22
Para. 17
17, Cases of Fever examined at Nowgong.—
Fifty-Four Mixed Out-Patients.
Case 1.—Hemaconta, m., 28, policeman of Nowgong, 2 days ill. Was taken ill on 15th
September with very high fever and was brought to hospital in an unconscious state. Ex-
amined 17th ; 9 A.M., just recovering from pernicious cerebral access.
Temperature
101.6° F. Condition of spleen and liver could not be clearly ascertained, but no marked enlarge-
ment, no anæmia nor emaciation. Peripheral blood, only one mature quartan parasite after long
search. Examined again at 8 P.M. and at 9 A.M. on 18th ; no parasites found. Complete
recovery from 17th ; no ensuing enlargement of the organs. Quinine.
NOTE.—Pernicious access with quartan parasite found.
Case 2.—Mola Bux, m., 5, 3 days ill. His father says that he lost four sons, brothers
of this child, from kala-azar three years ago, and that people in his house frequently get
fever. The child was attacked with high fever with rigors on 16th September. Examined 19th ;
temperature 101.4° F. ; looks very ill, already somewhat anæmic. No enlargement of
the organs. Well nourished. Fever continuous since attack. Peripheral blood, 8 A.M., numerous
small unpigmented amœbulæ, frequently assuming ring forms (æstivo-autumnal), No
pigmented leucocytes. No larger parasites, many doubly-infected corpuscles. Quinine given ;
seen again 3rd Oct. Father says he has had no fever since last seen. Looks recovered but
very yellow. Spleen 2 inches below ribs, and liver distinctly palpable and evidently tender.
Temperature 98.2° F., 8 A.M. Peripheral blood, no parasites, no crescents. Temperature was
taken by A. A. for a week after this date, and varied irregularly from 97.3° to 99.1°F. Quinine
given steadily. Recovery; decrease of organs; no crescents on several examinations.
NOTE.—Rapid enlargement of organs and absence of crescents.
Case 3.—Budu, m., 35, 5 days ill. No reliable history ; says fever irregular with rigors.
Examined 1st Oct., 1C A.M. Looks ill. Peripheral blood, fairly numerous small quartan para-
sites, one mature one ; no enlargement of spleen, nor of liver ; not seen again.
Case 4.—Sorab Ali, m., 8, 5 days ill. Father says several of his children died some
years ago with kala-azar. This child was taken ill five days ago with dysentery followed by
fever, no rigors. The fever remains continually slight ', dysentery is now better. Examined
1st Oct. 11 A.M. Anaemic, but not particularly ill. Temperature 101.4° F. Peripheral blood, no
parasites nor pigmented leucocytes. The temperatures were taken by A, A. for 12 days from
this date and remained between 98.2° and 99.2° F. Peripheral blood, frequently examined up to
20th October, never showed parasites nor pigment. Patient played in streets and was not ill. No
enlargement of the organs was ever noted; motions tended to be loose but were never brought
for my examination,
NOTE.—Nature of case indeterminate, slightly raised temperature and no enlargement of the organs.
Case 5.—Moshan, m., 45, out-patient, 5 days ill. Says had fever on two days, with
two days free between ; came yesterday; begins at 4 p. M., with rigor. No reliable history of
sickness in his house. Examined 4th October 10-30 A.M. Looking rather ill, but no
enlargement of the organs, nor anæmic. Temperature 98.0°F. Peripheral blood, one young
quartan parasite found after a considerable search. Came into hospital ; quinine ; complete
recovery forthwith.
Case 6.—Khoru, m., 2, 5 days ill. Mother says was attacked with severe fever 5 days
ago, which has continued every day since with slight morning remissions only. No relatives
are now getting fever. Examined 10th October 10 A.M., child ill and crying ; already
somewhat anæmic. Temperature 99.2°F. Spleen palpable; enlargement of the liver can just be
felt, Peripheral blood, one full-sized and one medium sized tertian parasite ; a crop of unpig-
mented amœbulæ forming rings—young of the æstivo-autumnal parasite; parasites not
very plentiful. Examined again on 11th, 7.30 A. M. Mother says had high fever last night.
Tertian parasites of all sizes ; no æstivo-autumnal parasites. Quinine ; recovery forthwith ; no
subsequent enlargement of organs.
NOTE.—Early enlargement of organs with two species of parasites.
Case 7.—Bahadur, m., 30, 6 days ill. Says was attacked 6 days ago. Came to hospital
on 13th September with fever. No fever on 14th until evening. Quinine. Examined 15th. Looks
rather ill ; no enlargement of organs. 4 p. M., temperature 99.6°F. Peripheral blood ; no
parasites, one pigmented leucocyte. 16th, one amœbula. Recovery forthwith ; no subsequent
enlargement of organs.
Case 8.—Bikir Ram, m., 10, 6 days ill. Father says fever begins daily with severe rigor,
and becomes very high. No relatives have had fever or kala-azar. Examined 18th October.
Looks very ill already and is groaning with pain ; cannot stand ; complains of great pain in
epigastrium. Spleen an inch and a half below ribs, not tender, Liver half an inch below
costal arch and tender. Father says, had slight fever four months ago, but it left no
enlarged spleen ; 9 A. M. temperature 103.3° F. Peripheral blood, no parasites nor pigmented
leucocytes. Examined again at 2-30 P.M.; father says the fever has been continuous since yesterday,
but there was a shivering fit at 10 A.M. (after previous examination). Temperature 103.3°F. is
now perspiring freely and looks somewhat relieved. Peripheral blood, numerous unpigmented
amœbulæ [æstivo-autumnal], with "tongues" (paragraph 21). Pigmented leucocytes. Large
doses of quinine. Examined again on 20th; 8 A. M., temperature 99.1°F. Feels much better.