Appendix.
259
CASE OF Malaria ComatOSA—DEATH.
A Swedish officer residing at "Glenwood," Caine Road. was admitted at 6 p.m. on 15th Novem- ber, 1990. suffering apparently from typhoid fever. He was extremely ill, temperature 102, dry brown tongue, sordes on lips, low m'ittering delirium and a quick sinall pulse. He had all the appearances of a patient dying from enteric fever. Next morning his temperature was subn rial and his blood was examined. The slides showed large numbers of malignant tertian parasites. Notwith- standing large hypodermics of quinine (70 grans in all) he continued in the same condition till 6 p.m. on 17th November. 1900, when he died, his temperature ranging from 101° to 103° and the blood showing crescents for the first time on the day of his death.
Post mortem.--Showed effusion on the surface of the brain and in the ventricles. Liver enlarged weighing 90 oz. Spleen enlarg d and very soft 33 oz. Kidneys congested 11 oz. each. Intestines and intestinal glands quite normal.
Remarks.--Without any history and without a microscopical examination of the blood it would have been difficult to distinguish this case from enteric fever as the subnormal temperature night have een due to hemorrhage on moving the patient. It is the worst case of this for n of malaria shat any of us had ever seen and emphasises the importance of examining the blood in all cases of fever in this country.
ENTERIC FEVER, TWO RELAPSES, RECOVERY.
A young German aged 25 years was admitted to hospital on January 7th with a history of five days' continued fever accompanied by hea lache, pain in the limbs, &c. His tongue was furrel i the centre and clean at the tip elges. There was gurgling in the right iliac fossa with pain on pressare. Temperature 104°.
symp-
Initial Attack-This lasted for 30 days, the temperature ranging between 101° and 104°. There were crops of roseola spots, splenic enlargement with tenderness pressure over the spleen, occasional epistaxis and delirium on the 21st day with a feeble pulse of 144 and constipation. This later sy tôm was most troublesome throughout. From the 30th to 41st day the fever was of the intermittent type, normal or 99 in the morning and 100' or 103° (105° once) in the evening. From the 41st to 54th day (13 days) it remaine 1 normal and on this day he had a dose of castor oil followed by great pain in the abdomen and an evening temperature of 102°.
1st Relapse. This lasted for 20 days, the temperature ranging between 100° and 10° with a dry furred tongue, retention of urine a dry rub at left base and a bad pulse throughout. The tempera ture remained normal for 14 days (up to 87th day) when patient had a do-e of cascara sajrada followed by much aborminal pain and distress and an evening temperature of 101.8.
2nd Relapse. This lasted 13 days. temperature varying between 100° and 103°, with low deli- rium, feeble quick pulse and great depression.
Patient slowly convalesced and was up for the first time on the 120th day and left for Europe after 149 days in hospital.
Remarks -This case shows the amount of vitality possessed by some patients. He was not a robust young man having been rejected for the army and only weighing 108 lbs. on admission.
Such
a long illness on an ordinary mattress without a bedsore speaks volumes for the nursing an great credit is due to Sister HOPE and Sister EDITH for the keen and intelligent interest they took in the case throughout.
PNEUMONIC PLAGUE-RECOVERY.
His tem-
A Greek sailor was admitted to hospital on the 17th April, suffering from gonorrhoea. perature was 101° with furred tongue and a general apathetic condition but this latt r was thought to be owing to his being unable to speak English. His condition for the next two days was decidely worse though nothing definite could be male out. On the 20th Dr. LowsoN saw the case and agreed that it was very suggestive of plague and shortly after this he coughed up some typical bloody spatum which was found full of ba sill. is pulse and general condition being so bad it was thought better to isolate him in a private ward here instead of transferring him to Kennely Town Hospital. Carbolic acid gr.x every 3 hours was at once started with Brandy, Strychniæ, &e, to counteract the cardiac depressi n. After a very few doses of this medicine his tongue which was dry and brown soon became moist and the violent delirium passed into the quiet kind when he was easily fed and kept from getting out of bed. On the 22nd he was decidedly better tongue moist and cleaning, breath no longer offensive, and pulse good and no longer intermitting, sleeping well and no delirium. Sputum increased in quantity but no blood. Bacilli still present. Temperature 103°. On the 24th his tem-
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