106 
W e-iaes^iay . 2ot]i: Eruption all over the body. Hyperesthesia of skin very marke«i. 
High nervous tension, muscles of tiack and limbs very rigid. 
Thurs*lay. 26th: Condition much the same as yesteniay. with more or less coma. 
Fri'iay. 27th: Almost complete coma: all nervous symptoms increase-i. 
.Satuniay. 2Sth: All corniitions of two previous <ilays more pronounce*,!. A •irlnk 
of water pr«>luces sp>asm of pharynx and diaphragm. 
Sunday. 29th: Previous conditions more marke*!; slight e-iema of right lung 
noticed at S o'clock p. m. 
Monday. 30th : B<:>th lungs quite e»!ematous. Eemaine*! in this condition during 
the day, dying at 9.15 o'clock p. m. 
2so photophobia at itny time, pupils reacting to hght up to and including 2Sth 
instant. 
T>x-ror Ash-bun’? notes.] 
Tick bites, May 11: chili. 16th: fever, slight sore thrciat. and eruption on 23*1. 
May 26: Eruption pr*;»fuse and measly everywhere but face. Temperature 103. 
Delirious. Tcngue heavy, white coat, becoming •Try and brown. Ab*iomen gener- 
ally tender. esp*ecially right side. Hyperesthesia marke*!. Face hushed, conjunctivje 
injecte*!. 
May 29: Comat*;«se. sp»ots purple, face still free. Eespiratien 50. pulse 13S. tem- 
j*erature 103. Splenic 'lullness not obtainable. 
51ay 30: Seen at >.30 p. m. with Doctor Minshall an<! I>octor Stiles. Parlenr 
comatose. Lungs hlle*! with hui*l, s*:' that loud rattling was hear! throughout the 
room. Bubbliug and crackling rales everywhere. Pulse weak, respiration 50. 
Patient eHdently about to -lie. an*! decided to use blee*iing follower! by intravenous 
injection of 1:10»X) formaline to normal salt s*dution. Patient die*! while this was 
being done. Informe*! by Doctor INlinshall. nurse, and mother that reflex excita- 
bility ha*! been so intense for 24 hours that slight touch use*! in putting spK>on to lip*s. 
sp**:*nging. etc. . would cause sp»asm and rigi«!ity of whole bc"!y. 
— Report on ca^-e ** spotted fever" in by K. 
Gwinn. AI. D. 
G. C. T.. of Florence. Mont., farmer, age*! 32 years. Has !»een tick bitten every 
tlay or s*> for the whole spring: he has *!isinfecte«! the bites with carbolic acid. <!n 
the 26th instant, was taken with chilD. fever, and headache. _ .Seen by Dr. J. F. Brice, 
of .Stevens^^!ie. 5lont.. on 27th instant, who a*!ministere*! ** calomel an*! fever me*!i- 
cine." Came to St. Patrick's Hosp*ital at 4 p». m. to-*_lay. when I find the patient 
complaining of hea*:lache an*! general s*?reness. Examination reveals many tick bites, 
together with an eruption all over like that of the “sp*:»tte*! fever." Pulse 92. tem- 
perature 103. 2 under axilla. PupiD large. Eespiration slightly accelerate*!. Tongue - 
heavily coate*!. X*:* apparent eruption in mouth or threat. 
Diagnosis: The s«:M;alle*! ■*spK)tte*! fever." 
May 29: .Seems ab*:>ut the same. Pulse 10<j. temperature 103.2. 
May 30: Pittient much the same, except eruption <!arker an*! the skin and con- 
junctivfe more ” jaun*!ice*!." Pulse KM. temp*erature 103.2. Doctors Mills an*! 
Stiles see the case ^uth me. when a search of 1 hour by each of us for the parasite 
*!eseribe*! by D*iH?tors Wiis^i-n an*! C'howning is ma*le with a negative result. 
May 31. a. m.: Pulse 104. temp«erarare in axilla 103.4: reste! during laner part of 
night: injection of warm s*:*ap>su*!s causes g*x*d action of the bowels. Examination 
of eyes shows melia a little blurre!. s*d that t'ne granular app*earance of the retina 
can not be seen. The larger retinal blood vessels are quite plain, however: no swell- 
ing or blurring of *!isk: no hemmorhagic petechi^e in retina. 
There is no stiffness of neck, an*! the hea*! can readily be bent forwar!. 27o herpes. 
There is no pain complaine*! of at all to-*!ay: not even hea*!ache. an*! there was 
scarcely any y*sster*!ay. 
