Imatges de pÓgina

such nosological arrangements suppose, does not hold. Besides the known fact that febrile contagion will not exist in warm climates, but is more readily extinguished by atmospheric heat than by any other cause, there is such a difference in the first symptoms, progress, and duration, of ardent fever from those of typhus, that all who are guided by practical views, and are not misled by too eager a spirit of generalizing, have pronounced it a totally different disease, in fact a disease of inflammation. Such a radical difference of character argues a corresponding difference of causation. The origin of this fever has, therefore, been attributed to causes of a local or domestic nature, because the disease itself is found to be strictly local. It only prevails in countries within the tropics, and in them only at those seasons when the thermometer ranges from 80° to 94° in the shade. It is therefore justly believed to be owing to the diffusion in the atmosphere of those poisonous exhalations, which are elicited by the powerful rays of a vertical sun from marshes, from putrefying vegetable matter, or from the soil itself of tropical countries. Miasmal poison is one of the most widely diffused causes of disease throughout the whole province of nature; and if northern climates know less of its pernicious effects, they owe this happy exemption solely to the inferior power of the sun's heat in collecting those noxious vapours.

Although the disease I speak of may be said to have its seat and throne within the tropics, yet in every country where the height of the thermometer is at certain seasons from 80° to 90°, fever, instead of the low type observed in high northern latitudes, assumes, in almost every instance, a decided inflammatory character. In short, amongst the febrile diseases of southern climates, there is a uniformity of character, which, in spite of hypothetical classification, powerfully argues a community of origin and of cause. For proof of these facts, I may refer to the valuable practical works of Dr Irvine on the diseases of Sicily, and Dr Burnett on the fever of the Mediterranean; as also to a judicious paper by Mr Boyle, published in the 6th volume of the Edinburgh Medical and Surgical Journal; and to the various reports of the American physicians.

Thus New-Orleans, though without the tropics, is almost every summer visited by a four or five-day fever, which has all the essential characteristics of the genuine kausus, and is in fact known popularly there by the name of yellow-fever. This heavy infliction is entirely owing to its climate and locality, (which I have already taken pains to describe),-to that profusion of marshes with which it is surrounded. In this respect, however, it is not singular; many spots in the interior of Âme

rica experience, during summer, the visitation of yellow-fever, where, from remote situation, and accidental non-intercourse, imported contagion is absolutely impossible. This is a stagger ing fact for those " demigods of fame," the abettors of conta gion; but as New-Orleans is a place of extensive trade, and has frequent communication with many islands in the West Indies (whence contagion might be imported), their spirits will, perhaps, revive at the sight of this "trou de rat," by which they have a chance of escaping from the difficulties and contradictions of their system. They may forthwith unlock their box of debateables, and expose to the public anew their battered generalities, thread-bare assertions, and damaged bundles of remarks. I shall here, however, state one conspicuous fact, which will go far to forestall the endless fertility of their explanations. * Towards the end of March (1815), a fever of great rapidity ap peared in New-Orleans, which carried off many strangers, and some of the inhabitants. Let us here particularly attend to dates. The river Mississippi, during the whole American war, had been blockaded, and indeed latterly with such rigour, during the time our expedition was on the coast, that no vessel of any description had passed up to the city for months. The interdict was not taken off till the 21st of March, when the ratification, at Washington, of the treaty of peace, was officially announced to the admiral commanding the fleet in the gulf of Mexico. It was some time afterwards before any vessel entered the channel of the Mississippi. The fever had certainly existed several weeks in New-Orleans before any strange ship arrived abreast of the town. Besides, every summer of the war, the city had suffered more or less from yellow-fever, though all intercourse with the West Indies had been suspended. Can any facts be found more unequivocal, to prove that this fever is always strictly indigenous to the district where it prevails?

While at Pensacola, in May last, the recent endemic of NewOrleans was described to me by a gentleman that had just quitted the city. He said, the disease first attacked with headach and sore throat, succeeded by violent fever, and proved fatal in

* Few medical subjects have excited more acrimonious controversy, than the one here alluded to. The contagionists, sensible that the "onus probandi" lies with them, seem to wince and stagger under the burden with unequivocal signs of fretfulness and debility. If they can't keep their temper, let them, at least, keep silence! Since, they say, they have got truth and reason, and all the rest of the good things on their side, let them rest satisfied with their good fortune, and, like the sagacious Dogberry, "Give God thanks, and make no boast of it."

three, four, or five days. The symptoms of cynanche I could well account for: The temperature was subject to sudden and considerable variations; it was not steadily above 80° in the day, and the nights were often cold. No wonder, then, that local inflammation of the tonsils often accompanied this fever. My informant farther stated, that its appearing at least two months earlier than the usual epidemic, led the alarmed multitude to consider it a nova pestis, different from the ordinary summer visitant, more especially as, in the latter, sore throat was a symptom never found. But there are facts which explain its premature appearance very satisfactorily. In the winter the marshes had been first frozen, and afterwards overflowed by rains; the city, in a great degree, had suffered the privations of a siege, and there was an unusual influx of strangers. The previous weather having been so uncommonly severe, and the pores of the earth locked up, was it not to be expected, after such a state of things, that the sudden increase of temperature would disengage the long-pent seeds of disease, and would draw forth from the saturated earth a cloud of poisonous exhalations by day, to be condensed and fall upon the city during the chill of the succeeding night?

This is merely another added to the many facts already recorded (to which I have neither occasion nor room to refer), that appear to set the question of contagion at rest for ever. On this subject, removed as it is from the cognizance of our external senses, direct proof cannot well be had; but, of there being no such thing as contagion, I myself have had abundance of negative evidence. At the period I speak of, as well as dur ing the time that the ship to which I belong was on the Jamaica station, when men laboured under endemic fever, there was the most unreserved intercourse betwixt them and their immediate companions in the ship, who frequently visited them. The attendants of the sick-birth also were in the constant habit of lifting the patients out of bed, placing them in the coldbath, changing their linen, and administering to all their personal wants. In such offices, it is evident that these men must be exposed to contagion in all manner of ways, if it exist. Yet it so happened, that, in the very considérable number of instances of fever, even its worst grades, not a single individual of those that had hourly intercourse with the patients was ever seized with the disease. If even it had been otherwise, I am far from being disposed to grant that contagion was thereby proved (for, where all are equally exposed to the peculiar causes, seizures must often be indiscriminate); yet, since it so happened that the most frequent commerce with the sick never


produced the same disease, that fact, however accidental, must go far to confirm the belief of its being non-contagious. I firmly believe that (except now and then a sporadic case, induced by intemperance, or exposure to the sun, or night dews, acting on an accumulated fund of predisposition), in every instance miasmata are necessary to the existence of this fever. As its cause is local, so itself must needs be.

Thus much for the disputed doctrine of contagion.

The endemic fever of the West Indies is justly classed in the order of intermittents, which are universally believed to be of local origin and non-infectious; if, in the former, the intervals betwixt each paroxysm are shorter (and they are frequently so short and indistinct as to be not observable at all), it is owing to the superior virulence which the noxious miasmal exhalations acquire from the action of excessive solar heat.* In the higher grades of yellow-fever, remissions cannot be perceived, at least I never could notice them; in its less violent forms, such remissions are, generally speaking, perceptible enough.

I have never been able to see the propriety of the distinction which authors have drawn betwixt the different gradations of West India fever. Of this, as of all other diseases, every case is not alike severe; yet the most violent cases they are pleased to denominate yellow fever, while those of a milder form are called by the name of Bilious Remittent. This appears to me a distinction without a generic difference,

"Facies non omnibus una,

Nec diversa tamen, qualis decet esse sororum,”


for these two forms have certainly the same inflammatory character,—the same morbid actions,—the same tendency to local congestions of blood, and are merely varieties of the same disease,-produced by the same diffusible poison,-obeying the same laws,-only modified by accidental circumstances of predisposition in the habit of the patient, or the strength of the dose of miasmal gas. It would introduce endless confusion into our nosological systems, were the ever-varying gradations of severity in any given disease assumed as a sufficient ground for referring it to a new cause or a new class.

Of the treatment I come now to speak.

Regarding this dis

* The thermometer, placed in the sun in the West Indies about noon, generally stands about 1279. Few can imagine, unless they have felt it personally, how overpowering such direct and continued heat is. No wonder it produces violent effects on the inflammatory unassimilated diatheses of northern strangers.

ease to be, to all practical intents and purposes, inflammatory, and the affection of the head to be primary and essential, which is evinced by headach, intolerantia lucis, and red eyes, occurring as the earliest symptoms (for the eye is here an index of the state of the brain, in the same manner as the tongue is of the state of the stomach), I have never hesitated to push evacuations to the utmost. Bleeding from the arm or frontal branch of the temporal artery was always my first step; and large and repeated bleeding during the early stage (the earlier the better) I consider the great palladium of the patient's safety. One cannot tell how many ounces ought to be taken; we ought to bleed to syncope, to break the morbid association of the symptoms, and induce a speedy remission; for I am convinced, that it is less by its unloading the vessels, than by the shock (I cannot express it in philosophical language) which it gives to the whole system, nervous as well as vascular, that blood-letting affords the magical relief I have so often witnessed. It is also by the inexplicable changes implied in the word shock, that cold affusion operates advantageously; for, in tropical climates, where the temperature of sea-water is generally from 80* to 82°, its refrigerating power must be much abated.

The state of the pulse is less to be regarded than the urgency of the other symptoms; even when the former is thready or undulating, the latter often imperiously demand renewed depletion; and their demand must be complied with at all hazards. In a disease like this, where the danger is frequently imminent in twelve or twenty-four hours, it is amazing how much its apparent character may be altered by active depletion. From a fever of the highest grade, management will change its complexion to one of the second or third order. To secure every chance of such success, no attention must be spared; the patient ought to be seen every two hours; and, whenever the febrile symptoms get up anew, new exertions must forthwith be made to subdue them.

It is a Herculean disease, and, without that almost omnipotent remedy, the lancet, we might be said to encounter it unarmed; for all other means are but of secondary force. It requires all the vigour and activity imaginable, else it will gain ground on us with rapid strides. A practitioner who will not bleed largely in the onset, will soon feel himself in the melancholy predicament of the celebrated Julian the Apostate,* who

*For the death of Julian, and the manner of it, see the elegant narrative of Ammianus Marcellinus (Hist, Lib, xxx.), as also Mr Gibbon's interesting ac


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