Fevers in the tropics: their clinical and microscopical differentiation, including the Milroy Lectures on Kala-azar / by Leonard Rogers.

  • Rogers, Leonard, 1868-1962.
Date:
1908
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Licence: In copyright

Credit: Fevers in the tropics: their clinical and microscopical differentiation, including the Milroy Lectures on Kala-azar / by Leonard Rogers. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    and occasion obstruction and enlargement of the liver and spleen.” But he adds : “ This difficulty is happily got rid of since the introduction of the sulphate of quinine into practice ”—a most acute observation, which appears to have been lost sight of for many years by his contemporaries and successors. He also advises caution in the use of calomel where the spleen is much enlarged, and states that in compli- cated and irregular agues bark should not be deferred until the tongue is clean. In the continued fevers of new arrivals he advises copious and repeated bleeding, calomel, emetics, purging, and bark or quinine only after suppression of the fever, the bark being given in as large doses as the stomach will bear. Annesley also writes of the mosquito curtain as an almost absolute preventative of malaria in his work published in 1828 ; a very early reference to its value in India. Thus we see that Annesley classified fevers simply in accordance with the type of the temperature curve, and treated all forms alike by the methods then in vogue, and although he undoubtedly saw typhoid, he did not recognize it as a separate specific fever. THE VIEWS OF WILLIAM TWINING, 1835 William Twining was one of the many eminent physicians who have utilized the extensive clinical material available in the European General Hospital, Cal- cutta, for advancing the knowledge of his day on fevers, and the folloiving brief extracts from the second edition of his book, published in 1835, will suffice to show that he made good use of his opportunities, and that in his classification he was ahead of his predecessors. He divided fevers into :—I. Intermittent Fever, or ague, due to malaria and occurring at the end of the rains and early cold weather, and “ intimately connected with the diurnal changes of temperature which take place at the commencement of the cold season.” II. The Common Continued Fever of the Dry Hot Season, due to exposure to the sun or heat, and showing inflammation of the brain, root of the mesentery and liver. III. Remittent Fever of the rains, characterized by a diurnal exacerbation and remission of pyrexia, commencing sometimes with shivering, followed by a hot stage ending in perspiration, often profuse, “ the intervals between the paroxysms often marked by entire cessa- tion of pyrexia,” and more or less enlargement of the spleen in almost all the cases. With prophetic insight he adds : “ It would be an interesting subject of inquiry, to ascertain, if possible, whether any peculiar changes occur in the blood as a general trait, and at an early period in all these fevers.” His account is an admirable description of the severe malarial remittent and intermittent fevers of Bengal. In discussing the pathology he lays great stress on the occurrence of “ local congestions and effusions ” in the “ stomach, intestines, cellular structure about the duodenum, and at the root of the mesocolon, more especially where it crosses the spine.” These peculiar views appear to have greatly influenced him in his treatment of the disease, of which he observes : “ Life often depends on the management of a single paroxysm, by the judicious use of the lancet, a purgative, and two or three large doses of quinine.” In order to subdue these “ local congestions and effusions ”