MALARIA ACQUIRED IN ENGLAND

A.C.D. Firth
1917 The Lancet  
162 unconscious and appeared to understand all that was said to him, although when asked to put out his tongue he.only opened his mouth. In a few hours there were an increase of the knee-jerk, ankle clonus, and a definite Babinski response in the right leg. Sensation seemed to be very slightly impaired. The bladder and rectum were not affected, and he was able to make his wants known. He remained in much the same condition for about a fortnight when the power of extruding the tongue returned. A
more » ... tongue returned. A regular course of instruction was commenced, making the patient write from copy with his left hand, and in the course of another fortnight considerable improvement took place ; he was able to move the leg but not the arm, whilst the face movements were practically normal. He was able to recognise objects handed to him and to name them, although sometimes he made a mistake, calling a knife a " pencil," &c. when this happened he was always aware of the fact, and could sometimes correct himself. His pleural condition meanwhile had much improved, there being no re-accumulation of fluid, but a large coarse friction remained for some time all over the left lung. Faradism and massage.were employed daily to the affected leg and arm. The cause of the hemiplegia was undoubtedly embolic, probably a small fragment having become dislodged from a clot in the left pulmonary vein. At the beginning of the illness, on the bare possibility of the condition being an extensive thrombosis due to syphilis, a Wassermann reaction was done, which, however, proved to be negative. The condition is an exceedingly rare one. A number of cases have been recorded from time to time of sudden death occurring during the course of pleurisy, with a large effusion, and it is reasonable to assume that in a proportion of these fatal cases the cause of death has been an embolus from the pulmonary vein or auricular sinus becoming lodged in the internal capsule. CASES of poisoning by sodium nitrite and by boric acid are so rare that the following notes of two fatal misadventures which have recently come under my notice may be of interest. 1. Poisoning by sodium nitrite.-An infant of 16 months was brought to me in a state of extreme collapse by its mother, who gave me this history. Her baby had for several weeks been suffering from eczema-Under a doctor's treatment this had greatly improved and she had brought the baby away for a change. After giving the baby the first dose out of a bottle of medicine which had been prescribed for him she placed him in his cot and left him. A quarter of an hour later she heard the baby cry and on going to him she found him pale and unconscious. She picked him up and brought him straight to me, together with the medicine and the prescription. The prescription ordered sodium citrate in doses of 3 1/3 grains, with small doses of mag. carb. and sodium sulphocarbolate. Nothing unusual was to be noted on tasting the medicine, and the only other fact elicited which might have had a bearing upon the case was that during the morning of the same day the baby had suffered slightly from diarrhoea. The child was moribund when I saw it, and died an hour after the administration of the medicine. On enquiry it was found that the prescription had been misread and sodium nitrite had been dispensed instead of sodium citrate. The baby had therefore been given 3g grains of sodium nitrite. Post-mortem examination revealed a flaccid empty heart and a marked degree of the status lymphaticus. There were no signs of gastro-intestinal irritation. In this case one can assume that a certain amount of cardio-vascular depression had been produced by the morning attack of diarrhoea, and that the dose of 3g grains of sodium nitrite acting on the already depressed circulatory system rapidly induced a further lowering of arterial tension with a. fatal result. 2. Poisoning by boric acid.-I was called at 9.30 A.M. to see a woman of 70 years who, at 4 A.M. on the same day, had taken a teaspoonful of boric acid in mistake for Epsom salts. I found her with a flushed face, but with no other symptoms than the mental distress produced by her mistake. She had already vomited, and I therefore did not consider it necessary to do more than administer a mixture containing carbonate of magnesium and bicarbonate of soda. During the afternoon she vomited several times, and there was some diarrhoea. A fairly comfortable night and day followed. On the next evening great thirst supervened, but she appeared to settle down into a normal sleep. She died in her sleep 46 hours after taking the acid. On post-mortem examination there was found on the posterior surface of the stomach near the middle of the greater curvature an area about 2 inches square showing numerous circular pock-like erosions of the mucous membrane. The whole thickness of the mucous coat was eroded, the sero-muscular coat being exposed in the floor of each erosion. The right auricle contained a large, firm, antemortem clot, the cusps of the mitral valve were thickened, and there was a small granulation on each cusp. Southall. ASSISTANT PHYSICIAN, ROYAL FREE HOSPITAL, ETC. ; HON. CAPTAIN, R.A.M.C. Up to the present this country has been free from disease imported as a result of the war, but it is of the utmost importance to report at once any case of disease so arising in the British Isles. On May 30th last a man, aged 20 years, was admitted to hospital suffering from prostration and pyrexia of two days' duration. For several days, owing to the fact that the man had never been abroad, the diagnosis was in doubt, but eventually the absence of physical signs, save enlargement of the spleen, noted on the ninth day after admission, and the rigors (indicated in the chart by arrows), led to a correct conclusion, confirmed at once by the demonstration of the Temperature chart of case of malaria. Q = quinine. benign tertian parasite in the blood. Recovery was uneventful, the patient being transferred to another hospital on the seventeenth day after admission. Careful interrogation both of the patient and his parents proved that he spent all his life in the North of England and Scotland before joining the Army, and was well until he reached a particular depôt, to which, as is well known, men who have returned from Salonika with malaria are drafted after discharge from hospital and from which cases of malaria are frequently sent to hospital. From this evidence it is reasonable to deduce that the infection arose at this depot, the probability of an imported infective mosquito reaching that particular place being very slight. THE PRESCRIBING OF COCAINE.-At Leeds recently, before the stipendiary magistrate, five summonses against a medical practitioner were heard, and one against another, under the regulations made under the Defence of the Realm Act in respect of the supplying of cocaine under illegal prescriptions. Druggists who had made up the prescriptions were also summoned. It was not suggested by the prosecution that any intentional infringement of the regulations had taken place, the offences having been committed in ignorance, but the summonses had been taken out in order that attention might be called to the law. Nor was it alleged that any undesirable results had followed from the giving of the prescriptions. In the case of the first medical man mentioned the summonses were dealt with under the Probation Act, the defendants being ordered to pay the costs. In the case of the second practitioner the summonses were withdrawn. The prescription on the occasion referred to in this summons had been given to an insured patient. words prohibiting the repetition of the prescription having been omitted. It was pointed out that this instruction was not now necessary, but that the druggist should retain the prescription.
doi:10.1016/s0140-6736(01)50823-5 fatcat:yjwbnddya5dkdmdarh3rab4oiu