89 
rate is probably about 1 or 2 per cent, but higher in old people; death usually occurs 
from exiiaustion. Sweet (1896) says that the death rate is slight, and Zipf ( 1896, p. 65) 
states that the disease is very seldom fatal; he has heard of only 1 fatal case this 
year (1896), and this patient had always been of weak constitution. 
Montana . — Spotted fever is verv fatal, but perhaps not more so than Asiatic cholera 
or yellow fever; it is more fatal in adult males than in Avomen and children. Han- 
bidge reports 12 fatal cases in 16; Gwinn, 30 fatal in 40 severe cases; St. Patrick 
Hospital, 12 fatal in 15; HcCullough, about 75 per cent fatal (McCullough, 1902, 
pp. 225, 227). Anderson (1903c, p. 38) gives the case mortality as about 70 per 
cent. The mortality varies within narrow limits from year to year; some years as 
many as 90 per cent of those attacked dying. Wilson and Chowning (1903a, p. 65; 
1904a, p. 41) give tables showing the case mortality for various ages of males and 
females (see aboA^e, under “Sex and age,”p. 37). Cases Avhich are marked by the 
eruption have a mortality of 70 to 80 per cent, but cases Avithout the eruption are 
neA’er fatal (1902a, p. 133; 1903a, p. 65; 1904a, p. 42). 
Co.AiPARisox. — In Texas fever the lethality A’aries greatly. The time of the out- 
break Avill largely decide Avhether practically all of the animals attacked die or all 
surviA'e; a midsummer outbreak, Avhen acute in its nature, is the most fatal. From 
this there may be all gradations toAvard the mild, nonfatal form of late summer. 
(Smith and Kilborne, 1893, p. 23). Starcovici giA’es the lethality as about 50 per 
cent for hemoglobinuria and 50 to 60 per cent for carceag. 
In Texas fever death usually occurs from the fourth to the fourteenth day; in 
hemoglobinuria, in A'arious stages of the disease; in carceag, usually from the second 
to the fifth day. 
DEATH. 
Idaho . — Death in adults and the aged results from toxemia and exhaustion 
( BoAA’ers, 1896, p. 63) . Death usually results from exhaustion (Springer, 1896, p. 62) . 
It is usually due to lowered A’itality from other causes, such as bad air and surround- 
ings (SAA’eet, .1896). . 
2[ontana . — Wilson and Chowning (190da, p. 41) have tabulated 88 
cases with reference to date of death and have shown that in 69 of 
these death occurred from the sixth to eleventh days, inclusive. 
Adding to these statistics the cases recorded by Gates and those I 
have collected we find that death occurred on the — 
Third daA" in 
1 
Fourth da\" in 
1 
Fifth daA^ in 
3 
Sixth daA' in 
13 
Seventh daA" in 
13 
Eighth da A" in 
14 
Ninth daA' in 
11 
Tenth claA’ in 
. 13 
EleA^enth day in 
9 
Twelfth day in 6 
Thirteenth day in 4 
Fourteenth day in. 2 
Fifteenth day in 2 
Eighteenth day in 1 
TAventy-second day in 1 
Twenty-seA^enth day in 1 
Twenty-ninth day in 1 
DIAGNOSIS. 
SPECIFIC DI.AGXOSIS. 
Idaho . — After once seeing and recognizing spotted feA’er the diagnosis is easy; there 
is no occasion for making a mistake; eA^en the laity recognize it on sight; its peculiar 
habitat and endemic character, the seA’ere aching pains in the muscles, joints, bones, 
and head, the absence of gastro-intestinal symptoms, the temperature range, the 
