Epedemic Hemorrhagic Fever

Abstract

Epidemic hemorrhagic fever (E.H.F.) had been unknown to World medicine until it was discovered in northeastern Manchuria in 1917 and named as such by medical team of Japanese Imperial Army. Clinical entity was unveiled by them at that time with almost sufficient accuracy. Since then, there have been considerable number of reports of outbreaks, large or sporadic, of E.H.F. in such areas as Russia, Scandinavia, Manchria, and Korea. It has now become clear that E.H.F. is a disease of wide distribution throughout temperate and frigid zone of Eurasian Continent.
It, however, has remained yet to be a disease of rarely known in our country. That is, it has rarely been taken into differential diagnostic considerations of physicians of our country. So, I would like to call a physicians' attention to this disease presenting my cases in this paper.
The author observed, during practising as a local practitioner in Kita ward, almost central district of Osaka city-one of the most vastly and densely populated city in Japan-the incidence of 63 cases of E.H.F. since 1960. Late information revealed that reports of the incidence are coming from the other wards of this city.
The author previously made public the fear that the dissemination of this disease all over Osaka city might be a matter of time. It has been coming into reality. It is feared again that it might, in some time, prevail all over Japan if the situation be left as it has been. As of now, any way, the endemic existence of it in the central area of Osaka city is apparent and quite hazardous to public health.
The patients presented in this paper are relatively mild in clinical appearance, though having shown wide variations in the severity of disease. High fever, for instance, lasted for 3 to, at longest, 5 days and recovery was almost always spontaneous without any special treatment. I should like to mention that the clinical features of E.H.F. enumerated in medical articles or textbooks available seem to be what can be seen in considerably severe cases. Milder cases would be overlooked or misdiagnosed without special differential diagnostic considerations as well as careful observations.
In the light of author's experience, the followings are considered to be characteristic and of diagnostic value in this disease, even in mild one:
1) Abrupt appearance of marked proteinuria on 6th day of illness which gradually decreases and disappears usually 5 days later.
2) Appearance of large polynuclear cells and fibrin formation in urine.
3) Lymphocytosis, increase of plasma cells and emergence of virocytes in blood.
4) Hemorrhagic diathesis-not always manifests to mild one; seen in only 10% of the author's cases, contrary to severe one where it would never fail to be noticed.