PSEUDOTYPHOID FEVER IN DELI, SUMATRA (A VARIETY OF 
JAPANESE KEDANI FEVER)? 
By WILHELM SCHUFFNER 
(Chief Medical Officer, Senembah Maatschappij, Deli, Sumatra) 
THREE PLATES 
INTRODUCTORY 
In the course of my practice in Sumatra I have, since 1902, 
met with a number of cases which, though resembling enteric 
fever in their general clinica] characters, appear from the re- 
sults of bacteriological investigation to constitute a distinct 
disease. At the Bombay Medical Congress in 1909 I referred to 
these cases under the name pseudotyphoid and in collaboration 
with Dr. Margarethe Wachsmuth published an account of them - 
in the same year. 
Further observation during the past five years has shown 
that the disease is preceded by an initial lesion in the form of 
a small area of dermal necrosis in some part of the body; this 
necrosis is followed by the formation of a small ulcer and more 
or less pronounced enlargement of neighboring lymphatic glands. 
These facts, together with the occurrence of a rash, show that 
the disease possesses many of the features which characterize 
kedani or tsutsugamushi fever of Japan. Until recently this 
disease has been known only in Japan, but in 1908 Ashburn and 
Craig described an analogous disease in the Philippine Islands, 
and it is probable that it occurs in other countries, also. 
As I have had no opportunity of observing personally the 
Japanese disease, it is impossible for me to compare it in detail 
with the disease which occurs in Sumatra. I must, therefore, 
content myself with an enumeration of the more outstanding 
points of resemblance and difference. 
COMPARISON OF PSEUDOTYPHOID WITH KEDANI FEVER 
SEASONAL INCIDENCE 
Kedani fever appears in Japan only at certain times of the 
year, which are determined by the periodical floods. In Sumatra 
there is no such regularity; the disease is observed throughout 
the year. The 158 cases during 1908 were distributed as 
follows: 
* Received for publication May 7, 1915. 
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