SEIFERT, M. J.
Journal of the American Medical Association
Seifert discusses the influence of malaria on pregnancy, citing several authors and pointing out the necessity for repeated blood examinations in cases of masked malaria where the symptoms per se are merely confusing, and where the diagnosis rests on microscopic findings and therapeutic tests. [The latter, as pointed oub by HENSON should not be relied upon as an aid to diagnosis. See this Bulletin, Vol. 3, p. 60.] An account is given of a very difficult case in which eventually a latent atypical malaria was found to be complicating the .puerperium in a patient suffering from a long standing chronic nephritis. An acute exacerbation of the nephritis occurred, together with acute mammitis and, to crown all, a late gonorrheal infection. All this formed a very perplexing symptom-complex.
The patient, an American, aged twenty-five, had lived in Illinois all her life. When between fifteen and eighteen she suffered from anaemia complicated at one period by dropsy. She married at the age of twenty and bore a healthy child nearly a year later. On the sixth day after labour she suffered from chills and fever without any local symptom to account for them. Malaria was nob then suspected, and under a sympathetic treatment she recovered and continued well until after her second pregnancy at the age of twenty-five. Labour was followed by lacerations, haemorrhages and fainting attacks. There was some rise of pulse and temperature, but both subsided to normal and the condition was looked upon as being dependent on the severity of the labour and the chronic nephritis which was known to exist.
Six days later acute mammitis supervened, together with fever and quickened pulse. These symptoms continued and, in the absence of any other septic complication, were attributed to the breast condition, even after the services of a consultant had been requisitioned. The temperature ran high, ranging from 104° to 105° F, while the pulse rate was 120 to 140. No periodicity was observed.
As the patient was losing ground, the situation was carefully reviewed, and it was found that malaria was the only disease which had not been considered. This led to a blood examination, the discovery of a large tertian infection, specific treatment and rapid recovery. At a later period gonorrheal infection was found to exist.
Points of interest are that the patient had never lived in a strictly malarial locality and never had an attack of malaria until after labour. At no time were the symptoms typical of malaria. The author concludes with a plea for a more thorough investigation of all unusual cases seen in general practice, especially in the direction of laboratory diagnosis. A. B.
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