27 
extended over side of head and down neck with shooting- pains to 
shoulder, arm, and hand. Patient had marked chill, followed hy fev^er. 
On April 20 spots appeared on hands and feet, extending up fore- 
arms and legs and appearing on hack in a few hours. Patient was 
seen on this day i)V Dr. Brooke, of Stevensville. No record of pulse, 
etc., was kept, but the 
after death of patient; 
following 
figures were obtained from 
nurse 
Temperature. 
April 20 
105.0 
April 24 
. 103.0 
April 21 
101.0 
April 25 
. 100.2 
Aj)ril 22 
99.0 
April 26 
. 100.0 
April 23 
105.0 
April 27 
. 98.0 
Pulse ran from 00 to 120 throughout the disease, until the last 
twenty-four hours. Respiration normal at first, l)ecame more rapid 
and labored until a few hours before death, then gradually grew 
weaker. Mind was clear throughout the course of the disease until 
a few hours before death. After initial constipation bowels were 
regular without medicine. Tongue was coated throughout course 
of disease. 
Patient was examined April 27, at 2 p. m., by Drs. Brooke and Wil- 
son. Temperature normal, pulse 108, respiration 30 and labored. 
Face and limbs much swollen. Mind fairly clear, but some stupor. 
Skin over whole of body, and especially of dependent portions, showed 
spots of dark red to purple in color and from 1 mm. to 3 cm. in diam- 
eter. Over the legs and forearms a marked marl)led appearance was 
produced. Fresh blood showed relatively large numbers of red blood 
cells which contained parasites. Count showed — 
Red blood corpuscles 4, 368, 000 
Leucocytes 7, 800 
Hemoglobin percent.. 60 
Patient died on April 28, 1 a. m. No autopsy was performed. 
Case 118, 1903. 
E. F., age 48 years, residence 4 miles north of Stevensville, on main 
road. (See map, p. 8.) Had been bitten many times by ticks during 
the spring of 1903. Had no remembrance of any single severe bite 
shortly before illness. W as not feeling well on Sunday, April 19. 
Had a chill on April 20, followed by fever with morning remissions 
during the next two da^^s. Spots began to appear April 22, first on 
extremities. Were well marked April 23, when patient was first seen 
b}" Dr. Bryce, of Stevensville. Patient at this time presented ,the 
usual symptoms of headache, fever (temperature 103), aching pains in 
back and limbs, and constipation. Patient was given calomel 10 grains 
and quinine sulphate 40 grains l)y the mouth. Patient examined 
