132 YERSIN AND VASSAL. 



up to hard and unfamiliar labor in surroundings to which they were not 

 accustomed. 



All the cases were observed a short time after their arrival, between 

 May 25 and June 1. The disease disappeared on the spot, without 

 spreading to the native population or the other coolies on the railway. 

 Our observations included five cases of natural and two eases of ex- 

 perimental disease. We will review them briefly. 



NATURAL INFECTION. 



Case 1. — Hoan Hiet, 20 years of age, from the village of Coi-Tri (Province 

 of Ninh-Binh, south Tonquin), entered the hospital on May 25, 1900, for sores 

 on the legs. On June 1 his temperature rose to 38° C, on the 5th to 40° C. A 

 large abscess was discovered at this time, which was immediately opened. The 

 temperature fell, but rose abruptly twenty- four hours later; after a careful 

 examination it was easy to see that it was not caused by the wound, but that 

 a new affection had begun. Moreover, the sores healed very rapidly. A number 

 of very peculiar symptoms appeared little by little with the pyrexia. The patient 

 fell into a state of profound prostration, which was not stupor but rather a 

 complete annihilation of his strength, accompanied by a nervous upset. He was 

 at times indifferent and dejected, at others delirious- and agitated, his attitude 

 was not without analogy to that shown by patients with bubonic plague. The 

 patient complained and groaned continually. There was headache and insomnia. 

 On the third day nausea began and the tongue remained coated without becoming 

 dry. Constipation persisted during the entire illness; the abdomen was neither 

 distended nor painful. The cardio-pulmonary apparatus revealed nothing abnor- 

 mal on percussion or auscultation, although the breathing was accelerated and 

 the pulse often as high as 120. There was no eruption on the skin nor on the 

 mucosa, but the conjuetiva became considerably injected. 



On the sixth and ninth days of the illness, the patient seemed more prostrated 

 than ever, but without ceasing to complain; the prognosis became more serious. 

 Suddenly, on the tenth day, a true crisis set in. The fever fell, the appetite 

 returned and cerebral calm was restored. From that moment recovery was 

 certain and continued without complication and with marvelous rapidity. 



The temperature chart was high during ten consecutive days, ranging between 

 3S°.2 and 39°. 6 C. during the first eight days, and between 37°.9 and 38° C. on 

 the two last ones. There were only three remissions in the morning between 

 37°. 8 C. The defervescence which had been perceptible on the ninth day was 

 sharply accentuated on the tenth. 



Case II. — Ngo Khoat, of the village of Coi-Tri (Province of Ninh-Binh, 

 south Tonquin), from the same village as Case I, entered the hospital the same 

 day as the latter. 



The man had been found on the railway embankment already in full pyrexia. 

 He was in a state of great weakness, the conjunctivae very much injected; no 

 eruption, and no intestinal phenomena were observed; he had been taken ill ver3' 

 suddenly five or six days before. In the hospital, the same principal phenomena 

 were observed as in the preceding case. There was nervous disorder, cephalagia, 

 delirium succeeded by prostration, habitual insomnia and tremor. The fever 

 fell by crisis on the sixth day of his hospital treatment, which was probably the 

 eleventh or twelfth day of his illness. There was a very rapid improvement and 

 recovery without complications. . 



