1(t ASHBURN AND CRAIG. 



marked in the urine of July 28, and the pulse was that day dicrotic. The 

 eruption showed on the hard palate and the fauces, and some cough was present. 



August 1 : The present condition is indicated by the foregoing notes, there 

 having been no change. 



August 2 : The patient is sluggish and stupid. The eruption is still present 

 but is not prominent ; the eyes are injected and suffused, the spleen is tender but 

 not palpable; respiration is rapid and the pulse feeble. The patient sleeps well 

 and has had no delirium. 



August 3: The urine contains considerable albumen and numerous coarsely 

 granular casts. The patient sleeps much and perspires freely, the pulse is 85 

 but very weak, the heart sounds feeble. There is no cough; breath sounds 

 everywhere harsh. The eruption still shows on the face and chest, but is 

 fading. The eyes are much injected. The tongue is dry, white in the center, 

 glazed at the margins, the papilla; prominent; gums spongy; spleen tender, but 

 not palpable. 



August 4 : The general appearance and condition are about as yesterday. 

 The gums are very spongy and are bleeding. Cough is present and produces a 

 scant, tenacious sputum, much discolored with blood from the gums. Respiration 

 is rapid and somewhat irregular, the breath sounds harsh. The pulse is rapid, 

 irregular and of low tension, the first heart sound feeble. There is slight oedema 

 of the feet. The eruption remaining on the face is papular and the apex of each 

 papule shows a minute scab; the conjunctiva; are much injected. 



August 7 : Dr. Craig and I left on the 5th to visit another infected region 

 and on our return this morning we learn that the patient became progressive]}' 

 worse and died on the morning of August 6 with high temperature and cedema of 

 the lungs. Autopsy was not obtainable. 



Case II. — I. Basigawa; female; age, 13 years. 



Family history. — Negative as regards this disease. 



Personal history. — The patient has been in the tsutsugamushi infected region 

 and was bitten by a red mite on July 17, 1907. This is her first attack of the 

 disease. 



Present illnes. — On July 22 she had a. chill and next day entered the hospital. 

 At that time she had fever, a flushed face, weak and rapid pulse, poor appetite, 

 and diarrhoea, the last a very unusual symptom. The left femoral glands were 

 enlarged, painful and tender and just below them was the small ulcer resulting 

 from the mite bite. It was surrounded by a slightly infiltrated, pink border. 



On July 27 the spleen was demonstrably enlarged and the urine gave the 

 diazo reaction. It contained no albumen. The patient was delirious at times 

 and was extremely hypersensitive. The temperature is shown by Chart 2. 



August 1 : Eruption appeared this morning for the first time, showing on the 

 face. It is rubeolar in appearance, but scanty. Diarrhoea has ceased under 

 treatment. The pulse is growing weaker. Cough is present, but unproductive 

 of aught save pain, breath sounds everywhere harsh. 



August 2 : The patient slept well last night and is not delirious. The pulse 

 is rapid and feeble; cough persists and causes abdominal pain; hyperasthesia is 

 very marked, and pain causes the patient often to moan. The abdomen is par- 

 ticularly painful and tender, but is not distended or rigid. The bowels are loose. 

 There is a dusky, faint, scattered, macular eruption on the face, arms and legs. 

 Tenacious mucus in the throat excites cough and nausea. 



August 3 : Face dusky, eyes congested, eruption less distinct ; tongue dry and 

 glazed and its papilla; prominent. Hyperesthesia, abdominal pain and diarrhoea 

 persist. Patient slept poorly last night and is delirious. Respiration rapid and 



