228 



FEVKKS IN TIIK SUDAN 



Trobable lOk' 

 of coliforni 

 urganisnib in 

 etiology 



.l/(i('c,v. C. {I'liitrl 10) came straifilit to Khartoum from England. L. (i'liurl '.)) 

 and W. {Churl 11) had spent 2 years in Cairo, but had never had fever or been in hospital. 



L. had an adniission for a similar attack on August 22, I'JIO, as shown in Chart D. 



I'riridiiit Hlsliinj. C. was jilaced on the syphilis register on April 2.0, 1910, and is still 

 undergoing a course of treatment l)y intramuscular injections of mercurial cream. 



Si/iiijihiiiiD. On admission the only symptoms and physical signs to be noted were 

 tliose common to all cases of j)yre.\ia, i.f. headache, with pains in tlie back and limbs; 

 increased frequency of the heart beat, high-coloured urine with slight furring of the 

 tongue. Several blood smears were made in each case which, though carefully gone 

 through, showed no evidence of malarial infection. W. siiowed some increase of the 

 large mononuclear leucocytes. None of the temperatures were affected by (juinine. 



Widal reactions with It h/filidKiis and li. /iiu-dti/iilinitux gave negative results. 



In the cases of L. ami W . Mn<i(l cultures were made using 5 c.c. of blood in eacli case; 

 no growths were obtained. 



There was nothing abnormal in the stools, nor in tiie urine. 



Chart 12 shows the temperature record of a case in the Egyptian Military 

 Hospital. The fever was of short duration. Malaria was excluded, quinine was not 

 given and the nature of the disorder remained undiagnosed. Thanks to Captain Cunnnins 

 I have similar charts of other cases where quinine was given, but without altering 

 the temperature in the slightest. 



Personally, I am inclined to put down some ot these cases to the action of H. mli 

 or allied organisms, the so-called paracoli bacilli which bear the same relation to the H. rati 

 of Escherich as K. piiratijphosus A. and B. to the li. Ii/jihu.-'iis of Ebertli. There can be 

 little doubt that one meets with cases ranging from a simple bowel upset of H culi origin 

 through the paratyphoid group to the typical enteric fever. It has even been suggested 

 that possibly the presence of ptomaines may so disturb the economy as to permit bacteria, 

 carried in with the food or normally present in the intestines, to pass the ordinary barriers 

 and invade the blood-stream, thus giving rise to a form of blood-poisoning. 



In this connection Roger's short chapter on " Unclassified Long Fevers, " is worthy 

 of study. Whether one type can be transformed into another is a vexed question into 

 which we need not enter, but as time goes on more links will undoubtedly be added to 

 the imperfect coli-typhoid chain.* A step in this direction has been taken in these 

 laboratories, for Captain Archibald has made the tirst serious attempt to separate out 

 and classify these fevers. The work is tedious and far from complete, but that it is of 

 practical value is, I think, shown by the results of the bacterial vaccine treatment he 

 has tried in three cases as will be found recorded in his attached paper to which these 

 brief notes serve merely as a general introduction. 



• See papers in the Joiirnnl Roijal .Innij Medical Corps for Deoembcr, 1910. 



