48 
front of the tibia; the spots vary in size, averaging about one-eighth inch in diam- 
eter; they appear over the entire body, are papular, evidently extravasation of blood 
beneath the skin, fading to a faint blue in 4 to 30 days; they often remain for months 
as faint blue indurated spots on exposure to cold. According to Zipf (1896, p. 65) 
the spots are red in the center and blue at the margin. Maxey (1899, p. 436) states 
that on first appearance the spots are a bright rose color, round, unelevated, and 
vary in size from that of a pin head to that of a split pea; on pressure they disap- 
pear, but return quickly when released from pressure; they may or may not be ten- 
der; pathologically the eruption appears to be an extravasation of blood into the 
deeper layers of the skin. 
MontcAim. — The eruption has the color and at a distance appears very much like 
measles, hut it is unlike the latter in being macular; when first out the macules 
almost disappear on pressure; they are often situated at a hair follicle, and they vary 
in size — when the eruption is new, from a pin head up to a split pea; gradually the 
macules become darker, assuming a purple or dark-blue color, becoming harder and 
harder to eliminate by pressure; they increase in size so that many of them become 
confluent in places, j^roducing a mottled appearance; after they become dark they 
have exactly the appearance of a hemorrhage under the skin; hut whether or not 
they are a true diapedesis Gwinn (1902) is unable to say. McCullough (1902, p. 226) 
refers to .the resemblance to a turkey egg, caused by the spots; the spots also vary 
and “may be seen in the form of a petechia extending to a decided ecchymosis upon 
an area of the body the hand would cover;” the macules partially disappear under 
pressure early in the eruptive stage, but later they become permanent and take on a 
darker hue, losing the pink tinge that predominates when the eruption first appears. 
According to Wilson and Chowning (1902a. p. 132; 1903a, pp. 62-63; 1904a, p. 38) 
the macules are at first rose colored and consist of circular spots, varying in size from 
1 to 5 mm. in diameter; they are not elevated; at first they disappear on pressure, 
but quickly reappear; they are sometimes tender to the touch; the appearance 
ordinarily rapidly changes, the macules becoming permanent, assuming a dark-blue 
or purplish color, and increasing in size until by confluence a mottled or marbled 
appearance may be given to the skin, especially on the dependent portions; in some 
cases the marbling covers the entire body; the color now no longer disappears on 
pressure; in some cases the eruifiion at no time becomes confluent and only small 
brownish or purplish petechi?e may l)e present, giving a speckled appearance which j 
has Ijeen likened to that of a turkey’s egg. 
Anderson (1903a, p. 507; 1903c, p. 22) says that 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 i 
soon become darker, and in some cases are almost purple; from about the sixth to 
the tenth day of the disease they fail to disappear on pressure and are distinctly 
petechial in character; in favorable cases, about the fourteenth day they begin to D| 
lose their petechial character and disappear slowly on pressure; in some cases the n 
eruption consists of small, brownish spots, giving a turkey egg appearance; Koplik’s 
spots are not present (Anderson, 1903c, p. 36). Gates (1903, p. 49) in describing a 
case says that the petechiae increased in size and number very rapidly during the 
first 2 weeks, forming large, irregularly shaped spots from the size of a little finger 
nail to spots one-half by one-half inch in diameter; they darkened in color, becoming ; 
bluish, with surrounding yellow tinge; they were slow in disappearing, some trace 
being visible 7 months after recovery. 
Ill 1904 the skill of case 1 was mottled. In case 2 the spots were 
not sore to the touch. In case 3 the}" first appeared on the arms. In 
case 4 the eruption covered the legs to the knees; on the 14th it was 
reported as elevated and extended over trunk to face and arms. In 
