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while of 14,000 inhabitants only 28 escaped the disease, and 5028 died.
The next general argument is derived from the history of the various epidemics of this disease which have been observed in the Peninsula. Its recent introduction, the distant periods at which it has appeared, the partial, and, if we may use the word, desultory, manner in which it has affected the Peninsula, all militate strongly against its endemic origin. Before the commencement of the 18th century, Spain had been repeatedly visited by the plague derived from Barbary or the Levant, which confined its ravages to particular places, or extended them more widely, as more or less care was taken to prevent all intercourse with infected places.
In 1730, the disorder since known by the name of El vomito negro, or black vomit, first made its appearance in Cadiz, and destroyed ' great numbers of persons, very few having escaped who were attacked by the disease. In the year following, it prevailed with equal fury, and spread general alarm throughout the country ; two symptoms were particularly noted as being most fatal in this disorder, which had not been before observed in Spain ; viz. spots of a livid, yellow, or dark colour, that covered the body, and were the certain forerunners of the black vomit : The physicians were of opinion, that the malady was of a pestilential nature, and they advised the magistrates to take the necessary precautions.' It was said to have been introduced by a vessel from Spanish America, and that it spread to other parts of the Peninsula. The year 1730 was remarkable for its drought, which was supposed to have caused the influenza then prevalent.
The vomito negro appeared for the first time in Malaga in 1741 ; and it was also said to have been introduced there by a vessel from South America. It carried off upwards of 10,000 persons. It again appeared in 1764, but was confined to Cadiz, nor even there was it very fatal or general. The preceding spring and summer had been remarkably dry. This epidemic has been briefly described by Dr J. Lind, whose opinion was,
that the fever may be communicated by contagion, but that this contagion is very slight, unless cooperating with a bad air; and in a ship is often greatly checked, if not wholly destroyed, by going out into the open sea.'
It again appeared in Cadiz about the beginning of August 1800, in the Barrio de Santa Maria. Although at first confined to this district, it continued daily to gain ground; but, on the 5th of August the people went in procession through the town to appease the supposed anger of the Deity; and in five days time, cases of fever were reported in the other Barrios. About the middle of September the deaths amounted to 200 daily. In October the mortality began to diminish; and on the 12th the city was
as declared to be healthy. Towards the end of August the neighbouring towns were not yet infected; but about that time it reached Isla de Leon, Port-Royal, Chiclana, Puerta de Santa Maria, St Lucar, and Rota. It also committed dreadful ravages in Seville and Xeres, but did not extend beyond the Sierra Morena. During the years 1799 and 1800, the true plague al most depopulated the states of Barbary, which caused the Governor, of Gibraltar to establish regulations and measures of precaution, for the safety of the garrison, which, in fact, remained perfectly bealthy, with plague on the one side, and yellow-fever on the other.
In 1801, the yellow fever appeared at Medina Sidonia, but soon ceased, and extended no further,
Toward the end of August 1803, it broke out in Malaga, and carried off great numbers. It declined as usual in the month of December, but only to burst forth with increased virulence early in the summer of the following year, and, upon this occasion, it extended its ravages in every direction. The cities of Cordova, Granada, Velez, Malaga, Carthagena, and Alicant, on the east side of Spain; Antequera, Cadiz, and the towns on the west side, as far as Ayamonte, were severally attacked. It also affected Leghorn, but no other part of Italy, and the lofty fortress of Penon de Velez on the north-west of Africa. At last our own fortress of Gibraltar was doomed to suffer severely, and the 28th of August 1804 is fixed upon as the day when the first case occurred. With the approach of the cold weather, it once more ceased all over Spain for some years.
In 1810, Cadiz was once more attacked, about the 11th of September; great inortality from the ship or jail fever having taken place in the early part of the year amoog the French prisoners of Dupont's army confined on board hulks. This year it was confined within the walls of Cadiz, on this side of the Peninsula, and even spared the Isla de Leon, to which the British troops had been reinoved on the first intelligence of the disease having reappeared; but it prevailed at Carthagena, aud slightly at Gibraltar; and about the 16th or 18th of October, in the distant island of Tenerisse, but did not extend to any other part of the Canaries.
The kingdom of Murcia continued to suffer in 1811, when the rest of Spain was healthy.
Early in September 1813, the last peninsular epidemic which we hope it will be our duty to record, began in Cadiz, from whence it spread to Port St Mary's, and several other places, to which the emigrants from Cadiz retired. Gibraltar was also visited by it this season.
When we carefully consider this chronological notice of the epidemics of the peninsula, which it has cost us some trouble to extract from the publications of Sir James Fellowes and Mr Pym, and trace their progress upon the map, connected with the local circumstances of the places, whether infected or healthy, it seems to us impossible to account for its progress upon any general principle of peculiarity of local circumstances, or atmospheric influence, independent of contagion.
The third general argument, and one perhaps still more conclasive, is derived from the effect of quarantine and seclusion, in preserving places or individuals from the disease when it was prevalent, and of separation of the sick in putting a stop to its further progress. Sir James Fellowes's Reports abound with the most striking proofs of this fact, and to them we must refer our readers. We shall only extract one or two.
When it prevailed in Murcia, in 1811, the French drew a cordon of troops around the infected district, and it did not extend beyond it. (p. 239.) In 1810 and 1813, when the French occupied Malaga, and had little communication with the surrounding country, Malaga remained healthy. Many cities, as Aguilar, (p. 195), Xeres, (p. 291), remained free from the disease, while it extended to others much more remote, where no precautions were taken. Even in infected towns, those who avoided communication with the diseased escaped, as exemplified in the case of the convicts in Cadiz, and of the workmen in the dock-yard at Gibraltar.
The last argument is the counterpart of the former, the numerous proofs of its being directly conveyed or communicated by personal intercourse, when no other circumstance seer.ed to favour its propagation. Of this it is sufficient to notice its appearance in 1804, in the fortress of Penon de Velez, on the northern shore of Barbary, distant in regard to situation, but receiving all its supplies from Malaga, while no other part of Barbary suffered from it. The instances in individuals, adduced by Sir James, are very numerous and striking:
We have entered much more at length than we intended into the proofs of the contagious nature of this disease, because we consider the establishment or refutation of that point to be of the very greatest practical importance.
Sir James also confirms, by many instances, the curious fact which we first learned from Mr Pym, but which seems to have been observed very soon by the Spanish physicians, that this disease attacks persons but once in their life.
• Professor Arejula closes his observations with the following remark VOL. XII. NO. 45.
· The yellow-fever of Andalusia only attacks persons once in their lives; and it is of great importance for the physician to know this, in order to form his prognostic and his plan of cure, as well as for the individual who may have passed through the disorder, that both of them, being assured of this fact, may step forward without fear to the relief of their fellow-creatures who may hereafter be afflicted with so dreadful a malady.
Sir James Fellowes has prefixed to the account of each epidemic, an excellent medical topography of the places where it prevailed ; and, in the appendix, has given an account of the climate and weather, founded on the most accurate meteorological observations. For many valuable remarks on the nature and symptoms of the disease itself, especially as assisting us in forming our prognosis on its pathological effects and its method of treatment, we must refer to the work itself. Besides his personal experience, his work contains a great deal of useful information derived from the best publications by the physicians of Spain, whose individual merits Sir James was well qualified to appreciate.
The fifth Report contains
• Observations on the bilious, or autumnal remitting and intermita ting fever (called the Walcheren fever), with remarks on the treatment of the disease, as it appeared in the military hospitals at Colchester in the months of September, October, November and December, 1809.'
It does not admit of analysis, but contains many excellent observations, of which we shall select a few. First, in regard to the prevention of the disease.
Oi referring to the returns of the sick that came under his charge to England, Mr Jones informed me that he observed one company of the right wing bore no proportion to the others, having only one man ill; and, on inquiring into the cause of their exemption from disease, it was found, that, when the troops entered their cantonments, strict orders had been given to prevent their smoking in any of the barns, for the fear of accidents from fire.
• In consequence of this order, it was customary for the men in the evening, after they had thrown off their accoutrements, and many of them part of their dress, to take their pipes and sit under the trees, or rest themselves in other open and exposed situations, where they enjoyed the conversation of their comrades, in some instances probably to a late hour; whilst the men belonging to the company alluded to, being quartered in rather a better description of house, were in the habit of smoking their pipes in a large kitchen, with the * servants of the Dutch family: Here they were sheltered from the echas lations so prejudicial to health in such elimates and under such circumstances, when the constitution was more liable to be acted upon, viz. in a state of inactivity after fatigue or exercise.' p. 343.
The interesting observation communicated by the surgeon of the 43d, of the comparative healthy state of the company of the right wing over all the others in that regiment, is highly deserving of attention : more real advantage may be derived from the knowledge of a single fact, so stated, than from volumes written expressly on the subject of military diseases: it shows how much depends on the attention of commanding and medical officers of regiments to all the minutiæ connected with their interior economy.
• It was to be regretted that the troops were taken out to exercise before sun-rise. The danger of allowing the men to be under arms every morning an hour before day-light, does not appear to have been considered ; and it is extraordinary, that after all that had been written upon the subject of preserving the health of soldiers in such unwholesome climates, no precautions seem to have been taken to guard against the fatal consequences of exposure to the damp and noxious exhalations.' p. 345. Next, in regard to the cure
From the appearances which were observed in these dissections, we were led to draw the following conclusions ;--that the original disorder was of an inflammatory nature, inducing a considerable vascular excitement and determination to particular organs, especially to the liver and spleen; and that the derangements in their functions occasioned those relapses or subsequent returns of fever which took place at distant periods and at lengthened intervals, from the original or primary attack.
• In fact, we found that no radical or perfect cure could be obtained until the congestions which had been formed in those important organs were either lessened or removed ; and by keeping in view the connexion that subsists between the bilious remittents of warm climates, and the remitting and intermitting fevers of our own latitudes, in which derangements in the bilious secretions are so remarkable, a correspondent plan of cure was adopted, and was attended with the happiest result
' The general plan of treatment at first, was to open the body by means of five or six grains of the submuriate of mercury, with an equal quantity of c. ext. of colocynth, followed up by the senna infusion, and sulphate of magnesia, after which the submuriate and antimonial fluid were given every three or four hours in small doses, and continued, either with or without mercurial friction upon the side, according to the state of the patient and the period of the disorder, or until the mouth became slightly affected.
• The warm bath, fomentations, and blisters to the side were also employed, together with an anodyne draught, and occasionally the camphorated mixture, with acetate of ammonia, &c. • • In the most obstinate cases, it was found necessary to push the inercurial friction to some length, so as to induce ptyalism; and when there was appearance of remission, the bark was given, and nut till