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Table XI—Shewing the ADMISSIONS into and DEATHS in the GOVERNMENT Maternity HOSPITAL
during each Month of the Year 1901.
MONTHS EUROPEANS JAPANESE CHINESE & INDIANS Total Admissions Deaths Admissions Deaths Admissions Deaths Admissions Deaths Remaining on the 1st January, 1901 2 January 6 February March April May June July August September October November December 3 19 22 Total 10 8 2 20J. M. ATKINSON,
Principal Civil Medical Officer.
Table XII. Shewing Varieties of MALARIAL FEVER, uncomplicated and associated with other Diseases, occurring monthly at the Government CIVIL Hospital during 1901, and Percentage of Cases to Number of Patients in Hospital.
MONTHS Quartan Simple Tertian Malignant Mixed Infection Total Percentage January 31 33.17 February 32 1 2 26.11 March 1 2 1 17.80 April 3 3 26.02 May 4 5 6 31.48 June 10 6 4 74 41.59 July 6 1 7 94 43.62 August 33 55 1 123 47.84 September 55 85 8 122 41.60 October 115 109 119 44.77 November 108 121 133 38.82 December 114 919 125 35.14 Total 1,036J. M. ATKINSON, Principal Civil Medical Officer.
HEPATIC ABSCESS DUE TO MALARIA—OPERATION—RECOVERY.
An officer of the Garrison was admitted to hospital on the 7th December suffering from fever of 3 days' duration. The patient was a strong young man with only 3 months' foreign service, all in this Colony. He had never had dysentery or malaria before and was a very abstemious person. His tongue was furred, temperature 103.4 with enlargement and tenderness of the liver. Blood slide showed numerous malignant quotidian parasites. Under quinine in various forms and doses and saline purgative he improved somewhat, the chart however being very irregular 100 to 101 or 104, occasionally normal all day and parasites being sometimes present (4th, 13th, 22nd February and 8th March) and at other times absent (12th, 18th, 19th and 24th January and 25th February). The liver dulness diminished considerably but still remained enlarged somewhat and tender in one spot. On the 28th February an exploratory puncture showed the presence of pus and the usual operation was performed. After the operation the temperature still kept up in an irregular manner rising to 100.8 or 103 in the evening—a small piece of necrosed rib was removed and on the 1st April the temperature fell to normal and kept so throughout. The patient began to mend and put on weight and left for home on the 1st May with a small sinus still discharging.
Remarks.—The cause of the liver abscess seems to have been the malaria which was very obstinate notwithstanding frequent and large doses of quinine. The presence of parasites in the blood was rather puzzling and took one's attention off the hepatic condition.
PROBABLE PYONEPHROSIS DUE TO CALCULUS—WITHOUT PAIN OR FEVER.
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 bile-stained and were about 5 or 6 a day and this diarrhoea throughout was quite unaffected by treatment. His blood showed no malaria and he complained 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 the 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 neighbourhood 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 99 in the morning and 101° in the evening. The quinine was reduced to 5 grains ter die 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 quinine 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 observation 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 complaints 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 November, 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 left 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.