I m 
I I 
I abating, kidneys acting freely, bowels moved from an enema given on the evening 
I of the 12th June. 
: On the 14th improvement continued, temperature at 5.30 p. m., 102° F. 
j This may be a case of meningeal irritation following measles, or may be due to the 
I tick bite and infection from that source. 
'! I I might mention that there was no cough or conjunctival congestion. 
ll A Clinical Eepoet of Four Cases of Piroplasmosis Hominis, with Table of 
' Seventeen Cases seen by the Author, by L. A. Gates, M. D., Bricger, Mont. 
jj Case 11. — C. B. ; age, 26; male; occupation, ranchman; residence. Sage Creek, 20 
i| miles southeast of Bridger, Mont. I saw this patient first July 1, 1903, being the 
I i tenth day of the disease. Patient gives a history of having been bitten by a tick 
;'i( June 21 oh the left leg, 7 inches below the knee. The small wound caused by the 
i bite became very sore, and there gradually developed around it an irregular, oblong 
j dark bluish-red spot. The patient also states that he was bitten by a tick on the 
: 22d and 23d, but only the first bite became sore. 
' ' On the 24th he had a very severe chill and says he has had considerable fever 
if! since that time; says he has been unable to sleep at all or eat anything for the past 
|]f ^three days. Following the chill, a very severe headache came on, followed by 
severe aching of all of the skeletal muscles. He said “They ache like the tooth- 
ache,” being especially severe in the calves of the legs. On the 27th he vomited; on 
I ! the 28th he noticed a few red spots on the palms of his hands, which he said seemed 
1 to be just under the skin and looked like the eruption of the measles. There were 
I also, at this time, a few spots beginning to appear on the feet. 
: On examination this tenth day of the disease, we find the patient’s countenance 
i bears a look of nervous anxiety. The eyes are bright, with considerable congestion 
I of the conjunctiva, the tongue quivers very much when protruded and is loaded with 
' a heavy, dirty, brown coat; sides of the tongue are so livid as to be almost blue. 
A petechial eruption is seen in the skin and involves every portion from the soles 
, of the feet to and including the scalp. They vary in color from bright red to bluish 
red. The greater number are seen on the extremities, where in places, two or more, by 
‘coalescence, form irregularly shaped spots. They vary in size from a pin head to the 
size of a dime, the larger ones being very irregular in outline. The skin is very dry. 
There is some cough and on auscultation numerous dry rales are heard over the 
posterior portion of both lungs. The abdomen is moderately tympanitic. The urine, 
which is almost brown in color and lessened in amount, contains some albumen. 
The pulse is 104, weak and irregular, temperature, 103° F. The accompanying chart 
shows the temperature, pulse, and respiration from the seventh to the twenty-third 
day of the disease, at which time the patient was convalescent. On the eleventh day 
the patient was unable to urinate and the catheter was passed — urine very dark. The 
general course of the disease was severe in this case from the onset, though no com- 
plications occurred. Especially well marked was the cough and insomnia. The 
temperature touched normal on the twenty-third day, from which time the patient 
made rapid progress to complete recovery. 
Case 14 . — C. F. P. ; male; age, 41 years; occupation, ranchman; residence, 4 miles 
southwest of Bridger, Mont. This patient was bitten on the leg by a tick April 11. 
On the 18th he felt a general soreness all over the body, which has gradually 
increased up to the first time 1 saw him, April 23. On the 21st he had a chill, 
followed by loss of appetite, headache, backache, and fever. 
Examination; The face was slightly flushed, eyes dull, conjunctiva slightly injected, 
tongue has a grayish coat, bowels are constipated. There is an annoying, dry cough. 
Xo abnormal sounds on auscultation of the lungs; heart sounds normal; pulse rate, 
70, strong and regular. The urine is high colored, but contains no albumen. Small 
