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History of Typhoid Fever, as it prevailed near Geneva, N. Y., in the Fall and Winter of 1846-47. By GEO. C. HAY, M. D., of Geneva. According to your request, 1 proceed to give you a brief account of the Typhoid fever, which recently prevailed in this region of country, and especially on the opposite shore of the Seneca lake. In that neighbourhood, fevers of a remitting type had prevailed quite extensively during the latter part of the last summer, and during nearly all the fall months, but not a single case, as I can ascertain, died of it at that time. In December, the first cases of the low form of fever showed themselves. All the cases which have occurred seem to be confined to a neighbourhood of from one to two miles square; and beyond the limits of this, as far as I can learn, no cases have appeared. The symptoms in the forming stage differ but little from an attack of ordinary fever, commencing with loss of appetite, sense of lassitude and disinclination to exercise of any kind,'chilliness, pains in bones, etc. After twenty-four or forty-eight hours, headache came on invariably in all the cases, and in many it was the first symptom, and continued very obstinate through the whole course of the disease. About the third day the patients were generally obliged to take to their beds, the headache increasing, attended with vertigo, dimness of vision, ringing in the ears, suffusion of the conjunctiva and deafness. The tongue was at first covered with a thick white fur which changed by the fourth or fifth day into a brown, and finally into a black during the latter stages of the disease. In a great majority of the cases diarrhea was a prominent symptom from the commencement, so much so that even the use of the mildest febrifuge medicine was inadmissible; this was controlled with great difficulty by opiates, and in some cases astringents had to be resorted to. Accompanying this diarrhoea, we found considerable tenderness of the abdomen in nearly all the cases. The discharges from the bowels were generally very watery, of a dark colour, very fetid, the urine scanty, sometimes entirely suppressed, and of a very red color. The skin was generally quite dry, although not very hot at any time, and in no case could I discover any of the "calor mordax" spoken of by writers, and which I have frequently felt in similar cases. the disease progressed, in many cases delirium was a constant attendant through the whole course of the fever, and none were entirely free from it. In many cases the collapse came on very suddenly, and in others a gradual sinking came on, and steadily progressed until the patients died. The collapse seemed to bear no relation whatever to the severity of the first stage, as is generally the case, as sometimes in those who had been attacked but slightly the collapse was sudden and fatal, while in those whose stage of excitement had been very severe the collapse came on very gradually, and progressed slowly, and vice versa. As to the post-mortem appearance I can give you but little information, as owing to the prejudice existing among the people it was next to impossible to procure an examination. After I had left, however, one examination was made of a boy aged fourteen, who died very suddenly, and I understood from
a physician who was present, that his bowels were a complete mass of mortification. As to the treatment, it was very various. All the patients, however, had in the commencement mercury, in some of its forms, and in two cases which have since recovered, it was carried to the extent of slight salivation. Some cases were bled generally, and some not, but it seemed to make but little difference in the continuance or violence of the disease. The local treatment consisted in cold applications, leeches, and blisters to the head and nape of the neck; cups and blisters to the chest, when the symptoms seemed to demand; hot fomentations, poultices, leeches, and blisters to the abdomen, etc. In some cases we ordered the patients to be washed over the whole body with a solution of nitro-muriatic acid made as strong as they could bear it; this was done twice in twenty-four hours, and seemed at least to give considerable temporary relief to the patients. The general treatment was at first calomel, hyd. cum. cretâ, or pil. hyd., followed by the liquor ammonia acetatis, or spiritus ætheris nitrici, with the potassæ nitras or vinum ipecacuanha or antimonii; but in some cases, and indeed in many, their use was impossible, on account of the tendency to diarrhoea, as everything taken into the stomach ran off by the bowels in a short time. In all the cases stimulants and tonics had to be resorted to sooner or later, but generally with little benefit, although at first the patients seemed to rally under their influence, yet they seemed to have no permanent effect in many cases. Those used were the infusum serpentariæ, or columbæ, camphor, ammonia, etc., together with sulphate of quinine, port wine and brandy, with a nourishing diet of beef-tea, chickenjelly, arrow root, etc. I forgot to mention that the pulse was in most cases very frequent, from the commencement, ranging from 100 to 130 and 140 during the whole time. In some cases the pulse was quite full and hard in the commencement, but generally it was quite small and very easily compressed. I may say in conclusion that it seemned to matter little what course of treatment was pursued, the patients in a large majority of cases died, some during the first week, others running on four, six, eight, and ten weeks. In one family, five persons died, all between the ages of fourteen and thirty; indeed nearly all the cases have been young persons.-New York Jour. of Med.
Prizes offered by the Lexington Medical Society-Prize for the best Thesis.-The Lexington Medical Society resolved to offer a prize of fifty dollars, or a gold medal or piece of plate of that value, at the option of the successful competitor, for the best Thesis submitted for the Degree of Doctor of Medicine, in the Medical Department of Transylvania University, for the session of 1847-48. Those competing for this prize are at liberty to select the subject of the Thesis. Annual prize.-The Society also resolved to offer an annual prize of fifty dollars, or a gold medal or piece of plate of that value, for the best original essay, on a subject to be selected by a committee. In accordance with the above resolutions, the committee propose, for
1847, a prize for the best account of Continued Fever, as it prevails in any of the States out of New England.
Remarks.-The Continued Fever of the Eastern States has been very carefully studied and very fully described. It is found to correspond exactly to the typhoid fever of France; and it is by that name that the disease is now generally called. The same disease is known to prevail extensively in some of the Middle, Western, and South-Western States; but throughout these regions it has not yet been very fully or thoroughly studied. This prize is offered as one means of remedying this defect.
Other things being equal, the prize will be awarded to that essay which contains an authentic and complete account and analysis of the largest number of cases of the disease; its leading phenomena during life, with the lesions in fatal cases; its average and extreme duration; the sex and age, and race, of its subjects; the season of its prevalence; and the prominent points of difference between it and periodical fever. It is very desirable that a careful examination should be made of the mucous membrane of the lower portion of the small intestines. Speculations about the remote and proximate causes of the disease will not add anything to the value of the essays that may be offered. The description of the disease must be sufficiently full and minute, to enable the committee to judge of the accurary of the diagnosis.
The committee also propose, for 1848, a prize for the best account of the several forms of Periodical or Malarious Fever in the United Stutes.
Remarks. This subject has already attracted so large a share of attention amongst physicians of the South and West, that some of them may be surprised at its being thus brought forward. But, extensively as malarious fever has been written about, there are many points of its natural history which need farther elucidation. Amongst these may be mentioned, particularly, the following:-the comparative liability of the sexes, of the black and white races, and of different periods of life, to the several forms of the disease; the influence of race upon its severity and danger; the relative proportions in different years and localities, of the three principal forms-intermittent, remittent and congestive; the most common type of the pure intermittent form; and the variations in the general character of the disease, in different seasons.
The essays must be sent, post-paid, to the Corresponding Secretary, Professor J. M. Bush, on or before the first day of January, 1848, for the first, and 1849 for second prize.
Each essay must be accompanied with a sealed address of the author. That of the successful competitor only will be opened. The essays will be considered as the property of the Society, to be deposited in their archives, or published in their transactions, as they may deem best.
The committee may suggest, that a convenient opportunity for forwarding essays from a distance, will be presented by the annual assembling of the pupils of Transylvania University, in the fall.-Ibid.
Faculty of Medicine of Paris-Lectures on General Pathology, by Professor Andral.-The seat of the morbid element by which disease is constituted may be sought for in three different parts of the system: 1, in the alterations of nervous influence; 2, in the changes of the blood; 3, in the changes which have supervened in those substances which emanate from the blood. In these three great groups many subdivisions should be introduced; and all diseases may either naturally, or with a little allowable hypothesis, be referred to one or the other order. Practically, however, we do not consider this classification applicable, and we prefer the following:
We recognize fourteen great classes of diseases, viz.: 1, pyrexia; 2, hyperemia; 3, phlegmasia; 4, anemia, or hyperemia; 5, hemorrhage; 6, fluxes; 7, dropsy; 8, pneumatosis; 9, alterations of nutrition, or trophopathies; 10, gangrene; 11, traumatic diseases: 12, hemopathies; 13, alterations of secreted fluids, or crinopathies; 14, neuropathies.
A few words on each.
1. Pyrexia. In this class the increase of temperature of the body is the only constant symptom; and pyrexia are also characterized by the factth at it is impossible to trace them to any alteration of solid texture. When such alteration appears during the progress of fever, they are caused by the same morbid influence which first occasioned the febrile excitement. They are specially observed on the skin and mucous membranes, and consist of congestion, inflammation, or hemorrhage-either interstitial in the shape of patechiæ and ecchymosis, or discharged from the affected surface; fluxes, as in cholera, miliaris, &c., are also observed. In each pyrexia the local alterations not only may have a special form, but seem to affect a special seat; the cellular tissue sometimes; the limphatic glands in syphilis; in other diseases the salivary glands; gangrenous inflammation of the cellular tissue and skin in the plague. The blood may be altered in its composition in pyrexia, and this alteration is always the same, consisting in a diminution of its natural amount of fibrine. In many pyrexia a virus or poison exists in the system.
Pyrexia are continuous or intermittent, hence a natural division into two orders in the first we must form numerous genera, and amongst these we may name synocha, inflammatory fever, typhoid ever, miliaris, typhus castrensis, yellow fever, the plague, variola, rubeola, scarlatina, cholera, acute farcy, and carbuncular fever. These various maladies are connected with each other by their essential characters, and some arise spontaneously; others are developed by contagion or infection; and several are special to particular latitudes.
The second order is constituted by intermittent pyrexiæ, in some of which no other morbid phenomenon, beside the febrile excitement, can be detected: in others the febrile paroxysms are attended with various accidents, much the same as those which may be observed during the progress of continuous fever: fluxes, for instance, or losses of heat (which have not, however, been thermometrically proved.) but
which have been known to cause death, as in the algid fever; hence a subdivision of intermittent fevers into benignant and pernicious. Cullen perfectly understood the connections between the two orders of pyrexiæ, so much so that as a type, in his description of fever, that illustrious author takes the paroxysm of ague. In the various parts of the globe, according to the intensity of the producing cause, of the different degrees of atmospheric heat, of the presence of marshes in mild or hot climates, we can observe the gradual transformation of intermittent into continuous fever, and reciprocally. They are differ. ent types of the same disease: but, like intermittent or continuous neuralgia, they are still the same malady.
Elevation of temperature is the only constant phenomenon which observation proves to exist in fever. Entering the field of hypothesis, my we not suppose this increase of heat to be the result of a more active combustion produced in the system by a temporary arrest of the nutritive movement? The removal from the system of a large quantity of nitrogen with the urine during fever, the production of an increased amount of water, carbonic acid, and bile in the same condition, for the separation of superabundant carbon and hydrogen, would seem to confirm our supposition. This arrest of the nutritive movement can occasionally be referred to the inference of a deleterious agent, external or internal, by which the vital properties are more or less interfered with, and the activity of nutrition slackened; or it may be attributed to an inflammation which calls to a limited part of the body an accumulation of blood, producing new secretions, a new mode of nutrition, a new and morbid elaboration of the elements of the blood; under the influence of a similar process, it is not impossible to admit that the general nutritive movement may be suspended, or at least rendered less active. All this is doubtless hypothetical; but a time comes when the mind, wearied with the dryness of the mere observation of facts, cannot resist the impulses of imagination; and such speculations, far from weakening its powers, serve, on the contrary, to enlarge its scope and to renovate its vigour.
2. Hyperemia is constituted by the accumulation of the blood in a part, due to the arrest or the diminution of the speed of its circulation; hyperemia is always attended with redness, sometimes with tumefaction; the serum of the blood, containing some albumen, but never any fibrine, may be extravasated during congestion. According to the nature of its causes, we divide this class into three orders: hyperemia due to increased excitability; hyperemia due to diminution of the powers of circulation; and hyperemia referrible to mechanical causes, impeding the return of venous blood to the heart.
3. Phlegmasia.--When congestion has been gradually transformed into phlegmasia, as the disease no longer remains limited to its solid seat; the blood is modified in its composition, and one of its constituent elements, fibrine, is increased in quantity. This latter circumstance is invariably connected with phlegmasiæ, when they are accompanied with febrile excitement; and yet fever alone will not produce it. We have never met with increase of fibrine in pyrexiæ. In