Contact Cases of Leprosy in the British Isles

BRITISH ISLES.[TSR BM"1orn 107 tioni owinig to its tenldenlcy to cause vomiting when taken by the miiouth.Large quanitities of fluids slhould be given (water, barley water, etc.).Lactogen, slightly sweetenied, hlas beeni swell tolerated where there has been much niausea, and Benger's food hlas also been easily taken.The patient should be kept in bed for at least fourteeii days even in the mllildest eases.It is owinig to patients failinig to realize the importance of this that thle prognosis of a mild case is so bad. RE,SULTS.Since assunming the post of district suirgeon, Bindura, I have seeni 36 cases of blackwater fever (29 males and(i 7 females); 33 recover-ed anid 3 died.Trhe percentage of mortalitv was tlhus 8.33.All the deaths occurred in males.Only onie was actually dIIe to blackNwater fever, and inl that one my warnillg not to move the patient had been disregarded.Dcatlis.Casf: l.-A middle-aged man, living temporarily in a tent, developed blackwater fever.On t.he day of onset I attended him, and found that he did not present aniy alarming symptoms.He was put on the treatment I have mentioned, and instructions as to diet were given to his wife.She was also warned not to allow him to be mo-ved.On the third day of the dises.seI had a message stating that his water was now quite clear and that he was much better.Oin the morning of the fourth day 1 received a very urgent message saying that the patient had been moved, for better nursing, to a cottage a quarter of a mile away, and was then in an extremely critical condition.I found the patient quite collapsed and very yellow.All attempts to improve matters by the use of hot-water bottles, subcutaneous and rectal saline, injections of camplhor, strychnlinie, and pituitary extract, failed to produce any improvemenet, and he died twenty-seven hours after having been moved.Case 2.-A middle-aged man who had nio blackwater for ten days, and who had a history of a severe kick in the epigastrium from a mule three months before, developed what clinically appeared to be intussusception and died.He had complete stoppage, passed blood per anum, and had a well defined sausage-shaped tumour in the region of the tr-ansverse colon; the diagniosis, therefore, was probably correct.Operation was refused, and I did not urge it owing to the weak state of the patieint; the relatives refused a post-Oiortc?aexaminiation.Case 3.-A young man developed severe blackwater fever, with scanty urine and retention, which niecessitated catheterizationi during the whole of his illness.The urine became clear in two days, when bronchopneumo71ia developed; this cleared up in fouir days and the patient's condition seemed most hopeful.The patient then developed a very severe attack of mumrips, and after aiiotlher twenty-four hours an old appendicitis of five years' standing lit up.The patient was too ill to stand an operation, and died twenty-four hours later.CONCLUSIONS.