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ABDOMINAL TUBERCULOSIS ABDOMINAL SECTION. RECOVERY.
A German sailor was admitted on May 1st with a history of having been ill a month with fever. A diffuse tender swelling over Poupart's ligament on the left side. There was a history of wasting and he had numerous scars about the neck suggestive of tubercular ulceration. His temperature varied between 99o in the morning and 101° and 102° in the evening. On May 13th an examination was made under chloroform but nothing very definite was made out. Some enlarg- ed glands were felt per rectum. His temperature still continued with some trouble in micturition and general pain all over abdomen, varying in intensity in different parts. An incision over Poupart's ligament did not reveal any suppuration or any tumour,
His condition slowly grew worse, the fever running up to 103° and 104° at night with obstinate constipation and pain all over the abdomen though more chiefly confined to the epigastrium. On June 23rd vomiting set in and his pulse became very quick and feeble. The following day abdominal section was performed. Immediately under the incision was a thick adhesion running between two ccils of the small intestine. This was ligatured and divided, some serous fluid evacuated and the incision closed.
The patient immediately felt the benefits of the operation. Vomiting. cons- tipation and fever ceased and he slowly, owing to crops of boils, convalesced. He was discharged cured on 6th August and proceeded home to Germany.
Remarks. Numerous enlarged glands were felt in the abdominal cavity at the time of operation but no further adhesions. The patient was very ill at the time and though seen by numerous medical men none were quite sure of the nature of his illness. The case shows the advantages of an exploratory abdominal
incision in these obscure cases,
OUTBREAK OF MALARIA AT SEA.
Two Russian torpedo boat destroyers left home for the Far East in October, 1902. They touched at Colombo, leaving there on April 10th for Sumatra. At this port they were auch:ored close to the shore and the crews were allowed leave. The destroyers left on the 19th for Singapore, at which port none of the members of the crews were on shore and the boats were anchored a long way off. On the 23rd they left for Hongkong, the health of the men being so far good. On May 1st and 2nd. several of the men were suddenly taken ill with high fever, headache, furred tongue, and in some cases vomiting. Out of the total of 58, 21 men were affected.
On the 5th these men were brought to hospital and were isolated as the Medical Officer reported them as cases of "Malignant Influenza.” Their symptoms were much the same as when first attacked, the temperature varying between 100° in some and 104° in others, most of them appearing very ill. A blood examination at once settled the diagnosis as they were all teeming with parasites, in the majority of cases (18) of the malignant type and in a few of the simple tertian variety.
The disease was no doubt acquired at Sumatra, which would give an incuba- tion period of over 13 days and was in all probability acquired on shore as the Captain informed me that he noticed no mosquitoes on board either boat. Under quinine they all recovered and left for the North after eight days in hospital.
This outbreak at sea is well worth recording as the latest authorities on the subject seems doubtful as to malaria occurring at sea, having evidently lost sight of the fact that the disease has, like most others, an incubation period.
PUERPERAL FEVER. USE OF ANTISTREPTOCCUS SERUM. RECOVERY.
A Chinese female was admitted to hospital with fever. She had been confined 4 days previously, having a normal labour. Fever and pain set in next day the pain being chiefly on the left side of the abdomen. Temperature on admission 104°, diffuse tender swelling left iliac fossa, lochia normal and not offensive. She continued ill for four or five days and was treated with anodyne applications to abdomen, diaphoretic mixtures with aconite, quinine and occasional hypodermics of morphia and strychina. The improvement in her condition was a direct result of the serum as the chart shows. She is now well and will leave shortly.
The therapeutic use of sera still being on its trial this case is worth recording as I think a consideration of the chart will show how immediate the benefit was after the serum. The case was was under Dr. LAING, Assistant Superintendent,