MALARIAL FEVER DURING THE PUERPER1UM. 1 



Bv J. M. Atkinson. 2 



When considering the subject-matter for a paper to be read before 

 this most important gathering, containing, as it does, members from 

 practically all the countries east of Suez, it occurred to me that some 

 useful practical deductions might be arrived at by the discussion of the 

 puerperiurn complicated by malaria. As a text for these remarks I 

 shall give you the notes of two of the cases which have occurred in my 

 twent3'-two years of clinical experience in Hongkong. 



The first was that of an English lady, who was admitted to the Maternity 

 Hospital of the Government Civil Hospital on December 21, 1902. The patient 

 was a primipara at full term, who stated that she had been suffering from fever 

 for some days before admission, and that her temperature had been as high as 

 40.5°C. (105°F. ). Though not in labor, the patient was recommended to enter the 

 hospital at once, both on account of the fever and especially because both she 

 and her relatives were very anxious in regard to her condition. She was admitted 

 the same evening, and her temperature at 9 p. m. was 38.9°C. (101.6°F.). She 

 was placed on low diet, and a diaphoretic mixture to be taken every four hours 

 was prescribed. On the following morning her temperature was normal. 



A blood film was examined at this time and simple tertian parasites and ring- 

 forms were found. Three-tenths of a gram (5 grains) of quinine was ordered 

 every four hours. At 6 p. m. on the evening of the 22d labor pains commenced. 

 At 6 a. m. on the 23d her temperature was 37.8°C. (100°F.), and at 12.15 p. m. 

 the child was born. 



Beyond slight post-partum haemorrhage, which was checked with a hot lysol 

 douche, the labor was normal. 



Quinine was continued as before. At S p. m. her temperature was 40°C. 

 (104°F.). The fever was evidently due to a tertian attack, as next morning the 

 temperature was normal. From this date there was no more fever; the quinine 

 was continued, and on the 27th the note was made that a blood film showed some 

 ring-forms but no simple tertian parasites. 



The patient was discharged eighteen days afterwards, free from malaria, re- 

 peated blood examinations having shown no parasites. 



This case is one of interest from the fact that the patient had only 

 arrived in the colony a few months previously. She had never to her 

 knowledge had malaria before and did not come from a malarial country. 



1 Read at the first meeting of the Far Eastern Association of Tropical Medicine, 

 held at Manila, March 10, 1910. 



2 Principal medical officer, Hongkong; delegate from the government of 

 Hongkong. 



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