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Ague

malarious, soil, found, spleen, district and fever

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AGUE.

who live in malarious districts are not exempt from ague ; indeed, in early life the system is said to be particularly susceptible to the action of the malarious poison. During infancy and up to the age of five or six years, the fever may assume peculiar characters, and unless detected early, and promptly treated, may even prove fatal. In more advanced childhood the symptoms present little variety from those met with in adult life.

Causation.—Ague is an endemic disease, which is excited by residence in a malarious neighbourhood. An ague-breeding district is usually low lying, marshy or ill-drained, and has a more or less porous soil, composed largely of rotting vegetable matter. Still, these conditions are not always found united in places where ague abounds. A disintegrated rocky soil, which is very porous, and is saturated with water to within a few inches of the sur face, may largely generate the malarious poison, although decaying vege table inatter is entirely absent. A soil thus deleterious is rendered doubly noxious by digging below the surface. Indeed, in some cases a spot previ ously healthy has been known to become malarious after disturbance of the soil for building or other purposes. Even a malarious district is only poisonous at certain seasons. In temperate climates the spring and au tumn are the agueish periods of the year. In the tropics the miasma is evolved in the dry hot season which succeeds to the periodic rains. The malaria is thrown out from the soil, especially at night-time, and rises to a certain distance from the ground. It is always more intense near the sur face, being apparently more diluted or rarifiecl as the distance from the earth increases. It may be carried by the wind to a considerable distance from the spot where it has been generated, but appears to be incapable of passing a broad sheet of water, and even a band of trees is found to arrest the progress of the miasma.

Amongst the residents of a malarious neighbourhood the disease is very common. The children living in the district are said rarely to escape ;

for even if considered healthy they will be found, according to Steiner, to have the spleen enlarged. Even the new-born infants of mothers who suf fer from intermittent fever may be found at birth to present the enlarged spleen, the bronzed skin, and all the other signs of a pronounced malari ous cachexia. It has even been affirmed that the milk of a cachectic wo man is capable of communicating the disease ; but this statement requires further proof.

Morbid Anatomy.—When children who have been subject to ague die, the only constant lesion discovered is an enlargement of the spleen. Dur ing an acute attack, and for some time afterwards, the organ is engorged with blood so as to be several times its natural size. It afterwards dimin ishes in bulk ; but if the child remain in the malarious district it contin ues to be harder and larger than natural. The cut surface is then pale and ciryish, with white stria from thickened trabecuke, and sometimes it has a gray tint or even a speckled appearance from dark gray spots. The capsule is thickened and often adherent. Besides the spleen, the liver is also congested during an acute attack, and afterwards may remain more or less enlarged.

Symptoms.—In early life ague may occur either in the intermittent or remittent form, Both are common ; for although in the adult the remit tent form is rarely seen, except in the more serious variety of the disease, which occurs in tropical climates, in the young child a comparatively fee ble dose of the poison may produce a profound effect upon the constitu tion, and excite fever of the remittent type even in a temperate zone. In most cases the fever is quotidian, but it may be tertian and even, although rarely, quartan. The three stages of the attack are usually to be recog nised ; but they are less perfectly marked than in the adult, and are often characterised by peculiar features not found in after-life.

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