GLANDULAR FEVER
Authors: H. L. Tidy, E. B. Morley
Journal: BMJ (1921)

GLANDULAR FEVER was first described by E. Pfeiffer in 1889 under the title "Drusenfieber."It may be defined as an acute infectious disease principally of children, characterized by rapid enlargement of the cervical glands and by a less constant enlargement of the liver, spleen, axillary, inguinal and other glands.The disease is rare, but there is some reason to believe that a considerable number of cases are occurring at the present time.The largest epidemics are those recorded by Park West, 96 cases; Bot.chkowsky, 54 cases; -Byers, 33 case Stark, 30 cases; Tschaigajew, 24 cases.-Korsakoffhas reported 29 cases oiserved -over a course of years.Pfeiffer stated in his original article that the disease occurred in small epidemics, and.especially in "house epidemies '; when one child of a family was 'affected the others rarely escaped.Subsequent observers-have agreed that it is infectious.Fishei, ecords a cases in one family, and Chapman 5 in his own household.Park West observed an epidemic in a country district in Ohio, aid saw 96 cases in the course of three years, besides hearing accounts of at least 40 others.The 96 cases occurred in forty-three families, -about -20 {childreu in the affected families not -being attacked.He states that the epidemic spread irregularly, the houses attacked-not being in any special contiguity or social connexion withL ech other.Von Starck's 12 cases occurred in eleven families, Haas's 12 cases in ten families, and Schiller's 11 in nine families.-Schaffer's 21 cases occurred in the space of four months in an institution for children, but there is no statement as to the total number-of inmates.Numerous sporadic cases are also on record.Authorities agree that it is more common in the spring months.CLINICAL FEATURES.The incubation period has been noted by many observers and may be stated to be 5 to 10 days, most commonly 7 or 8 days.The extreme limit may be longer.The disease is principally one of childhood.Botsch- kowsky had the experience, apparently unique, of observing an epidemic of 54 cases in a battalion of soldiers.Apart from this, it is probably correct to say that at least 80 per cent. of recorded cases were under the age of 12 years, and the majority between the ages of 5 and9 years.Park West's youngest patient 'was 7 months -and the eldest 13 years.He had no case in an adult.Robertson has reported a case in an infant of 6 months.The youngest of Schaffer's cases was 4 months old and the eldest 16 years.Àdults, however, are certainly not immune.In the series of 464 cases there are 20 adults (excluding Botsch- kowsky's epidemic), the majority being young mothers of affected children; three patients were over 40 years of age.In adults the condition tends to be very mild -and malaise slight, though Korsakoff saw a severe case with nephritis.There is no record of its occurrence during the war.The condition is, however, easily overlooked and may be mistaken for aberrant mumps, though one of us (H.L. T.) spent eighteen months in a hospital for infectious disases in France without recognizing its entity or calling to mind its existence.The onset is sudden, with tlle usual symptoms of an acute pyrexial attack in children: restlessness, loss of appetite, constipation, furred tongue, rapid pulse, and occasionally vomiting.Abdominal pain is sometimes present, and may be severe.Enlargemesznt of the Lymphatic Glands.This may be present with the earliest symptoms or develop iapidly within twelve to forty-eight hours.The glands constantly affected are the cervical glands, deep to the sterno-mastoid muscle about the middle of its length.The enlargement is marked, and produces a definite swelling of the neck.On palpation several discrete glands are felt, often the size of walnuts.Robertson records glands as