Sessional_Paper_1903 — Page 349

264

17

On November 13th chloroform was administered, the edges of the torn rectum trimmed and brought together by means of three strong catgut sutures which were left buried. The perineum was then freshened, fine " purse-string sutures of silkworm gut were inserted and tied carefully. The usual after-treatment was carried out.

Bowels were kept confined for a week, then opened with a small enema. The vagina was washed out thrice daily with a weak antiseptic lotion, and the parts kept clean. As catheter was passed every 6 hours, and the patient lay on her side with knees lightly strapped together. The silkworm gut sutures were removed on the 12th day, and patient was discharged from Hospital, a few days later, perineum sound and ample, and having complete control of her motions.

This case is interesting as one of pure septicemia in which the absorption of morbific material into the blood gives rise to symptoms of blood poisoning without the development of local lesions. The attack coming on immediately after child- birth indicates infection during or previous to labour. As this patient must have been in the hands of the Chinese midwives for 12 hours or more, and subjected to manipulation with their unwashed hands, and long septic finger nails, one marvels both at her rapid recovery and the vitatily of the race.

CASE OF PARTURITION COMPLICATED BY MALARIAL FEVER.

M. C., an English lady, was admitted to the Maternity Hospital on December 21st, 1902.

Patient was a primipara, up to full time, and stated that she had been suffer- ing from fever for some days and her temperature had reached 105° F. Though not in labour when admitted, patient was recommended to come in at once owing to the fever, and especially as both she and her relatives were very anxious.

Temperature on admission at 9 p.m. was 101.6° F. descending to 98° F. on the following morning. She was placed on low diet, milk and chicken broth with a diaphoretic mixture to be taken every 4 hours. A blood film was examined at noon which showed patient to be suffering from malarial fever of mixed infection, (simple tertian and æstivo-autumnal).

A five-grain quinine pill was ordered thrice daily and one pill was given at 6 p.m. when the temperature was 98.2° F.

Symptoms of commencing labour were then apparent, and the pains continued during the night. At 6 a.m. on the 23rd instant the temperature was 100° F. reach- ing 100.5° F. at 12.15 p.m. when the child was born.

Beyond slight post-partum hæmorrhage, checked by hot lysol douche, the labour was normal.

Pil. Quinine grains five was now ordered every four hours but the temperature steadily rose and at 8 p.m. same evening reached 104° F. Except for a severe headache patient stated she felt very comfortable. The diaphoretic mixture was continued and by noon on the 24th instant her temperature registered 97.4° F. The temperature now remained normal and on the 27th a blood film was examined when a few ring form parasites were found, but no simple tertian parasites were to be seen. Quinine was continued and patient discharged 18 days afterwards free from malaria after repeated careful blood examinations, temperature having been normal for 20 days.

This case is interesting from the fact that patient had only arrived in this Colony a few months previously, she never had malaria before, and did not come from a malarial district, but during her stay in Hongkong, she had resided in a locality known to be infested with anopheles and where malaria was rife (Macdon- nell Road).

Immediate blood examination revealed the cause of the fever, and the subse- quent rise of temperature after labour caused no anxiety as to sepsis, etc., besides enabling us to ease the mind of the patient and her relatives as to prognosis.

CASE OF MAdura Foor.

An Indian, aged 36, was admitted on 4th January. The right foot was swol- len with several sinuses leading to dead bone. The sinuses were discharging an oily purulent material smelling very offensively. The disease was of three months' duration and the patient had been in Hongkong for eleven months, previous to this he lived in the Punjaub. The disease somewhat resembled syphilitic necrosis and he was treated with iodide of potassium for some time but without any result. A sincar from the discharge was full of streptothrix. He was advised to submit to amputation but he declined this radical treatment and left on 28th February. This case shows that the streptothrix infection exists in this Colony and further cases of this interesting disease may be expected to occur.