220 



KEVKKS IN TIIK SI DAN 



\ii aliiKiniKtl 

 churl in 

 Malta Kcvcr 



• ■ Saiul-Hy ' 

 fi'ver 



I'oxic 

 enlerilis 



from tlie cliart, tlu' i'\liil)iti(>M of ipccacuaiilia liotli clcaiod up the diaj^iiosis ami cuixmI 

 the condition. 



Chart i2 is interesting as showing' a somewhat alinoriMal temperature in a ease of 

 Malta fever. The case was one of laboratory infection and the af^f^lutination reaction 

 marked, but fever was never a very marked symptom though most of the usual 

 characteristics of a mild case were present. We know that the blood in cases of typhus 

 fever will agglutinate M. melik'ttttln, and it is quite possible that other fevers exist whicii will 

 give this reaction. Otherwise, it is difficult to explain the occurrence of two isolated cases 

 in Khartoum, whicli had provisionally to be called Malta fever, but which may have been 

 something quite distinct and hitherto unrecognised.* 



Turning to the second class, a few words may be said regarding phlebotomus fever. 

 Its existence in the Sudan has not yet been definitely proved, but I have good reason 

 to believe it occurs, and indeed I am now strongly disposed to think that the short 

 and sharp fever from which I myself sufllerfil in Khartoum some years ago, and of which 

 mention is made on j^'^ge 69 of our First Review Supplement, was of this nature. Mr. King, 

 also, after being badly bitten by I'hlehiil<n>ius: at Berber on May 27, 2H and 29, 1910, 

 developed on June 3 a fever of short duration characterised by injected conjunctivae 

 and severe pains in the limbs and back which strongly suggested this condition. Two 

 species of I'lilebotomiis. namely I', ^apatii^ii and 1'. sp. incert. are known to 

 occur in the Sudan, while it is certain that a short fever of from four to seven 

 days' duration is not uncommon. The fact that "sand-fly" fever is pi'evalent in Egypt 

 also makes it probable that it occurs in the Sudan. In Khartoum, it was made notifiable 

 some time ago but, so far, no case has been reported. I am inclined to think that 

 Phlebotomus flies are not so common in Khartoum all tlie year round as they used to be. 

 One hears fewer complaints regarding them and certainly encounters them much less 

 frequently than used to be the case. In the sunnner months, however, they are still in 

 evidence in certain parts of the town init their infectivity cannot be great or w-e would 

 have tiiany more attacks of what is known poiiuiuily in Malta as "Pink-eye." 



Dengue is a fever of much interest, but here 1 would only refer to the remarks on 

 the differential leucocyte count in cases of this disease which appeared in our First 

 Review Supplement (pages 37 nml 38). The leucopenia, the diminution in polymorphs, 

 the early and great small lymphocyte increase, the late large lymphocyte increase and 

 the final increase of large mononuclears, are sufficiently characteristic when taken along 

 with the symptoms and the negative blood findings as regards hamatozoa. 



It may here be said that for clinical work the instructions of Rogers for carrying 

 out the differential leucocyte count, as set forth in the Second Edition of his book on 

 Fevers in the Tnipies, should be read and, I think, adopted. 



It is, however, Class III. which possesses for us the greatest interest. Fever is 

 not always a feature of ptomaine poisoning but it may be in evidence and cause a difficulty. 

 As a rule the history and symptoms guide one to a diagnosis, but I confess it may be 

 impossible to say whether a case of what we may call "toxic enteritis" is to be attributed 

 to the effect of ptomaines or not. 



Here is the record and temperature chart (No. 3) of a rapid and fatal case in a young 

 European adult which came under the notice of Captain Archibald and in which there was 

 absolutely no history pointing to the ingestion of ptomaines. One can only term it a case of 

 obscure toxic enteritis. 



• It is nl.sc well to reiiieinljer that NiVgre has recently shown that, within certniu limits, some normal sent 

 will agglutinate the micrococcus. V. Jl. Hoc. ///«/., December 17, I'JKl. 



