106 
Wednesday, 25th : Eruption all over the body. Hyperesthesia of skin very marked. 
High nervous tension, muscles of back and limbs very rigid. 
Thursday, 26th : Condition much the same as yesterday, with more or less coma. 
Friday, 27th: Almost complete coma; all nervous symptoms increased. 
Saturday, 28th: All conditions of two previous days more pronounced. A drink 
of water produces spasm of pharynx and diaphragm. 
Sunday, 29th: Previous conditions more marked; slight edema of right lung 
noticed at 8 o’clock p. m. 
Monday, 30th: Both lungs quite edematous. Eemained in this condition during 
the day, dying at 9.15 o’clock p. m. 
No photophobia at any time, pupils reacting to light up to and including 28th 
instant. 
[Doctor Ashburn’s notes.] 
Tick bites. May 14; chill, 16th; fever, slight sore throat, and eruption on 23d. 
May 26: Eruption profuse and measly everywhere but face. Temperature 103. 
Delirious. Tongue heavy, white coat, becoming dry and. brown. Abdomen gener- 
ally tender, especially right side. Hyperesthesia marked. Face flushed, conjunctivse 
injected. 
May 29: Comatose, spots purple, face still free. Eespiration 50, pulse 138, tem- 
perature 103. S]:)lenic dullness not obtainable. 
May 30: Seen at 8.30 p. m. with Doctor Minshall and Doctor Stiles. Patient 
comatose. Lungs tilled with fluid, so that loud rattling was heard throughout the 
room. Bubbling and crackling rales everywhere. Pulse weak, respiration 50. 
Patient evidently about to die, and decided to use bleeding followed by intravenous 
injection of 1:1000 formaline to normal salt solution. Patient died Avhile this was 
being done. Informed by Doctor Minshall, nurse, and mother tliat reflex excita- 
bility had been so intense for 24 hours that slight touch used in putting spoon to lips, 
sponging, etc., would cause spasm and rigidity of whole body. 
lOOIf-. Case 9 . — Report on case ^‘spotted fever” in 190L, by R. 
Gwinn, M. D. 
G. C. T., of Florence, Mont., farmer, aged 32 years. Has been tick bitten every 
day or so for the whole spring; he has disinfected the bites with carbolic acid. On 
the 26th instant, was taken with chills, fever, and headache. Seen by Dr. J. F. Brice, 
of Stevensville, Mont., on 27th instant, who administered “calomel and fever medi- 
cine.” Came to St. Patrick’s Hospital at 4 p. m. to-day, when I And the patieait 
complaining of headache and general soreness. Examination reveals many tick bites, 
together with an eruption all over like that of the “spotted fever.” Pulse 92, tem- 
perature 103. 2 under axilla. Pupils large. Eespiration slightly accelerated. Tongue 
heavily coated. No apparent eruption in mouth or throat. 
Diagnosis: The so-called “spotted fever.” 
May 29: Seems about the same. Pulse 100, temperature 103.2. 
May 30: Patient much the same, except eruption darker and the skin and con- 
junctivse more “jaundiced.” Pulse 104, temperature 103.2. Doctors Mills and 
Stiles see the case with me, when a search of 1 hour by each of us for the parasite 
described by Doctors Wilson and Chowning is made with a negative result. 
May 31, a. m. : Pulse 104, temperature in axilla 103.4; rested during latter part of 
night; injection of warm soapsuds causes good action of the bowels. Examiilation 
of eyes shows media a little blurred, so that the granular appearance of the retina 
can not he seen. The larger retinal blood vessels are quite plain, however; no swell- 
ing or blurring of disk; no hemmorhagic petechiae in retina. 
There is no stiffness of neck, and the head can readily be bent forward. No herpes. 
There is no pain complained of at Ml to-day; not even headache, and there was 
scarcely any yesterday. 
