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medical officers of the station, having adopted the opi- Gen. III. nion that the yellow fever is uncontagious. For want of
AE. maligsuch restrictions, within a few days after the arrival of nus flavus.
Yellow the Bann, the garrison became affected, now reduced
fever. from twenty-eight to twenty-two, in consequence of six men having been ordered to a distant part. And such was the dreadful mortality with which the disease raged, that out of this garrison of twenty-two officers and soldiers, not less than sixteen died, being rather more than three fourths of the whole. The inedical officers were soon, though too late, convinced of their delusion, and most unreservedly admitted the quality of contagion ; and that the disease they were called to contemplate, was genuine yellow fever will be placed beyond a doubt by the two following symptoms that the surgeon of the Bann particularly notices as among its other characters : "the skin tinged with yellow, assuming a deeper and deeper hue"; and, “ before death, the vomiting of a dark coloured Auid, like coffee-grounds”; conjoint symptoms, which, as Sir Gilbert Blane observes, will apply to no other epidemic whatever.
How far the tanks or pools of water, within the range Whether of the febrile miasm, from whichsoever of the two water in
tanks may sources produced, may become sufficiently impregnated be contamito propagate the disease, has not been sufficiently deter
well as air. mined. The Tamul or native practitioners on the Coromandel Coast, ascribe the epidemic that so often ravages their country to contaminated water as well as to contaminated air, and the able authors of the report on the Coimbatore Fever, incline to adopt this opinion.
In France where, consistently with the popular doc- Doctrine of trine of M. Broussais, the disease is supposed to be seat. B ed in the mucous texture of the stomach or intestines, and to be dependent on contagion alone, as its means of propagation, a considerable degree of fancy has of late been indulged in, respueting the origin of this contagion ; and the fancy has been varied according to the bent of the individual. Thus M. Morreau de Jonnés has endea- Morreau de voured to show, in a work of some learning, but more
Jonnés : VOL. 11.
Gen. III. imagination*, that the yellow fever however at first pro
duced, which has eluded his researches, has been perB E. malignus flavus. petuated among Europeans, in the manner of plague,
leprosy, and syphilis, by a specific poison that has exfever,
isted immemorially among the Indians of St. Domingo, and was communicated by them to the Spanish Fleet, under the command of Columbus, in December 1493; and from this fleet to all the world in succession, in consequence of the close intercourse which took place between the individuals of the new settlement of Isabella, which was colonized out of the fleet, and the adjoining natives. In answer to which, however, it is sufficient to observe, after Dr. Chisholmt, that the Spanish writers, Herrera and Oviedo, appealed to in proof of this fact, rather unite in showing that the Spanish settlers received the disease in the first instance from marsh-miasm, and then communicated it to the natives themselves. While M. Adouard traces the same contagious poison, to an effusion or exhalation from the mucous membrane of the stomach of the individual affected, produced by an engorged or congested state of its vessels ; and which, in consequence of the gasseous elasticity of the material thus eliminated, escapes by eructation, and propagates itself by being swallowed, and thus communicated to the stomachs of others; on the mucous surface of which it commences a like action, and fructifies a like barvest of contagious matter; the black material, which remains behind, being in his opinion a mere caput mortuum, unendowed with any infectious or other mischievous propertyť.
There is much truth in this last position, whatever Nature of.. becomes of all the rest. Black vomit, has been by many black vomit.
physicians, and was at one time supposed by Dr. Rush, Innocuous. to be vitiated and discoloured bile; but it is now more
• Monographie Historique et Medicale de la Fièvre Jaune des Antilles, &c. + Of the Climate and Diseases of Tropical Countries, &c.
Relation Historique et Medicale de la Fièvre Jaune, qui a régnée en 1821, à Barcelone; par M. F. M. Adouard, M.D. &c., 8vo. Paris 1822.
generally conceived to be, as already stated, grumous Gen. III. or granular blood, let loose from the liver, stomach, E. malic. or some other digestive organ, from the violent commo- nus flavus. tion of the disease. Dr. Bancroft affirms, that “it is always insipid”; and we have numerous instances of orderlies in sick rooms who have had their hands and faces covered with black vomit suddenly ejected from the stomach, which they have taken little pains to wash off, while others have slept in sheets or blankets, stained and inundated with its flow, and yet have escaped the complaint. It marks, indeed, the violence of the disease, and is hence, commonly, though not always, accompanied with the formation of contagious miasm, but in itself it is not a source of contagion. The following instance of disgusting hardihood, though it has been brought forward in proof, not only of the innocuousness of black vomit, but of the uncontagious nature of yellow fever from any source, falls rather within the limit of an exceptive idiosyncrasy, in the escape with which it was accompanied, than lays any foundation for a general rule. A. M. Guyon, of Fort Royal, Martinique, we are told Singular erin the Revûe Medical, had the bravery to wear, for i
of insusception twenty-four hours, the suit drenched with sweat of a sol- of contagidier who had been labouring under this disease in its ous worst state ; he suffered himself to be inoculated in both arms with the yellow matter issuing from suppurating blisters : he went into the bed of another patient, who had just died of the disease, while it was soiled with excrement; wore, at the same time, his shirt soaked through with black sweat and still warm, and himself slept soundly, and sweated through a good part of six hours and a half, which he dedicated to this delectable trial; he exhibited several other feats of the same kind, and crowned the whole by drinking about two ounces of the black vomit discharged from the dead man's stomach-and nevertheless entirely escaped the fever. Admitting the truth of this marvellous story, there is still no great difficulty in conceiving that a man, who was so totally torpid to all delicacy of mental feeling; might at the same time labour
Ger. III. under a like torpitude of corporeal feeling, and be insenBE. malig
:sible to various irritants that would be sure to affect nus flavus. others.
It is probably owing to an idiosyncrasy producing fever, Other ex
something of the same kind of insusceptibility to the acemplifica- tion of the contagion of yellow fever, that while the mi
asmic poison for the most part takes place immediately, it sometimes continues dormant for an indeterminate period. Dr. Jackson has known it remain in this state for
two months, and Dr. Bancroft for even nine or ten. Disease The individual who has passed through the disease is rarely oc
rarely attacked a second time. In the opinion of some curs a second time, with physicians he obtains hereby an immunity at least equal out absence
to that afforded by the small-pox*. The examples, same cli- however, of recurrence are too numerous to justify such
a comparison; though, in most instances, where the disthough sometimes; ease has returned it has evinced a milder character. But yet milder. ilder. this influence on the system, whatever it may amount to,
This ; Voyaging
Ent seems to be lost by a short absence from tropical cliclimate re- mates ; so that those who return to Europe for a few stores the suscepti
months, are as open to all the effects of a febrile incurbility. sion as though they had never been within the tropics
before. Variable ap- As the larger viscera suffer very differently in different
on cases of this malady, the appearances on dissection have dissection, cas
generally kept pace with the previous indications: for, in some, the integuments of the brain, or even its vessels, its substance, and its cavities have shown marks of inflammatory action, which have not been traced elsewhere; while in others, whose brain has appeared sound throughout, the stomach and its collatitious organs have been found chiefly affected with congestion, rupture, or, still more frequently, an erythematous inflammation, which, in some instances, has spread from the pylorus through nearly the entire range of the intestinal canal. In varions other examinations the chest has exhibited the chief seat of disorganization; and in others again the urinary or
* Report of the Army Medical Board on Dr. Pym's Observations.
gans*. The mucous membrane of the intestinal canal Gen. III.
Spec. II. is by far the most frequently injured organ; and this has been laid hold of with no small degree of triumph by M. nus flavus. Broussais and his adherents as affording a manifest proof fever
Yellow of the truth of their favourite doctrine: and that yellow fever can be no other than une GASTRITE, or, in still later language, une GASTRO-ENTERITE. But it should not be forgotten that most of the gastric symptoms, and all the severest ones, only occur in the course of the disease, and rarely in a very early part of it; and that they are hence rather to be regarded as effects of overwhelming febrile action upon the delicate and irritable texture of the membrane so severely excited, than as a proximate cause of the fever itself: and the more so as sometimes the biliary system, the lungs or the brain are chiefly affected, and the intestinal canal exhibits fewer proofs of suffering then any of these. Unfortunately the practitioners in warm climates have Remedial
process undiffered as much in their therapia as in their etiology; fortunately for the latter, as might be expected, has greatly in- di
different fluenced the former. Dr. Lind, Dr. Clark, and Dr. Bal- hands. four, whose authorities were implicitly allowed and submitted to some fifteen or twenty years since, alarmed at the debility which the system will have to encounter in the second stage of the disease, or as soon as it has run through its inflammatory career, shuddered at the thought of the lancet, and generally commenced with clearing the stomach and intestinal tube by gentle emetics or purga- Cordial and
U sustaining tives or both, and immediately had recourse to the bark , in as large doses as the patient's stomach could bear, paying little or no regard to the remissions or exacerbations of the fever: though the last of these physicians chose calomel as his cathartic, and alternated its exhibition with the bark till the disease was subdued or had effected its own triumph : at the same time allowing a
* Bally, sur la Typhe Amerique ou Fièvre Jaune, Paris, 8vo.- Palloni, Observations Medicales sur la Fièvre regnante à Livourne, &c.-Saverésy, De la Fièvre Jaune en Generale, &c.