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
Catalogue details

Licence: Public Domain Mark

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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    index of latent or incipient malaria, and is satisfied that this important sign manifests itself long before the more salient symptoms become apparent. As long as the impoverishment continues slight the sufferer can be restored by appropriate treatment on the spot, but as soon as it passes certain limits he should at once be invalided to Europe or at all events sent to a Sanatorium. The means thus furnished for unmasking the insidious enemy while it is still comparatively impotent, and before it has had time to acquire the firm hold on the patient’s constitution which it subsequently manifests, should enable the medical officer to save many a valuable life that otherwise would be sacrificed to the curse of Africa. . . .” 2. Turning to the Digestive and Excretory Systems : The lips are ensemic and dry, or almost blackish in grave cases ; the tongue is found to be dry, or moist and slimy, and encrusted with a thick dirty-yellow or dark-brownish fur, or sometimes leaden-coloured, with an abundance of sordes on the teeth and gums ; insatiable thirst; anorexia, deglutition may be affected from weakness; griping pains in the abdomen; irritable stomach as evidenced by nausea, or vomiting of green or yellow bile or, in malignant cases, coffee-ground coloured matter mixed more or less with frothy fluid, and when there is muoh retching there may be actual hsematemesis and epigastric uneasiness or actual oppression around the chest ; hiccough is also present, frequently distressing; constipation is the rule in all my cases, except where purgatives had been taken before the case came under my observation ; there may be, though rarely and not so much in this as in the simple Remittent variety, gastro-duodenal catarrh with bilious stools ; tenderness in the right hypochondriac region, with or without enlargement of the liver ; tenderness over the spleen and at times over the stomach. The alvine evacuations are, as a rule, feculent, with an admixture of mucus and a melanotic matter of very offensive odour, or they may be scanty, hard, and ‘‘ shotty ” black lumps (scybabe), or assume a peculiar mixture of green and reddish-black colour like pounded spinach mixed with palm oil, or at times black and jelly-like; this latter is contemporaneous with diminished urine and excessive vomiting of “ coffee-ground ” fluid matter. The skin is in some cases dry and hot, in others bathed in cold clammy sweat; the surface tempera- ture varies between 102° F. and 104° F., or higher, generally paroxysmal, or continuous or irregular, conforming to no regular type of fever. There is yellowness of the skin and con- junctive and nails, with at times injection of the conjunctive. In the more dependent parts of the body there may be ecchymosis giving a mottled appearance of the skin, especially over parts usually exposed to pressure, or the skin may be covered with lichen tropicus. The Urine.—There may be a certain amount of dysuria or retention present, or suppression at the very onset of symptoms, though in some cases urine and faeces are passed involuntarily. Usually the urine passed is scanty or of moderate quantity, the colour varies from at first, it may be, dark-reddish or sherry, afterwards it turns muddy port wine, or in some cases at the commencement it is thick and black, like molasses, Sp. g. varies between 1,020 and 1,030, acid in reaction and has sediment, contains a trace of albumen, but in bad cases it may be one-half, and constituents cf haemoglobin. Sediment consists of urates principally but no blood corpuscle, and as a rule no tube cast except when nephritis is a