92 
It seemed to me that cases occur which are not so easily differenti- 
ated symptomatically from some cases diagnosed as cerebrospinal 
meningitis, as the above remarks would lead one to believe. However, 
“spotted fever-’ does not show post-mortem lesions which would 
justify us in classifying it as meningitis. (See also page 79.) 
DENGUE. 
Idaho . — Dengue or breakbone fever is an epidemic, contagious disease, found only 
in subtropical climates. Its onset is abrupt with chill and intense pains in head and 
back, followed by high fever for from 1 to 5 days, when there is an intermission of 
all symptoms for a day or two, followed by a second paroxysm of fever and pain. 
There is a scarlatinal rash during the first paroxysm, and a characteristic erythem- 
atous rash or rubeolus eruption accompanies the second paroxysm. Nausea and 
vomiting are common, and the average duration is only 8 days (Maxey, 1899.) 
Montana . — Dengue is a disease of tropical or subtropical countries, whereas spotted 
fever occurs at an elevation of from 3,000 to 4,000 feet above sea level. The swollen 
joints, pleomorphic eruption over the joints, never petechial, apy retie period, and 
short course of the disease would differentiate it from spotted fever (Anderson, 1903c, 
p. 39). 
PURPURA HiEMORRHAGICA. 
Purpura hgemorrhagica occasionally accompanies severe cases, the hemorrhagic 
spots becoming as large as the thumb nail ( McCullough, 1902, p. 226). Purpura in this 
region [Bitter Root Valley] is manifested by the eruption being generally confined 
to the lower extremities, a less systemic disturbance than in spotted fever (Gwinn, 
1902). 
PELIOSIS RHEUMATICA. 
In peliosis rheumatica, the sore throat, multiple arthritis with purpura and urtica- 
ria, and comparative rarit}^ of the disease, offer a sufficiently distinct clinical picture 
( Anderson, 1903c, p. 39) . 
“ BILIOUS FEVER.” 
“ If seen at first, and it be a mild attack, it [spotted fever] very much resembles bil- 
ious fever or biliousness with constipation. However, if the patient has been chilly 
and the skin appears congested, the eyes congested as well as jaundiced, and it be at 
a locality and time when this disease may be suspected, it should not be overlooked 
in the diagnosis. If it be a severe attack, the danger of mistaking the two diseases is 
very much lessened by the pronounced chill, high fever, and inordinate aching, they 
being more severe than in biliousness” (Gwinn, 1902). 
MEASLES. 
Idaho . — If a case of spotted fever is not seen until the spots are well out, it might 
be mistaken for a case of measles; but when we take into consideration the epidemic 
and contagious nature of measles, the characteristic catarrhal symptoms referable to 
the respiratory tract, the elevated, crescentic, crimson eruption, and the presence of 
Koplik’s spots, we should not hesitate long (Maxey, 1899, p. 438). 
Montana . — When the eruption is new it may be mistaken for that of measles, but 
close examination shows the eruption to be purely macules, and not in the' least 
elevated (Gwinn, 1902). 
Treatment. 
GENERAL PRINCIPLES. 
Idaho . — “No abortive or reliable curative treatment has as yet been discovered. 
The disease is self-limited and a large portion of cases recover without any internal 
medication. Treatment of individual cases is governed by the rational and symp- 
