10 
The kidneys are often disturbed; they may be enlarged. Bladder (p. 83) normal 
or nearly so. The urine is reported as reduced in amount, slightly above normal in 
color to highly colored; specific gravity 1,018 to 1,030; reaction acid, so far as reported; 
albumen present or absent; sugar and bile not reported; granular, blood, hyaline, 
and epithelial casts are reported; hematuria and hemoglobinuria absent or slight. 
Menstruation is delayed by attack, and abortion is reported for pregnant women. 
Several authors refer to relapses, following muscular exertion or exposure to cold. 
Hypostatic pneumonia, rheumatism, and gangrene are among the most frequent 
complications (p. 87) mentioned; pneumonia predominates in frequency. 
Convalescence (p. 87) may be rapid or very slow, lasting ten to twelve weeks or 
even longer. 
Prognosis (p. 88) seems to be favorable (lethality about 1 to 3 per cent) in some 
places (as in Idaho); but it is very unfavorable m others (as in Bitter Boot Valley), 
where cases in which the eruption is marked show a lethality of about 70 per 
cent. See also under ‘‘sex and age,” page 37, and “number of cases,” page 29. 
Death (p. 89) occurs from third to twenty-ninth day, usually from sixth to twelfth 
day. 
Local physicians agree that diagnosis (p. 89) is not difficult, and even the laity 
recognize the disease on sight; its peculiar geographic and seasonal distribution, 
endemic character, severe aching pains in the muscles, joints, bones, neck, and 
head, appearance of nonelevated spots on the second to seventh day, at first rose- 
colored and on wrists, ankles, and back, disappearing momentarily on pressure, 
rapidly spreading to entire body, and becoming darker, and then not disappearing 
on pressure, the frequency of constipation, the coated tongue, accelerated pulse, 
temperature, icterus, and expression denoting profound intoxication of entire system, 
lead the local physicians to the diagnosis of “spotted fever.” 
It is generally admitted that the disease resembles typhus (p. 90) more than it 
does any other malady; some cases resemble cerebrospinal meningitis (p. 91) ; com- 
pare also typhoid, dengue, peliosis rheumatica, etc., (p. 92). 
Satisfactory specific treatment (p. 92) is unknown. 
Clinical histories (p. 100) of cases, and a bibliography (p. 116) of the subject are 
added. 
I have no new theories to present regarding the cause, transmission, and origin of 
this disease. 
During the investigations I incidentally found several new species of pkrasites 
which I hope to describe soon, and three of which I propose to dedicate to Doctors 
Anderson, Ashburn, and Buckley. 
Date of manuscript, January 14, 1905. 
IXTEODUCTIOX. 
Pursuant to orders from the Suro'eou-General. dated Mav 2, 190L, 
1 visited the Bitter Root Valiev to study the so-called ‘‘spotted fever*' 
("tick fever,*' piroplasmosis hominis") from a zoological point of 
view, and remained there from May 7 to July 6, 190L. 
The special object of my detail was to trace the life cycle of the 
parasite (Piroplasma harninis) which had been described as the cause of 
the disease, to study the tick which was supposed to transmit it, and to 
trace the disease in the burrowing squirrels, in which it was thought 
to originate. The points at issue, it will be seen, bore more directly 
upon discovering some method of prevention than upon a study of the 
symptomatology. 
As the seasonal duration of the outbreak is short, and as the parasite 
