28 VASSAL AND BROCHKT, 



since the morning, but his condition soon becomes worse. Appetite 

 fails, the tongue becomes coated, in some cases nausea is present. We 

 never noted diarrhoea or constipation in this first period. 



Cephahilgia is verj^ characteristic and plainly localized. There is no 

 photophobia, but the movements of the eyes are painful and a feeling 

 of pressure on them may be experienced. The patient is unable either 

 to look up or to one side on account of the pain. The pain in the forehead 

 continues without exacerbations; it diminishes rapidly. 



After the second day of the disease, the patient complains only of a 

 slight headache; the ocular and periorbital pains persist for several days. 

 In general the fever appears suddenly, but rarely is it accompanied with 

 a chill. The skin is hot and dry, there is at times excessive perspiration. 

 The pulse does not always increase in role in conformity with the tem- 

 perature; it is about 100 for 40°. In the case of one patient the pulse 

 was at 100 only when the temperature reached 42°. 



None of our cases had rachialgia or severe muscular pains. They 

 complained only of stiffness in the back and limbs. There M-as no 

 arthralgia; they were all able to stand upright and to walk. No erup- 

 tion appeared either on the skin or on the mucosa.^ Later, the fever 

 abated and the pains in the limbs and head diminished. The fever is 

 the constant and important symptom. 



We have collected during this epidemic 85 cases which may be divided 

 into the following three categories: 



(1) Attacks with one paioxy^m. 



(2) Attacks with two paroxysms. 



(3) Unusual and attenuated attacks. 



The fever in the first category reaches its maximum in about 24 hours 

 and falls in five or six days by lysis, more rarely the descent takes from 

 two to six days. The following are examples : 



Case No. 18, high temperature for 2 days. 



Case No. 71, high temperature for 3 days. 



Case No. 67, high temperature for 4 days. 



Case No. 16, high temperature for 5 days. 



Case No. 14, high temperature for 6 days. 



The fever in the second category may reach its maximum in twenty- 

 four hours, or more rarely not until two days have passed, it then falls 

 one or more degrees, rises again on the sixth da}' and ends on the sixth 

 or seventh. This is illustrated in the charts of cases 7, 9, 10, and 41. 



The chart of spirillum fever does not resemble that of dengue; indeed 

 there could be no confusion between the two except in the case of 

 .spirillum fever with two paroxysms, but in the latter the ascent takes 

 longer and stays at a high level, and the relapse is complete and lasts for 

 several days. 



