102 
Blotches have disappeared from face and ordinary spots abundant there. Spots 
generally darkening. Now plum color, but not distinctly petechial. Lungs— Sounds 
very harsh all over front and back, with large coarse rales; 6 p. m., comatose all day; 
respiration rapid. Face dusky. 
]\Iay 13: Quinine discontinued last night. Patient then comatose, breathing very 
rapidly and promised to die in a few hours, at most, as lungs were rapidly tilling 
with fluid. This morning face darkly flushed, coma deep, great perspiration. Ees- 
piration will be for a time quiet and regular, for 5 or 10 minutes, and then very rapid 
(60) for a time. Spots no darker. 
May 15: Filling of lungs progressed yesterday; edema well marked. Spots increased 
in size and darkened. Menstruation began for 1 hour yesterday and stopped. Began 
again last night and flowed freely until death. Urine and feces passed involuntarily 
and abundantly. Coughed freely yesterday. Finger nails this a. m. dark, face 
purple, much noise from breathing. Extremely offensive odor to breath. Dependent 
side of face turned black immediately after death, at 8 o’clock a. m. to-day. 
190 Jf, Case — Attending plwsician, Doctor Merrick (notes pre- 
pared b}" Doctor Ashburn, from memoranda by Doctor Merrick; pa- 
tient seen and microscopic examination of blood made by Doctors 
Merrick, Ashburn and Stiles). 
Diagnosis: Spotted fever. 
INIay 12. Symptoms: Severe intra-cranial and supra-orbital neuralgia, supra-scapular 
and lumbar pains. Tongue slightly furred and fissured. Anorexia. These symp- 
toms dated from May 8,1904. An eruption covering the legs to the knees. 
May 13: The neuralgia considerably improved under codeine. The eruption in- 
creasing. Complains of illusions. Anorexia. 
jMay 14: Eruption elevated and extended over trunk to face and arms. General 
condition prostrated. Pulse full. Blood examination for parasites negative. 
May 15: Eruption dusky in morning, becomes brighter through the day, completely 
covers body and palms of hands. Complains of pains in head. Sleeplessness and 
illusions and weariness. Many red blood corpuscles are deformed. Blood exam- 
ined by Doctor Ashburn. 
May 16: Eruption possibly cleared. Patient feeling better; bowels moved freely. 
Temperature, 100; respiration, 20; pulse, 80. Anorexia and illusions persist, with 
prostration. Doctor Ashburn and Doctor Stiles made blood examination. No organ- 
isms were found. 
May 17: Headache continues; fever 101.4. Illusions and prostration. No erup- 
tion on back, fading on arms and face. General condition of anxiety. 
May 18: Headache relieved; condition improved. Eruption fading. Temperature, 
100; pulse, 90. Sat in chair for one hour. Complains of weakness.* 
IMay 19: Temperature normal; pulse and respiration normal. Illusions disappear. 
Spots fading, only perceptible on limbs. Pains gone; tongue still coated; appetite 
returning. 
May 21: Patient sitting up; weak and extremely nervous; spots about entirely 
faded away. Appetite improved and patient sleeps well. No anatomical lesions 
apparent. 
N. B. — Doctor Merrick’s note about the eruption covering the whole body evi- 
dently refers to its general distribution, as it was nowhere abundant, and was the 
lightest eruption occurring in any case this year. 
lOOIf.. Case 5 . — iVttending physician, Doctor Mills (notes prepared 
by Doctor Ashburn; patient seen and microscopic examination of blood 
made by Doctors Mills, Ashburn, and Stiles). 
