CASE OF TOXEMIC JAUNDICE.

To the Editor of The Indian Medical Gazette.

Sik,?Maung Po Tin, age 32, Burmese male, a cooly by pro- fession, was admitted into the Bassein Civil Hospital in a moribund and semi-conscious condition on 24th August, 1917, suffering from characteristic yellow tinge of eye balls, con- junctivae, tongue, lips, teeth, in fact of the whole body ; loose- ness of bowels and vomiting of blood, weakness and slight fever of about 10 days' duration.

Past History.?The man who brought him, in a dooly, said that the patient came about a month ago from Yenangyaung to Bassein in search of work, and while he was working as a cooly he got this attack. So far as can be ascertained there was no history of malaria or syphilis ; nor was he addicted to any drug habit, either opium, alcohol, or cocaine. Present Condition.?Is unmarried. The patient appears a

well-nourished subject, though thin at present; eyes, face,

x- Tin* SERVICE NOTES. 155 April, 1918.] CORRESPONDENCE.

tongue, gums, teeth, scalp and the whole body are highly tinged yellow. The mouth is covered with blood, the result of vomiting which stained the mouth. Circulatory System. Heart-apex, 1st sound is weak, 2nd

sound is accentuated. Other sounds are also weak. No bruit. Pulse was 64 beats per minute, weak, slow, and soft.

Respiratory System.? Breath sounds are harsh but no crepitations are heard.

Digestive System.?Gums, tongue, mucous membrane of the lips and cheeks and teeth are highly tinged yellow. Bowels loose having about two motions in an hour. Motions are green and yellow, tinged with blood and mucus. He passes motions involuntarily. Vomits blood (hsematemesis). Liver dullness extends 2? inches below the right costal arch and on deep pressure tender. Blood, examined, slight increase of polymorphonuclears

present. No malarial parasite. Urine, was bright yellow, and specific gravity 1,025.

Reaction slightly acid. Bile pigments present centrifugalized a small quantity of urine, and examined microscopically no leucin or tyrosin crystals were found.

Stools, were examined, a few amoeba; were found. Treatment.?Emetin injection gr. 2/3 every day for 6 days. For haematemesis, he was given a mixture of adrenalin

chloride solution (1 in 1,000) calcium chloride with Dover s powder at bed-time. Stools under emetin reduced in frequency and became

devoid of blood and mucus and gradually assumed a normal appearance. The liaimatemesis also was controlled by the above mixture and entirely stopped on the third day after admission into hospital. On the 30th August, 1917, he was put on a mixture of ammonium chloride and bicarbonate of soda.

The jaundice by degrees disappeared and he made an un- eventful recovery, and was discharged cured on the 10th September, 1917, after stay of 24 days in hospital. His temperature was not very hijjh : it ranged between 00? and 99?, etc.

Yours.letc.,

c. R. CHETTI,

Assistant Scjrgkon,

Civil Hospital, Bassein, Burma.