In cities, contagious fevers may be traced to prisons, perhaps sometimes to hospitals; certainly often to narrow courts and alleys, and small crowded apartments; to the houses of the indigent; to filth, rags, and squalid poverty, co-operating with foul unventilated air: and in the open perflated streets, are much less frequent. Cities, therefore, should be more infested with them than the country; and the poor more than the affluent. Children with adults are subject to them, but more of the latter. In London, perhaps, nine-tenths of the fevers, are of the remittent, nervous, and putrid type, and not of the simple inflammatory. But I exclude from this calculation the exanthematous order, and the topical inflammations. Some, not without argument, alledge, that slow nervous fevers are in general derived from the same origin; and that they differ from the putrid in degree only. Petechial spots are by no means constant symptoms of the putrid type; but when they occur, they point out the disease more unerringly, and its greater malignity. In many instances, their differences may be rationally imputed to climate, season, constitution, miasma, and medical treatment.
I meet with inextricable embarrassment, in endeavouring to draw the exact limits, not only between nervous and putrid fevers, but also between them and what some authors have termed the universal remittent of this island; and which is not limited to any season of the year. I take this opportunity, therefore, to avow, that in what proportion these very general fevers with remissions originate from marshy effluvia, from climate, and constitutional indisposition, from animal contagion, or from other occult causes, I am unable to decide: Their precise relation as to lineage and consanguinity, is beyond my penetration. Nervous and putrid fevers have been described under the following different names: slow nervous fevers, febricula, maligna lenta insidiose mitis, nervous and putrid fevers, putrid remittents, typhus castrensis, jail, hospital, infectious, putrid, malignant, continued, putrid, spotted, purple, petechial fevers; yellow fever of the West Indies, or typhus Icterodes.
Slow nervous fever frequently steals on with treacherous mildness; the sick are rendered unfit for business, but yet not confined to bed, and except to sagacious judges, the fever is not apparently alarming; and too often the sick and their friends are lulled into fatal security. The symptoms slight alternate chills and fugacious heats, especially in the evenings; heaviness, giddiness, and headach, particularly in the posterior and superior part, and the pain often descending down the spine; great debility and prostration of strength; and in both nervous and putrid, the functions of the brain, and of muscular motion, considerably weakened, and interrupted; also depression of spirits, sighing, restlessness, very little sleep and not refreshing; accelerated, weak, and small pulse; nausea, total inappetency; inconsiderable heat of the skin or thirst; dry tongue, a little yellow at the sides; pale urine, and without sediment; irregular sweats; sometimes pains resembling rheumatick. After a few days, the fever, stupor, delirium, and headach increase, with low muttering delirium, chiefly during the nocturnal exacerbation, and with noise in the ears, and universal debility of the corporeal and mental organs. The remissions are generally more distinct in the beginning, and, by degrees, more obscure.
Putrid fever sometimes creeps on with deceitful approach under the nervous cloak; and sometimes, with furious onset, counterfeits the inflammatory. The symptoms when radicated and inveterate are, unremitting headach, pain in the back and loins, and course of the spine; vertigo, throbbing of the temporal and carotid arteries, noise in the ears; delirium, extreme diminution of strength and despondency of mind, trembling of the hands and tongue when thrust out; anxiety, restlessness, or no refreshing sleep; intense burning heat of the skin, especially in the evenings; nausea, bitter taste in the mouth, vomiting of green or black bile: sometimes insatiable thirst; at other times the sick are insensible to thirst and heat, and only complain of universal languor and weariness; the tongue, teeth, and lips covered with a brown or black tenacious crust, with thrush and ulcers; the fecal excretion black, and fetid; the breath and perspiration offensive to the smell; the pulse progressively small, irregular, and quick, often 130 to 140 pulsations, even in adults, every minute; the eyes glazy, the vessels of the tunica albugina turgid with blood, and what is called blood-shot: in stages of still more virulency, petechial eruption sprinkled on the skin, with hemorrhages from the gums and nose, and hemorrhagick subcutaneous extravasations. In the yellow fever of the West Indies, there is a jaundice-colour of the eyes.
In the duration, crisis, and termination of nervous and putrid fevers, there is considerable diversity. Some may be suddenly stifled before they burst into a flame: some of inveterate malignity may prove fatal in a few days; others may terminate in all the intervals within three weeks, or even later. Some terminate auspiciously without any sensible crisis or evacuation: in others, there is more or less sensible defecation by some of the excretories, by perspiration and sweat; diarrhœa and fetid stools; turbid urine; exspuition and salivation; vomiting; tumor of the parotid glands; eruption about the mouth.
Miliary fever, febris purpurata, rubra and alba, is never epidemick, and is denied to be a primary disease; but is spurious, symptomatick, accessary, or fortuitous; it is very rare, and may be complicated with the nervous and putrid, and with small pox and measles. The miliaris alba is more frequent amongst the female sex, especially during the puerperal state, and in other females debilitated by fluor albus, and hemorrhages, of weak constitutions, delicate, prolifick. It sometimes exhibits previous symptoms of angina, pleurisy, catarrh, rheumatism, erysipelas. Its peculiar diagnosticks are extreme languor, anxiety, despondency, terror, sighing, prostration of strength, headach, delirium, restlessness, quick weak pulse, oppression of the breast and stomach, dry cough without expectoration; sometimes profuse sweats towards the third day or later, and the sooner the worse; inextinguishable thirst; urine and stools various. In different stages of the fever, after a few days, a cutaneous efflorescence is perceivable, from which the disease takes its name, preceded by and accompanied with itching and pricking heat of the skin, and eruption of diminutive pustules, the size of millet seed, and, by the fingers, may be felt prominent: they are rarely seen on the face; commonly on the neck, back, breast, and extremities; some of them change into small serous vesications, distinct or clustered, and emitting a peculiar sour odour: of these there is often a retrocession and new eruption, variously protracting the fever to a few days, or even weeks. It is distinguishable from measles by the pruriency and sour smell, and the absence of morbillous sternutation.
Inflammatory Fevers,
synochus continua non putris of Boerhaave. To this we may add the febris diaria. A different genus of fever, both in its nature and cure, from the remittent, nervous, and putrid, is the simple inflammatory. The frequency and the fatality of this fever, is infinitely inferior to the preceding groups; and in comparison, is as a wasp to a tyger; or a babe to Hercules. The false lights hung out successively by multitudes of authors, and transmitted, in some degree, through the Boerhaavean school, to steer with the antiphlogistick compass and lancet in each hand, in the generality of fevers, have been the cause of numerous shipwrecks. Inflammatory fever is frequently complicated with some local inflammation, and then is distinguished under a different name, and hereafter described. Pringle observes, that in military camps, pleurisies, and peripneumonies are the most frequent form of fever with inflammation; and next to these acute rheumatisms.