GEN. III. SPEC. II. 6 E. malig nus flavus. Yellow fever. All the varieties exhi bited in this epidemic. As also at Mariegalante. liarly healthy; and the disease first showed itself in a swampy part of it, and amidst new-comers who were sailors, but from a healthy ship, and themselves in good health on first landing. It soon spread widely, and at length indiscriminately among all ranks and conditions, and situations-among blacks and whites, the newly arrived, and the oldest settlers in town and country." Nothing was better calculated than this fever to show that almost all the different kinds of fever that occur to us, are capable of issuing from a common source or miasm, merely modified by contingencies: for in Antigua they all occurred in different individuals. The disease sometimes commenced as an intermittent or remittent, and sometimes in a continued type; it sometimes ceased in four or five days, which was its usual course, and sometimes terminated in an intermittent. The head was in some cases chiefly affected; in others the stomach, liver, or some other organ: sometimes the patient died without hiccough or black-vomit, though he rarely recovered where these symptoms appeared; Dr. Musgrave recollects but one instance. Recovery was no exemption against a second attack. In new-comers the tint was of a lemon hue; in native or assimilated constitutions, of a deep orange. The state of the atmosphere at the commencement of the disease presented nothing peculiar. To the same effect, Dr. Dickson, in his valuable official report. "At Barbadoes and Antigua, I had generally seen the disease of an ardent and continued form, and did not fully understand why authors talked of a bilious remittent yellow fever, until after the capture of the French and Danish islands. But the anomalies of fever, the shades and changes which it assumes according to the intensity of the exciting causes, the state of predisposition, or the spot of residence, could no where be more strongly pourtrayed than in the destructive epi demic of Mariegalante in the autumn of 1808, from the most concentrated marsh miasmata; where the dif ferent types of fever were CONVERTED into each other of the worst and most aggravated species I have ever wit GEN. III. SPEC. II. B E. malig nessed. Yellow fever in the continued form; others with comatose remittents or intermittents; the exacerbations of which were so violent as to carry off a patient in two nus flavus. or three paroxysms; while others sunk into low a tracted character of fever resembling typhus."* pro Yellow fever. The Bulam and Antigua fever com In the midst, however, of so much discrepancy, there is still much that is concurrent, and quite enough to establish the identity of the two diseases, if an abundance pared and of other evidence to the same purpose were not at hand. indentified. The fever of Dr. Pym, specifically characterized by black vomit, is represented as being peculiarly dangerous and fatal; in that of Dr. Musgrave, this symptom only occurred in the most dangerous cases of the malady. According to the latter, the severest and most deadly attacks were amongst the new-comers; the mildest, amongst the natives or those whose constitutions were assimilated to the climate. The yellow hue of the former (and I have already endeavoured to account for this) was of a deep orange, that of the latter, a lemon colour. Dr. Pym describes three species of fever as common to warm climates, but which differ from each other in their mode of origin, and diagnostic character. In that of least danger, the colour of the surface, he tells us, is of " a very deep yellow"; in that of higher danger, it is of "a deep yellow", and in the disease before us, which is by far the most fatal, where there is any yellow at all, it is of "a very pale lemon colour"; which is, in effect, the very hue ascribed to the severest cases of the Antigua fever by Dr. Musgrave, as the "very deep yellow", or orange", is to the mildest. So that, examined by their external livery as well as their internal disorganization, there can be no doubt that the two diseases are the same. Dr. Pym appeals peculiarly, as a distinctive character of the Bulam fever, to the deadly and chlorotic paleness exhibited by the countenance, in its latest stage, or most fatal incursion. But even this only shows that, in such case, the disease makes a mortal attack upon the larger viscera, * Report, &c. pp. 143, 144. GEN. III. SPEC. II. 6 E. malignus flavus. Yellow fever. Confirmed by Jackson. Discrepan ciled. the and especially the liver, from the first; and demonstrates proposition I have ventured to lay down, that in proportion as this organ is severely affected is its inability to secrete proper bile or indeed bile of any kind: and, consequently, that if the irritation only reach a certain point, its secernents will be stimulated to emulge a larger quantity and of a deeper hue; a considerable portion of which, in consequence of such irritation extending to the neighbouring absorbents, will be sent back into the sanguiferous system, and produce the orange tinge, which, in the description of both these writers, peculiarly marks the disease before us in its less fatal attacks. While, if the febrile incursion be so violent as totally to derange the function, and still more the structure of the liver, no bile will be secreted at all, or, if secreted, less in quantity and consequently less diffusive in colour; and hence only conveying a chlorotic or livid tinge to the face, which at the same time exhibits a bloated fulness from effusion or debility of vascular action. In confirmation of this remark, Dr. Jackson's earlier cases of practice furnish numerous examples;—“ examples indeed", to adopt his own words, "of that form of disease when there is a considerable degree of vascular excitement in the early stage, terminating commonly by deranging the functions of an organ of importancemost frequently the liver or stomach. Yellowness and black-vomiting are common; and it is more especially to this form, that the name of YELLOW FEVER has been applied but though the yellowness and black-vomiting be common, they are not constant and essential. Determinations sometimes change suddenly, the brain becomes overwhelmed, and stupor and convulsion then cut short the ordinary rapid course*. Yet, after all, it is not denied by Dr. Pym, nor, so far cies recon- as I know, by any of the writers on the American or Andalusian fever, that the yellow fever from marsh-miasm ever evinces either of the symptoms that are so essen • Hist, and Cure of Fever, Chap. iv. p. 133. tially ascribed to the bilious remittent produced by contagion, but only that "it is rarely, if ever," to adopt Dr. Pym's own words, "attended with the fatal symptoms peculiar to the Bulam fever, viz. the black vomiting, and a peculiar bloated appearance of countenance." upon Cul thesis. There would, however, be an almost insurmountable Chiefly dedifficulty in reconciling these different descriptions of the pendent same disease, in consequence of Dr. Musgrave's telling len's hypous, very decisively, that not a single instance occurred in the Antigua fever of its being received by contagion, were there not strong reason for believing, as I have already observed on another occasion, and hence need not go over the ground again, that this explicit writer suffered himself to be deceived upon this point; most probably, like Dr. Pym, and, as already observed, Dr. Jackson †, from too close an attachment to the doctrine laid down by Dr. Cullen, that the fever from marsh-miasm does not produce contagion, which is specifically a result of a fever from human effluvium. mittents produced from both marsh and human Evidenced in that of Philadel phia, 1793. It is impossible to peruse the history of bilious remit- Bilious retents in warm climates offered from all quarters, without seeing that it may and does originate from both sources; each sometimes operating alone and sometimes in conjunction with the other, as was probably the case at An- effluvium. tigua, and certainly the case in the yellow fever that raged at Philadelphia in 1793; in which, says Dr. Rush, there were for several weeks two sources of infection, viz. exhalation and contagion. The exhalation infected at the distance of three and four hundred yards: while the contagion infected only across the streets. The more narrow, the streets, the more certainly the contagion infected. Few escaped it in alleys. After the twelfth of September, the atmosphere of every street in the city was loaded with contagion; and there were few citizens in apparent good health, who did not exhibit some mark or other of it in their bodies, particularly a preternatural quickness in the pulse, "which occurred in negroes as GEN. III. well as in whites; and in a few who had the disease SPEC. II. B E. malignus flavus. Yellow fever. In the Minorca fever. Report of Blane on the mortality in Ascension Island, 1823. before." In like manner the Minorca fever, uniformly originating, as Dr. Boyd observes, in marsh-miasm, frequently, as he has also observed, becomes contagious*: of which, indeed, he has furnished us with a striking example in his own person: for we are told by Dr. Denmark that he caught the fever from one of his patients, and nearly fell a victim to it f. But we have had occasion ot examine this subject so much at length, in the introductory remarks to the present order, that it is unnecessary to pursue it further ‡, except by introducing the following irresistible illustration. Sir Gilbert Blane, having been requested by the Board of Admiralty, to examine into the dreadful mortality that took place at the island of Ascension, in the summer of the present year, 1823, reported, and from the manuscript of this report I was permitted to copy, that the officers and privates of Ascension Island were first stationed there in September 1821, in number twenty-eight, and continued in such full health, as to be without the loss of a man, till the arrival of the Bann sloop of war, in May 1823. The Bann had left Sierra Leone towards the close of the preceding March, at which time the yellow fever was raging there with great mortality, and, at the time of sailing, had no sickness of any kind on board: but, within a few days after sailing, the yellow fever made its appearance, and continued its ravages till the beginning of June; during which time, not less than ninety-nine men had been attacked by it, and thirtythree cut off, out of a crew of one hundred and seven Europeans and officers, independently of twenty-seven African superannuaries, none of whom suffered from the disease. Upon the arrival of the Bann at the Isle of Ascension, an unrestricted communication took place between the sick crew and the healthful garrison, the De Febre Minorcæ &c., 1817. † Medico-Chirurg. Transact, vi. 301. |