499
others running their own course without, as far as one can see, any cause for the continued fever or for the difference between any two cases.
Coma" malaria is very interesting. The five cases we had were all very serious and two ended Only one was in a Chinese so that it would appear as if Europeans were more subject to this
fatally.
form.
Case 24.-Came to hospital with slight fever and with a history of intermittent fever of a week's duration. He was in a dazed. apathetic condition from which he never rallied. Numerous parasites were found in the blood and all internal organs were as far as one could judge healthy. In spite of vigorous treatment by quinine hypodermically the unconsciousness increased slowly but surely, and he died a few days after admission.
Case 25.-This case was interesting from the fact that he came to hospital after a week's fever quite unable to talk. He lay quite quiet in bed but no answers could be obtained to any questions put to him. For a week his temperature ranged between 100 and 103° in spite of quinine grs. v every 4 hours. The drug was then given more frequently and without effect until it was administered hypodermically when the temperature slowly came to normal and the patient after a long stay recov- ered though his speech was always a little slow.
Case 26.--A Chinese female prisoner (who was pregnant) was suddenly seized with a fit at the Gaol. She was quite unconscious, stertorous breathing and dilated pupils. Under the impression it might be a case of uræmia she was transferred here. Her blood was found full of parasites. She never regained consciousness in spite of quinine, &c. As these cases all show at the post mortem increase in the cerebral fluid one of us performed lumbar puncture and drew off a quantity of fluid. The case seemed to improve slighly after this but eventually, after the birth of a dead child, terminated fatally. l'arasites were present in the blood up to the last in spite of 20 and 30 grains of quinine hypodermically every day.
In these "coma" forms we have been somewhat disappointed in quinine as it does not appear to have much effect on the disease. In those who recovered we found iodide of potassium and arsenic help greatly towards regaining their normal mental condition, possibly by causing absorption and so relieving brain pressure. In all cases there was a marked slowing of the pulse for some time after (40-50) indicating stimulants and stychnia.
Two cases of malignant malaria, both in natives of Manila, were interesting in the way they ended. After three and five days respectively of a continuous fever their temperatures dropped sud- denly to 95° with a very bad pulse, profuse sweating, &c. They both, however, under strychnia and stimulants recovered. One of them was delirious on the 2nd day-rare in malaria-and but for the history might have been taken for typhoid.
MALARIA WITHOUT FEVER.
Two cases of this anomalous form occurred.
Case 27.-Was admitted on January 24th with crescents and sporing quartan parasites in the blood. On 25th quartan, 28th quartan and malignant tertian, and on the 31st crescents and malig- nant tertian were found. No rise of temperature throughout.
Case 28.--Admitted 30th January with malignant and simple tertian parasites en masse. Patient felt very seedy but had no fever. Under tonics and quinine he recovered.
In some few cases quinine did not seem to have much effect on the temperature though why this was so was not clear.
Case 29.-Parasites in the blood. Quinine grs. v every 4 hours was administered for 6 days without in any way affecting the temperature. The quinine was stopped and 4 days after the tem- perature fell to normal and remained so.
Case 30.-Parasites in blood. Temperature rose to 100° in the evening for 2 days when quinine was administered in 15-grain dose in the morning for 3 days. In spite of this the evening rise was 101°, 102.6° and 103° when the fever ceased.
Case 31.-Quinine grs. xv every morning for 3 days, then quinine grs. v every 4 hours for 6 days when temperature at last fell to normal with no further rise.
We found crescents in the blood of one patient throughout in spite of treatment for the attack of fever for which he was admitted. He left with the crescents still present, advised to continue arsenic and iron for a long period.
CLASSIFICATION.
As there seems to be some difference amongst authorities, as to the nomenclature of malarial parasites, we have adopted that suggested to us by Captain JOHNSTON, which we believe is that used by Major Ross. It seems to us both simple and scientific:-
Simple Malarial-Simple Tertian and Quartan.
Malignant Malaria.—1o M. Tertian (ring-shaped parasites with pigment).
2o M. Quotidian (ditto without pigment).
No comments yet.
Private notes are available after approval.