REVIEW — TROPICAL MEDICINE, ETC. 69 



The name indicates the usual duration. From 4 to 8 days seems to be the limit. The convalescence is rapid Fevers — 

 and relapses do not seem to occur. m.Uinued 



The differential leucocyte count shows a considerable reduction in the percentage of the polynuclears with a 

 corresponding increase in tho.se of: the lymphocytes and large mononuclears. The cause seems to be a bacillus 

 which has been cultivated fi-om the blood and resembles those of the coli group of organism.s. It differs, however, 

 from B. typhosus and J'nrntyphosiis. The agglutination test was positive up to 1 in 40, but the reaction was not 

 sufficiently constant to furnish a reliable diagnostic method. 



Salicylate of soda and belladonna seemed to be the most u.seful drugs. Quinine only made the headache 

 worse. No fatal case is reported. 



The fever is much commoner in adult males than in females or children, and is much rarer in natives than in 

 Europeans. The differential diagnosis is given, dengue being the great difficulty. 



As regards distribution, it seems to occur principally on or near the sea-coast. 



Clayton^ studied an outbreak of Seven Days' Fevei- among the men of a cruiser 

 temporarily quartered ashore in Bombay. The clinical symptoms are carefully described 

 and suggestive facts brought forward to show that possibly the disease was transferred from 

 sick to healthy through the medium of a suctorial insect. No organism was found in the 

 blood, and experimental work was not conducted. 



Another fever described is the Three Days' Fever of the hot season of Upper India, the 

 cause of which is unknown but in which there is a large mononuclear increase. The 

 temperature rises sharply and has a steady step-like decline, while headache and inliuenza- 

 like pains seem to be the principal features. It is identical with the Chitral Fever described 

 by McCarrison.- 



I have myself suffered in Khartoum from what was either an attack of Seven Days' 

 Fever or of Influenza. That it is was probably the latter is indicated by the marked benefit 

 derived from a full and early dose of opium in the form of Batley's solution, but I am bound 

 to say the rapid and complete convalescence after what was a short but severe and 

 prostrating attack of pyrexia rather suggested this Seven Days' Fever, which, however, at 

 that time had not been definitely distinguished. 



There occurs also in Khartoum, more especially during the hot weather, a febrile 

 condition of a few days' duration with indefinite symptoms of headache and malaise. In 

 such cases I have been struck by the increase in the number of blood-plates which one finds 

 when stained films are examined. Masses of platelets are visible usually along the edge or 

 towards the ragged end of the film, though they also occur scattered through it. I am 

 inclined to think there is some definite relation between this increase and the fever, but 

 further observations are required, especially as regards the differential leucocyte count. 



Castellani' has described cases of unclassed fever in Ceylon which, on superficial 

 examination, may be taken for atypical forms of typhoid, paratyphoid, or malaria. The 

 temperature is generally irregular ; pulse frequently very slow ; spleen not sensibly enlarged ; 

 no roseola ; slight intestinal symptoms occasionally present ; Widal test constantly negative ; 

 malarial parasites absent. The interesting bacteriological findings in these cases have 

 already been discussed under "Bacteriology " (page 12). 



Cropper'' has described in Palestine a so-called Syrian Fever, which is generally 

 quotidian or remittent in character, is accompanied by slight chills and more marked 

 sweats, and is seen most severely in young infants who may have moderate enlargement of 

 the spleen. In the red blood corpuscles the pale rods and melon-seed-shaped forms, known 

 as Cropper's bodies, are found (see pages 111-112). In this fever, quinine is distinctly of use, 

 but prolonged treatment is necessary. 



Wellman^* has observed, in tropical Africa, a fever common in the dry season, of gradual 

 evolution, long duration and characterised especially by persistent hyperpyrexia and a 

 heavy mortality. In one case he found a great number of short bacilli in the blood. 



' Clayton, F. H. A. (.June 15th, 1908), "A Contribution to the Study of Seven-d.ay Fevers of the Indi.iu 

 Ports." Journal of Tropical Medicine and Hyijiene. 



- McCarrison, R. (January, 1906), "The Three Days' Fever of Chitral." Indian Medical Gazette, p. 7, 

 Vol. XLI. 



■' Castellani, A. (January, 1907), "Notes on Cases of Fever frequently confounded with Tyjohoid and 

 Malaria in the Tropics." Journal of Hygiene, p. 1, Vol. VII. 



* Cropper, J. (February, 1907), " The Malarial Fevers of Palestine, and their Prevention." Journal of the 

 Royal Institute of Public H.alth, Vol. XV., No. 2. 



'■ Wellman, F. C. (1906), Arch, filr Schiffs. und Trop. ffyg., t. X. 



^ .\rtii'le not consulted in the original. 



