eruption, rash, red, colour, seen, fever and spots

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The digestive organs are usually deranged, partly on account of the fever ; partly on account of the mucous membrane of the stomach sympa thizing with the general derangement. The tongue is thickly furred ; there is often vomiting ; and the bowels may be relaxed.

The characteristic eruption appears as a rule on the fourth day, having been preceded by three clear days of catarrh and fever. In rare cases it is seen on the third day ; or, again, it may be delayed until the fifth, or even longer ; but these are exceptions. There is seldom any appreciable sub sidence of the fever on the appearance of the rash. Indeed, the opposite is usually the case. Both the fever and the catarrhal symptoms seem to be intensified when the rash comes out ; and if diaiThcea have not been present before, the bowels generally become loose.

The eruption is first seen about the chin, the temples, and the fore head, as slightly elevated spots of a yellowish red colour, which disappear under pressure. Small at first, they soon reach one and a half or two lines in diameter, and have irregular edges. From the face the rash soon spreads to the trunk and limbs, and in twenty-four hours is generally found to cover the whole surface of the body and extremities. As it spreads, the borders of neighbouring spots unite so as to form crescentic patches. Between these the skin is of normal colour, unless the eruption be very profuse, in which case, as we often see on the face, the junction of the closely set spots may produce a uniform blush over a considerable extent of surface.

As the rash becomes more completely developed, its colour grows of a deeper red ; and if the skin be very moist, vesicles with an inflamed base may be seen scattered over the surface. A child with the eruption fully out and the catarrhal symptoms well marked, presents a very character istic appearance. His face is somewhat swollen, so that the features appear thick and coarse. A dull red flush occupies each cheek ; and the forehead, mouth, and chin are speckled over with the crescentic patches. The eyes are red ; the eyelids congested ; and the upper lip is excoriated by the copious flow of thin mucus from the nose. Often crusts of dried blood

are seen about the nostrils, for epistaxis is a very common symptom. The rash remains at its height for about twenty-four or forty-eight hours, and then begins to fade. The colour changes again to a yellowish red, and in a day or two has disappeared, leaving nothing on the skin but a faint red dish stain, which may last for a few days longer before the normal colour of the integument is completely restored.

There are varieties in the rash. Sometimes the spots when they first appear are hard, scattered, and prominent. These are the cases which are often mistaken for variola. Sometimes the eruption does not completely disappear under pressure, and we then often find little points of extrava sation from rupture of small capillaries in the skin. This occurs in cases where there is great of the cutaneous tissue. It is of no bad augury. A further degree of the same phenomenon is sometimes seen in which the eruption grows darker and darker until it has acquired a deep purple tint. This is also the consequence of rupture of distended cutane ous capillaries. Such a rash does not disappear with pressure, and re mains visible for a much longer time than an ordinary eruption, fading very slowly.

The fever and catarrh remain at their height until the rash begins to fade. The severity of the catarrhal symptoms varies very much in differ ent epidemics and with different patients. Sometimes all the mucous membranes seem to suffer : the throat is sore ; the eyes are inflamed ; there is deafness from closure of the Eustachian tube, and the inflammation may even spread to the middle ear ; vomiting may be distressing, and purging severe ; a mild laryngitis may become intensified and be accom panied by spasm (stridulous laryngitis). All these symptoms are usually greatly relieved when the eruption begins to disappear ; and if there be no complication sufficiently serious to maintain the pyrexia, the tempera ture falls at once to nearly its natural level, and the pulse loses much of its frequency.

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