The rose-colored spots appear at the end ofi the first week, usually over the abdomen and lower part of the chest; but they may be scattered over the body, and are found sometimes only on the back. They entirely disappear in the stage of convalescence, but return when there is a relapse.
They appear in successive crops, each crop not lasting longer than three or four days, and they leave a very slight discoloration. They are slightly raised above the skin, rarely vesiculated, and pressure causes them momentarily to dis appegr. The number of spots at one time may not exceed eight or ten, and only in occasional cases does it exceed fifty or sixty. They are never found on the cadaver. The number is not an in dication of the severity of the disease They are differentiated from acne by their small numbers, short duration, less papular character, and by their not con taining pus. The blood drawn from the spots frequently contains bacilli. They are sometimes absent, especially in chil dren.
Sudamina are found in the later stages of the disease when there has been much perspiration. They exist in the form of minute vesicles on the surface of the skin, which soon terminate in fine scales. Sweats are not usually present until the latter part of the disease, but in some cases they are a marked feature in every stage.
Throughout the disease the skin is, as a rule, hot and dry. The palms of the hands and soles of the feet present thick layers of epidermis of a yellow color.
More or less desquamation takes place, and the hair falls out during convales cence, but grows in afterward. Boils and abscesses often form on the back and buttocks during the stage of convales cence. Bed-sores are present on some cases. Bluish patches of irregular out line are occasionally seen in this as in other diseases. They are the result of deep pigmentation, and occur only upon the skin of those who have body-lice. The I ache cerebrale — a red line with white borders produced by drawing the nail over the skin—is a vasomotor phe nomenon which exists in this as well as in other fevers.
Deafness is very commonly present during the first week, and in severe cases it is more marked toward the end of the second week. It disappears during con
valescence unless there has been an in flammation of the middle ear, a condi tion which rarely occurs.
The conjunctive are often congested and the pupils dilated. Keratitis and iritis are sometimes present. The loss of accomodation is frequently found in convalescence, and an oculomotor paral ysis, the result of neuritis, has been re ported (de Schweinitz). Among rare complications may be mentioned retinal hemorrhages, double optic neuritis, atro phy of the optic nerve, cataract, throm bosis of the orbital veins, and orbital Inemorrhage.
Temperature. — In many eases when the patient first consults a physician the temperature has already reached 102° or 103°, but when a chart has been kept from the very beginning it shows a gradual rise from day to day peculiar to typhoid fever. There is a daily rise from morning to evening from about to and the tem perature of the evening is the same as that of the following morning. This gradual rise continues until the end of the first or beginning of the second week. It then remains constant, with daily re missions, until the end of the third and gradually falls during the fourth week. In the third week there may be three or four degrees of difference between the morning and evening temperatures. In the fourth week the fever is rather of an intermittent type, the morning tempera ture being normal and that of the even ing showing a rise of 2° or 3°. In the abortive form, the fever may disappear at the end of the first week.
In mild cases the temperature, which may at first rise as high as 102° or 103°, gradually subsides until it becomes nor mal toward the end of the second week.
When a high fever exists for a num ber of days in succession, it is an indica tion of the severity of the disease. Those cases in which the temperature rises rap idly at first to 104° or 105° are apt to be severe. The writer has, however, ob served instances in which the fever was high during the first four or five days, and afterward gradually subsided, and the course of the disease became mild and favorable.