Malaise

“ Sometimes they are hardly perceptible, and are not complained of; usually there is well-marked malaise with rheumatic pains. Occasionally there is severe constitutional disturbance, lasting for about a week, with rigor, smart fever— 100° to 103° F.— persistent headache, pains— worse at night— in the long bones, joints, and loins, and sometimes gastric disturbance and diarrhœa. ”

“ Malaise, fever, and symptoms of debility usually precede and accompany its development. The lesions go on to gangrene and sloughing, recovery taking place or a fatal termination gradually resulting. There may be several or as many as thirty or forty patches. The progress of the disease, whether terminating fatally or in recovery, is slow, usually of several months' duration. Gangrene of the skin as a symptomatic affection is occasionally seen in grave cerebral and spinal diseases, and also in diabetes. ”

“ The patient exhibits distinct symptoms of malaise in the period of incubation. The fever of invasion, with its characteristic pains and nausea, is equally well marked. Defervescence occurs with a trifling eruption of maculo-papules, which in two days have wellnigh completely disappeared. There is no secondary fever, but the patient is far from well. There is a period of anæmia, mental depression, marked languor, and unmistakable evidences of physical prostration out of all proportion to the precedent symptoms. ”

“ Signs and symptoms of malaria
The clinical symptoms of malaria are primarily due to schizont rupture and destruction of erythrocytes. Malaria can have a gradual or a fulminant course with nonspecific symptoms. The presentation of malaria often resembles those of common viral infections; this may lead to a delay in diagnosis [8] . The majority of patients experience fever (>92% of cases) , chills (79%) , headaches (70%) , and diaphoresis (64%) [ [9] . Other common symptoms include dizziness, malaise, myalgia, abdominal pain, nausea, vomiting, mild diarrhea, and dry cough. ”

“ These acute attacks are of short duration and the patient apparently recovers, but not uncommonly both hallucinations and delusions persist, although they may be concealed.
The second or delusional stage sets in very gradually. This is the stage in which the patient most frequently comes under medical examination. The appearance is always peculiar and unhealthy. The manner is unnatural and may suggest a state of suspicion. The nutrition of the body is below par, and the patient frequently complains of indefinite symptoms of malaise referred to the heart and abdomen. ”

“ The onset of the disease is gradual and indefinite. The patient suffers from malaise, indigestion, constipation and irregular, rapid and forcible action of the heart. The urine become scanty and high coloured. The nervous symptoms are irritability, sleeplessness and a feeling of mental confusion. The actual onset of the acute mental symptoms may be sudden, and is not infrequently heralded by distressing hallucinations of hearing, together with a rise in the body temperature. In the fully developed disease the patient is flushed and the skin hot and dry ”

“ There is no involvement of the joints, and the so-called joint pains are really pains of the muscular insertions about the joints.
The backache of dengue is usually a well marked feature. Pain on motion of the eyeballs is a prominent symptom—it is a deep soreness.
Insomnia, characterized by frequent dropping off to sleep to be awakened immediately by disturbing dreams, is often noted.
The depression, mental and physical, is altogether out of proportion to the lack of seriousness of the disease.
Malaise and anorexia are marked. Constipation is the rule at first. ”

“ As the phenomena of chills and fever are most strikingly exhibited in malaria, let us study the course of events in that disease. It is known that the malarial parasite develops in the red blood-corpuscles, and that the chills and fever appear when the cycle of parasitic development is complete and the adults are ready to escape from the corpuscles of the blood plasma. Bass, of New Orleans, has proved that the favorable temperature for the growth of the malarial organism is 98'0, and that at 102'0 the adult organisms will be killed, though the latter temperature is not fatal to the spores. ”

“ The dwellers in a malarious region like the Terai (at the foot of the Himalayas) are miserable, listless and ugly, with large heads and particularly prominent ears, flat noses, tumid bellies, slender limbs and sallow complexions; the children are impregnated with malaria from their birth, and their growth is attended with aberrations from the normal which practically amount to the disease of rickets. The malarial cachexia that follows definite attacks of ague consists in a state of ill-defined suffering, associated with a sallow skin, enlarged spleen and liver, and sometimes with dropsy. ”

“ Mania is apt to follow certain severe infectious diseases in delicate individuals. Pneumonia, for instance, or typhoid fever or chorea, and sometimes consumption or rheumatism, may be followed by a period of maniacal excitement. Severe injury to the brain or the pressure due to the presence of a brain tumour, may also be a cause of mania. A certain number of good authorities in mental diseases have called attention to the fact that mania is a little more liable to occur in patients who are suffering from heart disease. ”

“ A brief consideration of malarial fever (including simple ague and the more deadly tropical forms) , of the causes that have made it less common at home, and more amenable to treatment everywhere, and of the views entertained about it, will serve to show how various are the forces that make for improved well-being, and how checkered the medical record has been. No single cause of premature death, of life-long misery, and of loss of working-power, has ever equaled malaria. ”

“ It is not flattering to one's vanity to overlook a case of malingering, but should this occur little harm is done. It is a much more serious matter to accuse a person of malingering when in reality he may be suffering from an organic disease.
Here are some of the diseases which are most frequently feigned:
Nervous Diseases, as headache, vertigo, paralysis of limbs, vomiting, sciatica, or incontinence or suppression of urine, spitting of blood; others, again, simulate hysteria, epilepsy, or insanity. ”

“ The prognosis as to life in cases of mania is very good. Very few patients die during an attack of acute mania. At times there is a development of tuberculosis that proves fatal, because of the restlessness of the individual. Pneumonia or typhoid fever may also prove fatal.
Besides mania or melancholia, there is a third form of functional mental disease, which is a combination of these two forms. It is usually spoken of as circular insanity. The patient has usually first an attack of melancholia, then an attack of mania, and then after an interval melancholia and mania once more. ”

“ MALARIA WORK AND THE HOSPITAL SYSTEM In the early years of our construction malaria was very common and gave a great deal of trouble. As I have explained before, malaria is caused by a small animal parasite which lives in the blood of man and feeds upon the red globules. The excretions of this parasite poison man and cause the fever and other symptoms which we know as malarial fever. This parasite is transferred from the sick man to the well man by the bite of the mosquito. ”

“ I have to announce a discovery to-morrow to the College of Medicine, for I am studying a disease that had disappeared—a mortal disease for which no cure is known in temperate climates, though it is curable in the West Indies—a malady known here in the Middle Ages. A noble fight is that of the physician against such a disease. ”

“ In many forms of malarial disease, if life is to be saved, action must be prompt, decisive, energetic, and based on accurate diagnosis. The diagnosis of ordinary agues may be postponed for a day or two without much danger, and be made correctly enough without the microscope; but every now and again a pernicious attack is sprung upon the practitioner, the nature of which he must be able to recognize at once, and recognize with confidence. When the parasite is seen in the blood, it is surely known that there is a malarial element in the case and that quinine is indicated. ”

“ Must we stand and fold our arms while the malaria of Popery is stalking all over our land, carrying death and disease with it wherever it goes? Paralyzed be that arm which would fold itself in such a case! ”

“ It appears that a disease which our ablest physicians have described as intensified malaria, has by no means confined itself to the malarious, i. e., swampy regions of the Atlantic slope, but in a great majority of cases may be traced to a city, or a well-drained but thickly-populated district, where the dietetic and domestic habits of the Caucasian race predominate over those of the American aborigines. ”

“ Has any one ever learned how it is that a distinct form of mental disease seems to lurk in all sorts of unexpected fastnesses, ready to breathe a numbing and poisonous vapour on those who are not fortified against the moral malaria? ”

“ Of the mortality due to malarial disease a small part only is referable to the direct attack of intermittent, and chiefly to the fever in its pernicious form. Remittent fever is much more fatal in its direct attack. But probably the greater part of the enormous total of deaths set down to malaria is due to the malarial cachexia. ”

“ Malaria.—It is not a mere theory, but a well-founded opinion, that all the destructive epidemics that have afflicted this globe have had their origin in malaria, which in a cold climate has produced typhus fever, in a more temperate one plague and yellow fever, and within the tropics cholera, each modified according to the idiosyncratic state of the sufferers. ”

“ Pathology and pathological anatomy.—— The pathology of malarial cachexia is virtually, in the first instance, that of acute malarial disease. There is blood destruction by the direct action of the malaria parasite and of its toxins, eventuating in oligocythæmia and in the deposit of hæmozoin and of hæmosiderin (yellow pigment) in the tissues. The activity and persistence of the process lead to congestion which ultimately determines organic changes in liver, spleen, kidneys, and probably in the bone marrow. ”

“ Eating salt provisions, drinking impure water, burning by day and shivering by night, on the borders of a creek which bred disease, with a fatal malaria around, they were unable to resist the ague, which in its worst form seized upon them. Without help and without hope, far from home, in an inhospitable country, sickness seized upon one and all. ”

“ It is not so much the letting in of bad air, but rather the confining of it—the breathing of it, “pure and unadulterated”—that causes disease. There is more malaria in a close bedroom in the most favored mountain-region, and in the alimentary canal of a constipated or drug-swallowing dyspeptic, than about the swamps and bayous of Louisiana or the dreaded Roman Campagna, where wrapped in a single blanket, the author has slept night after night—to prove his faith in the theory, as well the theory itself. ”

“ For instance, it is now very generally conceded that paresis, or what is sometimes called general paralysis of the insane,—a progressive mental and nervous disease, which invariably ends fatally in from three to seven years,—is always due to one of the so-called social or venereal diseases. How important this affection has become in modern life can be best appreciated from the fact that in Europe nearly one in four of those who die in the insane asylums are sufferers from paresis. In this country the disease is not so frequent, the proportion being less than one in five or even one in six. ”

“ His object was to discover the origin or cause of those fatal diseases which, under the names of fever, dysentery, plague, rheumatism, &c., render the position of man on the globe so precarious, his life at times so brief, valueless to himself or to others, his prospects so gloomy ”

“ It is my opinion that when this man first entered the hospital he was merely suffering from a simple case of malaria and not enteric fever, as you have diagnosed. Since then his kidneys have become affected, and he now suffers from both malaria and lumbago. For the fever, give him ten grains of quinine three times a day for two days and gradually diminish the quantity until the fever abates entirely. Begin to feed him after the second day. For the lumbago, give him at least two quarts of lithia water to drink each day. Now as to the man's mental calibre, I find him perfectly sane and normal. ”

“ This is a chronic affection of the nervous system having for its most characteristic symptom a tremor, but with marked muscular rigidity and weakness. It is much more common in men than in women, in almost the reverse proportion of Graves' disease. It is usually a disease of the old, but may occur in early middle life and has been known to develop even early in the twenties. In the old days when malaria was a common diagnosis for many different conditions, paralysis agitans apparently followed malaria so often that there was thought to be some connection between the two diseases. ”

“ So much land was ploughed, and so much vegetable matter turned under and decaying that there came a regular epidemic of fever and ague and bilious fever, and a large majority of the people were sick. At our house father was the first one attacked, and when the fever was at its height he was quite out of his head and talked and acted like a crazy man. We had never seen any one so sick before, and we thought he must surely die, but when the doctor came he said:—"Don't be alarmed. ”