50 
fourth week as the time of desquamation. According to Maxey (1899, p. 436) the des- 
quamation during convalescence is somewhat peculiar, and can best be studied on 
the feet; the spots seem to cause a circumscribed death of the skin. A short time 
ago he examined Mr. D., one of his spotted-fever cases, who was taken sick 2 
months previously; patient was sick 18 or 20 days, and made a rapid and perfect 
recovery. It was a warm day; he had taken a brisk walk just before coming to the 
office, and when stripped for examination spots could be dimly seen in the skin on 
the hands and feet, but none on the body. On the soles of the feet were many 
round, white areas of dead epidermis, corresponding to the former location of the 
spots, and when this dead epidermis was removed it gave to the thick skin of the 
sole a punched-out appearance. Over the body desquamation is hardly noticeable, 
but it does occur. 
Montana . — McCullough (1902, p. 227) reports a peeling of the eruptive spots upon 
patients who recover. According to Wilson and Chowning (1902a, p. 132; 1903a, 
p. 63; 1904a, p. 38), desquamation begins about the third week and extends over the 
whole body, but is slight except over the most affected areas. Anderson (1903c, p. 
23) agrees that when convalescence is well advanced desquamation begins and 
extends over the entire body. 
JAUNDICE. 
In addition to the eruption the skin takes on a congested, jaundiced appearance, 
well marked in the conjunctivie (Gwinn, 1902). According to McCullough (1902, 
p. 226) jaundice accompanies the majority of cases, depicted over the entire body, 
and well marked upon the conjunctivse. According to Wilson and Chowning (1902a, 
p. 132; 1903a, p. 63; 1904a, p. 38) the skin ordinarily shows some jaundice. Ander- 
son (1903a, p. 507; 1903c, p. 23) states that the skin is always jaundiced to a greater 
or less degree, first noticed in the conjunctivie. He reports (p. 32) the skin of case 
120 as distinctly yellow; on post-mortem (p. 33) deeply jaundiced. 
In 190d jaundice was noticed to a greater or less extent in practicalh^ 
all the Bitter Root Valley cases. It was reported especial!}^ in case 9 
for skin and conjunctivte. 
Comparison. — Jaundice of the skin is reported for Texas fever as “of rare occur»“ 
rence;” in dogs the skin becomes “icteric, may become chrome yellow in 'color;” 
icterus was “ver}' slight or not evident” in dogs which Nuttall studied; icterus was 
noticed “in the mucous membranes of the eye, mouth, and skin in 30 out of 63 cases 
observed” in France. Icterus is not reported by Starcovici for hemoglobinuria in 
cattle. 
CYANOSIS. 
The congested and cyanotic condition of the skin causes a bloated, stupid expres- 
sion of the face in most cases, which is a very diagnostic symptom (Gwinn, 1902) . 
Case 11 (1901) showed cj^anosis June 25-26 (seventh and eighth 
da3-s). 
GANGRENE. 
Idaho . — Sloughing of the scrotum occurred in one case (Bowers, 1896> p.'63). 
Fairchild (1896) also reports occasional sloughing of limited areas, such alB of the 
scrotum, etc. 
Montana . — Gangrene is not an infrequent complication and may affect the fingers, 
toes, the region about the lobe of the ear, or in fact almost any part of the body; in 
one case the odor of the exhalations and sputum gave strong evidence of gangrene 
of the lungs (Gwinn, 1902). According to McCullough (1902, p. 226) gangrene fre- 
quently affects the toes, fingers, and dependent portions of the body. Wilson and 
