498
PERNICIOUS ANEMIA AND MALARIAL CACHEXIA.
One case of each of these diseases came under notice and both had the malarial parasite present in the blood. Both, I regret to say, ended fatally.
SYPHILIS.
Only 4 cases were examined and 3 showed malaria. One of them was sufficiently interesting to
deserve notice.
Case 22.-Patient was sent in from Canton and parasites were found in the blood.
He was treated for some time with quinine, both by the mouth and hypodermically, but the fever still persisted running an irregular course. Eventually a typical sore was found on the scrotum and under mercury and iodide of potassium the fever rapidly subsided and the patient left quite well. In some of these obstinate causes of malaria it is just as well to bear in mind the possibility of a syphilitic element.
ABSCESSES.
Four cases were examined and in all malaria was present. very large and required several small operations for their cure. found. They all did well.
INJURIES,
Those in the neck and thigh were In only one was any obvious cause
The shock of an injury, even when very slight, seems frequently to bring out an attack of malaria. Of nine cases examined five showed malaria. One case seems worth reporting.
Case 23.-Patient was admitted having had his hand blown off in an explosion. The arm was amputated, and on the 3rd day the temperature went up to 103°. Under the impression the wound was not healing by first intention, it was examined and found to be doing very well. His blood showed a mixed infection of simple and malignant tertian malaria and under quinine he did well. He had been subject to malaria all the summer and had only just returned from Japan where he had been recruiting his health. Another time we will examine the blood first and the wound after.
GONORRHEA.
Four cases of this common complaint had fever and their blood was examined. All showed malaria and under quinine the fever rapidly subsided.
ERYSIPELAS.
Only two cases of this unwelcome complication in a hospital have occurred, both in the surgical ward. Malaria was found in each and both were very bad probably owing to the complication. They, however, did well. They were at once isolated and no further cases occurred.
MEASLES.
Two cases of this complaint were under treatment, one being complicated with malaria. The disease itself is a very mild one here, but the combination of malaria made the case more troublesome and necessitated a longer stay in hospital.
NEGATIVE RESULTS.
A few other cases with fever, slight or otherwise, were also examined but gave negative results. They comprise cases of Burns, Dyspepsia, Endocarditis, Otitis, Anaemia and Hepatitis. The shock of a burn should, we think, produce an attack of malaria and further investigations on this head are required. We were only able to examine one case.
MALARIAL FEVER (UNCOMPLICATED).
Of these cases-perhaps the most interesting of the record-261 were under treatment during the past six months out of a total of 1,323 patients. There is, therefore, a fair amount of material avail- able for the study of the disease in this hospital. Of this number 216 were of the malignant variety which is here at any rate by far the most common form of the disease. Simple tertian fever occurred in 30 cases and only one quartan came under observation. The latter variety would, therefore, seem to be extremely rare, which is perhaps fortunate, as it is stated to be very unamenable to quinine and tends more to produce anæmia than the other forms. Fourteen cases of mixed infection were also seen but the combination of two forms of malaria in the same patient does not appear to make the case more serious or more obstinate. One Policeman, who has been in three times, always has the mixed infection. In pondering over malaria, as viewed clinically, one cannot help being struck with the various forms of the disease which are all due to the same cause. From the patient who either has no fever, or a fever which after a few hours disappears leaving him well and able to get up, to the patient who is suddenly overwhelmed with coma and in spite of all treatment passes away after only a day or two's illuess occur all shades of the diseasc, some yielding rapidly to treatment and causing no anxiety,