Malarial haemoglobinuric fever (so-called), blackwater fever of the Gold Coast, chiefly from a clinico-pathological standpoint : with illustrative cases / by B.W. Quartey-Papafio.

Quartey-Papafio, B.W.

Date:: 1897

Credit: Malarial haemoglobinuric fever (so-called), blackwater fever of the Gold Coast, chiefly from a clinico-pathological standpoint : with illustrative cases / by B.W. Quartey-Papafio. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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$CASE II. Rev. Father S., aged 28 years. Result—Recovery. Patient is a Roman Catholic Missionary, and has been out two years on this Coast, during which he had suffered once from an attack of Malarial Hsemoglobinuric Fever in June last, so that this is his second attack of the same fever. On seeing him in the afternoon of 1st August, 1890, he complained of a feeling of uneasiness in the lumbar region, headache, thirst, periodical chilliness over the whole body, with shiverings, sleeplessness, loss of appetite, constipation, and nausea, and said that this illness began three days ago with lassitude and want of energy. I find the skin and conjunctiva; intensely jaundiced ; skin hot and slightly moist; eyes dazed and suffused ; tongue covered with a dirty-yellowish fur ; head tossed on the pillow from one side to the other ; incessant vomiting of white fluid mixed with frothy mucus; no tenderness elicited on pressure over the abdominal organs. Temp. 105° F. Pulse 120, rather rapid, regular, and fairly strong. Had not passed urine since last night, when he had much difficulty in doing so, and what came was very scanty and black-coloured. To take quinin. sulph. gr. x. and Calomel gr. x. at once; cold sponging of the head and upper part of the body, and hot water bottles applied to the feet; sterilised milk and soda ad lib., and beef tea ordered. 6 p.m.—Temp. 104° F. Pulse extremely febrile; patient complains of dysuria. About 2 oz. of black urine drawn off, looking very much like molasses, and contains a very small quantity of albumen, constituents of Hsemoglobin, and heavy deposit of urates, etc., but no blood, bile, sugar, or tube casts; thirst insatiable, but fluids are ejected as soon as they are swallowed : Antipyrin gr. xx. to be taken at once, followed in half-an hour by quinin. sulph. gr. xv. ; a large mustard poultice applied to the whole of abdomen. 2nd August, 8.30 a.m.—Sent for hurriedly to see the patient, who is reported getting worse. On attending, patient complains of having had a bad night, thirst, pains in the lumbar regions and also in the hepatic region. He is restless and very hot all over the body; the icteric tinge of the skin and conjunctiva; is very pronounced ; had been sick—-vomited matters consist of undigested food and frothy fluid, but contain no bile, nor blood; perspiration defective; temp. 105-2° F. ; pulse very rapid, irregular, and weak ; no urine passed since last note, and the bowels have not acted. To take anti- pyrin gr. xv. every hour till 30 grains have been taken, to be followed half-an-hour after by quinin. sulph. gr. xx. 1 p.m.—Temp. 103-2° F. Pulse rapid, regular, and compressible; no urine has been passed ; skin sweating profusely, one stool, darkish-red coloured ; milk and soda retained. Anti- pyrin gr. xv., to be followed by quinin. sulph. gr. x., ordered. 6 p.m.—Temp. 103-8° F. Pulse febrile and weak ; perspiration continues ; patient kept down egg-flip, beef tea, and milk. 9 p.m.—Temp. 101- 4° F. Pulse febrile and weak ; about three ounces of urine passed with difficulty ; colour of urine is like that of molasses. Calomelas gr. v. administered at once, and a sleeping draught ordered to be taken at 10 p.m. 3rd August, G.30 a.m.—I found the patient quiet and calm. He said he had a bad night and vomited once during the night, and then slept for one hour, after which he awoke and sweated throughout the night. Temp. 102° F. Pulse rapid and rather weak ; urine has the same character as last note, but increasing in quantity ; dysuria much lessened ; skin discoloration is improving; bowels not open ; headache persists. To take a draught containing ol. Ricini §ss, Tinct. Chlorof. Co. I)\xv., and Ess, Menth. Pip. TJ^ss, 12 noon.—Temp 101° F. Pulse febrile and weak; one stool, greenish-red coloured ; sweating profusely. Quinin. sulph. gr. xv. administered. Egg-flip, beef tea, and some white wine were retained. 6 p.m.—Temp. 102° F. Pulse febrile; urine is still black, but increasing in quantity ; four greenish-red stools. Icteric tinge of skin and conjunctive improving. Nausea and vomiting have ceased ; patient taking nourishment and wine freely. Quinin. sulph. gr. xx. administered, and a sleeping draught ordered to be taken at bedtime. 4th August, 8,30 a.m.—Patient had a bad night. He awoke in the night feeling very chilly and shivery ; perspiration defective; patient reported to me that he took some raw eggs this morning. Bowels have not opened ; icteric tinge of skin and conjunctive has increased. Dysuria has ceased, and urine is passed freely and increasing in quantity; colour is still black. Temp. 102- 4° F. Pulse febrile, regular, full, and compressible. To take quinin. sulph. gr. x., to be repeated at noon. Mist. pot. acet. co., chicken broth, beef tea, cold tea, and arrowroot ordered. 12 a.m.—Felt [186080]$