Sessional_Paper_1901 — Page 498

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After a long

Case 3.--Chinese cook to Acting Principal Civil Medical Officer was a similar case. stay in hospital the fever subsided under quinine and he is now (five months after) working with the tubercular symptoms in abeyance-no cough and no loss of weight.

Unfortunately there is a reverse side to this picture, as in most of the cases after one or two attacks of malaria the fever does not subside but takes on the hectic type and the case goes downhill. In this disease we think it is as well to examine for malaria as we are inclined to think the combina- tion much more prevalent than is generally supposed or even than our figures show. Another practical suggestion we would offer is that in all cases with fever and cough, however slight, though there are no lung symptoms, an examination of the sputum should be frequently inade. We have by this means detected several cases in the very earliest stage, ie, the stage when treatment or change holds out most hope. As a diversion we may add that all phthisical cases have been treated routinely with Chinosol but we have found that the drug has no effect on the disease and after a long course the bacilli are still as numerous as ever. It has therefore been abandoned here and must, we think, be added to the long list of reputed specifics for this disease which have been found wanting. Carbolic acid in large doses has been substituted and the result will be duly recorded.

LIVER ABSCESS.

It is laid down

Only two cases have been under treatment and both showed malaria in the blood. by the authorities that malaria does not produce suppuration in the liver but both our cases are against this view and we therefore give them in short detail.

Case 4.--A young Officer was admitted to hospital from Lyeemun fort with fever. He had only three months' foreign service and had never been ill before. His liver was much enlarged and the blood slide contained numerous malignant parasites. Quinine was administered in various doses, both by the mouth and hypodermically, but notwithstanding this, the fever kept up and the parasites continually recurred in the blood. As the liver diminished in size slowly, the fever was looked upon as purely malarial and our attention was taken off the hepatic condition. Eventually, however, he was aspirated and on pus being found the usual operation was performed and the patient went home in due course. The case impressed us with the necessity of watching each case of hepatitis carefully even though malarial parasites are present. None of the ordinary causes of liver abscess were here present and we do not see to what other cause it can be put down to save malaria. Another feature in the case was the extraordinary manner in which the parasites recurred in the circulation, some days being present and on others absent notwithstanding the constant use of quinine,

Case 5.-A French Officer from a coasting steamer was brought to hospital with fever and a typical liver abscess pointing in front. He had never had dysentery or diarrhea and had always been very abstemious. The operation was performed successfully but the temperature still kept up and three days after the operation he had a rigor and looked very ill, temperature 104.8. This condition recurred for two days but just previous to again exploring the liver-which we were loathe to do owing to his feeble condition-his blood was examined and showed numerous malignant parasites. Under quinine he rapidly improved and leaves for home by next French Mail. His condition was most suggestive of another liver abscess and we think the blood examination was most useful as it avoided another operation-not serious perhaps--but one which it was as well to avoid in an already feeble patient. We also consider, possibly erroneously, malaria as the cause of this hepatitis going on to suppuration.

APPENDICITIS.

The combination of malaria with this disease is interesting. We have only had two cases and both showed malaria. The first came in with malaria and later on complained of the appendix trouble. The usual operation was performed successfully. The second was more instructive.

Case 6-A French gentleman from Saigon was admitted with symptoms which were diagnosed as an appendicitis pointing towards the rectum. The temperature kept about 100°. The abscess eventually burst into the rectum and the patient's condition improved very much until four days after when the temperature suddenly rose to 103° and we concluded that the abscess must have filled up owing to the entrance into the rectum having become obstructed. Previous to any surgical inter- ference the blood was examined as part of the routine and to our surprise malignant tertian parasites were found-under quinine the temperature ceased rising in the evening in a day or two and the patient is now at home quite well. The only attack of malaria he had ever had was 8 months pre- viously at Saigon.

DYSENTERY.

The combination of malaria with this disease is extremely common. Out of 37 cases examined 35 showed malarial parasites. None were fatal though one or two were very obstinate and none were followed by hepatic abscess. Needless to say we found quinine most useful in addition to the saline