Infectious Diseases

This is a disease of the anterior horns of the spinal cord with sudden paralysis of one or more limbs. It occurs at all ages […]. Occurs more often in males and in hot summer months. The onset is sudden, with slight fever (100-102 degrees F) lasting from 1 to 4 days, sometimes with vomiting, diarrhea, delirium, and convulsions. Within 24 hours in acute cases, or a week in subacute, paralysis appears, most commonly a paraplegia, or in one leg, or diplegia, or simultaneous monoplegias. After the acute symptoms subside there may be pain in the back and limbs for a few days. […] The paralysis increases for from 1 to 4 days, remains stationary for from 1 to 5 weeks, and improves for from 6 to 12 months. Within 2 or 3 weeks there may be some atrophy in the affected limbs. The paralysis gradually disappears from the limbs least affected, but leaves one or both legs, generally one (and that the right) permanently paralyzed. The affected limb is cold, mottled, and reddish purple in color; the muscles are flaccid, become atrophied, R.D. is present, reflexes absent. In the leg the anterior tibial group of muscles are oftenest affected and foot-drop results. The paralyzed limb does not grow as rapidly as the unaffected limb, but remains smaller and shorter, and may develop contractures and various deformities – e.g., in the leg, talipes equinus, varus, and valgus, and contraction of the plantar fascia. Lateral curvature of the spine and a deformed knee may ensue. In adults the facial nerve may be attached. Rarely the nuclei of the ocular muscles are involved (polio-encephalitis superior) or the lower cranial nerve nuclei (polio-encephalitis inferior).

Butler, G. R. (1901/1909). The Diagnostics of Internal Medicine: A Clinical Treatise Upon the Recognised Principles of Medical Diagnosis, Prepared for the Use of Students and Practitioners of Medicine (3rd ed, pp. 1062-1063). New York: D. Appleton.

Created by: Taha Jilani, 06/09/2021

Entered by: Rachel Johnson, 07/13/2021

The patient feels indisposed, perhaps chilly, has slight headache, and sneezes frequently. […] There is usually slight fever, the temperature rising to 101o. […] At first the mucous membrane of the nose is swollen, ‘stuffed up’, and the patient has to breathe through the mouth. A thin, clear, irritating secretion flows, and makes the edges of the nostrils sore.

The mucous membrane of the tear-duct is swollen, so that the eyes weep and the conjunctivae are injected. The sense of smell and, in part, the sense of taste is lost. […] If the inflammation extends to the Eustachian tubes the hearing may be impaired. […] Usually within thirty-six hours the nasal secretion becomes turbid and more profuse, the swelling of the mucosa subsides, the patient gradually becomes able to breathe through the nostrils, and within four or five days the symptoms disappear, with the exception of the increased discharge from the nose and upper pharynx.

Osler, W. (1909). The Principles and Practice of Medicine (7th ed.). London: Appleton and Co. Pg. 593

Entered by: Erin Choi, 6/18/2020

Edited by: Sonia Y. Khan, 8/4/2020

The entire pharyngeal structures, often with the tonsils are involved. The condition may follow cold or exposure. In other instances it is associated with constitutional states, such as rheumatism or gout, or with digestive disorders. The patient complains of uneasiness and soreness in swallowing, of a feeling of tickling and dryness in the throat, together with a constant desire to hawk and cough. Frequently the inflammation extends into the larynx and produces hoarseness. Not uncommonly it is only part of a general naso-pharyngeal catarrh.

The process may pass into the Eustachian tubes and cause slight deafness. There is stiffness of the neck, the lymph glands of which may be enlarged and painful. The constitutional symptoms are rarely severe. The disease sets in with a chilly feeling and slight fever, and the pulse is increased in frequency. Occasionally the febrile symptoms are more severe, particularly if the tonsils are specially involved. The examination of the throat shows general congestion of the mucous membrane, which is dry and glistening, and in places covered with sticky secretion. The uvula may be much swollen.

Osler, W. (1892). The Principles and Practice of Medicine. New York: D. Appleton & Company. Pg. 330.

Entered by: Ayushi Chintakayala, 6/12/2020

The lacunae of the tonsils become filled with exudation products, which form cheesy-looking masses, projecting from the orifices of the crypts. Not infrequently the exudations from contiguous lacunae coalesce. Theintervening mucosa is usually swollen, deep red in color, and may present herpetic vesicles, or, in some instances, even membranous exudation, in which case it may be difficult to distinguish from diphtheria. The contents of the crypt are made up of micrococci and epithelial debris.

Chilly feelings, or even a definite chill, and aching pains in the back and limbs may precede the onset. The fever rises rapidly and in a young child may reach 105 degrees F on the evening of the first day. The patient complains of soreness of the throat and difficulty swallowing. The appearance is that of acute illness. On examination the tonsils are seen to be swollen and crypts present the characteristic exudate. The pharynx is usually inflamed and the uvula may be edematous. The tongue is furred, the breath is heavy and foul, and the urine is highly colored and loaded with urates. In children the respirations are usually rapid and the pulse increased in rapidity. Swallowing is painful and the voice often becomes nasal. Slight swelling of the cervical glands is present. About the third to fifth day the temperature falls, often by crisis, and the symptoms lessen rapidly.

Osler, W. & McCrae T. (1892/1925).The Principles and Practice of Medicine (7th ed., pp. 367). New York: Appleton and Co.

Created by: Taha Jilani, 06/23/2021

Entered by: Rachel Johnson, 11/05/2021

The essential symptoms of Ankylostomiasis are those of a progressive anemia ; an anemia which is generally associated with dyspeptic trouble, but which, in uncomplicated cases, is not associated with wasting. If the progress of a case be unchecked, serous effusions in different organs and fatty degeneration of the heart ensue, and death may occur from syncope or from intercurrent complication.

One of the earliest symptoms of an extensive Ankylostomum invasion is pain or uneasiness in the epigastrium. This is generally increased by pressure, but, for the time, may be relieved by food. The appetite, sometimes defective, is more often ravenous ; but its gratification is apt to give rise to dyspeptic trouble of various kinds, to colic, to borborygmus, and, perhaps, to diarrhea of imperfectly digested food. Constipation may be present in some instances, irregularity of bowels in others. The taste may be perverted, some patients exhibiting and persistently gratifying an unnatural craving for such things as earth, mud, lime, what is called pica or geophagy. The stools sometimes, though rarely, have a reddish-brown tinge from admixture of half-digested blood. Sometimes they may contain small flakes of blood-tinged mucus. Pure blood is rarely passed. An extensive hemorrhage, unless there be concurrent colitis, is still more rare, although post mortem considerable quantities of blood may be found in the small intestine. Fever of an irregular, intermitting, or even of a sub-continued type, is common. On the other hand, the temperature may be constantly subnormal. Or these conditions may alternate. After a longer or shorter time, symptoms of profound anemia may disclose themselves. The mucous surfaces of the skin become pallid, the face is puffy and the feet and ankles are swollen. All subjective symptoms of anemia now become more and more apparent ; there is lassitude, breathlessness, palpitations, tinnitus, vertigo, dimness of sight, mental apathy and depression, liability to syncope, and so forth. The circulation is irritable and hemic bruits can be heard over the heart and larger blood-vessels. Ophthalmoscopic examination may reveal retinal hemorrhages.

For some of these symptoms, where is not that with the advancing anemia there is no loss of weight, one might be led to suspect the possibility of tuberculosis of cancerous disease, Bright’s disease, leucocythemia, or an idiopathic pernicious anemia. So far from losing weight, the patient might appear quite plump and, though hemocytometric measurements testify to a slow and steady fall in the corpuscular richness of the blood until the lowest limit compatible with life is reached, there is no true poikilocytosis, no excessive leucocytosis (leukocytosis), and not necessarily any enlargement of lymphatic glands, liver, or spleen. The hemoglobin value of the corpuscles is not depressed correspondingly to the fall in their numbers.

The rate of progress is very different in different cases, In a few a high degree of anemia may be attained, and even a fatal issue ensue, within a few weeks or months of the appearance of the first symptoms. Such rapid cases are rare ; more frequently the disease is an exceedingly chronic one, ebbing, flowing, or slowly progressing through a long series of years.

Should serious ankylostomiasis occur before puberty, the growth and development are apt to be delayed or stunted.

In tropical countries, anemia without apparent cause should always suggest a microscopic examination of the feces. If the ova of the Ankylostomum duodenale are discovered, and no other reason for anemia be made out, the presumption is that the parasite is at the route of the mischief. […]

Manson, P. (1898). Tropical Diseases: A Manual of the Diseases in Warmer Climates (pp. 542-544). William & Company.

Created/Entered by: Rachel Johnson, 07/22/2020

Though not so common in tropical countries as trichocephalus, the ascaris is nevertheless very common indeed, especially in children who often harbour these loathsome creatures in enormous numbers—in dozens, or even hundreds. […]

In many instances the ascaris gives rise to no very noticeable symptom ; in other instances it is to be credited with a number of ill-defines gastric and perhaps nervous troubles— capricious appetite, foul breath, restless sleep, peevishness, vague abdominal pains, nausea, and so forth. Sometimes the worms get into the stomach and are vomited, their appearance giving rise to no inconsiderable alarm. They may even creep up the esophagus and into the mouth, or out the nostrils. Cases are on record in which they caused suffocation by wandering, in this way, into the rima glottidis. They have also been known to enter the bile ducts and give rise to jaundice ; to penetrate the intestinal wall and escape into the perineum, causing peritonitis ; or to burrow into the abdominal walls and give rise to abscess. These accidents are fortunately of rare occurrence ; their possibility, however, should be borne in mind and, apart from other obvious considerations, ought to make us endeavor to rid patients of these troublesome guests as soon as possible. […]

Adults, especially young adults, although to a much smaller degree than children, are liable to entertain these verminous visitors. Sometimes certain obscure dyspeptic symptoms in grown-up people will resist all treatment until [anthelmintic treatments] are administered. I had a patient once with unaccountable nausea. One day, while he was sitting at breakfast, the feeling of sickness came with unusual intensity. He had to leave the table and, after one or two retching efforts, brought up ascaris lumbricoides. After this he was no more troubled with nausea. It is well, therefore, when puzzled over some obscure dyspeptic condition in tropical patients, to bear ascaris in mind. If, for some reason, it is undesirable to give [anthelmintic treatments] unnecessarily, the stools ought first to be examined with the microscope. If ova are found, a dose or two of [anthelmintic treatment] may clear up diagnosis and cure the patient ; if no ova are found, the drug may be withheld and the idea of ascarides abandoned. […]

Manson, P. (1898). Tropical Diseases: A Manual of the Diseases in Warmer Climates (pp. 534-536). William & Company.

Created/Entered by: Rachel Johnson, 07/22/2020

Prodromal stage— In a certain but small proportion of cases there is a prodromal stage characterized by physical and mental depression, anorexia, aching of the limbs, feelings of chilliness, giddiness, palpitations, and sometimes dull pains in the groin at the seat of the future bubo.
 
Stage of invasion— Usually […] the disease sets in somewhat suddenly with fever, extreme lassitude, frontal or, more rarely, occipital headache, aching of the limbs, vertigo, drowsiness or perhaps wakefulness, troubled dreams. […] The face quickly acquires a peculiar expression, the features being drawn and haggard, the eyes blood shot, sunken and staring, the pupils probably dilated; sometimes the face wears an expression of fear or horror. The patient, when he can walk, drags himself about in a dreamy sort of way, or he staggers like a drunken man. There may be nausea and vomiting; in some instances, there is diarrhea.
 
Stage of fever— […] Generally […] the disease develop[s] abruptly without definite rigor or other warning, the thermometer rising somewhat rapidly, with a corresponding acceleration of pulse and respiration. […] Sometimes the patient becomes delirious. Coma, convulsions — sometimes of a tetanic character — retention of urine, subsultus tendinum, and other nervous phenomena may occur. […]
 
Stage of adenitis— Sometime between the first few hours and the fifth day, generally within twenty-four hours, the characteristic bubo or buboes develop. Usually (in 70 per cent.) the bubo forms in the groin, most frequently on the right side, affecting one or more of the femoral glands;  less frequently ( 20 per cent.) it is the axillary glands, and still more rarely (10 per cent.), and most commonly in children, it is the glands at the angle of the lower jaw that are affected. […]In some instances, they are no larger than a walnut; in others they attain the size of a goose's egg. Pain is often very severe. […] After a few days, if not opened by the surgeon, it bursts and discharges pus and sloughs, sometimes very evil smelling. […] The sores left by the buboes and abscesses of plague are extremely indolent and may take a long time — months — to heal. Hemorrhages of different kinds are not an unusual feature in plague. Ecchymotic effusions of a purplish or dull red tint, and varying in size from a hemp seed to spots half an inch in diameter, are very often found scattered in greater or less profusion over the skin. […] There may be bleeding from the nose, mouth, lungs, stomach, bowel, or kidneys.

Entered by: Bernardo Galvan, 6/16/2020

Edited by: Erin Choi, 7/7/2020

When true cholera sets in, profuse watery stools, painless or associated with griping, and at first fecal in character, pour, one after the other, from the patient. Quickly the stools lose their fecal character, becoming colorless or, rather, like thin rice water containing small white flocculi in suspension. Enormous quantities - pints -- of this material are generally passed by the patient. Presently vomiting, also profuse, at first perhaps of food, but very soon of the same rice -water description, supervenes.

Cramps of an agonizing character attack the extremities and abdomen; the implicated muscles stand out like rigid bars or are thrown into lumps from the violence of the contractions. The patient may rapidly pass into a state of collapse. In consequence principally of the loss of fluid by the diarrhea and vomiting, the soft parts shrink, the cheeks fall in, the nose becomes pinched and thin, the eyes sunken, and the skin of the fingers shriveled like a washerwoman's.

The surface of the body becomes cold and livid and is bedewed with a clammy sweat; the urine and bile are suppressed; respiration is rapid and shallow; the breath is cold and the voice is sunk to a hollow whisper. The pulse at the wrist soon becomes thready, weak, and rapid, and then, after coming and going and feebly fluttering, may disappear entirely. The surface temperature sinks several degrees below normal, 93° or 94°, whilst that in the rectum may be several degrees above normal — 101° to 105°. The patient is now restless, tossing about uneasily, throwing his arms from side to side, feebly complaining of intense thirst and of a burning feeling in the chest, and racked with the cramps. Although apathetic, the mind generally remains clear. In other instances, the patient may wander or pass into a comatose state.

Entered by: Bernardo Galvan, 6/16/2020

Initial fever and eruption— an attack of dengue may be preceded for a few hours by a feeling of malaise or, perhaps, by painful rheumatic like twinges in a limb, toe, finger, or joint. Sometimes the fever is ushered in by a feeling of chilliness or even by a smart rigor; sometimes a deep flushing of the face is the first sign of the disease. […] The head and eyeballs quickly begin to ache excessively, and some limb or joint, or even the whole body, is racked with the peculiar stiff, rheumatic- like pains which, as the patient soon discovers, are very much aggravated by movement. […] Gastric oppression is apt to be urgent, and vomiting may occur. […]
 
Defervescence—In this condition the patient may continue from one to three or four days, the fever declining somewhat after the first day. In the vast majority of cases this, the first and most acute stage, is abruptly terminated about the end of the second day by crisis of diaphoresis, diarrhea, diuresis, or epistaxis. When epistaxis occurs the relief to the headache is great and immediate. […]
 
Terminal fever and eruption— […] there is generally a return of fever, slight in most cases, more severe in others; it is usually of very short duration — a few hours, perhaps. […] With the return of the fever an eruption of a roseolar character appears. The pains likewise return, perhaps in more than their original severity. […]
 
Characters of the eruption— The terminal eruption of dengue possesses very definite characters. […] As stated, the eruption is roseolar in character. It usually commences on the palms and backs of the hands, extending for a short distance up the forearms. Its development is often associated with sensations of pricking and tingling. On the palms of the hands the spots are at first about the size of a small pea, circular, dusky red, and sometimes slightly elevated. The eruption quickly extends, and is best seen on the back, the chest, the upper arms, and the thighs. In these situations it appears at first as isolated, slightly elevated , circular , reddish brown, rubeoloid spots, from one- eighth to one-half of an inch in diameter, thickly scattered over the surface, each spot being isolated and surrounded by sound skin. After a time, the spots, enlarging, may coalesce in places; thus, irregular red patches from one to three inches in diameter are formed. 

Entered by: Bernardo Galvan, 6/16/2020

Edited by: Erin Choi, 7/7/2020

“Cases with a small amount of membrane.—Tonsillar diphtheria.— The exudation is usually limited to the tonsils, and may partake of the character of either follicular or croupous tonsillitis; sometimes there is a slight extension to the faucial pillars or to the pharynx. […]

The onset is accompanied by a little soreness of the throat; the initial temperature is from 100° to 103°F; but the symptoms are often not severe enough to keep the patient in bed. If seen early, the throat shows slight redness, followed by a gray film, and later by a gray or white deposit upon the tonsils. It may start as a small patch which enlarges, or as small, isolated spots which coalesce or remain separate. […] it is generally quite adherent, and can not easily be removed with a swab; usually it is sharply defined, but with a somewhat irregular outline. […] Severe cases.—There is slight indisposition for a day or two, and perhaps some soreness of the throat; the temperature, however is but little elevated. […] At other times the disease begins abruptly with vomiting, headache, chilly sensations, and a temperature of 103° or 104°F.

Occasionally, the first thing to attract attention is the swelling of the cervical lymph glands, which may be so great that mumps is suspected. […] The membrane upon the tonsils resembles that of the mild form of previously described, but instead of remaining limited to them, it gradually spreads to the fauces, the lateral wall of the pharynx, the uvula, the rhino-pharynx, and into the posterior nares. […] When a severe case is fully developed there is a very abundant discharge of mucus from the mouth and nose. The tonsils, the entire faucial ring, and the pharynx are covered with membrane which is at first gray and gradually becomes darker often being of a dirty olive-green colour.”

Holt, L Emmett. The Diseases of Infancy and Childhood: for the Use of Students and Practitioners of Medicine. Appleton and Co, 1897. Pg. 964-966

Entered by: Erin Choi, , 6/26/2020

Edited by: Bernardo Galvan, 9/7/2020

The Filaria or Dracunculus medinensis is a widely spread parasite in parts of Africa and the East Indies. In the United States cases occasionally occur. Jarvis reports a case in a post chaplain who had lived at Fortress Monroe, Va., for thirty years. Van Harlingen’s patient, a man aged forty-seven, had never lived out of Philadelphia, so that the worm must be included among the parasites of this country. A majority of the cases reported in American journals have been imported.

Only the female is known. It develops in the subcutaneous and intermuscular connective tissues and produces vesicles and abscesses. In the large majority of the cases the parasite is found in the leg- Of 181 cases, in 124 the worm was found in the feet, 33 times in the leg, and 11 times in the thigh. The worm is usually solitary, though there are cases on record in which six or more have been present. It is cylindrical in form, about two millimeters in diameter, and from fifty to eighty centimeters in length.

The worm gains entrance to the system through the stomach, not through the skin, as was formerly supposed. It is probable that both. Male and female are ingested; but the former dies and is discharged while the latter after impregnation penetrates the intestine and attains its full development in the subcutaneous tissues, where it may remain quiescent for a long time and can be felt beneath the skin like a bundle of string. Suppuration is after a time excited, and when the abscesses are opened or burst the worm appears and is sometimes discharged entire. The worm contains an enormous number of living embryos, which escape into the water and develop in the cyclops—a small crustacean—and it seems likely that man is infected by drinking the water containing these developed larvae.

The treatment consists in promoting the suppuration, and when the worm is seen the common procedure is to roll it round a portion of smooth wood, and in this way prevent the retraction, and each day wind a little more until the entire worm is withdrawn. It is stated that special care must be taken to prevent tearing of the worm, as disastrous consequences sometimes follow, probably from the irritation caused by the migration of the embryos. It is stated that the leaves of the plant called amarpattee are almost a specific in the disease. Asafaetida in full doses is said to kill the worm.

Osler, W. (1892). The principles and practice of medicine: Designed for the use of practitioners and student of medicine. New York, NY: D. Appleton and Company.

Entered by: Kate Holder, 7/17/2020

This was first described [in North America] by W. C. Dabney in 1888 from Virginia, who quoted the designation “devil’s grip.” […] The epidemic occurrence suggests an infectious agent […]. […] The onset is sudden, often with a chill, and with a rapid elevation of temperature to 102 to 104 degrees F. The principal symptom is pain in the epigastrium, lower thorax, and back which is aggravated by movement. Its severity may render breathing difficult. With this there is extreme tenderness which may persist after the pain is gone. Headache, sweating and a rapid pulse occur. There are no signs of lung or pleural involvement. There may be a return of the symptoms after the first acute features are over.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (10th ed). Pg. 376. New York: D. Appleton & Company.

Dabney’s first patient case

“[The patient] had been taken suddenly a few hours before with violent pain in the left side of the chest nearly over the region of the heart. His temperature was 103°, and the skin extremely hot and pungent to the touch; his bowels were rather constipated, but not markedly so; there was no nausea, but very little appetite. His chief complaint was of the pain in the chest, which was excruciating and aggravated by the slightest movement, or by drawing a long breath. Nothing abnormal could be discovered about the thoracic organs, however, on physical examination.”

Spencer F.J. (1966). The Devil and William Dabney: An Epidemiological Postscript. JAMA, 195(8), 645–648. doi:10.1001/jama.1966.0310008008502)

Created by: Taha Jilani, 07/1/2021

Entered by: Rachel Johnson, 08/29/2021

The stage of invasion is often marked by a rigor, and followed by a rapid rise in the temperature and other characteristics of an acute fever. When there is a local abrasion, the spot is slightly reddened; but if the disease is idiopathic, there is seen within a few hours slight redness over the bridge of the nose and on the cheeks. The swelling and tension of the skin increase and within twenty-four hours the external symptoms are well marked. The skin is smooth, tense, and oedematous. It looks red, feels hot, and the superficial layers of the epidermis may be lifted as small blebs. The patient complains of an unpleasant feeling of tension in the skin; the swelling rapidly increases; and during the second day the eyes are usually closed. The first-affected parts gradually become pale and less swollen as the disease extends at the periphery. When it reaches the forehead it progresses as an advancing ridge, perfectly well defined and raised; and often on palpation, hardened extensions can be felt beneath the skin which is not yet reddened. […] The formation of blebs is common on the eyelids, ears, and forehead. The cervical lymph-glands are swollen, but are usually masked in the oedema of the neck.

Osler, W. (1909). The Principles and Practice of Medicine  (7th ed.). London: Appleton and Co. Pg. 211-212.

Entered by: Erin Choi, 7/1/2020

Under this term may be considered the morbid conditions induced by the filaria sanguinis hominis, or the filaria Bancrofti, the name employed to designate the adult worm, which was discovered, by Bancroft, of Brisbane. In the adult form the worm lives in the lymphatics. The female is thus described by Patrick Manson, whose studies on this parasite have been so important: “A long, slender, hair-like animal quite three inches in length but only one one hundredth inch in breadth, of an opaline appearance, looking, as it lies in the tissues, like a delicate thread of catgut animated and wriggling. A narrow alimentary canal runs from the simple club-like head to within a short distance of the tail, the remainder of the body being almost entirely occupied by the reproductive organs. The vagina opens about one twenty-fifth of an inch from the head; it is very short, and bifurcates into two uterine horns, which, stuffed with embryos in all stages of development, run backward nearly to the tail.” The male worm is much smaller and has only occasionally been found.’ The female produces an extraordinary number of embryos, which enter the blood current through the lymphatics. Each embryo is within its shell, which is elongated, scarcely perceptible, and in no way impedes the movements.

They are about the ninetieth part of an inch in length and the diameter of a red blood-corpuscle in thickness, so that they readily pass through the capillaries. They move with the greatest activity and form very striking and readily recognized objects in a blood-drop under the microscope. A remarkable feature is the periodicity in the occurrence of the embryos in the blood. In the daytime they are almost or entirely absent, whereas at night, in typical cases, they are present in large numbers. If, however, as Stephen Mackenzie has shown, the patient, reversing his habits, sleeps during the day, the periodicity is reversed. The further development of the embryos appears to be associated with the mosquito, which at night sucks the blood and, in this way, frees them from the body. Some slight development takes place within the body of the mosquito, and it is probable that the embryos are set free in the water after the death of the host. The further development is not known, but it is probably in drinking water. The filariae may be present in the body without causing any symptoms. In animals, blood filariae are very common and rarely cause inconvenience.  It is only when the adult worms or the ova block the lymph channels that certain definite symptoms occur. Manson suggests that it is the ova (prematurely discharged), which are considerably shorter and thicker than the full-grown embryos, which block the lymph channels and produce the conditions of haematochyluria, elephantiasis, and lymph-scrotum

The parasite is widely distributed, particularly in tropical and subtropical countries. Guiteras has shown that the disease prevails extensively in the Southern States, and since his paper appeared, contributions have been made by Matas, of New Orleans, Mastin, of Mobile, and De Saiissure, of Charleston.

The effects produced may be described under the above-mentioned conditions.

(a) Haematochyluria.—Without any external manifestations, and in many cases without special disturbance of health, the subject from time to time passes urine of an opaque white, milky appearance, or bloody, or a chylous fluid which on settling shows a slightly reddish clot. The urine may be normal in quantity or increased. The condition is usually intermittent, and the patient may pass normal urine for weeks or months at a time. Microscopically, the chylous urine contains minute molecular fat granules, usually red blood-corpuscles in various amounts. It was in urine of this kind that Wucherer, of Bahia, first detected the filarian embryos. It is remarkable for how long the condition may persist without serious impairment of the health. A patient, sent to me by Dawson, of serious impairment of the health. A patient, sent to me by Dawson, of Charleston, has had haematochyluria intermittently for eighteen years. The only inconvenience has been in the passage of the blood-clots which collect in the bladder. At times he has also uneasy sensations in the lumbar region. The embryos are present in his blood at night in large numbers. Chyluria is not always due to the filaria. The non-parasitic form of the disease has already been considered.

Opportunities for studying the anatomical condition of these cases rarely occur. In the case described by Stephen Mackenzie the renal and peritoneal lymph plexuses were enormously enlarged, extending from the diaphragm to the pelvis. The thoracic duct above the diaphragm was impervious.

(b) Lymph-scrotum and certain forms of elephantiasis are sometimes caused by the filaria. In the former the tissues of the scrotum are enormously thickened, and the distended lymph-vessels may be plainly seen. A clear, sometimes a turbid, fluid follows puncture of the skin. The parasites are not always to be found. I have examined two typical cases without finding filaria in the exuded fluids or in the blood at night. So also, the majority of cases of elephantiasis which occur in this country are non-parasitic. In China it is stated that the parasites occur in all these cases.

Osler, W. (1892). The principles and practice of medicine: Designed for the use of practitioners and student of medicine. New York, NY: D. Appleton and Company.

Entered by: Kate Holder, 7/17/2020

Upon the skin there may be seen an eruption of pustules, papules, or bullae. The bullae are usually upon the soles and palms, but may be found upon other parts of the body. […] The general appearance of these infants is wretched in the extreme. The body is wasted, the skin wrinkled, and temperature subnormal. The spleen is usually enlarged and often the liver also. […] Generally the first symptom is the coryza or ‘snuffles’, which resembles an ordinary cold in the head, except that it persists. It is accompanied by a hoarse cry, indicating that they larynx participates in the catarrhal inflammation. […]

Fissures and mucous patches may be seen upon the lips, about the anus, etc. […] There may also be observed excessive tenderness of the shoulders, elbows, wrists, or ankles, due to acute epiphysitis, which may cause the child to cry from the slightest amount of handling. […] In severe cases, as these local symptoms develop, the infant’s general nutrition suffers in a very marked way. It loses steadily in weight; it becomes extremely anaemic; it whines and frets almost continually, but especially at night. […] Typical syphilitic teeth, according to Hutchison, have each a single notch in the centre of the edge.

The notch is shallow and more or less cresentic in shape. […] The most frequent affection of the eye in late syphilis is interstitial keratitis. […] Both eyes are usually affected and in all degrees of severity, from a slight haziness of the cornea to complete opacity. […] A form of deafness occurs in older children, which Hutchinson states is almost invariably due to syphilis. Its onset is quite sudden, without pain and frequently without discharge. […] The most important of the later manifestations of syphilis consists of the formation of subcutaneous gummata. […] when neglected they break down, leaving large deep ulcers.

Holt, L Emmett. The Diseases of Infancy and Childhood: for the Use of Students and Practitioners of Medicine. Appleton and Co, 1897. Pg. 1058-1065

Entered by: Erin Choi, 6/26/2020

The first clinical signs of loiasis may occur as early as 5 months after infection. The most common clinical manifestations are Calabar swellings and pruritus. Adult worms may be noticed by otherwise asymptomatic patients when the worms migrate across the eye under the bulbar conjunctiva (hence the name ‘eye worm’) or under the skin. Eye worms often leave the eye and re-enter the subcutaneous tissue less than 1 hour after they appear. Calabar swelling most commonly occurs on the hands, wrists and forearms, but it may appear anywhere on the body. The swellings are painless, they do not pit on pressure, and they may last from a few hours to several days. They usually occur in one body location and swelling may recur at irregular intervals for years after the patient has left the endemic area.

Calabar swellings occur in both microfilaraemic and amicrofilaraemic individuals. They are believed to result from host immune responses to adult worms. Loiasis can also cause generalized pruritus, fatigue and arthralgia. The death of an adult worm may occasionally cause a localized abscess. Calcified worms are sometimes seen in radiographs. An epidemiological correlation has been observed between loiasis and the occurrence of endomyocardial fibrosis. Since the latter condition can also occur in patients with extreme hypereosinophilia due to other medical conditions, it is possible that endomyocardial fibrosis associated with loiasis is also caused by toxins released into the blood by activated eosinophils.

Simonsen, Paul & Fischer, Peter & Hoerauf, Achim & Weil, Gary. (2014). Manson's Tropical Diseases, 23rd Edition: The Filariases.

Entered by: Bernardo Galvan, 6/20/2020

Sometimes for several days before the actual disease declares itself, there may or there may not be a premonitory stage marked by lassitude, a desire to stretch the limbs and to yawn, aching of the bones, headache, anorexia , perhaps vomiting, perhaps a feeling as of cold water trickling down the back. If the thermometer be used at this stage, it will be found that body temperature begins to rise some two or three hours before the other and more striking symptoms which ensue set in.

Cold stage - When rigor sets in the feeling of cold spreads all over the body, becoming so intense that the teeth chatter and the patient shivers and shakes from head to foot. He now seeks to cover himself with all the wraps he can lay hands on. Vomiting may become distressing. The features are pinched, the skin blue and cold - looking, the fingers shriveled. The feeling of cold is entirely subjective; if the temperature be taken, it is found to be already several degrees above normal, and to be rapidly mounting. In young children it is not at all unusual to have a convulsive seizure at this stage; a fact that has to be borne in mind, as it is very apt to lead to ideas of epilepsy.

Hot stage- After a time the shivering gradually abates, giving place to , or alternating with, waves of warmth and , before long, to persistent feelings of intense heat and febrile distress. The wraps, which before were so eagerly hugged, are now tossed off; the face becomes flushed; the pulse is rapid, full, and bounding; headache may be intense; vomiting frequent; respiration hurried; the skin dry and burning; the thermometer mounting to 104°, 105°, 106°, or even higher.

Sweating stage — After one or more hours of acute distress, the patient breaks out into a profuse perspiration, the sweat literally running off him and saturating his clothes and bedding. With the appearance of diaphoresis, the fever rapidly declines; headache, vomiting, thirst, and febrile distress giving place to a feeling of relief and tranquility. By the time the sweating has ceased the patient may feel quite well; a little languid, perhaps, but able to go about his usual occupation. The bodily temperature is now often sub -normal and may remain so until the approach of the next fit one, two, or three days later.

Duration of the fit. - The duration of an ague fit and of its constituent stages is very variable. On an average it may be put at six to ten hours; the cold stage occupying about an hour, the hot stage from three to four hours, the sweating stage from two to four hours.

Manson, P. (1898). Tropical diseases. United Kingdom: W. Wood and Company.

Entered by: Bernardo Galvan, 6/20/2020

The measles generally attack children. On the first day they have chills and shivers, and are hot and cold in turns. On the second day they have the fever in full—disquietude, thirst, want of appetite, a white (but not a dry) tongue, slight cough, heaviness of the head and eyes, and somnolence. The nose and eyes run continually; and this is the surest sign of measles. To this may be added sneezing, a swelling of the eyelids a little before the eruption, vomiting and diarrhoea with green stools. These appear more especially during teething-time. The symptoms increase till the fourth day. Then—or sometimes on the fifth—there appear on the face and forehead small red spots, very like the bites of fleas. These increase in number, and cluster together, so as to mark the face with large red blotches. They are formed by small papulae, so slightly elevated above the skin, that their prominence can hardly be detected by the eye, but can just be felt by passing the fingers lightly across the skin. The spots take hold of the face first; from which they spread to the chest and belly, afterwards to the legs and ankles.

On these parts may be seen broad, red maculae, on, but not above, the level of the skin. In measles the eruption does not so thoroughly allay the other symptoms as in small-pox. There is, however, no vomiting after its appearance; nevertheless there is slight cough instead, which, with the fever and the difficulty of breathing, increases. There is also a running from the eyes, somnolence, and want of appetite. On the sixth day, or thereabouts, the forehead and face begin to grow rough, as the pustules die off, and as the skin breaks. Over the rest of the body, the blotches are both very broad and very red. About the eighth day they disappear from the face, and scarcely show on the rest of the body. On the ninth, there are none anywhere. On the face, however, and on the extremities—sometimes over the trunk—they peel off in thin, mealy squamulae; at which time the fever, the difficulty of breathing, and the cough are aggravated.

Sydenham, T. (1850). The Works of Thomas Sydenham, M.D. Volume II. London: Sydenham Society. Pg. 250-251.

Entered by: Sonia Y. Khan, 6/23/2020

In those which are more severe there are frequently prodromal symptoms of from twelve to forty-eight hours’ duration,-- anorexia, headache, vomiting, pains in the back and limbs, and fever. […] The initial temperature in a mild attack is 100° to 101°F; in severe one, from 102° to 104°F. Of the local symptoms, the pain usually precedes the swelling; it is increased by movement of the jaws, by pressure, and sometimes by the presence of acid substances in the mouth. It is usually referred to the posterior part of the jaw just below the ear.

The swelling may begin simultaneously in both parotids, but more frequently one side is involved a day or two in advance of the other. It usually reaches its maximum on the third day, often on the second, remains stationary for two or three days, then subsides gradually. The degree of swelling varies with the severity of the attack. When it is marked, the patient presents a ridiculous appearance and is scarcely recognizable; it fills the lateral region of the neck between the jaw and the sterno-mastoid muscle and extends forward upon the face of the zygomatic arch, so that the center of the tumor is usually the lobe of the ear. […] The salivary secretion is usually very much diminished, and the dry mouth causes great discomfort.

Holt, L Emmett. The Diseases of Infancy and Childhood: for the Use of Students and Practitioners of Medicine. Appleton and Co, 1897. Pg. 948-949

Entered by: Erin Choi, 6/25/2020

Edited by: Bernardo Galvan, 9/7/2020

A disease of warm climates […], affecting principally the foot, occasionally the hand, rarely other parts of the body, never the internal organs. It is characterised by enlargement of the part ; an oily degeneration and general fusion of the affected tissues ; the formation of cyst-like cavities communicating by sinuses, and containing peculiar mycotic aggregations in an oily purulent fluid which escapes from fistulous openings on the surface. The disease runs a slow course, is never recovered from spontaneously, and, unless removed, terminates after many years in death […]

Mycetoma begins usually, though by no means invariably, on the sole of the foot […] The first indication of the disease is the slow formation of a small, firm, rounded, somewhat hemispherical, slightly discoloured, painless swelling perhaps about a half an inch in diameter. After a month or more this swelling may often soften and rupture, discharging a peculiar viscid, syrupy, oily, slightly purulent, sometimes blood-streaked fluid, containing in suspension certain minute, rounded, greyish or yellowish particles, often compared to grains of fish roe. In other examples of the disease the particles in the discharge are black, having the size and appearance of grains of coarse gunpowder. Sometimes these particles are aggregated into larger masses up to the size of a pea. In time additional swellings, some of which break down and form similar sinuses, appear in the neighbourhood of the first or elsewhere about the foot. For the most part the sinuses are permanent, healing up in a very few instances only. Gradually the bulk of the foot increases to perhaps two to three times the normal volume. There is comparatively little lengthening of the foot ; but there is a general increase in thickness, so that in time the mass comes to assume an ovoid form, the sole of the anatomical parts obliterated. The toes may be forced apart, bent upwards at the tarso-phalangeal joints or otherwise misdirected ; so that, on the foot being placed on the ground, the toes do not touch it. The surface of the skin is roughened by a number of larger or smaller, firmer or softer, hemispherical elevations in some of which the orifices of the numerous sinuses open. Most of these orifices are easily made out ; others are not so apparent, there position being indicated and , at the same time, concealed by a bunch of pale, flabby, fungating, and but slightly vascular granulations. In the latter the orifice may be hard to find ; once the probe is got to a considerable depth, even to the bone. In advanced cases it can be carried through the soft tissues with the greatest of ease in almost any direction, and without causing much pain or hemorrhage.

[…] With a very few exceptions it contains either grey or the black grains already referred to, rarely similar bodies of a reddish or pink colour.

To the touch the swollen foot feels somewhat elastic, and does not readily pit on pressure. The sensibility of the skin is preserved. Although complained of in some instances, severe pain is rarely a prominent feature. The principal complaint is of inconvenience from the bulk and weight of the mass, and, in advanced cases, of the uselessness of the limb for locomotion. […]

Manson, P. (1898). Tropical Diseases: A Manual of the Diseases in Warmer Climates (pp. 568-572). William & Company.

Created/Entered by: Rachel Johnson, 07/22/2020

The presence of skin lesions, eye lesions and/or subcutaneous nodules in individuals who live in or have visited endemic areas strongly suggests the diagnosis of onchocerciasis. Pruritic oncho dermatitis must be distinguished from: infection with Mansonella streptocerca in West and Central Africa which rarely affects the legs; scabies, where the typical burrows and mites are often present between the fingers; reactions to insect bites that are especially common in recent arrivals to the tropics; prickly heat; contact dermatitis; and herpes zoster (unilateral, segmental) in AIDS patients.

Chronic onchocercal dermatitis must be differentiated from tertiary yaws, superficial mycoses, leprosy and chronic eczema. Onchocercal nodules are usually painless, firm and mobile. However, some nodules (particularly those on the head) may be fixed due to adherence to underlying tissues. Nodules must be distinguished from enlarged lymph nodes, lipomas, dermal cysts, ganglia and neurofibromas.

Simonsen, Paul & Fischer, Peter & Hoerauf, Achim & Weil, Gary. (2014). Manson's Tropical Diseases, 23rd Edition: The Filariases.

Entered by: Bernardo Galvan, 6/20/2020

“The symptoms of pertussis are usually divided into three stages—the catarrhal, the spasmodic, and the stage of decline. The catarrhal stage continues on the average for about ten days. […] Some children whoop almost from the very beginning of the disease, while others may cough for several weeks before a typical whoop is noticed. […] During the first stage there may be symptoms of a mild grade of catarrhal inflammation of the nose, pharynx, and larynx, and often there is a slight elevation of temperature.

The spasmodic stage— […] There now occurs a series of explosive coughs, from ten to twenty in number, coming in such rapid succession that the child cannot get its breath between them’ the face becomes a deep red or purple colour, sometimes almost black; the veins of the face and the scalp stand out prominently; the eyes are suffused, and seem almost to start from their sockets; there follows a long-drawn inspiration through the narrow glottis, producing the crowing sound known as the whoop; and then another succession of rapid coughs follows and another whoop. […] The most common attendant symptom of the paroxysm are vomiting and epistaxis. […]

The stage of decline—Gradually the severity of the paroxysm abates, and the whoop ceases, and the cough resembles more and more that of ordinary bronchitis. This stage usually continues about three weeks, but may be prolonged indefinitely in the winter months.”

Holt, L Emmett. The Diseases of Infancy and Childhood: for the Use of Students and Practitioners of Medicine. Appleton and Co, 1897. Pg. 938-940

Entered by: Erin Choi, 6/25/2020

Edited by: Bernardo Galvan, 9/7/2020

Dogs are especially liable to the disease. It also occurs in the wolf, fox, skunk, cat, horse and cow. Most animals are susceptible [...]. It is contained [...] in the saliva [...].

Three stages of the disease are recognized:

(a) Premonitory Stage, in which there may be irritation about the bite, pain, or numbness. The patient is depressed and melancholy; and complains of headache and loss of appetite. He is irritable and sleepless, and has a sense of impending danger. There is often greatly increased sensibility. A bright light or a loud voice is distressing. The larynx may be injected, the voice becoming husky, and the first symptoms of difficulty in swallowing are experienced. There is a slight rise in the temperature and pulse.

(b) Stage of Excitement. This is characterized by great excitability and restlessness, and an extreme degree of hyperaesthesia. “Any afferent stimulant—i.e., a sound or a draught of air, or the mere association of a verbal suggestion—will cause a violent, reflex spasm . . . . The spasms, which affect particularly the muscle of the larynx and mouth, are exceedingly painful and are accompanied by an intense sense of dyspnoea, even when the glottis is widely opened or tracheotomy has been performed", Any attempt to take water is followed by an intensely painful spasm of the muscles of larynx and of the elevators of the hyoid bone. It is this which makes the patient dread the very sight of water and gives the name hydrophobia to the disease. These spasmodic attacks may be associated with maniacal symptoms. In the intervals the patient is quiet and the mind unclouded. The temperature in this stage is usually elevated and may reach from 100o to 103o. In some instances the disease afebrile. The patient rarely attempts to injure his attendants, and in the intense spasms may be particularly anxious to avoid hurting any one. There are, however, occasional fits of furious mania, and the patient may, in the contractions of the muscles of the larynx and pharynx, give utterance to odd sounds. This stage lasts from a day and a half to three days and gradually passes into the—

(c) Paralytic Stage [...]. This stage rarely lasts longer than from six to eighteen hours. The patient becomes quiet; the spasms no longer occur; unconsciousness gradually supervenes; the heart’s actions becomes more and more enfeebled, and death occurs by syncope.”

Osler, W. (1892). The Principles and Practice of Medicine. New York and London: D. Appleton and Company. Pg. 359-360.

Entered by: Sonia Y. Khan, 6/26/2020

This exanthem has also the names of rubeola notha, or epidemic roseola, and, as it is supposed to present features common to both, has been also known as hybrid measles or hybrid scarlet fever. It is now generally regarded, however, as a separate and distinct affection.

Symptoms.—These are usually mild, and it is altogether a less serious affection than measles. Very exceptionally, as in the epidemics studied by Cheadle, the symptoms are severe.

The stage of incubation ranges from ten to twelve days.

In the stage of invasion there are chilliness, headache, pains in the back and legs, and coryza. There may be very slight fever. In 30 per cent of Edwards’s cases the temperature did not rise above 100°. The duration of this stage is somewhat variable. The rash usually appears on the first day, some writers say on the second, and others again give the duration of the stage of invasion as three days. Griffith places it at two days. The eruption comes out first on the face, then on the chest, and gradually extends so that within twenty-four hours it is scattered over the whole body. It may be the first symptom noted by the mother. The eruption consists of a number of round or oval, slightly raised spots, pinkish-red in color, usually discrete, but sometimes confluent.

There are no special complications. The disease usually progresses favorably; but in rare instances, as in those reported by Cheadle, the symptoms are of greater severity. Albuminuria may occur and even nephritis. pneumonia and colitis have been present in some epidemics. Icterus has been seen.
Diagnosis.—The mildness of the case, the slightness of the prodromal symptoms, the mildness or the absence of the fever, the more diffuse cervical glands, are the chief points of distinction between rotheln and measles. The treatment is that of a simple febrile affection. It is well to keep the child in bed, though this may be difficult, as the patient rarely feels ill.

Entered by: Kate Holder, 6/25/2020

This attacks infants most, and that towards the end of summer. Shivers and chills at the commencement; but no great depression. The whole skin is marked with small, red spots, more frequent, more diffused, and more red than in measles. These last two or three days. They then disappear; leaving the skin covered with branny squamulae, as if powdered with meal.

Sydenham, T. (1850). The Works of Thomas Sydenham, M.D. Volume II. London: Sydenham Society. Pg. 244.

Entered by: Sonia Y. Khan, 6/23/2020

The eruption of the small-pox is preceded by a continued fever, pain in the back, itching in the nose, and terrors in sleep. These are the more peculiar symptoms of its approach, especially a pain in the back, with fever ; then also a pricking in which the patient feels all over his body ; a fullness of the face, which at times goes and comes ; an inflamed colour, and vehement redness in both the cheeks ; a redness of both the eyes ; a heaviness of the whole body ; great uneasiness, the symptoms of which are stretching and yawning ; a pain in the throat and chest, with a slight difficulty in breathing, and couch ; a dryness of the mouth, thick spittle, and hoarseness of the voice ; pain and heaviness of the head ; inquietude, distress of mind, nausea, and anxiety ; […] heat of the whole body, an inflamed colour, and shining redness, and especially an intense redness of the gums.

Rhazes (1848). A Treatise on the Small-pox and Measles. (Greenhill, W. A. Trans.). United Kingdom: Sydenham Society. (Original work written 910 AD)

Created by: Sara Ahmed, 06/08/2021

Entered by: Rachel Johnson, 07/19/2021

The first sign of thrush is the formation of small, whitish points on the tip and the edge of the tongue and on the inner surface of the lips , places on which desquamation of the mucous membrane is favored by the act of sucking. The points grow into patches of varying size, and may cover the entire inner surface of the mouth like a coat of plaster. In some cases the disease extends to the œsophagus and stomach; the nose and larynx may also be affected, rarely even the vulva. The patches consist of mycelial threads and epithelial cells, with leukocytes in small numbers. The mucosa is red and bleeds easily if the patches are forcibly detached. […] There may be slight fever and restlessness; an eczema of the buttocks is sometimes produced […]

Osler, W. (1908). The Principles and Practice of Medicine. (pp. 49-51). New York and London: D. Appleton and Company.

Created by: Sonia Khan, 09/30/2021

Entered by: Rachel Johnson, 11/30/2021

[...] Existing encapsulated in the muscles of swine, if lean pork be eaten either raw or imperfectly cooked, the worms are set free withinthe stomach and intestines.

[...] After the ingestion of trichinous pork, there are no marked symptoms until the production of offspring by the parasites introduced with the food. The new brood appears within a week after the introduction of the parents. The disease commences with the emigration of the young worms, that is, their passage into the mucous membrane. They begin to leave the alimentary canal a few days after birth. A chill, or repeated chilly sensations, may precede and accompany the gastric pain or uneasiness, anorexia, then nausea, and sometimes vomiting, which are the symptoms referable to the digestive system. With these symptoms are associated rise of temperature and increase of the frequency of the pulse. Diarrhea speedily follows, generally preceded by constipation. After a few days, muscular pains are prominent. The muscles of the extremities are painful, especially on extension, so that a flexed position is maintained. The muscles are also tender to touch and swollen. In severe cases the suffering from muscular pain is great. There is notable increase of the intensity of the fever. Edema of the face and limbs is a very constant symptom. Profuse sweating occurs in the great majority of cases. In some cases dyspnea is a prominent symptom, arising from the presence of trichinae in the diaphragm and intercostal muscles. This may prove the immediate cause of death. Their presence in the muscles of the larynx may cause more or less impairment of voice or complete aphonia. Impaired hearing may be caused by the presence of trichinae in the stapedius muscle. Movement of the eyeball are sometimes painful from the presence of the parasites in the ocular muscles. Herpetic and pustular eruptions during the progress of the disease are not uncommon.

Flint, A. (1879). Clinical Medicine: A Systemic Treatise on the Diagnosis and Treatment of Diseases (pp. 365-366). Philadelphia: H. C. Lea.

Created by: Taha Jilani, 06/23/2021

Entered by: Rachel Johnson, 11/05/2021

Long standing, chronic irregular fever with occasional intervals of complete apyrexia. The temperature rises in the evening to 100° F or 101° F, occasionally higher, and the morning drops to normal or sub-normal. The pulse is rapid and feeble, and intense muscular weakness, palpitations, and breathlessness. Patches of ill-defined erythema irregularly distributed over limbs and trunk. Some of the patches have a distinctly ringed appearance and may be seven or eight inches in diameter; other patches, some as large as the palm of the hand, are not circinate, being simply uniform blotches of congestion. In neither rings nor patches are the margins of the erythema abruptly defined; they shade off gradually into normal skin. The presence of areas of slight or of more pronounced oedema, especially about the face and lower eyelids. Such localized oedemas occur in other parts of the body, but they are especially noticeable in the face. Enlargement of the lymphatic glands, particularly of the cervical glands. These vary in size from that of a pea to almost that of a walnut, and, especially when large, may be painful. Tendency to tachycardia. Headache. Splenomegaly may or may not be present.

Manson, P. (1905). Lectures on Tropical Diseases: Being the Lane Lectures for 1905 Delivered at Cooper Medical College, San Francisco, U.S.A. August 1905. United Kingdom: Keener.

Entered by: Bernardo Galvan, 6/20/2020

This is a specific infectious disease due to Bacterium tularense, transmitted from rodents to man by insects (fly, lice, flea, and bed-bug) or acquired in handling infected animals. […] The disease in animals affects rabbits particularly but squirrels have also been found to suffer from it.

The insect bite may not be noticed until about the third day when necrosis appears followed by a small ulcer which leaves a permanent scar. The related lymph-glands show rapid involvement and in a number of cases suppuration results. The occurrence of conjunctival ulcers have been mentioned. The general features are chills, fever which may be high and with daily remissions, marked prostration, a course of several weeks with weakness, often striking during convalescence.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (10th ed, pp. 232). New York: D. Appleton & Company.

Created by: Taha Jilani, 06/09/2021

Entered by: Rachel Johnson, 07/13/2021

Incubation— […] As a rule, however, the invasion is abrupt and marked by chills or a single rigor, followed by fever. The chills may recur during the first few days, and there is headache with pains in the back and legs. There is early prostration, and the patient is glad to take to his bed at once. The temperature is high at first, and may attain its maximum on the second or third day. […] The face is flushed, the eyes are congested, the expression is dull and stupid. Vomiting may be a distressing symptom. In severe cases mental symptoms are present from the outset, either a mild febrile delirium or an excited, active, almost maniacal condition. Bronchial catarrh is common. […]

Stage of Eruption— From the third to the fifth day the eruption appears — first upon the abdomen and upper part of the chest, and then upon the extremities and face ; developing so rapidly that in two or three days it is all out. There are two elements in the eruption : a subcuticular mottling, “ a fine, irregular, dusky red mottling, as if below the surface of the skin some little distance, and seen through a semi-opaque medium. ” (Buchanan); and distinct papular rose-spots which change to petechiae. […] Collie describes the rash as consisting of three parts -rose-colored spots which disappear on pressure, dark-red spots which are modified by pressure, and petechias upon which pressure produces no effect. […] During the second week the general symptoms are usually much aggravated. The prostration becomes more marked, the delirium more intense, and the fever rises. The patient lies on his back with a dull expressionless face, flushed cheeks, injected conjunctivae, and contracted pupils. The pulse increases in frequency and is feebler, the face is dusky, and the condition becomes more serious. […] Comavigil is frequent, a condition in which the patient lies with open eyes, but quite unconscious. Subsultus tendinum and picking at the bedclothes are frequently seen. […] In favorable cases, about the end of the second week occurs the crisis, in which, often after a deep sleep, the patient awakes feeling much better and with a clear mind. The temperature falls, and although the prostration may be extreme, convalescence is rapid and relapse very rare. This abrupt termination by crisis is in striking contrast to the mode of termination in typhoid fever.

Entered by: Kate Holder, 6/24/2020

Edited by Erin Choi, 7/8/2020

After a period of incubation of ten or fifteen days the child becomes feverish and in some instances has a slight chill. There may be vomiting and pains in the back and legs. Convulsions are rare. The eruption usually develops within twenty-four hours. It is first seen upon the trunk, either on the back or on the chest. I have seen it, however, appear first on the forehead and face. At first in the form of raised red papules, they are in a few hours transformed into hemispherical vesicles containing a clear or turbid fluid. There is no umbilication as in the vesicles in small-pox. They are often ovoid in shape and look more superficial than the variolous vesicles. […] At the end of thirty-six or forty-eight hours the contents of the vesicles are purulent. They begin to shrivel and during the third and fourth days are converted into dark brownish crusts, which fall off and as a rule leave no scar. Fresh crops appear during the first two or three days of the illness, so that on the fourth day one can usually see pocks in all stages of development and decay. They are always discrete and the number may vary from eight or ten to several hundreds. As in variola, a scarlatinal rash occasionally precedds the development of the eruption. […]

The vesicles may become very large and develop into regular bullae, looking not unlike ecythema. The irritation of the rash may be excessive, and if the child scratches the pocks ulcerating sores may form, which on healing leave ugly scars. Indeed, cicatrices after chicken-pox are not so very uncommon. They are in my experience more common than after varioloid. The fever in varicella is slight, but it does not as a rule disappear with the appearance of the rash. […] There are one of two interesting complications of chicken-pox. In delicate children, particularly the tuberculous, gangrene may occur about the vesicles (Abercrombie). Cases have been described (Andrew) of haemorrhagic varicella with cutaneous ecchymoses and bleeding from the mucous membranes. Nephritis may occur. Infantile hemiplegia has developed during an attack of the disease.

Osler, W. (1892). The Principles and Practice of Medicine. New York: D. Appleton & Company. Pg. 65-66

Entered by: Ayushi Chintakayala, 6/12/2020

Acute Febrile Icterus—In 1886 Weil described an acute infectious disease, characterized by fever and jaundice. Much discussion has taken place concerning the true nature of this affection, but it has not been definitely determined whether it is a specific disease or only a jaundice which may be due to various causes. The majority of the cases have occurred during the summer months. The eases have occurred in groups in different cities. A few cases have been reported in this country (Lanphear). Males are most frequently affected. Many of the cases have been in butchers. The age of the patients has been from twenty-five to forty.

The disease sets in abruptly, usually without prodromata and often with a chill. There are headache, pains in the back, and sometimes intense pains in the legs and muscles. The fever is characterized by marked remissions. Jaundice appears early. The liver and spleen are usually swollen; the former may be tender. The jaundice may be light, but in many of the cases described it has been of the obstructive form, and the stools have been clay colored. Gastro-intestinal symptoms are rarely present. The fever lasts from ten to fourteen days; sometimes there are slight recurrences, but a definite relapse is rare.

Albumen is usually present in the urine; haematuria has occurred in some cases.

Cerebral symptoms, delirium and coma, have been met.

In the few post-mortems which have been made nothing distinctive been found. Its occurrence as an independent malady, apart from other infectious processes, has scarcely yet been definitely established.

Entered by: Kate Holder, 6/25/2020

In yaws there is an incubation stage of very variable duration – two weeks to six months (9-90 days) – the appearance of the characteristic eruptions being preceded by a certain amount of constitutional disturbance. The intensity of the general symptoms varies within wide limits. Sometimes they are hardly perceivable and are not complained of ; usually there is a well-marked malaise with rheumatic pain. […]

Stage of furfuraceous desquamation- The skin becomes harsh and dry, loses its natural gloss, and here and there patches of light-coloured, very fine furfuraceous desquamation, best appreciated with the aid of a lens, are formed. These patches are usually small and circular ; occasionally they are oval, irregular, or form rings encircling islets of healthy skin. There extent and number are very uncertain. They are mostly scattered irregularly over limbs and trunk ; but occasionally they may be almost confluent, the patches coalescing and giving rise to an appearance as if the entire skin had been dusted over with flour. On the other hand, thus furfuraceous desquamation may be so slight as to be overlooked. In other instances it may be very marked ; the heaping up of desquamating epidermic scales producing white marks […]

This patchy, furfuraceous condition of the skin occurs not only at the early stages of yaws, but it may persist throughout the attack, or reappear as a fresh eruption at any period of the disease.

The yaw- When the furfuraceous patches have been in existence for a few days minute papules appear in them . Describing these papules, Dr. Nicholls remarks that, in examining them with a lens, “they are seen to be apparently pushed up from the rete malpighii through the horny epidermidis, which breaks over their summits and splits in lines radiating from the centre, the necrosed segments curling aware from the increasing papule. When the papules become about a millimeter in height and breadth, a yellow point may be observed on the summitis… consisting not of a drop of pus under the epidermidis… but of a naked, cheesy-looking substance. Which cannot be wiped away unless undue force be used.” […]

The papule, having arrived at this stage, may either cease to grow, the apex becoming depressed, cupped, and lined with the yellow cheesy material alluded to ; or it may go on, increasing in size, to the formation of a typical yaw. In the latter case the lesion gradually grows into a rounded excrescence, the yellow material at the top widening out as to form a complete cap encrusting the little tumour. […] Several yaws may coalesce, and together cover a large irregular surface […] The mouth and anus are favourable sites for coalescent yaws ; in such situations the moisture of the parts softens and removes the crust wholly or in part, so that the surface, in addition to being fissured, may more or less bare, sodden, and fungoid.

[…] At first the crust is somewhat moist, but gradually it becomes dry, brown, and black even. The crusts are firmly adherent, requiring some force to remove them ; a proceeding which, though painless, may entail a little oozing of blood. […] Immediately after removal of the crust, the exposed surface begins to pour out pale, yellowish-grey, viscid fluid […]

Ulceration – Such is the normal process of evolution and involution of yaw. […] But it sometimes happens that the tumours […] break down and ulcerate, the ulceration, however, being confined to the yaw itself. In other instances ulceration goes deeper and extends laterally, giving rise to extensive sores with subsequent cicatricial contractions. […]

Manson, P. (1898). Tropical Diseases: A Manual of the Diseases in Warmer Climates (pp. 523-528). William & Company.

Created/Entered by: Rachel Johnson, 07/22/2020

 There may be an initial onset of sudden rigor, slight chills, or premonitory malaise leading up to the more pronounced symptoms. […] Roughly speaking, and provided there are no complications, an attack of yellow fever is divisible into three stages: 1. The initial fever; 2, “ the period of calm ,” as it is called; and 3, in severe cases, the period of reaction. The initial fever lasts usually from three to four days. The maximum temperature is generally attained within the first 24-48hrs and, in a case of medium severity, may rise to about 103° to 104° F. […] With, or soon after, the initial chill or rigor severe headache sets in, and is generally a prominent feature. For the most part the pain is concentrated about the forehead, in the circumorbital region, and in the eyeballs themselves. In many cases it is associated with intolerance of light. […] The face is flushed and swollen; the eyes are shining, injected, and ferrety; the skin is dry; and what with pain and febrile distress, the patient rapidly passes into a very miserable condition. […] At the outset, the tongue is not very dirty, but it soon acquires a white coating on the dorsum, the edges remaining clean. […] This is regarded as an important diagnostic mark; taken along with the progressive diminution in the strength and frequency of the pulse, and the peculiar behavior of the temperature, it is nearly conclusive as to the disease being yellow fever. […] The palate is congested and swollen; the gums may also swell and bleed. […] By the third day the sclera assumes a yellowish tinge, and very often the skin acquires the yellow color from which the disease derives its name. […] In the second stage, diarrhea, perhaps of black material resembling the vomit, may supervene; or there may be actual hemorrhage of bright red blood from the bowel. […] Sometimes pure blood is thrown up from the stomach; similar passive hemorrhages may take place from almost any part of the body — from eyes, ears, nose, mouth, bladder, uterus, and so on. […] In severe cases, the stage of reaction, in which the temperature again rises, though not to so high a point as in the initial fever, and a sort of remitting fever of an adynamic type keeps on for several days or weeks. […] The icterus is now very pronounced; black vomit may recur or appear for the first time; perhaps a profuse diarrhea ends in collapse; or the urine may be suppressed, stupor, coma, and other nervous symptoms ensuing, and very often ending in death.

Entered by: Bernardo Galvan, 6/16/2020

Edited by: Erin Choi 7/6/2020