Such was the predominance of the intermitting, remitting, and bilious fever, that the measles, the small-pox, and even the gout itself, partook more or less of its character. There were several instances in which the measles, and one in which the gout appeared with quotidian exacerbations; and two in which madness appeared regularly in the form of a tertian.
I mentioned formerly that this fever sometimes went off with a sweat, when it appeared in a tertian form. This was always the case with the second grade of the fever, but never with the first degree of it, before the third or fourth paroxysm; nor did a sweat occur on the fifth or seventh day, except after the use of depleting remedies. This peculiarity in the fever of this year was so fixed, that it gave occasion for my comparing it, in my intercourse with my patients, to a lion on the first seven days, and to a lamb during the remaining part of its duration.
The fever differed from the fever of the preceding year in an important particular. I saw or heard of no case which terminated in death on the first or third day. In every case, the fever came on fraught with paroxysms. The moderate degrees of it were of so chronic a nature as to continue for several weeks, when left to themselves. I wish this peculiarity in the epidemic which I am now describing to be remembered; for it will serve hereafter to explain the reason why a treatment apparently different should be alike successful, in different seasons and in different countries.
The crisis of the fever occurred on uneven days more frequently than in the fever of the year 1793.
I remarked formerly[116] that remissions were more common in the yellow fever than in the common bilious fever. The same observation applies to critical days. They were observable in almost every case in which the disease was not strangled in its birth. Dr. Chisholm describes the same peculiarity in the Beullam fever. “I have not met with any disease (says the doctor) in which the periods were more accurately ascertained[117].”
In addition to the instances formerly enumerated[118], of the predominance of powerful epidemics over other diseases, I shall add two more, which I have lately met with in the course of my reading.
Dr. Chisholm, in describing the pestilential fever introduced into the West-Indies from Beullam, has the following remarks. “Most other diseases degenerated into, or partook very much of this. Dysenteries suddenly stopped, and were immediately succeeded by the symptoms of the pestilential fever. Catarrhal complaints, simple at first, soon changed their nature; convalescents from other diseases were very subject to this, but it generally proved mild. Those labouring at the same time under chronic complaints, particularly rheumatism and hepatitis, were very subject to it. The puerperile fever became malignant, and of course fatal; and even pregnant negro women, who otherwise might have had it in the usual mild degree peculiar to that description of people, were reduced to a very dangerous situation by it. In short, every disease in which the patient was liable to infection, sooner or later assumed the appearance, and acquired the danger of the pestilential fever[119].”
Dr. Desportes ascribes the same universal empire to the yellow fever which prevailed in St. Domingo, in the summer of 1733. “The fever of Siam (says the doctor) conveyed an infinite number of men to the grave, in a short time; but I saw but one woman who was attacked by it.” “The violence of this disease was such, that it subjected all other diseases, and reigned alone. This is the character of all contagious and pestilential diseases. Sydenham, and before him Diemerbroek, have remarked this of the plague[120].”
In Baltimore, the small-pox in the natural way was attended with unusual malignity and mortality, occasioned by its being combined with the reigning yellow fever.