Page:The Journal of Tropical Medicine, volume 6.djvu/223

THE JOURNAL OF TROPICAL MEDICINE. OL

) June 15, 1903.]

In the cases above alluded to there is no difficulty in making out the malarial parasites in the blood, and their disappearance from the peripheral circulation during the course of the disease. _ Let me quote some illustrative cases. Here is a _ Man, a coolie in mission employ, who during his incu- _ bation period has to trim borders, and turn over some old ground in the heat of the day. His attack begins _ with four days’ apparent malarial fever with quotidian _ Tigors, and the presence of a small pigmented plasmodium in the blood. . SUEDE ___ Here is a woman who during the incubation period _ does a heavy day’s washing, and gets drenched with _ Tain during the course of the day. She has a week of rigors at regular periods, the temperature descending to normal in the intervals. Then it becomes continuous and high, and she passes through the last two weeks of an attack of typhoid. 7

On the other hand, here isa boy who had been admitted to hospital for lateral lithotomy, being operated _ upon two days after admission. He is kept under supervision, well fed and cared for. A week after operation, the temperature in thé meantime having been practically normal, his temperature slowly rose in the _ typical manner and he had an uncomplicated attack _ of typhoid fever.

_ (4) Is the mortality of typhoid the same as amongst meat-eating races, in cool climates, and is there any difference in the ultimate cause of death in these cases and in those specified above? —

, This question is an extremely difficult one to answer. _ The Chinese are full of their own notions, and occa- sionally precipitate a fatal resylt in this way. For | Instance, in one of my cases the friends insisted on _Temoving a girl in the third week of typhoid because they did not think she would récover, thereby causing | Perforation and death in a few hours. The patients | also will get hold of all kinds of indigestible food and devour this contrary to orders.

My own impression is that, if proper care were taken,

| the bill of mortality would be lower amongst the natives ) than amongst the Europeans, but I have not sufficient data to make a positive pronouncement on this point, |and as will be seen, the actual percentage mortality | amongst the natives is very high. , 7 During the period over which: my researches extend there have been 26 cases of typhoid amongst the small | European population of Amoy, with 4 deaths, a per- centage mortality of 15-4. During this period Dr. of the Amoy Hospital (fo Whom-my best thanks e due for allowing me to seashis cases and use the for statistical purposes), and myself have seen attacks of typhoid amongst the natives. All these e been clear attacks ; doubt/] cases in which Widal’s test could not be performed being excluded. Among this eee there were 11 deaths, a percentage mortality _ The sexes of these patients were as detailed below :-— hy Male 32, female 23. The majority of the patients were under 30 years of age, the youngest 12, and the oldest 56. The causes of death were: Perforation 3, septicemia miscarriage 2, toxemia 6.

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Two of the cases of death occurred in pregnant women. Both cases came into my hands far too late, and were profoundly septic ; in both the abortion was incomplete and the placenta stinking.

It will be clearly seen from what I have said that part at least of the mortality bill is avoidable, and as the natives come to trust foreign methods more these cases may be saved.

Still, taking it at its best, it is clear that the disease is a serious one, widespread, and a standing menace to Europeans unless due care is taken. And it is not yet sufficiently recognised that to partake of salads made up with Chinese grown vegetables, and to drink of unprotected water, or of milk, without efficient sterili- sation or filtration at the hands of other than Chinese, is to court disaster.

As the treatment to be adopted in a country like’ China differs somewhat from that prevailing in our own country, it will be well if we turn for a few minutes to this subject.

As to the reduction of temperature: my own cases have been treated by sponging when the temperature reached 104°; ice is unobtainable in my region, and so has not been used. Dr. Otte’s cases have been treated by baths. whenever the temperature rose above 103°, and certainly the patients seem to like this form of treatment. As to the ultimate results, they have been about the same, whether bathing were employed or not.

Constipation may be very troublesome. Chinese bear enemata badly and we hardly ever administer them. Our not infrequent practice is to administer a small dose of castor oil, if needed, even at the height of the illness. In some cases a grain of calomel daily secures the passage of a stool, and seems to preserve the tone of the bowel. If the patient is seen at the outset, I think it is wise to thoroughly clear out the bowel by a purgative, and in the Chinese, who are very often infested with worms, it is well to give a dose of santonin. This drug, followed by a saline next morning, serves to clear the bowel, and give one’s patient a fair start.

As a routine treatment, salol, gr. 5, combined with a grain of quinine, is my usual prescription, and the quinine serves to prevent the cropping up of malarial symptoms.

If diarrhoea be troublesome then the following pre- scription often checks it :—

Salol os “s ars Xe am OE AUD} Bismuthi Carb. .. ae ae ae eater: Sodii Bicarb. a Bs 4 an ORT WO; Pulv. Ipecac. Co. .. c gr. 2,

M. Ft. pulv., ter die until diarrhoea is checked,

Other symptoms must be treated as they arise, after the usual methods.

The native does not take to European food, and often will not touch either cow's milk or beef tea, but I have found that there is one form of food one can always get them to take. Their staple food is rice, and this I direct them to boil an hour longer than usual, with the result that it becomes a pulp; to this is added a large spoonful of sweetened condensed milk, one spoonful to one of the ordinary native bowls, which holds about 10 ounces. The patient is allowed as much of this as he will take, and must take at least three