MALARIA EXPEDITION TO NIGERIA 263 
twenty miles up the Akwayafe river, and, feeling ill four days before admission, got into a canoe 
and found his way down to the mouth of the river, where he was picked up by a launch and 
brought to the hospital. On admission, his temperature was only 99/6 0 F., and he was apparently 
going on satisfactorily when, as in the previous cases, his temperature began slowly to creep up — 
the beginning of a constant tendency towards hyperpyrexia. He was treated by baths, as will be 
subsequently described. After his fourth bath he was put into a cold pack, which was changed 
every hour for four days. The temperature then steadied, and eventually he left for home 
practically well. 
Case II. This patient was sent from an out-station on the fourteenth day of his illness, 
and was still under treatment when the record was made. So marked was the tendency to 
hyperpyrexia that on two occasions no fewer than two cold baths were necessary in the twenty- 
four hours, and it was not until the twenty-second day of the disease that it was possible to sub- 
stitute the continuous pack for the cold bath. From that time until now the temperature has 
averaged 102°. The patient lies helpless in bed, occasionally showing some glimmering of 
intelligence, but for the most part remaining unconscious of his surroundings, taking nourishment 
well, but passing urine and faeces under him. This condition, as far as we could tell, may con- 
tinue indefinitely, The temperature shows no tendency to assume alarming proportions, and the 
heart and lungs are acting well. 
Charts 
Treatment of the Condition 
This may be summed up in one word — baths. The patient is put into a cold bath, and 
his temperature brought down to 100 or 99°. He sleeps for about an hour, and then feels fairly 
comfortable, but the temperature at once begins to creep up again, and in eighteen or twenty-four 
hours it is back at 106°, or at the point at which it is considered advisable to check it. Quinine 
and other drugs have been systematically tried without influencing the course of the disease ; the 
coal-tar antipyretics are absolutely useless. Cold sponging and packs are incapable by themselves 
of reducing the temperature, although in a recent case which recovered it was found that by 
reducing the temperature by means of the cold bath to 101° or 102 " it was possible to keep it 
there by means of cold packs renewed at hourly intervals. 
Progress of the Cases 
It has been observed that, if the patient is to recover at all, some change for the better is 
to be looked for about the end of the third week. The temperature, which up to this time would 
constantly rise at once after the bath, might remain at 102 or 103° for several hours, and perhaps 
in the course of the next week two or more days might pass without the necessity for a bath. 
Convalescence is gradual, and it may be six weeks after the onset of the fever before the temper- 
ature finally assumes its normal course. On the other hand, in 50 per cent, of the cases which 
have come under observation a fatal issue has occurred.' 
Several examinations of the blood of both cases were made by Drs. Thompstone and 
Bennett and by ourselves, but neither malarial parasites nor pigmented leucocytes were observed. 
Several times on the day of the arrival of the second case at Old Calabar, and on many subsequent 
occasions, we carefully examined the blood both by fresh and stained specimens. 
