103 
L Female; school-teacher; age 24 year’s; single. 
Family historj’: Parents and brothers and sisters are living and in good health. 
No hereditary disease in family. 
Personal history (previous to present illness) : Measles in childhood. No other 
sickness. Been living at Woodman, in this county, since last September, teaching 
school. Kept house. No chickens. Just finished menstruating. 
History previous to admission: Positive she has had no tick bites or other bites of 
any kind. Chill night of the 12th. Headache and fever continued then to present. 
Came here next day. Eruption appeared yesterday afternoon. 
May 16. Symptoms: Quite calm facies; tongue has heavy, white, moist coat. 
Throat slightly sore, but shows no marked injection. No appetite. Bowels at pres- 
ent slightly constipated. Face slightly flushed. Spots on face, arms, hands, and 
body, etc. Heart sounds clear and regular. Breathing normal and sounds clear, 
front and back. Splenic dullness increased. Hepatic apparently diminished. Pass- 
ing urine normally. Vomits practically everything taken by mouth. No nausea or 
pain in stomach. Headache present. 
May 18: Condition good. Heart rapid and slightly weak and patient vomits a 
great deal, but otherwise is doing well. Bowels 0. K. Patient slept well last night. 
Spots not brighter and seem to be fading. Mind clear. Headache improved. 
May 23: Informed to-day by Doctor Mills that patient continued to do well until 
afternoon of May 21, when her respiration ceased. As heart was acting well, artifi- 
cial respiration was resorted to. In five minutes patient breathed, roused, and was 
quite rational. Failure of respiration continued to occur at intervals, patient appar- 
ently forgetting to breathe. She died about 7 a. m. May 22. Hypodermics of mor- 
phine apparently acted as respiratory stimulant (Dr. Mills). Urine examined by 
Ashburn, passed May 18, contained albumen; reddish, yellow, turbid, acid, 1,028; no 
microscopic examination. 
Later notes: Temperature on fourth day was 103° F. On day of death was 104° F. 
Treatment consisted principally of morphine in considerable doses. Diet was light, 
but almost everything was vomited unchanged soon after taking. This was also true 
of beer, which the patient had requested. 
190If. Case 6 . — Attending physician, Dr. Charles Pixley (patient 
seen and microscopic examination of blood made by Doctors Pixley, 
Mills, Ashburn, and Stiles). 
Eeport of a Case of so-called “Spotted Fever” in 1904. By Charles 
Pixley, M. D. 
Male patient, F. W., aged 21 years, of rather neurotic temperament. At one time 
he had used tobacco to excess. Two weeks prior to my first visit, which was on 
May 16, 1904, he had worked at Harvey Creek, a few miles east of Bock Creek, and 
parallel; also opposite to Quigley. 
Patient was bitten by ticks at Harvey Creek; also at home at Missoula after his 
return. He had brought bedding home with him. 
He had been complaining for about a week before I saw him. Two days prior to 
my visit he had fallen against the door at home, and he then went to bed. When 
first seen by me he had a temperature of 103° F., with headache, backache, and leg- 
ache; also felt restless. Small pink macular spots were present on legs, arms, and 
trunk; face of a florid complexion, but without visible spots. 
May 16, p. m.: Temperature, 103; respiration rapid; pulse good, but rapid; nervous 
symptoms marked; restless; talk a little incoherent. 
May 17, a. m. : Temperature, 102; nervous symptoms more marked; p. m., tem- 
perature rising until 9 p. m.^ 103.6; rash still more marked. 
