42 
a feeling of malaise for a few days, gradually growing worse and merging into a well- 
defined “ bone ache” and slight chilly sensations, mostly in the morning. 
Wilson and Chowning (1902a, p. 132) say that many of the cases are preceded by 
a short period of malaise; this is followed by a marked chill, which is usually most 
severe at the beginning of the attack and recurs at irregular intervals, though with 
decreasing severity; at the onset there is a severe aching in the bones and muscles, 
with pain in the back and joints; the patient is usually very weak and the headache 
may be severe; constipation at this period is usually present; there is considerable 
restlessness; a bronchial cough is frequently present; the urine is small in amount 
and highly colored; albumen is sometimes present; the skin is dry and the tongue, 
even at the onset, is thickly coated; the coat at first is white, but it becomes brownish 
as the fever increases, while the tongue becomes dry and cracked; sordes appear 
early, and may be quite pronounced; indeed, the whole facies in these respects is 
like typhoid. Wilson and Chowning (1904a, p. 37) also report that cases Xos. 94, 
96, 97, 115, 116, 117, 119, and 120 gave a history of soreness about the tick bite and 
pains radiating therefrom which continued until the initial chill. 
According to Anderson (1903a, p. 50; 1903c, p. 21), the patient may have chilly 
, sensations, malaise, and nausea for a few days, then there is a distinct chill, and the 
person takes to l^ed; there is some pain in the back and head, soreness of the 
miLscles and bones, causing a sensation as if the limbs were in a vise; bowels con- 
stipated; tongue with heavy white coat, red edge and tip; conjunctiv£e congested, 
becoming yellowish; urine usually small in amount, with albumen and a few casts; 
slight bronchitis after a few days; nose bleed, sometimes quite severe, is always 
present. In case 74 (1903a, p. 15) the symptoms were about three days in reaching 
their height. 
Comparison. — In Texas fever the fever usually precedes the outward symptoms 
by .several days; pulse and respiration ri.se with the temperature; loss of appetite 
always, and cessation of rumination usually accompany the high fever after the 
third or fourth day. 
Hemoglobinuria begins with exhaustion, loss of appetite, and fever; carceag with 
chill, exhaustion, and fever. Canine piroplasmosis is ushered in by a fever and loss 
of appetite, followed by increasing prostration, ending in complete helplessness. 
Duration. 
Idaho . — The period of incubation is uncertain, probably 10 to 21 days; from the 
appearance of prodromal symptoms until convalescence, 12 to 20 days; average period 
of convalescence, 1 month, very infrequently several months; in 1 case, 2 years elapsed 
before sunlight was borne without intense cephalalgia (Bowers, 1896, p. 63). Accord- 
ing to Figgins (1896, p. 64) the duration is 14 to 42 days, the eruption showing for 4 
or 5 months after the patient is up and around, especially when subject to heat or 
physical exercise. Fairchild (1896, p. 62) gives the duration as 14 to 28 days. Springer 
(1896, p. 61) reports duration as 2 to 3 weeks. Sweet (1896, p. 61) states that the 
duration is 3 weeks to 3 or 4 months, i. e., although the fever may not last longer than 
21 days, the lesions may continue for months. The disease usually terminates in 
course of 2 or 3 weeks by lysis, usually in recovery (Medical Sentinel, 1899, p. 457). 
Montana . — Gwinn (1902) reports that one case persisted 3 months before recovery. 
Gates (1905) reports convalescence in 14 of his 17 cases as follows: 
In a few days, 1 case; 10 days, 1 case; 12 days, 2 cases; 14 days, 1 case; 
15 days, 1 case; 18 days, 1 case; 20 days, 1 case; 21 days, 1 case; 22 
days, 2 cases; about 25 days, 1 caae; 28 days, 1 case; not given, 1 case. 
See also Deaths, page 89. 
In the 2 Bitter Boot Valle}’ recovery cases of 1904 1 (Xo. 4) was 
