Fevers. causes. but supCullen's system. posed so in And is it also equally true that each of these maladies _ORDER I. adheres as strictly to its own character in every age, and Pyrectica. 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 built upon an affirmative to these questions. For it, in fact, allows but two kinds of fever, each as distinctly proceeding from its own specific miasm as any of the exanthems. But this is to suppose what is contradicted by the The position currences of every day: which compel us to confess that, contradicted while we cannot draw a line of distinction between marsh and human effluvia from their specific effects, we have no other mode of distinguishing them. OC sup by daily facts. miasm in Some writers, indeed, have denied that intermittents, Febrile or rather the intermittents of marsh-lands, are produced intermit 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 . 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 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. ORDER I. Pyrectica. Fevers. Remote causes. Febrile miasm probably the same pro duced from "That intermittent fevers", says Dr. Fordyce, " produce 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 diffidence upon a subject respecting which we are so much in want of information, I may venture to anticipate 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 elucidation of the subject. Insalubrious effluvium from the decomposition of all dead organized matter. Burial grounds in France. In effect, we shall, I think, perceive that this mysterious subject is capable of being, in some degree, more clearly elucidated and still farther simplified than it has been by preceding pathologists. In the decomposition of all organized matter, whether vegetable or animal, when suddenly effected by the aid of heat and moisture, an effluvium is thrown forth that is at all times highly injurious to the health, and, in a closely concentrated state, fatal to life itself. Thus, we are told by Fourcroy, that in some of the burial 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 +. This effluvium is from the decomposition of animal matter alone; but the foul * On Fever, Diss. 1. p. 117. + Elemens de Chimie, Art. Putrefaction de Substances Animal. Tom. IV. Fevers. causes. Malaria on 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 rapid and wasteful destruction. 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 accompanied with an intolerable stench from the play of affinities between the different gasses that are let loose by the putrefactive decomposition; and hence it is impossible to affirm that the mortality thus produced is the 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. In these insma with a stench stances accompanied which itself may be injurious to the health. ORDER I. those of Ireland, the inhabitants are exempt from agues, though the ooze extends in immense tracts. Pyrectica. Fevers. Remote causes. Soil of marshes a compound of animal and vegetable principles. when slow. What agents quicken and The decomposition, however, to which we are, on the present occasion, chiefly to direct our attention, is of a mixed kind; for the marsh and oozy soil of countries that are closely or have been long inhabited, is necessarily a combination of animal and vegetable matter. If this decomposition take place slowly, as in cold or The decom- dry weather, and more particularly in a breezy atmoposition not sphere, not the slightest evil is sustained during its entire injurious process. And hence, in order to render it mischievous, and particularly in order to render it capable of producing fever of any kind, it is necessary that it should be assisted by the co-operation of certain agents, many generating of which we do not seem to be acquainted with, but 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. render it capable of a febrile miasm. Where their influence is sult is in termittents. The simplest and slightest fever that is produced feeble the re- under the joint influence of these powers, is the intermittent and we find these produced where their joint 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 contemplated as varying branches of the same disease, we have thus far, at least, reason to regard it as produced by a common febrile miasm, modified in its operation by a variation in the relative proportion which its auxiliaries, known and unknown, bear to each other during the vernal and autumnal seasons; coupled, perhaps, with some degree of change produced by the same seasons in the state of the human body. Fevers varied in their type and power by the varying influence of the febrile auxiliaries on the febrile miasm; and the varying state of the hu man body. If from our own country we throw our eyes over the causes. The more vigorous or the auxilia globe, we shall find in every part of it, where the same ORDER I. causes exist, that in proportion as they rise in potency Fevers. Pyrectica. they produce a fever of a severer kind, more violent in Remote its symptoms, and more curtailed in its intervals, till we gradually meet, first with no distinct intervals, and at length with no intervals whatever; and hence perceive abundant the remittent progressively converted into intermittent ries, the and continued fevers. And that here we have still the severer the fever, same miasm merely modified in its operation by the va- 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 constitution of the pacase; 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 continued fevers co-existing in every diversity of violence; commencing with either of these forms; keeping true to the form with which they commenced; or changing one form for another*. Such, as remarked by M. Devèze, Exemplified was the course of the fever at Philadelphia in 1793+; and Berthé. by Deveze and such, according to M. Berthé, that of the southern provinces in Spain, in 1800‡: 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- by the yelgraves, and to which we shall have occasion to refer Antigua in still more particularly in its proper place. This last 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, • 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. Hence recontinued, as well as fevers. mittent and intermittent low-fever at 1806. |