The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).

Date:
1849-59
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Licence: Public Domain Mark

Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    which intermittent fever is not known. The con- nection, therefore, between them does not depend on a UniUed, but a comprehensive induction of facts; the truth is abundantly confirmed. Ague, indeed, sometimes appears where the influence of marsh effluvia cannot be traced ; and the term malaria has been brought into modern use to denote a morbific atmosphere, arising from the soil, capable of producing intermittent fever, in which marsh miasmata, properly so called, are supposed not to constitute an essential part. Many facts would seem to countenance this opin- ion, as well as that which assigns to malaria the production of continued fever under certain cir- cumstances. In the metropolis we have known persons attacked with ague, mostly however of an irregular type, by working in damp cellars. In temperate climates, under ordinary circumstances, the milder forms of the disease appear, and these in the spring, as the quotidian and tertian. The quartan, more obstinate and protracted, usually appears in autumn. In Sydenham's time, and even in that of Fothergill, the quotidian of spring became continued fever in summer; while the simple continued fever of summer often changed to a malignant type in autumn. These were sim- ple observations at a time when systematic ar- rangements had not put physicians in trammels. But now, lest we should be guilty of medical her- esy, we must not insinuate that ague can change into continued fever, and non-contagious fever into contagious typhus, either in an individual case or in the course of the year ! It has been commonly observed that the spleen suffers more in cases of protracted intermittents in temperate climates, and the liver in tropical. Nevertheless, Dr. Jackson tells us of enlarged spleen after such fevers in the West Indies : Cleg- horn noticed the same in Minorca ; and we have the testimony of W. Twining, that this organ is often found diseased from this cause, in Bengal and all the low districts of Hindostan, (Calcutta Medical Trans, vol. iii. p. 354.) When tropical heat is added to the influence of marsh effluvia, then we have the various shades of intermittent, remittent, and even continued fever, passing sometimes into each other by al- most imperceptible gradations, and complicated more or less with bilious symptoms. When in- temperate seasons, deficient or unwholesome food, and animal filth, are superadded to the causes above mentioned, and acting upon a condensed population, the highest grades of pestilential fever are often exhibited, as the plague of Egypt and the Levant, the pestilential fever of Spain, and the yellow fever of America and the West In- dies. When marshy land is brought to a very dry state in summer, after long-continued drought, ague is often but little known in the vicinity ; but the first heavy shower after the drought will some- times give rise to it. And on the contrary, in a wet season, while much water is lying upon the marshes, the disease is rare; but in proportion as they become dried to a certain point, the mias- mata are found to be active, according to the de- gree of heat, the season of the year, and the state of the population. A cei«»ain quantity of mois- ture, therefore, seems to be necessary upon the Vol. II. — 6 » * marsh, in order that the miasmata may be disen- gaged ; and of vapour in the atmosphere to con- vey them to a distance ; while a superabundance either prevents their evolution, or entirely absorbs them. Notwithstanding that the notion has been ridi- culed by a few, there can be little doubt that cur- rents of air will sometimes waft the efliuvia to a great distance, so as to produce intermittent fever in places otherwise healthy ; and some facts would seem to show that hills of a certain elevation in the vicinity of marshy grounds have a sort of attraction for the miasmata, and are almost as unwholesome as the plains.* But it is upon a different principle that hilly grounds, in some cases, become more unhealthy than the plains. The British army in 1809 found that the hilly sides of the ravines in Portugal, after heat and rain, exposed the soldiers to a most destructive remittent, while the overflowed swamps below were more than usually free from disease : and such, says Irvine, is frequently the case on the lofty ridges of Sicily, when their fiumari, or water- courses, which are ordinarily dry, and used for roads in the summer months, are filled and inun- dated with sudden torrents of rain. For here the malaria changes its station, and quits the over- flowed low lands for the heights of the primitive hills. (Good's Study of Medicine, vol. ii. p. 166.) Plantations of trees have been known to inter- cept marsh miasmata, and thus to prevent their injurious effects upon the inhabitants at a short distance ; and for the same reason it is found that the site of a dwelling should not be too near such plantations. It is wonderful, says Dr. Fergu- son, (loc. cit.) to see how near to leeward of the most pestiferous marshes, in the territory of Gui- ana particularly, where these trees abound, the settlers will venture with impunity to place their habitations, provided they have this security; though every one is fully aware that it would be almost certain death for an European to sleep, or even to remain after night-fall, under the shade of the lofty trees that cover the marsh, at so short a distance. (Med. Chir. Eev., Dec. 1821.) There is something curious and not easily ex- plained in the circumscribed locality of intermit- tent fever in certain places. Perhaps, if the pre- valence of winds and the situation of such places as to exposure and wood and water, &c., were taken into account, the difficulty might be in part removed. A late writer on malaria states, that on the high Dover road, in Kent, not far from Ko- chester, some of the people living on one side of the road were attacked with ague, while on the other side all escaped. It is amply proved that marsh effluvia exert far more pernicious influence upon the body during * Medico-Chir. Review, vol. ii. p. 59], Dec. 1821 ; Dr. Ferguson on Marsti Poison. Dr. Robertson fully co,<. firiiis the observation of Dr. Ferguson, relative to the exposure of the inhabitants of liigh situations in the vicinity of marshy grounds to the etiects of t lie miasmata. (iMeU. itepos. vol. i. p. 3t)7.) He knew people to lie se- verely atfected by this cause, who hail ncjt been for some time without the walls of the castle of Santa Liarbara, at Alicante, 800 feet above the sea-shore; while at the same time, persons living on a level with the sea, and exposed to all the sources of marsh miasma, escaped every attack of fever. He considers that the high grounds present an impediment to the free dispersion o' the exhalations through the atmosphure.
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