110 
to the size of 2 lists and measures 11 cm. broad by 13 cm. long; soft, normal in appear- 
ance for a recently delivered uterus. The left ovary normal, as is the right, which 
contains corpus luteum. On section womb appears normal. Aspiration of spinal 
canal through the lumbar region withdrew 15 c. c. clear spinal fluid. Dura appar- 
ently normal. Spinal cord removed. On removing dura from cord showed con- 
siderable injection of vessels, Avhich was probably hypostatic. Xodymph exudation 
or other evidence of inflammation. Cross section of the cord at 1-inch intervals 
shows nothing abnormal. Xo scales present and organs could not be weighed. 
The folloTvino- notes have been sent to me hv Dr. R. D. Alton, of 
Livingston. Mont. : 
1904: (f) Case 12. — E. S., age 71, United States, came to St. Lukes Hospital, having 
been sent to me with the diagnosis “spotted fever.” 
Upon admission, May 14, 1904, he stated that he noticed 4 ticks in the vicinity of 
the left elbow, about 10 days ago. 
Upon closely questioning him, stated he saw the ticks 11 days ago, or on the 3d of 
May. He further said he saw the rash on the body a few days after observing the 
ticks; that the arm “swelled up as large as two arms and was as red as a beet.” 
From the arm the rash spread all over the body. He is positive regarding the 
presence of the ticks. He is equally positive that he was not bitten by anything 
else. Upon removing his clothing the odor of the body led me to ask him if he had 
ever had measles, to which he replied, yes. 
Temperature on admission was 102° F. This gradually declined to normal. 
At no time was he delirious. He complained of great soreness all over the body; 
his feet were exquisitely tender and continued so until he left the hospital. May 
27, 1904. 
The urine on admission was scanty and highly colored, no sugar or albumen 
found. His diet while in the hospital consisted of fruits, vegetables, buttermilk, 
lemonade, etc. 
He was given a combination of equal parts of Pulv. Glycyrrhizte Comp, and Potas- 
sium Bitart., in water, to regulate the bowels, with Basham’s Mixture after meals. 
In addition, he was given sour Ehine wine during the day. 
He made an tmeventful recovery, the rash disappearing from the face, forehead, 
trunk, arms, body, and lower extremities in the order named. 
On the 25th of May his daughter called on him; from her I learned that measles 
were present in the vicinity from which he came — Lewiston, Meagher County, Mont. 
The history, together with your negative findings, lead me to believe it was practi- 
cally a case of measles, occurring in an old, poorly nourished, scorbutic patient. 
1904: (.^) Case 13 . — On Sunday, June 12, 1904, I saw Charles E., age 26, Lhiited 
States, at Gardiner. Park County, 5Iont. 
L'pon examination found a cicatrix on the inner aspect of the left leg, middle third. 
Mas told he had been bitten by a tick, 12 days previously. 
At the time of my visit he was delirious, j^icking at the bed clothing, muttering, 
and rolling restlessly from side to side. Pupils dilated and irresponsive to light, 
patellar tendon relex exaggerated, ankle clonus pronounced. Tongue furred, bowels 
constipated, urine scanty and high colored. Xo albumen or sugar, Sp. gr. 1030. 
Temperature m axilla at 5.41 p. m., 104° F. 
Ordered Sod. Bromide, grains xv, every 3 hours to produce rest, ice bags to head, 
and a hot, mustard, footbath. 
While preparing to catheterize, he passed a fair quantity of urine, involuntarily. 
Further ordered he be given a glass of water every hour, with a glass of equal parts 
milk and water, every 4 hours. I inclose specimens of blood taken June 13, 1904. 
On the 13th was informed by telephone that he had rested well, nervous symptoms 
