91 
gious” (see above, p. 44). — McCullough, 1902, p. 225. Gwimi (1902) says: “I have 
been unable to find any marked difference by which to distinguish it [spotted fever] 
from this disease [typhus], save that typhus is by most authors given as a conta- 
gious disease, while the affection under discussion certainly is not contagious, and 
does not occur in crowded, filthy places, like jails, etc., as does typhus. Had this 
difference not existed I should never have claimed that this disease was one not 
described by medical literature. That one is contagious while the other is not is 
such a radical difference that one can not be justified in calling them the same. 
Either we have a disease to contend with heretofore undescribed by authors or most 
of our authors are mistaken as to the contagiousness of typhus.” Anderson 
(1903c, p. 40) says: “Spotted (tick) fever, I think more closely resembles typhus 
fever than other disease, and cases of typhus fever occurring in a locality in which 
spotted fever prevails would, without a blood examination and close bedside obser- 
vation, cause much trouble in diagnosis. In typhus we have a longer period of 
incubation, absence of a history of tick bites, the eruption which first appears on the 
abdomen and chest, its intensely contagious character, especially prevalent in the 
winter months, not limited to a short time in the spring, and marked nervous symp- 
toms. As before mentioned, two cases of spotted fever have never been known to 
occur in the same family the same season (see, however, abo-ve, p. 43), thus conclu- 
sively showing the noncontagious character of the disease.” 
TYPHOID. 
Idaho . — Many patients after a few days pass into a typhoid condition (Springer, 
1896, p. 62). Epistaxis, diarrhea, and other abdominal symptoms, the scattering, 
petechial eruptions not appearing until the end of the first week, the absence of 
severe pains in the muscles of the limbs and back, the nerve symptoms, the char- 
acteristic tongue, and the greater prevalence in the autumn, render the differentiation 
quite plain; in the 3 or 4 cases of spotted fever in which Ehrlich’s diazo test has been 
used the result has been negative (Maxey, 1899, p. 437). 
Montana.— AX the. onset, the whole facies in spotted fever is in certain respects 
typhoid (Wilson and Chowning, 1902a, p. 132; 1903a, p. 62; 1904a, p. 37). Anderson 
(1903c, p. 39) says that typhoid resembles spotted fever, but the rose spots appearing 
first on the abdomen — papular in character — diarrhea, Widal reaction, and presence 
of typhoid bacilli in cultures from the blood of typhoid fever, and the presence of 
parasites in the red cells of spotted fever (see, however, above, p. 90), suffice to sep- 
arate distinctly the two diseases. 
MENINGITIS. 
Idaho . — Before death, children have symptoms of meningitis (Bowers, 1896, p. 63). 
Maxey (1899, p. 437), in speaking of meningitis, refers to its occurrence in winter, 
its malignancy, its predilection for children, sudden onset with chill or convulsion, 
the severe headache or vomiting, painful rigid or contracted condition of the muscles 
of the back of the neck, with opisthotonos, the irregular fever, the scattering petechial 
or purpural eruption not present in all cases, the hyperesthesia, disorders of special 
senses, stupor or coma. 
Montana . — Gwinn (1902) mentions in one case rigidity of the muscles of the neck 
and back, very much resembling that of cerebrospinal meningitis; when spotted 
fever is seen after the eruption begins to darken it may be distinguished from cerebro- 
spinal meningitis by the absence of the typical vomiting, the rigidly contracted 
muscles of the neck and back, the herpes, and the irregular, low-averaging tempera- 
ture of the latter disease. McCullough (1902, p. 225) considers spotted fever as dis- 
tinct from meningitis. Anderson (1903c, p. 39) says in reference to meningitis that 
“the stiffness of the muscles of the neck, photophobia, sensitiveness to sudden noises, 
headache, and rigidity of the muscles of the back and neck, with the not altogether 
constant irregularly situated rash, should not cause much trouble.” 
