An ordinary malaria? Intermittent fever in Denmark, 1826-1886.

Intermittent fever is a historical diagnosis with a contested meaning. Historians have associated it with both benign malaria and severe epidemics during the Early Modern Era and early nineteenth century. Where other older medical diagnoses perished under changing medical paradigms, intermittent fever 'survived' into the twentieth century. This article studies the development in how intermittent fever was framed in Denmark between 1826 and 1886 through terminology, clinical symptoms and aetiology. In the 1820s and 1830s, intermittent fever was a broad disease category, which the diagnosis 'koldfeber'. Danish physicians were inspired by Hippocratic teachings in the early nineteenth century, and patients were seen as having unique constitutions. For that reason, intermittent fevers presented itself as both benign and severe with a broad spectrum of clinical symptoms. As the Parisian school gradually replaced humoral pathology in the mid-nineteenth century, intermittent fever and koldfeber became synonymous for one disease condition with a nosography that resembles modern malaria. The nosography of intermittent fever remained consistent throughout the second half of the nineteenth century. Although intermittent fever was conceptualized as caused by miasmas throughout most of the nineteenth century, the discovery of the Plasmodium parasite in 1880 led to a change in the conceptualization of what miasmas were. The article concludes that the development of how intermittent fever was framed follows the changing scientific paradigms that shaped Danish medicine in the nineteenth century.

The scorching tropics: fevers and public health in Brazil during the Joanine period, 1808-1821. / Ardentes trópicos: febres e saúde pública no Brasil joanino.

Although fevers (with the exception of yellow fever) have not yet been fully explored by the historiography of Brazilian health, they were almost inevitable in nineteenth-century Brazilian society, affecting huge portions of the population. Their victims suffered from a wide variety of symptoms, and identification and treatment of these symptoms were the object of intense debates in medical circles. The Luso-Brazilian intelligentsia considered European medical debates as well as their own clinical experiences and attempted to provide answers in a flurry of publications. Even so, the manifestations of fever in the tropics presented a challenge that lay beyond their European training, forcing them to combine experiences acquired in different parts of the Empire to comprise specific knowledge on tropical fevers.

Com exceção da febre amarela, as febres ainda foram pouco exploradas pela historiografia da saúde brasileira. No século XIX, contudo, sua presença na vida social era quase incontornável, atingindo enormes parcelas da população. Suas vítimas padeciam de uma grande variedade de sintomas em que a identificação e a terapêutica eram objeto de intensos debates nos círculos médicos. A intelectualidade luso-brasileira, atenta tanto aos debates médicos europeus quanto a experiências clínicas, esforçou-se para fornecer respostas na forma de intensa produção impressa; no entanto, as manifestações febris encontradas nos trópicos representavam um desafio extra à sua formação europeia, forçando-a a conjugar experiências adquiridas em partes distintas do Império na constituição de saberes específicos sobre as febres tropicais.

Ardentes trópicos: febres e saúde pública no Brasil joanino / The scorching tropics: fevers and public health in Brazil during the Joanine period, 1808-1821

Resumo Com exceção da febre amarela, as febres ainda foram pouco exploradas pela historiografia da saúde brasileira. No século XIX, contudo, sua presença na vida social era quase incontornável, atingindo enormes parcelas da população. Suas vítimas padeciam de uma grande variedade de sintomas em que a identificação e a terapêutica eram objeto de intensos debates nos círculos médicos. A intelectualidade luso-brasileira, atenta tanto aos debates médicos europeus quanto a experiências clínicas, esforçou-se para fornecer respostas na forma de intensa produção impressa; no entanto, as manifestações febris encontradas nos trópicos representavam um desafio extra à sua formação europeia, forçando-a a conjugar experiências adquiridas em partes distintas do Império na constituição de saberes específicos sobre as febres tropicais.

Abstract Although fevers (with the exception of yellow fever) have not yet been fully explored by the historiography of Brazilian health, they were almost inevitable in nineteenth-century Brazilian society, affecting huge portions of the population. Their victims suffered from a wide variety of symptoms, and identification and treatment of these symptoms were the object of intense debates in medical circles. The Luso-Brazilian intelligentsia considered European medical debates as well as their own clinical experiences and attempted to provide answers in a flurry of publications. Even so, the manifestations of fever in the tropics presented a challenge that lay beyond their European training, forcing them to combine experiences acquired in different parts of the Empire to comprise specific knowledge on tropical fevers.

Bartonella quintana, past, present, and future of the scourge of World War I.

During World War I, a mysterious new disease affected soldiers on both sides of battle field. The first reports described a relapsing fever of unknown origin with body lice being suggested as the vector. The outbreak affected >1 000 000 people, mostly soldiers fighting in front-line trenches. Shortly afterward, the illness was known as Trench fever, of which the causal infectious agent is currently classified as Bartonella quintana.

Facing the ongoing challenge of the febrile young infant.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2017. Other selected articles can be found online at http://ccforum.com/series/annualupdate2017 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .

In Carthage ruins: the illness of Sir Winston Churchill at Carthage, December 1943.

This paper reviews Churchill's illness in Carthage in December 1943. It was characterised by fever that lasted 6 days, left lower lobe pneumonia and two episodes of atrial fibrillation. He was managed in a private villa by Lord Moran, his personal physician, with the assistance of two nurses and the expert advice of colleagues. Sulphadiazine and digitalis leaf were prescribed and Churchill recovered. It is remarkable that, despite the severity of his illness, he continued to direct the affairs of State from his bed.

van Helmont's proposal for a randomised comparison of treating fevers with or without bloodletting and purging.

Around the year 1643, Joan Baptista van Helmont, a Flemish chemist, alchemist and physician who had devised what he claimed to be a new form of medicine, proposed a 'challenge' to traditional Galenic physicians to compare treatment of fever by traditional methods and by a regime which did not involve bloodletting and purging. Two groups of patients were to be treated and 'casting of lots' was to be used - in some way not specified in detail - to decide who received which treatment. This 'challenge' has been regarded as the first proposal for the use of randomisation in a clinical trial. This paper explains the background to the challenge and discusses what can be deduced from Helmont's text about the details of how he proposed that the 'trial' was to be carried out. It concludes that internal evidence in Helmont's writings makes it certain that no such 'trial' was ever conducted. It seems that the 'challenge' was probably a rhetorical device to support Helmont's vehement criticism of traditional Galenic medicine and its practitioners, and, in particular, toemphasise his absolute opposition to the use of bloodletting as a medicaltreatment. An appendix includes a short summary of Helmont's theories of the origins of disease and transcriptions of the passages of Helmont's Latin text translated in the article.

Human Brucellosis in Febrile Patients Seeking Treatment at Remote Hospitals, Northeastern Kenya, 2014-2015.

During 2014-2015, patients in northeastern Kenya were assessed for brucellosis and characteristics that might help clinicians identify brucellosis. Among 146 confirmed brucellosis patients, 29 (20%) had negative serologic tests. No clinical feature was a good indicator of infection, which was associated with animal contact and drinking raw milk.

Early evolution of the thermometer and application to clinical medicine.

By the time of Hippocrates and Galen the notion of fevers and temperature were known. Through ensuing centuries, ancient Greek, Roman, and medieval savants and physicians made additional contributions to the understanding of fever, temperature, and thermometry. By the end of that era, there was a working definition of what constitutes a rationale temperature scale, the distinction between fever as a symptom and fever as a disease, an elaborate classification scheme for temperature, hypotheses as to the causes of fever, and methods for measuring fevers. Based on the definition of fever at that time, the 16th century scientist Galileo promulgated production of thermometric instruments hundreds of years before they were routinely used in the clinical setting. In this work we examine the history of fever and clinical thermometry in the ancient world through the end of the eighteenth century with descriptions of instruments for its measure and human relationship to fever.

Magical-medical prescriptions against fever: an edition of BM 42272.

Containing twenty prescriptions, the Neo- or Late-Babylonian tablet edited here is one of the most comprehensive sources for the phylacteries against fever. Although a duplicate of the whole text is yet unknown to me, several parallels or text variants of the single prescriptions can be identified in the published and unpuplished medical tablets from A9sur and Ninive. In the present paper I transliterate and translate the tablet, with special attention to the fever prescriptions and their parallels?

Tropical Colonial Ports: Shifting concepts, 1500s-1800s

Based on a study of the history of exploration and settlement in North Australia in the 18th and 19th centuries, I became particularly interested in the concept of a 'good port' in the tropics and how in time this concept shifted. The threat of fevers played a significant part in these shifts. In this overview, I examine how similar shifts in the concept of a good port occurred in the maritime silk and spice routes of South and Shout East Asia.

[Preliminarily analysis on traditional Chinese medicine advices in Treatise on Febrile Diseases].

To make a systematic analysis on literatures concerning traditional Chinese medicine (TCM) advices in Treatise on Febrile Diseases, and summarize the main connotations of traditional Chinese medicine advices, relevant TCM advices in Treatise on Febrile Diseases were collected, screened, compared, summarized and analyzed according to TCM dosage form preparation methods, TCM administration methods, medication contraindications and nursing after TCM administration. The literatures concerning medications in Treatise on Febrile Diseases were consulted, summarized and compared to standardize medicine advices and facilitate rational clinical application of TCMs. The standard medicine advices were as follows. The boiling water for TCMs shall be tap water and well water. The decoctions that have effects in promoting blood and meridians can be boiled with wine. The decoctions containing toxic components can be boiled with honey. Some TCMs shall be boiled with special methods, e. g. Herba Ephedra that could be boiled before other medicine and skimmed. Japonica rice could be added in decoctions to measure the duration of decoctions. Different dosages were required for different forms (litre, pill, medicine spoon). Administration times, temperature and frequency shall be adjusted according to target positions, functions and stage of illness. As for dietary contraindications during medication, thick porridges are recommended, where foods impacting medicine efficacy are prohibited. Regarding nursing after medication is important to recover physical functions, particularly warm porridges can go with diaphoretic recipes, while thick porridges can go with purgative recipes. And drug efficacies shall be defined by observing urine and excrements, and blood form. In conclusion, Treatise on Febrile Diseases is the first book that discusses TCM advices and records them in details. In this study, new standard medicine advices were proposed to provide important basis for improving clinical advices of TCMs and supports for developing the TCM dispensing technology.

Performance in the heat-physiological factors of importance for hyperthermia-induced fatigue.

This article presents a historical overview and an up-to-date review of hyperthermia-induced fatigue during exercise in the heat. Exercise in the heat is associated with a thermoregulatory burden which mediates cardiovascular challenges and influence the cerebral function, increase the pulmonary ventilation, and alter muscle metabolism; which all potentially may contribute to fatigue and impair the ability to sustain power output during aerobic exercise. For maximal intensity exercise, the performance impairment is clearly influenced by cardiovascular limitations to simultaneously support thermoregulation and oxygen delivery to the active skeletal muscle. In contrast, during submaximal intensity exercise at a fixed intensity, muscle blood flow and oxygen consumption remain unchanged and the potential influence from cardiovascular stressing and/or high skin temperature is not related to decreased oxygen delivery to the skeletal muscles. Regardless, performance is markedly deteriorated and exercise-induced hyperthermia is associated with central fatigue as indicated by impaired ability to sustain maximal muscle activation during sustained contractions. The central fatigue appears to be influenced by neurotransmitter activity of the dopaminergic system, but inhibitory signals from thermoreceptors arising secondary to the elevated core, muscle and skin temperatures and augmented afferent feedback from the increased ventilation and the cardiovascular stressing (perhaps baroreceptor sensing of blood pressure stability) and metabolic alterations within the skeletal muscles are likely all factors of importance for afferent feedback to mediate hyperthermia-induced fatigue during submaximal intensity exercise. Taking all the potential factors into account, we propose an integrative model that may help understanding the interplay among factors, but also acknowledging that the influence from a given factor depends on the exercise hyperthermia situation.

Typhoid Fever in nineteenth-century Colombia: between medical geography and bacteriology.

This paper analyses how the Colombian medical elites made sense of typhoid fever before and during the inception of bacteriological ideas and practices in the second half of the nineteenth century. Assuming that the identity of typhoid fever has to be understood within the broader concerns of the medical community in question, I show how doctors first identified Bogotá's epidemics as typhoid fever during the 1850s, and how they also attached specificity to the fever amongst other continuous fevers, such as its European and North American counterparts. I also found that, in contrast with the discussions amongst their colleagues from other countries, debates about typhoid fever in 1860-70 among doctors in Colombia were framed within the medico-geographical scheme and strongly shaped by the fear of typhoid fever appearing alongside 'paludic' fevers in the highlands. By arguing in medico-geographical and clinical terms that typhoid fever had specificity in Colombia, and by denying the medico-geographical law of antagonism between typhoid and paludic fevers proposed by the Frenchman Charles Boudin, Colombian doctors managed to question European knowledge and claimed that typhoid fever had distinct features in Colombia. The focus on paludic and typhoid fevers in the highlands might explain why the bacteriological aetiology of typhoid fever was ignored and even contested during the 1880s. Anti-Pasteurian arguments were raised against its germ identity and some physicians even supported the idea of spontaneous origin of the disease. By the 1890s, Pasteurian knowledge had come to shape clinical and hygienic practices.

[Institutional iatrogeny and maternal death: Semmelweis and puerperal fever]. / Iatrogenia institucional y muerte materna: Semmelweis y la fiebre puerperal.

Puerperal fever is a disease that becomes epidemic in the eighteenth century as a result of two factors: the urban working masses generated by the industrial revolution and the progressive hegemonization and medicalization of birth care in large public hospitals. Institutionalized maternal death reached figures above 30%, while in the case of birth care provided by midwives, it was than 2%. Semmelweis, an Hungarian physician, sustained that physicians contaminated women in labor due to insufficient hygiene after performing necropsies and established prophylactic measures in the Vienna Hospital that reduced mortality dramatically. However, his ideas were rejected because they affected the institutionalization process of medicine, based on altruism and honor, which would make it impossible to cause harm to patients. He was forced to leave Vienna Hospital and he continued his struggle in Budapest, but the rejection and disagreement of his peers with his doctrine affected his mental health. He died in an asylum, a few years before Pasteur and Koch proved the existence of the bacteria that caused diseases such as puerperal fever.