99 
CIRCO.ATORY SYSTEM. 
The pulse appears out of all proportion to the temperature, usually 
running from 110 to 110, a pulse of 120 being not unusual with a tem- 
perature of 102^. It is rather thready, though sometimes full and 
strong, occasionally dicrotic in the first week. Ked blood counts show 
a progressive decrease in red cells, but as soon as the temperature 
becomes normal an increase begins. The white blood corpuscles are 
increased in number, varying from 8.000 to 12,000. A differential 
count in two cases gave an average of — 
Per cent. 
Polymorphonuclear leucocytes 77. 7 
Large mononuclear leucocytes 11. 4 
Small lymphocytes 10.0 
Eosinophiles 9 
Total ICO.O 
This shows as its most interesting feature an increase in the large 
mononuclears. 
There was a steady, but never very rapid, decrease in the percentage 
of hemoglobin, one case going as low as 50 per cent. 
The blood failed at all times to agglutinate Jxicillus typhosm. 
Fresh and stained blood showed the three forms of parasites described 
under etiology." 
THE ERUPTIOX. 
The emption appears usually on the third dai^, ffrst on the wrists 
and ankles, then on arms, legs, forehead, back, chest, and, last and 
least, on the abdomen. It is never very abundant on the abdomen, 
but the other portions of the body in some cases are literally covered 
by the eruption. 
At first the spots are of a bright-red color, macular at all times, 
from a pin point to a split pea in size. At first they disappear readily 
on pressure and return quickly, but if the case is a severe one they 
soon become darker and in some cases are almost purple. From about 
the sixth to the tenth day of the disease thev fail to disappear on 
pressure and are distinctly petechial in character. In favorable cases, 
about the fourteenth day they begin to lose their petechial character 
and disappear slowh’ on pressure. In some cases the eruption con- 
sists of small, brownish spots, giving a turkey-egg appearance, well 
shown by the photographs on pages 22 and 23. 
As the fever declines the eruption begins to fade; but a slight 
return of fever or a free perspiration will cause it to show distinctA. 
I am informed that, following a warm bath in a case ten months recov- 
«The average normal red blood count at this elevation (3,500 feet) gives over 
5,500,000. 
