Definition:—A mild acute fever, infectious in origin, characterized by an adenitis involving the cervical glands. It is common in childhood, occurs less often in youth and few cases have been observed in adults.
Etiology:—Immediate infection is the undoubted cause of all epidemics, as it has attacked several members of the same family. No specific micro-organism has as yet been isolated, consequently the exact cause of the disease is unknown.
Symptoms:—General malaise, headache, restlessness, aching and pain in the limbs precede the sudden appearance of fever. The temperature varies from 101° to 103.5° F., usually not exceeding 102.5° F. Among the early symptoms are stiffness of the muscles of the neck, with consequent immobility of the head, largely from pain. Nausea, vomiting and a degree of constipation are present, although in one epidemic in severe cases there was an acute intestinal catarrh with large watery greenish discharges. Acute colicky pains in the abdomen are not uncommon. The involvement begins with enlargement of the glands on the left side, usually on the second day, followed a day or two later by enlargement on the right side. The glands are very sensitive to the touch and painful on movement. The tonsils are usually enlarged. In some cases other glands become involved, notably the liver, spleen and kidneys. An acute nephritis becomes a serious complication in an occasional case.
The febrile reaction remains for from seven to ten days. The period of glandular enlargement usually lasts from fourteen to sixteen days. Suppuration and sequelae are rare.
Prognosis:—It is seldom that a case results seriously, and convalescence is rapid and uninterrupted.
Treatment:—At the onset aconite in small doses and Phytolacca are directly indicated in all cases. If the tongue and mucous membranes are pale and the tongue is coated white, a small dose of sodium bicarbonate should be given and repeated in two hours. A mild alkaline aperient may be needed or a few doses of neutralizing cordial, but the phytolacca must not be omitted. An initial dose of five grains of the potassium acetate in a small glass of water is sometimes of much value. The local application of antiphlogistine or a phytolacca ointment will quickly relieve the pain. Hot applications are beneficial. The food should be simple and nothing acid given. Other indications will suggest specific treatment.