116 
A Possible Case of ‘‘Spotted Fevek” ix Utah, by R, J. Smith, M. D. 
[Personal letter, dated May 22, 1904, to Dr. Thonias D. Tuttle, secretary Montana State board of 
health.] ' 
I have a case that looks to me very much like wood-tick disease, “spotted fever.” 
The patient, female, age 24, was visiting in Idaho, where within 2 miles of the 
place she was visiting, there were 2 cases of “spotted fever,” but I have been 
unable to obtain information as to onset, symptoms, etc. One young man recovered, 
left in very weak condition. 
Ten days ago this patient of mine was bitten in four places by 2 ticks, the ticks 
penetrating the right leg below the knee. 
The parts became very painful and swollen and in three or four days the patient 
suddenly became very ill, severe nausea, intense headache, backache, sore muscles, 
pains in limbs; could not sit u]i without dizziness and nausea; did not vomit. 
Her mother brought her home on Friday; I was called Saturday, 21st, and found 
temperature 103.5°, jmlse 92, eyes very bright, some roseolous spots on wrists, arms, 
back, abdomen, ankles; patient very nervous, stiff neck, no spinal tenderness, no 
hyperesthesia; numb all over, some twitching of muscles of forearm and legs. Tem- 
perature at 1.30 p. m., 103.5°; 4p. m., 103°; 10 p. m., 103°; this (Sunday) a. m., 104°. 
Temperature same all evening and night. Bathing had no effect. When face was 
first touched with cold water during the bathing chill came on; quite severe. Xo 
elevation of temperature afterwards. 
This morning spots all over body, on palms and soles; not papular except here and 
there; look like the roseola of typhoid fever; no pain, no nervousness, slight hacking 
cough, nausea completely relieved, no tenderness over spine, an occasional pain in 
ankles, muscles without stiffness, neck freely movable, eyes very bright, urine free; 
temperature 104, pulse 98; bowels moved freely; slept well, no opiates used. Gave 
cicutine hydrobromate, gi’ain, every hour until pain and stiffness relieved last 
evening — 4 doses removed pain, etc. 
My diagnosis is held in abeyance. 
BIBLIOGRAPHY. 
The following bibliography contains the complete medical literature 
on Rocky Mountain ‘hspotted fever, so far as it is known to me, 
except for certain references which have been published in text-books 
and based upon the references here given. 
signifies that the paper in question may be consulted at the 
libraiw of the United States Department of Agriculture; at the 
Surgeon-Generars library, United States Army; Lib. Stiles, in my 
private library at the Hygienic Laboratory, United States Public 
Health and ]\Iarine-Hospital Service. 
Altox, R. H. [M. D., Livingston, Mont.] 
1905. — [Two possible cases of “spotted fever” at Livingston and Gardiner, 
^Montana, 1904] <Bull. 20, Hyg. Lab., L". S. Pub. Health & Mar. Hosp. Serv., 
tVash., pp. 110-111. 
Ameeicax Medicixe. 
1902. — Strange disease induced by tick bite. [Xews item.] <Am. Med., 
Phila., V. 4 (10), Sept. 6, p. 365. [W% 5V“.] 
1902. — Spotted fever induced by tick bite. [Correction of p. 365.] <Am. 
Med., Phila., v. 4 (13), Sept. 27, p. 485. [W% W“.] 
