APPENDIX 
AN UNCLASSIFIED WEST AFRICAN FEVER 
In the British Medical Journal of January 26, 1901, S. W. Thompstone, F.R.C.S. and 
R. A. Bennett, M.B., M.R.C.S., district medical officers at Old Calabar, gave a preliminary 
note on an unclassified type of West African fever — to which they proposed to give the name 
' hyperpyrexial fever.' 
The cases occurred during the stay of the members of the expedition at Old Calabar, and 
we were able to watch the course of the disease in both cases. 
By the kind permission of Drs. Thompstone and Bennett we are allowed to reproduce 
the short account of their cases here — and we are indebted to Dr. Shekleton of Bonny for the 
earlier part of the temperature chart of the second case, which occurred at Bonny. Because of 
lack of hospital accommodation and the impossibility of affording such constant attention as such 
a case demanded, this patient was shipped to Old Calabar and treated at the European hospital 
there. 
We now give the remarks of the authors of the communications to the British Medical 
Journal. 
1 Clinical Features of Hyperpyrexial Fever 
This fever is generally ushered in by a slight rise of temperature followed by profuse 
perspiration and a fall in the temperature to about 99 0 F. After a period of apyrexia of perhaps 
twenty-four hours' duration the temperature begins again to rise, slowly at first, but when 105° is 
passed with alarming rapidity, one degree in ten minutes having been frequently observed, and it may 
reach 107° on the second day. For fourteen or even for thirty days subsequently there is abso- 
lutely no tendency for it to fall. The skin acts either very slightly or not at all, and all 
antipyretic drugs fail. 
The tongue is at first furred on the dorsum and red at the edges and tip ; late in the 
disease it becomes dry and shrivelled. There is no enlargement of the liver or spleen. The 
urine is of normal character and abundant ; the bowels are regular or inclined to looseness. 
The conjunctivae are injected and the pupils contracted. The mind remains remarkably clear 
in most cases, except when the temperature is at its highest, but constant symptoms in the early 
days are great anxiety and restlessness. 
With regard to the examination of the blood, no plasmodia nor pigmented leucocytes have 
ever been discovered, but in two of the later cases it was noticed that the blood tended to coagu- 
late the moment it was exposed to the air, so that it was only with great difficulty that satisfactory 
films could be obtained. 
Typical Examples of the Disease 
Case I. This patient had been on the Coast for about five months, and had had no 
fever until the present attack. During the last month he had lived in a tent at a quarry some 
