88 
twelfth day in case 103. It was very slow in cases 113 and 114, 10 or 12 weeks pass- 
ing before the patients were able to work; health afterwards was not so good (Ander- 
son, 1903c, pp. 14, 15, 16. 17 ). See also Duration, page 42. 
Gates reports that his case Ao. 15 suffered from severe intercostal neuralgia during 
convalescence. 
CoMPAEisoxs. — ^In carceag convalescence lasts about 14 days. 
PROGNOSIS. 
Idaho . — Delirium or involvement of the nervous system is a had prognostic sign; 
the amount of fever is deceptive, as fatal cases may have a temperature not exceeding 
103° Bowers, 1896, p. 64). Prognosis is, as a rule, quite favorable, if the patient is 
transferred to the lower valleys, where he can have home comforts and proper c-are; 
the disease appears to be more malignant in some localities than it is in others; the 
recovery is, in the majority of cases, complete (5Iaxey, 1899, p. 438'). 
Montana . — If the patient he promptly and thoroughly treated as here set forth 
see below, p. 92) within 12 to 24 hours after the onset, nearly all attacks can be 
abated: but when the case is seen later, and the disease he not broken up, about 60 
per cent or more prove fatal i Gwinn, 1902). In milder cases, where symptoms are 
not so marked, in which the jaundice, delirium, high temperature, eruption, and 
systemic infection are slight or entirely absent, the prognosis is usually favorable; 
it is very grave in typical severe cases, but there is no doubt that many mild and 
moderately severe cases recover; where the systemic infection is pronounced, jaundice 
very plainly discernible over entire body, delirium of low muttering type, hemor- 
rhagic diathesis portrayed in the dusky appearance of the eruption, these cases 
invariably die; typical cases run a well-defined course, and patients surviving the 
fourteenth to sixteenth day are likely to recover i 5IcCur.ough, 1902, pp. 25, 27 1 . 
In ^Montana, cases of the mild type of the disease, which show no spots, are as yet 
too indefinitely differentiated to permit of their inclusion "with those of the severe 
type which invariably develop the eruption; that such cases exist there can be no 
doubt; they are never fatal; on the other hand, the cases which are marked by the 
eruption have a mortality of 70 to 80 per cent (Wilson and Chowning, 1902a, p. 133; 
1903a, p. 65; 1904a. p. 40 •. It is unsafe to prognosticate a favorable termination in 
a case of mild initial symptoms, since many such cases rapidly l>ecome fatal i Wilson 
and Chowning, 1903a, p. 66). Prognosis of cases in Idaho, Xevada, and Wyoming 
is much more favorable i Wilson and Chowning. 1904a, p. 41). 
The abundance of the eruption apparently bears no relation to the severity of the 
disease i Anderson, 1903c, p. 39). 
Gates (1905, p. 115 ) states that in his experience the cases in children have been 
mild. 
LETHALITY. 
See also page 37. 
Idaho . — The lethality is about 2.5 per cent; in fleshy subjects the disease is a 
serious affection, but particularly in the aged it is fatal; from the fifth to the eighth 
decade the lethality progressively increases from 5 to 50 per cent i Bowers, 1896, 
p. 64). Collister (1896, p. 63) reports that the death rate is not very high: in chil- 
dren it will not exceed 1 per cent, and in old age it varies from 4 to 5 per cent. 
According to Dubois (1896, p. 64), the lethality persists during the entire attack from 
14 to 28 days; it is not high, but weak subjects, and even strong ones, succumb from 
intercurrent affections of the bowels, kidneys, or heart; it may be called a nonfatal 
disease. In FairchikTs experience (1896) the death rate is low, jterhaps 2 or 3 per 
cent. Figgins (1896, p. 64) has seen but 1 fatal case in about 60 cases he treated, 
extending over a period of 14 years; death in this case, he believes, was superinduced 
by years of dissipation and by age. According to Springer (1896, p. 62) the death 
