49 
case 6 the spots were on the legs and trunk when patient was first seen 
b}" ph 3 ^sician. In case 7 they were very slow and backward in appear- 
ance, in fact, and never became very pronounced. In case 8 no spots 
were noticed at 10 a. m. May 21 (fourth day), but at 2 p. m. they 
appeared quite distinct on wrist and chest; at 5 p. m. all spots disap- 
peared; the skin then became decided!}" mottled; on May 24 spots 
appeared in decided manner over entire back, arms, and chest. In 
case 9 spots were first noticed on the ankles. In case 10 first symp- 
toms were noticed on J une 2, first spots on J une 6. There was pro- 
fuse perspiration on May 13 in case 12, a few days after tick bite the 
‘‘arm had swelled up as large as two arms and was red as a beet,” the 
spots disappeared from the face, forehead, arms, body, and legs in 
the order named. 
PATHOLOGICAL FINDINGS. 
Wilson and Chowning (1904a, p. 42), reporting upon the pathological findings, say 
that the skin over all dependent portions of the body presented a marbled appear- 
ance; over nondependent portions it was covered with petechiae; in all cases small 
wounds of the skin due to tick bites were present; the capillaries of the skin are dis- 
tended with blood, which contains an excess of leukocytes; many of the red cells have 
escaped from the vessels into the surrounding tissues; in some cases blood-pigment 
granules are present in old extravasations; in a few cases phagocytes, containing 
infected red cells, are present, but not so many infected cells are found as are present 
in the spleen, kidney, and liver. Anderson (1903c, jd. 38) speaks of the congested 
capillaries and minute extravasations in the rete extending into the stratum mucosum. 
COMPARISON. 
The spotted condition of the skin is one of the most striking clinical 
features of so-called ‘“spotted fever,” although it is maintained by 
some physicians that a mild, nonfatal type of the disease occurs in 
which these spots are not present. 
In the articles referred to as summarizing piroplasmatic diseases no mention 
seems to be made of exactly similar regular conditions in cattle, sheep, and dogs. 
Starcovici, however, refers to a “jelly-like, hemorrhagic, subcutaneous. edema” in 
hemoglobinuria of cattle and “a yellow jelly-like edema, here and there under the 
skin” in carceag of sheep. Smith reports, for Texas fever, that “the skin presents 
nothing abnormal to the unaided eye. * * * In one case the hair on the abdo- 
men and the inner aspect of the thighs was matted into little tufts by dried blood; 
the skin showed at such places a bluish elevated spot, and when incised a little blood 
was found in the subcutis; this may be what has been called blood sweating.” 
If “spotted fever” is a piroplasmosis, rve would therefore seem to 
have in man a skin lesion which marks this disease as quite different, 
clinically, from similar diseases in other animals. 
DESQUAMATION. 
Idaho . — A browny desquamation is usual about the third week; subjects that die 
at this stage present a resemblance to smallpox, due to the loss of epidermis from 
the apices of the papules (^Bowers, 1896, p. 63). Figgins (1896) gives the third or 
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