A Treatise on Fever

by Southwood Smith

Of the Causes of Fever.

The causes of fever are of two kinds; first, those which immediately produce the disease, and secondly, those which bring the system into a condition capable of being affected by the first: the former, are called the exciting, the latter, the predisposing causes: a third has been spoken of in relation to this as well as to other diseases, namely, the proximate. But what is really meant by the proximate cause of disease (if the term have any meaning) is the condition of the organ, or of the system, produced by the operation of the exciting cause: this term, therefore, designates an effect, not in any proper sense, a cause: it relates to the disease itself, not to that which produces it.

I. Of the Immediate, or Exciting Cause of Fever.

The immediate, or the exciting cause of fever is a poison formed by the corruption or the decomposition of organic matter. Vegetable and animal matter, during the process of putrefaction, give off a principle, or give origin to a new compound, which, when applied to the human body, produces the phenomena constituting fever. What this principle or compound is, whether it be one of the constituent substances which enter into the composition of organised matter, or whether the primary elements of organised matter, as they are disengaged in the process of putrefaction, enter into some new combination, and thus generate a new product, we are wholly ignorant. Of the composition of the poison, of the laws which regulate its formation, and of its properties when generated, we know nothing beyond its power to strike the human being with sickness or death. We know that, under certain circumstances, vegetable and animal substances will putrify: we know that a poison capable of producing fever will result from this putrefactive process, and we know nothing more.

Of the conditions which are ascertained to be essential to the putrefactive process of dead organic substance, whether vegetable or animal, those of heat and moisture are the most certain, and as far as we yet know, the most powerful. Accordingly, in every situation in which circumstances concur to produce great moisture, while the heat is maintained with some steadiness within a certain range, there the febrile poison is invariably generated in large quantity, and in great potency. Wherever generated, we have no means of ascertaining its existence but by the effects it produces on the human body. Now and then circumstances arise which illustrate these effects in an exceedingly striking manner. This is the case when large numbers of men, previously in a state of sound health, are simultaneously exposed to it. Examples of such occurrences, as numerous and as complete as can be desired, were long since recorded, among many others, by one very accurate observer, who is of the number (no small one) of those who have given valuable lessons to the world, which have been forgotten, and to which it is a useful labour to recall the attention of the present age.

“In the beginning of June, 1742,” says Sir John Pringle, in his Observations on the Diseases of the Army, “the British troops began to embark for Flanders. There were in all, of foot and cavalry, about 16,000: the winds were favourable, the several passages short, the men landed in good health, and went into their several garrisons. The head-quarters were at Ghent. During the Summer and Autumn the weather was good, the heats moderate, and the country in general healthy. The British officers continued well, but many of the common men sickened. Ghent is situated between the high and the low division of Flanders; one part of the town called St. Peter’s Hill, is much higher than the rest, and in this, the barracks, having drains and free air, were quite dry; so that the soldiers who lay there enjoyed perfect health. But those who were quartered in the lower part of the town (mostly on the ground-floors of waste houses, unprovided with drains, and of course damp) were sickly. The battalion of the first regiment of guards was a remarkable instance of this difference of quarters. Two of the companies lay on St. Peter’s Hill; the remaining eight in the lower part of the town, in rooms so very damp, that they could scarce keep their shoes and belts from moulding. In the month of July, the sick of this battalion amounted to about 140; of which number only two men belonged to the companies on the hill, and the rest to those in the lower town.”[^[31]]

It is further stated, that in the end of August, Ostend having surrendered, the garrison, consisting of five battalions British, was conducted to Mons, where they continued about three weeks: that these men had been so healthy that, when they marched out, upon the capitulation, they left only ten sick; but that the same corps having been put into damp barracks at Mons, while the town was surrounded with an inundation, fever immediately appeared, and prevailed to such an extent, that in this short space of time 250 were seized with the disease.[^[32]]

Of the campaign in 1748, it is stated that the troops had scarcely been a month in the cantonments, when the returns of the sick amounted to 2000: that afterwards the number became much greater: that those who were near the marshes suffered by far the most, both in the number and the violence of the symptoms; that the Greys, cantoned at Vucht (a village within a league of Bois-le-duc, surrounded with meadows, either then under water, or but lately drained) were the most sickly; that for the first fortnight they had no sick, but, after continuing five weeks in that situation, they returned about 150; after two months, 260, which was about half the regiment; and at the end of the campaign, they had in all but 30 men who had never been ill: that a regiment at Nieuland, where the meadows had been floated all Winter, and were but just drained, returned sometimes above half their number: that the Scotch Fuzileers at Dinther, though lying at a greater distance from the inundations, yet being quartered in a low and moist village, had above 300 ill at one time, while a regiment of dragoons, cantoned only half a league south-west of Vucht, were in a good measure exempted from the distress of their neighbours, such was the advantage even of that distance from the marshes, of the wind blowing mostly from the dry grounds, and of a situation upon an open heath, somewhat higher than the rest.

When the troops were in Zealand, where the poison was in a high degree of concentration, they had not been a fortnight in the cantonments, before several of the men belonging to those regiments which were stationed nearest the inundations, were seized simultaneously with lassitude and inquietude, a sensation of burning heat, intense thirst, frequent nausea, sickness and vomiting, aching of the bones, pain in the back, and violent headache. There were some instances of the head being so suddenly and violently affected that, without any previous complaint, the men ran about in a wild manner, and were believed to be mad, till the solution of the fit by a sweat, and its periodic return, discovered the true nature of their delirium. Most of the men were first taken ill upon their return from forage. The regiment being cantoned close upon the inundations, and many of the quarters being above two leagues from the place where the magazines were kept, the men were obliged to set out about four in the morning, in order to get back before the greatest heat of the day. At this early hour, the meadows and marshes on each side of the road were covered with a thick fog, of an offensive smell. The party generally returned before noon; but several of the men, even before they could get back to their quarters, were already in a violent fever; some, in this short space of time, were actually delirious; and a few, on their way home, were so suddenly taken with a phrenzy, as to throw themselves from their trusses into the water, imagining they were to swim to their quarters. One man, on reaching home, was suddenly seized with intense headache, got out of his quarters, and ran about the fields like one distracted. Three years after this sickness, it was found that two of the men who were thus suddenly affected with phrenzy, though they recovered of their fever, had ever since been epileptic, and that all the rest who had been ill, remained exceedingly liable to returns of an intermitting fever.

The suddenness with which fever sometimes attacks individuals on board a ship, or even an entire ship’s crew, on the approach of the vessel to a shore where this poison is generated in large quantity, and in a high state of concentration, illustrates its operation, perhaps, in a still more striking manner. Dr. Maculloch, who has laboured with great ability and zeal to recal attention to the most important and long-forgotten subject of malaria, relates an instance of some men on board a ship, who were seized, while the vessel was five miles from shore with fatal cholera, the very instant the land-smell first became perceptible. Several of these men, who were unavoidably employed on deck, died of the disease in a few hours. The armourer of the ship, who, before he could protect himself from the noxious blast, was accidentally delayed on deck a few minutes, to clear an obstruction in the chain cable, was seized with the malady while in that act, and was dead in a few hours.