Quartan fever

“ Geographical distribution.—— The fever which the quartan parasite gives rise to—— single, double, or treble quartan ague is, relatively, much more common in temperate latitudes than in the tropics. Formerly it was common enough in England; it is still far from rare in the malarious districts of north and mid-Europe and, doubtless, elsewhere under similar climatic and telluric conditions. But as we proceed south it becomes, relatively to the other forms of malaria, rarer. In the tropics in some highly malarious places it is unknown. ”

“ Fevers are,—the continual, some of which hold during the day and have a remission at night, and others hold during the night and have a remission during the day; [654] semitertians, tertians, quartans, quintans, septans, nonans. The most acute, strongest, most dangerous, and fatal diseases, occur in the continual fever. The least dangerous of all, and the mildest and most protracted, is the quartan, for it is not only such from itself, but it also carries off other great diseases. ”

“ Many died who neglected it, or who took the common remedies for intermittents to cure it. It generally ended in a remittent before it destroyed the patient. The tertian type discovered itself in some people after the more violent symptoms of the fever had been subdued, and continued in them for several weeks. It changed from a tertian to a quartan type in Mr. Thomas Willing, nearly a [134] month after his recovery from the more acute and inflammatory symptoms of the disease.
It is nothing new for a malignant fever to appear in the form of a tertian. It is frequently the garb of the plague. ”

“ This disease is habitual to them both in summer and in winter, and in addition they are vey subject to dropsies of a most fatal character; and in summer dysenteries, diarrheas, and protracted quartan fevers frequently seize them, and these diseases when prolonged dispose such constitutions to dropsies, and thus prove fatal. These are the diseases which attack them in summer; but in winter younger persons are liable to pneumonia, and maniacal affections; and older persons to ardent fevers, from hardness of the belly. Women are subject to œdema and leucophlegmasiæ ”

“ And then, too, there is another kind of fatal disease, that which is produced by over-exertion of the mental faculties.1301 Nature has appointed certain laws as well for our maladies; quartan fevers never commence at the winter solstice, nor yet during the winter months; some diseases never attack us after the sixtieth year; some again disappear at the age of puberty, especially in females;1302 while aged persons are but seldom affected by the plague. ”

“ As regards relapses quartan is the malarial fever which is most apt to show this feature and aestivo-autumnal the least. Deaderick gives the percentage of cases showing relapses in quartan, benign tertian and aestivo-autumnal as 65, 55 and 45.
The great importance of malaria is rather its invaliding tendency and by thus reducing the powers of resistance it makes the death rate from intercurrent diseases higher. Tropical malaria does not seem to affect the native as it does the European but the high death rate of infants among the natives is undoubtedly largely connected with this disease. ”

“ In hot climates this fever is frequently induced by the exhalations of stagnating lakes or marshes, which abound with animal substances; but which in colder countries produce fevers with debility only, as the quartan ague, without inflammation. ”

“ Such a deposit may be expected, when the fever is of a continual type, and that it will pass into a quartan, if it become intermittent, and its paroxysms come on in an irregular manner, and if in this form it approach autumn. As deposits form most readily in persons below thirty years of age, so quartans most commonly occur to persons beyond that age. It is proper to know that deposits occur most readily in winter, that then they are most protracted, but are less given to return. ”

“ No convalescents are discharged from quarantine until free from infection, and whenever possible this is determined by bacteriological examination.
The United States quarantine regulations provide for inspection of but six diseases, yellow fever, typhus fever, bubonic plague, leprosy, smallpox and cholera. A few facts relative to these will make plain the nature of the special precautions necessary to exclude them.
Yellow fever is the great sanitary curse of the tropical Americas. It is an acute non-contagious fever of unknown causation. ”

“ Strict quarantine should be established and maintained throughout the course of the disease. Exposed persons should be isolated until such time has elapsed as may prove that they are not infected. The period of incubation, that is the interval of time between exposure to the contagion of scarlet fever and the first sign of the disease in the person so exposed, varies. ”

“ What we all find so hard to learn is, that the one way of infection does not exclude the other. Plague was for the most part a miasmatic infection in the air of a plague-stricken town; but it could be conveyed in clothes or bales, while it was prudent to remain not too long in the company of a plague-patient. In like manner contagion from the person was, as Rush said and Blane confirmed, a “contingency” in yellow fever; and there are some authentic cases of Asiatic cholera which cannot well be explained except on the hypothesis of contact with the persons of those sick or dead of the disease. ”

“ The eye becomes deeply injected and red, the cheek pale or flushed, the pulse rapid, and the temperature of the body a little above the natural standard. The patient, either delirious or comatose, then lies in a state resembling the last stage of the severest typhoid fever of this country. This struggle usually lasts from four to eight days, when the symptoms either gradually yield, or death ensues. In a few mild cases the fever assumes an intermittent type, or sometimes a quotidian, sometimes a tertian form: all these cases usually recover. ”

“ I know not of any visitation so much to be dreaded as epidemic fever; it is worse than the plague, for it lasts throughout all seasons. Cholera may seem more frightful, but it is in reality less destructive. It terminates rapidly in death, or in as rapid recovery. Its visitation, too, is short, and it leaves those who recover unimpaired in health and strength. ”

“ The contagion, -like that of typhus, appears to be most active in the immediate vicinity of the patient and to be greatly lessened by the access of fresh air. It is capable of being conveyed by clothing. The incubation of the disease is about one week. The symptoms of the fever then show themselves with great abruptness and violence by a rigor, accompanied with pains in the limbs and severe headache. ”

“ Such, however, is not the case with that other phantom of our quarantine laws—the yellow fever—which can never, under any circumstances of atmosphere, without the aid of the last be made a contagious disease. I speak thus decisively from my experience of its character, as one of the survivors of the St. Domingo war, where, in a period of little more than four years, nearly 700 British commissioned officers, and 30,000 men were swept away by its virulence ”

“ While continuing his experiments with mosquito bites, Dr. Reed was carrying on a rigorous test of the theory that infected clothing and bedding was the transmitting agent of the fever — a theory unquestioningly accepted by the medical profession and acted upon in framing and enforcing quarantine regulations. The very name given to these infected articles, supposed to be capable of passing on the flame of infection— "fomites," a word derived from the Latin term for "tinder" — indicates how seriously they were regarded as a means of spreading the flames of the fever. ”

“ Physicians have no offices, nor do they, as a general rule, call upon their patients. When an invalid is not able to go to the doctor, he is expected to die. Yellow fever, cholera, and consumption are unknown; while intermittent fevers, dysentery, and liver complaints, so prevalent on the coast, are uncommon. The ordinary diseases are catarrhal affections and typhoid fever. Cases of inflammation of the lungs are rare; more coughing may be heard during a Sunday service in a New England meeting-house than in six months in Quito. ”

“ When the fit is prolonged and periodicity is marked by only a slight fall of temperature, a slight sweating, a slight feeling of chilliness, the fever is said to remit to be a remittent. Sometimes there is no remission; such a fever is said to be continued. It occasionally happens that two distinct pyrexial attacks come off the same day; such a fever is said to be double. All sorts of blendings of malignant infections, benign tertians, and quartans occur; in such the infection is said to be a mixed infection. ”

“ We do not require to be told that placing many persons together in ill-ventilated places, whether they labour under ague, or catarrh, or rheumatism, or cholera, as well as where no disease at all exists among them, as in the Calcutta black-hole affair, and other instances, which might be quoted, fever, of a malignant form, is likely to be the consequence, but assuredly not ague, or catarrh, or rheumatism, or cholera. ”

“ If three generations of quartan parasites sporulate on three successive days we have a triple quartan infection. When two species of parasites are present in the same case we have a mixed infection. Mixed infections of malignant tertian and benign tertian are the most common, next, those of quartan and malignant tertian and very rarely those showing quartan and benign tertian. All three species have been found in a single individual. ”

“ It is considered so certain that everyone exposed to yellow fever will have the disease that proof that a man has lived in an endemic center for ten years is accepted as proof of his immunity. No quarantine is, however, absolute in any disease, in any locality, or carried out by any authority. Some people now and then will pass the quarantine who are either so slightly sick that the disease is not recognized, or who developed the disease after they had been released from quarantine. ”

“ The miasmata of an apartment, to be strong enough to become contagious, must arrive at a certain degree of concentration.
Cholera was, at all events, very different from typhus fever in the point of contagiousness: for in the epidemics of the latter many medical men fell victims, and the susceptibility to contagion was greater in proportion to the health and vigour of those who mixed with the sick. ”

“ This epidemic progression is spoken of as of a single but composite disease,—“the epidemic throat-distemper and miliary fever that appeared in the Duchy of Cleveland in 1760.” In adults it was mostly an affection of the throat, few having the miliary eruption, and only one adult [Pg 704] dying “within the circle of my observations.” But in children the fever with miliary rash was predominant, and of it the fatality is put at one death in every thirty cases. There is no discussion as between the names of scarlet fever and miliary fever ”

“ In 1703 and 1704 he was surgeon to two of Her Majesty’s ships “where a delirium, stupor and phrenitis” were found as symptoms of the fevers. In the summer of 1704, cruising in the latitudes of Portugal and Spain, the men brought on board from Lisbon unripe lemons with which they made great quantities of punch. This was the evident cause of a cholera morbus and dysentery: “after this we had a pretty many taken with the [Pg 105] synochus putris, and some with the causus” [malignant fever] . ”

“ Temper is irritable. The sloughing glands often take a long time to heal. Convalescence is soon established.
21 VARIETIES.
Just as before an epidemic of cholera visits a place, it is usual to observe cases of mild diarrhœa, and indigestion prevailing amongst its population; so, before plague actually breaks out, it has been found that cases of buboes and parotites with fever are commonly observed. Such cases were called Pestis Minor at Astrakhan. “No one died from the disease per se, but few people were confined to bed.” It is not known whether in pestis minor the plague germs could be found ”

“ It would be necessary to show that one of the laws of other febrile endemics, such as yellow fever, does not influence this, namely that when the essential cause is in much force it attacks persons, though with a certain relation to individual susceptibility, with various degrees, up to the least conceivable degree of it; while reversely, when the cause is little diffused or concentrated, only those who are especially disposed to it—only those who have excessive susceptibility, natural or acquired—constitutional disposition, or disposition from circumstances of life—suffer from it. ”

“ John Roche, an English physician who has had remarkable experiences, gives as his conclusion that cholera is purely and simply a specific fever, only inferior in its ravages to yellow fever, and closely allied to it. Cholera has a period of incubation varying from two to fourteen days; prone to attack the enervated and those subject to depression from any cause. ”

“ He happened to be serving with part of the British army, at Cadiz, when an eruption of yellow fever took place there, in the autumn of 1813, and as usually happens amongst medical men, the first time they have seen that fever, some of them were staunch contagionists, and impressed that belief upon the corps to which they belonged. In all these the disease was most fatal to great numbers. The men being half dead with fear, before they were taken ill, speedily became its victims, to the great terror and danger of their surviving comrades ”