Gex. III. SPEC. II. a E. malignus au Autumnal became oppressed with a sense of fulness rather than of throbbing; the lips were considerably swollen, ragged and black; a hemorrhage occasionally issued from the nostrils and the fauces; and the general debility wast ..tumnalis. greatly augmented. Such was the appearance towards remittent. the eleventh day. The tongue was not much furred, the pulse, though small, and rarely under a hundred and twelve, was steady: but the heat was intense, and the thirst unquenchable. The mineral acids in dilution, sometimes singly, and sometimes in the combined form of aqua regia, with acidulated beverages, were now chiefly trusted to, in connexion with farinaceous foods, jellies, and beef tea; and cold water was permitted in any quantity. This plan was continued till about the eighteenth day; when every thing allowed being rejected, and every evacuation accompanied with faintness, it appeared to me that the plan should be changed; that the chief cause of irritation was at this time debility; and that a more stimulant treatment should immediately be commenced. My colleagues, for whom I have a high respect, acceded with reluctance, as conceiving that we should only exasperate the febrile symptoms; and that if the stomach could not retain tasteless things, it would instantly reject wine or convert it into an acid. The attempt, however, was made; sound old Madeira was administered by tea-spoonfuls, and shortly afterwards a small portion of chicken-jelly. Both remained on the stomach; but the diarrhoea continued; and for this, as modern preparations had proved of little use, I recommended a scruple of the confectio Damocratis in half an ounce of cinnamon water after every loose motion. The diarrhoea ceased as by a charm; the ensuing exacerbation was less marked, the night was passed more tranquilly, and columbo, in small doses of the powder, was commenced the next morning, and persevered in. The change of treatment being thus found to succeed, was adhered to, and the patient slowly but effectually recovered. It is not often that the autumnal remittent is thus ob- General treatment. GEN. III. a E. malig nus au tumnalis. Autumnal remittent. Treatment. Emetics, stinate. But whether there be sickness or not, an emetic should be administered, as one of the best means of determining towards the skin. And singular as the advice may appear, it is rather to be recommended where there is little or no sickness than where the sickness is incessant; for in this last case the stomach is often so extremely irritable, that emetics only exasperate it and or no sick-add to the distress. It will also be useful to evacuate the bowels on all occasions, though the emetic alone will Aperients, frequently be sufficient for this purpose: and hence Stoll allows of nothing beyond: for purging, says he, augments the fever, while an emetic strangles it as at a blow *. ness. whether useful or not. Venesection, when useful. When injurious. Other remedies. The use of the lancet must depend upon the circumstances of the particular case. Where the onset is violent, and particularly where the patient is plethoric or of a vigorous habit, it should be employed instantly and freely; for, without it, from the urgency of the symptoms, there can be little doubt that some large organ or other will soon become locally affected with effusion or congestion, which is always to be avoided as one of the worst symptoms that can occur. And if we have reason to believe that such local affection exists at the time of the attack, and more especially that it is the cause of it, copious depletion will be still more necessary; for in this case we have not only to contend with the fever, but to guard against phlogosis or inflammation in the infarcted organ. But except in such cases there is no call for the lancet, and we may concede to Stoll that its use is injurious. Copious diluents, and small doses of antimonial powder in effervescing neutral draughts, will ordinarily take off the burning heat of the skin by exciting a breathing moisture; and if this can be maintained through the day, the ensuing exacerbation will probably be mitigated in its violence. If not, eight or ten drops of the tincture of digitalis should be added to the antimonial draught, and all tendency to sickness be restrained by a few drops of * Rat. Med. Part 1. p. 227. GEN. III. SPEC. II. « E. malignus au tuninalis. laudanum keeping the bowels in the mean time open with some gentle laxative, as rhubarb, and the sulphate or supersulphate of potash in combination. Blisters are never of service except when topically called for, or as Autumnal stimulants in the last stage of debility. If the diaphore- remittent. tic plan fail of effect, and the heat be pungent and augmentive, acids, vegetable, mineral, or both, will ordina- viceable. rily constitute the best sedatives and refrigerants: and Acids. where the debility is extreme, the stimulant plan should be had recourse to which is laid down in the preceding case. Blisters rarely ser One of the severest and most fatal forms under which 6 E malignus flavus. the malignant remittent shows itself, is that of the YEL- Yellow feLOW FEVER, constituting the SECOND VARIETY of the pre- ver. sent species; so denominated from the lemon or orange Distinctive hue which is thrown over the entire surface of the body, features. almost from the first attack of the disease, and which gives it a distinctive feature. The heat is here also intense, the thirst extreme, and the vomiting strikingly obstinate; but not, as in the preceding species, consisting of a colourless material, or the food that has been swallowed, but of a yellowish matter at the beginning and through the height of the fever, and of a chocolate-coloured colluvies towards its close. remote asm. The common remote cause of this fever is unques- Common tionably marsh-miasm: and hence it holds a stationary cause, abode in the swampy soils and morasses of the intertro- marsh-mipical regions, exposed to a high solar heat, and perpetually exhaling a decomposition of animal and vegetable materials; and is found occasionally in all climates that make an approach to the same character: where, in the correct picture of the poet, The rivers die into offensive pools, And, charged with putrid verdure, breathe a gross ver in its It is nevertheless a striking fact that although such Yellow fe"mortal nuisances" have been exhaled into the atmo- malignant sphere in all ages within the range of the tropics, the fever we are now entering upon is only of modern date in form of re cent origin. GEN. III. its malignant form. Whether this be owing to any de6 E. malig- gree of general change that has taken place in the hunus flavus. man constitution, or to a larger accumulation of that SPEC. II. Yellow fever. History of its rise and range; rica; mixed animal and vegetable compost which forms the hot-bed of the present destructive miasm, or to any other cause, it is difficult to determine. It certainly seems, as Sir Gilbert Blane has observed, to have some bearing upon the slave-trade, with which it is precisely coetaneous. Small-pox, syphilis, and rickets, were equally unknown to the ancients, yet the causes of their origin, as indeed those of all other epidemic or constitutional diseases, are involved in inscrutable darkness; and, in the language of the poet, -Noctescunt tenebris caliginis atræ. The yellow fever first showed itself, so far as we have any record of its origin, at Barbadoes in 1647, whence it spread to various other West Indian Islands, and at visits Ame- length made its appearance at Boston, in North America, in 1693, to which place it was carried from Mar-1 tinique by the fleet under Admiral Wheeler. In Europe its earliest footsteps were traced at Lisbon in 1723 *, after this period it seems to have declined as well in its violence as in its visits to the same regions, particularly in respect to North America and Europe. But in 1793 a new era of its prevalence commenced; the disease showing itself then and down to the present day with a frequency and fatality it had never evinced before, espe cially in the West Indies and North America. This aggravated form, however, did not manifest itself in Europe till the year 1800, when, after an interval of six and thirty years, it appeared at Cadiz in all its horrors. Since this period it has visited Cadiz four times; and has thence spread to neighbouring sea-port towns in the South of Spain at short intervals. Among other places in this line of coast it has several times visited Gibraltar; first.. in 1804, when more than one third of the garrison and po visits Europe; visits Europe afresh. * Sir Gilbert Blane, Select Dissertations, &c. p. 284. Lond. 8vo. 1822. pulation were carried off; and occasionally since, but with little comparative loss on account of those precau tionary means which had been entirely neglected on the first visitation. A 6 E. malignus flavus. Yellow fever. asm. To what extent the miasm of yellow fever, as it arises Atmosphere from its swampy and putrescent base may spread before of its miit becomes dissolved or decomposed in the surrounding atmosphere, it is not easy to determine. "It is probable, however, that where a trade-wind or monsoon sets over a large tract fraught with febrific miasmata, these invisible agents may be carried to a much greater extent than where calms or gentle sea and land breezes prevail. This is exemplified in the fever of Corimbatore, and ought ever to be borne in mind by navigators in anchoring ships in the vicinity of swamps, or generals in pitching tents or stationing troops."* Like the human effluvium less the miasm miasm of volatile than of the ordinary bili ous remit tent. Illustrated It is also satisfactorily proved that the modification of miasm producing yellow fever, does not spread so far or rise so high, and, consequently, is not so volatile as that producing the ordinary bilious remittent of hot climates, a feature by which it makes a nearer approach to the miasm of human effluvium, and shows that affinity to it, even from the first, which we have endeavoured to establish in the introductory remarks to the present ordert. Dr. Ferguson has given us a striking illustration of the from Fertruth of this remark, as also of the relative barometrical guson. elevations of the respective regions of yellow fever, ordinary bilious remittent, and a pure and healthy atmosphere, in the following passage, in which he is taking a medical periscope of the island of Antigua. "The autumn of 1816, became very sickly, and YELLOW FEVER broke out in all its low marshy quarters while the MILDER REMITTENT pervaded the island generally. It was the office of the white troops to take the guards and duties of the dock-yards amongst the marshes below; and so pestiferous was their atmosphere, that it often occurred to a • Influence of Tropical Climates, &c. by J. Johnson. M.D, 3d Ed. p. 148. Ut suprà, p. 85. Coroll. 6, 7. |