GEN. III. SPEC. II. y E. malignus Causus.

Ardent

first division of the Andalusian fever. And, hence, Dr. Chisholm informs us that "the diseases which originally proceed from marsh exhalations, may be so impressed with the action of irregular temperature, as to remittent. render them highly inflammatory, although the character from and nature of the original are so manifest as to make Chisholm : a mode of treatment suitable to the two diatheses, or rather the mixt diathesis, prevailing in the system, necessary+". And in proof of his remark, he has quoted several instances from the reports of the Army Medical Army MeBoard, of which, that which occurred in the year 1812, at Brimstone-Hill, St. Christopher's, is probably most worthy of notice, on account of the topography and general healthiness of the spot, which is described as follows:

dical Board.

"Situation N. Lat. 17°-soil light and dry-composi- St. Chris tion rock and sand-elevation six hundred feet-dis- topher's. tance from the sea a quarter of mile. Barracks exposed to currents of air and strong winds, directed on them by ravines. No swamps in the neighbourhood. Change of temperature sudden, from 70° to 80° and 90° in the course of a few hours. RAIN ABUNdant. Probable cause, previous hot dry weather, il ventilated and illconstructed barracks, some of them bomb-proof. Epidemic cause unknown; and prevalence of the disease cannot be accounted for."

The cause, however, is not difficult to assign; and, in Explained. truth, we have already adverted to it in describing the occasional origin of yellow fever: for however dry and elevated the situation may be, yet on the descent of copious and continued rains, such as are here set down, a temporary swamp is very soon produced, and of sufficient power, in hot climates, to generate even "on a light and dry soil, and a sandy rock", febrile miasm enough for the severest epidemic; and especially where such miasm receives the collateral aid of ill-ventilated barracks, and

Remarks on the Epidemic Yellow Fever on the South Coast of Spain, Lond. 8vo. 1821.

† Manuel of the Climate and Diseases of Tropical Countries, &c. Part. 11. Chap. 1. 8vo. Lond. 1822.

SPEC. II.

Ardent remittent.

GEN. III. currents of cold air blowing down long ravines directly E.malig upon the troops while in a state of perspiration; and nus Causus. producing a sudden abstraction of animal heat, more mischievous perhaps, within the tropics, than on the banks of the Copper-mine-river during the snows of the winter-season, where, as Captain Franklin informs us, the Chipewyan Indians find them the most detrimental and destructive to life of all the numerous and heavy evils to which they are exposed*.

Treatment.

The fever continued through the winter, evidently in this case kept up by its having become contagious. It was at first confined to one of the barracks occupied by a company of the 25th regiment: and its symptoms are thus briefly but forcibly described: "type continued:-thirtyfour admissions from this company alone: symptoms in all, of a most unfavourable character from the first attack; great head-ache, sickness and vomiting; pulse full and hard; eyes inflamed; face flushed; ardent heat of the skin; in many cases, yellowness of the whole body on the second day of the disease." The entire number of cases that occurred were four hundred and twenty-two: of which, not fewer than one hundred and eighteen died, affording a mortality that treads close upon the heels of that in the plague.

In the treatment of this variety, the advocates for free doses of bleeding and for those of calomel, may shake hands; for both may be allowed with liberality. The calomel, however, is found most successful when combined with antimonials or Dover's powder. Free purging is also to be strongly recommended: the means, in effect, whatever they are, must be vigorous to be of any avail-for the disease itself is of great vigour and rapidity; and, unless prostrated at the onset, will soon prostrate the patient. In conjunction with this process, we may also adopt that of Hippocrates, who, in the burning remittent of his own day, employed cold applications in

Narration of a Journey to the Shores of the Polar Sea, &c. p. 249. Lond. 4to, 1823.

Ardent remittent. Cold drinks,

every way; the coldest possible drinks; and the coldest GEN. III. SPEC. II. possible clysters, and ablution with cold water applied to y E. malig. every part of the body*. Under proper regulations nus Causus. there is no doubt of the advantage of such a treatment, and the medical process of the continent, as well as that of our own country, throngs with cases in which it has Cold water. been found serviceable. Marquet recommends the application of cold air as well as of cold water; and gives an Cold air. instance of a rapid cure in one who in a state of delirium exposed himself naked to the cold of the atmosphere out of doors t. And on this account Schäffer advises that the patient, in any acute fever accompanied with dry burning heat, should be carried forth from his chamber, on a mattrass, and thoroughly ventilated abroad. Dr. Jackson would indeed have him ventilated in any way, even on a cart or waggon, if there be no easier conveyance.

nus asthenicus.

remittent.

marsh and

human

effluvium.

In the preceding varieties, the malignant remittent has E. maligshown a tendency to an inflammatory or a synochous career. Under particular circumstances, however, it evinces Asthenie a like inclination to a deep nervous depression, sensorial debility, or A TYPHOUS CHARACTER from the first. And Originates this, whether the febrile miasm originate from a decom- both from position of marsh, or of human effluvium; for the records of medicine furnish us with innumerable instances of both. In the two cases, however, there are a few slight variations in the range and mode of its action, the laws of which I have already endeavoured to lay down as far as we are acquainted with them§; and hence M. Bally, confounding this variety with that of proper yellow fever, calls the latter, the American typhus, and makes two subdivisions of it, a contagious and an uncontagious, according to its degree of violence. This modification of the disease, therefore, is best distinguished by the name of ASTHENIC REMITTENT.

GEN. III.
SPEC. II.

nus asthe

nicus.

Asthenic

remittent.

The most

fatal cases

effluvium.

Exemplified

The epidemics of this kind accompanied with most E. malig mortality are those which arise from a decomposition of human effluvium in the midst of filth, poverty, or famine, great heat and moisture, crowded multitudes, and a stagnant atmosphere: for here we have almost all the auxiliaries of febrile miasm operating for its production. The from human remittent epidemics of Cadiz and Malaga seem chiefly to have been of this kind: and they are the common pestilences of dis-spirited armies, maintaining their ground with difficulty in the midst of great carnage, surrounded and Malaga, by the dead and the dying, reduced to short provisions, and worn out by the fatigues of the campaign. The writings of Sir John Pringle are full of examples of this kind; and Professor De Haen has given a striking description of the same in his account of the contagious epidemy that committed such tremendous havoc throughNoted epi- out the Prussian army, at Breslaw and its vicinity in

in the late epidemics of Cadiz

chiefly of

this variety.

demic of

Breslaw.

the middle of the last century, constituting the disease to which M. de Sauvages has given the name of tritæophya Vratislaviensis. It was peculiarly distinguished by irregular action, great debility, and overwhelming dejection of mind. The lipyria, or coldness of the surface, with which the disease opened, rarely yielded to any general re-action, for the extremities seldom became warm, and were often rigid and convulsive; at the same time that the interior parts burned like a fire; the head and stomach suffered with acute pain; there was great anxiety about the præcordia; and so exquisite a soreness over the entire surface that the patient had the greatest dread of being exposed to the contact of the external air, a mere change of the temperature being intolerable. De Haen's De Haen himself at length became a prey to the infection, and his attack commenced as thus far stated. On the fourth day, he tells us, all his symptoms were worse, his feet quite chilled, but his hands red, and agitated with convulsive motions; he had occasional vomitings, and was terrified with the image of impending death. On the eighth day the pulse was convulsive, and he was continually crying out from his pains. On the ninth,

statement

of his own

case.

GEN. III.
SPEC. II.

E. malignus astheAsthenic

nicus.

delirium, and a rejection of grumous blood from the stomach. On the eleventh, perspiration and a tranquil pulse, but the voice was broken, the speech was interrupted, and the teeth grated. On the twelfth, the jaw was convulsed, there was a sardonic laugh and deafness. remittent. On the fourteenth, an icy coldness covered the whole body, accompanied with a cold sweat, but a frequent use of ablutions afforded relief. On the eighteenth, he had a vivid delirium, but fainted on being taken out of bed; which was succeeded by hunger, copious sweats, and profound sleep, with an intolerance of noise. At this time, every thing appeared new and extraordinary; a feeling described by many sufferers as soon as the violence of the disease begins to abate, and which Dr. Pinckard has very strikingly noticed in his own case. The symptoms varied considerably from this period, and he had still many dangers to contend with. He recovered, however, though very slowly, and with numerous draw-backs; for on the thirty-sixth day, he had a cholera, and on the forty-eighth his skin scaled off, and he lost his nails.

Towards the close of the disease, the skin was cover- Sequel of ed with a scabid or ichorous eruption, rather than petec- the disease. chiæ; evidently from debility of the capillaries: a fact that has often occurred even in the slighter attacks of this variety of remittent in our own country, when it has occasionally broken out, as in 1765, among the troops stationed in the vicinity of Portsmouth, and is particularly noticed by Dr. Lind. In this last case it was often suspected to be the itch, to which it had a very near resemblance: and it is highly probable that in many instances it was so, and that the acarus scabiei found, in the sores, a convenient nidus for the deposit of its eggs. There are situations, however, in which the febrile Exemplimiasm producing this low variety of remittent is gene- produced rated by a decomposition of the stagnant matter of hu- from stagmid marsh-lands; such chiefly are the regions about nant Cape Coast, in Africa, especially when visited by the Cape Coast, foul and smouldering harmattan, and about Gombrow, Africa.

fied as

marshes.