A Treatise on Fever

by Southwood Smith

Dr. Potter states[^[33]] that he witnessed the rise of a most malignant yellow fever, in a valley in Pennsylvania, which contained numerous ponds of fresh water, and which, from the heat and dryness of the season, emitted a most offensive smell: that the fever prevailed most, and with the greatest degree of malignity among the people who lived nearest these ponds; and adds an exceedingly instructive case, illustrative of the generation and operation of this cause of fever, recorded by Major Prior, in his account of a fever which attacked the army of the United States at Galliopolis. The source of the malady was clearly traced to a large pond near the cantonment. When the disease was most severe, it assumed the continued form, and was accompanied with yellowness of the skin: when proper means were taken to destroy the pond, the fever immediately lost its continued form, and became first remittent, then intermittent, and ultimately disappeared. “The fever,” says this intelligent officer, “was, I think, justly charged to a large pond near the cantonment. An attempt had been made two or three years before to fill it up, by felling a number of large trees that grew on and near its margin, and by covering the wood thus fallen with earth. This intention had not been fulfilled. In August, the weather was extremely hot, and uncommonly dry: the water had evaporated considerably, leaving a great quantity of muddy water, with a thick slimy mixture of putrefying vegetables, which emitted a stench almost intolerable. The inhabitants of the village, principally French, and very poor, as well as filthy in their mode of living, began to suffer first, and died so rapidly, that a general consternation seized the whole settlement. The garrison continued healthy for some days, and we began to console ourselves with the hope that we should escape altogether: we were, however, soon undeceived, and the reason of our exemption heretofore was soon discovered. The wind had blown the air arising from the pond from the camp; but, as soon as it shifted to the reverse point, the soldiers began to sicken: in five days, half the garrison was on the sick list, and in ten, half of them were dead. They were generally seized with a chill, followed by headache, pains in the back and limbs, red eyes, constant sickness at stomach, or vomiting, and generally, just before death, with a vomiting of matter like coffee-grounds. They were often yellow before, but almost always after death. The sick died generally on the seventh, ninth, and eleventh days, though sometimes on the fifth, and on the third. As some decisive measures became necessary to save the remainder of the troops, I first thought of changing my quarters, but as the station was in every respect more eligible than any other, and had been made so by much labour and expense, I determined to try the experiment of changing the condition of the pond, from which the disease was believed to have arisen. A ditch was accordingly cut; what little water remained was conveyed off, and the whole surface covered with fresh earth. The effects of this scheme were soon obvious. Not a man was seized with the worst form of the fever after the work was finished, and the sick were not a little benefitted, for they generally recovered, though slowly, because the fever became a common remittent, or gradually assumed the intermitting form. A few cases of remitting and intermitting fever occurred occasionally, till frost put an end to it in every form. As soon as the contents of the pond were changed, by cutting the ditch, the cause, whatever it was, seems to have been rendered incapable of communicating the disease in its worst form.”

Dr. Potter further states that, on one occasion, he saw a lady, who had been confined three days only, and whom he found in the agonies of death, with the skin of a deep orange colour, the eyes red and prominent, the pulse intermittent, and ejecting copiously from the stomach every eight or ten minutes, the secretion now known by the name of the black vomit; that she expired in a convulsion, while he sat at her side; that petechiæ appeared immediately after death, and that putrefaction succeeded so rapidly, that it was necessary to order immediate interment: that, shortly afterwards, he was called to a gentleman who had been ill five days, and who, having expired in an hour or two after his visit, was removed into the coffin with the utmost difficulty, the flesh literally dropping from the bones: that, in one family residing in a house which stood on a level piece of ground, apparently beyond the reach of noxious exhalation, there being no stagnant water, as was supposed, within a mile of it, he found the mother labouring under a bilious remitting fever, which had continued eleven days; the daughter, seventeen years of age, suffering from a similar fever; two sons, the one between eight and nine, and the other six, ill with dysentery; and the father, on the brink of the grave, from a most malignant fever. There being no apparent cause for the condition of this afflicted family, the immediate neighbourhood of the house being free from the ordinary sources of malaria, and the adjacent country being not unhealthy, the condition of the house itself was minutely investigated. The cause of the evil was manifest. It appeared that the present family had resided in the house only about five weeks; that immediately preceding their occupation of it, a man had died suddenly in it; that he himself (Dr. Potter) was seized with nausea and general lassitude, immediately on leaving the house after his first visit; and that a fever, as he supposes, was arrested by a strong dose of tartarized antimony, which operated violently by vomiting and purging. On examining the premises, it was found that the cellar contained water about two feet deep, which had remained there from the first week in June, the country having been then inundated by torrents of rain. The cellar being useless, the door had been closed, and the only vent for the pestiferous gases was through the floor, which was open in several places. The family being immediately removed, all the sick became convalescent from the time they ceased to breathe the air of the place. The owner of the house hired two men to empty the cellar. These men having ripped up the floor, and placed a pump in the deepest part of the water, evacuated the cellar to the dregs in one day. On the second day after the execution of this task, one of these men was seized with a chilliness, succeeded by an ardent fever, which terminated with the usual symptoms of yellow fever; namely, hæmorrhages, yellow skin and petechiæ, and proved fatal on the third day from the attack: the day following the seizure of the first, the second man was attacked with similar symptoms, and died on the seventh day of the disease, with the black vomit, in addition to the ordinary symptoms of the yellow fever.

These examples may suffice to illustrate the operation of that febrile poison which arises chiefly from the decomposition of vegetable matter. The poison derived from the putrefaction of animal matter is still more pernicious: its effects are more powerful in degree, and worse in character; it operates more intensely on the nervous system, and less on the vascular; and the fevers it produces are invariably of the typhoid type, and of the continued form.

Without doubt, a febrile poison, purely of animal origin, in a high degree of concentration, would kill instantaneously; and when not intense enough to strike with instantaneous death, it would produce a continued fever with the typhoid characters, in the greatest possible degree of completeness and perfection. And this appears to afford the true solution of the origin of the plague. The more closely the localities are examined of every situation in which the plague prevails, the more abundant the sources of putrefying animal matter will appear, and the more manifest it will become, not only that such matter must be present, but that it must abound. And this also is one of the truths which was known to the observers of former times, but which has been forgotten. Were it not that the professional reading of an age, is bounded by as strict a line as that which divides century from century; were it not that no one reads back beyond the authority which happens to give to the day its prevailing doctrines; were it not that the great repository of facts treasured up in the volumes of the close observers, though sometimes the bad reasoners of former days, thus becomes neglected for the dogmas of some modern writer, who reasons as ill, and who observes less, the notion that vegetable malaria produces only intermittent fever, never could have become so prevalent as it is at present, nor could the influence of animal malaria ever have been so entirely overlooked. But it chanced that Cullen, in his definition of intermittent fever, assigned the miasma of marshes as the origin of the disease, while he makes no mention of animal malaria in his definition of any of the forms of fever; and as this author superseded all former authorities, by becoming the great authority of the age, few of his successors are acquainted in the slightest degree with the writings anterior to his period: whence it has happened that the numerous and invaluable facts observed and recorded by his predecessors, relative to the cause of fever, have been disregarded until they have become wholly unknown. To cite the antient and the more modern authorities who have observed and recorded the influence of animal malaria in the product of plague, would be to enumerate every distinguished writer, from Pliny and Diodorus Sicculus, down to Galen, from Galen to Mead, and from Mead to Pringle.

In assigning the reason why Grand Cairo, in Egypt, is the birth-place and the cradle of the plague, Mead states that this city is crowded with vast numbers of inhabitants, who live not only poorly, but nastily; that the streets are narrow and close; that the city itself is situated in a sandy plain, at the foot of a mountain, which keeps off the winds that might refresh the air; that consequently the heat is rendered extremely stifling; that a great canal passes through the midst of the city, which at the overflowing of the Nile is filled with water; that on the decrease of the river, this canal is gradually dried up, and the people throw into it all manner of filth, carrion, offal, and so on; that the stench which arises from this, and the mud together, is intolerably offensive; and that, from this source, the plague constantly springing up every year, preys upon the inhabitants, and is stopped only by the return of the Nile, the overflowing of which washes away this load of filth: that in Ethiopia the swarms of locusts are so prodigious, that they sometimes cause a famine, by devouring the fruits of the earth, and when they die, create a pestilence, by the putrefaction of their bodies; that this putrefaction is greatly increased by the dampness of the climate which, during the sultry heats of July and August, is often excessive; that the effluvia which arise from this immense quantity of putrefying animal substance, combined with so much heat and moisture, continually generate the plague in its intensest form; and that the Egyptians of old were so sensible how much the putrefaction of dead animals contributed towards breeding the plague, that they worshipped the bird Ibis, from the services it did in devouring great numbers of serpents, which they observed injured by their stench when dead, as much as by their bite when alive.

Nothing can be more striking than the cases recorded by Pringle, and which daily occurred to him of the production of fever, exquisitely typhoid, (according to the language of that day, jail and hospital fever) and of the sudden transition of intermittent and remittent into the continued and typhoid type, from the presence of a poison clearly and certainly of animal origin. Whenever wounded soldiers, with malignant sores, or mortified limbs, were crowded together, or whenever only a few of such diseased persons were placed in a room with the sick from other diseases, with those labouring under intermittent and remittent, for example, a severe and mortal typhus immediately arose; nay, whenever men, previously in a state of sound health, were too much crowded together for any considerable time, typhus (jail or hospital fever) was sure to be produced. The instances of such occurrences that are detailed, are too numerous to be cited, but they are so clearly stated, and so striking, that they well deserve to be consulted by whoever is desirous of clearly tracing the operation of this great cause of fever.

But by far the most potent febrile poison, derived from an animal origin, is that which is formed by exhalations given off from the living bodies of those who are affected with fever, especially when such exhalations are pent up in a close and confined apartment. The room of a fever-patient, in a small and heated apartment in London, with no perflation of fresh air, is perfectly analogous to a stagnant pool in Ethiopia, full of the bodies of dead locusts. The poison generated in both cases is the same; the difference is merely in the degree of its potency. Nature, with her burning sun, her stilled and pent-up wind, her stagnant and teeming marsh, manufactures plague on a large and fearful scale: poverty in her hut, covered with her rags, surrounded with her filth, striving with all her might, to keep out the pure air, and to increase the heat, imitates nature but too successfully; the process and the product are the same, the only difference is in the magnitude of the result. Penury and ignorance can thus at any time, and in any place, create a mortal plague. And of this no one has ever doubted. Of the power of the living body, even when in sound health, much more when in disease, and above all, when that disease is fever, to produce a poison capable of generating fever, no one disputes, and the fact has never been called in question. Thus far the agreement among all medical men, of all sects, and of all ages, is perfect.

But it happens that there is another form of animal matter capable of producing fever: namely, a matter secreted by the living body, constituting not only a poison, but a peculiar and specific poison. This specific poison produces not merely fever, but fever with a specific train of symptoms. In the acknowledgment of this fact, also, the agreement among all medical men is equally perfect.

But some contend that the poison generated in the first case, and that generated in the second, may both be properly called contagions: others maintain that the application of the same term to two cases so specifically different, destroys a distinction which it is useful to preserve, and that it would be more correct, as well as more conducive to clearness of conception, to call the poison generated in the first case an infection, and to restrict the term contagion, to designate the poison generated in the latter. Vast and immeasurable as the difference appears to be between the contagionists and the anti-contagionists, if regard be had merely to their language, yet if attention be paid only to their ideas, to this, and to this only, narrow as the compass is, the whole controversy is reduced. It resolves itself wholly into the question, whether one word shall be used to express two cases which differ from each other in some important circumstances, or whether it may not be more convenient to employ two terms, and strictly to appropriate each to designate its own specific class. It must be manifest that, since both sects are perfectly agreed about the facts, the dispute can be only verbal. If the one would consent to restrict their use of the term contagious, for which there is the best authority and ancient custom, to those diseases which arise from a specific contagion, and would call those which arise from every other poison infectious, there would be an end to this apparently interminable, and in many respects mischievous, controversy.

Is the febrile poison, whether of vegetable or animal origin, or whether composed of both, capable of adhering to clothes, apparel, and other substances, in such a manner as truly to infect them, so that when applied to the bodies of the healthy, at any distance of place, and at some distance of time, the specific effects of the poison are produced? That such substances may be so imbued with the poison of the small-pox, all admit: that the evidence should not be as complete relative to the power, or the inability of such substances to convey and communicate the poison of ordinary continued fever, is alike disgraceful to the state of our science, and injurious to the cause of humanity. There is no reason why the question should not be settled with absolute certainty; there is no manner of difficulty in determining it. Experiments the most direct, complete, and decisive, might be performed, which, if observed, during their progress, by competent witnesses, and duly authenticated, might ascertain the point with sufficient clearness and certainty, to satisfy not only the present age, but future generations. Once, for all, the full trial might be made, and if the trial were really full, it need never be repeated. A series of experiments completely decisive of the question, as far as regards the fever of our own country, which might be easily extended to the plague, were some time ago drawn out, and exertions were made to carry them into effect; but in the prevailing state of public opinion and feeling, it was found absolutely impossible to institute them on a scale at all adequate to render them decisive, without the aid of Government. There seems to be no possible mode of performing them effectually, unless Government will co-operate, by granting a free pardon to such convicts, as will voluntarily allow themselves to be made the subjects of them. The risk to them would be slight, the evil to the community none; while the danger, the suffering, the disease, the mortality that would be prevented, to say nothing of the expense that would be spared by the decision of the question, would be incalculable. It is earnestly to be hoped that those who have it in their power to afford the means of putting this question at rest, will not allow it to remain in its present unsettled state. Science, commerce, humanity, alike demand that the truth should be ascertained.