The diseases if infancy and childhood; for the use of students and practitioners of medicine / by L. Emmett Holt.

  • Holt, L. Emmett (Luther Emmett), 1855-1924.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The diseases if infancy and childhood; for the use of students and practitioners of medicine / by L. Emmett Holt. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    fall ia temperature, to return with the next paroxysm, or if quinine is given they may disappear entirely.* This group of symptoms has often led to the mistaken opinion that the disease was pneumonia, which had been aborted by the administration of quinine. Subacute or Chronic Forms of Malaria.—The most constant symptoms are ansemia, enlargement of the spleen, and slight fever. The anaemia is usually marked, often being extreme. The enlargement of the spleen is distinct, and easily made out by palpation, and sometimes is very great. The fever is often so slight as to be discovered only when the temperature is taken five or six times in the twenty-four hours. The other symptoms are of a very indefinite character; there may be slight oedema of tlie lower exti'emities, general muscular weakness, so that the child is easily fatigued, loss of appetite, coated tongue, constipation, headache, muscular pains, and often cough from a slight bronchitis. These symptoms may depend upon many conditions other than malaria, even when they are seen in a malarial district. The only positive evidence of malaria in such cases is the pres- ence of the malarial organisms in the blood. Even the swollen spleen, ansemia, and slight fever, which are often looked upon as diagnostic, may be present in cases of anaemia with which malaria has nothing whatever to do. Diagnosis.—The positive diagnosis of malaria rests upon the demon- stration of the malarial organisms in the blood. They will be found in nearly all the cases when examined under favourable conditions, which are : (1) that the examination be made by one with considerable experience in searching for malarial organisms; (2) that the examination be thorough ; * The following ease is a good example of this condition in its more severe form, and illustrates the difficulties in the diagnosis of malaria in infancy: A fairly nourished child, nine months old, who had been under observation in an institution for two weeks, was suddenly taken with vomiting and fever (Fig. 185). A cathartic was followed by a large undigested stool, and as the temperature then fell to normal, the attack was regarded as one of indigestion. On the third day the temperature was again liigh and accompanied by cough; coarse rales were found throughout the chest, and fine rales at the right base; it was then thought that pneumonia was developing. On the fourth day all the symptoms were so much improved that the infant was regarded as conva- lescent. At 6 p. M. the temperature was normal, and the infant went to sleep quietly. At 9.30 p. M. he awoke with a temperature of 104°, extreme restlessness, and marked dyspnoea. In half an hour his symptoms had increased to a point where he seemed likely to die. He became cyanotic, the respirations were of a panting character and rose nearly to 100 a minute, and he coughed with almost every breath ; the pulse was scarcely perceptible. The severe symptoms continued for about an hour, then passed away gradually, and at the end of two and a half hours they had completely disap- peared, and the child was in a quiet sleep which continued until morning. Malaria was now suspected, and the diagnosis established by the discovery of the plasmodium in the blood. The spleen was at this time much enlarged ; the signs m the chest were those only of bronchitis of the large tubes. Quinine was now begun in full doses, and immediately controlled the temperature and the pulmonary symptoms.