26 
On April 19 the soreness became much worse, and shooting pains 
began radiating from the axilla through the shoulder, down the arm 
and side of the bod\^ Patient had a severe chill, followed by high 
temperature and aching pains in back. These gradually extended to 
the whole bod 3 ^ Patient felt better on April 20 and 21 in the morn- 
ing, but was worse again in the afternoon. 
On April 22 she was brought to St. Patrick’s Hospital, Missoula, 
and placed under the care of Dr. McCollough. On the evening of 
April 22 spots began to appear first on the wrist and ankles. On the 
morning of April 24 spots were well developed all over bod}-, being 
of the small petechial type and quite vosy in appearance. Patient’s 
mind at this time was quite clear (except for slight wandering imme- 
diately" after awakening) and remained so until a few hours before 
death. 
Patient examined April 24, 9 a. m., by Drs. McCollough, Gwinn, 
Spottswood, and Wilson. Fresh blood showed a few red cells which 
contained ovoidal bodies with amoeboid movements (an alcohol lamp 
was in front of concave mirror). Count showed — 
Red blood corpuscles 4, 920, 000 
Leucocytes 7, 400 
Hemoglobin per cent . . 100 
Cultures with blood taken from the ear were made on agar and 
serum. These showed no growth after three davs in the incubator. 
Patient was examined again April 26 by- Dr. Wilson. Condition 
was apparently" the same as Avhen last seen except the patient was 
more restless. Fresh blood showed many" more infected cells than that 
collected April 24. Count showed — 
Red blood corpuscles 4, 600, 000 
Leucocytes 7,600 
Hemoglobin percent.. 80 
Patient died at 10 a. m., April 27. (For temperature, pulse, etc., 
see accompanying chart.) 
On the afternoon of April 24 Dr. Wilson, in company" with Mr. 
D., examined the latter’s ranch and searched for ticks in the locality" 
where Mrs. D. was supposed to have gotten her infection. No ticks 
were found. 
Case 117, 1903. 
J. H. D. , age 34, residence one-half mile north and one-fourth mile 
west of Florence. (See map, p. 8.) 
Was bitten on top of the head and on left arm by" ticks on Thurs- 
day, April 16. Ticks, when removed on this date, were partially" 
filled with blood, having evidently been in place for some time. 
Wounds were sore before removal of ticks and continued so until 
disease was well developed. On April 20 soreness of wound on head 
