PART II.

SPECIFIC DISEASES.

EASTERN HEMISPHERE.

Sect.1.-Fever in General.—It is not my intention to include in this section what is called Symptomatic fevers. It is to the subject of FEVER, strictly so called, that I shall confine my observations; and trite and exhausted as the theme may appear, I hope still to render it, in some measure interesting. If I have omited the adjective "idiopathic," it is not because I consider fever as in all cases dependent on topical inflammation or congestion; but because I wish to avoid a "war of words" about an abstract term. Some late writings, and particularly Dr. Clutterbuck's Essay, have divided the medical world in opinion, a very considerable portion subscribing to the Doctor's theory.

There is still, however, as far as I can learn, a majority in favour of the old doctrine that fever may originate, and even proceed some way in its course, without local inflammation-or those topical affections which may be considered analogous to, or synonymous with, local inflammation.

Contrary to the usual mode of proceeding, before entering on the nature of fever itself, I shall take a rapid survey of the causes of this wonderful disease. By systematic writers these have been divided into remote and proximate; but the latter being the actual state of the disease, will not yet come under consideration. The remote causes are subdivided into predisponent and exciting. The predisponent, however, often become the exciting, and the exciting the predisponent causes, as the following example will illustrate. Two labourers set out from London, in the summer or autumn, to work in the fens in Lincolnshire. The one is a sober man, the other a drunkard. The latter is attacked with intermittent fever, while the former, thongh equally exposed, escapes. Here inebriety is evidently the predisposing, and marsh miasma the exciting cause of the disease. But the sober man having returned to London in the winter, commits a debauch, and immediately afterwads he is seized with ague. Here, on the other hand, the latent miasma becomes, the predisposing, and drunkenness the exciting cause of the fever. Let this be borne in mind, for it may help to explain more than at first sight might be expected.

Speaking generally, however, the two great exciting causes of fever are human and marsh effluvia; while the predisposing causes are almost innumerable. The more prominent, however, are, plethora

inanition from excessive evacuations-the depressing passions-excess, whether in eating, drinking, gratification of the sensual passions-mental or corporeal exertions-extremes of atmospheric heat and cold, especially alternations of these or of heat and moisture-sollunar influence.

Now experience has determined, that of the foregoing and many other predisponent causes, any one, (excepting the last.) will, when in a very high degree, induce fever without the assistance of any other. If this be the case, then, it is a natural and just inference that the operation of marsh and human effluvium on the human frate bears a very considerable analogy to the operation of those causes enumerated as generally predisposing to, but sometimes actually exciting fever. This may give us a clue to assist in unravelling the ratio symptomatum hereafter; but before entering on the effects, we shall say something of the causes themselves.

Human Effluvium or Contagion.-The existence of this febrific miasm as the cause of fever does not appear to have been known to the ancients, since Hippocrates makes no mention of it, and the strict prohibitions against contact with unclean or diseased persons recorded in the Mosaic code, do not seem directed against febrile, but chronic or local infection-probably against cutaneous or genital defædations. It is curious, however, that Pliny, when describing the progress of an endemic fever, apparently solves a question which to this moment, gives rise to the most violent altercations- namely, whether endemic fevers ever become contagious?" Et primo temporis ac loci vitio, et ægri rant, et moriebantur; postea, curatio ipsa et contactus ægrorum vulgabat morbos." Lib. xxv. ch. 26. But more of this

bereafter.

Notwithstanding the exertions of Dr. Bancroft and some others to invalidate certain testimonies respecting the generation of contagious effluvium, facts too stubborn tobe swept away by the brush of sophistry, attest that the effluvium issuing from the bodies of a number of hu man beings confined too closely, whether in a state of health or disease, will occasionally produce a contagion which is capable not only of exciting fever among those so confined, but of propagating itself afterwards from them to others.

Setting aside the testimonies of Bacon, Lind, Pringle, and others, the transports which received and conveyed home the wretched remnant of Sir John Moore's army, after the battle of Corunna, afforded the most decisive and melancholy proofs that bodies of men confined close together between the decks of a ship in stormy weather, will soon become sickly, and that their diseases may be communicated to nurses and others, after they are landed, washed, and placed in the most clean and airy hospitals. It will hardly be contended that these men could have carried any infection on board, either in their persons or clothes, after a rapid retreat, during which, almost every stitch of garment was washed from their backs by the incessant rains. A dreadful and sanguinary battle at the water's edge, gave them no time to contract infection or even clothe themselves at Corunna. They precipitated themselves tumultuously, naked, exhausted, and wound

ed, into the first vessels that came in their way, and were there crowded from choice or necessity during a cold, wet, and tempestuous passage across the Bay of Biscay. On this passage a most fatal typhoid fever broke out, which spread far and wide among the nurses and medical attendants of the hospitals in England where they were landed. They embarked indeed with an unusual degree of predisposition to disease, arising from excessive fatigue-chagrin-exposure to the elements by day and night-nakedness-want-occasional inebriety-insubordination; and last of all-exhaustion after a tremendous conflict that closed this disastrous retreat. It was utterly impossible, however, that a particle of fomites or the matter of contagion could exist among them at the moment of their embarkation; and it was too fatally proved that every transport exhibited a most destructive focus of infectious fever before they reached England. I have dwelt the longer on this point, because it bears upon questions that are now agitating the public mind; and because Time's telescope cannot be inverted here as it has been on other occasions, nor facts be denied that are so recent in the memory of thousands now alive. Within a few yards of the spot where I now write, the greater part of a family fell sacrifices to the effects of fomites that lurked in a blanket purchased from one of these soldiers after their return from Corunna !

It is not so well ascertained that the effluvia from dead animal matters alone will generate a contagious disease; at least it has been fashionable to deny such an occurrence since Dr. Bancroft's publication. But there are not wanting respectable testimonies in the affirmative; and it does not seem very incredible that offensive exhalations from large masses of putrifying animal matters should, under certain circumstances, produce fever, as related by Forestus and Senac. The late fatal fever at Cambridge appears to have been of local origin at first, but propagated by infection afterwards.

Of what this contagious matter consists, we are totally ignorant, as it is perfectly incognizable by the senses, and incapable of being submitted to chemical analysis. Many people have declared that they felt an indescribable taste in their mouths, and sensation over their frames, together with a peculiar odour impressed on their olfactories, at the moment of imbibing the poison; but it cannot be ascertained whether these were produced by the contagion itself, or by any effluvium accompanying or conveying it.

With the laws which govern contagion, we are fortunately better acquainted. It does not appear to be much under the control of the seasons, since a full dose of it will produce the specific effect at any time of the year. As warm air causes a greater exhalation from bodies, it might, a priori, have been expected that this contagion would spread most in the summer; and the popular opinion to this day is, that hot weather is prejudicial to patients labouring under typhoid fevers. We find, however, that it is in winter that these diseases are most prevalent. The reason appears to be simply this :-the freer ventilation of summer dilutes and dissipates the exhalations from the sick, rendering them innocuous; while the confined air of small

apartments among the poor, in winter, tends to condense, as it were, the febrific effluvia, and embue the bedding, &c. of the sick with the same; forming a fruitful source for the dissemination of the disease by means of fomites, a form in which the matter of contagion is eminently powerful. Experiments have proved that this contagion, when diluted with pure atmospheric air, becomes harmless at the distance of a few yards-perhaps of a few feet; and hence the surest means of preventing its dissemination are, cleanliness and ventilation. Indeed it is only where these cannot be procured, that the juggling process of fumigation need ever be resorted to; and I firmly believe that if the latter ever checked the spread of contagion, it was more by its effects on mind than on matter. The history of animal magnetism alone will teach us how far imagination may go in actually arresting the progress of disease in its full career; and in no case have mental impressions more decided effects than in checking or facilitating the operation of contagion on the human body.

The next thing to be observed is, that from idiosyncrasy of constitution, some individuals are infinitely less susceptible of the contagion than others; and also, that habitual exposure to it, renders us more capable of resisting it, as is exemplified among nurses and medical men. This circumstance appears explicable on the principle of habit, which renders us able to bear a larger dose of any other poison, as of arsenic, opium, &c. Dr. Haygarth affirms that he has been in the habit of breathing, almost daily, air strongly impregnated with the infectious miasms of fever, during a space of more than 50 years, and yet never but once caught a fever in all that time. Some periods of life, however, render the body more susceptible than others-the very young and very old are more exempt than those of intermediate ages. Ulcers and other chronic diseases, also, seem occasionally to confer an insusceptibility on the constitution. The latent period, or that which elapses between the reception and manifestation of the contagion differs exceedingly, according to the degree of concentration in the poison and the predisposition of the subject. There is no doubt but that many doses of the poison are received which produce the fever or not according as the various predisposing causes are applied. It is, however, seldom less than fourteen, or more than sixty days between the receipt of the infection and the unfolding of the fever. Marsh Miasma. -The febrific effluvia of marshes, as well as human contagion, seem to have escaped the notice of Hippocrates. This is the more to be wondered at, as many of the fevers which he describes are clearly the bilious remittent fevers of the present day, [see, for instance, Popularium 1. Egrotus octavus,] and produced, of course, by the same causes. Lancisius was the first who drew the attention of medical men to the subject, since which, march effluvium has been traced as the cause of some of the most destructive endemics that occur both within and without the tropics. The fevers of Cadiz, Carthagena, Gibraltar. and Zealand, may compete, in respect to virulence and fatality, with those of Batavia, Bengal, St. Domingo, and Philadelphia. The term marsh, is not so proper as vegeto-anımal effluvium or miasma; since experience and observation have proved

that these febrific exhalations arise from the summits of mountains as well as from the surfaces of swamps. The mountains of Ceylon, covered with woods and jungle, and the vast ghauts themselves, give origin to miasmata that occasion precisely the same fever as we witness on the marshy plains of Bengal.-But the subject of Miasmata will again come under consideration, in the Section on Endemic of Bengal.

Ratio Symptomatum.-We now proceed to trace the action of these febrific causes on the human frame-or in other words, the ratio symptomatum of fever itself; for in nature and in truth, there is no such thing as a proximate cause of this disease, the whole train of symptoms being a series of causes and effects, extremely difficult to delineate or comprehend. If any thing could deserve the name of proximate cause, it would be some peculiar state or phenomenon invariably present at the beginning of fever, and without which, the disease could not be said to exist. But all writers agree that there is no one symptom, state, or phenomenon which is constantly observable in feNeither quickness of pulse-increased heat-thirst nor headache can be laid down as pathognomonic; for although some of these are always present, no one of them is invariably so.

ver.

If an appeal, however, be made to accurate clinical observation, it will probably be found that from the first till the last moment of fever, two phenomena are constantly present-a derangement in the balance of the circulation, and of the excitability. If the calibre of the radial artery, or the strength and velocity of its pulsations show nothing preternatural, (which by the bye will be a rare occurrence,) yet,. the experienced physician can instantly detect the unequal distribution of the vital fluid, as well by the torpid state of the extreme vessels on the surface, and throughout the glandular system, as by the turgidity of the primary trunks. The imperfect perspiration and secretions will point out the one; the peculiar febrile anxiety-hurried respiration on attempting to sit up or move-fullness of the præcordia, and heaviness about the head, will clearly demonstrate the other. In no one instance, during a long acquaintance with fever, have I failed to notice these indications of a deranged balance of the circulation.

The proofs of broken balance in the excitability are equally manifest. It is now well known how much the functions of the glandular system are dependant on the nervous. In fever, the secretions are never perfectly natural. They are in general scanty-sometimes preternaturally copious; but always depraved. While this torpor or irregularity is going on in the glandular system, the nerves of sense show plain marks of inequilibrium of excitability. The same degrees of light and sound that in health would be pleasing, will, in fever, be either distracting, or incapable of making any impression at all. The stomach will be in a state of morbid irritability, and the intestinal canal completely torpid. Speaking generally, however, the glandular or secreting system is irregularly torpid-the nervous or sentient system, irregularly irritable and debilitated.

Now if we find that the general operation of the various predisposing causes of fever, is to disturb more less, according to the force and condition of the subject, the balance of the circulation and exci

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