104 
May 18, a. m. Temperature, 101.8; p. m., 103.8; restless, twitching of muscles, 
labored breathing, rash becoming purple and more plentiful. 
May 19: Temperature about the same as on previous day ; pulse weaker; extremely 
nervous, restless; respiration rapid and labored; delirious all the time; thrown into 
a state of tonus when touched lightly anywhere on the body. 
May 20: All symptoms more marked; temperature about the same; rash profuse; 
delirium the most marked symptom; general rigidity of all parts of the body; twitch- 
ing of face muscles; unable to swallow. 
May 21: Died at 2.30 a. m., preceded by coma; temperature at 1 o’clock was 104. 
Treatment was at first purging with calomel; continued use of calomel in ^-grain 
doses every 4 hours,, also inunction of blue ointment; quinine per mouth in 5-grain 
doses; whisky, strychnine, and morphine throughout the last 3 days. 
The following additional notes on this case were made by Doctor 
Ashburn : 
Personal history (previous to present illness) : Working in lumber camp on Harvey 
Creek, where no spotted fever had previously been. 
Present illness: Bitten by tick at Harvey Creek about May 5 (date not exact). 
Bitten again after coming home. 5Iay 13, taken sick with chill, fever, general pain, 
and aching. 14th, fell in door, sick. Seen by Doctor Pixley May 16. Temperature 
103.5° P. Slightly delirious. Xervous twitchings and trembling. Spots beginning 
to appear on fianks and legs, unusually small. Temperature ranged higher in after- 
noon (to about 104°). Kept growing worse, twitching, tossing all the time. Spots 
increased gradually and darkened until at death patient had blue areas the size of 
the hand. Became more sensitive and irritable until at last the slightest touch would 
cause violent jump, almost a convulsion. Breathing irregular when awake, regular 
when sleeping. Had sore throat early and very slight nose bleed. Bowels 0. K. 
Paving almost to time of death. Comatose for a few hours. Urine not examined. 
Physical examination negative except the skin. Rash when seen by me very fine. 
Treatment: Calomel internally, mercurial inunctions. Quinine, 5 grains every 4 
hours. Alorphine as necessary. Formalin alx)ut 5 minims at end. Died Saturday 
night. May 21. 
190 Case 7.— Attending physician. Dr. J. W. Howard (patient 
seen also and microscopic examination made by Doctors McGrath. 
Ashburn. and Stiles). 
Report of a case of so-called “Spotted Fever” at Hamilton, 1904, by 
Dr. J. W. Howard. 
Cl. 51., male, aged 10 years, was brought to Hamilton from his home, 8 miles south- 
west of here, on the west side of the Bitter Root River. He came under my obser- 
vation 5Iay 14, 1904. 
The eruption at the time was very faintly marked, though he had been sick for 3 
or 4 days; temperature, 103° F. ; pulse, 110; very restless; appetite absent through- 
out entire sickness. Died 51ay 22, 8 a. m. 
The nose bled, not excessively, but frequently, for the last 5 days before death. 
The eruption was very backward and slow in coming out, and in fact never became 
pronounced. He had a con\'ulsion 8 or 10 hours before death; do not know whether 
he had others later; during the con\’ulsion he had slight opisthotonos. Disturbance 
of nervous system was marked throughout his illness by thrashing around in bed, roll- 
ing of the head, and throwing the arms; he could not be made to lie upon his left side 
for a minute at a time, but would immediately throw himself upon his right side or 
his back. Answered questions intelligently up to within a few hours of death. 
