Malaria and malarial diseases / George M. Sternberg.

  • George Miller Sternberg
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Malaria and malarial diseases / George M. Sternberg. Source: Wellcome Collection.

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    disconnected true vellow fever from malaria. The two agencies of yellow fever and paroxysmal fever are entirely distinct. . . . We have lately had under notice in this locality the following varieties of fever, partially concurrent or sequent: 1, Sim- ple continued fever ; 3, ague; 3, remittent fever; 4, malarial yellow fever ; 5, specific yellow fever. In the same report, Assistant Surgeon Jameson, of the 47th Begiment, says: The cases in which much alhumen, hemorrhage, yellowness of the skin, or black vomit were present, were returned as yellow fever. Those cases in which even imper- fect remission could be observed, and in which the symptoms of blood-poisoning were less pronounced, and the urine was free from albumen, were returned as remittent, and those having no appreciable paroxysmal tendency, and in which the symptoms were of still less severity, as continued fever. . . . That the different forms of fever thus designated, even those returned as continued fever, had a common malarial origin, may be looked upon as certain, the tendency being for the cases described as remittent to pass into continued, those of continued into yellow fever, and the latter into ague. . . . Quinine was found to have no curative influence in the cases of malarial yellow fever in which it was tried. On the contrary, from my own observa- tions and those of others, I should say its administration aggravated the symptoms; thus another method of distinguishing between this malady and specific yellow fever proved ineflicacious.—Appendix to English Army Medical Department Eeport for 1869. The confusion into which these English army surgeons fell as regards the etiology and differential diagnosis of malarial and yellow fevers is not surprising, and is but a repetition of a mistake which has been made many times in regions where both of these diseases are endemic, or where, from frequent importation, yellow fever is looked upon as a disease of the countiy. At the outset of nearly evei-y epidemic of yellow fever in our southern seaports, similar mistakes were formerly made, and this not by a few individuals but by the jjrofession generally. In New Orleans, for ex- ample, just before the acknowledgment is generally made that yellow fever prevails, the weekly mortuary reports commonly show a great increase in the niunber of deaths from malarial fevers. But when it is generally ad- mitted that the prevaihng disease is yellow fever, the deaths from remittent fever, congestive fever, and pernicious fever fall off in a notable manner. ^md epidemics of yellow fever, having a low rate of mortality, ai-e especially liable to be pronounced malarial fever. Berenger-Fei'aud, whose scientific attainments and opportunities for the study of yellow fever, both in the French Antilles and on the coast of Africa, entitle his opinion to great weight, beheves the fever known upon the i-slands of Gaudeloupe and Martinique as figure ivjlavimaloire, etc., to be nothing more nor less than a mild form of yeUow fever. He says : Certainly, for unprofessional persons, the fievre injlammatoirc is absolutely dif- ferent from yellow fever, for the important reason, as they say, that in one recovery is the rule, almost absolute, whilst in the other, one-quarter, if not one-half of those at- tacked succumb. This reason may appear sufficient for those who are not familiar with tlie study of disea.se, but is it iis convincing to us V No ! And if we admit, for example, that tliere is between the two diseases a simple difference of intensitj-, the question of great mortality on the one hand, and extreme benignity on the other, no longer prevents the union of the two diseases in a single group. The difficulties of diagnosis arise, not in the well-marked and fatal form of the disease, but in these milder ei^idemics which, when they occur among a creole population, are so easily confounded with other endemic or epidemic febrile disorders. It is doubtful whether these difficulties can be overcome, by any amount of professional acumen, ui^on a simple clinical
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