Sessional_Paper_1890 — Page 339

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III. CASE OF INTERMITTENT FEVER. RECOVERY.

LUI A-KAN, at 18, Coolie.

Admitted 10 A.M. 1st September, 1889.

""

On admission he stated that he had felt unwell the previous day; his temperature was 100-4° skin very dry and complaining of pains in his limbs, headache and general feeling of "malaise -at 11 A.M. his temperature had risen to 104° F., the following medicine was now given:-

R. Tr. Jaborandi m. xx. Antipyrin, gr. xx. Mist. Diaphoret ad Zi. 2 horis sdm.

At 11.30 A.M. his temperature had risen to 104.8° and at 12 noon to 106-6° F. As the medicine did not appear to have any effect and the temperature was steadily rising it was thought advisable to ice pack him; this was accordingly done in the manner already described in the previous case and in two hours his temperature by this means was reduced to 99-6°, the various observations during that time being as follows:-

12.15 P.M. 12.30

****

...

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12.45

""

1.00

>>

1.15

""

1.30

22

1,45 2.00 2,15

"

""

"2

-105.6°

...105°

.104.2°

.103.8°

..103.2°

..102-8°

...102°

...101°

99.6°

As he was now somewhat collapsed he was replaced in bed between blankets and heat applied externally, ten grains of quinine being given by the mouth and repeated every two hours, his diet being milk and congee.

At 8 P.M. his temperature had risen to 102° F. and at 10 P.M. to 103.2°, the following medicine was now given.

R. Antipyrin, grs. xx.

Aq. Camph. i. o horâ adm.

and the result observed, at 11 P.M. his temperature had fallen to 102-8°, at 1 A.M. (2nd September) it was 102°, at 3 A.M. 101°, and at 6 A.M., it had fallen to 98.6° the antipyrin was now discontinued quinine given as before; that evening it rose again to 104-2° F. (8 P.M.) the antipyrin was now substituted and it rapidly fell, after 4 doses the temperature had fallen to 99.6° midnight, the quinine was again ordered and this time it was given in 10-grain doses every hour during the day, the temperature that evening did not rise above normal. As the temperature was normal on the morning of the 3rd 10- grain doses of quinine three times a day were ordered, a pint of beef tea being added to his diet with one pound of rice.

On the fourth the quinine was reduced to 5-grain doses thrice daily-and he was discharged cured on the 7th.

REMARKS. This was a case of intermittent fever with the paroxysm more marked than is usually the case, during the year we have had many such cases, as a rule however the temperature does not rise above 105° F. when if antipyrin be administered it almost immediately begins to fall profuse perspiration setting in-if we find antipyrin has not this effect we invariably now ice-pack

these cases.

This patient had no return of the fever; I have been able to keep him under observation since that time, as he was soon after engaged as a Hospital servant.

Temperature chart (No. 4.) appended.

Appendix B.

I.-GUN-SHOT WOUND OF THE LEG AND THIGH.

WONG SAI SU, æt. 12, Chinese girl, admitted in the Hospital 27th January, 1889, at 4.15 A.M. suffering from gun-shot wound of right lower extremity.

On admission :-There was an abrasion of the skin on the contiguous sides of the great toe and the second toe of the right foot, a round wound about the size of a five cent piece with clean cut edges on the inner part of the right leg three inches below the knee, and another wound on the inner surface of the lower third of the right thigh some 21" above the knee this being much larger than the wound in the leg, the edges were not so clearly defined and more irregular.

Connecting these two wounds was a sinus running along under the skin.

The treatment consisted in syringing out the sinus with carbolic lotion, inserting a drainage tube between the two wounds and placing the limb on a macintyre splint; on the third day the temperature rose to 100-2° and there was evidence of "cellulitis." Warm lead and opium fomentations were applied.