107 
May 31, p. m.: Pulse 122, axillary temperature 102.5, rectal temperature 104.8, 
respiration 28. Urine S. G. 1,022, acid, no sugar, trace of albumen, granular casts 
abundant, no blood. Patient’s mind has been wandering for 2 days. Worse now. 
June 1, a. m. : Pulse 120, rectal temperature 103.8 at 9 a. m. At 2 p. m., pulse 130, 
weak and irregular. At 8 p. m., pulse 120, rectal temperature 103.8; patient is de- 
lirious. 
June 2, 9 a. m. : Pulse 130, weak and irregular; patient grew weaker and died at 
8 p. m. from heart failure. 
(The treatment in this case was symptomatic.). 
The following additional notes were made by Doctor Ashbnrn: 
Personal history (previous to present illness): Mumps, measles, scarlatina. Xo 
typhoid. Five years ago had spotted fever, which was aborted by Doctor Brice. 
Felt worse then at beginning than now*. Did not have eruption. 
History previous to admission: May 29: Been working in hills west of Florence all 
spring. Had very many tick bites which he cauterized with carbolic. May 25, had 
chill, followed by fever and mild pains. Took calomel. Headache more or less since, 
but not constant. 
Condition on admission: May 28: Measly eruption, not thick, appeared about 
ankles. It now shows on ankles, face, and arms; possibly elsewhere, nowhere 
marked. Tongue white, moist, coated. Eyes suffused and light hurts them. 
Urinous (?) odor to breath. Bowels 0. K. Xo cough, nose bleed, or especial 
discomfort. Urine passed about as usual. ' Spleen not demonstrably enlarged, not 
tender. Liver, heart, and lungs 0. K. Abdomen not tender, shows eruption. 
June 1: Xo photophobia, no pain. Apparent jaundice. Mind^not so clear as at 
last note. Doctors Chowning, Stiles, and myself found nothing in blood. 
190 Jf. Case 10 . — Attending physician. Doctor Mills (notes prepared 
by Doctor Ashburn; patient seen and microscopic examination of 
blood made by Doctors Mills, Ashburn, and Stiles). 
J. B. Male, age 6 years. Had measles. Family history good. 
Personal history (pre\dous to present illness): Left Iowa 6 weeks ago. Been in 
Bozeman 5 weeks. June 2, arrived in Missoula and went on to Hamilton. Felt badly 
that night and ate no dinner. Ate none next day and vomited. Pain in abdomen, 
occiput, and back of neck, lasting to present, but now less marked. Fever. Seen by 
Doctor McGrath June 5, and eruption appeared June 6.. 
Symptoms: Bright and intelligent. Face flushed. Eyes injected, slightest con- 
vergent strabismus. Tongue white and moist. Cervical glands somewhat enlarged. 
Throat and mouth show no eruption or soreness. Some cough present. Spleen 
enlarged. Abdomen painful and tender. ^Measly eruption on hands, arms, feet, 
legs, and buttocks, palms, and soles. Pain and tenderness in abdomen, occiput, and 
neck. Bowels loose. 
Blood examination: Fresh specimen negative. Large dipplococcus in stain, look- 
ing like contamination. 
June 8; Taking calomel and paregoric; room darkened. Has slept much of the 
time. Free from pain in the neck. Still has it in abdomen. Harsh breathing over 
right lower lobe. 
June 9: Xot seen by me. Doctor Mills reports spinal tenderness again. Pain still 
in abdomen. Spots not darkened. Condition much the same. 
June 10: Appearance excellent. Very slight convergent squint still present. Spots 
fading on legs and body, not on soles. Pain still present in neck and abdomen. 
Tongue lightly coated. Knee jerks normal. Mother states that last night he cried 
that his eye was turning out. She looked, and divergent squint (outward rotation of 
