X, B,5 Schiiffner: Pseudotyphoid Fever in Deli 849 
brownish color, and slowly disappears. In some cases the erup- 
tion may be very slight, consisting only of a few reddish spots. 
In this rudimentary form, while it is distinctive in the European, 
it can very easily be missed on the dark skin of the native. To 
this I attribute the fact that with natives I found the rash only 
in 70 per cent of my cases, while with Europeans it was present 
in ali. On the other hand, the rash may be so pronounced as to 
resemble the eruption of measles—in one of my cases some spots 
on the abdomen became hemorrhagic, and in this case only was 
there desquamation. 
THE TEMPERATURE CURVE 
The course of the fever can best be described by saying that it 
corresponds in all respects to that seen in enteric fever. In 
severe cases the temperature attains its maximum in four or 
five days and so remains for some time, then gradually falls by 
lysis. This course sharply distinguishes the disease from typhus, 
with its brusque onset and termination by crisis. Cases are 
met with in which the fever is of a remittent type, as in mild 
cases of enteric fever, or, again, after ten days or thereabouts of 
high fever, there may be transient remission, to be again followed 
by another period of high fever of about the same duration. 
As in the case in enteric fever the nervous system sufrers 
greatly. In mild cases there may be violent headache, and in 
severe cases drowsiness, the ‘typhoid state’ or continuous 
delirium. Restlessness is a notable feature of the disease, espe- 
cially during the night; patients attempt to rise from the bed, 
there are involuntary evacuations, and constant watchfulness 
is necessary. It is characteristic that this serious nervous dis- 
turbance appears relatively late in the course of the disease, when 
the fever has been at its maximum for several days, and that 
these disturbances continue even when the temperature is fall- 
ing. In many cases it is only in the afebrile period that the 
mental state returns to normal. 
i do not know whether these symptoms have been noted in 
kedani fever in Japan, but they are eminently characteristic of 
the disease as it appears in Deli. . 
CHANGES IN THE BLOOD 
A moderate leucocytosis from 10,000 up to 12,000 per cubic 
millimeter is the rule, but cases in which the leucocytes number 
as many as 26,000 per cubic millimeter or as few as from 4,000 
to 5,000 per cubic millimeter have been noted. 
More significant, however, than the total leucocyte count is 
the relative proportion of the different varieties. Where there 
