20 ASHBURN AND CRAIG. 



Army. These cases bear considerable resemblance to those of tsutsuga- 

 mushi disease and therefore it seems advisable to refer to them again 

 and more at length. 



Before discussing them it is well to mention the climatic conditions 

 under which they occurred. Camp Connell is located on the west coast 

 of Samar and lies but a few feet above sea level. At one side is a 

 low, flat stretch of land that was formerly a swamp, but it has been 

 drained and made into a target range. In time of very heavy rains 

 water still covers the range and it may be submerged for two or three 

 days at a time, or such was the condition in 1905 and 1906. The 

 ordinary annual rainfall at the post is about 330 to 400 centimeters, 

 and almost all of the precipitation occurs between the first of June and 

 the first of January. During January the target range generally be- 

 comes dry and hard. In 1905 the post suffered from drought, which 

 began in January and was not fully relieved until late in May. In 

 1906 there was again very little or no rain in January and a repetition 

 of the condition of the previous year was feared at the time that these 

 cases occurred. The condition of the target range in December, January 

 and February is somewhat similar to that of the tsutsugamushi infected 

 regions in Japan in June, July and August. 



One of us (Ashburn) happened to be at Camp Connell investigating 

 the question of water supply in February, 1906, and was asked to see the 

 two cases to be quoted, because of their resemblance to the spotted fever 

 of Montana. The notes to follow were made by Lieutenant Bruns 

 eighteen months before we saw anjr sufferers from tsutsugamushi disease 

 or considered the possible relationship between the two infections. 



Case A. — D. L. 0.; age, 29; private, Company M, Twenty-first Infantry. 



Family history. — Negative. 



Personal history. — The patient has had the usual diseases of childhood, pneu- 

 monia at 9 years and at 14 years of age, dysentery in 1901, malaria in 1901, 

 gonorrhoea and chancroids in 1905. 



Present illness. — January 29, 1906: For the past six days he has had head- 

 ache and pain in the back and has been feverish and constipated, but has had 

 no chill. He was admitted to the hospital this morning with the following symp- 

 toms and signs : Headache, pain over the kidneys, constipation, slight pain in 

 right iliac fossa, slight, dry cough; heart, lungs, liver and spleen normal. There 

 is an eruption of flat, rose-colored, irregular macules scattered over the ehest, 

 abdomen and legs, and about the anus. General glandular enlargement is pres- 

 ent, the right femoral glands being also painful and tender. (See Chart A.) 



January 30: No malarial parasites in blood; leucocyte count 5,400; urine 

 normal. 



January 31 : Glands in right femoral region more enlarged, tender and painful. 

 There is headache and slight abdominal pain. 



February 2 : Muttering delirium, nervous twitching and subsultus are present 

 this morning. The skin is mottled and the eruption increased on chest, abdomen, 

 neck, face, legs and about the anus. Tongue coated and dry, pulse dicrotic. 

 Femoral glands smaller. 



