148 REVIEW — TROPICAL MEDICINE, ETC. 



Paratyphoid 1. Paratyphoid fever differs from typhoid fever in (a) a shorter invasion stage and rise of temperature, 



pgygy (b) shorter or absent period of continued fever, and (c) marked diurnal remissions of temperature, much deeper 



, ■ r than enteric and without periodicity. An absence of the Widal is suggestive if it persist in reasonaljly high 

 dilutions. 



2. The duration is, on the whole, shorter than typhoid, aud in the oases where type " B " was adjudged the 

 etiological rOle this fact is more striking than in the type " A " cases. 



3. The general findings of the type " A " oases are nearer to typhoid than type " B," the latter presenting a 

 picture more like septicaemia. 



4. The complications of typo " B " infections are more numerous, more purulent, and the course is more 

 fulminating in these cases. 



5. The causal germs belong to the intermediates of the typhocolon series, the type " A " being nearer to the 

 bacillus of Eberth and GafEky, while type " B " approaches the meat-poisoning group. 



6. The clinical evidences of the respective organisms Just named agree with their general properties and 

 relations to infections in this order, ranging from the sub-acute typhoid to the hyper-acute meat-poisoning. 



7. Anti-typhoid serum will clump the paratyphoid " B " at the same time as the B. typhosus, sometimes even 

 in higher dilutions ; so that a positive reaction of a patient's serum to both B. typhosus and paratyphosus " B," 

 even if the latter be in higher dilutions, will not permit a diagnosis. On the other hand, only twelve times in 94 

 cases of fever did the serum react with the type " A " paratyphoid, so that a positive reaction with type " A " and 

 not with the bacillus of Eberth, may be taken as nearly a proof of the existence of an " A " paratyphoid infection. 

 (But ride infra). 



8. That there must be some other factor responsible for co-agglutinations than an increased value of the 

 agglutinins normally present in the blood seems probable. 



Castellanii has studied the condition in Ceylon and has noted the occurrence of mixed 

 infection. He concludes that Ceylon must be included among the countries where 

 paratyphoid fever is endemic, both types of the disease (" A " and " B ") being encountered ; 

 that the disease cannot be distinguished from typhoid, though it generally runs a milder 

 course ; that in one case of " A " infection, intestinal ulcers were found, aud that cases of 

 mixed infection are apparently not rare. 



Eogers- deals with the disease in India, where he believes several varieties probably 

 exist. In favour of this view he cites Castellani's Ceylon cases already mentioned under 

 " Bacteriology " {page 12). 



MaoNaught^ has also described new forms of paratyphoid bacillus, which he isolated 

 from the blood of cases occurring at Wyuberg in Cape Colony. He gives tables showing 

 the cultural characteristics of the bacilli isolated. 



Henry** states that the pathology differs widely from that of typhoid fever, the 

 autopsy findings being largely those of a septicaemia. Where ulceration of the intestine 

 has been found, he maintains, in contra-distinction to later authors, that the ulcers are 

 of a dysenteric type and do not affect Peyer's patches. He places the mortality at about 

 6 per cent. Vagedes'^* records a case of paratyphoid poisoning attributed to infected ducks' 

 eggs, which were used in the making of a cake ; and Conradi''* has reported the simultaneous 

 presence of B. typhosus and B. paratyphosus in a water which had fallen under suspicion. 



The blood of a patient suffering from fever was sent me from Wad Medani on the Blue 

 Nile. It gave negative agglutination reactions in dilutions of 1 in 20, 1 in 40, and 1 in 100, 

 a positive result with Paratyphoid " A " in 1 in 20, but not in 1 in 40, or 1 in 100 ; but a 

 definite and complete reaction in all three dilutions with Paratyphoid " B." 



In the absence of blood culture, one cannot be certain, but it is very probable that 

 this was a case of paratyphoid fever which in all probability exists in the Sudan, though, 

 like enteric fever, it cannot be at all common. 



Piroplasmosis. This subject, so far as the Sudan is concerned, will be found 

 considered in a special paper. Here one proposes to deal with some general papers of 

 interest and then consider articles dealing respectively with the equine, bovine and 

 canine piroplasmoses. 



' Castellani, A. (February 2nd, 1907), " Paratyphoid in the Tropics : Cases of Mixed Infection." Lancet, 

 Vol. I. 



- Rogers, L. (London, 1908), "Fevers in the Tropics." 



» MacNaught, J. Q. (February, 1908), " A Note on Two Cases of Par.atyphoid Fever, in which a New Variety 

 of Paratyphoid Bacillus was found" in the Blood." Journal of the Royal Army MedicaJ Corps, Vol. X. 



■• Henry, J. A. (April 15th, 1905). Amer. Med. 



' Vagedes, K., " Paratyphus-bazillen bei einer Mehlspeisevergiftung." Klin. Jahrb., Bd. XIV. 

 " Conradi, H. (1907), " Ein gleichzeitiger Befund von Typhus und Paratyphus-bazillen in Wasser." Klin. 

 Jahrb., Bd. XVII., fax. 2. 



• Article not consulted in the original. 



