105 
Xever complained of pain at any time, except occasionally when asked if his head 
ached, he would answer “Yes.” Was seen by Doctors Ashburn and Stiles on May 
20; they took blood samples for examination; examination negative; temperature 
ranged throughout from 97.5° to 105° F. ; pulse from 85° to 125° per minute; bowels 
and urine both acted regularly and without assistance. The basis of treatment was 
quinine sulphate in large doses; other medication as indicated from time to time. 
In addition to the above account I mav olve the followino- notes 
made by Doctor Ashburn: 
Family history: Father killed. Mother alive and well. One sister died of whoop- 
ing cough. One sister recovered from spotted fever under quinine 3 years ago. 
Personal history (previous to present illness): Had chills and fever 6 years ago. 
Measles and whooping cough. Xo other sickness. 
History previous to admission: May 11, complained at noon of being sick. Had 
nausea and headache. Slept that afternoon and was feverish and had headache and 
stomachache. On washing neck on first day complained of tenderness. 5[ay 13, 
spots showed on hips. 
May 14, seen by Doctor Howard. Then stupid, restless. Temperature 103.5° F. ; 
pulse, 115. Tongue had heavy moist coat. Xo pain except in bowels, from cathartic. 
Xo diarrhea, cough. Or sore throat. After medicine, bowels loose. Has -eaten 
practically nothing yet. 
Physical signs: Temperature from 103° in evening to as low as 99° in morning. 
Vomiting more or less aP through attack. Vomit greenish yellow. 
Present condition, May 20: Expression dull. Very restless and tossing. Xau-seated 
much of time. Xosebleed at times. Lips dry, blood stained, and crusted. Tongue 
dry, brown, and somewhat glazed. Vomit contains blood, thought to be from nose. 
Eruption general, fine purplish. Less marked on face. Xeck shows discoloration, 
yellowish. Heart sounds clear; respiration harsh, especially on right side. Spleen 
enlarged. Convulsions at 8 p. m.. May 21. Died at 2 a. m.. May 22. The daily 
dosage of quinine to May 20, was: 45, 45, 36, 48, 32, and 35 grains. 
190 Case 8 . — Attending physician, Doctor Minsball; patient seen 
by Doctors Minshall, Gwinn, Ashburn, and Stiles; microscopic exami- 
nation made by Ashburn and Stiles. 
[Dr. Minshall’s notes.] 
Bitten by tick in 4 places Sunday night. May 15, 1904. Slight chill in afternoon 
of May 17. Was sick the following night and day. tVas seen by Doctor Gwinn the 
evening of the 18th, who cauterized and dressed the tick bites. Temperature at that 
time said to have been 102. Severe headache, but no pain in back or limbs. I took 
charge of patient on May 19, at 5 o’clock p. m. Headache, but no pain elsewhere; 
coated tongue, intense thirst, but no nausea. 
May 20: Condition much the same as yesterday, bowels moving freely. 
May 21: Xo headache, no pain, no spots at 10 a. m., but skin presents a mottled 
appearance. At 2 p. m. spots appear quite distinctly on wrists and chest. By 5 p. m. 
all spots have disappeared. Skin of a decidedly mottled appearance. 
Sunday, 22d: Xo change from yesterday. Appetite fairly good, mind clear, no 
pain in any part of the bodv. 
Monday, 23d: Xo change since Saturday, except patient sleeps more, mind less 
active, some muttering during sleep. 
Tuesday, 24th: Spots make appearance in decided manner over entire back, upper 
limbs, and chest. Xervous symptoms increa.se^ more dullness,, with slight delirium; 
in fact, sleeps most of time. 
