ORDER I. Pyrectica. Fevers. Remote causes. Debilitated subjects suf fer sooner and more severely when newly exposed to miasm. Explanation of this fact. Black Assize of 1577. Remarks on statement that the Antigua or a still different organ. Hiccough and black vomit were common towards the close of the disease, though many died without it; and recovery was no exemption from a second attack. Dr. Musgrave asserts farther, that, during the whole of this fatal epidemy, there was no instance of its being received by contagion. The argument, however, which he offers upon this subject is not quite convincing. Yet admitting the fact to be as he states it, we have an additional proof, if proof were wanting, firstly, that when the animal frame has been previously debilitated or relaxed, as in the case of a ship's crew that has been long voyaging in high latitudes and living on salted provisions, it suffers sooner and more severely than where no such relaxation has taken place: and, secondly, that by a long and gradual exposure to the influence of febrile miasm, however produced, whether from the living human body or from dead organized matter, the animal frame becomes torpid to its action, as it does to the action of other irritants. Whence prisoners confined in jails with typhous miasm around them, as well as those who have long stood the climate in the West Indies, receive the contamination to which they are exposed far less rapidly than strangers, and are capable of communicating it from their clothes or persons to fresh-men without being in the least affected by it themselves; as appears to have been the case in various courts of justice, and particularly at the Black Assize at Oxford in July 1577, though Dr. Bancroft has endeavoured to explain this effect in another way*. The argument, however, of Dr. Musgrave upon this Musgrave's point we have said is not quite satisfactory; because he admits that those who were about the patients, and paid no attention to personal cleanliness, did not wholly escape; but then, says he, they escaped as generally and were not more frequently affected than those who never entered the doors of an infirmary. Now as all ranks and fever was not conta gious. Pyrectica. conditions, blacks and whites, even far off in the country, ORDER I. were affected indiscriminately, we have no reason to expect that those whose habits had rendered them pecu- Remote liarly torpid to the action of the febrile miasm should causes. be more frequently affected than others. The very admission that they were as much so, seems to imply that the febrile miasm was attacking them in some new mode, against which they were not guarded by previous habit. Nor is it easy to conceive by what means the local disorder of the coast could be converted into so extensive an epidemy, unless through the medium of contagion. I have dwelt the longer upon this subject, because it is desirable to reconcile as much as possible the conflicting testimony of respectable writers, who, having adopted different theories, are insensibly led to support them by inaccordant descriptions of the same disease. of other In direct opposition to Dr. Musgrave, Dr. Jackson, Counter Dr. Bancroft, and a host of distinguished writers who statements think with them, we are told by Dr. Pym, that the Bulam writers. fever, admitted by Dr. Musgrave to be the same as the above, not only is contagious, but is never introduced into any fresh region but by contagion +. While Dr. Rush, speaking of the yellow fever of Philadelphia of 1793, asserts that "there were for several weeks two sources of infection, viz. exhalation and contagion. The exhalation", says he, "infected at the distance of three and four hundred yards, while the contagion infected only across the streets. After the 12th of September, the atmosphere of every street in the city was loaded with contagion." He adds, that a few caught the disease who had it before: thus taking a middle course between Dr. Musgrave, who tells us that recovery affords no exemption from a second attack", and Dr. Pym, 66 Essay on the Disease called Yellow Fever, ut suprà. + Observations upon the Bulam Fever, which has of late years prevailed in the West Indies, on the coast of America, at Gibraltar, Cadiz, and other parts of Spain, &c. in 8vo. 1815. ORDER I. Pyrectica. Fevers. Remote causes. who affirms that the fever "attacks the human constitution but once". In the fever of Cadiz of the year 1800, Sir James Fellowes, who coincides in the view adopted by Dr. Pym, asserts not only that it was contagious and propagated only by contagion, but that the air "from its stagnant state became so vitiated, that its noxious qualities affected even animals: canary birds died with blood issuing from their bills, and in all the neighbouring towns, which were afterwards infested, no sparrow ever apaffect birds. peared." Atmo sphere so contaminated at Cadiz as to Similar fact I do not remember to have seen this last fact so directly affirmed by any modern writer; but it is not contradicted in the course of the controversy, and is in perfect coincidence with the state of the air during the plague in most places†, and particularly at Athens, as described by Thucydides f: τεκμήριον δὲ τῶν μὲν τοιού των ὀρνίθων ἐπίλειψις σαφὴς ἐγένετο· καὶ οὐχ ̓ ἐωρῶντο οὔτε Thucydides. ἄλλως, οὔτε περὶ τοιοῦτον οὐδέν. Οἱ δὲ κύνες μᾶλλον αἴσθησιν παρεῖχον τοῦ ἀποβαίνοντος, διὰ τὸ ξυνδιαιτᾶσθαι. Whence Lucretius, who does but little more than translate Thucydides : at Athens, as stated by Hence the same fever Nec tamen omnino temere illis solibus ulla There can be or rather there ought to be no question, * Reports of the Pestilential Disorder of Andalusia, which appeared at Cadiz in the years 1800, 1809, 1810, and 1813, &c. 8vo. 1815. + Diemerbr. De Peste, Cap. VI. Van Swieten, ex prof. Sorbait, in sect. 1407. Hist. XI. 52. § De Rer. Nat. Lib. vi. 1117. Fevers. from hu man and marsh effluvia. therefore, that the fever before us was in some regions ORDER I. contagious, or produced from human effluvium; as in Pyrectica. other regions, and under other circumstances, it was pro- Remote duced from marsh effluvium. And though, from a preju- causes. dice of education that will presently be pointed out, the produced by a like contrary is still contended for by names of considerable miasm issuweight, they seem to be overbalanced in number as well ing both as in authority, by those who have enlisted themselves on the opposite side of the question; of which last it may be sufficient to set down the names of Lind, Clarke, Belfour, Chisholm, Blane, M'Grigor, and Johnson, from among our own countrymen; and of Berthé, Bequine, Dalmas, Bally and Pugnet, among foreigners. The facts brought forward by Sir James M'Grigor upon this subject are decisive indeed of themselves *. And those who are more voracious of proofs may satisfy the most exorbitant appetite by the numerous and conclusive narratives collected by Dr. Chisholm, and especially the fever described by Dr. M'Cabet, as prevailing among the Royal York Rangers stationed at Trinidad. The Illustrated causes of this fever in its origin were excessive heat, marsh effluvia from a marsh of immense extent in the immediate vicinity of part of Spain, considerable labour and fatigue. Its contagious character superadded to its marshy, was produced by an influx of Spaniards from the Spanish main, in a deplorable state of misery and wretchedness. It was among these unfortunate people that the contagious fever began."+ It is probable that Sir James Fellowes, and Dr. Pym might contend that in this quarter the fever was imported, and maintained by contagion alone, as they have contended was the case in the Yellow Fever of Cadiz in the year 1808; but even in this last case they have completely failed in establishing the question of its supposed importation by a ship's crew from Spanish America; and • Medical Sketches, passim. Edinb. Med. and Surg. Journ. Oct. 1819. Climate and Diseases of Tropical Countries, p. 42, Svc. 1822. in Trinidad. And hence the fever of the Mediterranean and American ORDER I. Pyrectica. Fevers. Remote causes. coasts, in the East and one and the same, only varied by incidental circum stance. Hence as there is no doubt in the mind of those who have not buckled on the armour of controversy, that this fever was the common fever of the Mediterranean coasts, so well described by Dr. Cleghorn, and which, under different names and with different degrees of violence comWest Indies, mits its ravages mostly about the autumnal equinox, from the swampy shores of the Nile to the oozy banks of the Tiber, and which is often found as destructive in the Campania as in the East or West Indies, there should be no longer any doubt of the operation of one and the same miasm or febrile principle in all these cases; sometimes issuing from the effluvia of the living body, and sometimes from that of dead organized matter: generated, to adopt the language of Professor Frank, "Tam in ægrotantium variorum, corpore, quam in atmosphæra, plurimorum exhalationibus inquinata, favente anni constitutione"*; and consequently, that the whole of that part of Dr. Cullen's system is erroneous which supposes a this subject different specific principle of fever to be generated in each; the one distinguished by being limited to the production of uncontagious intermittent fever, and the other to that of contagious continued fever. And it is of the more importance that the error of this doctrine should be pointed out, since it has proved the very ground-work of that altercation which has prevailed upon the subject before us. For the writers on both sides having equally drunk from the Cullenian fountain, and, being equally impressed with the truth of this doctrine, have only warred with each other in support of Dr. Cullen's distinction; and hence those who have so clearly witnessed the origin of the fever from marsh effluvium, that they have been compelled to acknowledge this as its source, have felt themselves compelled at the same time to deny that it is contagious; while those who have as clearly witnessed its contagious power, have as forcibly felt themselves compelled to deny that it has sprung from marshy miasm. doctrine on erroneous. And the ground of the alterca tions that have arisen. • De Cur. Hom. Morb. Epit. Tom. I. 8vo. March 1792. |