194 ATKINSON. 



During her stay in Hongkong, however, she had resided in a locality 

 (MacDonald Eoad) known to be infested with Anopheles and where 

 malarial fever was rife. In the previous summer extensive building 

 operations had been carried on in this district of the town, many 

 European houses having been built there, and malarial fever was very 

 prevalent. In the Annual Eeport of the Medical Department for the 

 year 1902 3 I find, under the heading "Antimalarial measures," the 

 following : 



This locality had been especially dealt with, much undergrowth had been 

 removed, pools of stagnant waters had been drained, and the nullahs partially 

 trained. In the winter months a general fumigation of the servants' quarters 

 in the houses of this district was carried out by the sanitary board staff with 

 the object of killing off the Anopheles and their ova. 



In this case immediate blood examination revealed the cause of the 

 fever, and the subsequent rise of temperature after labor caused no 

 anxiety as to sepsis. The blood examination also enabled the attending 

 physician to ease the mind of the patient and assure ber relatives as to 

 the favorable prognosis of the case. 



The history of the next case is one in which an attack of malarial 

 fever induced premature labor. It occurred as recently as November 

 last and the history is briefly as follows: 



On November 27 last I received a telephone message that a case of premature 

 labor was being sent to the Victoria Hospital for Women and Children from 

 Stonecutters' Island. 



I must mention that arrangements have been made whereby the women and 

 children from the military, when sick, are sent to this hospital. 



At 3.45 p. m. that day I received a note from the sister on duty stating that 

 "the patient had just arrived, looking very ill, her temperature being 40° C. 

 (104 C F.) and pulse 128. She complained of severe headache, great thirst, and 

 had severe pain in the right side. The perineum was ruptured, very much swollen, 

 and tender to the touch." 



I sent word that the patient should be admitted to the isolation ward, as the 

 hospital was rather full, there being several recent confinement cases under treat- 

 ment. It appeared to me that the case might be one of acute puerperal sepsis. 



On examination I found the patient to be an English woman with a small, 

 eight-months' baby, weighing but 2 kilos (4J pounds). Her condition was as 

 described by the sister; in addition, she had a brown, dry tongue and was com- 

 plaining of severe headache. 



She was the wife of a sergeant in the Royal Garrison Artillery and had been 

 in Hongkong for two years, during the whole of which time she had been living 

 in the married quarters at Stonecutters' Island, situated in the harbor some 3 

 miles from Victoria. 



Eighteen months before she had suffered from an eight weeks' abortion, other- 

 wise her medical history was good and she had not previously had malarial fever. 



As she was so ill I did not disturb her further that night, but gave her 1 

 gram (15 grains) of trional and ordered fomentations of corrosive sublimate to be 

 applied to the swollen, torn perineum. The following morning the patient had 



"Report of the Principal Civil Medical Officer for the year 1902, p. 264. 



