ear

Pyrectica.
Fevers.

Illustrated

Dr. Jackson affords us one of the clearest proofs of ORDER I. the truth of this remark in his late as well as in his lier works. There is no writer who has more distinctly Remote pointed out the close analogy between the symptoms of causes. the marsh endemic of the West Indies, and contagious in Dr. fever as they very frequently show themselves, than he Jackson. has done; "the derangements", says he "are exteriorly so much alike, that the discriminating characters cannot be delivered but with doubt and hesitation; the result of the whole appearances will often determine the judgement, but the symptoms separately considered lead to no certainty. The causes of endemic and of contagious fevers were equally connected under certain conditions, with eruptions on the skin, ulcers of the extremities, diarrhœa, purging, dysentery, or flux, fever of an intermitting or remitting form, of a form continued,violent and rapid in course, moderate and of ordinary duration, or slow, lurking and irregular, ceasing and returning at intervals,-changing from general to local disease of various descriptions, and from local disease to general and formal fever.-The general manner of attack, the course, changes and duration of endemic and contagious fevers have great similarity.-Certain modes of action or combinations of action prevail more frequently in the one disease than the other, but forms and modes do not constitute characteristic differences: thus affection of the stomach and biliary system,-vomiting and yellowness are less frequent in contagious than in endemic fever; yet they do occur in the former, and sometimes to considerable extent: affection of the chest, alternating with delirium or affection of the head, appears to be more common in contagious than in endemic fever; so likewise is a peculiar maniacal derangement or lively delirium, occurring in the progress to recovery: yet the frequency of these appearances does not furnish a characteristic mark."* That is to say, all the leading symptoms which make and determine the diseases are the same;

* History and Cause of Fever, pp. 213, 214. 216.

ORDER I. Pyrectica. Fevers. Remote

causes.

How far

proximates

to yellow

fever.

and yet though practically and in fact they run into each other and are the same, yet speculatively and theoretically they are not the same, and never can run into each other in the opinion of this valuable writer, because Dr. Cullen has laid down the dictum that intermittents must proceed from paludal miasm and be uncontagious, and contagious fevers from the morbid effluvium of animal bodies alone. Yet, after all, the substantive part of the tenet seems to be relinquished by Dr. Jackson in the following passage, which occurs in his remarks on the yellow fever that ravaged the Spanish coasts in 1800, notwithstanding the firmness with which the Cullenian doctrine is ostensibly maintained. "The case may perhaps be thus explained. The yellow fever, during the reign of epidemic influence, often strikes like a pestilence by the mere concourse of people in a close place; and if a mass of sick persons be collected into a hospital during the epidemic season, the common emanations from the sick bodies, whether saturated with contagious particles or not, often act offensively on those who enter the circle, and often appear to be the cause of the explosion of a disease, which, without such accessory or changed condition of the medium in which man lives, would have probably remained dormant for a time and perhaps for ever."*

In typhus, or the fever that originates in crowded typhus ap jails, and other thronged and noisome abodes, there is no longer a question concerning its human origin or emanation from sick bodies, and its contagious property; at least, among practical writers. But typhus does not differ more widely in its symptoms from some of the modifications of the fever we have just contemplated, than such modifications do from others of the same fever, varied by the varying power of its co-operating agents†. And hence, we have reason to conclude that typhus also is generated from the same common

A modified offspring from the

same com

mon miasm.

* Remarks on the Epidemic Yellow Fever, &c. on the South Coasts of Spain, p. 44. Lond. 8vo. 1821.

+ Caizerques-Mémoires sur la Contagion de la Fievre Jaune, Paris.

febrile miasm, modified in its action by influential contingencies.

ORDER I. Pyrectica. Fevers.

Remote

causes.

Yellow fe

ver itself

often typhos from

the first.

In effect the yellow fever itself, under peculiar circumstances, assumes something of a typhous character even in its first origin, and where the source has unquestionably been marsh miasm. The second form of the Andalusian fever as described by Dr. Jackson, and specially characterized by defective energy, peculiarly exemplifies this remark; and such was expressly the case with the asthenic remittent at Breslaw in 1757*, as well as in the island of Edam on the coast of Bavaria in 1800, and is still oftener found in the remittent that takes place along the Gambia, after rain in the spring or early part of the summer; when there is less organized matter remaining on the surface of the earth to be decomposed, and what there is has been acted upon by a lower temperature and a shorter duration of heat than in the autumn. "In the month of June", says Dr. Lind, "almost two thirds of the white people were taken ill. Their sickness could not well be characterized by any denomination commonly applied to fevers: it however approached nearest to what is called a nervous fever, as the pulse was always low, and the brain and nerves seemed principally affected. It had also a tendency to frequent remissions." The patients were often attacked with a delirium, and ran into the open air, where they received benefit from an affusion of heavy rains upon their naked bodies. The delirium however, it seems, "soon returned; they afterwards became comatose, their pulse sunk, and a train of nervous symptoms followed; their skin often became yellow." And even where the But more disease has commenced with symptoms of great excite- frequently ment, and an intermittent type, it is so much disposed, gress. under peculiar incidents, as great fatigue, disappointment, and short provisions, to run into a typhus fever, as at Walcheren* and during the retreat of the British

• Chisholm, Manual of the Climate and Diseases of Tropical Countries, &c. p. 38, 1822.

in its pro

ORDER I. Pyrectica. Fevers.

Remote

causes.

Both originate in similar situations.

Cause of their difference.

army from Corunna, that many nosologists have thought
themselves called upon to make this form a distinct va-
riety or even species of fever, which they have usually
distinguished by the name of typhus icterodes, or yellow
typhus.

In like manner, where the yellow fever has commenced
originally from contagion, or, in other words, from a
decomposition of human instead of marsh miasm, it has
been under the very same auxiliaries of filth, poverty,
crowded numbers, and a stagnant atmosphere, that give
rise to typhus. Thus the fever of Malaga of 1803, uni-
formly admitted to be of the same kind as that of Cadiz
in 1800, spread first, according to Professor Arejula's
description, through the narrow, crowded, and offensive
lanes of the district de Perchel: and that of Cadiz itself,
according to Sir James Fellowes, made its earliest appear-
ance in the Barrio de Santa Maria, a part of the town in
which the streets are narrower, less ventilated and cleanly
than any other part, and where the poorer inhabitants,
dirty in their persons and crowded in filthy rooms, gene-
rally live together. It is true that it was conjectured by
many persons, and among others by both these writers
themselves, that the contagion did not originate in either
of these situations, but was introduced into them by
foreign shipping; but such a conjecture has, in the first
place, no trust-worthy evidence for its support, and, in
the second, the mere testimony of the captain of the ship
referred to was directly contradicted by the chief phy-
sician of the hospital at the Havannah, who was on board
the whole time and was privy to the cases in question. In
effect, a cause thus secondary seems to have been super-
fluous, for the local causes enumerated by Sir James
Fellowes and Professor Arejula* appear to have been
perfectly adequate. They are, as near as may be, the
same as those which operate so fatally in the miserable
and crowded cabins of Ireland; and if the fever had
shown itself at a cooler season of the and the sub-
year,

⚫ Brieve Descripcion de la Fiebre Amarilla, p. 229. Madrid, 1806.

1

Pyrectica.

causes.

jects of it had been still more broken down in constitu- ORDER I. tion by mental dejection and low diet, it would probably Fevers from the first have assumed a continued and typhous cha- Remote racter, instead of a remittent and more energetic. The proofs offered upon this subject from personal and accurate observation by Dr. Jackson and Dr. O'Halloran are in full confirmation of this view: for there can be no doubt that the fever of 1820 and 1821, which they describe, was the same as that of 1800 and 1803.

illustrated

late fevers

in Spain.

"From an impartial consideration", says Dr. O'Hal- Further loran, "of all the circumstances attending the epidemies from the of Spain in the year 1821, the conclusion is, I think, fairly deducible that the disease was not, and is not occasioned by imported contagion, and that its origin cannot be attributed to the germ of a former epidemic, resuming original activity from the operation of a peculiar state of atmosphere without which it would remain dormant, perhaps, for ever.-All the towns and cities which suffered from the yellow fever were, with the exception of Cadiz, filthy in the extreme, disgustingly so, and very objectionable on the score of ventilation, situation, and form of construction: while the different towns of Arens, Matero, Badalona, Tarragona, Vinaros, Benicarla, Valencia, Aliama, Velez, Malaga, Marabella, Estepona, Vejer, Conil, Puerto Real, Rota, Chipiona, Orcos, and Medina Sidonia,-all of which are in the vicinity of the sea, and which, it may be presumed from their relative situations, communicate freely with the theatres of disease, were not affected by the malady. They seldom, indeed, suffered in any other years; because, independent of their localities, being better chosen for health, they are comparatively clean."*

from human efflu.

The febrile miasm then, generated by a decomposition Miasm of human effluvium and of dead organized matter, appears to be essentially the same, modified alone in one

Remarks on the Yellow Fever of the South and East Coasts of Spain: comprehending Observations made on the Spot, by actual survey of Localities, &c. By Thomas O'Halloran, M.D., &c. p. 184. Lond. 8vo. 1823.

vium and

dead or