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a small purge at the onset is beneficial; the headache is sometimes most intractable and may require Hypodermic administrations of morphine.

With a view to cutting short the disease and preventing relapses I have experi- mented with several drugs, but no conclusion can be drawn from the treatment of natives since, as has already been stated, in a certain number of cases no relapses occur, and when this does happen, it is not safe to conclude that it is due to the treatment adopted.

Reference has already been made to two cases of Europeans which were watched from the beginning to the end. In these two instances the hypodermic injection of arsenie was fried and the result justifies further experiments with this drug. In the first case injections of arsenic were given daily up to the tenth day. It had already been observed that, as a general rule, if no relapse occurred by the tenth day none need be expected, and, under the impression that the patient was cured, the remedy was then stopped. He remained quite well for a month when he had a single relapse. But there is a fallacy in this case..

The patient had been about eight years in Uganda, and has had plenty of attacks of fever," no doubt most of them due to malaria, but it is more than probable that he has had spirillum before, and if so, had acquired a degree of immunity which had modified his last attack.

In the second case the fallacy could be excluded. The patient has been two years in the country, and had certainly not had the disease before. After his initial attack he was treated with daily injections of arsenic, but on the morning of the 10th day a relapse took place, and this was followed by a second nine days later.

As a rule there are at least four, if not more, relapses, so that in this case the disease did not run its usual course.

Mercurial treatment.-According to the latest views, syphilis is a disease caused by a spirillum, and as mercury is a potent anti-syphilitic remedy, I thought it might have some effect on spirillum fever.

I therefore treated several cases with the drug, but it had no effect, in fact one patient whom I was attending contracted spirillum fever whilst under mercurial treatment for syphilis.

No. IV.

A CASE OF SPIRILLUM FEVER.-By Captain R. II. PRICE, I.M.S.

The patient, a European lady, had fever for three days, when I was sent for on the 4th of April. The temperature was then 103°; there was no vomiting or other symptom, except slight cough. Examination revealed nothing. A diaphoretic was given.

April 5th.-Patient quite well; temperature normal, and remained so till April 10th, when it went up to 103 6°; on this date spirilla were found in the blood.

April 12th-Temperature again fell to norinal.

April 17th.-Had a third attack of fever; temperature again rose to 103 6o; but fell to normal the same night.

April 21st.-Temperature again up, but its character had changed; she now had pyrexia every two days lasting only a few hours. There was loss of appetite, and considerable nausea,

April 24th.-Now a daily attack of fever with rigor and sweating, each attack anticipated by two hours.

April 24th.-Fifteen grains of quinine were given-seven grains at noon and seven grains two hours before the evening attack was due. Patient had fever in the evening, but two hours later than due."

April 25th.-Fever again at night, and again two hours later'than on previous night. Quinine continued, but last dose rejected.

April 26th. No fever; seven grains of quinine night and morning, and a tonic of quinine and iron given.

April 27th, 28th, 29th, and 30th. No pyrexia, but patient very weak. Since the fever had left her she has had violent headache, and on one occasion incessant bilious vomiting.

May 1st. Temperature in the morning 101°, but it soon fell to normal. She lay on her back; both eyes were turned to the right, but this soon passed off; face also appeared drawn to the right, but there was no loss of control over the facial muscles. She could scarcely speak, and then only in a very feeble way. Had passed

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urine unconsciously. Forcibly refused to take any food. Given Sp. Animon. Arʊm. 2 dr., Tr. Nucis Vom. m 10, and Sodii Bicarb. gr. 10 every two hours.

May 2nd-No fever, still passing urine unconsciously. Brandy given, 4 dr. every four hours.

May 3rd.-A little better, still passing urine in bed, but appears to be aware

of it.

May 4th-Informed that she had had a "crisis of nervous excitation," had thrown her arms violently about, and bitten her tongue, causing it to bleed, and also had fever.

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She was seen at 5 p.m. by Dr. Cook and myself, when we found her quite unconscious, with stertorous breathing. Conjugate deviation to the right, pupils. equal and reacting to light. Left eye injected. l'assing urine unconsciously. Temperature 102.30; respirations 36; pulse strong and regular, 108. Spleen, liver, heart, and lungs normal. Blood examination showed a few spirilla and some doubt- ful malarial parasites. Eighteen gr. of quinine given hypodermically, and but little hope held out of recovery.

May 5th-Temperature at 9.30 a.m. 102°; pulse 144; respirations 44. General Condition as before; 20 gr. of quinine given hypodermically, and 10 gr. at 1 p.m.; at 1.30 p.m. temperature 101°; pulse 136; respirations 36. Another hypodermic of 10 gr. quinine given at 5 p.m.

May 6th-Informed that patient steadily sinking, and requested to discontinue

all treatment.

May 7th.-Reported much better. Seen by Dr. Cook and myself at 6 p.m. a marked improvement was found, she was conscious, and understood what was said, but was too weak to speak.

During the following week a large bedsore developed over the sacrum, and as time went on the slough separated exposing the bone, but at the same time she gradually gained in strength.

Urine now passed

May 23rd.-Thrombosis of vein of left leg developed. naturally.

May 25th.-Iritis appeared in right eye; pupil immobile and discoloured, lymph binding iris to lens, a circumcorneal zone, photophobia, with loss of vision except for light. Atropine instilled.

May 26th.-Left eye similarly affected. Both temples were blistered, a tonic of strychnine and iron given, and 1 gr. Hyd. cum Cret. four times a day. Bedsore looking well, and rapidly granulating up.

May 29th.-Patient had slight delirium during the night. Pupil of right eye well dilated, left not dilated, and no vision in it.

May 30th.-Had a bad night, wandered a good deal, but atropine continued. Ung. Hydrarg. applied to temples and gr. Hyd. cum Cret. t.d.s.

June 1st-Temperature again rose to 103°. As the atropine was causing a good deal of delirium at night, it was decreased to two drops in each eye morning and evening.

June 3rd-Temperature 103 2° with rigors and vomiting. Atropine and all other medicines discontinued, and 10 gr. quinine given hypodermically. Malarial parasites found in blood smears by Mr. Gray, of the Sleeping Sickness Commission.

June 7th-Ten gr. quinine given every day. Eyes nearly well. June 11th.-Patient now making rapid progress.. The thrombus in left leg gone. Both eyes cleared up, and vision normal. Gaining in weight, and able to sit up in bed. Bedsore nearly healed.

From the last date she made an uneventful recovery, and on the 24th of August walked a distance of two miles to report her condition. She was then looking well. her vision was normal, and the bedsore had quite healed.

This case is interesting in that it is an example of double infection by the parasites of malaria and spirillum fevers. The complications met with may he attributed as being caused in part by one and in part by the other. Coma and unconsciousness are rare in spirillum fever, but common enough in malarial infection. On the other hand, iritis or an iridocyclitis is quite a common complication of spirillum fever, and a temporary facial paralysis is not unfrequently met with in this disease though not so commonly as the eye affection.

It will be noted that coma, iritis, conjugate deviation, and facial paralysis had all been observed before quinine had been given in doses likely to produce any of these symptoms, and this probable cause may, therefore, be eliminated.