Sessional_Paper_1895 — Page 231

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paresis and the tongue when protruded did not come out so much to the left. There was slight paresis of the left facial nerve on this date and the fits were not nearly so frequent. 9th August: bad only one fit during the night and one during the morning up to noon. He now lies all the time with au india rubber ring to bite or insert between his teeth. He had a large number of short fits on the morning of the 10th, but they were of much shorter duration--the longest only lasting for about half a minute. The grasp in the left hand was now fairly good, but could not perform fine movements with his fingers. These short fits gradually diminished in number and on the 16th it was noted that they are confined to irritation of the leg muscles. He was now very drowsy; this was ascribed to the ainount of bromide of potash that he was then having, grs. xxx. four times a day. On the 26th it was noted that there had been no twitchings of the leg muscles for about four days, and the patellar reflexes were somewhat exaggerated. There was no albumen at any time in the urine-be never had a fit before his attack of plague and never had one after 26th of August until the day of his discharge. Remarks:-Any diagnosis in this case is difficult to make; evidently a unilateral lesion was present, but its exact location is doubtful. With the experience of Case XVII in mind it is quite possible there was no hemorrhage. Here the man's cerebral condition between fits was good, while Case XVII was unconscious all the time, and I do not think there were enough symptoms of meningitis to say that it was severe enough to account for the above condition. On several occasions the convulsion distinctly commenced in the left thumb and my opinion at the time was that a small hemorrhage was present in the region of the arm centre at the upper part of the right fissure of Rolando, but I am afraid now this would not explain all the symptoms.

*

Case XVI-Japanese. t. 23.

Admitted 15th August, 1894, with slight dyspucea, headache, furred tongue, slight pain in the left femoral region and tenderness on pressure. Has had fever for some days. The glands in the left femoral region are slightly enlarged. Temperature chart. Bacilli were found in blood by Dr. TAKAKI on the day of admission. On the 18th a number of roseolar spots appeared over the upper part of the abdomen and chest, with gurgling and tenderness in the right iliae region. The bowels were constipated but stool was very light yellow, and the patient kept on fluid nourishment as typhoid was suspected in addition. On the 19th was seen by Professor AOYAMA who also said typhoid." On the 20th again plague bacilli were found in the blood. There were several crops of spots. The patient was discharged well on the 11th October.

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AUGUST, 1894.

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Remarks.--The only result we could come to in this case was that it was one of mixed infection, typhoid and plague. Typhoid is one of the most likely diseases to be mistaken for plague, when no history can be got from the patient. Patients brought in by the search parties often could not give us any assistance and in this case we were all the more cautious as on one previous occasion a diagnosis of plague was made when post mortem examination showed the disease from which the patient had suffered was typhoid but this was before the bacteriology of the disease was properly known.

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