APPENDIX.

A REPORT OF TWO CASES OF "SPOTTED FEVER."

By Dr. G. A. GATES,

Bridger, Mont.

CASE I.

On May 29, 1898, I was called to see L. M., at Thermopolis, Wyo. Patient was a male, white, aged 23 years, sandy or red hair, rather spare built; had come from Iowa about three months previous to present attack. He became ill while traveling overland from Lander to Thermopolis, Wyo. Having camped out several nights during the journey, on one or two occasions his bedding became thoroughly wet from the heavy rains of that season.

When first seen patient's face was deeply flushed, eyes bright, skin hot and dry, with a beginning petechia on the forehead, back of hands, wrists, and ankles. Headache, thirst, slightly sore throat, and a soreness of muscles and aching throughout the body were complained of by the patient. Temperature 104° F., pulse 120, urine highly colored, no albumin. Complete loss of appetite; no other gastro-intestinal symptoms.

Patient was given small doses of aconite and spirit of nitrous ether and small doses of alcohol until fever was reduced and bowels moved freely.

This was followed by a prescription containing salol, hydrate of chloral, with soda bicarbonate, caffein citrate, and pepsin, combined in a powder and given every four or six hours. Patient was sponged with cool or cold water, as needed for high temperature, and placed on a diet of milk, gruel, raw eggs, and whisky.

The fever ran an irregular course, with great variation, reaching at times a temperature of 104.5° F. and again sinking to 97° F. This low temperature was observed during the last of the first week of the disease, at which time patient was in a state of collapse, being almost pulseless and having a hard chill at the time.

Slight albuminuria appeared during the second week.

Delirium was very slight; patient could be aroused at any time. Fever gradually subsided after eighteen days.

The petechiæ increased in size and number very rapidly during the first two weeks, forming large, irregularly shaped spots from the size of a little finger nail to spots one-half by one-half inch in size. These spots darkened in color, becoming bluish, with a surrounding yellow tinge. The spots were slow in disappearing, some traces of them being visible seven months after recovery.

CASE 8.

Mrs. H., white, aged 67 years, was bitten by a tick May 4 and 8, the tick being removed from the left thigh on May 8, 1903. The species of ticks to which this one belonged is said to have been brought to this section of country by sheep from Bozeman or vicinity. This tick is recognized by having a grayish or whitish spot on the back of the head. The tick which bit patient came from near the mouth of Dry Creek, on the west side of the Clarke Fork River, 7 miles south of Bridger.

Patient first complained of feeling ill on May 9. She complained of headache, tired feeling, general soreness of the muscles, and loss of appetite.

I saw patient first May 11. Temperature 103, pulse 104, cheeks flushed, tongue white coat on sides, rather dry. Quite severe headache and tired feeling were the only subjective symptoms. Urine dark; on examination showed slight amount of albumin and some hyaline and granular blood casts and numerous bacteria; the quantity for following twenty-four hours was 32 ounces; the quantity gradually diminished from this time until two days before death, when there was complete anuria. Red and white blood cells, with an enormous number of granular, blood, and epithelial casts, were present in last samples of urine obtained.

During the 12th and 13th temperature varied from 101 to 103.5 F. On the 14th it rose to 104.4, slowly dropping to 101 on the morning of the 17th, where it remained until death.

Food and medicine were taken well until the last thirty-six hours. Vomiting occurred once. A number of watery evacuations were produced by the action of elaterium.

Rectal and subcutaneous injections of normal saline solution were given. The combined use of the above and hot packs, together with hot elder water and liquor ammonii acetatis internally, produced only slight diaphoresis, and that mostly about the head.

On the 15th petechial eruption began to make its appearance upon the buttocks, back, and thighs. These increased in number and size until every portion of the body was covered, though but little showing on the face. They seemed to be subcutaneous or intracutaneous extravasations of blood, rapidly darkening in color.

There seemed to be a profound impression on the nervous system from the very first symptoms of the disease. Muttering delirium, and a semicomatose condition, from which the patient could be roused only with much effort, were early and prominent symptoms.

Respiration varied from 30 to 40 per minute throughout the course of the disease and continued until after all signs of heart action had ceased.

Highest pulse rate observed was 186 per minute.

Patient died on the morning of May 19 about 1 a. m.

This case was also seen by Dr. Johnson, of this place, and Dr. Lutz, of Red Lodge, in consultation with me.