The first symptoms announcing the approaching bleeding usually appear about noon on Thursday. Upon each of the rosy spots on the hands and feet, a _bleb_, or little bladder, is seen to rise and slowly develop. This exactly corresponds, when fully formed, with the size of the patch; and is filled with a transparent serous fluid, sometimes of a reddish tint in those on the soles of the feet and the palms of the hands. The bleb consists of the epidermis detached and elevated from the true skin by the accumulating serous fluid. No swelling or redness is seen in the zone of skin immediately surrounding the bleb. The bleeding nearly always begins between midnight and one A.M. on Friday, and it does not occur in all the stigmata at once, but in each successively and in no regular order. Most commonly the flow begins from the side of the chest, then in succession from the stigmata on the hands, feet, and forehead. A rent occurs in the raised cuticle, which is sometimes longitudinal, sometimes crucial or triangular: the serous fluid then escapes, and is immediately followed by blood, which oozes from the exposed papillæ. Usually the flow of blood detaches and washes away the shreds of epidermis, and the bleeding surface is left uncovered; but sometimes on the palms of the hands and the soles of the feet, where the epidermis is thicker, the blood collects and clots in the bleb. At each of his Friday visits, Dr. Lefebvre examined the stigma on the chest, which lay in the space between the fifth and sixth ribs, external to and a little below the centre of the left breast.[50] At the first examination, which was made August 30, 1868, the bleeding point showed no trace of a previous vesicle; the cuticle was not detached, nor was the skin discolored, and the blood was seen to ooze from three little points almost imperceptible to the naked eye, and about one centimetre apart. In three subsequent examinations a vesicle had formed like those on the hands and feet; it had burst, and the blood oozed from a circular spot of the raw skin nearly a quarter of an inch in diameter. Upon four different occasions, blood was observed to be flowing from the head. It was difficult to ascertain the condition of the skin under the hair; but on the forehead no vesicle appeared, nor was there any apparent change in the color of the skin. The blood was seen to issue from twelve or fifteen minute points arranged in circular form upon the forehead. A bandage, of the breadth of two fingers, passing around the head equidistant from the eyebrows and the roots of the hair, would include the bleeding zone, which is slightly puffy and painful upon pressure. On examining these points with a magnifying 176 lens, most of them looked like minute cuts in the skin, of triangular shape, as if made by the bite of microscopic leeches: others were semilunar in shape, and some quite irregular.