51 
Chowning (1902a, p. 132; 1903a, p. 63; 1904a, j). 38) report that in some cases the 
skin becomes gangrenous over considerable areas, as on the elbows, fingers, toes, 
lobes of the ears, scrotum, etc. Anderson (1903a, p. 507; 1903c, p. 23) states that 
in very severe cases there may be gangrene of the fingers and toes, and still more 
frequently of the skin of the scrotum and penis; in case 120 the epidermis over scro- 
tum sloughed off from an area about 2 to 5 centimeters in diameter (Anderson, 1903c, 
p. 33). 
Gates (1905, p. 115) reports that in his case 6 (1900) the skin of 
the scrotum and legs became gangrenous before death, and Buckley 
noticed gangrene in case 1 (1904). 
HYPERESTHESIA. 
Idaho . — Bowers (1896, p. 64) reports hyperesthesia on the surface of the body. 
Montana . — McCullough (1902, p. 227) says there is an exaggerated superficial 
hyperesthesia of the skin, as well as deep soreness, the patient fearing to be moved 
or touched. 
In the cases observed in 1904, hyperesthesia was especially marked 
in Minshall’s case (No. 8), and in Buckley’s case (No. 2). 
Fat. 
See also Emaciation, page 74. 
The panniculus adiposus was about normal in case 120 (Anderson, 1903c, p. 32). 
In 1904, case 11, upon autopsy, showed a good amount of subcutane- 
ous fat when incision was made from manubrium to pubis. 
Head. 
FACE. 
Idaho . — Early in the disease the face acquires a dusky flush, and is slighfly 
swollen; the expression .becomes listless, dull, and heavy (Bowers, 1896, p. 63). 
Zipf (1896, p. 65) reports flushed face. 
Montana . — The congested and cyanotic condition of the skin causes a bloated, 
stupid expression of the face in most cases, and this is a very diagnostic symptom 
(Gwinn, 1902). There is a glazed appearance of the face, bordering upon being 
copper colored, and taking a bluish or dusky hue as the disease advances. 
In all severe cases more or less edema of the face and extremities is present. This 
may be marked, and may appear as early as the third day of the disease (Wilson and 
Chowning, 1902a, p. 133; 1903a, p. 64; 1904a, p. 40). There was considerable swell- 
ing of the legs and face the last day or two in cases 24 and 72 (Wilson and Chowning, 
1903a, pp. 32, 37; Anderson, 1903c, pp. 13, 15); in cases 117 and 120 there was also 
more or less swelling of the face and limbs (Anderson, 1903c, pp. 27, 32). 
Gates (1905, p. Ill) reports the face of his case 14 as slightly flushed. 
In 1904 the face of case 1 was reported as congested; of cases 8 and 
10, flushed; of case 5, slightly flushed; of case 3, as placid, blotched 
with eruption, and then darkly flushed (May 13); of case 6, as florid; 
case 11, as dusky. 
EARS. 
Wilson and Chowning (1903a, p. 44) report ringing in the ears for case No. 109; 
the patient had been partially deaf for 2 or 3 days at the beginning of the sickness; 
case 89 (p. 49) experienced xleafness (but had had quinine); deafness is also recorded 
for case 107. Anderson (1903c, p. 36) reports ringing in the ears in case 121. 
