39 
90 per cent of those attacked dying. The cases which have occurred 
near Bridger, Mont., show about the same mortality. Death usually 
occurs between the sixth and the twelfth da}x The abundance of the 
eruption apparently bears no relation to the severity of the disease. 
The disease in Nevada and Idaho is not nearly as fatal as in Montana. 
Dr. Maxey says of the Idaho cases: 
The prognosis in spotted fever is, as a rule, very favorable if the patient is trans- 
ferred to the lower valleys where he can have home comforts and proper care. The 
disease seems to be more malignant in some localities than it is in others, and in one 
year than in another. 
DIAGNOSIS. 
Cases occurring in the infected localities and presenting a history of 
tick bites, chill, pain in head and back, muscular soreness, constipation, 
macular eruption, first on the wrists and ankles, appearing on the 
third da}" of illness, becoming petechial in character, do not present 
much difficulty in diagnosing spotted (tick) fever. A blood examina- 
tion should be made in all suspicious cases. There are five diseases 
which might cause some difficulty in differentiating them from spotted 
fever. 
DEXGUE. 
This is a disease of tropical and subtropical countries, whereas spot- 
ted fever occurs at an elevation of from 3,000 to d,000 feet above sea 
level. The swollen joints, pleomorphic eruption over the joints, 
never petechial, apyretic period, and short course of the disease would 
differentiate it from spotted fever. 
CEREBRO-SPIXAL MEXIXGITIS. 
The stiffness of the muscles of the neck, photophobia, sensitiveness 
to sudden noises, headache, and rigidity of the muscles of the back 
and neck, with the not altogether constant irregularly situated rash, 
should not cause much trouble. 
PEEIOSIS RHEUWATICA. 
In this disease the sore throat, multiple arthritis with purpura and 
urticaria, and comparative rarity of the disease, offer a sufficiently 
distinct clinical picture. 
TYPHOID FEVER. 
Clinically this disease closely resembles spotted fever, but the rose 
spots appearing first on the abdomen — papular in character — diarrhea, 
AVidal reaction, and presence of the typhoid bacilli in cultures from 
the blood of typhoid fever, and the presence of parasites in the red 
blood cells of spotted fever, suffice to separate distinct!}" the two 
diseases. 
