112 
petechite are present over the entire body except the face. There is great muscular 
soreness, including the muscles of the eye. Has slept but little the last 2 or 3 nights. 
Temperature, 102f° F. 
April 24: Patient feels better, eruption is not so well marked. He had a chill this 
a. m.; temperature, 102° F. ; pulse, 64. 
April 25: Patient complains bitterly of backache and pain in ankles and knee 
joints; temperature, 103° F. ; pulse, 64. 
April 26: Patient has had two chills this a. m.; anorexia complete; says he feels 
very tired; temperature, 102f° F. ; pulse, 72. 
April 27 : Bowels moved twice during last 24 hours without laxative or enema. 
The cough is not so troublesome; the eyes are very sensitive to light; the spots are 
very conspicuous; temperature, 101f° F. ; pulse, 62, full and regular. 
April 28: Complains of frontal headache and severe, heavy, aching pains in the 
tibiae; the spots are very red; the insomnia persists; temperature, 103° F. ; pulse, 70. 
April 29: Patient has had a slight chill, this a. m.; the pain has left the legs; the 
eruption shows very bright and red; bowels loose; urine much reduced in quantity, 
no albumen; temperature, 102.7° F., pulse, 66. 
May 1: Patient says he feels very much better; free from all muscular soreness and 
pain; slept fairly well last night; has some desire for food; the spots appear very 
dark red; temperature, 101.5° F. ; pulse, 70. From this date the patient gradually 
recovered strength and was able to resume his work about the ranch June 1. This 
case was below average in severity for cases occurring in this valley. Of special 
interest in connection with this case are the slow pulse and repeated chills. 
The following facts, I believe, are unique as regards the theory of the tick-bite 
origin of the disease, being, so far as I am aware, the only recorded instance in which 
a tick, after having bitten a patient suffering from “ spotted fever ” has then become 
detached from the patient, bitten a second person, and this second individual thereby 
contracting the disease. This is what actually occurred. The second party devel- 
oped the disease in its most severe type, ending in death. (See p. 113.) 
On May 29, Mr. C. A. H., of Bridger, Mont., visited the Clarke Fork Canyon, some 60 
miles south of this place. He remained in the vicinity of the canyon about 4 da^’s 
and while there Avas bitten in 5 or 6 places by ticks. About 7 days from the time he 
was first bitten by the ticks, viz, June 5, he arrived at his home in Bridger, at which 
time he felt the first symptoms of the onset of the disease. When he arrived home 
there were two ticks attached to his body which of their own accord, or from friction 
of the clothes, became detached from the body on June 6 and then bit his wife, who, 
on June 12 — that is, after a period of incubation of 6 days — developed the first symp- 
toms which marked the first symptoms of the disease. The petechiae occurred on the 
3d day. The following is a rather meager clinical history of the disease as it occurred 
in husband and wife. 
Case 15. — C. A. H., male, age 46; occupation, stockman; residence, Bridger, Mont. 
June 10: The patient is a large man, weighing about 198 pounds; has indulged 
A^ery freely in alcoholics the past 3 years; has neA’er been sick excepting 2 years ago, 
Avhen he had smallpox. On the legs and abdomen are the marks of seA’eral tick 
bites, one of them on the ankle being A^ery tender and around it a dark, bluish spot. 
There are noAV a number of small petechial spots on feet and hands, this being the 
fourth or fifth day since the onset. The conjunctivae are congested, temperature 
103f° F., pulse 97. He complains of general muscular soreness, severe backache, 
headache, and of being Axry tired and exhausted. No appetite AvhateA^er. BoAvels 
are constipated, urine dark and shoAvs a trace of albumen. During the course of the 
disease, Avhich lasted 20 days in this case, the dry cough Avas most troublesome. 
Nervous symptoms Avere not marked. The urine was much lessened at times; 
besides a slight amount of albumen, it contained numerous blood and epithelial 
