Gaaetto.-2-12-90.-? 10. Re&. Reg. No. 464, Med. Gazette.?2-12-90.?710.
Photo 8.1. O Calcutta. 1>hct0 ;;3.I.0,0alcutta. ,
(?Htginal
(Eommumcatiomi.
NOTES ON HILL MALARIA. By Surgeon G. CAPEL
HALL, i.m.s. Up in the Chin Hills with only field kit, few books of reference, and without microscope, I have found it difficult to attempt to do justice to this subject (being forcibly reminded of this by Dr. Banuerman's masterly resume of Medical literature vide Indian the latest Gazette, August 1890). However, with the reader's indulgence, I will now make some comments on six months (April 1890 to end of September and figures that I have of observation 1890) endeavoured to the best of my ability* to collate. The four posts of Fort White, No. 5 stockade, No. 4 stockade and No. 3 stockade comprise our stations in the northern part of the Chin Hills. From Kalemyo (vide accompanying map), lying in what is known as theKaldValley to Fort White in the Chin Hills, the road is indicated by a black dotted line passing through No. 3 (No. 2 being abolished), and No. 4 posts, which are situated on a spur thrown out from a high range of mountains called the Letha Range (indicated by a thick black line), on the distal side of which is a semi-circular spur whereon Fort White is marked. This fort is on the side of the spur, height 5,000 ft. above sea-level, and the severe outbreaks of fever of 1889 and 1890 occurred
here. This year, our average strength 2-4 Gurkhas has been 360, decreasing in August to 170, but then reinforced by 150 of 38th B. I. During the period, April to end of September 1890, the total number of admissions for fever were as follows:? Admissiom, 2-4 Gurkhas 735 ...
38th B, I.
132
0
51
0
...107 50
2
...
Q. O.S. $ Miners Followers Unrecorded Tota
Died. 3
...
Invalided. 25 To Myingyan for change of air 61. To Myingyan for change of air 11. (Strength only 30 decreasing to 25). To Mandalay for change of air 5, (Strength about 60.)
Officers, civilians, &c.,
un-
attached.
...1,075
* Some experiences of malaria in the plains of Upper Burma during 1887 and 1888 are also embodied here.
The other three posts may be dismissed in a few words. No. 5, height 7,200 ft., strength 50-80, 2-4 Gurkhas, though cold and damp, was bracing. Number in hospital varied from 0 to 5 maximum, more dysentery aud diarrhoea than fever. No. 4, height 5,200 ft., strength 80 of 38th B. I., who were relieved by 80 of 2-4 Gurkhas in August, aud these men coming on to Fort White, enabled me to definitely prove that the malaria was not brought as I had first supposed might be the case, entirely from the Kale and other unhealthy valleys. From April to end of July 1890 the 38th B. I. had enjoyed excellent health at No. 4, but the charts (black levels) shew the admissions just after arrival here. No. 3, height 3,700 ft., strength 80 of 38th B. I., garrison frequently interchanged with that of Kalemyo?scurvy and dysentery prevailed rather than fever, although at these posts Nos. 5, 4, and 3 a very heavy rainfall was recorded (once in a single day nearly 6 inches, frequently 2 or 3 inches); no relation whatever as to admissions can be traced. Careful enquiry amongst the native Chins elicits the fact that fever is endemic all the year round in this valley, but is especially rife during the rainy seasons. As to the
geology,
the spur
on
which Fort
White is situated consists almost entirely of
a
friable shale (laminae being very loose), with quartz in small quantities, its surface covered with finely powdered shale debris and in parts with a light vegetable mould (most fertile). Light scrub and grass jungle with a few fir trees grew formerly. The other posts are one and all on dense igneous rock, sandstone, &c. (Nos. 5 and 4 especially.)
light
From thetopography of Fort White it appeared that the old theory of malaria (as met with in marshy and undraiued lands) considered to be, in the concrete, as a ground emanation, in the abstract, as an entity caused by two main factors, viz., soil plus water, could not possibly The fort is on the slope hold good here. of the spur, aud the natural drainage is admirable, since the general rise is 1 in 4 or 15? and in many places steeper still, aud further more is perfected by many artificial trenches, necessarily of steep gradients, so that during heavy rain, small cataracts as it were, at once carried off surplus water.
However the theory is borne accompanying charts, shewing the
by the relation between rain plus something else (which I take to be soil), and an almost immediate increase of daily admissions for fever. I can only suggest that the surface soil is porous and spongy enough to hold sufficient fluid to manufacture, so to speak, the emanation known as malaria ; or if considered casually as the bacillus of Marchiaout
THE INDIAN MEDICAL GAZETTE.
and other observers, is then most favourable to its development and multiplication. The charts speak for themselves and shew, I think, more than mere coincidences. Explanation of monthly charts. Along the top line is the daily rainfall in inches, taken at 8 A.M. on the morning of the date which is shewn along the bottom line. At the right hand is the actual number of fever cases that were admitted per diem, the levels in the daily columns correspond accordingly, being placed on the line of such numbers, lied levels refer to 2-4 Gurkhas and black ones to 38th B. I. These latter only commenced in August, by the beginning of which month their full strength had arrived, and in August and September their charts are combined, e.g., on September 24th four 2-4 Gurkhas and one 38th B. I. were admitted. The maximum of fever cases admitted in one day was 25 on 29th April 1890, probably,partly due to rain '6 inch previously, partly to fresh arrivals and partly to the march through the Terai.
fara, Celli,
mittents, how
[Jan.
1891.
invariably a heavy rainfall is associated with a slight exacerbation. Water.?As in the healthy posts of Nos. 5 and 4, the water supply is a mountain spring fenced in to avoid all sources of contamination : here, issuing from the spur side a little above and about ? mile from the fort. It has always been good and plentiful.* To consider this as a cause: many cases have now come under my notice in which men direct from England or healthy parts of India, who may fairly be considered as without a trace of malaria in their constitutions, have joined detachments during an epidemic and within six days developed ague or remittent, fever in a severe form. I had then been personally supervising the mess water in two boilings, then in its filtering through a new charcoal filter. Of this sufficient only is again boiled for tea, &c., at cliota hazri, at other times of the day Rangoon or Myingyan soda-water or German or English beer, is drunk. The (apparently) strong argument in favour of water causingmalariais the well known "Argo" case (Parke's Hygiene), where the passengers are supposed to have drunk malariMay was a most malarious month; allowing ous water and suffered, whilst the sailors drunk for coincidences, the rises on lltli and 28th are good water and escaped; but malaria was then noticeable. little understood (its incubation period may June?Same remarks apply ; rise of 17th in extend some times over many months), and the, to me, significant fact?as to where the passenparticular. July?Rise of 24th at end of this month gers had resided, is left out. At any rate they note decrease of strength and a most distinct had come from malarious districts. inoculation* or acclimatisation manifested itAs regards the outbreak last year, I was not words of one of the medical self? all officers (7) ceased to have fever present, but in the " The fever began and ended by beginning of August (except Lieut. Battye, officers who was who however ceased in September); also many with the rains ; every one had his dose of fever sepoys known tome personally; also with the and then kept well;" certainly their sick as followers and officers, orderlies and servants. shewn in the Station Staff Office correspond We seemed to become ' fever proof,' certainly very much with ours, though I have not the rainthis lasted to date of writing. That malaria fall book for 1889. Other diseases have been was still prevalent is shewn by chart for August conspicuous by their absence; only 16 dysentery when 38th B. I. arrived. aud 18 diarrhoea being totalled ; these are August shews inoculation of 2-4 Gurkhas generally classified as malarious, and in this resand suffering of 38th B. I., almost all of whom pect do hill and plain malaria appear to differ. had been through hospital by the end of the Scurvy, in any form was hardly noticed, it month. was probably anticipated by the most abundant September shews continued inoculation of supply of fresh vegetables with plenty of goats both regiments until very heavy rain on 20th, and fowls. Lime-juice I did not use, nor do I 21st, and 22nd, when four of each were soon ad- believe in its efficacy, having seen it signally mitted on 24th and 25th. On 24th what seemed fail where a subsequent supply of vegetables and to me remarkable was the ' unrecorded list, fresh meat was received and the scurvy disnumbering 7, and on 25th 3 as the majority appeared. had never previously suffered, but now did so Treatment.?Prophylaxis by quinine (2 grs. and severely too.f daily to all 2-4 Gurkhas) was tried during months Further I hope, at some future time, to print of June and July and then stopped, and this many temperature charts, shewing, in the case brings me to the question of quinine in general of chronic intermittents and convalescent re- for fever. During 1887 and 1888, I had given this * This I did not notice at all in the drug an extended trial, and then decided in my plains. f The unrecorded list comprised Burma Myook, Post Official, Orderly Kahars, Babus, Commissariat Sergeaut, * Six bottles were sent to Rangoon for analysis, but I all living in various parts of the Fort, and thus the extra have not heard the result. work was impressed on my mind. '
'
uv
incAti
4-
i?t-
Dat&
^
iV
2
3
4
5
4
5
6
7
8
6
7
8
9
10
11
12
13
14
15
Hi
18
17
19
20
21
.April
22
23
i | | j 24j 25 20 [27 | 26 ! 29
Dabs
IV
5
S
10
11
12 IS 14 15 16 17 18
19
20 21 22
23 24 25 26 27 28 20 50
UrunJalL
per diem zruJ,
in,
JB&i
12
15
4_i_
Jlauy
10
14
15
16
17
18
19
20
24
25
26
28
m -21
?16
03
T L. _L
oaa-
4
JkSt
?pea-
ssasSes
-taak?
to
li
13
14
15
16
17
18
IP
20
21
22
2S
24 25
26
Jan.
HALL ON HILL MALARIA.
1891.]
mind that its effect was almost nil, but qualify this by adding, in and during a malarial epidemic. Here the 2-4 Gurkhas have all had quinine regularly, but the 38th B. I. none whatever. Its effect at such healthy bases as
own
must
Mandalay, Myiugyan, Pokoko, Pagan, &c., dry healthy places where fever is not endemic(though cholera and diarrhoea abound) maybe explained in this way. Post hoc has been confused with Propter hoc, the effect of the quinine is not the cause of the improvement, but climate has brought about the result. I had many opportunities
this in 1888 and in and during malarial doses of quinine gr. 1 carefully increased to grs. 120 daily* have in hundreds of In the few cases, in my hands, had no effect. cases relatively, where patients have been removed to healthy parts and have, instead of improving, got worse, it has been found that quinine was inefficacious. Some opinions of medical officers with respect to remittent fever and quinine have lately been published with a verdict against it, and with respect to intermittent, I think that the natural tendency to cure has been overlooked when quinine has been given. of
seeing
epidemics,
To take a supposititious case. To any given uumber of ague cases in hospital, during an outbreak, quinine is given, and to a similar number is omitted. What do we find ? Preoisely the same occurs. Some continue their agues, some stop. In a healthy climate, if the same plan be tried, the majority will stop having fever, with or without
quinine.
I substitute a tonic mixture of Ferri et Quin. Cit. with Tr. Nucis Yom. or Ferri et Amnion. Cit. with Quinine Sulph. gr. ^?tds. (In small doses it seems an invaluable tonic). This tonic effect is, in prophylaxis probably the only.result the quinine has, i.e., in obviating such predisposing causes to fever, which have lowered the tone of the system, e.g., anxiety, worry, over-work, diarrhoea, chills, all weakening diseases. Antifebrin or antipyrin are moat useful to induce perspiration and to lower temperature in remittent or intermittent fever, but phenacetine seems superior to both,and indeed to all other febrifuges, not being so depressant, though sedative and to be more efficacious. Complications have been few. A prolonged debility stage,owing perhaps to previous malaria at Kan with hard work during the late expedition and a want of fresh milk, was noticed. I add cod-liver oil with good result to the usual remedies.
For insomnia sulphonal "where symptoms such
acts
well, especially
headache
and behind the eye are prominent symptoms. Iu these cases I sometimes found the head temperature (lingual) to be somewhat
burning pains *
Surgeou Blaucard,
aaily
during epidemics
as
has given up to grs. 200 in 1887 without result.
than the body (axillary) e.g., lingual to be 99'6? and axillary 98'8?, i.e., at the same
higher time.
Though dysentery is rarely met with at Fort White, it may not be out of place to mention here a drug that I prefer even to Ipecacuanha, viz., Hamatnelis, the preparation chiefly used
being Pond's extract of Hamamelis?dose 10 to 40 m. every hour, in 1 oz. of water day and night for an acute case. In the few dysentery cases,
occurring in the later stages of remittent fever, I have here used enemata of Argnt. Nitrat. three times daily as per formula, with excellent results. R
Tr. opii Liq. Argent.
(3) grains
Mucilag.
...
Nitrat.
to
Acac.
...
...
...
...
...
...
...m_20ss ...
3L ???
5
3'"
An interesting record of temperature occurred iu the case of Sergeant Lewis, Commissariat Department, who, after three weeks' ordinary quoiidian ague. 011 28th August 1890, passed through li the three stages of ague three times, with a maximum temperature each tune of 104? 111 the burning stage, and 011 29th August 1890 twice, maximum first time being 104 and second 106. Phenacetine was the only drug used, the warm stage being hastened as much as possible, shivering being severe, with well heated blankets and hot water bottles, &c. He made an excellent recovery 011 the river. I11 conclusion, I would state that it is most difficult, when working by oneself in a malarial epidemic to remain unprejudiced. If I have weighed facts impartially or even succeeded in the attempt to do so, I am more than satisfied. ?
?
1
Photo 8.1. O Calcutta. 1>hct0 ;;3.I.0,0alcutta. ,
(?Htginal
(Eommumcatiomi.
NOTES ON HILL MALARIA. By Surgeon G. CAPEL
HALL, i.m.s. Up in the Chin Hills with only field kit, few books of reference, and without microscope, I have found it difficult to attempt to do justice to this subject (being forcibly reminded of this by Dr. Banuerman's masterly resume of Medical literature vide Indian the latest Gazette, August 1890). However, with the reader's indulgence, I will now make some comments on six months (April 1890 to end of September and figures that I have of observation 1890) endeavoured to the best of my ability* to collate. The four posts of Fort White, No. 5 stockade, No. 4 stockade and No. 3 stockade comprise our stations in the northern part of the Chin Hills. From Kalemyo (vide accompanying map), lying in what is known as theKaldValley to Fort White in the Chin Hills, the road is indicated by a black dotted line passing through No. 3 (No. 2 being abolished), and No. 4 posts, which are situated on a spur thrown out from a high range of mountains called the Letha Range (indicated by a thick black line), on the distal side of which is a semi-circular spur whereon Fort White is marked. This fort is on the side of the spur, height 5,000 ft. above sea-level, and the severe outbreaks of fever of 1889 and 1890 occurred
here. This year, our average strength 2-4 Gurkhas has been 360, decreasing in August to 170, but then reinforced by 150 of 38th B. I. During the period, April to end of September 1890, the total number of admissions for fever were as follows:? Admissiom, 2-4 Gurkhas 735 ...
38th B, I.
132
0
51
0
...107 50
2
...
Q. O.S. $ Miners Followers Unrecorded Tota
Died. 3
...
Invalided. 25 To Myingyan for change of air 61. To Myingyan for change of air 11. (Strength only 30 decreasing to 25). To Mandalay for change of air 5, (Strength about 60.)
Officers, civilians, &c.,
un-
attached.
...1,075
* Some experiences of malaria in the plains of Upper Burma during 1887 and 1888 are also embodied here.
The other three posts may be dismissed in a few words. No. 5, height 7,200 ft., strength 50-80, 2-4 Gurkhas, though cold and damp, was bracing. Number in hospital varied from 0 to 5 maximum, more dysentery aud diarrhoea than fever. No. 4, height 5,200 ft., strength 80 of 38th B. I., who were relieved by 80 of 2-4 Gurkhas in August, aud these men coming on to Fort White, enabled me to definitely prove that the malaria was not brought as I had first supposed might be the case, entirely from the Kale and other unhealthy valleys. From April to end of July 1890 the 38th B. I. had enjoyed excellent health at No. 4, but the charts (black levels) shew the admissions just after arrival here. No. 3, height 3,700 ft., strength 80 of 38th B. I., garrison frequently interchanged with that of Kalemyo?scurvy and dysentery prevailed rather than fever, although at these posts Nos. 5, 4, and 3 a very heavy rainfall was recorded (once in a single day nearly 6 inches, frequently 2 or 3 inches); no relation whatever as to admissions can be traced. Careful enquiry amongst the native Chins elicits the fact that fever is endemic all the year round in this valley, but is especially rife during the rainy seasons. As to the
geology,
the spur
on
which Fort
White is situated consists almost entirely of
a
friable shale (laminae being very loose), with quartz in small quantities, its surface covered with finely powdered shale debris and in parts with a light vegetable mould (most fertile). Light scrub and grass jungle with a few fir trees grew formerly. The other posts are one and all on dense igneous rock, sandstone, &c. (Nos. 5 and 4 especially.)
light
From thetopography of Fort White it appeared that the old theory of malaria (as met with in marshy and undraiued lands) considered to be, in the concrete, as a ground emanation, in the abstract, as an entity caused by two main factors, viz., soil plus water, could not possibly The fort is on the slope hold good here. of the spur, aud the natural drainage is admirable, since the general rise is 1 in 4 or 15? and in many places steeper still, aud further more is perfected by many artificial trenches, necessarily of steep gradients, so that during heavy rain, small cataracts as it were, at once carried off surplus water.
However the theory is borne accompanying charts, shewing the
by the relation between rain plus something else (which I take to be soil), and an almost immediate increase of daily admissions for fever. I can only suggest that the surface soil is porous and spongy enough to hold sufficient fluid to manufacture, so to speak, the emanation known as malaria ; or if considered casually as the bacillus of Marchiaout
THE INDIAN MEDICAL GAZETTE.
and other observers, is then most favourable to its development and multiplication. The charts speak for themselves and shew, I think, more than mere coincidences. Explanation of monthly charts. Along the top line is the daily rainfall in inches, taken at 8 A.M. on the morning of the date which is shewn along the bottom line. At the right hand is the actual number of fever cases that were admitted per diem, the levels in the daily columns correspond accordingly, being placed on the line of such numbers, lied levels refer to 2-4 Gurkhas and black ones to 38th B. I. These latter only commenced in August, by the beginning of which month their full strength had arrived, and in August and September their charts are combined, e.g., on September 24th four 2-4 Gurkhas and one 38th B. I. were admitted. The maximum of fever cases admitted in one day was 25 on 29th April 1890, probably,partly due to rain '6 inch previously, partly to fresh arrivals and partly to the march through the Terai.
fara, Celli,
mittents, how
[Jan.
1891.
invariably a heavy rainfall is associated with a slight exacerbation. Water.?As in the healthy posts of Nos. 5 and 4, the water supply is a mountain spring fenced in to avoid all sources of contamination : here, issuing from the spur side a little above and about ? mile from the fort. It has always been good and plentiful.* To consider this as a cause: many cases have now come under my notice in which men direct from England or healthy parts of India, who may fairly be considered as without a trace of malaria in their constitutions, have joined detachments during an epidemic and within six days developed ague or remittent, fever in a severe form. I had then been personally supervising the mess water in two boilings, then in its filtering through a new charcoal filter. Of this sufficient only is again boiled for tea, &c., at cliota hazri, at other times of the day Rangoon or Myingyan soda-water or German or English beer, is drunk. The (apparently) strong argument in favour of water causingmalariais the well known "Argo" case (Parke's Hygiene), where the passengers are supposed to have drunk malariMay was a most malarious month; allowing ous water and suffered, whilst the sailors drunk for coincidences, the rises on lltli and 28th are good water and escaped; but malaria was then noticeable. little understood (its incubation period may June?Same remarks apply ; rise of 17th in extend some times over many months), and the, to me, significant fact?as to where the passenparticular. July?Rise of 24th at end of this month gers had resided, is left out. At any rate they note decrease of strength and a most distinct had come from malarious districts. inoculation* or acclimatisation manifested itAs regards the outbreak last year, I was not words of one of the medical self? all officers (7) ceased to have fever present, but in the " The fever began and ended by beginning of August (except Lieut. Battye, officers who was who however ceased in September); also many with the rains ; every one had his dose of fever sepoys known tome personally; also with the and then kept well;" certainly their sick as followers and officers, orderlies and servants. shewn in the Station Staff Office correspond We seemed to become ' fever proof,' certainly very much with ours, though I have not the rainthis lasted to date of writing. That malaria fall book for 1889. Other diseases have been was still prevalent is shewn by chart for August conspicuous by their absence; only 16 dysentery when 38th B. I. arrived. aud 18 diarrhoea being totalled ; these are August shews inoculation of 2-4 Gurkhas generally classified as malarious, and in this resand suffering of 38th B. I., almost all of whom pect do hill and plain malaria appear to differ. had been through hospital by the end of the Scurvy, in any form was hardly noticed, it month. was probably anticipated by the most abundant September shews continued inoculation of supply of fresh vegetables with plenty of goats both regiments until very heavy rain on 20th, and fowls. Lime-juice I did not use, nor do I 21st, and 22nd, when four of each were soon ad- believe in its efficacy, having seen it signally mitted on 24th and 25th. On 24th what seemed fail where a subsequent supply of vegetables and to me remarkable was the ' unrecorded list, fresh meat was received and the scurvy disnumbering 7, and on 25th 3 as the majority appeared. had never previously suffered, but now did so Treatment.?Prophylaxis by quinine (2 grs. and severely too.f daily to all 2-4 Gurkhas) was tried during months Further I hope, at some future time, to print of June and July and then stopped, and this many temperature charts, shewing, in the case brings me to the question of quinine in general of chronic intermittents and convalescent re- for fever. During 1887 and 1888, I had given this * This I did not notice at all in the drug an extended trial, and then decided in my plains. f The unrecorded list comprised Burma Myook, Post Official, Orderly Kahars, Babus, Commissariat Sergeaut, * Six bottles were sent to Rangoon for analysis, but I all living in various parts of the Fort, and thus the extra have not heard the result. work was impressed on my mind. '
'
uv
incAti
4-
i?t-
Dat&
^
iV
2
3
4
5
4
5
6
7
8
6
7
8
9
10
11
12
13
14
15
Hi
18
17
19
20
21
.April
22
23
i | | j 24j 25 20 [27 | 26 ! 29
Dabs
IV
5
S
10
11
12 IS 14 15 16 17 18
19
20 21 22
23 24 25 26 27 28 20 50
UrunJalL
per diem zruJ,
in,
JB&i
12
15
4_i_
Jlauy
10
14
15
16
17
18
19
20
24
25
26
28
m -21
?16
03
T L. _L
oaa-
4
JkSt
?pea-
ssasSes
-taak?
to
li
13
14
15
16
17
18
IP
20
21
22
2S
24 25
26
Jan.
HALL ON HILL MALARIA.
1891.]
mind that its effect was almost nil, but qualify this by adding, in and during a malarial epidemic. Here the 2-4 Gurkhas have all had quinine regularly, but the 38th B. I. none whatever. Its effect at such healthy bases as
own
must
Mandalay, Myiugyan, Pokoko, Pagan, &c., dry healthy places where fever is not endemic(though cholera and diarrhoea abound) maybe explained in this way. Post hoc has been confused with Propter hoc, the effect of the quinine is not the cause of the improvement, but climate has brought about the result. I had many opportunities
this in 1888 and in and during malarial doses of quinine gr. 1 carefully increased to grs. 120 daily* have in hundreds of In the few cases, in my hands, had no effect. cases relatively, where patients have been removed to healthy parts and have, instead of improving, got worse, it has been found that quinine was inefficacious. Some opinions of medical officers with respect to remittent fever and quinine have lately been published with a verdict against it, and with respect to intermittent, I think that the natural tendency to cure has been overlooked when quinine has been given. of
seeing
epidemics,
To take a supposititious case. To any given uumber of ague cases in hospital, during an outbreak, quinine is given, and to a similar number is omitted. What do we find ? Preoisely the same occurs. Some continue their agues, some stop. In a healthy climate, if the same plan be tried, the majority will stop having fever, with or without
quinine.
I substitute a tonic mixture of Ferri et Quin. Cit. with Tr. Nucis Yom. or Ferri et Amnion. Cit. with Quinine Sulph. gr. ^?tds. (In small doses it seems an invaluable tonic). This tonic effect is, in prophylaxis probably the only.result the quinine has, i.e., in obviating such predisposing causes to fever, which have lowered the tone of the system, e.g., anxiety, worry, over-work, diarrhoea, chills, all weakening diseases. Antifebrin or antipyrin are moat useful to induce perspiration and to lower temperature in remittent or intermittent fever, but phenacetine seems superior to both,and indeed to all other febrifuges, not being so depressant, though sedative and to be more efficacious. Complications have been few. A prolonged debility stage,owing perhaps to previous malaria at Kan with hard work during the late expedition and a want of fresh milk, was noticed. I add cod-liver oil with good result to the usual remedies.
For insomnia sulphonal "where symptoms such
acts
well, especially
headache
and behind the eye are prominent symptoms. Iu these cases I sometimes found the head temperature (lingual) to be somewhat
burning pains *
Surgeou Blaucard,
aaily
during epidemics
as
has given up to grs. 200 in 1887 without result.
than the body (axillary) e.g., lingual to be 99'6? and axillary 98'8?, i.e., at the same
higher time.
Though dysentery is rarely met with at Fort White, it may not be out of place to mention here a drug that I prefer even to Ipecacuanha, viz., Hamatnelis, the preparation chiefly used
being Pond's extract of Hamamelis?dose 10 to 40 m. every hour, in 1 oz. of water day and night for an acute case. In the few dysentery cases,
occurring in the later stages of remittent fever, I have here used enemata of Argnt. Nitrat. three times daily as per formula, with excellent results. R
Tr. opii Liq. Argent.
(3) grains
Mucilag.
...
Nitrat.
to
Acac.
...
...
...
...
...
...
...m_20ss ...
3L ???
5
3'"
An interesting record of temperature occurred iu the case of Sergeant Lewis, Commissariat Department, who, after three weeks' ordinary quoiidian ague. 011 28th August 1890, passed through li the three stages of ague three times, with a maximum temperature each tune of 104? 111 the burning stage, and 011 29th August 1890 twice, maximum first time being 104 and second 106. Phenacetine was the only drug used, the warm stage being hastened as much as possible, shivering being severe, with well heated blankets and hot water bottles, &c. He made an excellent recovery 011 the river. I11 conclusion, I would state that it is most difficult, when working by oneself in a malarial epidemic to remain unprejudiced. If I have weighed facts impartially or even succeeded in the attempt to do so, I am more than satisfied. ?
?
1
