M (1) 14
of the subtertian, and 5-10 per cent. of the benign tertian, slightly different figures being returned by different observers, but quite 95 per cent of the cases are due to the subtertian parasite. The quartan is seldom seen, it is doubtful if it occurs more than once in two hundred cases.
Considering the frequency of fever caused by the subtertian parasite it is natural to meet with some of the complications which are apt to be associated with it, especially in children. This summer and autumn I saw twelve or fifteen children of five and under who were sent to hospital because of convulsions, or coma, or other cerebral conditions and all with the characteristic history of being taken suddenly ill, of a rapidly rising temperature which became normal or nearly so after a limited period, the convulsions or the coma occurring for the most part as the temperature rose. Hyperpyrexia was noted in one of the cases and aphasia in another. Several groups of two or even three children belonging to the same family were brought to hospital at the same time not only suffering from malaria but from similar complications of malaria, e.g. coma, convulsions. The diagnosis was made not only by the finding of the malaria parasites in the blood, but by the rapid improvement in the conditions after the intramuscular injections of a solution of the hydrochlorate of quinine. In two instances two children of different families were treated in hospital twice during the year for malaria. A considerable proportion of the children who were affected this year were sent in with the diagnosis of sunstroke. All of these cases recovered.
The liability of children who suffer from malaria, to one or other of the cerebral complications is a definite one, and the importance of distinguishing between it and sunstroke is essential for the treatment of a very dangerous condition. Although examples of hyperpyrexia, coma, convulsions, aphasia, and paresis were seen none of the patients suffered from such complications as are described as syncopal, or haemorrhagic, but the so-called “blackwater fever" has been observed in this colony. It was reported as occurring in a child in 1914 and the condition seemed to be in every respect the same one which is often encountered in tropical Africa. Since then several other cases have been reported as having been observed in the other hospitals of the colony. It is known to occur in Indo-China, Malaya, and in Formosa and other places in the far East, but it is not nearly so common in this part of the world as it is in Africa. It is on account of its association with malaria in the opinion of many that reference has been made to it in this place, and not because it has been proved to be a purely malarial complication.
The species of mosquitoes which are known to act as carriers of malaria are Anopheles maculatus, Anopheles minimus, Anopheles sinensis and Anopheles tesselatus. Anopheles karwari is suspected to act as a carrier.
Of the other mosquitoes, the stegomyia group is represented by three species: Stegomyia fasciata, Stegomyia scutellaris, and Stegomyia W. alba, the Stegomyia scutellaris being the commonest mosquito in this colony. It breeds in any receptacle containing
M (1) 14
of the subtertian, and 5-10 per cent. of the benign tertian, slightly different figures being returned by different observers, but quite 95 per cent of the cases are due to the subtertian parasite. The quartan is seldom seen, it is doubtful if it occurs more than once in two hundred cases.
Considering the frequency of fever caused by the subtertian parasite it is natural to meet with some of the complications which are apt to be associated with it, especially in children. This sum- mer and autumn I saw twelve or fifteen children of five and under who were sent to hospital because of convulsions, or coma, or other cerebral conditions and all with the characteristic history of being taken suddenly ill, of a rapidly rising temperature which become normal or nearly so after a limited period, the convulsions or the coma occurring for the most part as the temperature rose. Hyperpyrexia was noted in one of the cases and aphasia in another Several groups of two or even three children belonging to the same family were brought to hospital at the same time not only suffering from malaria but from similar complications of malaria, e.g. coma, convulsions. The diagnosis was made not only by the finding of the malaria parasites in the blood, but by the rapid improvement in the conditions after the intramuscular injections of a solution of the hydrochlorate of quinine. In two instances two children of different families were treated in hospital twice during the year for malaria. A considerable proportion of the children who were affected this year were sent in with the diagnosis of sunstroke. All of these cases recovered.
The liability of children who suffer from malaria, to one or other of the cerebral complications is a definite one, and the import- ance of distinguishing between it and sunstroke is essential for the treatment of a very dangerous condition. Although examples of hyperpyrexia, coma, convulsions, aphasia, and paresis were seen none of the patients suffered from such complications as are descri- bed as syncopal, or haemorrhagic, but the so-called “blackwater fever" has been observed in this colony. It was reported as occur- ring in a child in 1914 and the condition seemed to be in every respect the same one which is often encountered in tropical Africa. Since then several other cases have been reported as having been observed in the other hospitals of the colony. It is known to occur in Indo-China, Malaya, and in Formosa and other places in the far East, but it is not nearly so common in this part of the world as it is in Africa. It is on account of its association with malaria in the opinion of many that reference has been made to it in this place, and not because it has been proved to be a purely malarial com- plication.
The species of mosquitoes which are known to act as carriers of malaria are Anopheles maculatus, Anopheles minimus, Anopheles sinensis and Anopheles tesselatus. Anopheles karwari is suspected to act as a carrier.
Of the other mosquitoes, the stegomyia group is represented by three species: Stegomyia fasciata, Stegomyia scutellaris, and Stegomyia W. alba, the Stegomyia scutellaris being the commonest mosquito in this colony. It breeds in any receptacle containing
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