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yrectica. Fevers.

causes.

And is it also equally true that each of these maladies Order I. adheres as strictly to its own character in every age, and every part of the world, as small pox and measles; and Remote that they have uniformly shown as strong an indisposition to run into each other? Dr. Cullen's system is but sup- .

posed so in built upon an affirmative to these questions. For it, in Cullen's fact, allows but two kinds of fever, each as distinctly system. proceeding from its own specific miasm as any of the exanthems. But this is to suppose what is contradicted by the oc- The sup

position currences of every day: which compel us to confess that, contradicted while we cannot draw a line of distinction between marsh by daily

facts. and human effluvia from their specific effects, we have no other mode of distinguishing them.

Some writers, indeed, have denied that intermittents, Febrile. or rather the intermittents of marsh-lands, are produced in by a miasm of any kind; for they deny that any kind of tents; miasm is generated there; and contend that the only cause of intermittents, in such situations, is air vitiated by being deprived of its proper proportion of oxygene in consequence of vegetable and animal putrefaction, combined with the debilitating heat of the autumnal day, and the sedative cold and damp of the autumnal night *. But this opinion is too loosely supported to be worthy of much attention. It is sufficiently disproved by the intermittent described by Sir George Baker, as existing in the more elevated situations of Lincolnshire, while the adjoining fens were quite free from itt. And in like manner the severe and intractable intermittents of whatever form or modification, that exercise their fearful sway from Cape Comorin to the banks of the Cavery, from the Ghauts to the coast of Coromandel, not unfrequently pass into a contagious type, and propagate themselves by contagion ț. We have as much reason to suppose a febrile miasm in intermittents as in typhus, and in some instances they have been found as decidedly contagious. sometimes

miasm in intermit

contagious. * Currie. Trans. Amer. Phil. Soc. + Medic. Trans. Vol. 111. Art. xiii.

Report on the Epidemic Fever of Coimbatore: by Drs. Ainsly, Smith, and Christie.

tica.

Remote causes.

Febrile

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Order I. « That intermittent fevers”, says Dr. Fordyce, “ produce Fevers.

this matter, or, in other words, are infectious, the author (meaning himself) knows from his own observation, as well as from that of others.”*

And notwithstanding that it becomes us to speak with bably the

o diffidence upon a subject respecting which we are so same pro- much in want of information, I may venture to anticipate duced from both effluvia. that the evidence to be advanced in the ensuing pages

upon the general nature and diversities of fever, will show that there is more reason for believing that the febrile principle produced by marsh and human effluvia is a common miasm, only varying in its effects by accidental modifications, and equally productive of contagion, than that it consists of two distinct poisons, giving rise to two distinct fevers, the one essentially contagious,

as contended for by Dr. Cullen. Proposed In effect, we shall, I think, perceive that this mysteelucidation rious subject is capable of being, in some degree, more of the subject.

clearly elucidated and still farther simplified than it has

been by preceding pathologists. Insalubrious In the decomposition of all organized matter, whether effluvium

the des vegetable or animal, when suddenly effected by the composition aid of heat and moisture, an effluvium is thrown forth of all dead organized

" that is at all times highly injurious to the health, and, matter. in a closely concentrated state, fatal to life itself. Thus, Burial

we are told by Fourcroy, that in some of the burial France. grounds in France, whose graves are dug up sooner

than they ought to be, the effluvium from an abdomen suddenly opened by a stroke of the mattock, strikes so forcibly upon the grave-digger as to throw him into a state of asphyxy, if close at hand; and if at a little distance, to oppress him with vertigo, fainting nausea, loss of appetite, and tremours for many hours: whilst numbers of those who live in the neighbourhood of such cemeteries labour under dejected spirits, sallow countenances, and febrile emaciation t. This effluvium is from the decomposition of animal matter alone; but the foul

grounds in

* On Fever, Diss. 1. p. 117. + Elemens de Chimie, Art. Putrefaction de Substances Animal. Tom, Iv.

evers.

and noisome vapour that is perpetually blown off the Order I. coast of Bavaria, and the stinking malaria that rushes Pyrectica. from the south-east upon the Guinea coast, though loaded Remote with vegetable exhalations alone, triumph in a still more causes. rapid and wasteful destruction.

Malaria or

The last peculiarly so, the Guinea as being thoroughly impregnated with destructive miasm coast. while sweeping over the immense uninhabitable swamps and oozy mangrove thickets of the sultry regions of Benin, insomuch that Dr. Lind informs us that the mortality produced by this pestilential vapour in the year 1754 or 1755 was so general, that in several negro towns the living were not sufficient to bury the dead; and that the gates of Cape Coast Castle were shut up for want of centinels to perform duty; blacks and whites falling promiscuously before this fatal scourge. In this case, as in the preceding, the vapour is always In these in

cstances acaccompanied with an intolerable stench from the play of companied affinities between the different gasses that are let loose with a stench

which itself by the putrefactive decomposition; and hence it is im- may be inpossible to affirm that the mortality thus produced is the jurious to

the health. result of any single or specific miasm operating to this effect. But it shows us that the general effluvium from the decomposition of all dead organized matter, whether animal or vegetable, is equally deleterious to health and life. “ Its presence”, says the judicious Dr. Jackson, “is often connected with something offensive to the senses,to the smell, and, perhaps, even to the taste. A certain degree of salivation, nausea, sickness, and head-ache, are often occasioned by the exhalations of a swamp, or the air of an infected apartment, but febrile action is not ordinarily the immediate consequence. To produce fever a space of time is required, different according to circumstances.”. How far the decomposition of dead vegetable matter, though its effluvium prove thus injurious to the health of man, may alone, be capable of exciting fever of any kind, may, perhaps, admit of a doubt; for in the bogs or peat-mosses of Scotland, and still more

• Outline of the History and Cure of Fever, Part 1. Ch. iii. p. 104.

tica.

Remote causes.

Order I. those of Ireland, the inhabitants are exempt from agues, Fevers. ca. though the ooze extends in immense tracts.

The decomposition, however, to which we are, on the

present occasion, chiefly to direct our attention, is of a Soil of marshes a mixed kind; for the marsh and oozy soil of countries compound that are closely or have been long inhabited, is necessaof animal and vege

rily a combination of animal and vegetable matter. table prin If this decomposition take place slowly, as in cold or ciples.

w dry weather, and more particularly in a breezy atmoThe decomposition not sphere, not the slightest evil is sustained during its entire injurious

process. And hence, in order to render it mischievous, when slow. What agents and particularly in order to render it capable of proquicken and ducing fever of any kind, it is necessary that it should render it capable of

be assisted by the co-operation of certain agents, many generating of which we do not seem to be acquainted with, but a febrile miası,

which, so far as we are capable of tracing them, appear to be auxiliary to the general process of putrefaction, as

warmth, moisture, air, and rest or stagnation. Where their The simplest and slightest fever that is produced influence is feeble the re- under the joint influence of these powers, is the intersult is in- mittent: and we find these produced where their joint termittents.

influence is but feeble, and where it exists, perhaps, in its lowest stage, as in the favourable climate of our own country; where we are not frequently overloaded with equinoxial rains, and have not often to complain of a sultry sky or a stagnant atmosphere. Even here, however, we perceive a change in the character of the intermittent at different seasons: for while in the spring it usually exhibits a tertian type, in the autumn we find it

assume a quartan. And as these can only be contemvaried in

plated as varying branches of the same disease, we have their type

thus far, at least, reason to regard it as produced by a by the va

common febrile miasm, modified in its operation by a rying influence of the variation in the relative proportion which its auxiliaries,

known and unknown, bear to each other during the veriliaries on

nal and autumnal seasons; coupled, perhaps, with some miasın; and the va

degree of change produced by the same seasons in the rying state state of the human body. of the hu

If from our own country we throw our eyes over the man body.

Fevers

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evers.

causes.

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fever,

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globe, we shall find in every part of it, where the same Order I. causes exist, that in proportion as they rise in potency

Pyrectica. they produce a fever of a severer kind, more violent in Remote its symptoms, and more curtailed in its intervals, till we

The more gradually meet, first with no distinct intervals, and at vigorous or length with no intervals whatever; and hence perceive abundant

the auxiliathe remittent progressively converted into intermittent ries, the and continued fevers. And that here we have still the severer the same miasm merely modified in its operation by the va- i.

do Influenced ried action of its auxiliary powers on the constitution of also, by the the individuals it attacks, is as clear as in the former case; because, in many attacks, we see different indivi- tient. duals touched by the very same influence, exhibit all the varieties now alluded to, and intermittent, remittent, and Hence re

mittent and continued fevers co-existing in every diversity of violence; continued, commencing with either of these forms; keeping true to as well as

intermittent the form with which they commenced; or changing one fevers. form for another*. Such, as remarked by M. Devèze, Exemplified was the course of the fever at Philadelphia in 1793t;

7937; and Berthé. and such, according to M. Berthé, that of the southern provinces in Spain, in 1800ț: and such was peculiarly the fact in the highly malignant yellow-fever of Antigua Illustrated in 1816, as fully and admirably described by Dr. Mus. gravey, and to which we shall have occasion to refer Antigua in still more particularly in its proper place.

1806. Thislast disease first showed itself during sultry weather and a quiet atmosphere, in a swampy part of the island, among a ship's crew lately arrived, but from a healthy vessel, and themselves in good health on first landing. It soon spread widely, and at length indiscriminately in town and country, among all ranks and conditions and situations, blacks as well as whites, the oldest settlers as well as the newest comers. The head was, in some cases, chiefly affected; in others the stomach, the liver,

at

• See Sir Gilbert Blane's valuable article on Yellow Fever, in his Select
Dissertations, &c. p. 284. 8vo. Lond. 1822.
+ Traité de la Fievre Jaune, &c. 8vo. Paris. 1820.

Precis Historique de la Maladie, qui a regnée dans l'Andalusie in 1800.
Medico-Chirurg. Trans, Vol. ix. p. 92.

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