A dictionary of medicine : including general pathology, general therapeutics, hygiene, and the diseases peculiar to women and children

PART II. Macule to Zyme and appendix

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LONGMANS, GEEEN, AND CO.

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MAOXTIi^ {macula, a spot or stain). — Stnon. : Fr. Mamies ; Ger. Flecke.

Description. — Willan's definition of macula is 'a permanent discoloration of some portion of the skin;' and that author adopted ^he term as the title of his eighth order of cutaneous affections, including sunburn, ncevus, and spilus. The term macula is likewise applied to a hypersemic state of the skin, which may be simply chronic without being permanent, such as those which have received the name of maoula syphilitica. Maculse, therefore, may be merely pigmentary, and located in the rete mucosiim alone ; or they may be haemostatic or hsemorrhagic, and be seated in the derma and subcutaneous tissues. Sunburn, freckles, liver-spot, bronzed and melasmic spots, and the stains left on the skin after the dispersion of certain cutaneous eruptions, such as lepra vulgaris, acne, lichen planus, syphilis, and elephantiasis, are examples of pigmentary maculse, whilst leucosmic spots and blotches represent an absence of pigment. The maculse resulting from a permanent hyperaemia of the blood-vessels of the skin, such as flat vascular nseviand the claret-stain nserus, are haemostatic and disappear underpressure; whilst the haemorrhagic maculse are represented by the escape of the red corpuscles of the blood from the vessels, and their diffusion in the connective tissues, such as occurs in purpiu'a and in bruises.

Treatment. — The therapeutics of maculse wiU be found treated of under the heads of pigmentary affections of the skin, and of the respective diseases with which they are associated.

Erasmus Wilson.

MADEIBA; North Atlantic Ocean.— Moist, mild, equable, relaxing climate. Mean temperature in winter, 60'6° Fahr. Prevailing wind N.E. See Climate, Treatment of Disease by.

MADNESS. See Insanity.

MADtTEA-FOOT. — A synonym for fungus-foot of India. See Ftjngus-Diskase of India.

MAGGOTS. — A popular term for the parasitic larvae of various insects, including bots. See OEstrus.

MAGNETISM, ANIMAL.— This name was formerly applied to the imaginary now force or principle, supposed to be akin to magnetism, and to be in operation when individuals were 'mesmerised.' This hypothetical new force was thought to be called into play by the mesmeriser ; and it was deemed to be by virtue of its influence that the will, thoughts, and actions of the ' medium,' or person mesmerised, are capable of being influenced in the so-called mesmeric trance or sleep. This view as to the nature of the causal conditions is now regarded as altogether erroneous, although certain remarkable effects appep.r to have been produced on many persons by so-called ' mesmeric passes,' or other means, owing to the induction in such persons, under physiological conditions, of some at present imperfectly understood state or modification of cerebral activity {sec Mesjdsrism). This state is now generally spoken of as the 'hypnotic condition,' ' hypnotic sleep,' or ' hypnotism '; or more rarely as ' induced somnambulism.' On the other hand, when such a state is induced, as a therapeutic means or agency, it has been spoken of as ' Braidism.' See Braidism.

H. Charlton Bastlan.

MALACOSIS {fiaXaKhs, soft).— A term for the morbid softening of structures. See Softeninb.

MAIiACOSTEON {iiaXaxhs, soft, and omiov, a bone). — A peculiar disease of bone, characterised by softening. See Mollities Ossium.

MALAGA, in South, of Spain. — Dry, mild, bracing, equable climate. Mean temperature in winter, 56° Fahr. Winds : N.W. (Terral), dry and dusty ; E. (Levanie), cold and damp. Drawbacks : bad drainage and cookery. See Climate, Treatment of Disease by.

MALAISE (Fr.) — Stnon. : Indisposition; Ger. Missbefinden. — In cases of simple digestive derangement, in ague, and in the stage of invasion of many acute diseases, the patient very commonly first becomes aware that his health is disturbed by a feeling of general illness, which is known as malaise. •

Description. — Under the circumstances just mentioned, the ordinarily unconscious feeling of being well, or bien-etre, which accompanies perfect health, is replaced by a painful and depressing feeling, which the patient probably cannot describe otherwise than as a sense of being weak, languid, listless, and disinclined to bodily or mental exertion. Malaise is commonly associated with bodily debility, chilliness or ^ actual rigors, moderate pyrexia, general pains or aches, giddiness, headache, and anorexia. In the course of the more serious diseases in which it occurs, malaise either passes off or soon gives place to more urgent symptoms — such as depres sion, apathy, delirium, or stupor ; but in other instances it persists, and constitutes the chief subjective phenomenon of the disease, as in some cases of typhoid fever.

Treatment. — The treatment of malaise will depend upon the nature of the cause of the feelings just described, and should be directed to its removal or remedy. J. Mitchell Bruce.

MALABIA (Ital.).— Stnon. : Marsh Miasm. ; Fr. Mauvais Air ; Intoxication des Marais ; Intoxication Tellurique; Ger. Malaria.

Definition. — An earthborn poison, generated in soils the energies of which are not expended in the growth and sustenance of healthy vegetation. By almost universal consent this poison is thfl cause of all the types of intermittent and 3 N remittent fevers, commonly called malarial, and of the degeneration of the blood and tissues ro- Bultiug from long resilience in places where this poison is generated.

The Italian word malaria is now employed to convey the meaning expressed in the above definition, it is certoinly preferable to the term 7narsh miasm, which impUes that marshes are the sole source of the poison. M. Uon Colin, Professor of MiliUry Medicine in the Val-de-Grace, who has written an instructive work on malarial fevers, does not use the term malaria to distinguish the agent that causes them ; he prefers the term telluric poison, intoxication tellurique, proceeding from the energy of the soil, when that energy is not absorbed by its natural consumers, crops OP plants— in a word, healthy vegetation. This telluric influence or poison is, however, after all, a malaria, a bad or poisonous air under another name.

Essential Nature. — Chemists have not been able to demonstrate the presence of a malaria — a fever-generating agent—in the air of marshes, any more than they have been able so to do in other places where the same fevers prevail. Much light has, however, been thrown upon the intimate nature of the malarial poison, by the researches of Professors Tommasi Crudeli, of Eome, and Klebs, of Prague, who made the physical cause or poison to which malarial fevers are due the subject of careful investigation in the Agro Romano, in the spring season of 1879. They examined minutely the lower strata of the atmosphere of the district in question., as well as its soil and stagnant waters; and in the two former they discovered ' a microscopic fungus, consisting of numerous movable shining spores, of a longish oval shape, and nine micromillimetres in diameter. This fungus was afterwards artiflcially generated in various kinds of soil; the fluid matter thus obtained was filtered, and repeatedly washed ; and the residuum left after filtration was introduced under the skin of healthy dogs. The same thing was done with the microscopical particles obtained by washing large quantities of the surface soil. All the animals experimented upon had the fever, with the regular typical course, showing free intervals, lasting various lengths of time up to sixty hours, and an increase of the temperature of the blood during the shivering fits up to nearly 42° C; the normal temperatui'e in healthy dogs beingfrom38°to39° centigrade. The animals affected by intermittent fever showed precisely the same acute enlargementof the spleen as human patients who had caught the disease in the usual way; and in the spleens of these animals a large quantity of the characteristic form of fungus was present.' Tommasi Crudeli and Klebs have given to this organism the name oiBacilhis malaria.

Doctors Marchiafava and Valeuti, of Rome, affirm that they have detected the Bacillus mala^ ri(B in human patients, in a more advanced stage than in the animals opoKited upon by Crudeli and Klebs. Dr. Crudeli still more recently sUtes, as the result of further pathological investiga^ tions, that the bacilli may always bo found in the blood during the period of invasion of the feverbut that during the acme tliev disappear, and spores only cjin be discovered," The bacilli have heen found chiefly in the spleen of the human

MALARIA.

subiect ; and in the marrow of bones in animals experimented on. The bacillus has not yet beet found in Bengal. According to the researches ol Laveran, extended and corrected by Richard, the blood in malarial fever contains, during the accession, spherical organisms, developed in connexion with the red corpuscles, and furnished with filaments ; also certain curved and pointed bodies, which are only infected and deformed corpuscles. The pigment granules of malarial blood are produced in the red corpuscles during the growth of the organisms. Lancet, 1882, vol. i. p. 993. Should future investigations by independent observers in other malarial regions confirm these conclusions, it would bedifficSt to overrate tl'eir importance.

Genetic Relations. — When we consider that in many regions of the globe two-thirds of the mortality is caused by the fevers, and their sequels, to which this poison gives rise, we can understand why all that relates to malaria is important to the statesman, the soldier, the sanitarian, and the physician. ' Fevers,' says Dr. Cornish, the Sanitary Commissioner of Madras, 'one year with another destroy twice as many people in India as small-pox, cholera, and all other epidemic causes put together.' Dr. Parkes has well said 'that when a climate is called " unhealthy," it is simply meant that it is malarious.' This remark is especially true of tropical climates. Malaria has generally been said to be the product of heat, moisture, and vegetable decomposition. The terms marsh miasm, and paludal fevers, long employed to distinguish the poison and the fevers to which it gives rise, mark the almost universal belief that the air of marshes alone is endowed with the power of generating them. That low, moist, and warm localities are generally noted as malarions is indisputable. Marshes are not, as a rule, dangerous when abundantly covered with water ; it is when the water level is lowered, and the saturated soil is exposed to the drying influence of a high temperature and the direct rays of the sun, that this poison is evolved in abundance. The production of malaria on a great scale in this way was seen in the district of Burdwan, in Bengal. •The soil is alluvial, but dry ; and, until within the last few years, Burdwan was more salubrious than the central or eastern districts of the Lower Gangetic delta. The drainage of the district beaime obstructed by the silting up of its natural and artificial outlets, the result being a waterlogged condition of the soil, the development of malaria, and an alarming increase in the death-rate.

Malaria is, however, generated underconditions apparentlywidely diflferentfrom the above. When the British Army under WeUington was operating in Estremadura, the country was so arid and dry for want of rain, that the rivers and small streams were reduced to mere linos of .»-idely defrvir J° ^""^ by a remi'ttent

fever of such destructive malignity ' that,' says

all Europe believed that the British host was exsame army tirpated.' A fever of like maTi'g^h; ^co^^rgel tT^ Oiud .H r;;.i1L • ^'■^ country by which

PoSgaKT^e IZT'-' '-^^'''^'^ ' the vegetation was says the same author, whole country resembLd Tb^Skl^^^^ must, however, be kept in mind that both districts are in the rainy season flooded with water, at which time they are healthy, until the drying process begins under the action of a powerful sun.

Malaria is notoriously rife in soils the upper strata of which are rich in organic matter, and are from any cause left to nature and the influence of the sun. The Roman Campagna' is a well-known example of this kind. M. L6on Colin has explored this tract of country in search of the commonly recognised sources of malaria, and reports it everywhere dry and free from stagnant water. But the cultivating hand of raan has long been withdrawn from this once fertile region, and the energies of its rich soil, instead of being directed to food-producing ends, ftre wholly gfven up to the development of malaria, for which it is notorious.

It is well known that so-called malarial fevers prevail in some of the most sterile regions of the earth. Here, it is often said, ' there is no organic matter, no vegetative energy running waste, on which to fall back for an explanation.' Yet many of those desert places, to all appearance under the curse of perpetual barrenness, do contain organic matter, and are in reality so full of vegetative energy, that water only is wanted to fit them for the productive labour of the husbandman. There are millions of acres in India, now supplying abundant harvests, which, if water was withdrawn, and the cultivating hand of man withheld, would quickly relapse into deserts fruitful only in malaria.

We need not go to tropical countries in search of examples of this kind : our own country can furnish them in abundance. So late as the reign of the sister of Elizabeth, ' to whose name a horrible epithet adheres,' large tracts of country from political causes fell out of cereal cultivation, and forthwith malarial fevers became epidemic, attended with a heavy mortality.

The disturbance of soil that has long been fallow is often followed, both in hot and temperate climates, by the evolution of malaria. A familiar example was the prevalence of intermittent fever in Paris during the construction of the Canal St. Martin ; also during the excavations for the fortificatious of the same city, in the reign of Louis Philippe ; and on a larger scale in different parts of Prance when the railways were in process of construction.

Malaria is freely generated at the bases of mountain ranges in tropical climates. The strip of land extending along the ba.se of the Himalaya, called the termi, is a notable example of this kind. The soil of this region is immensely rich, well supplied with water, and covered with dense forests, which with the vast mountain range makes free perflation of air impossible. At particular seasons of the year it is almost certain death to enter this region.

Some rocks in a state of disintegration, when freely exposed to the drying action of the sun and air, are in tropical countries often highly malarious, and give rise to severe forms of fever.

' Every sanitarian must %vish success to the gigantic schemes suggested by Garibaldi to make Uonio (it in a sanitary point of view for tlie capital of Italy, and to purify the pestilential Agro iloinano. In the present state of matters Rome is unsuitable for a capital, oxcoi/t for reasons purely sentimental

MALARIA. yi6

The example most familiar to the writer fnjm personal knowledge is the island of Hong-Kong. The soil, according to Dr. Parkes, contains only about 2 per cent, of organic matter ; but like all granitic rocks it is highly absorbent of water ; and Friedell, quoted by the same authority, affirms that it is permeated by fungi. The writer was encamped on this island before it was ceded to the British Government. At this time the soil was but little disturbed, and the troops did not suffer. But when excavations were made at a subsequent time, for the construction of the city of Victoria, on the side of the island facing the harbour, a fatal form of remittent fever appeared, which caused great mortality among both the civil and the military population.

Parkes {Practical Hygiene) thus suras up his account of the soils with the largest organic emanations: '1. Alluvial soils, old estuaries, deltas. Peaty soils are much less malarious. Marshes overflowed regularly by the sea are often healthy, while the occasional admixttire of salt water increases the emanations. 2. Sands, if there is an impermiable clay or marly subsoil. Old watercotirses. 3. The lower parts of the chalk, where there is a subsoil of gault or clay. 4. "Weathered granitic or trap rocks, if vegetable matter has become intermixed ; such soils absorb both heat and water. 5. Rich vegetable soils at the foot of hills.'

When malarial fevers appear in ships returning from unhealthy climates, the explanation is to be looked for under one or other of the following causes : — («) the sufferers may have had their systems charged with malaria before embarkation, as is constantly seen in the case of invalids returning from India ; (i) they may have used water on board drawn from a malarious locality ; (c) the source of the malaria may be in the ship, from decayed vegetable matter mingling with the bilge water, in ships under a bad sanitary regime ; ' or {d) it may be derived from malarious mud, as in the case of H.M. ship ' Powerful,' returning from India, when a severe outbreak of fever was traced to this cause. There is, however, reason to believe that when fever has been observed to follow the consumption of unwholesome water at sea, it has sometimes been not malarial but enteric, from the unsuspected presence in it of the specific germs of that disease.

Instances are also recorded, in which symptoms having a periodic character, and yielding to the treatment which is effective in malarial diseuses, have resulted from exposure to deca,ying vegetable matter, a connection of which with a special marsh poison coidd not well be traced.

Attkibutes. — Malaria, however generated, possesses certain properties well known to those who live in malarial localities. Temperature exercises great influence over its development and acti\'ity ; many places can be visited with impunity in winter which are dangerous in summer and autumn. Wenzel made observations on the effect of temperature in the development

' The writer is indebted to the Into Dr. Mansfield, R.N., for an instructive example of a fatal form of yellow malarial fever on board II. M. ship 'Egmont,' long used as a storeship at Ilio. The ship was found to bo in a state of decay ; the timbers wore permeated by fungi of a white or oremn colour, giving olT a sickening ond oITciisive odour.

of malaria during the construction of the fortified port of Jahde ; ho observed that the increase of attacks of malarial fever was coincident with a rise in the temperature. In the charts con- Btrxicted by him to illustrate the point, a constant precedence of tbe temperature curve by twenty or twenty-five days of the sickness curve of attacks is to be seen ; so that in a temperate climate like that of Jahde, three weeks of increased temperature appeared to be necessary for the genesis of ; the malarial poison, and the outbreak of sickj ness. When in any year the medium summer temperature did not reach 12° E. (69° F.) the sickness remained at its minimum.

Malaria drifts along plains to a considerable distance from its source, when aided by winds sufficiently strong to propel, but not to dispel it. Under the influence of currents of heated air it can ascend, in dangerous concentration, far above its source, and buildings elevated some hundreds of feet above a malarious plain are often more under its influence than those on the plain itself. When favoured by ravines and currents of heated air, it can scale mountains to a height which appears to differ in different climates, varying from four or five hundred to two or three thousand feet. It is unsafe to place human habitations on the edge of such ravines on mountain tracts generally considered above ' feverrange.' A belt of forest interposed between any malarial place and human habitations affords considerable protection, and a sheet of water similarly placed exercises an absorbing power — facts long familiar to sanitarians. Soils protected from the sun's rays by forest trees are generally healthy ; but when exposed to the sun after the forests have been cleared away, malaria is evolved •until the land is brought under cultivation.'

Pathologicai Relations. —The physician can demonstrate the existence of malaria by the best of all tests, namely, its pathological action. This action has been recognised for ages in the property it possesses of producing a class of fevers distinct from all others in their symptoms and sequels, to which the name of malarial or paroxysmal has been given ; the latter term from the almost clock-like regularity of the periods of apyrexia and recurrence. Pathologists have also recognised its power of impressing on other disorders, in a lesser degree, the same stamp of periodicity, and its more insidious but not less dangerous endowment of inducing that 'slow blight of the constitutional powers' to which the term malarial cachexia is now applied. The most striking features of this condition are easily recognised. The sufferers appear much older than they are; the skin assumes a brownish

' A popular belief has arisen that the blue pum tree of Australia, Eucalyptus Globulus, is particularly efficacious tn this way. This tree is now popularly known as tho • fever tree,' and U being extensively planted for protective purposes in tho malarious parta of Italy. Its supposed virtues are said to be due to the cnmphoracious constitution of the leaves of this noble, gipuntic, and rapidly-growing tree. It is a notable fact that the extensive pasture lands of Australia are very free from malaria, and the fact is there attributed to the existence o£ vast forests of the blue gum tree.

All the species of eucalyptus grow with amazing rapidity ; wherever they are planted they are great consnmers of moisture, and thus exercise a drying influence on the subsoil, whicli must have a considerable effect oa tho aUmate where they exist In hirge numbers.

MALARIA.

yellow tint, of various shades, according to the natural complexion of the person and length of residence in an unhealthy climate. They become ansemic with an immense increase in the white corpuscles of the blood. The rapidity with whicli this anaemia is developed is surprising. Professor Kelsch has shown by carefully conducted observations made by Malassez's method, that in twenty-four hours a man affected with intermittent fever lost more than a million of globules per millimetre cube. This condition of the blood often gives rise to murmurs, not confined to the cardiac region, but heard also in the large vessels, misleading unwary observers into a false diagnosis of organic disease. Persons whose blood is thus so affected are prone to attacks of a fatal form of pneumonia, if exposed to cold when not protected by sufficiently warm clothing. Their digestive and heat-generating powers are impaired, and they are liable to diarrhoea from slight causes, often of an intractable kind. The liver is generally enlarged, but the most characteristic lesion is enlargement of the spleen, which often attains such a size as to occupy a large part of the abdominal cavity. There is in the pathological museum at Netley a preparation of the section of a spleen taken from the body of a small drummer boy, who had been under the care of the writer. This lad had spent some years of his brief life in the Peshawur Valley. The weight of the spleen was 10 lbs. 15 oz., that of the liver 9 lbs. 10 ozs. The condition was alike in both organs, an immense development of connective tissue having taken place. These two organs made up one quarter of the total body-weight of the boy. Both spleen and liver, and sometimes even the brain and spinal cord, are deeply pigmented. The urine is sometimes albuminous, with oedema of the lower extremities — symptoms suggestive of Bright's disease, leading to a grave prognosis, often ill-founded, as the above symptoms usually disappear under good climatic and therapeutic means.

Neuralgic affections, varied and numerous, are common sequels of malarial poisoning ; ' brow ache ' is a familiar example. To the above may be added palpitation of the heart, rheumatic pains in limbs and joints, and amenorrhosa; and if, as often happens, scurvy be engrafted on the malarial cachexia, such of the above affections as may be present are at once seriously aggravated.

'Tropical dysentery prevails in its worst forms in malarial localities ; the same is true of sup - purative inflammation of the liver. It seems probable that when malaria acts as a predisprsing cause of dysentery, it is taken into the sy.stem through the medium of water. It is a significant fact, elsewhere insisted on by the writer, that exactly in proportion as we have banished malaria from the soil of the British Islands, so has dysentery disappeared as an endemic diseaee.

The late Dr. Cutchliffe, of the Bengal army, noticed that in some very malarious districts in tho Bengal Presidency, large numbers of males were impotent, the women proving fruitful with males from other non-malarious regions. In such localities, also, the children of those affbcted are often born, not only with the external signs of the malarial cachexia, but also with the visceral changes and pigmented organs described above.

MALAEIA.

Since we cannot yet affirm that the essential nature of the malarial poison has been discovered, ■we may notice two other theories that have been advanced. It need only be said of the few who maintain that the grave pathological changes attributed to malaria are all explicable either on the hypothesis of ' chill,' according to Dr. Oldham, or ' certain electrical conditions,' according to Dr. Munro, that they have a difficult thesis to support. If ' chill ' will account for the loss of 10,000 men at Walcheren, for the frightful disaster of a like kind at Carthagena, ior the terrible visitation of paroxysmal fevers in the Mauritius, and countless examples of the same kind, and for the yearly loss of life in India from fevers — the country in which Dr. Oldham serves, why, seeing that mankind are exposed to 'chill' everywhere, are not such fevers with their sequels imiversal in their prevalence, instead of being confined to places under one or other of the conditions described in this article ? Wliy, above all, in a country like Great Britain, where vast multitudes of the population are hourly exposed to every variety of atmospheric change, have paroxysmal fevers, once endemic there, disappeared, save in such exceptional places as are still under one or other of the conditions de- Bcribed above ? No satisfactory answer has been given to this question. As for the ' electrical conditions ' of the other hypothesis, when its author can explain what these conditions are, and why they no longer exist in the British Islands, or do not produce their usual efifects, we shall be prepared to discuss their value from a pathological point of view.

W. 0. Maclean.

TVT AIiARTA.Ij. — Pertaining to or connected withmalaria; for exa.m^\e,malarialfever, malarial region, malarial poison. See Malaria.

MAIiFOBMATION'S {male, amiss, and forma, I fashion). — Synon. : Fr. Malformations ; Gar. Misshildungcn.

Definition. — Deviations from the normal standard, in the size, form, number, or situation of any part or organ of the body.

Varieties and .iExiOLOGY. — The malformations of the human body may be conveniently considered under two distinct Jieads, namely— (A) Acquired malformations, more commonly called deformities ; and (B) Congenital malformations.

A. Acquired Deformities. — Acquired deformities may be the result of disease, affecting, for instance, the spine, which may become curved, or the joints, or the tendons. Similarly, tlie bones may be the seat of deformity, as in rickets, mollities ossium, or osteitis. Certain injuries and accidents, such as bums, scalds, fractures, and dislocations, lead also to a great number and variety of deformities. Various habits, customs, and occupations, by giving rise to pressure on certain parts of the body, by altering the amount of blood circulating through them, or by interfering with their due innervation, bring about changes in the relative size and shape of the bony or soft textures, and so lead to malformations. It is thus that the brow is flattened by certain tribes of American Indians; the waist deformed, and the corresponding viscera compressed and

MALFORMATIONS. yi;

dislocated, by means of the tight-lacing practised by more civilized peoples ; and the feet distorted by many nations, especially the Chinese. Not only is sucli a striking example as the common depression of the lower parr, of the sternum in shoemakers a deformity, but the huge development of certain groups of muscles at the expense of others induced by some occupations, must be looked upon in the same light, lor these, too, are deviations from the normal outline of the human figure. Besides these cases, which may be termed primary malformations, many others of a secondary character, that is, dependent on soma antecedent change or lesion, are frequently seen. These may occur in organs correlated in growth, as the absence of hair on the face and pubes, and the increase of subcutaneous fat, if from any cause the testicles waste, or if they are removed before puberty. Absence of, or disease in, any part which causes the disuse of other parts, also induces a secondary deformity, as the atrophy and degeneration of a group of muscles, or of a limb, when the nervous supply is in any way interrupted either at the centre or the periphery. The brief reference which has been made to these acquired malformations will suiiice, and this article will be devoted to a consideration of the large class of congenital deformities, and of these to such only as are of a general character. Special malformations of organs will be noticed with the diseases of those organs, such as the brain, heart, and liver. Deformities of the chest, which are a subject of the greatest interest to the practitioner, are also separately discussed. &eDBFOB-