113 
casts. The spots appeared over the entire surface, being large and irregular on the 
legs, very bright red at the height of the disease, fading to a brownish pink color as 
the fever subsided. Many spots were yet visible 6 weeks after the temperature 
reached normal. Highest temperature observed was 104.1° F. The insomnia in 
this case was not troublesome. A severe intercostal neuralgia occurred during 
convalescence. 
Case 16. — Mrs. G. H. (wife of C. A. H., case 15), age, 43; housewife; residence, 
Bridger, Mont. This patient is a very fleshy woman, with pendulous abdomen. She 
received bites from two ticks, which had previously bitten case 15, during the onset 
of the disease in that case. This occurred June 6. One tick bit this patient on the 
abdomen in the hypogastric region; the other on the leg. The bites occurred dur- 
ing the night; the ticks were removed and killed by the patient the following morn- 
dng. Following the removal of the ticks she applied carbolic acid to the bites. On 
the evening of the 11th she felt chilly, feverish, and general malaise. The morning 
of the 12th she arose as usual, but had a pronounced rigor and such severe headache 
and aching in limbs and back as to compel her to return to bed. The temperature 
that evening rose to 104° F. During the first 12 days of the disease it ranged 
between 102° and 104.4° F., for 5 days keeping close to the 104° F. mark. After the 
twelfth day of the disease the temperature gradually fell and the eighteenth day it 
registered 97° F., when an unfavorable prognosis was given, though in every other 
Avay the patient seemed on the road to recovery. The following four days the tem- 
perature remained about normal. 
The respirations, early in the course of the disease, reached 40 per minute, at 
which rate they remained until the last week of the disease. Gheyne-Stokes respir- 
ation was observed during the last of the second week, some cough, but not so much 
as is usually observed. The heart action was Aveak from the first, and during the 
second and third weeks became very w^eak and irregular, with A^ery low arterial 
pressure. The rate of pulsation varied from 120 to 140 per minute. The tongue, 
mouth, and pharynx became A^ery dry early in the disease. No Ammiting occurred, 
and food AA’as well taken at all times. The urine became A^ery scant at the end of the 
first Aveek and contained many fatty, blood, and epithelial casts and, at times, some 
albumen. By the end of the second Aveek the urine had increased to normal amount 
and Avas free from albumen and casts. The intensity with Avhich the disease attacked 
the nervous system Avas marked from the onset. A Ioav, muttering delirium came 
on during first AA*eek. During the second Aveek patient Avas in heavy stupor from 
Avhich she could be aroused with difficulty, but AA'hen aroused Avould ansvA’er ques- 
tions correctly and then perhaps talk at random. The condition of the mind 
approached the normal during the third AA’eek. The eyes Avere A^ery sensitiA^e to 
light and A^ery much congested. The petechise commenced to appear on the third 
day, first on feet, ankles, hands, and Avrists. It rapidly spread all over the body 
and AA’as very thickly distributed on the back. During the third week the patient 
each day expressed herself as feeling better than on the day previous. The temper- 
ature, after having reached 97° F., became normal. The respiration Avas easier and 
all symptoms seemed to indicate a beginning coiiA’alescence. On the twenty-second 
day of the disease the patient said to the nurse, “I feel a pain around my heart.” 
The nurse turned her on her side, in which position she seemed to rest a fcAV 
minutes and then breathed her last. 
The points of interest in this case were mode of infection (see also, p. 23); high 
temperature at onset, Avhich persisted; rapid breathing; great congestion of the kid- 
neys; extreme AA^eakness of heart action; the decided effect on the nerA’Ous system ; 
subnormal temperature, and sudden deatli without AA'arning, Avhen apparently recoA^- 
ering from the disease. 
23339— No. 20—05 8 
