1U4 
May IS. a. m. Temj:»eranire. lOl.S: p. m., 103.S; restless, twitching of mtisoles, 
labored breathing, rash becoming purple and more plentiful. 
May 19: Temperature alxmt the same as on previous day: pulse weaker: extremely 
nervous, restless; respiration rapid an<i labored: delirious all the time: thr:>wn into 
a state of tonus when touches! lightly anywhere on the l>xly. 
May 20: All symptoms more marker!: temperature about the same; rash profuse: 
delirium the most marked symptom: general rigidity of all parts of the body: twitch- 
ing of face muscles; unable to swallow. 
May 21: Died at 2.30 a. m.. preceded by coma: temperature at 1 o’clock was KM. 
Treatment was at first purging with calomel: continued use of calomel in 1-grain 
doses every 1 hours, also inunction of blue ointment: quinine per mouth in 5-grain 
doses: whisky, strychnine, and morphine throughout the last 3 'lays. 
The following additional notes on thi.s case were made by Doctor 
Ashbiirn : 
Personal history ^ previous to present illness , : W orking in lumber camp on Harvey 
Creek, where no spotte^i fever ha*! previously been. 
Present illness: Bitten by tick at Harvey Creek about May 5 elate not exact ). 
Bitten again after coming home. May 13, taken sick with chill, fever, general pain, 
and aching, llth. fell in door, sick. Seen by D'X-tor Pixley May 16. Temperature 
103.5- F. Slightly delirious. Aervous twitchings and trembling. Spots beginning 
to appear on flanks and legs, unusually small. Temperature rangel higher in after- 
noon I to about KM- > . Kept growing worse, twitching, tossing all the time. Spots 
increased gra*lually and darkencl until at death patient had blue areas the size of 
the hand. Became more sensitive and irritable until at last the slightest touch would 
cause violent jump, almost a convulsion. Breathing irregular when awake, regular 
when sleeping. Had sore throat early and very slight nose bleeii. Bowels O. K. 
Rawng almost to time of death. Comatose for a few hours. Urine not examinei. 
Physical examination negative except the skin. Bash when seen by me very fine. 
Treatment: Calomel internally, mercurial inimctions. Quinine. 5 grains ever}* 4 
hours. Alorphine as necessary. Formalin ab*tut 5 minims at entl. Died Saturday 
night. May 21. 
Case r. — Attending physician. Dr. J. W. Howard (patient 
-een also and microscopic examination made by Doctors IMcGrath. 
A^hburn. and Stilesc 
Report of a case of so-called “SP'>tted Fever" at Hamiltox. 19CM, by 
Dr. .T. W. Howard. 
< T. M., male, agel 10 years, was brought to Hamilton from his home. S miles south- 
west of here, on the west side of the Bitter Root River. He came rni'ler my obser- 
vation 5Iay 14. 1904. 
The eruption at the time was very faintly marked, though he had been sick for 3 
or 4 days; temperature, 103" F. : pulse, 110: very restless; appetite absent through- 
out entire sickness. Died May 22. s a. m. 
The nose bled, not excessively, but frequently, for the last 5 days before death. 
The eruption was very backward anti slow in coming out, and in fact never became 
pronounc-el. He had a convulsion S or 10 hours before death: do not know whether 
he had others later: during the convulsion he had slight opisthotonos. Disturbance 
of nervous system was market throughout his illness by thrashing around in bet. roll- 
ing of the head, and throwing the arms; he could not be made to lie upon his left side 
for a minute at a time, but woul'l immediately throw himself upon his right si*ie or 
his back. Answere>i questions intelligently up to within a few hours of death. 
