10 
The kidneys are often «li5mr]:>ei: they may be enlarge*!. Bladder , p. S3 1 normal 
r.r nearly se». The urine is reporte*! as re*inced in amonnt. slightly above normal in 
color t-:- highly colore*!: specinc gravity I.OIS to 1,030; reaction acid, so far as rei>c>rted; 
albumen present or ah«sent; sugar and bile not reported: granular, bloo*!, hyaline, 
and epithelial c-asrs are rep*orte*i: hematuria and hemcrglobinuria absent or slight. 
Menstruation is delaye-i by attack, and abortion is rep<jrted for pregnant ’^vomem 
•Several authors refer to relap«ses, following muscular exertion or expeenre to cold. 
Hyp«jstatic pneumonia, rheumatism, and gangrene are among the meet freiguent 
complicati;-ns p. ^7 mentione*!: pneumonia pre*iominates in frequency. 
Ce*nvalescence p, S7 ' may be rapid or very slow, lasting ten to twelve weeks or 
even longer. 
Prcrgnosis p. SS seems to be favorable t lethality about 1 to 3 per cent ) in s*jme 
places (,as in Idaho » : but it is very unfavorable in others (as in Bitter Boot Valley -. 
where cases in which the eruption is marke*i show a lethality of about 70 per 
cent. .See aIs-:> under ’‘sex and age," page 37. and •‘number of cases." page 29. 
Death p. S9 occurs fre-m thiri to twenty-ninth «!ay. usually from sixth to twelfth 
•lav. 
Local physicians agree that <iiagnc«sis p. S9 is not difficult, and even the laity 
recognize the 'iisease on sight: its peculiar geographic and seasonal distribution, 
endemic character, severe aching pains in the muscles, joints. bc>nes. neck, and 
head, appearance of ncnelevate*! spots on the sec-ond to seventh day, at first rc«se- 
colore*! and <:>n wrists, ankles, and tack, <iisappearing momentarily on pressure, 
rapiily sprea-iing to entire bo*iy. and becoming <iarker. and then not disappearing 
on pressure, the fre«guency of c-onstifation. the coate*! tongue, acc-elerate*! pulse, 
temperature, icterus, and expression denoting profound intoxication of entire system, 
lead the local physicians to the <iiagnosis of "spotted fever.’’ 
It is generally admine*! that the <iisease resembles typhus p. 90) more than it 
dc-es any other malady: s*ome cases resemble c-erebrospinal meningitis i p. 91 j ; com- 
pare also typhoid, dengue, peliosis rhenmatica, etc.. i p. 92 >. 
•Satisfactory specific treatment p. 92 ■ is unknown. 
Clinical histories ip. 100- of cases, and a bibliography i p. 116) of the subject are 
addeti. 
I have no new theories tc* present regarling the cause, transmission, and origin of 
this 'iisease. 
Emring the invesrlgations I incidentally found several new sp>ecies of parasites 
which I hope to descril'e s>:-n. an-i three of which I propc»se to dedicate to Doctors 
Anders*^n. Ashbum. and Buckley. 
Tate of manuscript. January 14. 1905. 
lATEODucnoy. 
Pursuant to orders from the .Surgeon-General, dated May lOCM. 
1 visited the Bitter Root Valley to study the so-called ** spotted fever" 
("tick fever." "piroplasmosis horn inis") from it zoological point of 
view, and remained there from May 7 to July 6. 19«M. 
The special object of my detail wa^ to trace the life cycle of the 
parasite [PiropJa-sma hortunis) which had been described as the cause of 
the disease, to >tudy the tick which was supposed to transmit it. and to 
trace the disease in the burrowing squirrels, in which it was thought 
to originate. The points at i^NSue. it will be seen, bore more directly 
upon discovering some method of prevention than upon a study of the 
symptomatology. 
As the seasonal duration of the outbreak is short, and as the parasite 
