47 
In the Bitter Root Valley cases of 1904 the spots were first noticed 2 
days after the first chill in 1 case, 2 days after initial ferer in 1 case, 
third da}' after first chill in 1 case, fourth day after chill in 3 cases, 
fourth day after initial symptoms in 1 case, record incomplete in 
remaining cases. 
DURATION'. 
Idaho . — Bowers (1896) says that the spots reach the stage of absorption and des- 
quamation in 8 to 21 days. They disappear slowly during the period of absorption, 
which is very variable — a few weeks to several months. After Collister (1896, p. 63), 
they can be seen for weeks, sometimes for months, after recovery, especially if the 
patient becomes a little chilly. Dubois (1896, p. 64) says that they fade slowly and 
maybe discerned weeks after convalescence has set in. Fairchild (1896) reports 
that the eruption continues throughout the disease or until convalescence is fairly 
established, when it gradually fades. AVhen exposed to cold the remains of the 
spots can be seen for months after complete recovery. Springer (1896, p. 61) agrees 
that the eruption continues throughout the attack. It is faintly visible often for 
many weeks, and is visible even after convalescence, especially if the surface becomes 
chilled; there is considerable irregularity regarding its disappearance. After Zipf 
(1896, p. 65), the spots stay out even after the patient feels well again. Maxey 
(1899, p. 436) says that as the fever declines the spots fade, but any temporary 
exacerbation of fever or free perspiration will freshen them temporarily, and a 
characteristic feature of this disease is that for several weeks after the fever has sub- 
sided the spots will show imder the skin after a warm bath or active exercise. 
Montana . — The spots fade as the fever subsides, but may not entirely disappear 
for weeks or months after convalescence is established (Wilson and Chowning, 1902a, 
p. 32; 1903a, p. 63; 1904a, p. 38). Anderson (1903a, p. 507; 1903c, p. 23) says that 
the spots fade as the fever declines, but show distinctly on slight return of fever or 
free perspiration. Warm baths produced spots 10 months after recovery. 
Gates (1905, p. 115) reports that the spots were visible 4 months 
after recovery in his ease 2 (1898), and in case 15 (1904) many spots 
were still visible 6 weeks after the temperature reached normal. 
CHARACTER. 
Idaho .' — According to Bowers (1896, p. 63) the spots are due to a sanguineous 
exudate, probably into or beneath the corium; they have a characteristic red color; 
on their first appearance they are one-eighth to one-fourth inch in diameter, and 
disappear momentarily on pressure; in 3 or 4 days they enlarge one-fourth to one- 
third inch in diameter, become papular, and are modified only slightly on pressure. 
In fatal cases they turn dark purple before death. Collister (1896, p. 63) describes 
the eruption as flat, rosy-red papules about one-sixth inch in diameter; when they 
are pressed upon, esjiecially soon after they have formed, their color disappears, but 
later they do not disappear on pressure. Dubois (1896, p. 64) refers to the spots as 
fine, red, round papules of an erythematous nature. “The term exanthesis rosalia 
arthrodynia more nearly expresses the disease than spotted fever.” Fairchild (1896) 
describes the eruption as hemorrhagic in appearance; the spots vary in size from 
one-eighth to one-half an inch in diameter; sometimes they coalesce, covering a 
large surface; they do not disappear on pressure. Figgins (1896, p. 64) refers to the 
spots as raised, first of light-red color, assuming a dark-purple hue as the disease 
progresses; eruptive patches one-fourth to 1 inch in diameter, mostly of circular 
form. According to Springer (1896, p. 62) the eruption does not fade on pre.ssure and 
in many cases there are large areas of almost black (hemorrhagic) skin, especially in 
