Hints to Travellers, Scientific and General, Vol. 2 / Tenth edition, revised and corrected

by Royal Geographical Society

Liver Abscess.

It is extremely difficult for the traveller to decide if abscess of the liver is present; it may be suspected if a patient, convalescent from dysentery, still remains feeble and ill, or if he has an irregular temperature, a muddy complexion, night sweats, wasting, and pain or uneasiness in the right shoulder. Sometimes a definite swelling can be made out. A dry cough is not uncommon.

Treatment.—Emetine is the specific treatment for the prevention of liver abscess, and it would seem in some cases actually able to bring about a cure even when the abscess has formed. It should be given as for amœbic dysentery ([p. 187]), and it is essential that a patient with liver abscess should as soon as possible come under medical control, as it may be necessary to give emetine by the needle subcutaneously or even to inject it into the abscess cavity. Ammonium chloride may be given; the patient’s strength must be supported, and he should be as quickly as possible placed under the care of a surgeon, who will probably decide to operate. If this cannot be done, then the patient should not be interfered with surgically, for he will have a better chance of recovery if the abscess is allowed to burst naturally than he would if the traveller attempted to operate.

Malaria.

Of all diseases in the tropics malaria is the one which is most likely to trouble the traveller. Hence it is essential that he should be well posted regarding it. In addition to the books which have already been indicated he will find the recently published ‘Malaria at Home and Abroad,’ by Colonel S. P. James, a work of much value and interest. It is true it is more especially intended for the medical man, but any intelligent layman can study it with interest and profit, and the chapters dealing with prophylaxis and treatment are specially valuable and well up to date. Here it is possible to give only a mere outline of the chief facts concerning the disease.

1. Malarial fever is caused by a small animal parasite which lives chiefly in the blood of patients attacked by it. 2. Under ordinary conditions in nature it can be conveyed only from one person to another by the bite of a mosquito which has previously sucked the blood of an infected person. 3. The parasite undergoes a series of changes in the mosquito’s body and eventually finds its way to the salivary glands of the insect whence it is injected through the mosquito’s proboscis into another victim. 4. There are only certain species of mosquitoes, belonging to the family Anophelinæ (from a Greek word signifying “harmful”), which can carry malaria, and it is only the females of these species which are affected as the males are not blood-suckers. Anopheline mosquitoes breed in shallow puddles and in almost all collections of stagnant or gently flowing water. It is therefore very dangerous to pitch camps close to stagnant pools, sluggish reed-grown streams or marshy places. 5. In the tropics one of the chief reservoirs of infection is the native, and more especially the native child, who frequently harbours the malarial parasite in the form which is adapted for life and reproduction in the mosquito and hence is a distinct source of danger. It is therefore inadvisable to camp in the vicinity of native villages or to spend a night in the neighbourhood of native habitations unless efficiently protected from the bites of mosquitoes.

Symptoms.—Malarial fever presents itself under two chief forms, though it should be noted that malaria is one of the most protean of all diseases and may simulate any malady. (1) Intermittent fever. In this disease the temperature may rise high, but returns each day to normal or lower; hence there is, after each attack, a period of complete freedom from fever. An intermittent fever or ague is usually less serious than a remittent fever, but it is harder to cure in the long run. (2) Remittent fever. In this the temperature, though it varies, keeps constantly above the normal, and the higher the fever, and the slighter the difference between the extremes of temperature, the more serious is the condition of the patient. Where the temperature is remittent, and appears to be unaffected by quinine, the disease is probably not malarial, but may be a case of enteric fever, and should be treated as advised below under that heading.

The attack may be sudden, but it is usually preceded by a feeling of languor, yawning, and general discomfort; this is followed by the cold stage, which, in the tropics, is usually short, and in the more ordinary attacks is ushered in by a violent shivering fit or rigor, though this is not common in Central Africa. The sensation of cold is entirely subjective, for though the patient feels chilly and piles clothes upon himself his temperature will be found elevated. At this period violent vomiting is not infrequent. Then comes the hot stage, often of long duration, followed by the sweating stage, during which the perspiration pours from the patient and soaks everything on and about him. After this there is a period of remission, or intermission of the feverish symptoms with corresponding relief to the patient. Usually, after some hours, the attack comes on again, beginning with the cold stage, but if the fever is treated very early, the disease may now pass off. The whole attack lasts as a rule from six to ten hours, say one hour for the cold stage, three or four for the hot period, and two to four for that of defervescence. There is sometimes a feeling of pain and discomfort in the right side owing to the congestion of the spleen, which enlarges during the rigor.

There are three distinct species of malarial parasite, and each causes a different type of fever. According to the type with which the patient has become infected, the fever recurs after one, two, or three days. At the same time all kinds of febrile irregularities are met with, so that it is often impossible to diagnose the disease in the absence of blood examination for the detection of the parasite.

Anæmia is a constant feature of the malarial attack, as is but natural, considering the great destruction of red blood cells brought about by the parasites which have infected them.