NOTE ON MALARIAL FEVER. By Surgeon-Major M. D.
O'Connell,
m.d.,
Army Medical Department. Remittent fever
and
Ague together
under the title of
For this
fever.
they
are
are
With these
classed
usually
paroxysmal"
classification, however,
not appear to be sound.
that
"
malarial
or
the
do
reasons
exceptions, viz.% by side ;
found at times to exist side
that in both there is increase of temperature; that occasionally one disease is said to run or change into the other, and that both
are said to yield to there little reason to quinine, appears by consider that they own a common origin. If these exceptions are examined separately they will perhaps appear less convincing than they seem at first sight. As to the fact that they are at times found ist. side by side, it may be said that it is important but not conclusive. Formerly Typhus and Enteric were found side by side, and were from this and other
treatment
believed
to own
thought Many other
to be
reasons
fact
were
fever.
common
diseases exist side
this considered
not from
a
origin,
and in
different forms of the to
by side,
same
but
be different forms of
are
one
disease. In both diseases the temperature is raised.
2nd. This
can
scarcely
be considered
these two fevers in
one
class.
temperature charts of both be are seen
they
there is
an
to differ
a
reason for
That in
widely.
placing
Moreover, if typical placed side by side one
disease
intermission of temperature and in the remission appears to separate them most
other only a widely and distinctly. As regards remission of temperature, it is known, since the use of charts became
general,
disease
running
that there is an
daily remission is $rd. is
seen
into
a
scarcely
uncomplicated
any febrile
course in
which
a
not the rule.
It is said that to pass into a
quotidian,
tertian, and vice
remittent fever intermittent and then While not prepare
occasionally versa.
a
288
THE INDIAN MEDICAL GAZETTE.
this is
to say that
not so, I have never seen a
tempersupport this statement. Moreover, if such chart be produced, it is no more a proof that ague and remittent fever are different forms of
one
ed its maximum of
would
which
chart
ature
than
disease,
But if the three Presidencies be taken
Bengal
forms
of
one
in almost From my is
have
as
efficacious in remittent fever
is in ague. An attempt is often made to
it
as
enormous
the mala-
result must be the
some
diseases in The
one
extreme
they
whether
same
the
quantity first
insignificant. It may be seen of the reasons for uniting these two or
class
reasons
for
apparent than real. on them as distinct and
are more
looking
widely different diseases sideration.
that
are
Some of them
not
are
as
unworthy of confollows, viz., the
relative prevalence, the period of maximum prevalence, relative mortality, and liability to recurrence. i st.
Relative prevalence.?Ague is
a
very
common
disease, while remittent fever is comparatively rare. In the Report of the Sanitary Commissioner with the Government of India for 1882, it may be seen that amongst European troops there were 28,271 admissions for ague, and only 625 for remittent fever. This indicates that these diseases do not arise from
single poison 2nd.
or
Period
disease
of
a
cause.
maximum
quoted
prevalence.?Although
it is
seen
the very fact of
with whom
be
a
strong
reason
but that the of natives India, is especially amongst from the state of ill health produced by rebe
doubt, however,
no
state
of
that ague attain-
debility
least inter
in which the
disease will prove fatal, but that remittent fever kills of itself.
current
4th.
gives
Liability
recurrence.?This undoubtedly looking on ague and
to
the strongest evidence for
remittent fever
essentially different diseases.
as
One attack of ague predisposes and renders more liable to another. In fact recurrence is characteristic of the disease. one
attack
With remittent fever it is to
seems
confer
a
protective
the
system against a recurrence of Maclean, whose vast experience enables
with great in
unhealthy
that attacks
posed
to
liability
the
so :
not
power
on
disease.
him to
speak
" This says of remittent fever : countries is often the first form of fever
authority, new
comers, but
such
are
seldom
ex-
second attacks ; in other words, there is less to a recurrence of the disease than in the
intermittent form," Vol.
II.,
that
one
page
(Quain's Dictionary of Medicine, 1334). He does not, however, say
attack of remittent fever protects from
a
subsequent attack of ague. During eleven years' experience of Indian fevers I can
only
call to mind
remittent fever
statistics shew that both diseases often prevail at the For instance, same time, yet it is not invariably so. in the Report above
who
men
from ague amongst
attacks of ague. Perhaps it would be simpler kills by reducing its victims to an
peated
in the system, and therefore the
introduced be large then that
specific poisons
few medical
a
occur
to say that ague
fiftieth remittent fever, by supposing that they receive the poison in different quantities. But in putting forward this explanation it is apparently forgotten
multiply indefinitely
death
a
seen
can
mortality,
poison
that it is characteristic of
In
uncommon.
caused 32 deaths.
proving fatal would questioning the diagnosis.
There
undoubtedly
explain why
fever is not
the disease for
should produce in one man ague and in remittent another fever, or more correctly, why it should produce in forty-nine cases ague and in the
rial
never
European soldiers,
class.
one
but
mortality,?Ague seldom kills,
from remittent
much less prevalent, Perhaps, also, there are not
uniting ague Quinine is useful any fever, in other words, it is antipyretic. own experience I cannot say that quinine
and remittent fever in
while
the month in which both
as
although
cannot be considered a reason for
This
separately,
result,
same
Report above referred to ague is credited with a total of four deaths in India, while remittent fever,
useful in both diseases.
is found
Quinine
re-
the
disease.
4th.
the
Bombay give
Relative
3rd. death
Yet it is not suggested and sometimes tertian ague. that because enteric fever sometimes ends as a typical be
and
Madras give September fevers are most prevalent.
perature in the fourth week of uncomplicated enteric fever is often exactly similar to that of quotidian
must both
October, while
in
mittent fever reached its maximum in August. '1 his to European troops in the whole of India*
fever is proof that enteric fever and ague are different forms of the same disease. The course of tem-
intermittent fever, they
prevalence
refers
chart of enteric
typical
a
1884.
[October,
on
one
more
patient
than
who suffered from
one
occasion.
This
is in my experience the exception which proves I have seen small-pox attack a native the rule. case
twice within twelve months, still this does not lead me to doubt that, as a rules, it protects against a woman
FRACTURE OF PATELLA TREATED BY METALLIC SUTURES.
October, 1884.]
second attack. As to recurrence then, ague and remittent fever differ widely, and in this respect remittent fever rather resembles scarlatina, measles and
small-pox, &c. it scarcely admits of doubt that a remitdistinct from Enteric fever, and usually
However, fever, as
tent
of from five to fifteen
it is
not
frequently
Occasionally considerable
days' duration, exists, although
seen.
in
occur
cases
in
difficulty
which
giving
there may be
the fever
a
name, but
affirm that the study of disease only is full of difficulties, and that modified forms of
to say
this is
to
diseases
different
essentially
each other that
error
be expected. One may meet that he is
an
in
old friend
recognized
at
diagnosis
with
times
simulate
so
must now and
then
altered in appearance difficulty, if at all; and it so
may have happened to many men, to shake hands with a perfect stranger under the impression that they were
greeting an
So it is with disease.
old friend.
It is not with remittent
fever, however,
that this
particularly, but with ague. There are perhaps good grounds for believing that a specific malarial (as distinct from climatic) cause of the disease paper deals
exists.
Whatever this
bacillus, microbe,
or
cause
poison,
of disease be
it is
probably
remittent fever and not of ague. connected with climatic
is proposed in influences can the normal
a
or
subsequent
poison.
to
(See
of
Ague is so obviously influences, that it
paper to consider if these so to interfere with
be shewn at times
physiological our
cause
seasonal
functions of the
cause intermittent fever and
calling
called,?
the
body
its sequelre,
as
to
without
assistance the hypothetical malarial Indian Medical Gazette, August
also
ist, 1882.) Ainbala.
0
289
O'Connell,
m.d.,
Army Medical Department. Remittent fever
and
Ague together
under the title of
For this
fever.
they
are
are
With these
classed
usually
paroxysmal"
classification, however,
not appear to be sound.
that
"
malarial
or
the
do
reasons
exceptions, viz.% by side ;
found at times to exist side
that in both there is increase of temperature; that occasionally one disease is said to run or change into the other, and that both
are said to yield to there little reason to quinine, appears by consider that they own a common origin. If these exceptions are examined separately they will perhaps appear less convincing than they seem at first sight. As to the fact that they are at times found ist. side by side, it may be said that it is important but not conclusive. Formerly Typhus and Enteric were found side by side, and were from this and other
treatment
believed
to own
thought Many other
to be
reasons
fact
were
fever.
common
diseases exist side
this considered
not from
a
origin,
and in
different forms of the to
by side,
same
but
be different forms of
are
one
disease. In both diseases the temperature is raised.
2nd. This
can
scarcely
be considered
these two fevers in
one
class.
temperature charts of both be are seen
they
there is
an
to differ
a
reason for
That in
widely.
placing
Moreover, if typical placed side by side one
disease
intermission of temperature and in the remission appears to separate them most
other only a widely and distinctly. As regards remission of temperature, it is known, since the use of charts became
general,
disease
running
that there is an
daily remission is $rd. is
seen
into
a
scarcely
uncomplicated
any febrile
course in
which
a
not the rule.
It is said that to pass into a
quotidian,
tertian, and vice
remittent fever intermittent and then While not prepare
occasionally versa.
a
288
THE INDIAN MEDICAL GAZETTE.
this is
to say that
not so, I have never seen a
tempersupport this statement. Moreover, if such chart be produced, it is no more a proof that ague and remittent fever are different forms of
one
ed its maximum of
would
which
chart
ature
than
disease,
But if the three Presidencies be taken
Bengal
forms
of
one
in almost From my is
have
as
efficacious in remittent fever
is in ague. An attempt is often made to
it
as
enormous
the mala-
result must be the
some
diseases in The
one
extreme
they
whether
same
the
quantity first
insignificant. It may be seen of the reasons for uniting these two or
class
reasons
for
apparent than real. on them as distinct and
are more
looking
widely different diseases sideration.
that
are
Some of them
not
are
as
unworthy of confollows, viz., the
relative prevalence, the period of maximum prevalence, relative mortality, and liability to recurrence. i st.
Relative prevalence.?Ague is
a
very
common
disease, while remittent fever is comparatively rare. In the Report of the Sanitary Commissioner with the Government of India for 1882, it may be seen that amongst European troops there were 28,271 admissions for ague, and only 625 for remittent fever. This indicates that these diseases do not arise from
single poison 2nd.
or
Period
disease
of
a
cause.
maximum
quoted
prevalence.?Although
it is
seen
the very fact of
with whom
be
a
strong
reason
but that the of natives India, is especially amongst from the state of ill health produced by rebe
doubt, however,
no
state
of
that ague attain-
debility
least inter
in which the
disease will prove fatal, but that remittent fever kills of itself.
current
4th.
gives
Liability
recurrence.?This undoubtedly looking on ague and
to
the strongest evidence for
remittent fever
essentially different diseases.
as
One attack of ague predisposes and renders more liable to another. In fact recurrence is characteristic of the disease. one
attack
With remittent fever it is to
seems
confer
a
protective
the
system against a recurrence of Maclean, whose vast experience enables
with great in
unhealthy
that attacks
posed
to
liability
the
so :
not
power
on
disease.
him to
speak
" This says of remittent fever : countries is often the first form of fever
authority, new
comers, but
such
are
seldom
ex-
second attacks ; in other words, there is less to a recurrence of the disease than in the
intermittent form," Vol.
II.,
that
one
page
(Quain's Dictionary of Medicine, 1334). He does not, however, say
attack of remittent fever protects from
a
subsequent attack of ague. During eleven years' experience of Indian fevers I can
only
call to mind
remittent fever
statistics shew that both diseases often prevail at the For instance, same time, yet it is not invariably so. in the Report above
who
men
from ague amongst
attacks of ague. Perhaps it would be simpler kills by reducing its victims to an
peated
in the system, and therefore the
introduced be large then that
specific poisons
few medical
a
occur
to say that ague
fiftieth remittent fever, by supposing that they receive the poison in different quantities. But in putting forward this explanation it is apparently forgotten
multiply indefinitely
death
a
seen
can
mortality,
poison
that it is characteristic of
In
uncommon.
caused 32 deaths.
proving fatal would questioning the diagnosis.
There
undoubtedly
explain why
fever is not
the disease for
should produce in one man ague and in remittent another fever, or more correctly, why it should produce in forty-nine cases ague and in the
rial
never
European soldiers,
class.
one
but
mortality,?Ague seldom kills,
from remittent
much less prevalent, Perhaps, also, there are not
uniting ague Quinine is useful any fever, in other words, it is antipyretic. own experience I cannot say that quinine
and remittent fever in
while
the month in which both
as
although
cannot be considered a reason for
This
separately,
result,
same
Report above referred to ague is credited with a total of four deaths in India, while remittent fever,
useful in both diseases.
is found
Quinine
re-
the
disease.
4th.
the
Bombay give
Relative
3rd. death
Yet it is not suggested and sometimes tertian ague. that because enteric fever sometimes ends as a typical be
and
Madras give September fevers are most prevalent.
perature in the fourth week of uncomplicated enteric fever is often exactly similar to that of quotidian
must both
October, while
in
mittent fever reached its maximum in August. '1 his to European troops in the whole of India*
fever is proof that enteric fever and ague are different forms of the same disease. The course of tem-
intermittent fever, they
prevalence
refers
chart of enteric
typical
a
1884.
[October,
on
one
more
patient
than
who suffered from
one
occasion.
This
is in my experience the exception which proves I have seen small-pox attack a native the rule. case
twice within twelve months, still this does not lead me to doubt that, as a rules, it protects against a woman
FRACTURE OF PATELLA TREATED BY METALLIC SUTURES.
October, 1884.]
second attack. As to recurrence then, ague and remittent fever differ widely, and in this respect remittent fever rather resembles scarlatina, measles and
small-pox, &c. it scarcely admits of doubt that a remitdistinct from Enteric fever, and usually
However, fever, as
tent
of from five to fifteen
it is
not
frequently
Occasionally considerable
days' duration, exists, although
seen.
in
occur
cases
in
difficulty
which
giving
there may be
the fever
a
name, but
affirm that the study of disease only is full of difficulties, and that modified forms of
to say
this is
to
diseases
different
essentially
each other that
error
be expected. One may meet that he is
an
in
old friend
recognized
at
diagnosis
with
times
simulate
so
must now and
then
altered in appearance difficulty, if at all; and it so
may have happened to many men, to shake hands with a perfect stranger under the impression that they were
greeting an
So it is with disease.
old friend.
It is not with remittent
fever, however,
that this
particularly, but with ague. There are perhaps good grounds for believing that a specific malarial (as distinct from climatic) cause of the disease paper deals
exists.
Whatever this
bacillus, microbe,
or
cause
poison,
of disease be
it is
probably
remittent fever and not of ague. connected with climatic
is proposed in influences can the normal
a
or
subsequent
poison.
to
(See
of
Ague is so obviously influences, that it
paper to consider if these so to interfere with
be shewn at times
physiological our
cause
seasonal
functions of the
cause intermittent fever and
calling
called,?
the
body
its sequelre,
as
to
without
assistance the hypothetical malarial Indian Medical Gazette, August
also
ist, 1882.) Ainbala.
0
289
