Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/155

Rh of liver or spleen. Subsequently Dr. Tirard saw the patient and reported that the febrile temperatures still kept recurring, although the night sweats from which he had suffered had ceased, and that he had gained weight.

Soon after this, temperature became steadily normal; weight went up, to 11 stone 2 lb., and in November, 1904, he was again able for clerical work in this country, although at times he suffered from feelings of mental fatigue. With the exception of during a short neurasthenic attack about the end of 1905 he kept at work till March, 1906.

The old febrile symptoms recurred, however, toward the end of March of that year (1906), and he was again obliged to give up work. On May 4th he was reported to be suffering from enteric fever. This diagnosis was evidently erroneous, the fever being of a very irregular character, sometimes having two or three rises in the twenty-four hours. The nocturnal sweatings again set in and were profuse. Later, on the supposition that the fever was malarial, large doses of quinine were administered, both by mouth and hypodermically, and kept up over a long period, but without permanent effect. On June 27th, 1906, the spleen was found to be enlarged and malaria parasites were reported as having been present in the blood—an observation, the correctness of which I doubt. Notwithstanding the continuance of the fever the tongue was clean, the appetite good. On the other, hand anaemia and wasting became pronounced.

When admitted to hospital on November 1st, 1906, he was seen to be markedly anaemic, sallow, wasted (9 stone 12 lb.). The tongue was clean, the appetite and digestion fair, bowels normal. A systematic examination of the various organs gave only negative results, except in the case of the liver and spleen, which were much enlarged, the former extending an inch below the costal margin in the mammary