89 
F 
j rate is probably about 1 or 2 per cent, but liigber in old people; death usually occurs 
I from exhaustion. Sweet ( 1896 ) says that the death i-ate is slight, and Zipf ( 1896, p. 65 ) 
I states that the disease is very seldom fatal ; he has heard of only 1 fatal case this 
j year (1896), and this patient had always been of weak constitution. 
: Montana. — Spotted fever is very fatal, but perhaps not more so than Asiatic cholera 
j or yellow fever; it is more fatal in adult males than in women and children. Han- 
: bidge reports 12 fatal cases in 16; Gwinn, 30 fatal in 40 severe cases; St. Patrick 
i Hospital, 12 fatal in 15; McCullough, about 75 per cent fatal (McCullough, 1902, 
i pp. 225, 227). Anderson (1903c, p. 38) gives the case mortality as about 70 per 
I cent. The mortality varies within narrow limits from year to year; some years as 
I many as 90 per cent of those attacked dying. Wilson and Chowning (1903a, p. 65; 
; 1904a, p. 41) give tables showing the case mortality for various ages of males and 
I females (see above, under “Sex and age,”p. 37). Cases which are marked by the 
i eruption have a mortality of 70 to 80 per cent, but cases without the eruption are 
never fatal (1902a, p. 133; 1903a, p. 65; 1904a, p. 42). 
j Comparison. — In Texas fever the lethality varies greatly. The time of the out- 
' break will largely decide whether practically all of the animals attacked die or all 
j survive; a midsummer outbreak, when acute in its nature, is the most fatal. From 
' this there may be all gradations toward the mild, nonfatal form of late summer, 
(Smith and Kilborne, 1893, p. 23). Starcovici gives the lethality as about 50 per 
I cent for hemoglobinuria and 50 to 60 per cent for carceag. 
- In Texas fever death usually occurs from the fourth to the fourteenth day; in 
; hemoglobinuria, in various stages of the disease; in carceag, usually from the second 
to the fifth day. 
. DEATH. 
Idaho. — Death in adults and the aged results from toxemia and exhaustion 
i ( Bowers, 1896, p. 63) . Death usually results from exhaustion (Springer, 1896, p. 62) . 
It is usually due to lowered vitality from other causes, such as bad air and surround- 
ings (Sweet, 1896). 
i Montana . — Wilson and Chowning (190Ta, p. 41) have tabulated 88 
I cases with reference to date of death and have shown that in 69 of 
I these death occurred from the sixth to eleventh da^^s, inclusive. 
Adding to these statistics the cases recorded by Gates and those I 
have collected we find that death occurred on the — - 
I Third day in . . . 
' Fourth day in. . 
Fifth day in 
Sixth day in 
I Seventh day in . 
I Eighth day in. . 
I Ninth day in 
' Tenth day in . . . 
, Eleventh day in 
j‘; DIAGNOSIS. 
1 ■ SPECIFIC DIAGNOSIS. 
1 Idaho. — After once seeing and recognizing spotted fever the diagnosis is easy; there 
is no occasion for making a mistake; even the laity recognize it on sight; its peculiar 
habitat and endemic character, the severe aching pains in the muscles, joints, bones, 
and head, the absence of gastro-intestinal symptoms, the temperature range, the 
Cases. 
. 1 
. 1 
. 3 
. 13 
. 13 
. 14 
. 11 
. 13 
. 9 
Cases. 
Twelfth day in 6 
Thirteenth da.y in 4 
Fourteenth day in 2 
Fifteenth day in 2 
Eighteenth day in 1 
Twenty-second day in 1 
Twenty-seventh day in 1 
Twenty-ninth day in 1 
