Mabch 16, 1906.] 



SCIENCE. 



411 



28. Stomach in good condition. The patient re- 

 tained five grains of bisulphate of quinine every 

 three hours, also retained small quantities of milk. 

 Jaundice did not increase. October 24 (seventh 

 day of illness) : Patient still improving and feels 

 much better; stomach in good condition, tempera- 

 ture 100° F., pulse 78, respiration 24. October 25 

 (eighth day of illness) : Temperature normal, 

 98ya° F., pulse 60, respiration 20. October 26 

 (ninth day of illness) : Temperature QSVa" F., 

 pulse 48; respiration 20. October 27 (tenth day 

 of illness) : Temperature 98.4° F., pulse 48, respi- 

 ration 18, urine normal. Patient went on to un- 

 interrupted recovery. 



Dr. Bell 's eases total fifty-five in number, 

 carefully observed microscopically, phys- 

 ically and every way possible. 



Total number of cases seriously ill, fifty- 

 five ; total number of cases which were very 

 ill but not in danger of death, twenty-one ; 

 total number of recoveries, fifty-four ; total 

 number of mild cases, fifteen; only one 

 death— all treated with quinine. Of the 

 fifty-five cases, fifty-three were natives of 

 NeAV Orleans and lived in New Orleans 

 up to the time of illness. One was born 

 in New Orleans, but lived in LaFouche 

 ten years. Of the fifty-five cases forty- 

 eight cases occurred in forty-eight different 

 houses; the remaining seven occurred, as 

 follows: Two cases in one house; two in 

 another. No family visited by Dr. Bell 

 consisted of less than five members ; seven 

 had had yellow fever. 



Sex of Patients. — Males, thirty-five; females, 

 twenty. Race. — ^White, 50; colored, 5. We all 

 had many cases of this fever, but I quote Dr. Bell's, 

 as all records were bedside records carefully taken. 



Pathological Anatomy (gross). — ^Autopsy No. 

 900. Lungs: right, twenty-three ounces; left, 

 twenty-three ounces. Spleen: nine ounces. Pan- 

 creas: two ounces. Heart: fourteen ounces. 

 Liver: eighty- four ounces. Kidneys: right, six 

 ounces and one quarter; left, six ounces and one 

 half. Body of white man slightly jaundiced 

 about face and neck, conjunctiva yellow; pupils 

 slightly contracted; post-mortem rigidly marked; 

 heart, normal; lungs, cedematous; spleen, soft, 

 muddy, enlarged and intensely congested. 



Liver. — Fatty degeneration marked. 



Gall Bladder. — Full. Pancreas, normal. Kid- 

 neys congested; granular, slight fatty degeneration. 



Diagnosis. — From post-mortem. Dr. O. L. 

 Pothier, pathologist; acute pernicious malarial 

 fever. 



Microscopical Pathological Anatomy. — In 

 acute or primary cases there is slight or no 

 pigmentation of organs, but the organs 

 mostly infected are found full of malarial 

 parasites, especially the spleen, the liver, 

 kidneys and brain. I fear if I go too far 

 in minutite I shall tire you. In this aestivo- 

 autumnal fever the patient is either dead 

 or well before the usual evidences of ma- 

 laria are produced. Hence, the finding of 

 the crescent, or ovoid bodies in the various 

 organs is the most reliable sign. Nearly 

 every organ is in a state of congestion. 



Diagnosis. — This disease in the first day 

 or two can be confounded with almost any 

 disease beginning with chill, fever and high 

 temperature. If the patient lives in the 

 country or suburbs the malady is likely 

 malarial, as this fever usually occurs in the 

 country or suburban districts. That is the 

 case in this city ; whereas, yellow fever 

 usually starts in the older quarter, thickly 

 populated districts near the wharves and 

 shipping, and among newly arrived persons. 

 The finding of the crescents or testivo- 

 autumnal parasites is proof positive that 

 the patient has this fever beyond question. 

 Whether it is a mixed infection or not is 

 another question; it is possible but not 

 probable. Sir John Hunter was right in a 

 measure, but we do know that sometimes 

 there occurs mixed infection— say, typhoid 

 and yellow fever. At times malaria also 

 complicates both of these diseases. Under 

 these circumstances, the wisest and most 

 astute physician may be puzzled. When 

 you fitad the patient has the malarial para- 

 site in the blood, he certainly has malaria, 

 and very seldom anything else. The find- 

 ing of the parasite is a certain indication 

 of malarial infection. The test of Torti, 



