NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
201
Isotonic point.—First definite increased tint at .425. Marked hæmolysis at .4
per cent. salt.
Hœmonosozic value.—1.258 %.
Films taken at 10 A.M., 4 P.M. and 9 P.M. showed no parasites or pigmented leucocyt
es.
A count of 500 leucocytes gave:—
Polymorphonuclears
. .
. .
. .
. .
7 3 . 6 %
Large mononuclears
. . . .
. .
. .
20.2%
Small mononuclears
. . . .
. .
. .
6.%
Eosinophiles
. . . .
..
. .
.2%
Urine.—Hæmoglobinous urine passed all day.
23rd February 1908.—Urine hæmoglobinous up to 10 A. M. Spleen just below costal
margin. Marked yellow colouration of the conjunctivæ and skin.
Anæmia much more pronounced than yesterday.
24th February 1908.—Patient convalescent. Temperature 99. Spleen just palpable
Urine free from hæmoglobin.
25 th February 1908.—At night had a rise of temperature to 103.
27th February 1908.—Given 2½ grains of quinine at 9-30 A.M., 1-30 P.M., and 5-30 P M.
28th February 1908.—Given 2½ grains of quinine at 2 A.M., 6 A.M., 10-30 A.M., and
2-30 P.M.
5.P.M., slight rigor.
5-15 P.M., passed 8 oz. hæmoglobinous urine.
H æ m o g l o b i n u r i a c o n t i n u e d t i l l 1 0 P . M . T h e r e w a s a S e c o n d r i g o r a t 6 - 4 0 P . M . U r i n e
at 1 A.M. next morning free from hæmoglobin, but temperature remained between 101 and 103
throughout the whole of the 29th and showed an evening rise to 100 on the following two days.
Estimation of amount of hœmoglobin in urine—
Time.
Urine
Q u a n t i t y .
Percent-
age hæmo-
globin.
Total
hæmoglobin
(blood
equivalent).
22nd February 1908
4 A.M. ..
. . . . . .
312 c.c.
2%
6.25 c.c.
"
7 A.M. to 8-30 A.M.
. .
625 c.c.
3%
18.75 c.c.
"
10 A.M.
..
..
284 c.c.
5%
14.2 c.c.
"
1 P.M. to 2 P.M.
. .
570 c.c.
5%
28.5 c.c.
"
3 p.m. to 4-30 P.M.
...
510 c.c.
3%
15.3 c.c.
"
6 P.M.
. . .....
285 c.c.
3%
8.5 c.c.
"
7 P.M. to 9-30 P.M.
655 c.c.
3%
19.6 c.c.
227 HD
202
Time.
Urine
Quantity.
percent-
age hæmo-
globin.
Total
hæmoglobin
(blood
equivalent.)
22nd February 1908
10-30 P.M.
to
..
. .
. .
510 c.c.
3%
15.3 c.c.
23rd February 1908
6 A.M.
"
7 A.M.
. . ..
310 c.c.
2%
6.2 c.c.
"
9 A.M. .. . . . .
300 c.c.
. 5 %
1 c.c.
TOTAL
.
. .
. . 133.6 c.c.
Case XXII.—Baradighi. April 1908.
Marwari. Age 18.
Native country. —Hissar district, Punjab.
Length of residence in Duars.— 9 months.
History. —Suffered ever since coming to the Duars from repeated attacks of fever.
States that he had fever two or three times every month. In December this man
was seen by us and found to have enlarged spleen and quartan parasites in his
blood. Another man in the same house had a simple tertian infection.
Takes rice, dhal, chappattie, and butter, never fish or meat.
In his own country cannot remember feeling ill.
About a fortnight ago being feverish took 20 grains quinine in two days. Ten days
later he got high fever and was given diaphoretic mixture. Next day in the
morning when his temperature was down was given 10 grains quinine sulphate.
23rd April 1908.—Just after noon had high fever again with rigor, headache, and a
temperature of 104. At this time passed reddish black urine.
24th April 1908.—Passed four specimens of reddish black urine.
Seen by us about 6 P.M. on this day.—Pallor marked. Yawning. Spleen below umbilicus.
Splenic puncture performed shortly after seeing patient. Film showed scanty
crescents, pigmented endothelial and mononuclear cells, also large macrophages
with engulfed red cells and many included nucleated cells resembling very small
mononuclear leucocytes.
Washed B.W.F. corpuscles.
Normal serum.
Hœmolysis.
½ c . c . W a s h e d B . W . F c o r p u s c l e s
emulsion.
(150 c.m. normal serum+
No hæmolysis.
50 c.m. B.W.F. serum at 37° for 15 m.) Agglutination.
1 c.c. Washed corpuscles native. 150c.m. B.W.F. serum.
No hæmolysis.
Agglutination.
½ c.c. Washed corpuscles very
anæmic native.
150 c.m. B.W.F. serum.
Aggultination.
25th April 1908.—Temperature fallen to 96. Urine free from hæmoglobin.
203
Case XXIII.— Baradighi. April 1908
.
Coolie. Age 58.
Native country. —Ranchi, Chota Nagpur.
Length of residence in Duars.— 14 years.
History.—Unknown.
2nd April 1908.—Had fever with temperature of 104.
3rd April 1908.—Temperature 104. Vomiting. Passed reddish black urine.
4th April 1908.—Continued to pass black urine. Jaundice.
5th April 1908.—Temperature in the morning 102. Urine a little clearer.
6th April 1908.—Temperature in the morning 99, in the evening 102.
Seen by us on this day.—Marked anæmia. Slight jaundice. Hæmoglobinuria ceased.
Films of peripheral blood showed some engulfed red cells, shadows, endothelial
plaques, polychromasia, and nucleated red cells. No parasites or pigmented
leucocytes.
Case XXIV. —Huldibari. May 1908.
Chinaman. Age 35.
Native country.—China.
Length of residence in Duars.— 3 years.
History.—States has had much fever at first but not so much latterly. Had two days
fever recently.
7th May 1908.—Seen by Dr. Babu who found he had a temperature of 105° and was
passing hæmoglobinous urine. Temperature in the evening 103.
8th and 9th May 1908.—Temperature still high.
Seen by us next day.—Was passing very small quantities of very dark, nearly black
hæmoglobinurious urine. Anæmia. Marked yellow colouration of conjunctivæ.
Spleen slightly enlarged. Splenic puncture performed. Spleen blood showed
much recent malignant tertain pigment, both scattered and in the form of reli-
quats, also a segmenting malignant tertian parasite.
Blood. —Serum showed orange tint chracteristic of hæmoglobinæmia. No tendency
for clot to dissolve in serum. Blood received into citrate solution shows hæmo-
globinæmia.
Films of peripheral blood show some large endothelial plaques and some included red
cell shadows
A count of 500 cells gave:—
Polymorphonuclears
. . . .
. .
. .
. .
. . 75
Large mononuclears
. . . .
. .
. .
. .
. . 11.7
Small mononuclears
. . . .
. .
. .
. .
. . 12.3
Transitiona
. .
. .
. .
. .
. .
. .
. 5
Eosinophiles
. .
. .
. .
. .
. .
. .
.3
204
Films of splenic blood showed distinct agglutination and many spherocytes. Some de-
colourised included red cells present. Macrophages contain engulfed small mononuclear cells.
Hœmolysis experiments:—
½ c.c. washed B.W.F. corpuscles emulsions 150 c.m. normal serum.
Rapid hæmolysis.
½ c.c. washed B.W.F. corpuscles mulsions 150 c.m. normal serum+50 c.m. No hæmolysis.
B.W.F. serum at 37 for 15 min. Aggultination.
Washed B.W.F. corpuscles
Allowed to stand in .9% salt. No hæmolysis.
11th May 1908.—Small quantity passed free from hæmoglobin. Hæmoglobinæmia no
longer to be detected. Serum bright yellow but free from hæmoglobin.
Case XXV. —Nagasuri. May 1908.
Bengali Babu, Age 30.
Native country.—Murshidabad.
Length of residence in Duars.— 5 years.
History.—At his home scarcely had one attack of fever in the year ; in the Duars
had two or three attacks every month. Has been one year at Nagasuri living in
the midst of coolie lines.
29th May 1908.—About midnight he had an attack of fever but with a more severe
sensation of cold and shivering than usual. In the morning noticed that
his urine was red.
30th and 31st May and 1st June 1908.—Passed hæmoglobinous urine. Had severe
epigastric pain and much vomiting, especially on the 31st. Jaundice was first
noticed on the 30th and was very marked on the 31st.
2nd June 1908.—Urine dark in the morning but subsequently cleared. Blood film taken
by Dr. McCutcheon.
Seen by us on the 3rd.—Hæmoglobinuria over. Spleen enlarged. Yellow colouration of
c o n j u n c t i v æ p r e s e n t . Ma r k e d t e n d e r n e s s o v e r t h e l i v e r , l e s s s o o v e r t h e s p l e e n .
Serum yellow. No hæmoglobinæmia. Clot dissolved to some extent overnight
though it did not do so in a control blood.
Hœmolysis experiments—
½ c.c. washed B.W.F. emulsions + 150 c.m. normal serum, S. R. C. No hæmolysis.
No agglutination.
Washed B.W.F. corpuscles. + Undiluted normal serum S. R. C. No hæmolysis.
No agglutination.
Case XXVI.—Indong. July 1908.
Bengali Babu. Age 25.
Native country. —Dacca.
Length of Residence in Duars .—3 years.
205
History.—Previously lived in Sylhet where he did not have any serious fever. Since
coming to the Duars has had fever not leas than once a fortnight and has been
home f or t hi s s eas on. Had a pr evi ous at t ack of Bl ack- wat er Fever at Bogr a.
Has been one year at Indong.
5th July 1908.—Noon.—Felt indisposed and took 10 grains quinine.
3 P.M.—Rigor.
4 P.M.—Passed high coloured urine, and noticed at the end of micturition
some drops of blood coloured fluid.
7 P.M.—Passing hæmoglobinous urine.
10 P.M.—Seen by Dr. McCutcheon who noted histemperature to be 105,
and took blood films.
Seen by us 4 P.M. 6th July 1908.—Temperature 103. Passing dark red hæmoglobinous
urine. Yellow colouration distinct. Spleen 3 fingers below costal margin.
Splenic puncture performed.
Blood.—Serum orange yellow. Blood received into citrate shows small amount of
hæmoglobinæmia. No solution of clot in the serum.
Isotonic point.— 5 P. M. 6th July 1908.
Percentage salt
.. .525
.5
.475
. 4 5 .425 .4
tint.
tint.
tint.
tint. tint. increased
tint.
Control
. . nil.
nil.
nil.
nil.
tr
h
due to hæmoglobinæmia.
Hæmosozic value ..
. .
. .
. .
1.175%
Splenic blood received into hypertonic salt solution gave only same tint (approximately)
as peripheral blood. Stained with neutral red in 3% citrate solution showed many dark
staining corpuscles, more than were present in peripheral blood. Films showed large numbers
of macrophages of mononuclear type containing numerous red cell shadows. Phagocytosis
of red cells are present. Agglutination very noticeable. Spherocytes present. Malignant
tertian pigment scattered and in the form of reliquats.
A count gave :
—
Large shadow corpuscles
. .
. .
. .
. .
1%
Small poikilocytic shadow
. .
. .
..
..
.05%
Spherocytes
. .
..
. .
. .
. .
.4%
Hæmolysis Experiments—Vide Part IV, Chapter II.
Patients urine + Emuls. patient's corps.
No hæmolysis.
No agglutination.
150 c.m. urine +
150 c.m. ditto.
No hæmolysis.
plus
50 c.m. normal serum.
8th July 1908.—Hæemoglobinuria still present up to late in the day.
227 H. D.
3F
206
Isotonic point—
Percentage salt
.. . 4 7 6
.45
.425
.4
nil
tr
tr
Control
. .
tr
h
inc H
Serum contains no recognisable hæmoglobin but is of a strong yellow colour.
Case XXVII.—Monabari. July 1908.
Bengali Babu. Age 48.
Native country.—Dacca.
Length of residence in Duars.— 18 years.
History.—Until coming to Monabari 18 months ago did not suffer much from fever but
at Monabari has suffered constantly and severely. Had a previous attack of
Black-water Fever (Case XI) in October 1907. A week before present attack was
feeling feverish.
9th July 1908.—6 A.M.—Took quinine 5 grains.
10 A.M.—Took another 5 grains.
2 P.M.—Passed hæmoglobinous urine. Temperature in the evening 105.
10th July 1908.—Temperature in the morning 100. Passed very dark urine all day.
Seen by us at 4 P.M. 10th July 1908.—Passing hæmoglobinous urine. Temperature 104.
Spleen enlarged. Yellow colouration.
Blood.— S e r u m r o s y r e d . H æ m o g l o b i n æ m i a a s s h o w n b y a d d i n g b l o o d t o c i t r a t e s o l u t i o n
and centrifuging equal in amount to that shown in the serum. Estimation of
amount of hæmoglobin showed this to be about equivalent to 3.75% solution
of blood.
Isotonic point—
Percentage salt
..
. 4 7 6
.454
.434
incr
. 4 1 6
incr
.4
.384
tint
tint
tint
tint inc H
Control
..
nil
nil
nil
h
hh inc H
Hœmosozic value—
1.07% salt.
Blood—in solution of neutral red in 3% citrate showed some dark staining corpuscles.
A count gave 5 in 20 fields.
Hœmolysis Experiments. —Vide Part IV, Chapter II, page 150.
Urine.—An estimation of the amount of hæmoglobin gave :—
1st sample passed
. .
. .
. .
.. 10% blood equivalent
Urine passed 10th July 1908 ..
. .
.. 1% blood equivalent
Hæmosozic value of urine
. .
. .
. . 1.28% salt.
207
11th July 1908.—Hæmoglobinuria still continues. Temperature in the morningl 102.
Serum ruddy yellow tint. Estimation of the amount of hæmoglobinæmia
gives about 1.5% blood solution.
Isotonic point—
Percentage salt .. . 4 7 6
.454
.434
.416
.4
.384
incr
tint
tint
tint
tint
inc H
Control
.. nil
nil
nil
nil
hh
inc H
12th July 1908.—Hæmoglobinuria over.
13th July 1908.—Given quinine 5 grains.
14th July 1908.–Given quinine 5 grains.
15th July 1908.—No quinine administered.
16th July 1908.—A relapse. Stated to have come on apart from administration of
quinine.
17th July 1908.—Urine dark red. Temperature in the morning 105, in the evening 104.
18th July 1908.—Temperature 103 in the morning, 101 in the evening. Hæmoglobinuria
ceased towards evening.
Case XXVIII
—
Mr. M—European Assistant. Aged about 29.
Length of residence in the Duars. —Between four and five years all on one garden.
Arrived in Duars. —December 1903.
History.—Had a mild attack of Black-water Fever in May 1905. Used to get a good
deal of fever and did not take quinine regularly, only when fever occurred, and
then not for long. Has had a lot of fever since March 1908, and in the middle of
May 1908 had a mild attack of intermittent Black-water Fever lasting two
days off and on. On the 5th June went for a sea trip to Rangoon. While on
board ship had two relapses very slightly. Was not then taking quinine. The first
attack in May 1908 came on after taking quinine hydrochloride. Got back to
the garden on June 15th and was feeling very fit. On the 17th had a bit of fever
and took 10 grs. quinine hydrochloride and remained at work. Fever came on
again on the next day at 5 P.M. 9P.M. took grs. 5 quinine hydrochloride, and during
the night at 3-30 A.M. another grs. 5. Next morning took grs. 5 again at 7 A.M., and
another tabloid a little later on the garden. Went out to work. After coming in
at midday passed black urine at 2 P.M. but went out again into the garden for a
short time. Then came in and went to bed. Woke up at 9 P.M. shivering. Got
hot bottles, and finally began to sweat and bilious vomiting became troublesome.
Notes.— 5th day, June 23rd.—When patient was first seen he was found to be lying ill in
a bungalow near the tea house, within 20 yards of a line harbouring servants and
208
tea house men and their families. Altogether nearly sixty souls, including over
30 young children. Enquiry showed that quite a number of these people were
recent arrivals, having been but two months or so in the Duars. Among some
thirty examined all had enlarged spleen and ten had fever, while all but two show-
ed malarial parasites in the blood. Alongside this line and within 80 yards of
the bungalow was a small drain from the tea house in which many thousand
larvæ of Barbirostris and other anopheles were discovered. In the bungalow
many specimens of M. Listoni, Barbirostris and other species were seen.
On examination patient was found to be sallow and slightly jaundiced, liver not
enlarged but spleen nearly 4 fingers breadth below ribs and rather tender. The
urine which had remained brackish-red for over four days was commencing to clear
but still showed bands of oxy and met-hæmoglobin. Patient was markedly
a n æ m i c , h æ m o g l o b i n s t a n d i n g a t 3 0 % . T e m p e r a t u r e w a s a b o u t 1 0 0 .
June 24th.—Patient remained fairly well until about 10-20 when the temperature rose
to 101, and shortly after he passed clear urine.
June 25th. —Patient remained well until 9-20, when he had a slight rigor, and shortly
after passed dark red urine containing oxyhæmoglobin, while his temperature rose
to 102.5, dropped again with a slight sweat to 100, but immediately afterwards rose
once more to 103.
Temperature fell towards evening and urine cleared slightly.
June 26th.—At 9-2 P.M. temperture rose again, reaching 102.5 at 12 a.m., but though the
urine was a little dark in colour it was nearly free from hæmoglobin. Temper-
ature dropped again that evening, the urine also improving.
June 27th.—The morning temperature was only 99, but at 8-20 there was a rigor, and
black urine was passed, while the temperature speedily rose to 103.3, dropping after
a short interval to 102.6, only to rise again to 104. By this time the urine had
become quite clear again. That evening as the temperature appeared to be typi-
cally malignant tertian in character, although microscopic examination failed
to show parasites, grs. 5 quinine bi-hydrochloride was administered hypodermically.
June 28th.—Morning temperature was 99, but it rose to 102 at midday, though urine
remained quite clear. Towards the evening temperature dropped.
June 29th. —Morning temperature normal, but at 11 A.M. it rose to 100, falling a little
later to nearly 99, but again rising to 101. Urine remained clear, and patient was
given another 5 grs. of quinine.
June 30th.—Morning temperature normal, but gradually rising after midday to 102 in
the evening. Quinine grs. 5 was administered. Urine remained quite clear and
temperature fell during the night.
July 1st.—Temperature in the morning normal. Patient was given grs. 5 quinine at
day-break. At about 10 A.M. there was a rigor, and a little later black urine was
passed, while the temperature rose to 103, fell again to 102.5, and again rose to 104.2.
209
At evening it had again fallen to 99, and the urine was quite clear once more.
From this time the quinine was stopped again entirely.
July 2nd and 3rd.—Urine remained quite clear. and though temperature rose each day
to 101 or 102 for a short time, the patient appeared to be doing well.
July 4th.—Patient's morning temperature 99.2, urine quite normal. No quinine had been
given since the grs. 5 on the morning of the 1st. At 1-30 P.M. there was a sharp
rigor, temperature rose to nearly 103, and once more black water was passed. By
4 P.M. the urine was again clear, and temperature fell rapidly after 5 P.M. to nearly
normal.
July 5th.—From this morning quinine was once more administered, as it was evident
that unless something could be done to check the disease the patient would die
before he could be removed. 1½ grs. were given at intervals totalling 7½ grs. per
diem. There was a little smoky urine at 11 A.M. on this day, but nothing further,
the treatment being continued during the ensuing week, temperature each day
remaining more nearly at the normal, and the urine keeping quite clear, while
the spleen became smaller in size. Finally patient became sufficiently well to
be sent to England.
•
The most interesting features of this case are the number of relapses within a short period;
the facts that the attacks followed hydrochloride of quinine in the first case ; that subsequent-
ly a relapse occurred on 6 occasions without any relation to quinine administration, and that
on three occasions such a relation could be traced. A number of blood specimens were
taken which have not yet been fully examined.
(Dr. R. L. Paterson' s case included to show association of Black-water Fever with quinine hydro-
chloride and calcium chloride.)
Case XXIX. —Tezpur, Assam. Attacked with Black-water Fever—
(1)
(2)
(3)
April 19th. July 22nd. August 4th.
V. F.—Tea planter, aged 24, European.
Length of residence in Assam.— 15 months.
History.—Arrived in Assam from England January 1907. Kept good health a short
time and then had severe attack of malaria (with malignant tertian parasites
in blood). Subsequently took quinine as a preventive, but somewhat irregularly.
Had further attacks of fever necessitating a short trip on account of health.
Kept fairly fit during cold weather of 1907-08.
Attack.—(1)— April 19th.—Felt " rotten" but worked. Took quinine, grains 10, in the
evening. After midnight had a rigor, vomited, fever came on together with
diarrhœa. Urine not seen.
227 H. D.
3G
210
April 20th.—Passed typical black-water at 11 A.M., temperature 104. Jaundice present.
Blood showed no parasites. At 3 P.M. urine sherry coloured. Recovery rapid.
Went a trip to Ceylon, and while there got fever. Took quinine hydrochloride
grains 15, with no ill-effects. Returned to work and remained fit, taking
quinine hydrochloride, grains 10, regularly once a week.
Attack.—(2) July 22.—Felt feverish. Took quinine hydrochloride, grains 10, in the
forenoon, but remained at work. At 7 P.M. took another grains 10 quinine hydro-
chloride and went to bed. Vomited soon after. At midnight had a rigor and
vomiting. At 3 A.M., 5 A.M. and 6 A.M. passed black urine, total of 26 oz.
July 23.—Temperature 103.4 all day. Blood showed no parasites. Jaundice present
and urine still black, 26 oz. being passed during the day and 22 oz. at night.
July 24th. —Temperature normal. Urine still black, but clearing a little towards
evening. Spleen and liver not enlarged or tender. Total urine passed 17 oz.
July 25th.—Urine became clear, amber in colour ; no blood pigment or albumin.
Quantity only 11½ oz.
July 26th to 31st.— Steady improvement.
August 1 s t .
—Headache. Temperature 104. Blood examination showed numer-
ous small ring malarial parasites. Urine clear. Was given calcium chloride, grains
25, preparatory to quinine treatment. Temperature fell slightly.
August 2nd.—Urine clear. Was given quinine hydrochloride grains 5. Temperature
r o s e t o 1 0 3 . 8 . W a s g i v e n a n o t h e r g r a i n 5 q u i n i n e a n d t e m p e r a t u r e f e l l . U r i n e
remained clear. Calcium chloride continued, in grs. 10 doses.
August 3rd.—Urine remained clear. Blood showed no parasites. Temperature 100
to 101. Quinine hydrochloride grs. 5 given morning, midday and evening (total
grs. 15). Urine still clear.
Relapse August 4th.—After midnight on the 3rd had a rigor and vomiting. Tempera-
ture rose to 104.2. At 4 A.M. passed 6½ oz. black urine. Temperature fell to 100,
but urine remained black all day and jaundice was present. Total urine 33 oz.
Calcium chloride continued. During night passed 25 oz. of urine.
August 5th.—At 6 A.M. urine cleared slightly and at 10 A.M. was sherry coloured. It
contained no blood pigment or albumen. Blood showed no parasites. Patient
rapidly became convalescent, and left for England on the 7th.
• Case XXX. —Tezpur, Assam. Attacked Black-water Fever May and June 1901.
•
E. P., Tea-planter, aged 42, European.
Length of Residence in Assam. —Uncertain, but had passed considerable time in Cachar.
Had also been in China. About four years in district where attack occurred.