Cases have been reported where a phthisis-like condition was due to a mould infection (Monilia). While such a condition may be primary it is more often secondary in cachexias as may be the case with buccal Monilia infections (thrush) which occur in the victims of cachectic states.
Guha.—In Guam there is also a rather fatal capillary bronchitis affecting young children which goes under the name of epidemic asthma or, as termed by the natives, guha. This affection comes on during the rainy season and is attended with marked dyspnoea and slight elevation of temperature.
Nasal Myiasis.—In the tropical and subtropical parts of North and South America a fly, Chrysomyia macellaria, is apt to deposit its eggs about the nasal orifices of persons with an offensive discharge from the nose. The fly seems to be attracted by foul odors. The larvae which develop are called “screw-worms” on account of the segmental bands of bristles and tend to invade the various sinuses, causing great destruction of tissue.
The case sets in with signs of a very severe coryza, together with fever and marked frontal headache. The face becomes swollen, red, and tender in the region of the nose. As the larvae reach maturity they come out of the nose. A nasal douche of 15 parts chloroform in 100 parts milk is often efficacious in bringing away the larvae. At times Sacrophaga larvae may be found.
The Lymphatic System
Plague.—The buboes are the most characteristic feature of the more common form of plague, bubonic plague. There may also be slight enlargement and tenderness of the glands in septicaemic and pneumonic plague but many such cases fail to show any evidence of superficial glandular enlargement. In pestis minor the only feature suggestive of plague is the glandular enlargement.
Very characteristic of the glandular involvement in plague is the marked tenderness of such glands. The slight pressure of palpation causes some pain and a sharp punch over an affected gland, excruciating pain. So exquisitely painful are these buboes that the patient with groin or axillary buboes will flex the leg or extend the arm to relieve pressure. In about 70% of cases the bubo is located in the groin, with 15% to 20% for axillary involvement and 5% to 10% for the submaxillary or cervical region. There may be involvement of both deep and superficial glands of a region, such buboes giving a large area of induration. As a rule there is a single bubo. The bubo is formed not only by the glands but by a periglandular oedema which fuses the glands into a solid mass. The buboes tend to suppurate about the commencement of the second week, so that gland puncture with subsequent culturing for plague bacilli and animal inoculation should be carried out before this time as pyogenic organisms replace the plague bacilli upon suppuration taking place.
Trypanosomiasis.—One of the characteristics of the disease recognized as diagnostic more than 100 years ago is enlargement of the glands of the posterior cervical triangle (Winterbottom’s sign).