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The Clinical History of these cases reminds one forcibly of the severe remittents which are recorded as occurring in the early years of the Colony's history.
CLINICAL HISTORY OF THESE CASES OF MALIGNANT REMITTENT Fever.
Invasion.
The premonitory symptoms are the same as in all febrile disorders, namely, pains in the back and limbs, a feeling of lassitude, tenderness about the joints, nausea and headache.
As a rule these are of very short duration lasting only for a few hours, the onset of the fever paroxysm being very sudden and generally accompanied by distressing bilious vomiting.
Symptoms.
The patient at the first appears quite prostrated, countenance pinched and flushed, tongue generally foul and dry, bowels constipated, and complaining chiefly of headache, and distressing vomiting. On taking his temperature it will generally be found as high as 102° to 105° F., as a rule he is very restless and anxious.
In this condition the patient will remain for three or four hours or perhaps longer, then as a rule the urgent symptoms will to some extent subside, the temperature will fall two or three degrees, the skin becomes more moist, and the vomiting either ceases or becomes much less: this is the remission.
In some cases, however, where the patient is more severely attacked by the disease, no remission occurs, but the temperature will gradually but surely rise, despite every means taken to lower it, the skin remains dry and hot, the vomiting continues, rapid respiration sets in, the patient soon becomes delirious, the delirium passes on to coma, and death may occur, in a few hours.
This was the case with P.C. HAMILTON, admitted on 6th June at 9.50 P.M. He had been on duty that evening near the Bridge over the Kennedy Road, and, feeling ill, came into the Hospital. His temperature on admission was 105° F, antipyrin was given, and, by 11 P.M., the temperature had fallen to 104°.5 F., however, it soon rapidly rose from this point notwithstanding that he was wet packed and antipyrin administered but not retained, it continued rising, the patient soon became delirious coma supervened, and he died at 2.35 A.M. next morning, his temperature just before death being 107°.8, after death it registered 110°. F. in the rectum.
On admission this patient simply complained of distressing pains in the limbs accompanied by vomiting.
This man had only been in the force for some five months, and it is undoubtedly the case that new comers seem to be more liable to this malignant type of the disease.
The only case of severe remittent fever that has ended fatally in the Government Civil Hospital this year amongst Europeans is that of a gentleman who had only been in the Colony for a few months and this was his first attack of fever; he was not smitten down quite so suddenly, but he succumbed after a week's severe illness. (Temperature chart attached).
In cases where remission occurs it will last from 2 to 10 hours and then the exacerbation supervenes, the temperature probably rising some two or three degrees higher than in the initial attack.
The urine is acid, high coloured and generally contains a trace of albumen.
As the temperature rises during the exacerbation, all the symptoms become more severe, as a rulé drugs are now quite useless as the stomach rejects everything, the patient soon becomes delirious, and unless active measures are taken to lower the temperature, coma sets in and death in a short time may occur.
Duration.
Is from a few hours to as many weeks. MACLEAN states "that death is rare before the eighth day," but in some of the cases I have named death has occurred in a few hours.
Varieties.
There are at least three varieties of Remittent Fever met with here
Ist. The Malignant type in which the patient seems to be quite overcome by the virulence of the poison, this resists all the modes of treatment we know of at present, and proves fatal generally under a week. (See case of HUGH PARKER in Appendix.)
2nd. The purely Remittent, in which the onset is sudden and severe followed by exacerbations and morning remissions ultimately ending in recovery generally under a fortnight. (See case of LOCKHEAD in Appendix.)
3rd. The mixed type, in which at first the patient is suffering from Intermittent Fever, the temperature falling to normal in the morning, but in a few days the remittent type sets in and runs its course as before described. (See case of WELTZ in Appendix.) 4th. The so called "Typho-Malarial" fever, I think this term should be blotted out of our nomenclature, there are so far as I can ascertain no such diseases as a hybrid of enteric fever and malaria or a transformation of malaria into enteric. The disease to which this name has been applied by authors is either a severe form of remittent fever with marked nervous prostration, or else enteric fever occurring in a patient who has pre-
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