glands an arrangement to prevent too great accumulation of the water in the blood. And the urgent nature of the sensation (thirst), which in health prevents the quantity of water being reduced too much, has been felt by all. In maintaining the temperature of the body at

rous

its normal standard two functions are active, viz.?1st, tissue metamorphosis ; 2nd, cooling function of the skin. While there may perhaps be many causes of fever, it is suggested that excess of water in the blood is one cause, particularly in malarial fever. The following then are the seven heads :? I. The meteorological conditions (heat and

moisture)

included in the term malarial climate are such aa will, by preventing its excretion, inevitably lead to increase in quantity of the water of the blood. II. That as a matter of fact the water of the blood is known to be increased in fever. III. That increased amount of water in the blood will (a) increase tissue metamorphosis (temperature), and (6) arrest the natural cooling function of the skin thus

causing fever. IV. That the decline or arrest of a paroxysm of malarial fever invariably coincides with a copious excretion of water from the blood by the skin, kidneys or intestine. V. That medicines which arrest or cut short paroxysms of malarial fever all cause copious excretion of water by the skin, kidneys or intestine. VI. That change of climate will cure the disease. VII. That the medicines which are most efficaciousin curing the disease are all sparingly soluble in water. Each of these propositions will now be examined

NOTE ON MALARIAL FEVER. By Surgeon M. D.

O'Connell, M. D.,

A. M. D.

The following remarks refer chiefly to intermittent or ague, and may be conveniently stated under

fever

seven

heads.

weight of evidence forward to prove that these fevers are due to the presence of microscopic bodies in the blood, it is not impossible that the result will be to show that under what is now called malarial fever, are included several distinct diseases. From time immemorial this fever has been attributed But the quality to the use of impure drinking water. While quite recognizing the

brought

rather than the quantity of water appears to have been insisted on. That the quantity may also be a factor in the causation of ague will appear from the following remarks, an increase of the water in the blood may It is however known that an appear of no importance. alteration in the quantity of the other constituents of the blood will give rise to symptoms of disease, as for instance in the

the the

quantity of the red or white corpuscles, fats, &c. &c. The importance of water in economy is apparent when it is remembered that

salts,

or

four-fifths of the blood and three-fifths of the whole body The necessity of maintaining the quantity are water. of water in the blood at a nearly constant standard is

apparent when the examined.

means

There is

seen

appointed for this purpose are in the kidneys and sudoripa-

separately.

L The meteorological conditions (heat and moisture) included under the term malarial climate are such as will, by preventing its excretion, inevitably lead to increase m the quantity of water in the blood. In any text book of Physiology it will be seen that the quantity of water in the blood depends on?1st, the amount ; 2nd, the quantity of urine and perspiraThe two latter are generally found to be in inverse proportion to each other, and depend chiefly on the temperature and hygrometric state of the atmosphere. During low temperature the blood is driven from the surface of the body, and there is increased activity of renal function. This prevents -excess of water in the blood. If the temperature is high there isdetermination of blood to the skin and

consumed tion.

comparative

anajmia of the kidneys. Then the activity of the cutaneous function prevents accumulation of water in the blood. But if in addition to a high temperature there saturated state of the atmosphere which water from the skin, then it is evident that it must accumulate in the blood. Experience teaches that the cold season when kidneys are acting freely is not the fever season. It also teaches that the hot dry season when the cutaneous ex-

is

a

highly

prevents the exhalation of

halation is abundant, is not the fever season. It also teaches that the wet season when there is a comparatively cool atmosphere, is not the fever It is during the drying up of the rains when season.

August

1, 1882.]

SURGEON M. D. O'CONNELL ON MALARIAL FEVER.

there is high temperature with a saturated atmosphere that fever is most prevalent. Heat by causing determination of blood to the skin diminishes the flow of urine, while the saturated state of the atmosphere prevents the free perspiration that would naturally ensue. It will be seen that a marked change must be produced in the

two conditions most

micro-organisms

are

203

favourable

decomposing

to the

production of organic matter and

water. Both these are present in excess in the blood of fever. It is probable then that excess of water will increase tissue metamorphosis, and consequently body temperature, Some simple experiments recently made by the writer would seem to confirm this view. After some hours' abstinence from fluid of any sort temperature was accurately taken. Then the thermometer was

body when it is remembered that about 120 oz. of excreted daily from the kidneys and the water are cutaneous systems. It is evident then and pulmonary that the two conditions, heat and moisture, which are included under the term malarial climate, will produce

replaced

in axilla and a draught of water (about 6 oz.) taken. After about, ten minutes the temperature was again noted, and it was frequently found to have increased,sometimes as much as T?n of a degree F. Sometimes the

a marked increase of water in the blood. Formerly decomposing organic matter was considered essential for the production of the so-called malarial poison.

temperature

"When it is found it is rather an indication that the two essentials, heat and moisture, are present as it is known that these two conditions are most favourable

did not increase, and then it was noticed that copious perspiration followed the draught of water. Now if an increase of such a small quantity of water to the

decomposition of organic matter. That as a matter of fact the water of the llood is blown to be increased in fever. This has long been

blood will increase temperature of a degree when cooling function of the skin is active, it may be assumed that the increase will be greater if the quantity of water be greater and the activity of the cutaneous

to the

the

II.

" Next to the occurrence of preknown. Aitken writes : ternatural heat in fever the excessive retention of water in the febrile system is perhaps the most remarkable and constant phenomenon ?" And again, " This retention of water in the system cannot be explained, but Dr. Parkes has suggested that it may possibly be due to the

presence in the blood (or tissues generally) of some intermediate waste product of the febrile body, of some substance which (like gelatine) has a powerful attraction for water." It is possible however that this retention of water in the system is (at all events in the case of malarial fevers) to be explained by the influence of the malarial climate, viz. high temperature and a nearly saturated And in connection with this state of the atmosphere. retention of water in the blood in fever may be also

noted the retention of Chloride of sodium which is known to have such a powerful attraction for water. III. That excess of water in the blood will cause (a) increased tissue metamorphosis and consequently increased heat production, (b) arrest of heat loss or the natural cooling

?perspiration. With regard to (a), it is body temperature depends on tissue metamorphosis including chemical changes in the blood.

function of the skin, known that

Kirkes says that the presence of water form3 the most favourable condition for the decomposition of nitrogenous compounds." And again, that " its abundance favours chemical action, for generally and within the limits of health the amount of action in the several parts of the body is in direct proportion to the quantity of water they contain." Aitken says, "Under its (water) influence as a fluid of daily consumption considerable chemical " To accelerate changes are promoted in the body.''''

Again,

the defective textural metamorphosis or waste is very often the practical result to be aimed at, and such means exist in the simplest and most manageable form in many of the appliances of the so-called water cure" Out of the

body

the

most

rapidly

of organic matter proceeds influence of heat, (moderate)

decomposition under the

moisture and free access of oxygen. With regard to the bacillus theory of malarial fevers, it is known that the

function less.

In

health,

climate, the quantity of

and

presumably in a cool daily by skin and

water excreted

is about 120 oz. that the retention of even half this will cause considerable increase of water of quantity | heat production as well as diminution of heat loss. Now with regard to (6) that increase of water in the blood

kidneys It ia

probable

will arrest the natural cooling function of the skin. This natural cooling function of the skin is the passage of water from the capillaries to the sudoriparous glands, and thence in the form of sensible or insensible perspiration Now while a certain degree of fulness of the capillaries is known to favour osmosis, over-distension of these vessels is known to arrest osmotic currents. This then is perhaps the critical point in production of a paroxysm of malarial fever. The meteorological conditions, lessening excretion of water, increase

gradually

the fulness of the vessels until the point is reached at which the osmotic currents are arrested, perspiration is checked, and the patient has fever. That the increase of water is very gradual in the first instance is probable, and during the increase there would also be a rise of temperature, kept within bounds however until the point is reached at which perspiration is arrested. IV. That the decline or arrest of a paroxysm of malarial fevers invariably coincides with a copious excre-

of water from the blood by the skin, kidneys, intestine lungs. This is so well known as regards the first three excretory surfaces, that it need only be mentioned Here the periodicity of malarial fevers may be referred to and this water theory applied to its explanation. tion

or

When fever

occurs

evacuation, if

and the paroxysm ends in

a

critical

the same

meteorological conditions persist, to the same result, and hence perhaps

they will lead a?ain the periodicity of the disease. Moreover it is conceivable that frequent recurrence of paroxysms would lead to a habit (so to speak) of periodical increase of water in the blood, persisting even for some time after removal from the influences which gave rise to it, or after these influences had ceased to be present. In

THE INDIAN MEDICAL GAZETTE.

204,

many parts of this country the natives insist on the eviNeffect of drinking too much water or liquid of any sort during the drying ui> of the rains, laying far more stress the quantity than on the quality of the water. V. That medicines which arrest or cut short paroxysms of malarial fever all cause copious excretion of water by the on

intestine. This also is well known. and purgatives are often known to cut short paroxysms of malarial fevers apparently by the copious excretion of water which they are known to

shin,

kidneys

or

Diaphoretics, diuretics,

produce.

VI. That change of climate will cure the disease. If the disease be caused by certain meteorological conditions, it is conceivable how a change of climate would cure the disease. But if a specific poison or a bacillus is the cause of the disease, it is difficult to understand how it can be cured by change of climate ; change of climate is not known to cure any other disease said to be due to a poison or a micro-organism in the blood, VII. That the medicines which are most efficacious in the treatment of the disease are all sparingly soluble in Here it is only necessary to mention quinine, water. arsenic, iodine, carbolic acid, beberia, salicin. In conclusion then the points may be again repeated. The meteorological conditions (heat and moisture) included under the term malarial climate will increase the quantity of water in the blood, that is unless the amount consumed t>e largely reduced. The water of the blood is known to be increased in fever. Excess of water in the blood will cause fever by (a) directly increasing tissue metamorphosis, and (&) checking, when it reaches a certain point, the natural cooling function of the skin. Copious excretion of water however

produced reduces the temperature Amballa, 9th June 1882.

to the normal

standard.

[Augsut 1,

1882,