Five Cases of Quartan Fever

Five Cases of Quartan Fever

August 1901.1 *IVE CASES OF QUARTAN FEVER. 291 January, 1901, the tremors disappeared, but the FIVE CASES OF QUARTAN FEVER. knee jerks were still increased and exophthalmos and ankleclonus still present. On 23rd 1901, the M.A January, By A. N. BRAHMACHAR1, , M.B., \/ exophthalmos had markedly diminished, and the tremors and ankleclonus had all The knee House Physician, Medical College Hospital, Calcutta. disappeared. jerks were still increased. On 25th January, 1901, the patient left hospital against advice. At the time of of were was This following cases quartan fever discharge exophthalmos very slightly present, but treated in the wards of the 1st Physician at the the other nervous symptoms had all disappeared. Medical between College Hospital, Calcutta, Sep- Remarks.?Quartan Fever is considered to tember 1900 and February 1901. The diagrams be very rare in India. In Ins presidential address of the in each case are parasites observed ap- on the fevers of India in the Indian Medical Con- pended. gress Dr. Grombie remarks that he had seen Case No. 1.?Akawon, Chinaman, (tit., thirty, was ad- one case in his whole in India.1 1900. only experience mitted on 23rd Patient was one September employed Dr. records doubtful case in an in the division in a tea- Maynard Jalpaiguri in Rajahahye in the Medical garden during 1898 and 1899. While there, he was outpatient College Hospital, attacked with malarial fever for the first time and was Calcutta.2 Ross found only two patients to be treated with quinine. He came to Calcutta in May suffering from quartan fever out of 112 cases 1900 and suffered from fever from time to time, and as of malarial fever examined by him in the the attacks more frequent he came into became hospital Madras The Case No. 2.?Dhookmooia, Hindu, female, cet., sixteen, Infantry.8 following table, mostly taken from treatise on was admitted on 2nd October, 1900, suffering from Mannaberg's malarial was of malarial fever. Patient employed in 1899 in fevers shews the number observations made Lilooah, a station three mile3 fr<>mHowrah, as a labourer in the other parts of the world by different in the railway construction works for about eight observers:? months. While there, she was attacked with intermit- tent fever. came to Calcutta in June and She 1900, Total num- had often suffered from malarial fever since then. ber of c^ses Case No. 3.? Lord, European, male, adult, was ad- Name of ob- of malaria Seat of obsen server. ation. mitted on 13th October 1900. He had the first attack of fever malarial fever in Hyderabad (Deccan) in 1899, and was observed. admitted for treatment into the Residency Hospital in June there for a 1899 and remained about fortnight. Moil lot Algiers. was for the same in He readmitted there complaint Krch I tidy. in January 1900, and remained hospital for about three Fin ah Algiers. weeks. He came to Calcutta from Hyderabad in Durand Tunis. February 1900. While in Calcutta he had frequent Osier Haltimore. attacks of fever and eventually sought admission into Laveran Algiers. hospital. Giiegenyer ... Tiibenger. Case No. 4.?Abdul Huq, Mahomedan, male, <xt. Thayer and Hewetson ... Johns ITopkin'a Mxteen, was admitted on 27th November, 1900, for Hospital. tl.e treatment of hemiplegia- Patient was in Midna- purfor about eight days in 1899and then in Calcutta, where had attacks of intermittent fever he the first Double fever is considered by many after three He was treated with quartan staying days. quinine. to be uncommon. He then went to Buidwan and stayed there for about quite Mannaberg quotes its existence. He a fortnight. He then lived in a village called Gol- from authors who deny observ- gram, about six miles from Burdwau, where he fre- ed only two cases in his own experience. Out fever. He came to quently suffered from malarial of 77 cases of malarial fever, the notes of the of in Novem- Calcutta for the treatment hemiplegia blocd examination of which have been by ber 1900, and remaining outside for about a week was kept me and which were observed in the wards of admitted into hospital. was Medical Case No. 5.?D'Costa, Eurasian, male, fvt., forty, the 1st Physician, College Hospital, admitted on 19th January, 1901, complaining of fever Calcutta, there were five cases of quartan fever, and hand and in both the tremors in the right legs. two of which were double quartans. Patient was in in 1894 for about a month. He Hughli In all the five cases the quartan parasites had been suffering from intermittent fever since 1895, 1 were in the blood, characterized he attacks coming on between September and February. recognised by He had often been in Hughli, his last visit to the place (a) their sharp contour and retractile nature (/3), about two to the attack, being months previous present the presence of coarse pigment granules which which on the 14th of began February. were motile and more or less some ner- only peri- As the putient very abnormal slightly presented the distributed except in the swollen extra vous symptoms, the notes of case are given at full pherally length. corpuscular forms in which the pigment was On admission the patient was found suffering from irregularly distributed and in dancing motion, and of the hand in which tremors of both the legs right the small size of the full grown parasites, were most marked. The tremors after (y) they began and of the extra bodies the fit of on the 14th They were somewhat especially corpuscular ague tertian and the continuous, diminishing during rest and increasing as compared with the ones, (s) during action. There was nothing characteristic about absence of expansion of any of the infected red the speech. The knee jerks were markedly increased and ankleclonus was distinctly present on both sides. Transactions of the Indian Medical Congress, 1895. There was in both the eyes. There was exophthalmos Indian Medical Gazette, November 1895. of the hand, the shew- slight paresis right dynamometer Indian Medical Gazette, 189G. ing 20 in the right and 30 in the left hand. On 21st 292 THE INDIAN MEDICAL GAZETTE. [August 1901. which were even sometimes blood corpuscles of his discharge from the hospital after he had smaller than normal and never lost their colour. I been treated with for more than a were seen in all quinine The characteristic rosettes fortnight. in case No. 5, in whose blood, however, except Some of the above cases presented some were not looked for at the time when they they farther points of clinical which to The within importance generally begin develop. spores may be mentioned here. the rosettes never exceeded 10 in number, Case No. 2 after a course of cinchona febri^ were sometimes as few as 6 through they had a of for some time The of the fuge period apyrexia (vide diagrams). arrangement and then began to suffer from a of fever in the forms was type spores segmenting quite at first intermittent and then remittent. characteristic and differed from what is found During these attacks the blood was examined on several in those of the tertian parasites. occasions, but no were found. The forms well merit the term hcemosporidia segmenting This latter fever did not yield to or or rosette forms so quinine "Marguerite" frequently cinchona and ended to them. the rosettes febrifuge fatally. applied Occasionally, The post-mortem examination shewed no shewed some evolution, while on the peculiar tubercle in the or any other organ of the slide under the but their have lungs microscope, changes bod}r. There was no evidence of fever. not been shewn in the While observ- typhoid diagrams. The mesenteric glands were and a the in one case under the enlarged, ing parasites microscope section shewed a number of I noticed that the after re- large pigmented pigment granules leucocytes. The liver was very and the in the centre of a rosette fatty, maining clumped up spleen shewed an increase of fibrous tissue with for commenced a most active twenty-four hours, a number of " very large pigmented leucocytes. movement described as a boiling move- (well The post-mortem diagnosis of the case was ment which continued for ten The " ") days. chronic malaria." The case shews how some within the rosette became indistinct spores very of the intermittent fevers may become remittent, after hours, so that it was forty-eight practically resist and end fatally. It is possible converted into a more or less quinine hyaline spherical that many of the remittent fevers of India with a of body clump very actively moving with such intermittent attacks, and such in the centre. After ten began pigment grannies days a termination of intermittent fever is difficult to the the parasite disintegrated, leaving pigment the free. The slide the of the explain by parasite theory. containing specimen Case No. 4 is also interesting. The blood was in the the of tempera- kept wards, range ture chart exhibited a double fever with from 80?F. to 85?F. The quartan temperature being a It supports the state- cover was with vaseline to simple quartan relapse. glass painted prevent ment of observers that fever is the blood many quartan drying up. the most obstinate of all the intermittent fevers. On one occasion a rosette was seen to rupture The case shews the beneficial effect of small within an hour after the blood had been drawn, doses of in the treatment of and in several other cases a similar quinine quartan phenomenon fever as has been by was observed at a later within suggested Legrain.1 period, generally Case No.

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