Pro NEPHROSIS DUE TO CALCULUS-WITHOUT PAIN OR FEVER.
735
A German aged 56 was admitted on the 21st of December. Patient looked ill and seemed much older than the age he gave. He stated that he had been suffering from dysentery in Manila and had come over to get stronger. His stools were liquid and bilestained and were about 5 or 6 a day and this diarrhoea throughout was quite unaffected by treatment. His blood showed no malaria and he com- plained of no pain anywhere throughout the illness. His temperature varied between 96 and 98.4 during his illness. His urine was examined on several occasions and was always normal save on the last occasion, 6 days before death, when "a faint trace of albumin" was reported. He slowly became more and more drowsy but was easily roused for his food and medicine. His lips and mouth were frequently covered with thrush. He passed his motions in bed throughout. Towards the end he became delirious and very irritable. The case was seen by several medical men and the diagnosis of auto-intoxication confirmed, the absorption probably taking place from an old dysenteric ulcer. The treatment consisted in liquid diet, stimulants and various antiseptics. He died on 17th February.
Post mortem.-Intestines much atrophied but no signs of dysentery. Liver cirrhotic. Heart and lungs normal. Right kidney enlarged and lobulated. Left kidney had a small stone firmly blocking thẻ ureter, pelvis dilated and full of pus, the abscess cavity extending into the substance of the kidney.
MALARIAL COLITIS SIMULATING APPENDICITIS-RECOVERY.
A German soldier was brought to hospital by his medical attendant to be operated on for appendicitis on the 2nd April. He had been ill for three days with constipation, fever (102°), furred tongue and offensive breath. The abdomen was very tympanitic and tender more especially over McBurney's point. His bowels had not acted for four days, his temperature was 102.4, pulse 110. On the following day he was still very tympanitic and tender and the least pressure in the neighbour- hood of the appendix elicited much pain. There was frequent vomiting and dulness in both flanks. His temperature was 101.4 and a blood slide showed numerous non-pigmented ring-formed parasites (malignant quotidian). After several doses of saturated solution of magnesium sulphate the bowels acted copiously and the stools were full of "jelly like" material. Under quinine grs. 5 every 4 hours and saline purgatives he slowly improved, vomiting ceased, tongue cleaned and the distension and tenderness disappeared and the temperature became intermittent 9° in the morning and 101° in the evening. The quinine was reduced to 5 grains terdie but in 48 hours the symptoms recurred, pain more especially in R. iliac'fossa extending to the region of the bladder and the stools were again full of "jelly like" mucus. The quinine was ordered to be given every 3 hours, hot fomentations applied to the abdomen and a quiniue enema (30 grains) given every night. In 48 hours the patient was much improved and the temperature fell to normal and remained so. Dulness and a sense of resistance in the R. iliac fossa continued for some few days but eventually cleared up. Patient was discharged quite well on the 1st May.
GENERAL PARALYSIS OF THE INSANE-RECOVERY AFTER THREE YEARS.
A German sailor was admitted to the Asylum from the Gaol on 9th April, 1898. He had been several times in Gaol for petty thefts (kleptomania) and on the last occasion the Medical Officer considering he was "silly" transferred him to the Asylum. For several months he was under obser- vation without any definite symptoms save that he was decidedly silly, laughing constantly and for no apparent reason, &c. He was sent to a general ward in the Civil Hospital where in a day or two com- plaints were made, by the other patients, of his stealing all and everything he could find and hiding them away, sitting up all night writing (the writing being unconnected and mostly rubbish), putting on several suits of clothes, &c. On re-admission to the Asylum he rapidly became worse, noisy and violent and full of delusions. His ideas were all of an extravagant type. He was at times Emperor of Germany, Queen of England, President U.S.A., &c., owned stores and stores of money, millions of ships, &c.
He required a bullock for each meal, barrels of beer and 1,000 of cigars. This stage lasted for a long time and for over two years he was the noisest lunatic we have ever had, incessantly talking and shouting and hardly ever sleeping. He became very dirty in his habits and very troublesome as he had a delusion the walls and floors were covered with arsenic and it was his business to clean them with his head and mouth and it was extremely difficult to prevent him doing this. At times he ceased to be violent and noisy and was extremely liberal to his attendants, giving them gold, silver, jewels and ships, &c. His pupils were unequal and presented the Argyll-Robertson phenomenon. No history of syphilis was obtainable though on the chance he occasionally had Iodide of Potassium but as he resented any medicine under the impression they were poison, it was not persisted in. His weight fell from 162 lbs. to 124 lbs. but he slowly regained it towards the end and weighed 172 lbs. when he left. Slowly his violent attacks diminished in frequency, his appetite returned, and his delusions ceased to be marked up to 11th Novemher, 1900, when he had a series of fits of an epileptic nature with a very feeble pulse. After this the cure became more rapid and more marked so that in July he was allowed out daily and went round visiting his friends, the Consul, &c. and returning daily to the Asylum. He lǝft on August 22nd, 1901, for Germany looking well and apparently free from all delusions.
Remarks.-A cure from this disease being very rare, the case is recorded. There was no doubt of the diagnosis as he was seen by several medical men who all agreed as to the nature of the illness.