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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    9. Sypliilitic fever. lOv Urinai-y intermitting fever. 11. Hepatic intermitting fever. 12. Intermitting fever from morpMa. The remai-k is made that in pysemia the paroxysms, though often irreg- ular, ai-e at other times remarkably periodic. Ulcerative endocarditis now and'then gives rise to an intermitting fever which may recur daily for weeks, or even for mouths. In lymphadenoma the paroxysms are usually quotidian, and may recur for weeks ; in some instances they are made up of three distinct stages—of rigors, heat, and sweating. The same author says : Even the so-caUed continued fevers are more or less remittent. ' Harley says : One of the most general facts obsei-ved in reference to enteric fever is the frequent occurrence of intermittence in the pyrexial condition.' Trousseau remarks that enteric fever may simulate, at first, intermittent fever. ^ These authoritative statements, which might be greatly multiplied, show that an intermittent or remittent pyrexia cannot be taken by itself as evidence of malaiial poisoning. What test have we then ? The present writer knows of none of uni- versal application, unless the curative power of the cinchona alkaloids be accepted as such a test. But, while it is very generally admitted by practi- tioners in malarious regions in all parts of the world that these alkaloids •cure malarial intermittent fevers, even of the gravest type, it is also in evi- dence that they do not cure other fevers ascribed to malaria. We must therefore admit that this test is not reliable, or that the fevers which do not yield to quinine have a different etiology from those which do. A third possibility worthy of consideration is, that the malarial fevers which do not yield to quinine are compHcated by organic lesions, the result of the action of the malarial poison, which require time for their restoration. Of course, any complication resulting from the action of a difierent specific disease-poison, removes the case at once from the category of strictly malarial fevers. It is evident that the quinine test, which without doubt is of great value even if we cannot accept it as a universal touchstone for the differ- -ential diagnosis of malarial fevers, must be applied with great caution. For this remedy is of decided benefit in the various forms of septic poison- ing, which, as pointed out by Murchison, often exhibit an intermittent p-VTexia. And also in cei-tain ephemeral fevers evidently not due to ma- laria, e.g., thermic fever. Moreover, there is always liability to eiTor in ascribing to the remedy a recovery which may have taken place quite in- dependently of it. Thus in mild cases of a specific continued fever of brief duration, such as yellow fever, recovery occurs promptly, without special medication. But very many practitioners, when this disease pre- vails, adapt the routine practice of giving quinine in every case of fever which falls into their hands, and these gentlemen often take great credit to themselves for having promptly cm-ed their patients, when one familiar with the natural history of the disease would say rather that the patient had recovered in spite of the remedy. If we have no test which enables us to decide definitely, imder all cir- cumstances, whether a fever is or is not of malarial origin, there is at least ' Lancet, Lond., May 3, 1879. ' Reynolds' SyHtem of Medicine, vol. i., p. 389. ' Clinique Medical, 2d ed , p. 247.
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