Rocky Mountain Fever. 
BY 
ROLAND G. CURTIN, M. D., 
PHILADELPHIA. 
REPRINTED FROM 
Or 'Xcto York fttc&ical Tlountal 
for January 8, 1887. Reprinted from the New York Medical Journal 
for January 8, 1887. 
ROCKY MOUNTAIN FEVER* 
By ROLAND G. CURTIN, M.D., 
PHILADELPHIA. 
At a meeting of the Philadelphia Committee of Arrange- 
ments of the American Climatological Association it was 
concluded desirable to have an article on “Rocky Mountain 
Fever.” 
Accordingly, a physician was invited to prepare a paper 
on the subject. At a second meeting, a short time ago, the 
gentleman who had been so invited was reported as having 
desired to be excused from compliance with the request 
of the committee. 
The president, knowing that I had had a slight experi- 
ence with this disease, asked me to lay it before the asso- 
ciation, together with other material that was promised from 
persons living in the Rocky Mountain region. Several 
letters were written to physicians settled in that locality, 
with indifferent success. One of those written to had died 
(as was reported by his relatives). Another had removed, 
and his whereabouts could not be ascertained. A third 
had never seen but two cases. Three failed altogether to 
reply. Two promised information which has not as yet 
* Read before the American Climatological Association at its third 
annual meeting. 2 
ItOCKY MOUNTAIN FEVER. 
been received. The only reply bringing with it anything 
of satisfaction was from Dr. Dougan, of Colorado. It 
seems fitting to make this statement, by way of premise, as 
an apology for any disappointment which our perhaps 
meager paper may occasion. If any additional data should 
be received at any future time, they will be very gladly pre- 
sented to the society. 
I will now read the paper furnished by Dr. Dougan, 
after which I will add information gathered from others, 
following which I will give my own very slight experience 
in this disease : 
The term mountain fever has, by long-continued and fre- 
quent use, almost established itself in the nomenclature of dis- 
ease in the mountain districts of the West. Whether or not 
its use is proper as designating a separate and distinct type of 
fever, a pathological entity, may well be questioned. A some- 
what extensive acquaintance with the physicians of Colorado 
warrants the statement that many of them believe that we 
have in our high altitude a fever not described in the text- 
books, and to which this designation is applicable; while an- 
other and perhaps larger portion of the medical profession of 
the State decline to admit that such is the case. The experi- 
ence of the writer, based on a practice of two years in the 
mountains, induces him to class himself with those who regard 
cases of mountain fever (so called) as belonging to one or an- 
other of the well-known and already classified varieties. 
The fact must be admitted, however, if we accept the latter 
view, that the cases present variations, and often wide variations, 
from the usual course of the fevers to which we would assign 
them, and it is because of this departure from the course of 
recognized types that many practitioners have decided to accept 
the idea of a new variety. 
And yet it is not necessary, because the phenomena ob- 
served in a case, or series of cases, differ from the phenomena 
which we usually regard as characteristic of a given form of 
fever, to decide that we have a new variety to deal with. It is ROCKY MOUNTAIN' FEVER. 
3 
a well-known fact that the general symptomatology of fevers 
may be modified by environment, and that names may be given 
them suggested by locality; hence we have the swamp fever of 
the South, the Panama fever of the isthmus, and the coast fever 
of Africa, ull of which are accepted malarial fevers modified by 
the conditions existing in the localities where they are found. 
Not a few of the cases that are sometimes called mountain 
fever are ephemeral in character and difficult of classification ; 
but the fever that is recognized as peculiarly entitled to this 
designation, by those who believe it a proper term, presents 
many claims to be designated as typhoid, modified, it is true, 
by causes and conditions peculiar to its surroundings. 
It is freely admitted that this assumption is open to argu- 
ment, that the position is not sufficiently established to justify 
dogmatism ; but, as it is desirable that the truth should be ar- 
rived at, reasons will be offered in support of this view, and no 
doubt we shall have the opposite side of the question presented 
in due time. 
At the introduction of the discussion we encounter an em- 
barrassment from the fact that there is no accepted description 
of the clinical history of mountain fever, and that different ob- 
servers fail in an exact agreement as to its successive phe- 
nomena, but the following will no doubt be taken as a fair pre- 
sentation of the symptoms observed in an average case. 
At first we are informed that the patient has become sud- 
denly ill, but a little inquiry usually elicits the fact that he had 
not been quite so well as usual for a few days. A chill may or 
may not have announced the commencement of the illness. The 
temperature is usually 101° or 102° F. at the apparent onset. 
Sometimes it may be found as high as 104°, and not infrequently 
it remains nearly stationary until the approach of convalescence, 
being without the progressive daily increase and characteristic 
daily remissions usual in typhoid. There is absence of appetite 
without nausea, the tongue is not dry and but slightly furred, 
sometimes remaining nearly natural throughout the illness. 
The bowels are usually constipated, and require an occasional 
laxative. The skin is dry, but without other peculiarities. While 
the temperature does not exhibit diurnal changes, it may in 4 
ROCKY MOUNTAIN FEVER. 
some instances fall suddenly one or two degrees, remain at the 
lower point one or more days, and then as suddenly rise to its 
former elevation, or the diminution may be permanent, and the 
further course of the disease be upon the lower temperature 
level, and this without reference to the therapeutic measures 
that may have been employed; in fact, quinine in large doses, 
thirty grains or more, seems powerless to even modify the tem- 
perature. Delirium may occur, but is not usual, and the patient 
rarely suffers from loss of sleep. The course of the disease is 
comparatively short—from one to two weeks—but it does not 
appear to end on the expiration of any definite number of days; 
the tendency is always toward recovery. The simplest treat- 
ment is sufficient, nourishment being of most importance. The 
absence of fatal cases prevents a knowledge of the condition of 
the intestinal tract, and if any alteration of the Peyerian glands 
occurs it probably does not advance to ulceration. 
Among the reasons for believing the above-described cases 
to be mild and irregular developments of typhoid are the fol- 
lowing: 
1. Such cases are usually seen during the season of the 
year when typhoid is most prevalent—viz., from July to No- 
vember. 
2. They are most apt to occur under conditions favorable to 
typhoid, such as crowded and badly ventilated sleeping apart- 
ments, proximity of decomposing organic matter, impure water, 
defective drainage, and general disregard of sanitary require- 
ments, conditions that too often may be found in the West as 
well as elsewhere. 
3. Not infrequently a case commencing as above described 
will, before its conclusion, present some feature so characteristic 
of typhoid as to leave no doubt of its nature, such as spots 
of roseola, diarrhoea, or tympanites. 
4. In the high altitudes where mountain fever is said to 
occur, a large proportion of the cases of undoubted typhoid 
pursue a remarkably mild course, and cases of “ walking ty- 
phoid ” are not rare. From this we may assume that the cli- 
matic conditions here existing are sufficient to moderate the in- 
tensity of the disease, and we are perhaps justified by this ob- ROCKY MOUNTAIN FEVER. 
5 
servation in believing that the same conditions may in other 
respects modify the phases of its development. 
The conditions herein referred to as having a modifying in- 
fluence on typhoid fever are the purity, dryness, and coolness 
of the atmosphere. It is hardly necessary to enter into a dis- 
cussion as to whether such conditions can affect the course of 
disease; if heat and moisture favor the development of disease- 
germs, the opposite condition may be presumed to retard it; and, 
even though these causes may be inoperative within the body, 
they may so impress the prehuman or extra-human life of germs 
as to alter the usual developmental processes that they undergo 
within the human organism. As a matter of fact we do not 
see this modifying effect of atmospheric conditions in our ob- 
servations of other diseases. It is not maintained that all the 
effect of atmospheric conditions as related to fevers is exerted 
on the disease-germs. The entire condition of the patient may 
be modified by the same causes ; respiration, circulation, diges- 
tion, nutrition, and the condition of the nervous system, may all 
be more or less influenced by the peculiarities of the atmosphere, 
and each contribute toward the clinical history of a case. 
If by the term mountain fever we understand simply that 
we hereby indicate mild cases of typhoid occurring in the 
mountain districts, the use of the term, while unscientific and 
objectionable, may still be tolerated as satisfactory, especially 
to the laity; but if it is to be understood as designating a specific 
disease, let us wait for clinical and pathological proofs before 
admitting it into the literature of the profession. 
D. II. Dougan, M. D. 
822 Storkt Strket, Denver, Col. 
In looking over the scanty literature on the subject, I 
have found in print the following allusions to the subject 
under consideration: 
Dr. Charles Smart, of the U. S. Army, in an extensive 
article upon ‘“Mountain Fever’ and Malarious Waters,” in 
the “ American Journal of the Medical Sciences” for Janu- 
ary, 1878, arrives at the conclusion that the “camp fever” 
of our civil war and the “ mountain fever” bear a striking 6 
ROCKY MOUNTAIN FEVER. 
resemblance to one another, and considers the latter to be a 
mixture of malarial and typhoid fever poisons. 
Dr. Hall, of the U. S. Army, in an article in the January 
number of the “ American Journal of the Medical Sciences” 
for 1880, entitled “ Typho-malarial Fever, the so-called 
‘Mountain Fever’ of the Rocky Mountains,” gives a careful 
account of many cases observed by him, and furnishes the 
following deductions : 
1. The fever of the Rocky Mountain region is a hybrid dis- 
ease, the prominent features of whicli are typhoid—the modify- 
ing, intermittent; is, in fact, the typho-malarial fever of Wood- 
ward. 
2. It appears during or after the exposure incident to field- 
service, generally, though not necessarily, in late summer and 
early autumn, and seems to bear no relation to typhoid infec- 
tion, as now usually accepted by the profession. 
3. At its inception, this disease manifests itself as an inter- 
mittent of quotidian, tertian, or other form; this stage is fol- 
lowed (in about two weeks) by the typhoid stage, lasting in the 
neighborhood of four weeks, in which typical typhoid symp- 
toms may be observed, modified to a greater or less degree by 
intermittent indications. 
4. The pathological anatomy of the disease is that of ty- 
phoid fever. 
5. The treatment should be antiperiodic and antipyretic. 
A physician who resided temporarily in Montana in- 
formed the writer that he had followed the practice of a 
doctor located there for the purpose of observing “mount- 
ain fever.” Four cases were pointed out to him as typical 
cases of this disease. My informant examined them care- 
fully, and found all the physical signs of croupous pneu- 
monia, with the ordinary symptoms incidental to the latter 
disease: 
In 1868, while an assistant on the U. S. Geological Ex- ROCKY MOUNTAIN' FEVER. 
7 
ploring Expedition under Professor Ilayden, while in Chey- 
enne City, Wyoming Territory, it was iny fortune to see 
in a private hospital four cases diagnosticated as “ mountain 
fever.” In two of these cases the patients were “ prospect- 
ors,” men who had been engaged in seeking after the out- 
croppings of the precious metals in the fastnesses of the 
mountains at a great altitude, camping out along the streams, 
and leading a nomadic life in general. The other two were 
cases of persons who had been living in canvas tents while 
at home, and yet had often been called by business to the 
mountains. One of the patients died during the third week, 
no post-mortem being made in his case. At some period 
of the disease they all had more or less diarrhoea, which in 
one case was continuous and very marked throughout the 
whole course of the disease. In one case I noticed there 
was a doubtful “ tache rouge,” coming in crops and disap- 
pearing on pressure. The margin of the spots was poorly 
defined, and not circular in shape. (This patient recovered.) 
One had epistaxis at the beginning of the disease. Tym- 
panites was more or less marked in all the cases. In con- 
versation with the physician who had these cases in charge, 
and who had been established in the region for some years, 
he informed me that the symptoms were about the same as 
those observed by him in other cases called “ mountain 
fever.” To me the cases appeared to be of typhoid fever 
or typho-malarial fever. 
We will now proceed to study the salient points of the 
information laid before us. 
In Dr. Dougan’s paper he informs us that the tempera- 
ture is usually 101° to 102° at the commencement of the 
attack, and that not infrequently it remains nearly station- 
ary until the approach of convalescence, being without the 
progressive daily increase and characteristic daily remissions 
usual in typhoid and (I might add) remittent fever. 8 
ROCKY MOUNTAIN FEVER. 
Absence of appetite without nausea is, according to the 
doctor, another symptom. 
A constipated condition of the bowels was also noted 
by him. He also observes that the course is comparatively 
short—from one to two weeks. 
No dryness of the tongue was ever observed by the doc- 
tor in any of his cases. 
The tendency was always toward recovery. 
The symptoms given by Dr. Dougan in some respects 
seem to tally with those given as of simple continued fever. 
With regard to the mortality, as before stated, Dr. Dou- 
gan observes that he never had a fatal case, while the phy- 
sician with whom I conversed in Cheyenne City informed 
me that one out of every eight or ten died. 
I have conversed with several shrewd and competent 
physicians on the subject, all of whom agree with Dr. Dou- 
gan that the “ Rocky Mountain fever” is not a separate and 
distinct disease, but that it is fever of other well-known 
forms, modified perhaps by climatic influences. 
It seems to me that the following causes may have led 
to the assumption that there is a febrile affection peculiar 
to the Rocky Mountains: 
Inaccurate observation may have led to errors in diag- 
nosis. In the early history of the Rocky Mountain region 
the class of physicians there located perhaps included many 
who were probably unable, from habit and limited education, 
to observe with that degree of closeness which is requisite 
at all times for a proper diagnosis. 1 make this statement 
because the cases coming under my notice were either of ty- 
phoid fever or typho-malarial fever. A physician in Montana 
mistook croupous pneumonia for “ mountain fever.” An- 
other influence probably at work was fashion. W’e have 
fashions in medicine in various directions. It shapes our 
stethoscopes, it changes our treatment, and why may it not ROCKY MOUNTAIN FEVER. 
9 
also change the names of diseases? In our own midst we 
have an example of this. Almost every infant or young 
child in Philadelphia that dies of bowel trouble is reported 
as having died of cholera infantum ; entero-colitis, diarrhoea 
of dentition, summer diarrhoea, and other fatal diarrhoeas 
are often grouped under this head. This fact is the occa- 
sion of surprise and remark among the profession abroad 
at the frequency of cholera infantum in this country, pre- 
senting a strong contrast to the comparative rarity of the 
disease among them. Thus it would appear with all febrile 
affections in the Rocky Mountain region. They seem to 
have been grouped under the head of “ mountain fever.” 
The peculiarities of climate may have had some effect on 
them, making the different varieties appear somewhat alike 
to the superficial observer. 
I will now give you a brief account of the impressions 
made upon my mind as to the climatic and other influences 
at work in the Rocky Mountain region. These conditions 
which might modify disease suggested themselves to me 
during my brief sojourn there : 
1. The altitude, which lowers the temperature and rare- 
fies the atmosphere. 
2. The purity and dryness of the air. 
One of the prominent local features of a large part of 
the Rocky Mountain region, and a factor liable to modify 
disease, is the alkaline condition of the earth’s surface. The 
granite and other rocks found at the summit of the mount- 
ains decompose easily, and, when they break down, the salts 
of calcium, sodium, and magnesium are liberated and spread 
over the surface. The soil is often seen with an efflorescence 
of these salts on the surface, sometimes giving it a whiteness 
resembling snow. It is also seen on the margins of the ponds 
and lakes. The streams are often so bitter that it is impos- 
sible to drink from them, and streams less affected will often 10 
ROCKY MOUNTAIN FEVER. 
cause a diarrhoea. This condition of the water might pro- 
duce a diarrhoea in a malarial fever, or simple continued 
fever. When the wind blows, the sand and dust, impreg- 
nated with the alkalies, are set in motion. Of course this 
causes great irritation to the air-passages, and renders the 
atmosphere unfavorable for those afflicted with throat and 
lung diseases. This condition of the air might in a fever 
patient occasion a cough similar to that usual in typhoid 
fever. 
The water usually found is that of the streams running 
down from the melting snow at the summit of the mount- 
ains. This scarcity of water has a tendency to make travel- 
ers and “ campers out ” careless about bathing, as indeed, 
also, the temperature of the water itself, which is apt to be 
too low to admit of bathing with comfort and safety. 
This condition of affairs, occasioning personal uncleanness 
in connection with the excessive fatigue incident to the life 
and habits of the early mountaineers, doubtless rendered them 
susceptible to simple continued fever. In camping in that 
region, it is usually along the streams, so that water can be 
readily secured ; this again favors the imbibition of ma- 
larial poison. 
A fever called the “ mountain sickness ” is said to pre- 
vail in the Andes, in South America; and a fever has also 
been reported among the Himalayas, the highest mountains 
in the world. 
To sum up, first, it would appear that in the Rocky 
Mountain region almost every disease with a febrile reac- 
tion has been called “ mountain fever.” Secondly, proof 
is wanting that there is a separate and distinct disease pe- 
culiar to that region. 
22 South Eighteenth Street, Philadelphia. 
The following letter will explain itself: ROCKY MOUNTAIN FEVER. 
11 
Fort Benton, Montana, June 10, 1886. 
Dr. Roland G. Curtin : 
Dear Doctor: My excuse as a stranger for addressing you is 
the great pleasure your paper on “ Mountain Fever,” read before 
the American Climatological Association, gave me. I have been 
a resident practitioner in Montana since 1879, and during that 
time I have not seen a case of fever different from the “ already 
classified varieties.” I have been criticised for even doubting 
it, and saying, if such a type existed, it had escaped my obser- 
vation. As I said, your paper gave me great pleasure, and I 
hope you will not consider me intrusive for expressing it. 
Very respectfully, 
F. Atkisson. REASONS WHY 
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