

 appearance we have found very characteristic, and, in the circumstances 

 under which we have worked, an almost pathognomonic sign. A similar 

 appearance may be produced by so many beginning diseases that we 

 would not give it any such weight where there was danger of confusing it 

 with such diseases. 



The redness may extend over the entire surface, but it is usually 

 more marked on exposed parts, such as the face, neck, and hands. It is 

 not a true eruption, but a general capillary dilatation and in appearance 

 it resembles a mild sunburn, or the dilatation caused by a hot bath, rather 

 than a scarlatinal rash. It may last for any length of time, from five or 

 six hours to two or three days. It is not constantly observed and we have 

 seen a few cases in which pallor was present instead. 



We have in no case seen jaundice, neither did Guiteras and Cartaya. 

 who, of course, kept it constantly in mind. These writers state that the 

 skin is generally hyperaesthetic. "We have not noticed such a condition 

 and have bad no complaints of it. so that we assume that it may vary in 

 different epidemics. 



The true rash undoubtedly varies greatly in the frequency of its 

 occurrence, as well as in its duration and localization. We agree with 

 Guiteras and Cartaya in regarding it as possibly present in all cases, 

 though not noticed in all because it frequently is faint in appearance and 

 of ephemeral duration. While we have not kept careful notes of all the 

 patients we have examined, we think that we have seen the rash in about 

 75 per cent of our cases. 



It most commonly appears about the fourth day. not infrequently with 

 the terminal rise. At times we have seen it upon the third day, and 

 at least twice in our experimental cases upon the second. As we received 

 a majority of our cases, excepting those produced by inoculation, on the 

 second, third, or fourth day, and as quite a number had the eruption 

 when we first saw them, we could not determine accurately just when 

 it did appear in some instances. We feel well satisfied, however, that the 

 fourth or fifth day usually marks its first appearance. 



The localization of the eruption varies. It occurs with greatest 

 frequency, in our experience, on the trunk, either the anterior or posterior 

 surface, or both, being involved. With this it may also appear on the 

 wrists, ankles, neck, thighs, palms, or generalized over the entire body, 

 the occurrence in the different locations being about in the order named. 



