108 
left eye) ^vas present. She calmed him to sleep and the outward rotation was not 
present this morning. 
June 12; Still complaining somewhat of pain in neck and belly. Spots fading. 
Doing well. 
June 15: Pain in knees; temperature normal. Patient sitting up in bed and eating 
well. Spots all disappeared, but a few discernible on palms. 
June 17: Patient left hospital practically well. 
190 J^. Case 11 . — Attending physician, Doctor Mills (notes prepared 
by Doctor Ashbiirn from hospital chart and bedside; patient seen and 
microscopic examination made by Doctors Mills, Ashburn, and Stiles). 
Monday, June 20, 1904: Mrs. E., aged 23 years, married, one 9-months-old child 
living. Xow pregnant in the sixth month. Patient born in the Tyrol, Austria, and 
arrived in this country 4 weeks ago. Came to Missoula 19 days ago. Remained in 
town 5 days and removed to a ranch purchased on the Lo Lo. 
Saturday evening, June 18: Patient felt entirely well. That day she had merely 
tasted and then refused to eat veal because of bad odor. She had gone barefooted 
during the day and felt chilly, but it was a very cold day. That night she had 
occipital headache and could net sleep. 
Sunday, the 19th: She vomited. All day she ate nothing and felt feverish. At 
9.30 p. m. she started for Missoula, reaching here at 1 a. m. Slept at a hotel and 
came to hospital this morning. On her way to town she vomited bitter fluid. At 
present she has frontal headache, some tenderness of the back of the neck. IMany 
abrasions on the feet and legs, all said to be due to scratching mosquito bites. Tick bites 
denied. Eyes slightly injected, otherwise normal. No tenderness of eyeballs, scalp, 
or general surface. Tongue moist and shows a moderate white coating. No erup- 
tion. Spleen not demonstrably enlarged and not tender. Bowels regular. Temper- 
ature, 101° E. ; pulse, 105. Patient has had a slight cough for 2 weeks. Examina- 
tion of lungs negative. Heart sounds normal. 
June 22: Condition not so good. Pulse more rapid. Scattered measly eruption 
on body and limbs. Examination of the blood shows no protozoa. Leukocyte 
count 15,600. 
June 23: Spleen not demonstrably enlarged. Fetal movements felt. Examina- 
tion of lungs shows decidedly harsh respiratory sounds over the left apex anteriorly 
and posteriorly and over entire right lung posteriorly. Tongue red and moist, with 
white streaks. Eruption abundant on body, limbs, and face; measly, not petechial. 
Urinous (?) odor of breath. 
June 24: Had respiratory depression last night, respiration falling to 8. Fetal 
movements felt at noon today. Spinal puncture made at 4.30 p. m., negative. 
Patient’s general condition not so good as yesterday. Face somewhat dusky, spots 
darker, but not hemorrhagic. Sordes on lips and tongue. Patient very nervous. 
Urine, reddish-yellow, turbid; heavy yellowish precipitate; acid, specific gravity 
1,018; albumen j^resent in small amount; no sugar; no bile (Gmelin); urea, 3.5 per 
cent; abundant vaginal ei^ithelium and small round epithelium; numerous blood, 
epithelial, and granular casts; free red and white blood cells; much granular debris. 
June 25: Condition worse. Delirium constant and marked. Only 6 ounces of 
urine past 24 hours. Drawn by catheter. No fetal movements felt. Pulse very rapid 
and weak. Cyanosis present. 
June 26: Miscarriage at 2 a. m. Very rapid and not followed by much bleeding. 
Child lived an hour and showed no spots. Patient very restless and constantly 
delirious; at times violent. Alcohol seems to aggravate this. Face cyanosed, spots 
purple and somewhat increased in size. Urine, 8 ounces in past 24 hours. 
June 27 : Patient was bled last evening to the amount of 12 ounces, with marked 
