Some remarks on the position of certain remittent fevers hitherto frequently classed as malarial, with illustrative cases and temperature charts / by J.H. Tull-Walsh.

  • Tull-Walsh, J. H.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Some remarks on the position of certain remittent fevers hitherto frequently classed as malarial, with illustrative cases and temperature charts / by J.H. Tull-Walsh. Source: Wellcome Collection.

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    Lungs—Somewhat congested ; no pneumonia and no tubercle. ■^Liver—Marked fatty degeneration. Spleen—Apparently normal; weighed 6 ounces. No blood or fluid in the peritoneal cavity. On opening the small intestines, the ileum was found to contain a few small and old blood clots, and also several round, sharp-edged ulcers were seen on Peyer’s patches, with floors so thin as to be torn in the washing in one or two cases. There were also numerous small ulcers at the entrance to the caecum. There were no parasites present, and the large intestines, though slightly congested, were free from ulceration. Brain, kidneys, etc., normal. 1 am of opinion that this was a case of typhoid fever, whether combined with any r. jnalarial element it is difficult to say. The case does, however, in many respects resemble re¬ ported cases of ‘ pernicious ’ ' remittent fever due to malaria, and also resembles cases of Malta fever. Case V. {Malta Fever.) H. R., aged 25, seaman, H. M. S. Boadicea. Unwell sometime previous to admission, and seriously ill for five days. Admitted into the Presidency General Hospital on the 28th Decem¬ ber 1891. Usual febrile symptoms with high temperature and anxious expression ; stools loose on admission; varied afterwards; nothing typi¬ cal about them, and no blood at any time. There was never any albtrmen in the urine. Spleen not enlarged. No malarial plasmodia seen in the blood. The patient was treated with quinine, but as it seemed to have no influence on the course of the disease, it was omitted, and anti¬ pyretics and intestinal antiseptics were used. Many of the normal temperatures seen in the chart are no doubt merely the result of doses of antipyretics. This patient suffered late in the illness from severe pains in the hips, knees and back. H. R., after remaining in hospital for 105 days, was invalided to England, 11th April 1892. He recovered completely, and was one of the unfortunate victims in the loss of H. M. S. in 1893. Contributors to the columns of the “ Mirror of Hos- ital ijPractice ” will receive twenty-five copies of their % JHipiiof Hospital ^raqfiqe. ABDOMINAL SURGERY AT DARBHANGA IN 1896. By Surgx.-Capt. E. Harold Brows, m.d.. Purneah. {Continued from page 328.) Case 7.—Puri, Hindu, aged 50; multipara; duration two years; girth 47 inches; tumour left-sided. The patient was an old and very weakly woman, with an enormously distended abdomen. On examination no solid matter could be detected, and the diagnosis arrived at was an unilocular cyst with probably free ascitic fluid. The patient was perfectly crippled, being scarcely able to sit, and could not walk, owing to the size and weight of the tumour. Pulse 130. Operation on 21 st Wovem&er.—Abdominal wall not vascular; incison 3 inches ; peritoneum much thickened and adherent to the cyst wall. On tapping, several gallons of thin fluid escaped and the abdominal walls slowly collapsed ; to expedite emptying of the cyst its anterior wall was incised, the fluid being prevented from pas¬ sing into the peritoneal cavity by taking the usual precautions. On passing the hand into the cyst cavity some secondary cysts were dis¬ covered high up on the left side, and these were also emptied in the same way. I now seized the cut edge of the cyst wall and gently separated the parietal peritoneum from it, the connection between the two being very inti¬ mate, and the whole anterior surface being thus adherent for several inches in all directions. The connections, though firm, were fibrous and there was no haemorrhage at this stage ; but at the sides, the adhesions were softer and more vascular, and, though more easily separated than the others, resulted in fairly free oozing. There were no other adhesions, the sac not having attached itself to any of the neighbouring organs, and the empty cyst was now drawn out, and its pedicle, which was of fair size, was transfixed and ligatured. As no fluid had entered the peri¬ toneal cavity, and as there had been but trifling venous oozing, I did not think it was neces¬ sary to irrigate, so closed the wound and dressed it as usual. When removed from the operating table the patient was in a very favourable condition, the pulse, which was 130 prior to operation, having fallen to 86. She d’d well for the first four days, the highest temperature being 102 2; there was no sickness or distension, but she complained of a good deal of pain. The dressings were re¬ moved on the fifth day, when the temperature was 100 4 and the pulse 116. The wound was healed, but below the umbilicus there was an irregular horse-shoe shaped swelling, extending across the middle line to the extent of two and a half inches. It was rather hard and tender, without fluctuation. The patient’s general state was good ; the bowels had been moved freely by natural efforts, and there was neither sickness nor tympa¬ nites, while the tongue was clean and moist. The following day the temperature had fallen to 99°, and the parts looked better, the patient also complaining less of pain; the pulse was 100.