Malaria, Influenza And Dengue | by Julius Mennaberg and O. Leichtenstern

Gives detailed explanation of mosquito borne diseases Malaria, Influenza And Dengue. Includes details of mosquito, symptoms and other information.

Title	Malaria, Influenza And Dengue
Author	Julius Mennaberg and O. Leichtenstern
Publisher	W.B. Saunders and Co.
Year	1905
Copyright	1905, W.B. Saunders and Co.
Amazon	Malaria, influenza and dengue

Preface: The excellence of the series of monographs issued under the editorship of Professor Nothnagel has been recognized by all who are sufficiently familiar with German to read these works, and the series h...

Alfred Stengel. Editor's Preface: My duties as editor of this volume have been in one respect slight, in another more arduous. For, on the one hand, I have thought it best to leave almost unchanged Prof. Mannaberg's very comprehensive...

Malarial Diseases. General Part. History: The existence of malaria in the ancient times is proved from the chronicles of contemporaneous writers. It appears, moreover, likely that the disease extends to the infancy of the human race, for it ...

Malarial Diseases. General Part. History. Continued: * Bellos (Athens) declares there is a complete identity between the fevers described by Hippocrates and those occurring too dday in Greece. ** The goddess of fever (Mefitis) had a temple on the Cap...

Geographic Distribution: Malaria is one of the most widely distributed infectious diseases; yet its distribution is by no means uniform, for it is most prevalent in the region of the equator and gradually diminishes toward th...

Geographic Distribution. Part 2: Prominent centers occur in the Malay archipelago, in the Nico bar Islands, Sumatra (especially Singkel), Java (Batavia), Borneo, Celebes, and Amboina (in the Molucca Islands), while the Philippines su...

Geographic Distribution. Part 3: In 1891 morbidity of ............30.6 per cent. 1892 ........... ............40.4 1893 ............34.7...

Etiology: Our knowledge of the etiology of malaria has been enriched to such an extent in the last ten years that we may consider the disease among those the etiology of which is best known. Among the etiol...

Etiology. Part 2: A further fact, showing the effect of heat, is that malarial epidemics occurring about disease foci are more severe in warm than in cool summers. Moreover, during especially hot summers malaria break...

Etiology. Part 3: The importance of swamps in the origin of malaria has been proved many times by the disappearance of the disease on draining them. Still there are numerous examples of swamps which, on account of ...

The Malarial Parasites.: The suspicion that malaria was caused by a living contagium has been entertained from the most ancient times and repeatedly expressed by even the oldest writers (Vitruvius, Varro, Columella). Lanc...

The Malarial Parasites.. Part 2: Methods Of Examination The examination of the natural (unstained) blood is of greatest importance to the clinician, though the making and examination of dry preparations are also very valuable, esp...

The Malarial Parasites.. Part 3: In the second case the preparations are placed on a half concentrated watery methylene blue solution* for half an hour, washed in water, dried with filter paper, and counterstained with a 2 per cent, ...

General And Special Morphology And Biology Of The Malarial Parasites: The malarial parasites are unicellular organisms whose cycle of development from beginning to end takes place within the reel blood corpuscles. They are, therefore, parasites (cytozoa) of the erythroc...

General And Special Morphology And Biology Of The Malarial Parasites. Part 2: The last stage in the development of the parasite is that of multiplication. This is ushered in, as a rule, by the pigment which was previously irregularly distributed, concentrating itself centrally ...

General And Special Morphology And Biology Of The Malarial Parasites. Part 3: Since 1893 my opinion has been that the flagella were organisms which act as intermediaries in the transition of the parasites to saprophytic conditions. I believed that the flagella represented the b...

General And Special Morphology And Biology Of The Malarial Parasites. Part 4: I proposed an explanation of the origin and significance of the crescent different from all others. I considered the crescents to be syzygies of the parasites of the second group. B}^ syzygies zoologi...

The Unity Or Multiplicity Of The Parasites, Species Of Parasites, And Types Of Fever: Soon after Laveran's discovery the question arose whether there was only one parasite for all cases or whether different species were to be differentiated? It seems to me that we may consider this ...

The Unity Or Multiplicity Of The Parasites. Continued: In reference to the geographic distribution, we observe that in the southern and tropical malarial regions the parasites of both the first and second group occur, though even here with a predominance ...

Position Of Malarial Parasites In Zoology: Nomenclature The classification of malarial parasites from a zoologic standpoint did not at first meet with decided success, inasmuch as they were placed by some observers in the class of the sporo...

Special Characteristics Of The Individual Species Of Parasites.: We divide the malarial parasites as follows: 1. Malarial parasites that sporulate but do not form syzygies (i. e., crescents): (a) Quartan parasites. (6) Tertian parasites. 2. Malarial parasi...

Special Characteristics Of The Individual Species Of Parasites. . Part 2: The segmentation of the parasites occurs immediately before and during the fever paroxysm. Ordinarily we see that the first sporulation forms about three hours before the outbreak of the chill, at whi...

Special Characteristics Of The Individual Species Of Parasites. . Part 3: Simultaneously changes are occurring in the infected red blood corpuscles. These lose in color, look pale in comparison with the non infected ones, and often increase in size. Description Of Plate ...

Special Characteristics Of The Individual Species Of Parasites. . Part 4: Blood examination: 1. Quite numerous large forms, taking up half of the hypertrophic and decolorized red blood corpuscles, and filling the normal ones entirely. 2. Several in the act of sporulation in...

Special Characteristics Of The Individual Species Of Parasites. . Part 5: Nor can I confirm another statement, made in the same paper, namely, that premature sporulation forms containing from five to ten spores are frequently seen in anticipating tertian. If we apply Gol...

Special Characteristics Of The Individual Species Of Parasites. . Part 6: Observing such a ring with an open Abbe and deflected light, we can see that it makes a deep sharp furrow in the surface of the blood corpuscle, which protrudes into the center like a finger in a ring...

Special Characteristics Of The Individual Species Of Parasites. . Part 7: After the course of two or three weeks paroxysms of fever may again occur, accompanied by the invasion of young ameboid organisms. The question at once proposes itself, What organism is to be consi...

Special Characteristics Of The Individual Species Of Parasites. . Part 8: 7 p.m.: Temperature, 39. Received 0.33 quinin. August 13, 5 a. m. : 0.33 quinin. 9 a. m.: Temperature, 37.6. Blood examination: 1. Numerous non pigmented organisms, endowed with ame...

Special Characteristics Of The Individual Species Of Parasites. . Part 9: Blood examination: Numerous endoglobular organisms at rest, about one quarter the size of the red blood corpuscle, containing more pigment. This pigment is sometimes scattered and in motion, again con...

Special Characteristics Of The Individual Species Of Parasites. . Part 10: Blood examination: 1. Very many crescents and spheres of the same order. 2. A few melaniferous leukocytes. October 8, 9 a. m.: Temperature, 38.2. Blood examination: The same as yesterday, only...

Diagnosis Of Malarial Parasites. Diagnostic Value Of Positive And Negative Findings: It may possibly appear superfluous, after our complete description of all the forms and phases of malarial parasites, to speak again of their diagnosis, yet our excuse lies in the fact that it is not ...

Diagnosis Of Malarial Parasites. Part 2: Groups of blood platelets are differentiated from sporulation forms by the fact that they show no pigment, while no sporulation form, with one single exception, occurs without pigment; and this except...

Diagnosis Of Malarial Parasites. Part 3: The two species of the first group may be differentiated by the activity of the ameboid movement, by the size and color of the infected blood corpuscles, and, in case sporulation forms are present, by...

Cultural Attempts: As numerous and different as the attempts to culture malarial parasites have been, all have resulted negatively. Moreover, not only the media used in bacteriology have been employed, but also other su...

Toxic Production Of The Human Parasite: That malarial parasites produce a poison was first suggested by Golgi, and since then has been assumed as probable by many investigators. So far, no one has in any way described or demonstrated this p...

Modes Of Infection: One of the most important questions that arose in connection with malaria was, In what manner does the human being become infected with malaria? On the correct solution of this problem depended the r...

Modes Of Infection. Part 2: If the malarial virus was suspended in the air, it would be impossible to understand why it would not be carried by the wind, so as to display its effect at a distance from its breeding place. Yet we ...

Modes Of Infection. Part 3: Laveran, like Lancisi, expresses the opinion that mosquitos may inoculate the malarial virus into man. The manner in which this is done he does not indicate. Bignami also believed that mosquitos inocu...

Incubation: The experience of many observers taught that malaria , unlike other infectious diseases, had no fixed period of incubation. In the very great majority of cases the incubation seems to be about six to ...

Table IV.-Duration Of The Incubation In Experimental Malaria: Quantity of the Blood Injected in Cubic Centimeters. 0.03* 0.20 0.50 0.75 1.0 1.5 2.0 3.0 ...

Transference Of Malaria In Utero: There are only a few cases which show with certainty that malaria may be transferred from an affected mother to the fetus, and it is an established fact that this transference is not only not constan...

Relations Of Malaria To Sex, Age, And Occupation: Both sexes are to the same degree susceptible, though men are attacked more frequently for the reason that they are exposed more frequently to the influences which produce the disease. Malaria spar...

Debilitating Circumstances Predisposing To Malarial Infection: As in other infections, so likewise in malaria , badly nourished, not properly sheltered, overworked individuals are more frequently attacked than those living under better conditions. An outbreak ...

Influence Of Race: All the races are susceptible to malaria , yet numerous writers (Lind, Boudin, William, and others) maintain that negroes enjoy a relative immunity. The English Niger Expedition (1841-1842) consist...

Acclimatization-Acquired Immunity: The majority of observers maintain that there is, especially among Europeans, no acclimatization-that is, no immunity to the fever after a long resort in fever regions. On the contrary, daily experien...

Malarial Epidemics: We occasionally see epidemics of malaria in regions where it otherwise does not exist, or exists only in a mild form. At such times the malaria cases around the endemic foci also increase in number a...

Malaria In Its Relation To The Mosquito. Historic: It will serve no useful purpose here to follow the acute controversies as to priority which have arisen, not only as to the discovery of the malarial parasite, but also within the last few years as to...

The Mosquito-Malarial Cycle: Before considering in detail the developmental cycle of malaria parasites in certain mosquitos it will be well to review briefly their zoologic position, for, in the first place, we shall see their r...

The Mosquito-Malarial Cycle. Part 2: 6. The spore, in its turn, undergoes subdivision, forming a number (eight) of spindle shaped bodies termed sporozo'ites; there is here again a residuum, in this case termed the sporal residuum, wh...

The Mosquito-Malarial Cycle. Part 3: In the case of the malaria parasites there are also two cycles, the asexual and the sexual, or, to give them their synonyms, that of auto infection, schizogony, monogony, or endogenous cycle, on the ...

Developmental Cycle In Mosquito: We may here first summarize briefly the characters of the gametes, though the subject is one which requires further elucidation, more especially as to the characters of the young forms. Malignant tert...

Development Of Simple Tertian Parasites: The vermicule, at first clubbed at one end, gradually elongates, and the nucleus becomes centrally placed, while the pigment is irregularly distributed. The forward movement is caused by a secretion o...

Mosquitos: The Culicidce or mosquitos or gnats belong to the nematocerous section of the suborder Orthorhapha of the order Diptera, or flies. Nearly allied families are the Simuliidae or sand flies, the Chiron o...

Life-History Of Culicidae: The Imago The perfect insect does not feed for some time (twenty four hours) after hatching. When first hatched, their wings are soft and they fly but feebly when disturbed. The hatching may be stu...

Life-History Of Culicidae. Part 2: Duration Of Egg Stage The time taken by the eggs to hatch is a variable one, dependent very largely upon the temperature and probably upon the genus and even species of mosquito. In Havana, Taylor ...

Life-History Of Culicidae. Part 3: Breeding Places Of Mosquitos There is no collection of water, however insignificant, which it is safe to disregard as a possible source of larvae. There are few places, however dry, where by carefu...

Life-History Of Culicidae. Part 4: The pupa of Tanypus also resembles that of the Culicidce. The respiratory trumpets are long and cylindric. The pupa, however, remains mainly below the surface, attached by its (armed) tail. Further, i...

Distribution Of Culicidae: The distribution of the Culicidce is practically world wide. From the tropics to the polar regions they are encountered, and in such desolate regions as the tundras of Siberia they occur in countles...

Anatomy Of The Mosquito: The true proboscis in the Anophelince is concealed by the maxillary palpi, which lie slightly dorsal to it. The maxillary palpi in the female consist of five segments. The first or basal segment is ex...

Anatomy Of The Mosquito. Part 2: He figures the maxillae as lying dorsal to the mandibles, and thicker and more triangular in cross section than the latter. The saws on the maxillae and mandibles have their points directed backward...

Anatomy Of The Mosquito. Part 3: The Pumping Organ After passing through the ganglionic ring formed by the supra esophageal and infra esophageal ganglia the pharynx widens into the large chamber, the pumping organ. In cross sectio...

Anatomy Of The Mosquito. Part 4: The midgut extends from the proventriculus to the point of entry of the Malphigian tubes. It consists of an anterior thoracic narrow portion and a larger abdominal posterior portion, the so called sto...

Anatomy Of The Mosquito. Part 5: The Granular Type The granular appearance in the stained cell is caused by an accumulation of secretion by which the nucleus is displaced to the periphery of the cell. This secretion in the fresh g...

Anatomy Of The Mosquito. Part 6: The Digestive Process The imbibed mass of blood is surrounded in the crop with a gelatinous secretion from the chitin layer, so that the digestion of the blood and the absorption of nutriment tak...

Anatomy Of The Mosquito. Part 7: (3) The labrum ends in the clypeus, but is continued upward as a chitinous rod to which is attached a fan shaped muscle taking its origin from the exoskeleton of the clypeus. (4) The hypopharynx, t...

Anatomy Of The Mosquito. Part 8: The Occurrence Of Flukes In The Anophelinae Martirano and Schoo and Ruge have noted the occurrence of flukes in the Anophelince. Thus Martirano found that in May, 1 to 20 per cent., but in June, 50...

Anatomy Of The Mosquito. Part 9: The legs are respectively prothoracic, mesothoracic, and meta thoracic in origin. They are six in number, and each consists of coxa, trochanter, femur, tibia, and a tarsus consisting of five segments;...

Anatomy Of The Mosquito. Part 10: B. Thoracic Scales These may be of several types, of which the following are most common: (1) Hair like curved scales; these are finer than narrow curved scales and may form a dense felt work over ...

Anatomy Of The Mosquito. Part 11: Genus 9: Gilesia: Resembles Culex and Stegomyia; distinguished by-(1) Scutellum has small flat scales, a few spindle scales; (2) head, broad flat spindle scales; (3) basal joint of antennae hairy and ...

Classification Of The Anophelinae: The old genus Anopheles has been divided by Theobald into 12 new genera. The basis of this classification is almost entirely dependent on scale structure. 1. Anopheles Thorax and abdomen have ha...

Classification Of The Anophelinae. Part 2: Yet another feature has been used by Donitz in differentiating species-viz., the shape of the eyes and the shape and width of the portion of the frons intervening between the eyes. The shape of the ey...

Classification Of The Anophelinae. Part 3: Group III: Dark mosquitos, with apex of palpi black. (17) M. turkhudi: Palpi apices black, the band not so broad as in M. his paniola; third vein mostly dark, but variable. Pale interruptions in basal...

Classification Of The Anophelinae. Part 4: Genus 8: Nyssorhynchus: (A) Legs unspeckled: (1) N. juliginosus (= A. leucopus Donitz): Costa four large and one or more small spots. Mid femora, pale spot near the apex. Hind tarsi three and one fift...

The Ova Of The Anophelinae: The eggs are generally laid upon a floating object, though also upon the surface of water or moist mud. They are laid in a piled up mass, even when deposited on the water, but these masses are quickly...

Larvae: Hatching Of Larvae A cap like piece of the thick end of the egg shell is split off. This cap is not defined on the egg, but the separated portions are of about the same size. The larva consists ...

Larvae. Part 2: Food Of Larvae This is mostly supposed to consist of unicellular organisms, fresh water algae, diatoms, but the larvae of Anophelince may also exhibit cannibalism. The exact nature of the food of l...

Larvae. Part 3: The Respiratory Stigmata On the eighth segment are situated the openings of the tracheal system. There is in the Anophelince no projecting tube, as in other Culicidce, but the openings are situated...

Larvae. Part 4: Habitat Of Larvae It is perhaps not too sweeping a statement to assert that mosquitos (Anophelince) will breed in any collection of water if they are unable to find their natural breeding places el...

Larvae. Part 5: Enemies Of Larvae Fish, as we have already pointed out, and as has been confirmed by many observers, devour larva? greedily, but, on the other hand, fish and larva? may occur together. The reason f...

The Pupa: Celli gives thirty days as the time that elapses between the egg stage and that of the perfect insect (Anophelince) at a temperature of 20 to 25 C. These, after another twenty days, lay eggs...

Distribution Of Anophelinae: It is possibly not justifiable to say that the distributions of malaria and of the Anophelince are identical, for there are many regions, or at least districts, of the earth where malaria is known to...

Distribution Of Anophelinae. Continued: Relation To Moisture Malaria has long been known as marsh fever, and its connection with low lying water is universally admitted; but malaria also exists in apparently arid dry places. Even in pre ...

Habits Of Anopheline: Influence Of Wind And Rain There can be little doubt that mosquitos, as other diptera, dislike wind, though we shall consider later exceptional instances where mosquitos are transported long ...

The Relation Of The Anophelin To Malarial Endemicity: We have already alluded to the fact that, in spite of ignorant assertions to the contrary, no place where malaria is endemic is known where Anophelince also do not occur. We have pointed out that the...

The Relation Of The Anophelin To Malarial Endemicity. Part 2: Here the endemic index was 12, remarkably low compared with 70 per cent, to 80 per cent., a common figure in West African children; and it was only on reaching the foot of the Himalayas that we found ...

The Relation Of The Anophelin To Malarial Endemicity. Part 3: These observations then showed us that an almost exact parallelism existed between the presence of Anophelinse and distance of breeding grounds, and the value of the endemic index, and we would mentio...

Technic: Capture Of Anophelinae This can be effected in two ways: (1) By capture of the winged insects; (2) by breeding out from larvae and nymphse. Nothing less than personal investigation will suffice to ...

Dissection Of Mosquitos: (A) Isolation of the Salivary Glands.- It is convenient to remove the legs and wings. The anopheline is then placed in a drop of salt solution,-0.5 per cent, suffices,-lying on its right side with the...

General Symptomatology. The Fever: The most constant and dominating symptom in the clinical picture of malaria is the fever. The great attention always bestowed on this symptom and the readiness by which it could be proved resulted in...

General Symptomatology. The Fever. Part 2: Some writers differentiate between subintrant (seu subingrediens) and subcontinued. In this case the name subintrant is applied to that continued or remittent fever which arises by prolongation and an...

General Symptomatology. The Fever. Part 3: The older writers mention a typus inversus by which they understood a reversal of these symptoms-that is, first, sweating; then fever; and finally the chill. I have never seen such an occurrence, and ...

Enlargement Of The Spleen: Enlargement of the spleen is the second most important clinical symptom of malarial infection. In regard to its frequency, writers are by no means unanimous. While some have scarcely ever missed it (f...

Chloranemia And Melanemia: The blood of the malaria patient always shows at some time„ the signs of an anemia or of a chloranemia-that is, of a chlorosis with an anemia. The discovery of the parasites demonstrated the reason f...

Chloranemia And Melanemia. Continued: The dark color of certain organs (as the liver, spleen, brain) was recognized by the older investigators-for instance, Lancisi, Folchi, Bailly, Annesley, and others. The discovery of the pigment, micr...

Skin: Changes are frequently found in the skin, yet since they are neither constant nor specific to this disease, they possess less of a diagnostic than of a general pathologic interest. We have already ...

Urine: The peculiarities presented by the urine differ somewhat from those which we are accustomed to find in other infectious diseases, yet they are not sufficiently definite to be considered characteristic...

Nervous System: The malarial virus possesses a particular affinity lor the nervous system, and to this is attributable many of the symptoms that characterize the clinical picture. It is well known that before the rec...

Gastro-Intestinal Tract, Respiratory Tract, Circulatory Apparatus: The gastro intestinal tract frequently participates in the malarial infection. Loss of appetite, eructation, a feeling of weight in the stomach, vomiting, cardialgia, are very common symptoms at the b...

Special Part. Classification Of Malarial Diseases: In the classification of malarial diseases our purpose is to separate the actual disease from its sequelae. Our considerations, therefore, will concern the fully developed infection. All who have a...

Fevers Caused By Golgi's Common Tertian And Quartan Parasites: Geneneral Characteristics The fevers in this group are characterized by definite peculiarities by which they may be classified under one clinical head. These fevers are relatively less frequent ...

Quartan Fever, That Is, Fever Caused By The Quartan Parasites: It is a general, well confirmed fact that quartan is the least frequent of all malarial fevers. There are malarial districts where it does not occur at all. The following figures will best illustrate ...

Tertian Fever-Fever Caused By The Common Tertian Parasites: This is the most frequent fever of the temperate zone. Among my 143 cases, 88 were tertian; among 71 observed by me in Vienna, 61 were tertian; among 72 in Dalmatia and Croatia, 27 were tertian. From ...

Fevers Caused By Crescent-Forming Parasites: General Characteristics The fevers belonging to this group are endemic in the severe malarial regions of the tropical and subtropical zone, and constitute there the predominant infection. Still the...

Type Of Fever: Corresponding to the parasites causing the fevers, the two types are quotidian and tertian; quartan does not occur.* * In regard to the relative frequency of the two types in different places, ther...

Malignant Tertian: The occurrence of a tertian type in severe fevers of a pernicious character was known even to Celsus. In Lib. iii, Cap. iii, of his works he writes: Tertianarum vero duo genera sunt. Alterum eodem mo...

The Ordinary Symptoms Of The Fevers Caused By The Crescent-Forming Parasites: As has been stated, these fevers present an extraordinary variety of symptoms, in that there is scarcely a system of organs which does not occasionally participate and in a conspicuous way. These symp...

Perniciousness: It was the custom of the old writers to differentiate among the malarial fevers pernicious forms. This custom has been continued, and though it no longer has the justification that it had, for instanc...

Perniciousness. Part 2: Borius found in Senegal that the majority of pernicious cases occurred in new arrivals and individuals who were in the tropics over thirty six months. He stated that, among 100 malaria cases, 4.1 per...

Perniciousness. Part 3: Yet it may be regarded as settled that, ceteris paribus, an infection with a large number of malignant parasites is more severe than one with a smaller number. There are apparent individual excepti...

Perniciousness. Part 4: The pernicious symptoms seldom occur at the beginning of the malaria -Laveran observed no such case among all his rich material; on the contrary, they usually appear only after the intermittent or con...

Typhoid Pernicious Malaria: (Syn., Perniciosa Typhosa ; Subcontinua Maligna; Subcontinua Typhosa? Acces Pernicieux avec etat Typhoide.) By typhoid pernicious we understand those cases of malarial infection the general appeara...

Typhoid Pernicious Malaria. Part 2: The fever curve of a subcontinued for one or two weeks will sometimes show the original type,-whether tertian or quotidian,- though in a majority of cases this is not decisive. In addition to the spon...

Typhoid Pernicious Malaria. Part 3: The exitus letalis is usually ushered in by coma of short duration, yet it may appear unexpectedly. During the course of the disease different culminating symptoms -coma, convulsions, hemoglobinuri...

Typhoid Pernicious Malaria. Part 4: August 12: Eruption of innumerable, almost confluent, sudamina; subsultus tendinum, irregular unequal pulse, secessus involuntarii. August 14: At the morning visit the patient appeared somewhat bet...

Cerebral And Spinal Pernicious Fevers: In addition to the fevers of typhoid character, there are others showing a participation of the brain. These constitute the majority of pernicious fevers in severe malarial regions. The symptoms wh...

Comatose Pernicious: This form is decidedly the most frequent of all cerebral pernicious fevers. Its characteristic stamp is the coma. Naturally, gradations occur, and in isolated cases the disturbances of the sensorium m...

Delirium: This is frequently encountered in mild form in fevers both of the first and second group. Yet it sometimes happens that the psychic disturbance is so marked as even to dominate the picture. The deliri...

Motor Irritative Symptoms (Convulsions): Irritative symptoms of slight intensity and well localized are not uncommon during the comatose attack. We mentioned before that trismus and deviation of the eyes were often observed. It happens quite...

Paralysis: Paralyses are much rarer than the motor irritative symptoms, yet a number have been observed, and they are consequently of pathologic diagnostic interest. These paralyses must, on clinical and etio...

Pernicious Algid: By this we understand a very malignant, frequently fatal expression of malaria , the chief symptom of which consists in an extraordinary cooling of the surface of the body during the hot stage. This i...

Gastro-Intestinal Pernicious: After the nervous system, the gastro intestinal tract is the most frequent seat of severe symptoms in pernicious malaria . We have already mentioned (p. 262), in describing the general symptoms of ...

Cardialgic Pernicious: This is characterized by intense epigastric pain (acerrimus mor sus oris ventriculi-Torti), which comes on during the paroxysm, usually during the hot stage, and ceases with its termination, though ...

Choleraic Pernicious: This is the most common form of pernicious malaria associated with gastro intestinal symptoms. In tropical as well as subtropical regions it is exceedingly frequent; in the malarial regions of the te...

Choleraic Pernicious. Continued: ' The two diseases, cholera and fever, supposing them to be distinct, certainly masked one another so effectually that diagnosis was extremely difficult at times. The people, by the end of October, ...

Bilious Pernicious: (Syn., Biliaris Remittens; Fievre Pernicieuse Bilieuse; Grande Endemique des Pays chauds; Remittent Fever; Bilious Inflammatory Remittent Fever? Tunele Fever, etc.) The most common summer and autum...

Bilious Pernicious. Part 2: The diagnosis presents many difficulties. It is exactly the sub continued bilious malarial fevers which often show, from a clinical point of view, no sharp separation from other similar diseases occur...

Bilious Pernicious. Part 3: The icterus has again increased. Temperature, morning, 39.6; evening, 38.6. Deep adynamia. Mucous membrane of the mouth and throat very dry. Total aphonia, bilious vomiting, involuntary feca...

Hehoglobinuric Bilious Fever: Our knowledge ol this form ot malarial lever is relatively recent, dating back only to the beginning of the fifties. Among Torti's otherwise complete descriptions there is no suggestion of blackwater ...

Hehoglobinuric Bilious Fever. Part 2: In addition to these the role of provocative agent has been often attributed to physical hardship and psychic emotion. Moreover, the disease has been observed to break out rather commonly after cha...

Hehoglobinuric Bilious Fever. Part 3: Grocco reports a case in which, while parasites were present in the blood, a dose of 0.40 gram quinin per os called forth a severe paroxysm of hemoglobinuria, with a temperature of 40, while afte...

Hehoglobinuric Bilious Fever. Part 4: Omitting complications, when first passed, the urine is always clear. After standing a few hours there falls to the bottom of the vessel a muddy sediment (cloudy in its upper layers) of red or grayish...

Hehoglobinuric Bilious Fever. Part 5: French writers mention the frequent occurrence of a colic resembling lead colic (colique seche ou colique nerveuse des pays chauds). The abdomen is contracted, and the patient complains of continuous ...

Hehoglobinuric Bilious Fever. Part 6: Doring reported the findings to be almost always positive at the beginning of the attack. The blood examinations show otherwise a striking and rapid decrease of erythrocytes, which is explained by ...

Hehoglobinuric Bilious Fever. Part 7: Without the last, a differential diagnosis between quinin poisoning and blackwater fever is often impossible. This is especially true when quinin was administered before the paroxysm and when the dise...

Hehoglobinuric Bilious Fever. Part 8: Remembering that only such persons are affected as have suffered repeatedly from malaria and have lived for some time in tropical malarial regions, we are forced to attribute the destruction of the r...

Hehoglobinuric Bilious Fever. Part 9: 7 a. m. : Temperature, 39.3; sweating. After a long search, one endoglobular parasite, about one fifth the size of a blood corpuscle, was found. 10 a. m.: The scanty urine appears like pure, v...

Pneumonic Subcontinued: It is rare to see, in the course of an acute malaria , symptoms on the part of the respiratory tract that would justify this name. Some observers of considerable experience deny their occurrence absol...

Latent Fevers: When the fever is absent or insignificant, we consider the malaria latent. The syndrome of such a case frequently rouses less a suspicion of malaria than of the disease imitated by the symptoms. W...

Latent Fevers. Continued: In regard to the diagnosis of malarial neuralgia, we must insist that neither the intermittence of the paroxysms nor the result of tinuos Hemicraniam molestam, sinistram capitis partem occupantem, ab ...

Acute Malaria In Children And Old People: Mention has been made in a previous section that children show a special susceptibility to malaria . They may be infected any time after birth; in fact, not a few cases have been recorded in which the...

Acute Malaria In Children And Old People. Continued: Icterus has been observed, especially in the tropics; likewise, hemorrhages into the skin in the form of petechiae, as well as hemorrhages from the mucous membranes, particularly the nose. Eclampti...

Relapses; Reinfections: Malaria is one of those infectious diseases in which a relapse may be considered an essential feature. In this respect it resembles most closely acute articular rheumatism. It is a daily observation t...

Relapses; Reinfections. Continued: There are frequent statements of malarial fever relapsing after years; yet so far as I have gone into the literature I have found no case in which this was determined with the necessary certainty. In ...

Chronic Malarial Infection: By chronic malarial infection we understand one continuing for months. This continuance does not depend on reinfection, but on an obstinate persistence of the virus. From one point of view malarial in...

Chronic Malarial Infection. Continued: Still we usually find an outspoken chloranemia-i. e., a diminution in the hemoglobin and in the number of erythrocytes, the decrease in the former being disproportionately great in comparison with the...

Malarial Cachexia: The term malarial cachexia is given different meanings by different writers. Some understand by it a condition of the organism, the principal characteristic of which consists in the impossibility of e...

Malarial Cachexia. Part 2: Acute cachexia occurs almost only in severe malarial regions, as Senegal, Guadeloupe, the west coast of Africa, Madagascar, India, and Tongking. A few cases have been observed in Holland'and in Italy....

Malarial Cachexia. Part 3: The hemorrhages naturally may have a local cause; the hematemesis, for instance, may be the result of thrombosis of the portal vein or of cirrhosis of the liver; hemorrhage from the left nasal cavity,...

Malarial Cachexia. Part 4: The general nutrition of the cachectic is bad, even though the bloated face, the edema of the legs over the emaciated muscles, conceals more or less the disappearance of the fat. Gaylor characteristic...

Malarial Cachexia. Part 5: In regard to the amyloid degeneration, this can be made a criterion for the classification of malaria , no more than of tuberculous cachexia, since it is rather to be looked on as a sequela. In spi...

Respiratory Tract: In the course of previous remarks we have repeatedly alluded to the frequent affections of the bronchi in malaria . Here we need recall only the common symptoms, dry cough, dyspnea, and sub crepitant ...

Respiratory Tract. Part 2: The symptoms of this double infection are naturally made up of the symptoms of the two components. There are added, therefore, to the symptoms of the malarial affection, pain in the side, tormenting c...

Respiratory Tract. Part 3: August 6: During the night, a profuse sweat. 3 a. m. : Violent headache, which disappeared toward morning. At present quite exhausted. Temperature, 36.4; pulse 86; respirations, 28. Still m...

Digestive Tract: The mucous membrane of the mouth, and especially of the gums, sometimes undergoes marked changes in chronic malaria . Loosening of the teeth, hemorrhage, and gangrene may occur. These complications ar...

Digestive Tract. Part 2: The first observations on malarial cirrhosis come from Haspel, yet these are limited to a simple description of the macroscopic appearance of the liver at autopsy, without a further study of the natur...

Digestive Tract. Part 3: From these researches it appears that malarial cirrhosis, at least from a clinical point of view, possesses no special characteristics, but, on the contrary, presents as many differences in the sympto...

Urogenital System: Nephritis Nephritis constitutes one of the rarer sequelae, though observations as to its frequency are considerably at variance. These differences are due, in the first place, apparently to ende...

Urogenital System. Continued: Martin states that he never saw thickening of the epididymis remain, though often hydrocele. The majority of other writers report a termination in atrophy of the testicle. Girert observed in Panama, a...

Heart And Blood-Vessels: The heart participates but little in the malaria process. Apart from light grades of hypertrophy and degeneration of the myocardium with dilatation encountered in cachectics, there is no lesion posit...

Acute Malaria Effects To The Nervous System: The nervous system constitutes one of the principal points of attack. The typical intermittent paroxysm itself may in great part be regarded as the reaction of the vasomotor centers to the infection. ...

Acute Malaria Effects To The Nervous System. Part 2: Tremor of the paralyzed extremities has probably been observed oftenest (Vespal). Choreic symptoms were observed by Maillot and Ouradou; tetany (?), by Wilckes. Boinet and Salebert describe an inte...

Acute Malaria Effects To The Nervous System. Part 3: Diffuse Affections Of The Central Nervous System Among these the chief place is occupied by a disease that imitates the complete syndrome of multiple sclerosis. On account of the rapidity with whic...

Functional Neuroses: Hysteria plays a certain role, inasmuch as when manifested during or after a paroxysm of intermittent fever, it may give rise to difficulties in diagnosis. Neurasthenic disturbances have been obser...

Organs Of Special Sense. Eyes: Swelling and redness of the conjunctivae and eyelids, associated with photophobia and hypersecretion of tears, are not rare in connection with latent supra orbital neuralgias. In addition, some wri...

Affections Of The Ears: These have been described by several writers among the complications of malaria . We have a record of such complications from Weber. Liel mentions an intermittent otitis as a form of malaria. It begin...

Diseases Of The Skin: The symptoms on the part of the skin that ordinarily accompany the paroxysms, like herpes and urticaria, have been previously described. We may mention, as a rarer occurrence, a rubeola like eruption,...

Muscles, Bones, Joints, And Lymph-Glands: Diseases of the muscles in the course of malaria appear to occur only exceptionally; at least, but little is said about them in the literature. Steudel mentions an infiltration of the muscles after b...

Blood: In malaria it is the red blood corpuscles that first suffer. There is, therefore, no malaria without a decrease in erythrocytes and in the amount of the hemoglobin. To what degree this anemia may adv...

Blood. Continued: In the typical cases of Tomaselli, Murri, Vincenzi, and others the idiosyncrasy against quinin was preserved for a very long time, even months and years, and could be demonstrated at any moment. Tomas...

Diabetes: Diabetes Mellitus We mentioned, on page 235, that sugar was found in the urine in rare cases of malaria , either during the paroxysm or shortly after it. This glycosuria is usually very transitory....

The Relation Of Malaria To Other Infectious Diseases: Malaria And Typhoid Boudin's notion that typhoid and malaria locally exclude each other is contradicted by the facts. Over the earth there are a large number of foci in which both diseases are end...

The Relation Of Malaria To Other Infectious Diseases. Continued: These two diseases influence each other only inasmuch as the symptoms of dysentery are usually more severe during the fever paroxysm. On this account the association of the dysentery may be overlooked...

Malaria From A Surgical Aspect: From our study so far it is evident that there are numerous occurrences in the course of malaria interesting to the surgeon. I might mention only the gangrene, the neuralgias, the ruptures of the spl...

Pathologic Anatomy. Acute Malaria: Pigment The anatomic characteristic of acute malaria is the melanemia. Macroscopically this is evident in the grayish brown to graphite color of certain organs, as the spleen, liver, brain, and...

Pathologic Anatomy. Acute Malaria. Part 2: Bone Marrow The large mononuclear marrow cells are especially pigmented; less so, the smaller ones. In addition the blood capillaries contain pigmented parasites. In other organs-for instance, t...

Pathologic Anatomy. Acute Malaria. Part 3: Kidneys The kidneys rarely show evident pigmentation macro scopically. Still, cases occur in which the cortical substance is dotted with gray points, and the vessels of the pyramids are indicated b...

Pathologic Anatomy. Acute Malaria. Part 4: Marchiafava and Celli observed in several cases the vessels of the brain filled with non pigmented parasites. This explains the occurrence of cerebral pernicious fevers without pigmentation of the bra...

Chronic Malaria And Cachexia: The pathologic findings in long continued cases of malaria are variable and numerous. It is necessary to differentiate between organic lesions the direct result of the infection, and ones due to c...

Chronic Malaria And Cachexia. Continued: According to their description, also, the enlargement cannot be identified with hypertrophic cirrhosis. Atrophy of the liver in cachectics is not infrequent. Frerichs affirms that it is not infrequ...

The Pathogenesis Of Malaria: Its Position In Pathology: From the standpoint of general pathology, malaria is an infectious disease of man caused by protozoa, which attack the blood, or, more accurately, the red blood corpuscles. If, on the basis of our pr...

The Pathogenesis Of Malaria: Its Position In Pathology. Part 2: If we analyze the most important symptoms with reference to their origin, our attention is attracted to the triad, melanemia, anemia, and fever. In regard to the melanemia, we have nothing to add t...

The Pathogenesis Of Malaria: Its Position In Pathology. Part 3: The occurrence of degeneration in the nervous centers and the kidney epithelium (Marchiafava and Bignami), independently of thrombosis of vessels, favors the view that a poison is present in the blood...

The Pathogenesis Of Malaria: Its Position In Pathology. Part 4: Infections caused by parasites of the second group very frequently show at the beginning a continued fever. Only after the course of several days, and then usually under the influence of quinin, does ...

The Pathogenesis Of Malaria: Its Position In Pathology. Part 5: The more rapid development may depend either on an increased virulence of the parasites or a lessened resisting power on the part of the individual. Postponement is almost always the result of a retar...

The Pathogenesis Of Malaria: Its Position In Pathology. Part 6: In case of cerebral disturbances without melanemia of the brain the existence of non pigmented parasites must not be forgotten. These have been repeatedly found in large numbers in the brain (Marchiaf...

Malaria Diagnosis: Malaria is diagnosed from the clinical symptoms, the action of quinin, and the blood examination. The clinical symptoms are often sufficient to determine positively the infection. This applies espe...

Malaria Diagnosis. Part 2: A man living in a fever region suffered for seven months from intermittent paroxysms. He complained of pain in the left thorax, and manifested objectively an area of dulness below and posteriorly, ove...

Malaria Diagnosis. Part 3: In my practice I have never been obliged to make a splenic puncture for the purpose of diagnosis. After repeated careful examinations I believe the exclusion of malaria is justifiable from negative f...

Prognosis: The prognosis of malaria is so different according to the kind of infection, the climatic conditions, and individual circumstances that little in general can be said about it. Certain rules valuable ...

Spontaneous Cure: It is an old, well known fact that malaria frequently recovers even when quinin is not employed-in other words, in response to expectant treatment. These spontaneous cures have been observed, especia...

Spontaneous Cure. Continued: Kelsch, who first called attention to the decrease in leukocytes (1: 2000 in comparison with the erythrocytes) during the acute infection, found that on strong faradization of the spleen the number of...

Treatment: Malaria is one of the few infectious diseases for Which we possess a positive specific. What an inestimable blessing quinin has been to humanity can be realized only by reading the writings of former...

Treatment. Part 2: The word Kina, in old Peruvian, signifies bark-Kina-Kina, good bark. Linne named the tree cinchona in honor of the Countess of Chinchon, who first brought the bark to Europe. The tree belon...

Treatment. Part 3: As is evident, these two species, closely related normally, show too a marked similarity in their behavior toward quinin. The small, crescent forming parasites can be studied better in stained than i...

Preparations Of Quinin. Methods Of Administration: The number of quinin salts manufactured and put on the market is very large. In the last edition of Ewald's Handbuch der Arznei verordnungslehre (thirteenth edition, 1898) I counted, apart from quin...

Time Of Administration And Amount To Be Administered: Different opinions were held by older writers as to the best time for administering quinin. In intermittent fever Torti gave the bark immediately before, Sydenham immediately after, the paroxysm; in o...

Special Treatment: Intermittent Fever To adults 0.3 to 0.5 quinin hydrochlorate or bihydrochlorate is administered three to five hours after the expected paroxysm. This is repeated four or five days, even when no fur...

Special Treatment. Continued: Statistics as to the results of different methods of treatment of malarial hemoglobinuria are of only relative value, since among the differently treated cases there would be a large percentage of ind...

Additional Effects Of Quinin: It is well known that quinin produces, in the majority of people, additional mild or severe effects. Many complain of a sensation of pressure in the stomach, which may even lead to vomiting. Still, th...

Substitutes For Quinin: In addition to the modern invaluable antipyretics, a large number of drugs of vegetable, animal, and mineral origin have been recommended, sometimes empirically, again on hypothetic grounds. But so fa...

Substitutes For Quinin. Continued: Ehrlich and Guttmann were induced to try this remedy on account of the election shown by the malarial parasites for it in the staining of preparations. On administration no evident staining of the par...

Symptomatic Treatment Of The Acute Infection: In addition to the specific treatment, which is indispensable, opportunities for symptomatic therapy frequently arise on account of tormenting or even threatening individual symptoms. It is not our in...

Treatment Of Chronic Malaria And Cachexia: In the treatment of chronic malaria and cachexia the principal role is played by residence in a healthy climate, good nourishment, quiet life, moderate exercise, and baths. The remedial treatment is s...

Prophylaxis: Setting aside the great advance that has accrued to our knowledge since the discovery of the connection between mosquitos and malaria , yet even prior to this there were few infectious diseases so tho...

Prophylaxis. Part 2: In swamps where drainage was impossible a regular level was aimed at, especially during the summer months, by the regulation of the incoming and outgoing water, and by the building of dams, since it w...

Prophylaxis. Part 3: 1. Excavations should be done piecewise, in order that too much earth may not be turned up at one time. 2. The laborers should come from the region in which the work is done. Only the robust and he...

Remedial Prophylaxis: For a long time the endeavor has been made to prevent malaria by the use of quinin, and numerous are the expressions of opinion in regard to the results. The majority contend that a systematic contin...

Influenza And Dengue Influenza. History, Epidemiology, And Etiology Of Influenza: The winter of 1889-90 is indelibly engraved on the history of great epidemics. An influenza epidemic greater than any before arose in the far East, spread like a hurricane through Europe, and thence o...

Nomenclature Of Influenza: Medical writers previous to the middle of the last century described influenza under the name of catarrhus epidemicus, febris or cephalcea catarrhalis epidemica, tussis epidemica, contagious catarrhal...

Antiquity Of Influenza: Very varying answers have been and probably will be given to the question how far back influenza can be traced by different medical historians. We cannot be surprised at this when we observe the indef...

Retrospection Of The Great Epidemics And Their Distribution: It is not the object of this work to present a detailed history of influenza. We refer the reader seeking for such information to the above mentioned historians. Only the most noteworthy outbreaks wil...

Relation Of Influenza Vera To The So-Called "Catarrhal Fever," Vulgo "La Grippe.": Although there can be no doubt of the relationship of the previously mentioned world pestilences to true influenza, as regards the other outbreaks, to which we have also alluded, the numerous so calle...

Epidemiology Of Pandemic Influenza: Numerous contradictions in the epidemiologic teachings regarding influenza would have been avoided if the writers had recognized that the pandemics which affect the whole world do not follow the same ...

Origin Of The Pandemic: Just like our latest pandemic, nmnerous earlier ones had their origin upon the Asiatic continent and often in the furthermost parts of Russia, spreading over Europe from east to west. This was the cas...

The Geographic Distribution Of The Disease In Regard To Territory And Time: Among all the infectious diseases arising epidemically there is none that can even approach influenza in regard to the extent of its geographic distribution over the earth. It is the world pestilence-...

The Geographic Distribution Of The Disease In Regard To Territory And Time. Continued: An exact report of the geographic distribution of the pandemic of 1889-90 over the earth will be given at the conclusion of this section. The great rapidity with which pandemic influenza becomes di...

Manner And Rapidity Of Spread Of The Pestilence Formerly And Now: Remarkably interesting results are revealed by comparing the course of the epidemic of the spring of 1833 through the Prussian garrisons with the corresponding behavior of the pandemic of 1889-90. In ...

Manner And Rapidity Of Spread Of The Pestilence Formerly And Now. Continued: In sparsely populated districts, in which the course of the disease could be more accurately observed, it could readily be seen that influenza spread gradually in all directions from the district whic...

Spread Of The Pandemic Of 1889 And 1890 Around The World: June, 1889. Turkestan. Beginning of October (1-10). Wjatka (Eastern Russia). Middle of October (11-20). Western Siberia (Tomsk, Perm). Southeastern Russia (Ufa, Astrakhan). End of October (21...

Beginning, Acme, And End Of The Epidemic: There is no infectious disease which, wherever it breaks out, in so short a time causes such universal infection as influenza. This epidemiologic peculiarity of the pestilence produces an enormous dis...

Epidemics Following The Pandemic: In the earlier influenza epidemics we know that, as a rule, after intervals of several months or longer, epidemic outbreaks of more or less extensive geographic distribution follow the first great pes...

Epidemics Following The Pandemic. Part 2: In England the spring epidemic of 1891 began in numerous rural districts. For nearly four months the disease raged in the north before it reached London, about the beginning of May (!). A similar cond...

Epidemics Following The Pandemic. Part 3: * See section on Mortality. 1889 up to this time-may be explained by a successive lessening of the susceptibility of the population, due to their immunization from the preceding attacks of the dise...

Epidemics Following The Pandemic. Part 4: Since R. Pfeiffer and Kruse have seen the influenza bacilli thrive for months in the sputum of tuberculous subjects who were affected by influenza, Baumler thinks it possible that patients afflicted w...

Influenza In Families, High Altitudes, And At Sea: The numerous instances recorded in literature regarding the direct transmission of influenza from person to person can be only partially substantiated. In many cases other explanations are possible. W...

Influenza In Families, High Altitudes, And At Sea. Part 2: Duflocque describes how, on December 6, 1889, a lady returned from Paris, which was infected, to a village still free from the disease. She was taken ill on December 8; her coachman became ill on Dece...

Influenza In Families, High Altitudes, And At Sea. Part 3: The troop ship Himalaya arrived on January 30 at the uninfected harbor of Colombo (Ceylon) with 19 cases of influenza on board (during the voyage 140 cases had occurred). On February 7 the epidemic ...

Influenza In Institutions (Prisons, Etc): These institutions furnish the best and most favorable field for studying the origin and the transmission of the disease from the first case. Official and private observers in all countries have caref...

Influenza In Institutions (Prisons, Etc). Continued: This was the case in the City Hospital at Cologne, which has 700 beds. Altogether there were 439 influenza patients; the maximum daily number in the hospital at the height of the epidemic was between ...

Morbidity And Mortality: Among all infectious diseases there is none which affects the entire population, irrespective of age and condition, in so short a time as pandemic influenza. An enormous morbidity with a relatively...

Morbidity And Mortality. Part 2: * See pages 210 and 237, loc. ext. ** Zeitschr. f. Schulgesundheitspflege, 1890, p. 505. *** Revue mens, des maladies de l'enf., 1890, p. 144; cf. Ripperger, loc. cit. p. 205 ff. A...

Morbidity And Mortality. Part 3: * Reuss, Annales d'hyg. pub., 1890, No. 2. ** Beginning of the influenza epidemic in Paris, November 17. *** See the statistics of P. Friedrich. Moreover, there exists also much statistical...

Influence Of Age, Sex, And Occupation: No age can be said to confer immunity against influenza. In spite of the contradictory statements regarding age incidence, it would appear, from the majority of opinions of physicians and from the sta...

Influence Of Age, Sex, And Occupation. Continued: Deep sea fishermen and keepers in lighthouses and on lightships frequently have no communication with land for a long time. The careful official investigations which were made in England have shown th...

The Influence Of Meteorologic And Telluric Conditions: In ancient times the thoughtful physicians who sought for the reasons and the nature of universal pestilences attributed to elementary powers, such as atmospheric and telluric conditions, an influence...

Transmission Of Disease Through Merchandise: There exist many stories and reports to prove the transmission of influenza through merchandise of all kinds, letters, linen, clothing, fur, and even through grain from Russia. They date almost exclus...

Immunity: One attack of influenza in the majority of cases confers protection from the disease for some time, but the degree of immunity does not approach that conferred by small pox, whooping cough, scarlet fe...

Bacteriology Of Influenza: The rapid distribution of the pandemic immediately led the bacteriologists of all countries to investigate and try to discover with the microscope the new germ, the specific cause of the disease. Ther...

Bacteriology Of Influenza. Part 2: Cultivation Of Influenza Bacilli The obtaining of a pure culture and the further cultivation of the influenza bacilli upon artificial culture media at first offered great difficulties. The ordinary...

Bacteriology Of Influenza. Part 3: In the bacteriologic diagnosis of influenza we must remember that, unfortunately, there exists also the pseudo influenza bacillus. In three cases of diphtheric bronchopneumonia Pfeiffer found in the s...

"Influenza" Of Domestic Animals: The statement that domestic animals, especially horses, are simultaneously affected with man at the time of large influenza epidemics, and are victims of this human disease, can be traced back for som...

Entrance And Exit Of The Influenza Organism: In the majority of cases, undoubtedly, the influenza germ enters and settles in the respiratory tract, generally in the upper, nasal, or nasopharyngeal portion, but occasionally also primarily in the ...

Pathology And Treatment Of Influenza. The General Features Of The Disease And Its Different Varieties: The clinical picture of influenza is so varying, so protean, as it is termed, that many authors have expressed the opinion that there is no typical form of influenza-Every case presents a different...

Onset And Duration Of Influenza. Convalescence. Relapses: The onset of influenza is almost always sudden, hence the early German name, Blitzkatarrh. The disease begins with a chill, frequently with a rigor; simultaneously with this the temperature rises. O...

Onset And Duration Of Influenza. Convalescence. Relapses. Continued: Relapses We pointed out, in the section on Immunity (see p. 577), the frequency of relapses in influenza. These relapses generally occur in the following way: One or more days after the fever has d...

Influenza Diagnosis: Wherever the specific bacilli are found, the diagnosis is certain. But even apart from this, the manifestations of influenza in the pronounced and typical varieties are so characteristic that the dise...

Differential Diagnosis: During an epidemic, or in its typical form, influenza presents no difficulty of diagnosis; at other times or in other forms a positive immediate diagnosis may be well nigh impossible. The chief diseas...

The Fever Of Influenza: Under fever symptoms we shall refer only to the variations of body temperature. With the initial chill the body temperature rapidly rises. Only in a few cases has the temperature been taken at the tim...

Symptoms Relating To The Respiratory Apparatus: Even although numerous influenza cases run their course without any symptoms referable to the respiratory apparatus, as, for instance, in the purely toxic forms (compare p. 591), nevertheless the rule...

Symptoms Relating To The Respiratory Apparatus. Part 2: Intense hyperemia and edema were the principal symptoms. No doubt these conditions occasionally developed secondarily to the terrible paroxysms of coughing. Acute inflammatory edema of the glottis, ne...

Symptoms Relating To The Respiratory Apparatus. Part 3: The sputum in influenza bronchitis varies. Characteristic influenza sputum is frequently mentioned. But there are various kinds. Especially characteristic is the copious sputum which is often expect...

Influenza Pneumonias. Anatomic And Bacteriologic Varieties: Pneumonia is the most frequent and most important complication of influenza. It is the decisive factor in influencing the mortality of the disease. The question regarding the relation of influenza ...

Influenza Pneumonias. Anatomic And Bacteriologic Varieties. Part 2: Wassermann obtained similar results: The opinion that influenza pneumonia is caused only by a mixed infection with pneu mococci and streptococci would be tenable only if we were always to find pneumo...

Influenza Pneumonias. Anatomic And Bacteriologic Varieties. Part 3: Kundrat, speaking of the bronchopneumonia areas in influenza, says that they are characterized by the fact that in the majority of cases the exudate is comparatively rich in fibrin, as shown to the na...

Influenza Pneumonias. Anatomic And Bacteriologic Varieties. Part 4: A definite diagnosis regarding the variety of the pneumonia arising in the course of influenza can, as has been previously mentioned, only occasionally be made at the bedside. There is, strictly speak...

Influenza Pneumonias. Anatomic And Bacteriologic Varieties. Part 5: * Week of the influenza epidemic. ** Regarding the details, compare with our influenza lectures (pp. 5 and 36-42), together with the corresponding instructive curves. We will now briefly conside...

Influenza Pneumonias. Anatomic And Bacteriologic Varieties. Part 6: * Deutsch. med. Woehenschr., 1882, p. 268. We must also shortly describe another form, which was designated, both bacteriologically and pathologically, by Winkler as the most important and most f...

Influenza Pneumonias. Anatomic And Bacteriologic Varieties. Part 7: We believe that we have, in the foregoing, conclusively shown that besides the true catarrhal influenza pneumonia, due to the bacillus of Pfeiffer and to the catarrhal streptococcic pneumonia, the fib...

Influenza Pneumonias. Anatomic And Bacteriologic Varieties. Part 8: But from this lobular development of the infiltration we cannot at the bedside conclude that any pneumonia is of the catarrhal variety or a bronchopneumonia. Similar characteristics are not rarely pre...

Influenza Pneumonias. Anatomic And Bacteriologic Varieties. Part 9: The influenza double pneumonia occasionally was characterized by a remarkably rapid course and a rapid dissemination over several lobes. While such cases occur in ordinary times, they were particularl...

Influenza Pneumonias. Anatomic And Bacteriologic Varieties. Part 10: Together with the hyperemia just described, an edema of the lungs, like the ordinary passive edema, which we often see in croupous pneumonia in the uninfiltrated lung (foaming edema, fluid contain ing...

Termination Of The Influenza Pneumonia: The termination of influenza pneumonia by a true crisis is unusual; resolution is often delayed for some time. Pseudocrises, viz., a fall of temperature lasting one or even several days, with subseque...

Frequency Of Pneumonia In Influenza: The extraordinarily large amount of statistical material which exists (P. Friedrich, F. Schmid, German collective investigations) is only of partial value. The usual percentage calculations are unreli...

Affections Of The Pleura: The pleura in the course of influenza is affected as a result of influenza pneumonia, which may be followed by a fibrinous, serous, or purulent pleurisy. Hemorrhagic exudates are exceedingly rare. But...

Tuberculosis Of The Lungs And Influenza: The mortality tables of all countries agree in showing considerable rise in the mortality from pulmonary tuberculosis in influenza periods. With this fact the observation of every clinician agrees,* t...

Nervous Symptoms: After the respiratory system, the nervous system is most frequently affected in influenza. We have to deal only in part with gross anatomic inflammatory processes; more often with so called functio...

Affections Of The Sensory Nerves: Among the neuralgias, headache is the most frequent attendant of influenza. It has its seat especially in the frontal and supra orbital regions, at the back of the orbit; frequently also it affects th...

Paralyses Due To Neuritis: A glance at the great number of motor paralyses following influenza teaches us that they are due partly to neuritis, partly to cerebral or spinal implication. In the group of paralyses due to neuri...

The Influenza Encephalitis: A second important group of paralyses in influenza is of cerebral origin. These paralyses, hemiplegias and monoplegias, are clinically differentiated from the above mentioned neuritic and nuclear vari...

The Influenza Encephalitis. Continued: * Compare the section on Bacteriology of Influenza, p. 585. ** Deutsch. med. Wochenschr., 1892, No. 2. *** Arch. f. Psyehiatrie unci Nervenkrankh., 1892, Bd. xxiv. The veins in the areas ...

Influenza Meningitis: We will pass over the cases in which an influenzal otitis or an empyema of the accessory cavities of the nose gives rise to a secondary purulent meningitis (Ewald, Baumler). Of much more importance is...

Influenza Meningitis. Continued: Kuskow described, under the title of hemorrhagic influenza, cases of simple hemorrhage into the meninges, especially infiltration of blood into the pia, without a trace of an inflammatory infiltrat...

The Comatose Variety Of Influenza: We have previously stated that influenza occasionally commences with peculiar cerebral manifestations: with a sudden attack of giddiness and obfuscation of the senses, or with an apoplectic* or epil...

Influenza Epilepsy And Other Manifestations Of Motor Irritation: We have remarked above that influenza frequently begins in children with an eclamptic seizure, and very rarely in adults with typical epileptiform attacks combined with total unconsciousness and succe...

Influenza Epilepsy And Other Manifestations Of Motor Irritation. Continued: Hysteria and neurasthenia not infrequently arise from influenza or are enormously exaggerated by it. All forms of hysteria have been observed after influenza, particularly hysterical convulsions an...

Affections Of The Spinal Cord Resulting From Influenza: Regarding these affections we possess numerous clinical, but only very few anatomic, reports; and there are practically no thorough and extensive microscopic observations. Below we shall give a short ...

The Influenza Psychoses: In the epidemics of past centuries the occurrence of mental disturbance as a result of influenza is recorded by various writers. But it is the last pandemic which has especially directed attention to ...

The Influenza Psychoses. Continued: A number of these post influenzal psychoses we kept in hospitals until convalescent, usually after one or more weeks. Of others whom we handed over to the lunatic asylums on account of suicidal tenden...

Symptoms Referable To The Digestive Apparatus (Including Peritoneum, Spleen, And Parotid Gland): In most cases of influenza the symptoms arising in the digestive apparatus are but slight and limited to transitory anorexia during the febrile stage. But gastro intestinal forms occasionally occur, a...

Symptoms Referable To The Digestive Apparatus. Part 2: Klebs and Lubarsch found ulcerations of Peyer's patches which, for a moment, gave rise to a suspicion of typhoid. Flesch found ulceration of the jejunum and swelling of the mesenteric glands. Kuskow h...

Symptoms Referable To The Digestive Apparatus. Part 3: Holz saw two children who, on the second day of influenza, were attacked by a cholera like enteritis with convulsions and unconsciousness. After a coma of twenty four hours they awoke and recovered ...

Symptoms Referable To The Digestive Apparatus. Part 4: But the statements regarding the condition of the spleen in influenza are remarkably contradictory. While the pathologists, Birch-Hirschfeld generally found no changes in the spleen, and Jiirgens...

Symptoms Referable To The Circulatory Apparatus, Including Blood, Thyroid, And Lymph-Glands: Influenza affects the heart in various ways. The influenza toxins may harm the heart muscle directly; generally, however, the toxic influence is limited to the cardiac nervous apparatus. Indirect ...

Symptoms Referable To The Circulatory Apparatus. Part 2: The clanger to the heart is all the greater if previous pathologic changes of this organ exist, such as weak heart, fatty heart, valvular defects, or arteriosclerosis. We repeatedly saw, as also did D...

Symptoms Referable To The Circulatory Apparatus. Part 3: In accordance with what has just been said above, is an observation by Johannsen (St. Petersburg). He describes a case of venous thrombosis of the right arm and leg. The latter became gangrenous. At t...

Symptoms Referable To The Circulatory Apparatus. Part 4: Von Jaksch could find no changes in the blood; Klebs only a slight decrease in the red cells; Pribram only a decrease in hemoglobin during the period of convalescence. On the other hand, Schermer, in ...

Symptoms Referable To The Genito-Urinary Apparatus: As far as the frequency of renal disease is concerned, influenza does not occupy any particularly prominent position in comparison to other acute infectious diseases. The influenza bacteria and toxins...

Symptoms Referable To The Genito-Urinary Apparatus. Continued: Albumosuria and peptonuria were frequently observed (Dochmann, Hofmeister, Meixner, Alison), which is not surprising considering the frequency of purulent inflammations in the lung, bronchi, and pleur...

Affections Of The Skin And Locomotor Apparatus: The redness of the skm, mostly combined with hyperidrosis, is generally considered an important symptom of influenza, and is interpreted as an angioneurosis (vasomotor paralysis) due to influenza toxi...

Affections Of The Skin And Locomotor Apparatus. Continued: The study of the history of influenza teaches us that, like most of the symptoms, the various skin eruptions were known to the older influenza writers. Herpes is mentioned in one place by Wittich (...

Diseases Of The Ear And Eye Following Influenza: It is not our intention to enter into a detailed consideration of the special literature on diseases of the ear and eye following influenza. As far as diseases of the eye are concerned, important and ...

Diseases Of The Ear And Eye Following Influenza. Continued: The last named affection of the cornea, of which but a few cases had until then been- observed, was seen and described during the influenza period remarkably often by many. It appears from the third t...

Therapy Of Influenza: In a disease like influenza, so intimately connected with human intercourse and commerce, whose germs are carried with the utmost rapidity to all quarters of the compass by innumerable persons, provis...

Therapy Of Influenza. Part 2: The members of one troop of the Bonn hussars regiment had daily doses of 0.5 gm. of sulphate of quinin in whisky for three weeks. This troop, in comparison with others, had a very small number of infl...

Therapy Of Influenza. Part 3: In Madeira during November, 1889, there was a severe epidemic of small pox, for which numerous revaccinations were performed. At the beginning of 1890 influenza was brought into the country and quickl...

Therapy Of Influenza. Part 4: Salipyrin was immediately followed by migrainin, salophen, and other compositions with similar recommendations as specifics. [Many eminent physicians obtained excellent results by the administration o...

Dengue: Dengue fever ** has several epidemiologic and numerous semiotic characteristics in common with influenza, so that in former times the question was raised whether both diseases were not varieties of th...

Nomenclature: Opinions regarding the etymologic origin of the word dengue diverge considerably. According to some learned investigations, the word is of old Arabic origin, and signifies asthenia (Vambery), whil...

Geographic Distribution Of Dengue And The Most Important Epidemics: 1779-1800: The first reports concerning dengue originate from the year 1779, during which it was observed at Java (Batavia), and about the same time at Cairo and Alexandria. During the years ...

Epidemiology And Etiology: The just described, precisely considered and for the first time concisely arranged tabulation of the greater known epidemics teaches us important epidemiologic features of dengue. In order to complete...

Epidemiology And Etiology. Part 2: The exclusive limitation in itself of dengue to the tropical regions and their vicinity and the restriction of epidemics to the hot season show that in the occurrence of an epidemic external exogenous...

Epidemiology And Etiology. Part 3: * Loc. cit., p. 48, 55. I am convinced that the reverse is the case. The highly contagious influenza extends with great rapidity wherever an infected individual is found; the far less contagious, b...

Epidemiology And Etiology. Part 4: 4. There is a general consensus that one attack of dengue does not protect against a second attack. De Brim in Smyrna states that there is no acquired immunity and that frequently the same individual...

First Stage (Stadium Febrile): The disease begins quite suddenly (prodromal symptoms are very rare) with a chill, which frequently develops into a rigor. Coincidentally with this chill the temperature rises abruptly (more rarely...

Second Stage (Stadium Exanthematis): Generally on the third or lourth day ot the disease the temperature falls to normal and there appears a variable rash. With this begins the second stage of the disease. The rash appears principally on...

Third Stage (Convalescence): Alter the disease has run its course, which m typical cases is in six to seven days, the stage of convalescence is reached. This is, even after a mild attack, just as in influenza, frequently prolonge...

Diagnosis, Prognosis, And Therapy: The diagnosis of dengue at the time of an epidemic is very easy. Mild cases, and especially undeveloped cases, can be differentiated from influenza, especially when the latter is complicated by an eru...

Epidemiologic And Clinical Differences Between Influenza And Dengue: Influenza. Dengue. Pandemic influenza is distributed equally in all climates, seasons, continents, and seas. Endemic epidemics are more common in the colder ...