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In one District Laboratory at the request of the Specialist in Dermatology
complement deviation tests for gonorrhæa were undertaken with the object
of deciding when the correct moment had arrived for beginning treatment with
Sulphanilamide. At first a considerable number of tests were carried out;
but, with the introduction of M. & B. 693, the value of the test declined and
pari passu the number of sera received in the laboratory decreased.
Malaria.—No cases of haemoglobinuria occurred amongst malaria patients
treated with atebrin and plasmoquin. In the previous year six such cases
occurred.
In one District, a fatal case, which presented the clinical picture of "black
water fever" together with the signs and symptoms of cerebral malaria,
was reported. Blood smears showed a very heavy infection with malarial
parasites which were considered by the medical officer who examined the
slides at the clinical side room to be the result of a mixed P. malariae and P.
falciparum invasion. On the slide being submitted to the District Laboratory
for confirmation, the D. A. D. P. considered that P. falciparum alone was
present but in various stages of development, a diagnosis which was subse
-quently confirmed by the Director of the Malaria Institute of India. The
mistake at the clinical side room had arisen through the medical officer mistak
-ing the pre-crescent stage of P. falciparum for the "band" forms of P. mala-
riae.
Another interesting fatal case was reported from a different District.
A British soldier was admitted to hospital suffering from fever. Although
repeatedly looked for, no malarial parasites were at first found. The patient
subsequently developed jaundice, and finally P. falciparum parasites were
discovered.
This case is in marked contrast to the other described, in which the peri
-pheral blood was loaded with parasites. It is, however, well recognised that
in some severe cases of subtertian malaria the parasites may be extremely
scanty in the peripheral blood.
Anaemias.—Attention was drawn in the annual reports for 1937-1938
that a number of cases of hyper-chromic macrocytic anaemia had been detected
in Waziristan District. The presenting picture of these anaemias consisted
of debility, anorexia, flatulence, diarrhæa, sore tongue, loss of weight and
anaemia. In all Districts in Northern Command accurate and complete
blood pictures from oxalated samples of venous blood are now carried out as
a routine in all cases of anaemia. The investigations include, among others,
the determination of the size of the red cells, counting the reticulocytes and
testing the Van den Bergh reaction.
Officers in charge of laboratories when reporting on these specimens
express an opinion regarding the nature of anaemia present. The clinician is
thus guided in the treatment and progress of his cases.
Notes on routine laboratory work.—Biochemical work showed a definite
increase over 1938, e.g., blood sugar estimations rose from 321 to 336, and
blood urea from 278 to 345. The increase in the number of examinations of
this kind is considered to be due to the fact that clinicians are becoming more
alive to the great help that these tests afford them in the diagnosis of their
cases, and there is also a great readiness apparent on the part of Officers in
charge of laboratories to undertake them. Furthermore, with the steadily
improving standard of equipment in military laboratories, there is a much
greater capacity to complete the more complicated biochemical investigations.