101 
evening; breathing easy after a hot bath; slept calmly about two hours; became very 
restless again about 10.30 p. m.; pulse very poor at 12, 
May 8: Choking spells about 12.30 a. m.; breathing very heavy; finally becomes 
unconscious; eyes bloodshot, pupils very much dilated; spots out in profusion; pulse 
good, but great struggle at times for breath. 
May 9: Patient very restless during the night until about 3 a. m., then sank into a 
comatose condition; much weaker; spots very purple; p. m., sinking spell; improved 
after subcutaneous saline injection; lungs filling up; mouth full of bloody matter. 
May 10: Finger nails turned purple, beginning at the tips about 1 a. m.; died with 
very little struggle at 1.25 o’clock a. m. 
190 Case 3 . — Attending physician, Doctor Fitzgerald (notes pre- 
pared partially from hospital records, partially at bedside by Doctor 
Ashbnrn: patient seen and microscopic examination of fresh and 
stained blood by Doctors Fitzgerald, Buckley, Ashburn, and Stiles). 
Female, age 28 years. Born in Xew Brunswick. 
Family history: Father died of piles (?), one brother of consumption. Mother 
and four brothers and sisters living and well. History otherwise negative. 
Personal history (previous to present illness): Had 3 children. Measles in child- 
hood, bowel trouble last sumner. 2so other .sickness. 
History previous to admission: Moved to present home in January. Had great fear 
of ticks and has watched for them and has not been bitten by them. Has had bites 
by chicken lice — last, probably about April 27. May 3 had chill. Backache and 
fever followed, and on May 7 eruption apj^eared on arms. Since that time, too, 
throat has been very sore. 
Condition on admission: Date, May 10. First seen by Doctor Fitzgerald on May 
7, 1904. 
Symptoms: Sore throat, fever, slight malaise, but claims to feel well. Body pre- 
sents on all parts a discrete maculo-papular eruption, very measly in appearance, but 
no crescentic arrangement. Xo purpura or petechise. Fauces and pharynx much 
injected and show adherent mucus-pus. Cervical glands enlarged. Xo eruption in 
mouth or throat. The tongue tremulous and has heavy, white, moist coat. Face 
placid. Blotched with eruptions. Eyes normal; mind clear. Heart sounds clear 
and regular. Lungs — Respiration slightly harsh and prolonged anteriorly; more so 
behind. Blowing over right upper lobe posteriorly. Xo cough. Spleen enlarged. 
Liver not enlarged. Abdomen not distended, tender, or painful. 51enstruated 
April 11th. Bowels have been regular; now loose from salt enemata. Urine passed 
normally. 
Diagnosis: Spotted fever. 
Treatment: Seventh to 10th, calomel first day and quinine sulphate, grains 15, every 
4 hours. Xext day salol, grains 5, and quinine, grains 10, every 4 hours. Strych- 
nine, grain, every 6 hours. Saline enema, 1 pint every 3 hours. Probably none 
of this was carried out as prescribed. 
May 11: Arrived at Sisters Hospital this a. m. Xervous on admission. Looks 
and says she feels better. Throat not so sore. Spots unchanged, possibly a trifle 
darker. Xot petechial. Skin presents faintest yellow tinge. Xo jaundice of scle- 
votics or tongue. Bowels moved after salt solution. AVas very drowsy all afternoon; 
restless between 4 and 5 o’clock. Retained saline enemas. Patient apparently 
thii-sty. Took nourishment; resting easy at 7.30 p. m. 
IMay 12: At about 8 o’clock became drowsy; by 8.30 very stupid. Stupor con- 
tinued all night with rapid respiration. Coma from 12 p. m. to 3 or 4 a. m. Bladder 
full at 3 a. m., when it was emptied for vesical irrigation. Xow, 9.25 a. m., in deep 
sleep or coma. Pulse 80 and of good quality. Respiration 39 and slightly stertorous. 
