FOUR CASES OF PYREXIA 237 



3. The signs and symptoms simulate somewhat a case of enteric in the second week of 

 the disease. 



4. The fever is a septicaemia and the bacillus has been isolated from the blood as late 

 as the fifth week of the disease. The blood serum has no agglutinative reaction on 

 B. typhosus and B. paratyphoid Ti. and B. dijsenteriee, but agglutinates the specific bacillus 

 up to a dilution of 1 : 100. 



5. In two of the cases the bacillus was isolated from the fcEces. 



Notes ox the Treatment of two of the Cases 

 BY means of Vacoines 



It is the usual custom in these laboratories to prepare a vaccine of any organism 

 isolated from the blood of cases of severe pyrexia, occurring in Khartoum. Treatment with 

 such a vaccine is shown to be justifiable if one refers to the account of two of these febrile 

 cases treated by autogenous vaccines. The most marked result of vaccine treatment was 

 obtained in Case IV., that of the Englishman. Case I. was of interest owing to the fact that 

 the patient received two different vaccines. For the notes on this case I am indebted to 

 Captain Cummins, R. A.M.C. The following were the chief points. Four days after admission 

 a blood culture was carried out and a vaccine made of the above-mentioned bacillus. The 

 patient's general condition was serious, passing from a state of delirium into one of coma. 

 The pulse was weak and rapid. There was some enlargement of the parotid gland. An 

 injection of b c.c. of the vaccine representing 50,000,000 organisms was given on the 

 sixth day of the disease. 



For the next two days there was no change in the patient's condition. The swelling of 

 the parotid gland had increased in size. A second injection of the vaccine was given on the 

 eighth day, the amount used being 1 c.c. which represented 100,000,000 organisms. This 

 was followed by a rise of temperature. The following day there was some improvement 

 noted as the patient appeared more rational. An incision was made into the parotid 

 swelling from which pus freely exuded. Two days later the trunk, arms and legs of the Outcrop of 

 patient were covered by multiple boils, several of which were suppurating. There was also 

 a purulent discharge from the right ear. 



He was now in a somewhat asthenic state, due doubtless to septic absorption. Many 

 of the boils had broken down and formed large bed sores. 



Cultures made from the pus present in these boils showed the presence of a Staphylococcus 

 alhus. A vaccine was made and an injection representing 50 million killed staphylococci 

 was given subcutaneously. Fresh boils appeared on the scrotum. The temperature at this 

 stage was showing an evening rise to 100' F. and a morning fall to 99 F. A second 

 injection of the staphylococcus vaccine was given eight days after the original one, the dose 

 representing 100,000,000 organisms. This was followed by such beneficial results that at Success of 

 the end of a week the boils had entirely healed. From this onwards, progress towards ™'='^'"^ 



treatment 



recovery was gradual hut well maintained, and in three weeks the patient left hospital in a 

 convalescent state. 



The history of Case IV. is of equal interest. For the notes on it, I am extremely 

 indebted to Dr. Squires of the Sudan Medical Department. 



Patient was admitted to hospital suffering from severe headache, malaise and pyrexia. 

 On the second night after admission the temperature reached 103' F. and then fell by lysis 

 till the eighth day, when a secondary rise occurred. After patient had been under 



Q 



