Gr. H. F. Nuttall 
377 
also come to my notice. Crab-lice may therefore produce effects which 
cannot be belittled. 
Maculae caeruleae. 
The occurrence of Phthirus upon the body is usually signalized by 
the presence of bluish spots in the skin to which French authors have 
given the frequently quoted names of “taches bleuatres” or “taches 
ombrees.” These spots were formerly included among the rashes met 
with in typhoid fever and were thought to possess some relation to this 
disease whereas they are purely adventitious. As Dubreuilh and Beille 
(1895, p. 137) correctly point out, the bluish spots were doubtless 
formerly associated with typhoid because clinicians frequently examined 
the abdomen closely for the specific rose rash of typhoid, a corresponding 
degree of attention not being given to abdominal inspection in other 
affections. 
Character of the spots. The maculae are few in number. Osier (1892, 
p. 15) describes them as pale blue, “sub-circular, from 4 to 10 mm. in 
diameter, of irregular outline and most abundant about the chest, 
abdomen and thighs. They sometimes give a very striking appearance 
to the skin. It can be readily seen that the injection is in the deeper 
tissues and not superficial.” After Osier’s attention was drawn to the 
association of these spots with lice, he “met with no instance in which 
these were not present.” I may add that the spots are painless and do 
not disappear on pressure; more accurately speaking, their colour is 
pale bluish-grey, a good light being required in which to see them. The 
spots may at times measure 2 and even 3 cm. across, they are most 
noticeable in skin regions that are sparsely haired, and usually disappear 
in about a week after removal of the lice. It should be noted that the 
maculae do not occur on all persons that are infested with the louse 
(Moursou, Duguet, Gibier). 
Phthirus the causative agent. That the maculae are attributable to 
crab-lice only was first shown by French authors. Falot (1868) 1 regarded 
(2) Healthy youth of 19 years, admitted to hospital on two occasions with a temperature 
of 106-2-106'4° F., much pruritus, infested with an immense number of lice; the lad was 
bathed and his clothing changed, after which his temperature at once fell to normal. 
This case was communicated to Jamieson by Dr Wood, who has seen febrile attacks due 
to Pulex irritans, cured in the same way. 
1 I have been unable to trace this reference. The date is given as 1860 by Knott (1897); 
Brumpt (1910) cites Falot and Moursou (1868); Dubreuilh and Beille (1895, p. 138) who 
cite Falot (1868) give the fullest account, and I quote from them. Gibier, Hewetson, 
Blanchard, and others give no reference. Simon (1881) and Mallet’s (1882, vide Biblio¬ 
graphy) papers are unfortunately inaccessible. 
25—2 
