ACCOUNT

OF THE

PRESENT

EPIDEMIC FEVER.

AN account of the present Epidemic may be sup posed to include a great many particulars, on which the nature of our design, and the means of information we possess, will by no means permit us to enter. Nevertheless, though it is our object rather to be useful than amusing, by affording convincing proof of the advantages derived from the use of the lancet in fever, we shall briefly state some account of its appearance and causes.

The persons brought to our hospital were of various ages, from children of three to old people of nearly eighty years of age. As this hospital, like all others of the sort, was designed chiefly

for the relief of the needy, instances of poverty and dejection were of course frequently found amongst them; but by far the greater number, at least of males, appeared to be Irish or Highlanders, engaged in the numerous public works of this city. The rest were generally artisans, and exhibited no other characters of misery than might have been expected in poor people, whom the nature of their complaint had rendered equally incapable of earning support, and of removing that squalid appearance, which, even in better circumstances, is almost inseparable from disease.

The mode in which this fever makes its attack is very various. Frequently the persons affected continue at their usual employment for some days, with languor, lassitude, aversion to motion, and loss of appetite; there are besides transient slight chills and flushings, upon which they are attacked with decided rigours, pain of back, and other

symptoms of fever. More generally, however, the attack is sudden, the patient feeling previously no unusual sensation : sometimes when at work; getting out of bed, to which they had gone in perfect health the preceding evening; or, in short, after any unusual operation, they find themselves attacked with severe rigours, headach, pain of back, nausea, and sometimes vomiting or diarrhoea. To these symptoms, in a day or two, sùc

ceed pains in different parts, as in the præcordia, limbs, abdomen or chest. The symptoms, of which they usually complained on admission, were as follow: Lassitude, with disinclination as well as inability to move the limbs, particularly after a little rest had intervened: Shiverings, with a sense of cold, described at times as resembling cold water, at other times like some cold animal creeping along the back; some of the patients felt this coldness as more rapid in its progress, and described it as shooting suddenly along the spinal canal: The sense of cold frequently alternated with flushings, and even with sweating fits, and in some cases succeeded regularly in the order of an intermittent. Headach, if not cotemporaneous, was quickly superadded to these symptoms; and this was found in every possible degree of variety. Sometimes the patient moaned much, and referred the pain to some particular part of the head, generally the forehead, whilst the whole countenance exhibited evident marks of the oppression that was going on within; at other times the headach was moderate, but was almost always present in some degree; indeed, there were many persons brought to us who seemed to have no particular complaint, except this in a slight degree, though evidently enough affected with the disease, and after some time visited with its graver symptoms.

B

But the sensation of pain is by no means com→ fined to the head; the limbs are often affected with severe pains, and even with spasms, which continue very pertinaciously. It will be seen that irregular muscular action forms one of our columns of febrile symptoms; and if to this we add the cases affected with tremor, the proportion becomes far from inconsiderable. Singultus and subsultus tendinum often make their appearance towards the latter periods of the disease, and though commonly reckoned fatal symptoms, were only so in our tabular numbers, in the proportion of 12 out of 33. A moderate bleeding, indeed, such as practised by Dr Mills, and also by many physicians in this city, or even the use of leeches, will remove these pains for a time; but most frequently, after a small interruption,

they reappear, with vio

Along with pains in the

lence little diminished. limbs, a pain in the loins and back was very frequently complained of. A very common symptom of this class, occurring sometimes in the disease, but oftener during convalescence, was rheumatic pains of the joints, which occasioned considerable annoyance to the patient, and were removed with difficulty. Severe pain of the feet, with slight oedema, was likewise observed in a few cases in the stage of convalescence.

But by far the most serious, though least re

markable train of symptoms referable to this class, is the pains of internal regions, as of the breast, praecordia and abdomen. The former generally occasion some difficulty of breathing, and accordingly seldom escape the observation either of the patient or his attendant, whilst the others, being in the way of no very active function, and always accompanied with diminished sensibility, too often pass without attention being paid to them.

Were it necessary for me to explain or reconcile the very different accounts that have been given of fever at different times, or by different individuals at the same time, I should have no scruple in referring it in a great measure to the following source: That each, with his head full of his favourite theory, has only been attentive to elicit answers from his patient that might illustrate his own views of the disease, or which at least had been suggested by them. Thus, in the same fever, some have found inflammation uniformly taking

up its residence in some one or other of the internal organs, whilst others either could not perceive this action to be present at all, or at least considered it as a rare occurrence. It is proper, therefore, that the mode in which these internal pains were ascertained with us, should be distinctly explained; and accordingly it will be found detailed in a succeeding part of this division of our subject.