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October 31st.-Morning visit-his temperature had fallen to 100° F., his pulse was 96, in the evening pulse temperature was 108 and 102-8°; the rash seemed to be spreading over skin of chest and abdomen, the spots being irregular in outline, colour deeper at the centre than the edges.
November 1st.-Roseolar eruption was pretty general all over the body, pulse morning 108, Temperature 103.2° F. and in evening pulse 112 and Temperature 102° F.
November 2nd.-Bowels open four times during the last twenty-four hours, fæces thin and..... yellowish, pain was complained of this morning in the left hypochondriac region, and at base of the left lung, there was slight dulness there with a few fine crepitations, pulse and temperature will be seen by referring to the chart. *
The rash had become much more dusky in appearance, presenting a mulberry hue.
November 3rd.--This evening patient was much worse and delirious, he was also markedly deaf at 11 P.M. his temperature had risen to 106° F.; previous to this the treatment had consisted in the administration five minims of Tincture of Aconite every four hours in an ounce of chloroform water, I discontinued this medicine and gave him ten grains of antipyrin every hour.
November 4th.-At 4 A.M. his temperature had fallen to 102° F., at 9 a.m. it was 96-4° the antipyrin was now discontinued and Hydrocyanic Acid dil. minim. IV. every 4 hours in an effervescing mixture was given as he had been slightly sick, there being however no signs of collapse, the rash was now more of a dark mulberry colour.
November 5th.-Seemed decidedly better to-day in the evening however he became very delirious. Chloral hydrate grain X Pot Brom grs. XX was given, he slept after this.
November 6th.-Not so deaf this morning rash desquamating slightly and fading in colour. November 7th.-Dulness at right base, a few fine crepitations to be heard, spitting a little rusty sputum, still complains of pain left hypochondrium; was sleeping at my evening visit.
November 8th.-Became delirious again early this morning rapidly sank and died at 10.45 a.m. Post Mortem Examination same day at 1.30 P.M. :——
Lower part of Ileum intensely congested, mucous membrane ulcerated the ulcers being typical typhoid ulcers, one large ulcer had perforated through the mucous and muscular coats, the mesenteric glands were enlarged, softened, and in some cases had quite broken down-spleen patch of lymph on the surface about size of a crown piece on, cutting into this there was seen a whitish opaque mass about the size of a walnut immediately under the capsule this seemed broken down in the centre (? Infarct).
7
Remarks. Dr. AYRES, the Colonial Surgeon, and Dr. JORDAN both saw this case with me several times during this short illness and we were of the opinion that the patient was suffering from 'typhus fever the rash being almost typical of typhus with the exception of the slight desquamation, it all came out in three days no fresh spots being developed after this, the temperature was also more like that of typhus the gradual rise of the first three or four days, and then the decided fall on morning of the seventh.
Appendix D.
MEDICAL REPORT ON THE RECENT SMALL-POX EPIDEMIC.
From November 1887 to March 1888 there were under treatment in the Small-pox Hospital one hundred and eleven cases.
The following table shews the nationalities of the patients and the number of deaths:
Table shewing the Admissions and Mortality in the Government Small-pox Hospital during the year 1888.
Admissions.
Deaths.
Small-pox,
DISEASE.
71
Europeans.
Indians.
Chinese.
From this table it will be seen that the percentage mortality was 20·7.
* Chart not printed.
Total.
6 34 111
12
Europeans.
4
Indians.
Chinese.
23
Total.
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