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Gen. III. employing mercury as a sialogogue, the evils which flow
;from the uncertainty of its action, both in respect to time B E. malignus flavus. and degree, and its frequent inroads upon the constitu
tion, even where it has been of use, are serious and imfever.
On the employment of EMETICS, there is now no · longer any question. It is admitted, on all hands that, in the irritability of the stomach and its collateral organs during this disease, they are generally improper, and almost always augment the morbid action; on which account, even the antimonial sudorifics are of very doubt
ful efficacy: and, whenever ventured upon, should be Carriage combined with opium. And for the same reason, the exercise.
use of carriage exercise, so strongly recommended by Dr. Jackson, and some of the most distinguished American practitioners, even “ under the inconveniences of a scorching sun, of clouds of dust, and of a jolting cart,”* has rarely been put to the test, except in the emergency of the sudden retreat of an army: and has hardly been
allowed to enter into the catalogue of ordinary remedies. General
The general treatment, indeed, may be summed up in summary.
few words. Copious bleeding, a free repetition of active purgatives, combined with opium where the ventricular irritation is considerable, in the commencement of the fever; frequent sponging, or affusion of cold water, with an interposition of the neutralized salts as diaphoretics, during its progress; and bark and other tonics, as soon as the febrile commotion begins to subside. The more powerful and violent remedies of repeated bleedings to faintness, mercurial salivation, or the stimulants of spirits, ether and opium, being alone added to the list ac
cording to the circumstances of the individual case. Pure air by
Pure air by a ventilation of the atmosphere, is however a more powerful remedial agent than all the rest put together; and to this position I apprehend every class of writers will accede, how much soever they may differ upon other points. The Army Medical Board is
ventilation the most important mean of cure.
[ORD. I. 193 therefore peculiarly entitled to the gratitude of the Gen. III. country for the great pains it has taken to give improve- &
Spec. II. ment to this important object, by an establishment of nus flavus. open and wide-spreading encampments, instead of con- &
fever. fined and unperflated barracks; and no man can hear of Establishthe desirable success with which this enlightened mea- ment of ensure has been attended without exultation.
The at- for this purtempt, as I am permitted to state from the manuscript pose;
and their documents in the possession of the Board, has been great be made at Barbadoes, Tobago, and Antigua; not more fit. than four individuals being allowed to occupy a single A tent, instead of ten or twelve, which is the usual propor- Tobago, and tion at home: and the success developed in these islands, Antigua : has already become so considerable and decisive, that and about to
spread furgovernment has consented that a like trial should be ther. made in all the islands around them. In the affected Benefit il
lustrated in crew of the Pyramus, distributed by Dr. Hartley into the crew of an encampment at Antigua, in the year 1822, not a the Pyrasingle case of fever was found to travel from one individual to another. We cannot wonder therefore at beholding this able officer, anxious, in his report for 1823, that the same plan should be extended to other places, and adopted in other diseases. " In cases of sickness,” Hartley's says he, “ and especially in yellow fever, I feel convinced in my own mind, that nothing could prove so beneficial in checking the ravages of this disease as separating the troops; and particularly by removing them to some distant dry field from the locality of the attack. Nothing could more immediately substantiate the advantages of removing and encamping a body of men, than the result in the Pyramus's crew.”
In Barbadoes, where, as I have just observed, the Exemplisame improvement has obtained a footing, the mortality for the last two years is almost incredibly abated. I have examined the tables subjoined to the annual reports in the office of the Army Medical Board, and have found that, from having been upon an average of seven years, about one in twenty-one of the sick list, in 1822, the mortality was only one in twenty-four; and in 1823,
Gen. III. only one in thirty-five. In this last year, however, it
should be observed that the hospital list was somewhat 6 E. malignus flavus. enlarged by the occurrence of an influenza unaccom
panied with much danger; yet the aggregate of patients
amounted to not more than about a hundred beyond Other coin- those of the preceding year. I am ready to allow that cidents.
several other important regulations, for which we are equally indebted to the vigilance and the judgement of the Army Medical Board, may have contributed to this salutary change, but the greater part of it is still, perhaps, to be ascribed to the new plan of encamping. I cannot give a better description of the adjuvant regulations I am now referring to, than by adopting the words of Mr. Tegart, an enlightened inspector of hospitals at Barbadoes, who, in his manuscript report for 1823, thus enumerates them, and at the same time confirms the
ameliorated health of the soldiers quartered in that staTegart's tion, and to which I have just referred. “The loss in that report.
year" alluding to 1822, or the preceding, “ was so comparatively small with former ones, that I hardly hoped to send so favourable a one again. This return, however, exceeds greatly any hopes I could have anticipated; being not one half the average amount of the preceding six years : and not a sixth part of the yearly loss sustained in the fourteen years antecedent to those. There are many reasons for this favourable change; the men are better clothed, better fed, and better looked after by their officers; there are many local improvements in the vicinity of the barracks, which formerly were not much attended to: such as draining swampy and marsh ground; clearing away brush-wood and long grass, which harboured moisture, and emitted, at certain seasons, noxious exhalations, producing fever and other diseases, the treatment of which was very different from that of the present day. I believe most sincerely that we are also indebted for the favourable comparison in the scale of mortality to the improved education of medical men, to the discoveries in the various branches of medical science, and to the rationale of medical practice.” The writer of
this work cannot avoid adding his conscientious assent to Gen. III. the correctness of these views.
Spec. II. There is another variety of malignant remittent which y E. maligo
nus Causus. has been known to medical practitioners from the time Ardent of the Greeks, though less frequent than the yellow fe- rem
How dever, and which, by Hippocrates, has been denominated scribed by CAUSUS; as it has by later writers, who have only Hippo
crates. tranlated the Greek term, been called FEBRIS ARDENS, ARDENT or BURNING REMITTENT. From its being usually accompanied with much disturbance of the stomach and intestines, it is called by Professor Frank, febris gastrico-inflammatoria, as the last variety is febris Febris gas
trico-ingastrico-nervosa. In Hippocrates it is briefly described Hammatoria as a fever, characterised by extreme heat, violent thirst, of Frank. a rough and black tongue, complexion inclined to yellowish, saliva bilious. There is commonly an acute aching in the head, nausea, great anxiety of the præcordia, with frequently a gnawing pain at the stomach. The bowels are unusually costive, particularly at the commencement of the disease. The tongue, mouth, nostrils, and, indeed, the whole surface of the body are parched and fiery-hot, whence, indeed, the Greek name for the disease; the pulse is full and strong; the voice hoarse: the breathing short and quick, with sometimes a slight cough, and occasionally delirium. It chiefly attacks the young and the vigorous, who Causés
various, bear the attack better than old persons. The causes to which it was formerly ascribed, are long exposure to the heat of the sun, great fatigue from undue exercise or labour, or too heating a diet. It has of late, however, Probably
febrile been supposed, and with much plausibility, from its frequent occurrence towards the autumnal equinox, and especially from its resemblance to the yellow fever, that, like the latter, its ordinary remote cause is the miasm of swamps and marshes. And, if so, it affords us a proof that under certain modifications, febrile miasm issuing from this source may, as I have already suggested, produce a caumatic or inflammatory, as well as a synochous or typhous tendency, in constitutions predisposed to this
Gen. III. character of fever*, for the causus is, in fact, whatever Spec. II.
be its cause, a vehement inflammatory remittent. It is nus Causus. on this account, that Dr. Mosely conceived the causus
of the ancients and the yellow fever of the present day, Confounded to be one and the same disease; whence he applies to with yellow the latter, the Greek name of causus. This, however, fever by Moseley. is not quite correct : for in the real causus, the burning Distinctive heat is more intense, the thirst more intolerable; while
the stomach is generally less irritable, and will bear vomiting with advantage: and, in the second stage, the chilliness which, in the yellow fever, is merely accompanied with horripilation, and is a mischievous symptom, in the causus, is accompanied with a smart rigor, which often terminates in a copious and salutary sweat. The process moreover, in the causus, generally lasts only four days, and is terminated, when left to itself, by a critical diaphoresis, vomiting, diarrhæa, or nasal hemorrhage ; but if the fever be not carried off in this way, it com
monly beconies fatal.. Yet nearly. We have nevertheless satisfactory proofs that though connected.
the causus and yellow fever be not precisely the same disease, both often issue from the same febrile miasm, and sometimes run their race conjointly; the difference depending chiefly upon the idiosyncrasy or the peculiar
condition of the constitution at the time of attack. Proofs : Thus in that most formidable assault of yellow fever
which took place at the Mole in St. Domingo, in the from autumn of 1796, Dr. Jackson tells us that the symJackson :
ptoms of the disease among a set of men vigorous by nature, and often transgressing the rules of temperance, were ardent and violent, with much vascular excitement in the early periods, often subsiding on the third day, and terminating rapidly in black vomiting, and a formidable train of horrors.”+ And he has since met with the same form in Spain, which, in effect, constitutes his
* Devèze, Traité de la Fièvre Jaune. Svo. Paris, 1820. Saverésy de la Fièvre Jaune en generale, et particulièrement de celle qui a regnée a la Martipique en l'an 1803—4.
+ Hist. and Cure of Fever, &c. Part 1. Ch. 11. p. 66.