Some remarks on the position of certain remittent fevers hitherto frequently classed as malarial, with illustrative cases and temperature charts / by J.H. Tull-Walsh.

  • Tull-Walsh, J. H.
Date:
1897
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Licence: Public Domain Mark

Credit: Some remarks on the position of certain remittent fevers hitherto frequently classed as malarial, with illustrative cases and temperature charts / by J.H. Tull-Walsh. Source: Wellcome Collection.

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    inhabitants of affected villages, when they make the change, must take their sick along with them. Though the mortality from kald-azdr is at a minimum during the cold-weather months, the death-rate even then is very little below the average of the year. In 1896, 23 21 per cent, of the kah't-azcir deaths occurred during the months of December, January and Februarv. (b) He recommends that means should be taken to prevent the entry into tracts, not affected with the disease, of persons suffering from the kala-dzar, and with a view to giving I effect to this proposal, he suggests that the provision of the lately-passed Epidemic Dis¬ eases Act, which renders this action possible, j should be put in force. It is certainly the case ! that kald-azdr has usually been checked when it reaches a broad belt of uninhabited country, i and there have been many examples of outbreaks j of the disease in villages soon after the arrival in them of persons suffering from kala-dzar, but as, in order to be effectual, the provision would have to be in force for a considerable time, and j as even medical men can with difficulty recog- j nise single cases of the disease, I am very doubt¬ ful whether the provision of the Epidemic Diseases Act referred to should be put in force for this purpose. The inhabitants of non-affect- ed villages might, however, be encouraged to prevent people, believed to be suffering from the disease, visiting their villages. (c) Appendix II attached to this report is a note on the spread of kala-dzar and how it may be checked. Dr. Rogers recommends that tins note should be translated into the languages of the inhabitants of the Upper Assam Valley, and distributed gratis to the heads of villages in both the affected and threatened tracts of country. I strongly recommend that this sug¬ gestion be given effect to. Dr. Stephen then expresses his concurrence with the prophylactic measures suggested by Dr. Rogers t-o prevent outbreaks among coolies working on tea plantations, and concludes by alluding to the ‘energy and zeal which Dr. Rogers had evidenced in the course of his obser¬ vations. He adds that he considers Dr. Rogers has proved that: (1) the disease is distinct from anchylostomiasis, thus confirming the long-held and almost universal opinion of other medical officers in Assam ; and that he has (2) shown the close alliance between malarial fevers and kald-azdr; but that he has failed to prove its identity with malarial fever, and that the disease was carried by human intercourse from Rangpur to Assam, or that it arose from an intensification of the ordinary malarial fever of that district. SOME REMARKS ON THE POSITION OF CERTAIN REMITTENT FEVERS HITHER¬ TO FREQUENTLY CLASSED AS MALA¬ RIAL, WITH ILLUSTRATIVE CASES AND TEMPERATURE CHARTS. By Surgn.-Maj. J. H. Tcjll-Walsh. I. MS. All authors admit that the remittent fevers vary very much in type, and years ago Norman Che vers wrote concerning them as follows :— ‘ Remittent fever is not in my opinion modified oi- aggravated intermittent fever.” So far as many of the cases are concerned I quite agree with this opinion, as do a great number of medi¬ cal men in this country. Remittent fevers classed under malaria seem to fall into two main groups. (a) Ordinary remittent fevers presenting in the blood ‘ crescents ’ or other forms of the plasmodium malariee. The attacks are not ver}7 severe, lasting generally a week, or at most 15 to 35 da vs. Cases I and II %/ aud charts taken from my note-book are given as examples for comparison. (b) Severe or < pernicious ’ remittent fever.—A serious form of fever with many symp¬ toms resembling those of typhoid fever, and lasting from 30 to 70 days or more— Case III and chart. There are strong reasons for thinking that many of the £ fevers ’ classed by custom under this ‘ heading ’ should be removed entirely . from the catalogue of malarial diseases. There is further a diagnostic test in the way many remittents react to quinine, and Osier believes that where we find no benefit from quinine we are not dealing with malaria. Many of these cases present no signs of the plasmodium malaria in the blood. They do, however, present certain features which would lead one to regard them as in some way clinically allied to the typhoid fever class. Up to within the last few years all remittents occurring in malarial areas (not markedly typhoid or owning other accepted origin) have been included under the * heading' Malaria. It is, I admit, often very hard to distinguish many of these anomalous cases from ordinary malarial remittents, and perhaps this difficulty lias given rise to the term a typho- malaria” as used by some writers. It only requires a little thought to convince us that, having accepted the plasmodAum malariw as the active cause of true malaria, we cannot possibly have a disease, which, from an etiolo¬ gical standpoint, is a ‘cross' between typhoid fever and malarial remittent fever. The two diseases might, of course, exist together, and many prolonged remittents present, as we have | seen, certain symptoms, haemorrhage, etc., which ! occur also in typhoid fever. Further, men of 1 any experience know that we meet with very j curious and atypical cases of typhoid fever