July 1,
SURGEON-MAJOR GREENE ON CONTINUED FEVER AT ADEN.
1879.]
CONTINUED FEVER AT ADEN. By Surgeon-Major Hubert
Greene, A.M.D. following rough notes of some cases of pyrexia, characterized by very persistent high temperature, have been written in the hope that, though very imperfect, they may possibly contribute in some slight degree toThe
wards the elucidation of the nature of the complex diseases which are usually classed under the head of Continued Fever.
Simple
The circumstances under these
which
occurred
they
are
:?
The 1/14th P. W. 0. Regiment arrived at Aden on the 28th December last, having come direct from Ranikhet, a hill station in the Himalayas, where it had been quartered since March 1877, and where its general health in every respect. On arrival the regiment was distributed as follows:? Steamer Point, one company ; Isthmus, three companies ; Crater, Head-quarters, including Band, and four companies The cases now reported occurred among the latter, but there were also cases of continued fever in the companies at Steamer Point and the Isthmus, which were of the same nature, and at the former station seems
to have
been
remarkably good
apparently one
I
died.
man
examination, but were
was am
not
present
at the
informed that
no
post-mortem
special
lesions
discovered.
unmarried, and
lived under similar circumdistributed almost evenly among the stances,?being different barrack rooms. They were, with one exception, steady, well-conducted men, not given to drink or addicted to vice; and their average service in India was nearly six years. were
all
Various causes have been blamed for the disease. Some observers call it 'acclimatizing fever,' and others, 'sun fever': while not a few lay the onus on sea bathing, or on 'refraction of the sun's rays from the surrounding rock.' To me. however, these names convey no meaning ; and I am inclined to seek for a cause in the insanitary
condition of the settlement which has been allowed, so far as the native portion of the community is concerned, to remain in a state of nature ever since we first occu-pied Aden in 1839. The following table shows the temperature of the air during the first three months of the year. As, however, the observations were taken with an ordinary thermometer, the results must be looked on as only ap-
proximate. 1879.
Maximum.
January, February,
March,
...
... ...
78 79 83
The treatment in the following cases included nourishwith small quantities of wine or brandy.
ing diet,
Case No. 1.?Private C. Gorman, age 27 ; time in India 1 T\ years ; previously healthy ; reported sick 7th January 1879. Symptoms: pyrexia, sleeplessness, debility. Medicine : Diaphoretic mixture every 4th hour. January 8th.?No sleep ; 10 grains quinine administered
.
9th.?20 grains calomel last quinine and diaphoretic.
Minimum. 75 75 77
Range. 3 4
6
Mean of each month.
night;
no
sleep.
Continue
11th.?Same state ; bowels regular ; no abdominal disturbance. To have 10 grains quinine in the morning and 10 more during the day. and a certain of insomnia, this fever presents no characAppetite pretty good; continue any kind.
13th.?Except high temperature, debility, amount ter of
quinine. 14th ?Not cold douche.
well: fever stronger: headache.
so
Apply
15th.?Very low last evening, necessitating exhibition of 2 oz. brandy with soda water. Slept fairly. Diet hitherto has consisted of milk, chicken, lime juice, and ice. Continue treatment, i e., quinine and cold douche to head. 1 Qth.?Headache less : no other
continue
The rest of the garrison, consisting of three batteries of artillery, which have been stationed in Aden upwards of a year, remained free from the disease. The origin of the first case dates from early in January : the other nine cases seemed to commence beThe men tween the 30th January and 10th February.
195
change
; omit douche ;
quinine.
19th.?Absolutely no symptoms except high temperadebility. Ordered 4 oz. Port wine: quinine 5 grains thrice daily.
ture and
26th.?Daring the past week this case has presented no salient symptoms of any kind beyond abnormal temperature. The patient's appetite has been good ; his bowels regular, and he has slept fairly. Since admission he has lost flesh
considerably,
and he looks very ill and
debilitated. 31 st.?Remains in
statu
quo: omit medicine
(qui-
nine). February 3rd.?For some days past there has been sluggishness of bowels : R. Mag. Sulph. 3ss, Ferri Sulph. gr ij, Tinct. zingib. ITlxv , Quinise Sulph. gr. ij, Acid.
Sulph.
Dil.
Aquam ad |i.
Ter die
capiat.
supply Salicylic acid having been obtained, the following was ordered :?R. Sodas Bicarb., Amnion. Carb. ad. gr. v., Acid. Salicylici gr. x., Aqute J i. Bis die of
6th.?A
capiat. 10th.?Medicine omitted.
12^.?Night respects.
sweats have set in. No change in other Bark and Ammonia in efferves-
To have
cence.
March 1st.?Has been gaining ground very slowly since last report, and though the evening temperature is still high, it is thought best to discharge him to light " duty. As he is to proceed to The Isthmus," the change of air may prove beneficial.
THE INDIAN MEDICAL GAZETTE.
j 96
[July 1,
187k
Temperature Chart. January. 10
11
13
Day of disease,
4
5
7
Morning temp...
101-2
101-s
101*4
Evening temp..
104 *5
103
Date.
14
102-8
15
16
19
20
24
9
10
13
14
18
100 100
100
100
102-4
100-2
100
99 6
1
102
1028
103*5 102
102
28
99'8'
100
103, 103 101
100-8
29
30
23
24
99-2 99'2
100
100 100
100-G
February. 6
Date.
Bay of disease
.
25
Morning temperature.
100
Evening temperature.
101
27
I
28
29
30
100
101-2
99
100
101
100-6
102
100
31
102
11
12
13
14
15
34
35
36
37
38
39
40
99 6
100
99
99-2
100
98-5
99"8
99
101-e
101
101
101-2
103
162
23
24
25
26
27
49
50
51
53
54
98'8
99
99
99
07
99
101
100
33
99
101
10
101
....
100
February. Dato.
1G
19
Day of disease
41
44
Morning temperature.
99-8
18-2
Evening temperature.
101-8
102-8
45
101
Case No. 2.?Private J. Greenbury, age 32 ; time in India 8T\ years ; previously healthy ; reported sick 1st February. Suffering from fever, nausea, debility, and loss of sleep. The treatment consisted at first of quinine (20 grs. daily), diaphoretic mixture and Dover's powder at bed time. On the 5th February he was ordered
Salicylic acid with soda and ammonia. February 6th.?Passed a very restless night ; though 20 grs. chloral were given at bed time. 1th.? Suffers from nausea and occasional vomiting of bitter matter : unable to rest at night. To have 3 ij. Liq. Morph. H. S S. 8th.?Bowels constipated : less nausea. Diet consists of milk principally, mixed with lime water. 2th.?No hypnotic yesterday : slept. Still complains of nausea. There is very slight gurgling in right iliac fossa, but no tenderness. Bowels have responded freely to a purge. 10 th.?Feels better; gurgling distinct ; abdomen full ; omit mixture. R Acid salicylic grs. v., Spt. Rect. n\xx., Aqua i. Ter die capiat.
J 12th.?Supply of salicylic acid exhausted. To have 5 grs. of quinine thrice daily. Gurgling nearly gone : bowels regular : stools fairly healthy. 15th.?Seems much better ; appetite good. 17th.?Has had restless nights since last report. 25 grains of chloral were given last night, but seemed to have
100
100
28
101-8
101-8
Complains of pain in his head and ringing quinine. To have an ounce of Inf. Quassias thrice a day. a
bad effect.
in the ears.
Omit
18th.?40 1TI. chlorodynelast night, but no sleep. Skin dry ; tongue foul. Is slightly jaundiced. Vomited last even
ing.
19 th.?Bad night again. Had a calomel and jalap purge last evening, and this morning half an ounce of Warburg's tincture on an empty stomach. Dose to be repeated in three hours. 20th.?No this
morning Warburg.
sleep, ;
but lay
quiet
tongue stained
all night; vomited one? bright yellow. Continue
21sf.?No vomiting since ; no much better. Continue Warburg. a
sleep
; says
22nd.?Slept well. Warburg's tincture to day in drachm doses,
be
he feels
given
thrice
27th.?Much better. Tongue clean : bowels regular : well: appetite good ; no night sweats. Continue medicine. March bth.?Convalescent. Omit medicine.
sleeps
8th ?Still very weak. Not able to walk much as his way under him. Has slight night sweats.
legs give
Ordered Bark and ammonia in effervescence. 25th.?Invalided to Is still
extremely
England
for
weak and anasmic.
change
of climate.
July 1,
SURGEON-MAJOR GREENE ON CONTINUED FEYER AT ADEN.
1879.]
Temperature and Pulse February.
Record.
Date.
Day oI disease
6
7
197
10
Morning temperature.
101-8
101-6
102
101
101
102
101-6
100
Evening temperature.
104
101-8
103-6
102
102-8
101
101
101
102
100
Pulse
13
14
15
16
14
15
16
17
100
100-2
101-2
09-8
99-8
101
102
100-8
100-2
102-4
101-8
103-8
100
100
104
March.
February. 26
27
28
4
10
15
26
27
28
29
33
39
44
101
100
99-6
98-4
98
97*8
99
98
102
100
100
99-2
|
98
99
99'4
92
100
|
76
Date.
17
18
19
22
Day of disease
18
19
20
23
25
Morning temperature..
102
102
103
101
99-6
100-8
Evening temperature.
104
104
101
100
101 2
101*2
Pulse
120
104
112
100
92
102-2
J
|
|
99*8
108
....
Respiration normal.
Case No. 3.?Private R.
India 13TSZ years ;
Sharrack, previously healthy.
February 6th.?This old been
in
hospital
age 46 ; time in
soldier, and Good Templar,
since 31st
January complaining
has of
and loss of appetite. As he is very deaf, it is sometimes difficult to make out his symptoms. He has been taking iron and quinine since admission. 1th.? Temperature last evening was 104?: it is now 104-2?. Has had no sleep, though 20 grains of chloral were given. Omit medicine. R. Acid salicylici gr. x., Ammon. carb. gr. v., Sod? Bicarb, gr. v., Aq. Bis die
debility
ji.
capiat.
8th.?Slight delirium last night ; complains of pain in his chest and cough. Sinapism. 9^7i.?Slept well : 4 stools yesterday ; tongue white with red edges : moist ; abdomen normal.
11 th.?Very restless last night: at times semi-delirious ; slight twitching of the muscles of the extremities.
lias
To have 5 grains of the Salicylic acid.
12th.?Slept quite clear.
quinine
three times
a
day,
in lieu of
well: feels better: spasms gone.
Mind
stool; fasces dark and liquid. 28th.?Has improved: bowels regular ; omit quinine. To have an ounce of Infusion of quassia three times a day. 25th.?Has been free from fever for over a week, but is Transferred to still very weak and unfit for duty. 13^.-8 times at
Steamer Point for
change of air.
March 26th.?Invalided to England, ed at all during the past month.
Has not
improv-
Temperature and Pulse Record. February. Date. 10
Day of disease
9
12
13
11
14
15
Morning temperature
104-2
103-2 104-9 101-8
Evening temperature 104
104*2
103-8
Pulse
104
68
100-6
101-8
80
101
101-2
100
101
14
15
16
17
18
19
20
21
22
23
24
25
18
19
20
21
22
23
24
25
26
27
28
98'2
98'6
98
98
98*2
98'2
99
99"4
98*2
99
98
99
100-4
100-8
72
Respiration normal.
100
100
08-2 98 99
99
THE INDIAN MEDICAL GAZETTE.
19S
Case No. 4.?Private W. Clinton, age 25 ; time in India 4/j years ; previously healthy. February 6th.?A case of simple pyrexia. Abdomen normal ; bowels somewhat constipated lately. Quinine 5 grs. three times a day. 7th.?Had .20 grains of chloral last night but did not
sleep.
again but no rest. Bowels have given yesterday ; omit quinine. To have 5 grains of Salicylic acid dissolved in spirit three times a day. $th.?Slept a little: no draught; abdomen rather 8th.?Chloral
responded
to a purge
full : otherwise normal. 11th Says he feels very ill. finished, to have quinine again. ?
12th.?Vomiting
set in
Salicylic
yesterday evening,
ceased : feels a little better. 14th.?Profuse nocturnal perspiration. no appetite ; abdomen still rather full.
acid
being
but has
but he slept well, and says he feels much better. Temp, now 99?. Complains of rheumatic pains. 25th.?Feels very weak: has a severe pain across loins ; bowels sluggish ; urine red ; still sweats greatly
night.
at
brick-dust To have Nitrate of potash and spirits of nitric aether in Decoction of scoparium. Also local external applications. March 4th.?Pain gone from back, but located now in left buttock. Urine quite normal ; bowels regular ; sleeps well. 28th.?Urine
16th.?1Tongue very foul: bowels sluggish ; omit quinine. To have Nitro-muriatic acid and chiretta. 17th.? Slept:.but saturated sheets with perspiration. 19
SURGEON-MAJOR GREENE ON CONTINUED FEVER AT ADEN.
1879.]
CONTINUED FEVER AT ADEN. By Surgeon-Major Hubert
Greene, A.M.D. following rough notes of some cases of pyrexia, characterized by very persistent high temperature, have been written in the hope that, though very imperfect, they may possibly contribute in some slight degree toThe
wards the elucidation of the nature of the complex diseases which are usually classed under the head of Continued Fever.
Simple
The circumstances under these
which
occurred
they
are
:?
The 1/14th P. W. 0. Regiment arrived at Aden on the 28th December last, having come direct from Ranikhet, a hill station in the Himalayas, where it had been quartered since March 1877, and where its general health in every respect. On arrival the regiment was distributed as follows:? Steamer Point, one company ; Isthmus, three companies ; Crater, Head-quarters, including Band, and four companies The cases now reported occurred among the latter, but there were also cases of continued fever in the companies at Steamer Point and the Isthmus, which were of the same nature, and at the former station seems
to have
been
remarkably good
apparently one
I
died.
man
examination, but were
was am
not
present
at the
informed that
no
post-mortem
special
lesions
discovered.
unmarried, and
lived under similar circumdistributed almost evenly among the stances,?being different barrack rooms. They were, with one exception, steady, well-conducted men, not given to drink or addicted to vice; and their average service in India was nearly six years. were
all
Various causes have been blamed for the disease. Some observers call it 'acclimatizing fever,' and others, 'sun fever': while not a few lay the onus on sea bathing, or on 'refraction of the sun's rays from the surrounding rock.' To me. however, these names convey no meaning ; and I am inclined to seek for a cause in the insanitary
condition of the settlement which has been allowed, so far as the native portion of the community is concerned, to remain in a state of nature ever since we first occu-pied Aden in 1839. The following table shows the temperature of the air during the first three months of the year. As, however, the observations were taken with an ordinary thermometer, the results must be looked on as only ap-
proximate. 1879.
Maximum.
January, February,
March,
...
... ...
78 79 83
The treatment in the following cases included nourishwith small quantities of wine or brandy.
ing diet,
Case No. 1.?Private C. Gorman, age 27 ; time in India 1 T\ years ; previously healthy ; reported sick 7th January 1879. Symptoms: pyrexia, sleeplessness, debility. Medicine : Diaphoretic mixture every 4th hour. January 8th.?No sleep ; 10 grains quinine administered
.
9th.?20 grains calomel last quinine and diaphoretic.
Minimum. 75 75 77
Range. 3 4
6
Mean of each month.
night;
no
sleep.
Continue
11th.?Same state ; bowels regular ; no abdominal disturbance. To have 10 grains quinine in the morning and 10 more during the day. and a certain of insomnia, this fever presents no characAppetite pretty good; continue any kind.
13th.?Except high temperature, debility, amount ter of
quinine. 14th ?Not cold douche.
well: fever stronger: headache.
so
Apply
15th.?Very low last evening, necessitating exhibition of 2 oz. brandy with soda water. Slept fairly. Diet hitherto has consisted of milk, chicken, lime juice, and ice. Continue treatment, i e., quinine and cold douche to head. 1 Qth.?Headache less : no other
continue
The rest of the garrison, consisting of three batteries of artillery, which have been stationed in Aden upwards of a year, remained free from the disease. The origin of the first case dates from early in January : the other nine cases seemed to commence beThe men tween the 30th January and 10th February.
195
change
; omit douche ;
quinine.
19th.?Absolutely no symptoms except high temperadebility. Ordered 4 oz. Port wine: quinine 5 grains thrice daily.
ture and
26th.?Daring the past week this case has presented no salient symptoms of any kind beyond abnormal temperature. The patient's appetite has been good ; his bowels regular, and he has slept fairly. Since admission he has lost flesh
considerably,
and he looks very ill and
debilitated. 31 st.?Remains in
statu
quo: omit medicine
(qui-
nine). February 3rd.?For some days past there has been sluggishness of bowels : R. Mag. Sulph. 3ss, Ferri Sulph. gr ij, Tinct. zingib. ITlxv , Quinise Sulph. gr. ij, Acid.
Sulph.
Dil.
Aquam ad |i.
Ter die
capiat.
supply Salicylic acid having been obtained, the following was ordered :?R. Sodas Bicarb., Amnion. Carb. ad. gr. v., Acid. Salicylici gr. x., Aqute J i. Bis die of
6th.?A
capiat. 10th.?Medicine omitted.
12^.?Night respects.
sweats have set in. No change in other Bark and Ammonia in efferves-
To have
cence.
March 1st.?Has been gaining ground very slowly since last report, and though the evening temperature is still high, it is thought best to discharge him to light " duty. As he is to proceed to The Isthmus," the change of air may prove beneficial.
THE INDIAN MEDICAL GAZETTE.
j 96
[July 1,
187k
Temperature Chart. January. 10
11
13
Day of disease,
4
5
7
Morning temp...
101-2
101-s
101*4
Evening temp..
104 *5
103
Date.
14
102-8
15
16
19
20
24
9
10
13
14
18
100 100
100
100
102-4
100-2
100
99 6
1
102
1028
103*5 102
102
28
99'8'
100
103, 103 101
100-8
29
30
23
24
99-2 99'2
100
100 100
100-G
February. 6
Date.
Bay of disease
.
25
Morning temperature.
100
Evening temperature.
101
27
I
28
29
30
100
101-2
99
100
101
100-6
102
100
31
102
11
12
13
14
15
34
35
36
37
38
39
40
99 6
100
99
99-2
100
98-5
99"8
99
101-e
101
101
101-2
103
162
23
24
25
26
27
49
50
51
53
54
98'8
99
99
99
07
99
101
100
33
99
101
10
101
....
100
February. Dato.
1G
19
Day of disease
41
44
Morning temperature.
99-8
18-2
Evening temperature.
101-8
102-8
45
101
Case No. 2.?Private J. Greenbury, age 32 ; time in India 8T\ years ; previously healthy ; reported sick 1st February. Suffering from fever, nausea, debility, and loss of sleep. The treatment consisted at first of quinine (20 grs. daily), diaphoretic mixture and Dover's powder at bed time. On the 5th February he was ordered
Salicylic acid with soda and ammonia. February 6th.?Passed a very restless night ; though 20 grs. chloral were given at bed time. 1th.? Suffers from nausea and occasional vomiting of bitter matter : unable to rest at night. To have 3 ij. Liq. Morph. H. S S. 8th.?Bowels constipated : less nausea. Diet consists of milk principally, mixed with lime water. 2th.?No hypnotic yesterday : slept. Still complains of nausea. There is very slight gurgling in right iliac fossa, but no tenderness. Bowels have responded freely to a purge. 10 th.?Feels better; gurgling distinct ; abdomen full ; omit mixture. R Acid salicylic grs. v., Spt. Rect. n\xx., Aqua i. Ter die capiat.
J 12th.?Supply of salicylic acid exhausted. To have 5 grs. of quinine thrice daily. Gurgling nearly gone : bowels regular : stools fairly healthy. 15th.?Seems much better ; appetite good. 17th.?Has had restless nights since last report. 25 grains of chloral were given last night, but seemed to have
100
100
28
101-8
101-8
Complains of pain in his head and ringing quinine. To have an ounce of Inf. Quassias thrice a day. a
bad effect.
in the ears.
Omit
18th.?40 1TI. chlorodynelast night, but no sleep. Skin dry ; tongue foul. Is slightly jaundiced. Vomited last even
ing.
19 th.?Bad night again. Had a calomel and jalap purge last evening, and this morning half an ounce of Warburg's tincture on an empty stomach. Dose to be repeated in three hours. 20th.?No this
morning Warburg.
sleep, ;
but lay
quiet
tongue stained
all night; vomited one? bright yellow. Continue
21sf.?No vomiting since ; no much better. Continue Warburg. a
sleep
; says
22nd.?Slept well. Warburg's tincture to day in drachm doses,
be
he feels
given
thrice
27th.?Much better. Tongue clean : bowels regular : well: appetite good ; no night sweats. Continue medicine. March bth.?Convalescent. Omit medicine.
sleeps
8th ?Still very weak. Not able to walk much as his way under him. Has slight night sweats.
legs give
Ordered Bark and ammonia in effervescence. 25th.?Invalided to Is still
extremely
England
for
weak and anasmic.
change
of climate.
July 1,
SURGEON-MAJOR GREENE ON CONTINUED FEYER AT ADEN.
1879.]
Temperature and Pulse February.
Record.
Date.
Day oI disease
6
7
197
10
Morning temperature.
101-8
101-6
102
101
101
102
101-6
100
Evening temperature.
104
101-8
103-6
102
102-8
101
101
101
102
100
Pulse
13
14
15
16
14
15
16
17
100
100-2
101-2
09-8
99-8
101
102
100-8
100-2
102-4
101-8
103-8
100
100
104
March.
February. 26
27
28
4
10
15
26
27
28
29
33
39
44
101
100
99-6
98-4
98
97*8
99
98
102
100
100
99-2
|
98
99
99'4
92
100
|
76
Date.
17
18
19
22
Day of disease
18
19
20
23
25
Morning temperature..
102
102
103
101
99-6
100-8
Evening temperature.
104
104
101
100
101 2
101*2
Pulse
120
104
112
100
92
102-2
J
|
|
99*8
108
....
Respiration normal.
Case No. 3.?Private R.
India 13TSZ years ;
Sharrack, previously healthy.
February 6th.?This old been
in
hospital
age 46 ; time in
soldier, and Good Templar,
since 31st
January complaining
has of
and loss of appetite. As he is very deaf, it is sometimes difficult to make out his symptoms. He has been taking iron and quinine since admission. 1th.? Temperature last evening was 104?: it is now 104-2?. Has had no sleep, though 20 grains of chloral were given. Omit medicine. R. Acid salicylici gr. x., Ammon. carb. gr. v., Sod? Bicarb, gr. v., Aq. Bis die
debility
ji.
capiat.
8th.?Slight delirium last night ; complains of pain in his chest and cough. Sinapism. 9^7i.?Slept well : 4 stools yesterday ; tongue white with red edges : moist ; abdomen normal.
11 th.?Very restless last night: at times semi-delirious ; slight twitching of the muscles of the extremities.
lias
To have 5 grains of the Salicylic acid.
12th.?Slept quite clear.
quinine
three times
a
day,
in lieu of
well: feels better: spasms gone.
Mind
stool; fasces dark and liquid. 28th.?Has improved: bowels regular ; omit quinine. To have an ounce of Infusion of quassia three times a day. 25th.?Has been free from fever for over a week, but is Transferred to still very weak and unfit for duty. 13^.-8 times at
Steamer Point for
change of air.
March 26th.?Invalided to England, ed at all during the past month.
Has not
improv-
Temperature and Pulse Record. February. Date. 10
Day of disease
9
12
13
11
14
15
Morning temperature
104-2
103-2 104-9 101-8
Evening temperature 104
104*2
103-8
Pulse
104
68
100-6
101-8
80
101
101-2
100
101
14
15
16
17
18
19
20
21
22
23
24
25
18
19
20
21
22
23
24
25
26
27
28
98'2
98'6
98
98
98*2
98'2
99
99"4
98*2
99
98
99
100-4
100-8
72
Respiration normal.
100
100
08-2 98 99
99
THE INDIAN MEDICAL GAZETTE.
19S
Case No. 4.?Private W. Clinton, age 25 ; time in India 4/j years ; previously healthy. February 6th.?A case of simple pyrexia. Abdomen normal ; bowels somewhat constipated lately. Quinine 5 grs. three times a day. 7th.?Had .20 grains of chloral last night but did not
sleep.
again but no rest. Bowels have given yesterday ; omit quinine. To have 5 grains of Salicylic acid dissolved in spirit three times a day. $th.?Slept a little: no draught; abdomen rather 8th.?Chloral
responded
to a purge
full : otherwise normal. 11th Says he feels very ill. finished, to have quinine again. ?
12th.?Vomiting
set in
Salicylic
yesterday evening,
ceased : feels a little better. 14th.?Profuse nocturnal perspiration. no appetite ; abdomen still rather full.
acid
being
but has
but he slept well, and says he feels much better. Temp, now 99?. Complains of rheumatic pains. 25th.?Feels very weak: has a severe pain across loins ; bowels sluggish ; urine red ; still sweats greatly
night.
at
brick-dust To have Nitrate of potash and spirits of nitric aether in Decoction of scoparium. Also local external applications. March 4th.?Pain gone from back, but located now in left buttock. Urine quite normal ; bowels regular ; sleeps well. 28th.?Urine
16th.?1Tongue very foul: bowels sluggish ; omit quinine. To have Nitro-muriatic acid and chiretta. 17th.? Slept:.but saturated sheets with perspiration. 19
