Page:Tropical Diseases.djvu/341

XV] cases in which it is supposed to be absent, being slight, it is overlooked. As stated, the eruption is rubeolar in character. It usually commences on the palms and backs of the hands, extending for a short distance up the forearms Its development is often associated with sensations of pricking and tingling. On the palms of the hands the spots are at first about the size of a small pea, circular, dusky red, and sometimes slightly elevated. The eruption quickly extends, and is best seen on the back, chest, upper arms, and thighs. In these situations it appears at first as isolated, slightly elevated, circular, reddish-brown, rubeoloid spots, from one-eighth to one-half of an inch in diameter, thickly scattered over the surface, each spot being isolated and surrounded by sound skin. After a time the spots, enlarging, may coalesce in places; thus irregular red patches from 1 to 3 in. in diameter are formed. Or perhaps there is a general coalescence of spots, isolating here and there patches of sound skin; in this case the islands of sound skin give rise, at first sight, to the impression that they constitute the eruption— a pale eruption, as it were, on a scarlet ground. In a few instances the whole integument may be covered with one unbroken sheet of red. The rash is usually most profuse on the hands, wrists, elbows, and knees; in these situations it is generally coalescent, and there, too, it may be detected though absent elsewhere. The spots disappear on pressure, and never or rarely become petechial. They fade in the order in which they appear— first on the wrist and hands; then on the neck, face, thighs, and body ; last on the legs and feet. Slowing of the pulse as the fever advances, and leucopenia as in yellow fever, have been remarked.

Desquamation.— Desquamation may go on for two or three weeks. In many it is trifling in amount; for the most part it is furfuraceous. Rarely does the epidermis peel off in flakes of any magnitude; never in the broad sheets seen after scarlatina. Often for a day or two desquamation is accompanied by intense pruritus. Convalescence.— In some instances, and in some