Some cases present a prodromal period lasting a day or so with malaise and chilly sensations followed by the symptoms noted above. Hyperaesthesia and photophobia are apt to be present during the course of the disease.
The eruption first appears from the second to the fifth day as macules about the wrists and ankles, thence spreading over the extremities and extending to the trunk. These macules tend to become petechial.
The Pulse.—The pulse is not very rapid (90-110) and the fever steadily rises day by day from the initial 102°F to reach a maximum of about 105°F. by the end of a week or so. A toxaemic condition appears early.
A stuporous state is fairly common but in many cases the mind is clear throughout the course.
The spleen is palpable early in the disease and is quite firm, not soft like the spleen of typhoid fever.
The kidney involvement shows itself early as an albuminuria.
Constipation is rather a constant feature.
Icterus and vomiting tend to come on later in severe cases.
Gangrene.—Gangrene of the tonsils, scrotum and prepuce are more common in the milder type of the disease, as seen in Idaho, than in the more severe one of Montana.
There is leucocytosis early in the disease, falling to about 10,000 after a few days. There is an increase in the large mononuclears. The eosinophiles are decreased in percentage.