﻿ETIOLOGY OF DENGUE FEVER. 141 



The appearance of the rash also varies. The most common eruption 

 more nearly resembles that of measles than any other well-known eruption, 

 but it is not so dark in color, neither are the macules usually so coarse nor 

 aggregated into such large patches. Another type resembles scarlatina, 

 consisting of close set or coalescent, bright, red points, while between 

 these two are intermediate types. Very rarely is the rash so vivid and 

 plain as in scarlatina, measles or rubella. The measles-like eruption may 

 be, at times, appreciable to the touch. 



In some of the scarlatiniform eruptions the injection may be so intense 

 as to produce capillary rupture and minute extravasations, which show 

 on the bright-red background as small, purple dots. An eruption of this 

 character is longer in fading than the others. These small extravasations 

 are more commonly seen on the back and buttocks than elsewhere, 

 possibly because of the greater heat and pressure to which these parts 

 are subjected. In one patient (Case 10) these small extravasations ap- 

 parently suppurated ; at all events, an abundant crop of miliary pustules, 

 1 to 3 millimeters in diameter, appeared over the buttocks, where the extra- 

 vasations were abundant. The pustules were not painful and gave 

 rise to no symptoms. 



Occasionally, the eruption leaves small areas of skin, from 1 to 2 centi- 

 meters in diameter, uninvolved, which then present somewhat the ap- 

 pearance of wheals on a blushing surface. We have not seen an urticarial 

 eruption. 



The duration of the rash usually varies with its intensity, the well- 

 marked eruptions lasting longer than the others, and, as stated, the scar- 

 latiniform rash with extravasations the longest. In one such case (Case 

 2) the eruption lasted eight days. We have seen no other in which it 

 lasted so long, though we have observed others in which it was visible for 

 a week. In most cases it lasts about two days ; that is, it appears on the 

 fourth day, or the fifth and disappears by the time the temperature falls. 

 on the sixth day. In many cases it lasts only one day, or possibly less, 

 being well marked one morning and absent the next. In about one-fourth 

 of our eases it was never seen at all, and possibly did not occur. 



The disappearance of the rash in a minority of cases is followed by 

 a fine desquamation which will not be noticed unless watched for closely. 



In a very small minority the desquamation is easily observed as fine, 

 bran-like, but abundant, scales. In one patient whom we saw but did 

 not have under our care, the skin of the hands, arms and feet came off in 

 large strips, many of them an inch square. 



Alimentary system. — The tongue in nearly all cases presents a charac- 

 teristic appearance. At first it is covered by a light, creamlike coat which 

 rapidly thickens and darkens in the middle, disappearing from the edges ; 

 during the rest of the attack the tongue usually presents a heavy, yellowish 



