Sessional_Paper_1901 — Page 497

493

No. 27

1901

HONGKONG.

CLINICAL REPORT ON MALARIA.

AS SEEN IN THE GOVERNMENT CIVIL HOSPITAL DURING THE HALF YEAR OF 1901,

BY

Dr. J. BELL, Acting Principal Civil Medical Officer,

and

Mr. G. STEWART (Lieut. I.M.S.), Acting Assistant Superintendent.

Laid before the Legislative Council by Command of His Excellency the Governor,

Having had the great privilege of being instructed all last summer and winter by Captain Jonx- STON, I.M.S.—a co-worker of Major Ross-in the technique of the examination of blood for malaria, the various forms of the disease and the deductions to be drawn from an examination of a blood slide, we determined this year to examine the blood of all patients with fever and as many, as possible, with symptoms suggestive of malaria, and the results of our observations are embodied in this report. We are not aware of any extensive attempt in this direction having yet been made in a tropical hospital where, needless to say, there is a large amount of material available. No case of uncomplicated malaria has been returned as such without the parasite having been previously found. Many cases which might have shown malaria, as a complication, have no doubt been passed over, for, owing to the pres- sure of work, especially during the prevalence of plague, we have not been able to keep the record as complete as we would have liked. Practice in this, as in other similar work, makes perfect and it is surprising how quickly, after a few months' training, the eye detects the slightest signs of malaria in a blood slide. In a few cases-and very few-it has been necessary to withhold quinine for a few hours till a second examination showed the parasite, absent or overlooked at the first trial. A routine practice of this kind, apart from the benefit to the patients which naturally ensues, may, also lead to the accumulation of facts which, it is possible, will tend towards helping to eradicate the discase itself. We make no claim whatever to being authorities on malaria, but have simply recorded facts which have come under our notice clinically. We have dealt with over 400 cases, in the majority of which malaria has been present if not at the first examination at a subsequent one and it is possible these facts may be of interest to others.

PATHISIS.

The combination of malaria with this disease is very important as well as very interesting. Of 17 cases examined 15 were complicated with malaria. Hongkong and, we believe, most tropical countries are looked upon as being very prejudicial to the cure of tubercle. Amongst the Chinese here it is generally, and probably rightly so, to a certain extent, put down to overcrowding and insa- nitary surroundings, but this does not apply to Europeans and Indians who form the bulk of our patients and who suffer quite as much as the natives. We are inclined to think that the malarial combination accounts in a great measure for the rapidity with which the disease advances. Several of the cases have come in two or three times for fever without anything but inalaria being found until eventually they have returned with another attack of malaria, the sputum previously negative now full of tubercle bacilli and the lung symptoms in full swing.

Case 1.-European wardmaster with phthisis, who improved very considerably, especially when doing duty at Kennedy Town Hospital, contracted malignant malaria with dysentery. This set a light to the lung mischief which advanced rapidly, after the malaria and dysentery had been cured, and ended fatally.

It is useful to examine the blood of all phthisical patients for, if the disease is in an early stage, and the malaria treated, some cases improve considerably, and without a blood examination most of the cases would be treated only for the phthisis to which the fever would be supposed to be due.

Case 2.-An Indian Policeman with fever and cough. Malaria was present in the blood and though no lung symptoms could be detected tubercle bacilli were found in the sputum. Under quinine the fever subsided entirely, the patient put on weight and the bacilli disappeared. After a lapse of four months he is still doing his duty.