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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    1. The phenomena referable to the blood and circulatory system contribute the greater, if not the most serious, aspect of this malady, because all the secretions of the body are maintained in an active and regular condition by means of the activity of the circulation of the blood, which is constantly driving out the Malaria-germ when moderate quantities are absorbed, but should the circulation be enfeebled from any cause whatever, then the Malaria- germ has time to attack directly the red corpuscles of the blood (as Machiafava and Celli have demonstrated), and thus produces infection, which becomes either this form—the subject under review—or some other variety of Malarial Fever. The chief points observable with reference to the circulation and blood are that the pulse is quick, soft, small, regular, and easily compressible, or it may be slow, irregular, and intermittent. The heart’s impulse is weakened, and sometimes the apex sounds have a tendency to overlap each other. But I have not observed in any of my cases any distinctive cardiac murmur. In the convalescents, however, after the abatement of general symptoms, or sometimes in bad cases before death, a distinctive hsemic bruit is audible in the large veins of the neok, indicating a profound anaemic state of the blood, frequently described as oligocythaemia and haemoglobinaemia, a condition induced by the excessive breakdown of the red blood corpuscles. In this connection the use of the haemocytometer and haemometer at the bedside is simply invaluable, for if blood from a patient is examined by these means it will be observed that the number of red corpuscles is reduced, whilst the white appear to be relatively increased, with a marked deficiency of haemoglobin. In connection with the clinical examination of the blood in this morbid condition the Lancet has drawn the attention of the profession to the usefulness of the haemometer in malarious diseases generally, and it will not be out of place to quote here its remarks, as they coincide with my own view of the matter and cannot be too strongly insisted upon. The Lancet9 remarking on the “ Pernicious Fevers of Eastern Africa ” in connection with a most interesting paper on the subject of “ Bilious Haematuric Fevers,” written by Staff-Surgeon-Major Stendel, of the German Army, says: “ In twelve cases he (Staff-Surgeon-Major Stendel) made an examination of the blood by means of Fleiscbl’s haemometer, and found that the amount of haemoglobin present oscillated between 50 and 21 per cent, of the normal standard. In two other cases the quantity was too small to be determined by the instrument, but it was estimated by the observer at not more than 5 and 8 per cent, respectively. He lays stress upon the prognostic value of haematological examinations, and furnishes details regarding two patients with a deficiency of haemoglobin in their blood, in whom bilious fever subse- quently showed itself on several occasions when their ordinary mode of life underwent a change for the worse.” The clinical facts here described agree in some important respects with the condition of the blood in Malarial Hoemoglobinuric Fever. Continuing its remarks, the Lancet adds : “ It seems only reasonable to conclude that a systematic use of the haemometer cannot but render great service in the detection of the incipient stage of a disease which is invariably attended by more or less destruction of the red corpuscles of the blood. Staff-Surgeon-Major Stendel looks on the diminution of hmmoglobin us a certain » The Lancet, July 27th, 1895, p. 225.