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GEN. IV.

pregnates a given space with its specific miasm and accompanying colluvies.

SPEC. II. Typhus.

fever.

Its contagi

ous range

not fully asthough

certained,

To what extent febrile miasm, issuing from the source Typhus before us, may spread in a free influx of pure air without becoming dissolved, or, in other words, so as to retain its contagious power, has never been very accurately ascertained. We know, however, that its range is very circumscribed, and reaches to but a very small distance known to be from the patient, or the nidus of foul clothes or utensils in which it may be lodged; and never infects a person in an adjoining street, or house, or room in the same house; nor even, as Dr. Haygarth has observed, in the patient's own chamber, if large, airy, and kept clean.

very circumscribed.

Does not clothes con

render clean

unquestion

clean.

It is also of great importance to know that typhous miasm, like the specific miasms of exanthems, does not render clean clothes of any kind contagious; or, in tagious, but other words, does not adhere to or harbour in them. ably unWhen, however, they are not clean, they may unquestionably be rendered contagious; and, hence, it is probable that the animal filth with which they are impregnated, while it is a source of additional miasm, becomes a fomes of that already formed, and separated from the patient's body.

A susceptibility, however, to diseases of every kind varies very considerably in different individuals; and hence we find that many persons upon an equal exposure to typhous contagion with others, receive it far less readily, and in some cases seem to be almost favoured with a natural immunity. As we have already remarked that a peculiar state of body gives a peculiar tendency both to generate and receive typhus, we can easily conceive that where the body is in an opposite state it must be much less susceptible of its influence; and we are thus put in possession of a general cause of escape. But there seems to be something beyond this, dependent, indeed, not upon the incidents of more vigorous health or higher animal spirits, but upon the nature of the idiosyncrasy itself.

All indiviequally re

duals do not

ceive the

contagion.

Dr. Haygarth has endeavoured to determine, from What pro

Q 2

portion of individuals

GEN. IV.

SPEC. II.

Typhus. Typhus fever.

are naturally

exempt

from its in

fluence.

Miasm con

tinues latent

in the body

seven days,

and sometimes much longer.

Man may

be brought bear expo

by habit to

sure harmlessly.

very ingenious and plausible data, the average proportion of those who in this manner remain exempt from contagion, while spreading on every side around them. And he limits the immunity to one in twenty-three: for he tells us, that when one hundred and eighty-eight men, women, and children, were exposed fully to the typhous contagion for days and nights together, in small, close, and dirty rooms, all of them, except eight, were infected with this fever. And he has farther endeavoured to show, that the miasmic poison, when received into the body, continues in a latent state for seven days, from the time of exposure to the contagion, before the fever commences, and may continue in the same state for seventytwo days, beyond which we have no instance of its producing any effect. And this deduction is in pretty close unison with the experience of Dr. Bancroft †, who in ninety-nine cases of orderlies and nurses that attended the English army on its arrival at Plymouth from Corunna in 1809, observed that they were rarely attacked with fever earlier than the thirteenth and in no instance later than the sixty-eighth day.

Man, however, is so much the creature of habit, that his constitution is in a thousand instances brought by degrees to endure poisons of the most fatal power. This we see daily in the use of opium and ardent spirits; and we shall in due time have to notice something of the same kind even in plague. This adaptation of the constitution, however, to the circumstances by which it is surrounded, is in nothing more conspicuous than in the But not all fever before us. Not, indeed, in all persons-for all do not possess the same pliability of constitution-but in those who are endowed with it. And, hence, one reason why nurses and perhaps hospital-surgeons escape so often without injury; and especially why prisoners brought into a court for trial remain themselves occasionally in perfect health, while their clothes are so impregnated

persons

equally.

* Letter to Dr. Percival, p. 31.

† Essay on Yellow and Typhus Fevers, p. 515.

SPEC. II. Typhus.

fever.

with the contagious miasm as to infect a whole court, GEN. IV. and communicate the disease to the judge or others who are at the greatest distance from them: of which we are Typhus furnished with melancholy examples in the Oxford assizes of 1577, those at Exeter and Taunton in 1586, Examples. those of the Old Bailey 1736 and 1750; besides similar instances in various hospitals and ships of war.

There are other persons again, as Sir George Pringle Some more slightly has well observed, whose constitutions forming a middle affected than line between those who readily receive, and who power- others; fully resist the contagious aura, are affected only in a modified degree. They bend to the assault, but are not cut down by it. They become feeble and irritable; the sleep is disturbed; the tongue white in the morning; the appetite impaired; the smallest exertion fatigues them, and accelerates the pulse; and in this state they remain for weeks together, and at length recover without any formal attack of fever.

in yellow fever as

well as in

We have seen that the same influence of habit exists under yellow fever; during which the natives of those climates, where its remote causes are in almost perpetual typhus. operation, suffer far less when it attacks them, and are far less susceptible of its attack.

sometimes

swamps,

But though febrile miasm issuing from a decomposi- Typhus tion of human effluvium has a peculiar tendency to ge- produced nerate typhus, we have seen that the same miasm issuing from from a marsh effluvium or a decomposition of dead organized matter, under a peculiar state of modification, has produced remittents with a typhous character, and sometimes specific typhus itself. And as, in this case, and then the miasm is apt to spread more widely, typhus has by epidemic. occasionally many writers been said to be occasionally epidemic. When, however, the disease issues from this source, it is Occurs chiefly in far more generally in temperatures too low than too high low tempe and heated; since, as already observed, cold, and espe- ratures. cially cold and moisture, have a peculiar tendency to depress the living power: and hence this disease is said

Epanetus malignus asthenicus, Suprà, Cl. 111. Ord. 1. Gen. III. Spec. 11. d.

GEN. IV.
SPEC. II.

Typhus. Typhus fever.

a E. Typhus mitior. Nervous fever.

Character.

Sporadic typhus generally

under this form.

ease.

to be almost stationary at Carlscrone, or at least to have lingered there for four or five years on some occasions*. Typhus, therefore, originating from different causes, and all these causes modified in their action by collateral circumstances, may readily be supposed to be accompanied with very different symptoms, and to appear under very different degrees of severity. The chief varieties, however, are the two following:

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The FIRST VARIETY, or MILD TYPHUS, was called by Dr. Huxham febris lenta nervosa, and has hence been commonly distinguished by the name of low or slow NERVOUS FEVER, from the great languor and dejection of mental or sensorial power with which it is always accompanied, and on this account it has sometimes been denominated the hysterical fever t. It is particularly characterised by slight shiverings; heavy vertiginous head-ache; oppression at the præcordia; nausea; sighing; despondency; coma, or quiet delirium; whey-like urine.

When the disease appears sporadically, it is usually under this form. There is nothing alarming to the patient's friends on its accession. The first symptoms are slight, the tongue exhibits little change, and the pulse is Progress only a little quickened, and somewhat smaller than usual: at the same time, however, there is great anxiety and depression of mind; so that the symptoms do not much differ from a mild and comparatively insignificant fever of any kind operating upon a nervous temperament. But as the disease advances, all the symptoms of sensorial debility become severer; the skin, which has hitherto been mostly dry, will about the third day be covered with profuse, clammy, debilitating sweats, while the heat is still inconsiderable, and the countenance pale and sunk. The sweat is often offensive to the smell, fre

Foxe Neuen Schwed. Abhandl. Band. vIII.

Manningham: on "The Symptoms, Nature, and Cure of the Febricula, commonly called the Nervous or Hysterical Fever." Lond. 1776.

GEN. IV.

SPEC. II. & E.Typhus

fever.

marked by

quently acid, and sometimes, according to Stoll, as sour as the sharpest vinegar*. About the tenth day the weakness greatly increases; all the limbs tremble; and the mitior. tremors soon become convulsive, with a despondency and Nervous alienation of mind, at first observable only in the night, but soon continuing with little intermission: the delirium is of the mild or quiet sort, and rarely amounts to phrensy. The disease often runs on to the twenty-first day, and Rarely occasionally to a much longer period. It is seldom marked by that sudden change which can be called a crisis; but gradually becomes more aggravated in its symptoms till it reaches a fatal termination; or slowly advances to convalescence, by evincing a disposition to natural sleep; more steadiness and firmness of pulse; a more favourable countenance; a tongue more florid at the edges; a firmer and more collected mind; and a returning desire for food, often indeed capricious, but without nausea or sickness.

a crisis.

Termina

tion.

Singular In an anomalous and very singular case, related by case of Dr. Satterley, the desire for food, which at first was typhus. greatly loathed in whatever form offered, re-appeared about the fifth day with an enormous craving which it was impossible to satisfy. Animal food was preferred, but food of any kind was swallowed voraciously; and when food was not allowed, various indigestible substances were devoured in its stead. This desire returned with every returning ingravescence of the fever, which adhered to no regular period; and it continued as long as the ingravescence lasted, which was usually ten or twelve hours. The disease extended with numerous variations to upwards of thirty days, when the fever unequivocally subsided, and the patient gradually recovered.

Of the treatment we shall speak, after considering it in its severer forms.

as

E. Ty

phus

Putrid

The heavier, severer, or PUTRID TYPHUS chiefly differs from the mild in the violence and rapidity of its gravior. march, and the marked and undisguised character it fever. sumes from the first. While the mild therefore commences insidiously with only slight shiverings, the heat

* Rat. Med. 1. p. 79.

+ Med. Trans. Vol. v. Art. xxII.

How differs from mild

typhus or

nervous fever.

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