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SCIENCE. 



[N. S. Vol. XXIII. No. 585. 



temperature low (subnormal). There is 

 jaundice, with hemorrhages, albuminuria, 

 black vomit, uremia, and death occurs in 

 a manner very closely resembling that 

 caused by yellow fever. The clinical 

 charts vary as to pulse, respirations and 

 temperature. The face and chest are 

 quite red, the eyes congested— little photo- 

 phobia — pupils about normal for amount of 

 light present. Ophthalmoscopic examina- 

 tion of the retina shows it somewhat con- 

 gested, the optic disk slightly so. The lips 

 are somewhat red, during chill quite blue. 

 The gums are usually normal or slightly 

 red, except in bad cases, when they are 

 spongy and bleeding. The tongue is some- 

 what broad, with yellowish coating, some- 

 times indented. There is tenderness over 

 the stomach, liver and spleen both some- 

 what enlarged. Jaundice is usually noticed 

 after the first day. The urine is increased 

 in quantity, then diminishes, and often con- 

 tains bile, albumin, casts and blood. The 

 blood taken from the lobe of the ear or 

 from finger-tips shows sestivo-autumnal 

 parasites. In the year 1899 this fever 

 was investigated by Dr. J. D. Bloom, 

 then surgeon of the Charity Hospital 

 of this city; Dr. 0. L. Pothier, patholo- 

 gist and bacteriologist of the Charity 

 Hospital; Dr. G. S. Bell, visiting physi- 

 cian of the Charity Hospital; Dr. S. 

 Y. Mioton, assistant pathologist of the 

 Charity Hospital; Dr. Maurice Couret, 

 assistant pathologist of the Charity Hos- 

 pital, and the speaker. In every case 

 we found the sestivo-autumnal parasite 

 where the blood was examined. This was 

 done in over a hundred cases. The blood 

 of one hundred and thirteen persons (not 

 ill) was examined out of that number, 

 and eleven had the parasites in their blood, 

 and on tracing the history of the eleven 

 six had the fever and five were afterwards 

 taken ill. I will now detail one of Dr. G. S. 

 Bell's cases simulating yellow fever with 



black vomit, ending in recovery, recorded 

 by collaborators in the article published 

 in the Netv York Medical Journal, May 19 

 and June 2 and 9, 1900, to which I would 

 refer any one who wishes further cases, 

 clinical charts, etc. 



M. G. A boy sixteen years old, born in Bayou 

 LaFouche, La., family history good; previous his- 

 tory good. Patient came to New Orleans two 

 weeks before taking sick, but had been feeling 

 bad for a while in LaFouche. Complains of pains 

 throughout the body, chilly sensations, impaired 

 appetite, tired feeling, etc. On October 18, he was 

 taken sick with fever, headache, no appreciable 

 chill (no chill), vomiting, pains all over the 

 body. The same symptoms continued the next 

 day, October 19, 1899. Dr. G. S. Bell was called 

 for the first time to see the patient on October 20, 

 1899, and found the following conditions: The 

 patient was very nervous, restless and suffering 

 with intense headache; eyes slightly jaundiced; 

 stasis, but not very marked; gums slightly soft. 

 He had profuse diarrhoea. It was stated that the 

 patient had twenty actions from the bowels; they 

 were watery but of natural color. Temperature 

 was 104° F., pulse 120, respiration 40. Dr. Bell 

 making a careful physical examination found heart 

 normal, lungs normal, liver slightly enlarged, 

 spleen distinctly enlarged and tender on palpation. 

 On examination of the blood he found malarial 

 parasites, urine contained two per cent, of albu- 

 min, hyaline casts, bile, no granular casts. Or- 

 dered five grains of bisulphate of quinine in water 

 every three hours. October 21 (fourth day of ill- 

 ness) : Temperature 102.4° F., pulse 112, respira- 

 tion 32. Other symptoms about the same, ma- 

 larial parasites still present in the blood. Urine 

 contains two per cent, of albumin, bile, hyaline 

 casts. Ordered five grains of bisulphate of 

 quinine; continued every three hours. No other 

 treatment. October 22 (fifth day of illness) ; 

 Temperature 101° F., pulse 112. Patient vomit- 

 ing black. He had black vomit three times while 

 Dr. Bell was at his bedside. The blood still con- 

 tains a few malarial parasites. The stomach 

 being irritable, Dr. Bell stopped the quinine by 

 mouth, and gave him five grains of bisulphate of 

 quinine hypodermically every three hours and 

 stopped all nourishment. He saw the patient 

 twelve hours after; stomach was less irritable, 

 vomiting had ceased; patient feels better. Octo- 

 ber 23 (sixth day of illness) : Patient feels much 

 better, temperature 100° F., pulse 80, respiration 



