Sessional_Paper_1902 — Page 835

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The improvement was so gradual and so marked that one is justified in looking upon it as a cure and not a remission.

MALIGNANT MALARIA WITH OBSTRUCTIVE JAUNDICE.

A European sailor from a coasting steamer was admitted on 28th June. His temperature was 100, conjunctive jaundiced, left lobe of liver very tender and constant vomiting, a blood slide showed numerous malignant quotidian parasites. The jaundice became rapidly general and the vomiting very persistent, under hypodermics of morphia the latter symptom subsided but the patient became delirious and rapidly sank, dying on the 2nd July. The temperature was normal in the morning and 104 in the evening of 29th, normal all day 30th, 105 in the morning and 102 in the evening of 1st.

Post mortem.-Jaundice deeply marked all over. Gall bladder slighly distended but no obstruction could be made out. Brain congested and excess of fluid. Spleen enlarged and soft. Smear from this organ teemed with malarial parasites.

CHRONIC PANCREATITIS JAUNDICE-DEATH.

An engineer was admitted from a steamer on the 30th May, 1901, deeply jaundiced and dying. The only history obtainable was that he had had jaundice for over a year but had been doing his duty up to a few days before his admission. He was deeply jaundiced all over, temperature 101, quick almost uncountable pulse and great dyspnoea. He was put to bed and given stimulants but died a few hours after, passing a large tarry stool just before death.

Post mortem.-Gall bladder was much distended and full of bile, intestines full of blood. Pancreas very much enlarged and hard being about double the average size and weighing eight ounces. The head was firmly adherent to the common bile duct and intestines. Section of pancreas was stained and

showed a large increase in the connective tissue but no recent haemorrhages.

MALARIA COMA-PREMATURE BIRTH-DEATH.

A Chinese prisoner in about the 8th month of pregnancy was suddenly seized with a fit at the Gaol on 1st June, 1901. When seen she was quite unconscious, with contracted pupils, deep stertorous breathing, insensitive conjunctivæ and small feeble pulse. Under the idea she was suffering from uræmia she was transferred to the Maternity Hospital. On arrival she was in much the same condition, temperature 100, and passing her urine unconsciously. By means of a catheter a specimen was obtained-1015, acid, trace of albumen-3.3% urea. The following day she was slightly better and could be roused by loud shouting and tried to do what she was told (put out tongue, &c.). The urine contained albumen with blood corpuscles and blood casts. Labour came off naturally, the child, however, being dead. On the 3rd the temperature was 103, urine normal, patient again more uncon- scious-a blood slide showed large numbers of malignant quotidian parasites. Ten grains of quinine hypodermically were given night and morning but without any drop in the temperature which on the 4th went up to 106.8. As the patient was quite unconscious and evidently sinking, lumbar puncture was performed and the tube left in for 48 hours. Under ice packing the temperature fell to normal at mid-night. The blood next morning was still full of malaria though the patient was much better and more easily roused. The quinine was increased to 15 grains twice daily hypodermically and a mixture of Tinct Ferri mXV and Quinine gr. II given every two hours. The patient, however, slowly became more unconscious, the temperature ranging between 101 and 105 till the 7th when she died, temperature 106. Throughout urine and fæces were passed unconsciously.

Post morten-Heart and lungs normal save for some old adhesions at right base. Liver cirrhotic, 2 lbs., kidneys normal but much congested, spleen 5 oz., brain soft and congested but no increase in the fluid either at base or in ventricles, blood smear from spleen teemed with parasites.

well

INTESTINAL OBSTRUCTION DUE TO STRICTURE OF RECTUM.

A married European female, aged 31, was admitted to hospital on August 21st. She was quite up to the 20th, when she was seen by a medical man who prescribed a pill (Pil Hydrarg grs. III. Pil Coloc Co. grs. IV.) for vague abdominal pain and vomiting. On admission her temperature was 102.4, with furred tongue, tympanitis and tenderness all over the abdomen, but more especially in the right iliac region, malignant malarial parasites were found in the blood. Her previous medical history was good though there was a history of an attack of dysentery in 1895 but no abdominal trou- ble since. The vomiting continued throughout, the rejected matter consisting of green "spinach like " material and never feculent. Bowels did not respond to enemata, salines or small repeated doses of calomel. On 24th she was examined under chloroform but nothing definite could be found to account for the symptoms. There was no dulness in the right iliac fossa and nothing was felt

per rectum.

On 25th her condition was the same and as the tympanitis was distressing and the vomiting continued a small trocar was inserted into the intestines and a quantity of fœtid gas escaped with a certain amount of relief. On 26th, as her condition was decidely worse laparotomy was performed. The intestines were much congested and distended, there was no appendicitis and no cause was found to account for the distension. She slowly sank and died the same day.

Post mortem.-No peritonitis or appendicitis. Intense enteritis. The whole of the small intestine and the large intestine as far as the sigmoid flexure were distended and at the lower end of the sigmoid flexure a stricture was found, the intestine being contracted to the size of a goose-quill. On cutting through this constriction it was found to be due to the cicatrisation of a dysenteric ulcer with thick- ened and indurated edges. There was no tubercular disease anywhere.