SPOTTED FEl'ER OF THE ROCKY MOUNTAINS 375 



enlarged and soft. Kidneys are congested, sometimes with sub- 

 capstilar haemorrhages. 



Microscopically one finds capillary congestion of the viscera with 

 excess of leucocytes. Extravasation into and pigmentation of the skin. 



Acute parenchymatous degeneration of heart muscle, spleen, liver 

 and kidneys. 



SYMPTOMATOLOGY. 



Incubation. — Two to seven days. 



Prodromata. — Pains radiating from irritating tick bites, malaise, 

 nausea. 



Oiisc't. — Fairly sudden with chill, severe headache, pains in back, 

 temperature 103° to 104° F., furred tongue, dried skin, congested con- 

 junctiva?, dry cough, epistaxis, febrile urine. 



Course. — Temperature gradually rises to 105° to 107° F. from the 

 sixth to the twelfth day. 



There is an eruption about the third day on the wrists and ankles, 

 co\ering the bod}- in two days. 



The macules, i to 5 mm. in diameter are not raised, at first they 

 disappear on pressure, then become permanent and later petechial, 

 sixth day. There is also a dusky red mottling of the skin. 



In very mild cases the eruption may be absent. 



The pulse is no to 150, becomes weaker, often dicrotic and may 

 be irregular. There is a slight reduction of the red cells and hb. with 

 a slight increase of leucocytes. 



In severe cases oedema of the face and limbs may be present. 



Constipation is troublesome. 



There may be mild bronchitis with a slight increase in respiration. 



The urine may show a trace of albumin with a few granular casts or 

 it may be suppressed in bad cases. 



From the fifth to the twelfth day the tvphoid state may lead to 

 death. 



If not, then lysis about the eighteenth day and convalescence. 



COMPLICATIONS. 



Pneumonia is common. 



Gangrene of the fingers and toes and the skin of the penis and 

 scrotum may occur. 



Nephritis, cardiac weakness and meningitis are not unknown. 



DIAGNOSIS. 



Typhoid fever may be troublesome. It has, however, a more in- 

 sidious onset, the nature and commencement of the rash are difTerent, 

 there are intestinal symptoms and a Widal reaction can be done. 



