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Gen. III. Spec. II. à E. maligo nus asthenicus. Asthenic remittent. Gombrow on the Persian coast.

Danger augmented by dense offensive vapours.

or as Sir John Chardin calls it, Bander-Abassi, on the Gulf of Persia*: in which last place the mortality is so severe between the months of April and September that the deaths are ordinarily calculated at nine out of ten of the inhabitants : and this notwithstanding that most of them retire during such period towards the mountains, and all mercantile concerns are relinquished ; so that, says the Chevalier, “la moisson est fermée, comme un parle.” The diseased are commonly removed higher up the country as soon as they sicken ; but, whether removed or not, they usually die in four or five days.

There can be no doubt that in both these places the danger of the disease may be augmented by the dense and stinking vapour that is perpetually blowing upon them during the pestilential season, the “puantes vapeurs de la mer”, as Sir John expresses himself, “ qui faient bondir le cœur la première fois qu'on le sent.” These on the African coast are impregnated from the impenetrable mangrove swamps of the interior of Guinea, and on the Persian, from the saline and sulphurous exhalations of the several adjoining islands which the winds of the season pass over in their periodical sweep: and the copious disengagement of hydrogene, whose presence the intolerable stench seems to indicate, will account in no small degree for the deficiency of living power, which so peculiarly distinguishes the malignant remittent in these quarters. In the latter region, indeed, some such debilitating influence seems to operate habitually: for the ingenious author thus quoted adds, that “the nations carry in their complexion and constitution the proofs of their malignant atmosphere, being yellow and ghastly from the age of twenty-one, and decrepid at thirty.” Of the destructive power of such vapours, we have sufficient proof from what occurs on the coast of Batavia, and the islands that immediately surround it: for if, by judicious treatment, a patient, in this quarter,

Coast of

• Voyage du Chevalier Chardin, &c. Tom. IX. p. 511-518.

should become convalescent from an attack of yellow fe- Gen. III. ver, he is still almost certain of falling a prey to the dis- ; E. maliginvigorating and deliquescent influence of the noisome nus astheexhalation by which he is surrounded, and especially Asthenie between sun-set and sun-rise, unless timely removed to remittent. a more salubrious quarter. We may bence readily conceive how yellow fever may cies of sym

Discrepanunder certain circumstances have a strong tendency to ptoms acthe same asthenic character, and run rapidly into a ty

counted for. phous form, or be combined with its symptoms from the first. This is, in truth, the hybrid disease of Sir Gilbert Hybrid fe

ver of auBlane, Dr. Lempriere, and Dr. Dickson. “In certain thors.

Blane, seasons," says Dr. Jackson, “in certain situations, and

Lempriere, in certain periods of the year, the character of the EN- Dickson, DEMIC is insidious and malignant. The disease under Jackson. those circumstances often begins regularly as a single tertian; and two, and sometimes three revolutions pass over without giving any alarm to ordinary observers : but at one or other of the above periods, a paroxysm commences with coma, stupor, and suspension of functions, threatening immediate destruction : or, as often happens, the energy of action becomes less and less distinct in every succeeding paroxysm; the skin becomes dry, or damp and greasy, the powers of life are overwhelmed, the pulse contracts itself, or becomes apparently weaker and weaker under the use of bark, wine, and the strongest stimulants of the materia medica." His second form of the Andalusian fever of 1820, is precisely to the same effect to

It is to this variety of the endemic of intertropical Malignant regions, that Dr. Chisholm has given the name of ma- fever of lignant pestilential fever. “ It must be kept in mind”,

Chisholm. says he, “ that this, the most tremendous of all the tropical diseases, wherever it appears, is the typhus of Europe, grafted on the yellow remittent fever of the

• Hist. and Cure of Fever, &c., Part 1. Ch. xi. p. 277.
+ Remarks on the Epidemic, &c. on the South Coasts of Spain, 1821.

nus asthe


Gen. III. torrid zone, or of countries whose climate, during part

Spec. II. of summer and autumn, possesses the temperature of the d E. malig

torrid zone.”* _“ It is evident”, says he, in another nicus. Asthenic re

place, “ that typhous infection does exist, perhaps does remittent. originate within the tropics. How fraught with mischief

therefore is that theoretical notion, that such infection cannot exist, cannot originate, and cannot be propagated in hot climates. Let the young and unexperienced practitioner guard himself against it; and be prepared for it when he meets it.”+

Dr. Chisholm offers a variety of examples in proof of this assertion, to several of which he had been an eyewitness, especially to that which is so well known to have

broken out in the unfortunate attempt to colonize the isBulam Pe land of Bulam in the spring of 1793, and which gave

rise to the fever of this name, so strikingly characterized by its asthenic signs. He has noticed others also, of nearly equal demonstration, extracted from the reports communicated to the Army Medical Board of our own

country. But, perhaps, none offer more striking proofs Edam remittent of

of this peculiar type than the Edam remittent of 1800, Shields. described by Mr. Shields, and that of Trinidad of 1819, Trinidad re- described by Dr. M.Cabe I. In the former of these, mittent of M.Cabe.

the marks of an extreme debility were often peculiarly impressive from the first. The patient with little previous notice, was seized with giddiness and cold chills, great sense of weakness, pain over the orbits, and in the epigastrium, together with vomiting. He frequently fell down and was insensible during the paroxysm, his body covered with a cold clammy sweat, except the pit of the stomach, which always felt hot to the palm of the hand; the pulse was small and quick; great torpor in the intestinal canal ; the pupil dilated and incontractile: great despondency at first, then low delirium or insensibility to danger. The patients, while on the island, were carried off in eighteen, twenty-four, thirty, or forty hours :

* Climate and Diseases of Tropical Countries, p. 167. Lond. 1822. + Id. p. 43.

Edin. Med. and Surg. Journ. Oct. 1819.



though often, when removed, not till after as many days. GEN. III. So malignant indeed, was this pestilence, that “almost a Es maligevery one who slept on the island a single night died.” nus asthe The organs chiefly affected, were first the brain, and in nicus.

Asthenic succession the stomach and liver. In the Trinidad re- remittent. mittent so reduced was the vital energy, that it was found necessary in various instances, to give the patient three bottles of brandy in less than twenty-four hours, and to continue this proportion for several days.

The treatment has here varied as much as in yellow Medical fever; in truth it ought to vary—not indeed according to varies and preconceived and general hypotheses, whose only va- ought to riance consists in fighting general rules against general rules, but in modifying the plan, whatever it may consist in, to the peculiar case.

Bleeding, however, must never form a part of the general practice, how necessary soever it may be in particular instances where atonic congestion may oppress the head or any other large organ. And even in such instances it will generally be found more expedient to employ calomel in large and repeated doses than the lancet, unless we see the patient at the very opening of the disease. Under either practice, the bowels must be opened and kept open by active purgatives; since from the general disturbance of the functionary balance, there is violent action in the abdominal viscera, while the vessels on the surface are entirely torpid. To restore this balance should be our uniform effort: and hence in conjunction with the above nothing bids fairer, or has in fact been found more successful, than the use of warm diaphoretics with opium. Cold water as a beverage, or in the form of injection, has also proved a highly refreshing tonic; frequent potations of old hock still more so. The bark is a doubtful remedy, for it often sits uneasy on the stomach and is rejected. It has hence fallen into undeserved disrepute. When, however, it harmonizes with the stomach, and is retained without oppression, it is entitled to all the praise that has been bestowed on it by former writers, and cannot be given too freely. The best pre

Gen. III. paration of it for the present purpose is undoubtedly the Spec. II. à E. malig

sulphate of quinine. Ablution with cold water has been nus asthe tried very generally during the malignant remittents of

most climates and always with very great advantage *. Asthenic remittent.




Hectic Jever.



arranged by

Gen. III. The symptoms of this species, except in its sweating

stages, are far less violent, and consequently its ducomplex ration is far longer than that of either of the preceding. and irregular:

Nothing, however, can more fully prove its complexity and irregularity than the different characters given of it,

and the different places allotted to it by different auand hence thors. Sauvages and Sagar introduce it into the list of differently

by continued fevers : Linnéus, Crichton, and Parr, into different the present division, or that of remitting and exacerNosologists.

bating fevers: Boerhaave regards it as of a mixed nature, a continued intermittent. « Febris hectica”, says he; est referenda ad febres continuatas intermittentes.” Vogel' and Cullen degrade it into a mere symptomatic affection. “As I have never”, says the latter, “observed a fever of this kind except when symptomatic, I could not consent to admit it into the list of idiopathic fevers, which alone ought to be enumerated."

• Epidemia vertia quae Wratislaviam, anno 1737, afflixit, Vide Act. Nát. Curids. Tom. xi

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