TYPHUS FEVER IN INDOCHINA. 133 



In spite of careful observation we did not find the least sign of eruption. 

 Both Cases I and II received quinine in large doses by mouth and subcutaneous 

 injection without result. The analysis of the blood, moreover, showed no signs 

 of specific hrematozoa. 



Case III. — Pham Khang, 28 years of age, also from the village of Coi-Tri, was 

 ill several days on the railway works. We witnessed in the hospital only the 

 terminal crisis which developed with remarkable suddenness. From the inquiry 

 we made among the comrades of Pham Khang, we elicited the information that 

 the following symptoms had been noted: Bloodshot eyes, prostration, fever 

 without apparent remissions, constipation, rambling and incoherent complaints. 

 The patient left the hospital on June 5, cured. An examination of the blood 

 proved negative. 



Case IV. — Lai van Due, 2G years of age, from the village of Thuong-Huu 

 ( Province of Nam-Dinh, south Tonquin ) , came into hospital on the second or 

 third day of his illness, which had begun on the railway. We observed six 

 consecutive days of very high fever, reaching 39°. 9 and 40° C. with two matu- 

 tinal remissions to 3S.°4 and 38° C. The fall was abrupt; a slight ascent was 

 noted the next day to 37°. 4, then a descent to a point well below the normal 

 during four days. 



The same phenomena were present as in the preceding cases, except that 

 diarrhoea followed several days of great constipation. No spots of any sort were 

 present, but the conjunctiva; were again excessively red and inflamed. Quinine 

 had no effect and there were no hsmatozoa in the blood. 



Case V. — Tran Luan, 24 years of age, from the village of Van-Khan (Prov- 

 ince of Nam-Dinh, south Tonquin), entered the hospital on June 1, 1900, in 

 the evening. On one of our weekly visits to the railway embankment, we found 

 him very much prostrated and not able to stand alone. We took him into the 

 automobile, but he was unable to remain in a sitting position without help. 

 We learned that he had suffered from a sudden attack of fever the day before. 

 His illness in hospital lasted ten days, the fever remaining high during six 

 days. On the seventh there was a matutinal remission to 37° C. but the same 

 day it again went up to 39°. 3 C. in the evening. The next day there was a 

 marked defervescence, and forty-eight hours later a return to normal, however, 

 with a tendency to hypothermia during several consecutive days. Thus this case 

 resembled those of the other patients. The clinical signs were reproduced with 

 remarkable precision. 



Let us repeat once more the characteristic features of this case. First, the 

 sudden attack, fever lasting eleven days, great weakness with delirium, the 

 miserable and distressing aspect of the patient, and lastly the rapid recovery 

 after the crisis, and entire absence of relapse or complications. 



Quinine medication was inefficacious and all the examinations of the blood 

 were negative. 



EXPERIMENTAL INFECTION. 



We had tried in vain to reproduce the disease in the laboratory 

 animals, such as rats, guinea pigs, or rabbits, and we thought that it would 

 be of great scientific interest if we could be enlightened as to the transmis- 

 sion of the disease in the quickest possible manner, namely, by experi- 

 ments on man. The relatively benignity of this cyclic fever justified 

 this procedure. The positive knowledge of the nature of yellow fever 

 and of its prophylaxis only dates from the first experiments on man 



