SPOTTED 
OR 
CONGESTIVE FEVER. SPOTTED 
OR 
CONGESTIVE EEVER. 
By C. B. COVENTRY, M. D., 
Of Utica, N. Y. 
ALBANY: 
VAN BENTHUYSEN & SONS' STEAM PRINTING HOUSE. 
1867. SPOTTED OR CONGESTIVE FEVER. 
During the past season (1865 and 1866), a disease made its 
appearance in the county of Oneida, which was new in that sec- 
tion of the country, though it had formerly prevailed in some of 
the New England States, and more recently appeared in some 
places in Pennsylvania and different parts of our own State, and 
which, during its prevalence in Massachusetts and Connecticut, 
was known by the name of spotted fever. The name of spotted 
fever no doubt arose from the circumstance that in many cases the 
body assumed a spotted or mottled appearance. These spots were 
not always present, and varied much in their character. The only 
work on the»subject which I have been able to find is a small 
volume published by Elisha North, in 1811, and several articles 
in the medical journals and papers about the same time.* 
In an article by Dr. Samuel Woodward, first published in the 
American Mercury, a newspaper published at Hartford, Ct., and 
republished in this work of Dr. North, he says: "At a meeting of 
the councillors of Massachusetts Medical Society, held on the 7th 
day of February, 1810, it was voted that a committee be appointed 
to collect information respecting the history and treatment of a 
malignant disease, commonly called spotted fever, which is now 
prevailing in the county of Worcester, and which has prevailed 
within five years past in Hartford, Connecticut, and Providence, 
Rhode Island." Dr. Fisk, a member of the committee, says: 
"Upon the appearance of any new disease, every reflecting 
physician will endeavor to class the non-descript with some 
disease which he has seen, and by comparing its leading features, 
be enabled to adopt a practice which gives some promise of suc- 
cess. How far it has been done in this disease I know not, as I 
have seen no treatise on the subject. If it has been attempted, 
the result I apprehend has proved fallacious." "In a close atten- 
tion to it for fourteen days, at Rutland and elsewhere, I have been 
led to the opinion that though no class yet identified will claim 
* Since the above was written, several articles have appeared in the Journals, and an 
article by Dr. Burr in the Transactions of the New York State Medical Society. 4 
the monster, yet under some genus it may find a settled affinity." 
Our standard works on practice have little or nothing on the sub- 
ject, or if mentioned at all it is simply referred to as a form of 
typhus or typhoid fever. It is sufficient to say that no intelli- 
gent physician who had a personal acquaintance with the disease, 
could possibly confound it with either typhus or typhoid fever. 
It is only in the few cases where the disease is long protracted and 
the system exhausted that there is any resemblance to typhus or 
typhoid fever. Different writers have differed materially as to 
its classification, some, as has been seen, speak of it as a form of 
typhus, and term it typhus petechialis. North considers it as a new 
form of fever. Dr. Fisk says it has a strong analogy to scarlatina 
anginosa. By some it was considered a malignant remittent fever. 
A similar disease is described as prevailing in Geneva, Switzer- 
land, where it was known by the name of malignant cerebral 
fever-not contagious. In this disease it is said, with the greater 
number of patients who died in twenty-four hours, the body was 
covered with violet spots at the moment of death or a little 
after, and sometimes before death. On opening the bodies of the 
dead no morbid alteration of the viscera was found, only a turgidity 
of the cerebral vessels. There can be no doubt the same disease 
was prevalent during the last two or three years in this country 
under different names, sometimes confounded with cerebro-spinal 
meningitis, sometimes designated as congestive chills. Dr. Burr* 
© © © 
describes the disease as it prevailed at Carbondale, Pa., in the 
winter and spring of 1861, under the name of cerebro-spinal 
meningitis, or spotted fever. 
Cerebro-spinal meningitis, as we shall see, is one of the many and 
perhaps the most fatal form of this Protean disease, inflammation 
of the meninges of the brain and spinal cord is but one of the 
many forms of the disease, and we must look for some more com- 
prehensive term by which to designate it. If we look alone at 
the symptoms, I apprehend it would be impossible to place it in 
any known nosological arrangement. If, however, we look at the 
pathology, I think there could be no hesitation in placing it in 
the class of congestive fevers, so ably described by Dr. Armstrong. 
Congestion is the one prominent condition, always present, but 
confined to no one organ, and the symptoms, as we shall see, vary- 
ing with the organ affected and the severity of the attack. In all 
* Transactions of the Medical Society of the State of New York, 1865. 5 
severe congestions the function of the part or organ affected is 
impaired, and if not promptly relieved, and the patient survives, it 
is followed by inflammation anti fever. If the brain and spinal 
marrow is the seat of the congestion, we have spasms, coma, and 
delirium, and if not relieved, followed by inflammation and all the 
symptoms'of cercbro-spinal meningitis; if the stomach, we have 
obstinate vomiting; if the intestines, we have diarrheea or obstinate 
constipation; if the heart and large blood vessels, we have irregu- 
larity of the pulse, oppressed breathing and general distress; if 
the limbs are the seat of the congestion, we have pain, swelling, 
tenderness, resembling / phlegmasia. As has been seen, the 
symptoms vary, not only with the organ affected, but with the 
severity of the attack, from a slight indisposition to a disease 
causing death in six, twelve or twenty-four hours^ogib 'mlimig A 
Dr. Woodward says: "The disease appeared in Winchester, 
Ct., in April, 1809. Young people under twenty-one were most 
liable to it, and among adults, females were more liable than males; 
no age or sex was, however, free from attacks. It assumed in 
different subjects all grades of disease, from a mild fever to a 
£ ooidi io owl Iasi odi gnimb inolnvoiq 
11 The symptoms were various according to its inveteracy. It 
attacked with chills, lassitude, great prostration of strength, eyes 
red and watery, pupils dilated in some cases, in others, small, 
as in dying persons. Often delirium, with exquisite pain in the head, 
great anxiety at the stomach, with tossing of the body, nausea, and 
often troublesome vomiting. A pain and lameness of the limbs 
often ushered in the disease; there was soreness of the flesh and 
generally spots on the skin."^)nB 9£{j lo asmiinsm odi lo 
Dr. Bestor says: "The patient is for the most part attacked 
with a sense of extreme coldness, sometimes with shivering, at 
other times with rigors, accompanied with pain in the head, 
usually over one or both eyes, severe pain in the extremities- 
sometimes in a toe or finger, but most commonly in the legs, knees, 
thighs or arms. An alarming prostration of strength, delirium or 
coma. The eyes often red or suffused, pupils enlarged, double or 
triple vision, in some patients a total blindness for the first twelve 
or twenty-four hours: difficult deglutition, distressing pain and anxi- 
SYMPTOMS. 
*Note.-North on Spotted Fever. Page 112. 6 
ety of the stomach, attended with nausea, and for the most part 
with vomiting." 
Dr. North says: "The disease may be divided into two varieties, 
the distinction, however, is in the severity of the disease." If there 
is any one symptom which may be regarded as premonitory of the 
disease in all its forms, it is a sore throat. I have observed this 
in so many cases and found so few exceptions, that were it not an 
attendant on so many diseases I should consider it a pretty sure 
premonitory sign of this complaint, and yet this affection is so 
slight that few patients mention it unless they are questioned about 
it. The symptoms of the first species are a great and surprising loss 
of strength, which is a constant and prominent symptom. A cold 
surface, sometimes accompanied with chills, sometimes not. The 
extremities in the cold stage appear of a purplish or leaden color. 
Violent pain of the head, and many times of the limbs, are among 
the first symptoms, sometimes the one, sometimes the other, are 
first attacked. When the pain commences in the limbs it soon 
mounts up to the head. Distress about the precordia, violent and 
extreme; also numbness of the extremities are often added to the 
above list of symptoms. The breathing is pften laborious and 
attended with frequent sighing. Syncope sometimes occurs. The 
pulse in this and all the varieties and stages of the complaint is 
soft, weak, and never hard, though it is sometimes slow, even slower 
than in health; it is often intermitting, fluttering or totally absent, 
even in cases in which the patient has ultimately recovered. The 
tongue is usually covered with a white coat, but in some bilious 
cases it is of a brownish hue; sometimes it has been observed to 
have a bloodless appearance. The urine deviates but little from 
health, except a hysterical flow, which sometimes has been observed 
to happen. There is loss of appetite, sickness at the stomach and 
vomiting. The worst form the disease assumes, particularly in 
children, is that of coma, or cholera morbus. It frequently assumes 
the form of violent mania at the time or within a few hours of the 
attack. Sometimes delirium is among the first symptoms, some- 
times coma, and many times petechia. Unless the patient recovers, 
he usually dies within the first twelve, twenty-four or forty-eight 
hours. 
In those who recover, the disorder puts on, cither before or 
soon after forty-eight hours, the form of a mild typhus of uncer- 
tain duration. Among the more unusual symptoms are mentioned 
dilatation of the pupil, blindness, double vision, a drawing back 7 
of the head, with a kind of clonic spasm of the muscles of the 
neck, an erysipelatous inflammation of the limbs, swelling-like 
rheumatism of the joints, paralysis of an arm or leg, or both, car- 
buncles and buboes, strangury and violent pains in the fingers 
and ... Vf.rn 
UUJ 1' • / luJi 111. >ll£ J I Oi DtJU IfrMH 1 .III V I.III III11 I Jj if itiis i ill / > j 11 i t • irrrn r 
Let us compare the above with the symptoms of congestive 
fever, as given by Dr. Armstrong : 
oa at oonronB Bia® Jo-£ dhb janiiqmoo emj io ngia yioimomsiq 
General WJ] jj ( 
1. More or less reduction of the heat of the skin. 
2. More or less prostration of the muscular strength. 
3. Diminution or oppression of the heart's action. 
4. More or less lassitude and torpor. 
5. Disturbance of the function of some important organ. The 
functions of the skin are disturbed. The internal organs undergo 
certain changes, and these take place in the following order: 
1. Heart and large adjacent vessels. ,X; j j mi nanom 
2. The lungs and mucus membrane of the bronchia. 
3. The brain or spinal marrow; odT .gfnoiqm^e 'io toil ovodn 
4. The liver and vessels associated in its circulation. 
* Particular Symptoms. ^nB fli 
Suppose the congestion to exist in, first, the heart and large 
blood vessels, it is Uien denoted by the following symptoms : 
1. Some uneasiness in the region of the heart. 
° , navoo vlmuaw ei ougnot 
2. A deficiency of power in breathing, ^gj^^d £ q0 g- p . 
3. A small, weak and irregular pulse, or oppressed pulse. 
If it exist in the lungs or bronchial lining, it is characterized 
, . Hbirg^mrnwos n^rnw tvfoiiTii9iiwavd uiqooxo jlfucni 
by : jrn 
jjhk n .LHioJr. qilj jb d^onnoia ,9iiJ9qqB io eaol sr aiadT .noqqjvL of 
1. A peculiar color of the lips and cheeks. The lips are either 
of a violet color, a plum color or leaden color. 
r.-innwwn rr ^uoTorn irmonaio tnmoo io Judi si fn9ibhd9 
2. A labored or short, weak and frequent respiration. 
nTOir Jo omn jpsioiv io nrioi oil! 
It the congestion is in the brain or its appendages, we have : 
1. Confusion, immobility or indifference to surrounding objects, 
.i;rrrooFiq mif vinminnB jmSbo abinir 
or giddiness, with pain. . , . . - 
® * • . , 1 ifc'irt odi mdiiw ^9ib vllnneu sd 
2. An intoxicated or stunned or alarmed expression. 
3. A blanched state of the conjunctiva, with watery appear- 
ance of the eye,. ci« 
25 . ,, qy-i lira £ io cmoi adt ,8iuod Jdgio-vrioi i9Jie nooa 
It in the spinal cord or its membrane, we may have : 
jirormjn n wqmt8 adj giionrA .iioWwb nmi 
1. General convulsions and partial spasms. 
Symptoms of Congestive Fever. 8 
2. Wandering'pains and tenderness on the surface of the body. 
If in the live? and associate vessels, wo have : 
2. dullness with fliiftilence in the epigastric region. 
3. Some unoaMy sensation of a load or tightness or fullness in 
the region of the 1^¥.°^°* 81 rbovonoi ^liqmoiq ion li 
Dr. Armstrong says, this is an extremely dangerous affection, 
that he has knoWn some casbs to terminate fatally in one hour, in 
three hours, in four hours, and very often in twenty-four hours. 
He says, if you have produced a sttltb of excitement, the patient 
is generally going on well, if properly managed. If the conges- 
tion continue, and the brain, stomach and lungs are disturbed, the 
case will generally terminate fatally. If the excitement is imper- 
fect and the case put on the congesto-inflammatory character, it is 
very serious. If the*trunk bo hot while the extremities remain 
cold, with great disturbance of the lungs, the brain and liver, the 
case is mostly very serious. If the excitement is perfectly 
developed, the fever is 'either simple or inflammatory, and prog- 
nosis is to be given accordingly. It is most dangerous in infants, 
in old persons, and in women after delivery, and in persons labor- 
ing under much mental excitement. The disease, as it has pre- 
vailed in the city of Utica, has been comparatively mild, but few 
deaths occurring, and those mostly among children. It has, how- 
ever, been sufficiently severb and fatal to indicate the true character 
of the disease. In home parts of tile county it has been more 
severe, and 'MonsCqubntly the mortality greater. The symptoms 
were various; one of the most frequent and often the first to 
attract attention, was obstinate vomiting, particularly in children; 
frequently^here was slight indisposition 6f one or two days, when 
the patient was'suddenly "soiled"with most excruciating pain, often 
in the head,r but Sometimes in the chbst, ol' abdomen, or in a leg, 
foot or hand. ^Frequently they would wake from sleep, and cry 
out," Oh, my head* head 1" and'seem on the point of going 
into convulsions. In adults, if the attack is not severe, they often 
complain of severe pain in the head, which they represent as dif- 
ferent and more intolerable than anything they ever before 
experienced. At the same time the surface is cool and moist, the 
tongue covered with a slight, moist, whitish mucuS; the pulse is 
often nearly natural a^ ' to fbequehby, but soft and easily com- 
pressed. If the throat bo examined, the mucous membrane of the 9 
pharynx will be found redder than natural, and the vessels con- 
gested, though the patients seldom complain of the throat unless 
their attention be drawn to it. Whatever may be the seat of the 
congestion, general prostration is a prominent symptom. When 
the meninges of the brain and spinal cord are the seat of conges- 
tion, if not promptly relieved, it is followed by inflammation, 
with all the symptoms of cerebro-spinal meningitis. Whether 
cercbro-spinal meningitis ever prevails as an epidemic independent 
of this complication is uncertain; it is, however, certain that it 
often occurs as one of the forms of this protean malady. We 
seldom find all the symptoms mentioned as occurring in any 
single case: the following which was the first case I met with, will 
illustrate some of them: On the evening of February 3, 1866, I 
was called to the child of Mr. R , about nine months old; I 
found her suffering from vomiting, with but little disturbance of 
the circulation-the child was teething. I made the ordinary 
prescription; next morning I was surprised to find that the vomit- 
ing still continued. I cut the gums, applied mustard over the 
stomach, and bathed the feet and legs in warm water, and directed 
some small powders of calomel and calcined magnesia. The next 
morning I was informed that my patient had a restless night. On 
visiting her in the morning, I was surprised to find she had great 
nervous excitement, general tremor as if on the point of going into 
convulsions, and the appearance of great agony. The pulse had 
become very frequent and irregular, the head was drawn back, 
the muscles of the neck rigid. On the third day the knees 
became swollen and inflamed. She died on the fourth day. 
Pathology. 
But few " post-mortem " examinations have been made in spotted 
fever, but those few are sufficient to show the identity with the 
post mortem appearances found in congestive fever, as described 
by Dr. Armstrong. Dr. Burr, in his account of the disease as it 
prevailed at Carbondale, Pa., says: "The principal lesion 
observed was intense congestion of the blood vessels of the brain 
and its covering, with evident traces of meningeal inflammation; the 
spinal cord was not examined." If the patient dies within a few 
hours, the only lesion found is intense congestion. If twenty-four 
or forty-eight hours have elapsed, there may be effusion combined 
with the congestion. Still later, there will be traces of inflamma- 
tion and deposition of coagulable lymph, and if the patient has 
Art. 7. 10 
survived to a still later period, there will be softening and disor- 
ganization. Dr. Armstrong says the morbid appearances dis- 
played by dissection after death in fatal cases of congestive fever, 
are two, and sometimes a third occurs. 
1st. An over accumulation of venous and arterial blood in the 
part, the function of which has been disturbed during life, and 
especially the veins, or 
2d. An effusion of mucus or serous fluid according to the struc- 
ture of the part. In the brain and spinal cord, a serous effusion, 
in the bronchial lining, a mucus effusion, and in the intestines 
both a serous and mucus effusion. 
3d. Sometimes there is an effusion of blood. 
Danielson and Mann* relate five cases of post-mortem examina- 
tions of spotted fever, but, unfortunately, they give no history of 
the cases, or state at what stage of the disease the patients died. 
The first was a boy ten years of age, whose case was strongly 
marked, and terminated in 22 hours; examination seven hours after 
death. On removing the cranium and dividing the dura-mater, 
there was discharged, by estimate, half an ounce of serous fluid. 
The dura-mater and pia-mater, in several places, adhered together, 
and both to the substances of the brain. The veins of the brain 
were tinged with a fluid resembling that discharged from between 
the membranes; and the substance of the brain itself was remarkably 
soft. In the stomach there were six ounces of fluid resembling 
coffee grounds, and its villous coat was nearly in a state of disso- 
lution. " The lungs •were darker than usual, otherwise all the 
viscera were in a healthy condition." 
The second examination was made twelve hours after death on 
the body of a girl five years old. Between the dura and pia-mater 
Was effused a substance resembling pus, both over the cerebrum 
and cerebellum, the veins of the brain tinged with blood and the 
hemispheres adhering together with considerable strength. The 
appearance of the stomach differed in nothing from the preceding 
case, only that the villous coat was not so tender. In the three 
other cases examined there was nothing peculiarly morbid, except 
that the veins and sinuses of the brain were found remarkably 
tinged with a very dark-colored blood. 
Dr. Burrf says not many post-mortem examinations were made 
during the epidemic. The principal lesion discovered waS intense 
•North on Spotted Fever, page 89. 
t Transactions of the New York State Medical Society for 1865, page 43. 11 
congestion of the blood vessels of the brain and its coverings, with 
evident traces of meningeal inflammation. The spinal cord was 
not examined. Dr. Budlong, of Cassville, Oneida county, where 
the disease first appeared in the county, made a post-mortem 
examination of a case where the patient had lingered several months. 
He found softening and disorganization of the medulla, oblongata 
and base of the brain. 
Cause. 
It is probable that sporadic cases of spotted fever have occurred, 
but if so, they were confounded with some other disease. It is 
only when prevailing as an epidemic that the attention of the pro- 
fession has been called to it as a distinct disease; it consequently 
follows, that whenever it occurs in an epidemic form, there must 
be some general cause, which predisposes to this particular form 
of disease. Dr. North thinks it is attributable to the state of the 
seasons, and says "the seasons have been unusually cold and wet 
since the prevalence of the epidemic." Some have thought it had 
a malarious origin. Dr. Burr says, " Of the cause of this epidemic 
we know literally nothing." It is not contagious. In truth, it is 
like all epidemic diseases, though we suppose there must be some 
general cause; yet what it is we do not know. In regard to the 
immediate existing cause we have more evidence. Everything 
that weakens and exhausts the system tends to develop the dis- 
ease; hence we find that children and women, and persons 
exhausted by dissipation or disease, are the most frequent victims. 
Diagnosis. 
So varied and multiform tire the symptoms of this disease that 
no description, however graphic, will enable the practitioner to 
recognize its presence. To be known it must be seen; but the 
observant practitioner, having once seen and recognized this dis- 
ease, will not mistake it. No doubt sporadic cases have often been 
mistaken for other affections. I have known a well marked case 
of this disease, where, of three or four different physicians who had 
seen it, each gave it a different name. One said it was inflamma- 
tion of the brain, another called it apoplexy, another paralysis. 
When, however, it is known that the disease is prevailing as an 
epidemic, other diseases will be more likely to be taken for the one 
under consideration than the reverse. The most striking charac- 
teristics are the suddenness of the attack, the excruciating pain, 
* vfohjo? dioY w*>X odl lo spoilt)ctqxhT t 12 
often shifting, sometimes in the head, sometimes in the hand or 
foot, and this with a moist, cool surface, and soft, compressible 
pulse. In some cases there will be petechia. I have seen it at 
the commencement of the disease, at other times later, and often 
not at all. When it affects the brain and spinal marrow, the 
symptoms arc more strongly marked: often spasms, the head 
drawn back and the muscles of the neck rigid, with a general 
expression of agony. 
Prognosis. 
When it prevails as an epidemic, this is undoubtedly a very 
malignant and dangerous disease. As it prevailed in the New 
England States in 1810 and 'll, it was not inaptly compared to 
the plague. Dr. Burr tells us that in the village of Carbondale, 
Pa., in the winter and spring of 1864, there were *400 deaths out 
of a population of 6000^ Dr. Elisha North, speaking of the dis- 
ease as it prevailed in Winchester, in 1807, says, "According to 
the best of my information, one-third of those who had it died." 
In reference to the prognosis in individual cases, much will 
depend upon the stage of the disease. If seen within the 
first 12, 24 or 48 hours from the attack, we may hope, even in 
the most violent cases, by prompt and judicious treatment, to save 
our patient, whilst on the contrary, if the first stage has been 
neglected or injudiciously treated, even the mildest cases may end 
fatally. If the vomiting is controlled, warmth and moisture 
restored to the general surface, the pulse becoming fuller 
and stronger, with a gradual abatement of the severe pain, 
we may consider our patient as doing well. If, on the contrary, 
the distribution of warmth is irregu*lar, the body becoming hot 
whilst the extremities remain cold-if, notwithstanding our 
ri n uotruiiiir noi OHffifO up ilk'ii "Of f f Hol r i r 
means, the disturbance of some important organ, as the stomach, 
the brain or lungs, continue, the case will usually prove fatal. If 
the excitement be perfectly developed, the disease cither subsides 
or assumes the form of simple inflammatory fever. If the excite- 
ment is imperfect, the congestion being but partially removed, the 
patient sinks into a typhoid condition of very uncertain duration. 
It is the fashion of the present time to deride the influence of med- 
icine and laud the efforts of nature, and this by some members of 
our own profession. In the disease under consideration, the 
expectant treatment will not answer. Active, energetic treatment 
is demanded, if you wish to save your patient. The prognosis is 13 
influenced by the importance of the organ principally involved- 
that of the brain and spinal cord being most dangerous; also by 
the age of the patient, and his previous condition, it being most 
fatal in infants, in old persons, in women soon after delivery, and 
in persons depressed by mental anxiety dr deficient nourishment. 
Treatment. 
The treatment must depend upon the violence of the attack, the 
importance of the organ or organs implicated, and the period 
of the disease. 
The first or early stage of the more severe form of the disease, 
s ylbEddn^rtW.pimabiqo BB-simvoiq Ji mm/T ' 
is characterized by the tollowing symptoms: 
1. A cold skin with a sense of chilliness, sometimes an actual 
qOoisqmoa yliqaai joa saw dr fITom; UIol ui gomTo 
Chill. . * rr zr 
.^birodWJ-iQ.onBiliv oni nt dead au sllod Tina-Ml - .oirmq odd 
2. By a small, weak and easily compressed pulse, sometimes an 
absence of pulsation at the waist; the pulse when present often 
irregular. ® od d 'W 
3. By a feeble and oppressed respiration. 
i.bafb di bud onw oedod lo-Dimd-uno r non# anoint vin io deed oat 
4. By great prostration ot muscular strength. 
5. By great topical disorder, which may be seated in the head, 
heart, lungs, bronchial lining, m the liver, stomach or intestines. 
' • v x- vcpMia odTmoiI &mod -ip 4; 
The indications are to restore the balance ot the circulation 
nvcg ot TgpmjBOij auoimbm bim.mmo'ig vd (8o&bo motor/ Jeoni ohj 
between the venous and arterial system, and the surface and 
jmoa and omda Jain .oaT ii .vwao& pdjjjo. dalidw -.dhounq tuo 
internal organ; to relieve the pain and suffering, and try to cor. 
X -I t I X rrV • T k i 
rect the local derangement. Ibis is accomplished- 
i -n -P +k x- r +k i c i r i c 
1. By exciting the action of the heart by stimulants. 
... W odd Roaring inionoa.odi ot _boiotaoi 
2. By exciting the skin by the external application ot caloric. 
_ _/ „ .end lo .JiioniOT/idA TbAdbis jrTIjrw. ,TO2aoiJa ban 
3. By alleviating pain and topical derangement by anodynes. 
mk t + i i k Ji ti v c ' " 
The heart can be excited by the exhibition ot- 
1. Diffusible stimulants; the best is a tumbler of hot camphor 
. , . . . fdon Jf-blot) amraoi 1 
iulep, giving halt an ounce every ten or fifteen minutes, an mfu- 
. 1 19 an -naaio mmioqmr qiuog do oon&hudgm oar .aanoin 
sion ot spearmint or peppermint; more active stimulants, as 
brandy or wine, may be required. Jbrom twenty (20) to thirty 
. i jiliio osnogib odd ,Ijoifo 1 avob vijooftocr ofi-rnojii jjioxo odd 
(30) drops ot laudanum, or an equivalent portion of opium or mor- 
mirozo mlf.il ..iovoi vioJBaimBmii oiqcmOo anol odd aoaiuagB io 
prune may be given at the same time with the stimulants. 
2. Hot drinks when the patient is thirsty-cold drinks should 
onodumb amHoonn vimi ipaipiimaQo biqdqvd apdrn axing dnoiduq 
not be allowed even if desired by the patient. In extreme cases, 
and particularly when the stomach rejects all drinks, brandy may 
do eftKirnoni o$ob vd ardd him mqiiiarr io ano Up odd IpmlBini oaroi 
be given pure, dropped on a little sugar, in doses of a teaspoon- 
r 11 X Ax ' X X I' LV x xT T 
full- every ten or fifteen minutes, watching its effect on the heart 
. r ,. , . ^lowatm fon mvz JaomiBoid imiiooqxb 
and respiration, and withholding it as soon as warmth and general 
ai odl .inormq inorovBg of daivr uov ii .boDimiaob gf 
circulation is restored. 14 
3. The administration of a warm, stimulating enema for this 
purpose; a strong infvision of ginger is preferable: if, however, 
the stomach is so irritable as not to retain any stimulants or medi- 
cine, or the muscles of the throat paralyzed so that the patient 
cannot swallow, more stimulating injections must be used, as a 
tablespoon-full of brandy with a teaspoon-full of laudanum, re- 
peated from time to time, according to circumstances. 
4. With these means should be combined the application of 
external warmth when the patient is able to sit up; a warm foot 
bath of water and mustard, continued for 15 or 20 minutes. 
When not able to be up, hot fomentations, with cloths rung out of 
hot water, applied as warm as the patient can bare them, and 
repeated from time to time. Warm mustard cataplasms, hot bricks 
or billets of wood soaked in hot water, and applied along the body 
and limbs, bottles of hot water, and where it can be done, the 
hot air bath. 
5. Regulating the temperature of the room. This should be 
from 70Q to 80^; but fresh air should, if possible, be freely admit- 
ted, and the covering should be sufficient, but not excessive. 
6. Regulating the position of the patient. In severe cases the 
patient should not, on any consideration, be permitted to rise from 
a horizontal position. 
7. All company and visitors should be excluded, and no person 
admitted except the necessary attendants. 
In addition to the above general directions, particular symptoms 
require some modification of the treatment. If the pain subsides, 
warmth returns to the surface, and free and general perspiration is 
produced, the stimulants should be gradually withdrawn; exces- 
sive sweating would tend to weaken the patient, if too long con- 
tinued. Anodynes may be given in some other form, but I am 
accustomed to give a powder composed of camphor, grs. ij., 
calomel, grs. ij., opium, gr. ss., ipecac, gr. ss., repeated every four 
hours. 
Dr. Fisk says, " If we were bold and liberal in the use of any 
thing, it was calomel; this combined with camphor and ipecac, 
with opium sufficient to prevent the cathartic effect of the medi- 
cine, was diligently administered to most until a slight affection of 
the glands was observed." Mercury is admitted to be the most 
general stimulant known-stimulating the secretions generally, 
and is the most efficient agent in preventing and removing local 
congestions. I have not, however, usually found it necessary to 15 
carry it to the extent of producing ptyalism or any perceptable 
effect on the gums. When the head is prominently affected with 
severe pain, or delirium, or coma, or convulsions, sinapisms should 
be applied to the back of the neck and spine, but if the severe 
symptoms are not promptly relieved, blisters should be substitu- 
ted. Vomiting which is often a very troublesome symptom, is best 
relieved by small doses of calomel, comphor and opium, in form 
of pill, repeated from time to time, with a mustard plaster over 
the stomach. If the patient is unable to swallow on account of 
paralysis of the muscles of the throat, we must not abandon him, 
but endeavor to sustain the system by stimulating and nutritious 
encmata. If the pain centers in one of the extremities, the best 
means is the application of a blister in addition to the other gene- 
boilqqe buc 'loinw foil ni bodnoa boow 'io afollid io 
The practitioners should be guarded against the administration 
of cathartics in the early stage of the disease, but if the bowels 
arc not moved on the second or third day, a mild cathartic of 
castor oil, or rhubarb and magnesia should be given to remove 
any irritating matter. If we are successful in removing the local 
pain and disturbance, restoring general excitement and free and 
general perspiration, the patient is usually out of danger, and with 
proper care we may hope for a speedy recovery, If on the other 
hand, the reaction is imperfect, if the local, disturbance and pain 
still continue, if the extremities remain cold whilst the heart or 
chest becomes hot, if the pulse becomes more frequent and the 
tongue hot and dry, we may be sure the disease has passed into 
the congestive inflammatory stage. Active stimulants must be 
abandoned; warm applications should be continued tp the feet if 
cold, and cold applications to the head if hot, counter-irritation 
by blisters, mild diaphoretic drinks, mild nourishment, and a 
persistance in the alterative powders, until some evident effect is 
produced. If the patient survives for forty-eight hours without 
material relief, he will probably sink into a typhoid condition, 
and must be treated accordingly. When the disease is less violent 
it is sufficient to confine the patient to the bed, give the powder 
of calomel, camphor and opium for twenty-four hours, with some 
warm'diaphoretic drink, and counter-irritation, followed by a mild 
cathartic of rhubarb and magnesia or castor oil. 
The foregoing article was prepared to be read before the medical 
society of the county of Oneida, at its annual meeting, July, 1360. 
APPENDIX. 16 
Jt was my d^ign to present the views of others who had had more 
exp^rjenpq .than myself, rather than any of my own. Subsequent and 
more ample experience, has not, however, produced any change 
ip my teWx spotted fever is objectionable as it refers 
to a symptom of the disease, which conveys no idea of its character, 
and which though sometimes present is often wanting; while on 
the other hand it is frequently present in other diseases. The 
name of " cerebro-spinal meningitis " is still more objectionable in as 
much as it applies only tp one of the many forms of this protean 
malady, but carries the idea of an inflammatory affection, thus 
overlooking the first and most important stage, viz., that of 
congestion. I have therefore ventured to suggest a new name for 
the disease, viz: that of congestive fever, which it is believed wi|l 
apply to all forms of the disease, and at the same time designate 
its character. It may indeed be questioned whether the term 
fever can properly be applied to the disease, as in the first stage 
there is an absence of all those phenomena described as character- 
izing fever. > r . . . ■ ( .. ] 
I have subjoined from North's work, on spotted fever, the 
treatment adopted by several different writers. 
Dr. Woodward says: ° Having no guide but experiment; bleed- 
ing, vomiting, purging, sweating and stimulants were all tried; 
Sweating appeared to give the most relief. The methods to 
procure it were various, but that which proved the most certain 
and easy was by the application of external heat with internal 
stimulants. Fomentation with hot cloths, the application of hot 
blocks, hot bricks or stones, and a column of steam conveyed into 
the bed by a funnel wore all tried, but the steam preferred. 
Laudanum, brandy, wine, essence of peppermint, hot sling, hot herb 
tea, as pennyroyal, peppermint, rue, saffron and many other kinds 
of warm teas by themselves, or with spirits, were used according 
to the habits of the patients and other circumstances. When herb 
teas would sit on the stomach and produce sweat I thought them 
preferable to ardent spirits, as not so apt to produce headache and 
delirium. Sweating produced by any hot application, not essen- 
tial what, seemed to answer the desired purpose, and after this 
method was adopted the disease proved much less fatal. Those 
who died, chiefly went off with the lowness which took place early 
in the disease, some in five or six hours, but they generally died 
hid .wb udj no oi W9iv b djivz ton .iiTPWrbvd ots 
TREATMENT. 17 
between twenty-four and forty-eight hours after the attack. If 
they survived forty-eight hours the disease Assumed the typo of 
fever and became manageable like othdt febrile' diseases. Some 
•. T if "t I HP * I 
died at a later period, but no more than are commonly carried off 
by 
Dr. North says: "If I am called to a patient attacked with 
spotted fever and find him attended with violent pain of the head, 
drawing back the head, tossing about the limbs', sighing, dis- 
tress for breath, coldness of the extreme parts, sickness at the 
stomach, great distress and agony, comatdsd, with an involuntary 
running of tears, lividness of the lips, or with delirium or mania; 
with a low or feeble pulse, or perhaps none at all, I conclude that 
there is no time to be lost; that he is in danger of dying in a few 
hours, either by syncope or pulmonary congestion, or otherwise. I 
put the patient to bed after having bat hed his feet in warm water, 
and then apply a blister to the back of his neck, give tinctura 
opii, hot brandy sling, heated wine and warm teas. I also apply hot 
blocks wrapped in cloths near the patient in bed; also bottles of 
hot water or similar blocks to his feet. In some cases 1 Have 
given oil of peppermint, essence of peppermint, tiuct. castor, comp., 
camphor, &c., taking carertp jj^fowd the stomach or excite 
vomiting. Generally as soon as the patient gets warpa he is 
relieved; not always, however, until he sweats." 
Dr. Bestor says, "My practice has been when I found a patient 
extremely cold, much pained with symptoms of great debility, 
derangement of intellect, feeble pulse, nausea and retching, with- 
out any particular evidence of biliousness predominating, the 
tongue being covered with a white coat, to immediately give, if an 
adult, from forty to sixty drops of tincture of opium in pennyroyal 
tea, with half a gill of brandy, apply a blister to the back of the 
neck and pained extremities, sometimes to the stomach if much 
pained, hot bricks or stones, or billets of wood taken out of hot 
water and wrapped in cloths, to be applied to the feet, legs, 
thighs and sides of the patient. The warm teas to be repeated as 
the stomach will bear; a glass ot brandy every hour, the tincture 
\ ■ n p J J 
of opium to be repeated in dpse^ of twenty drops every two hours, 
if the stomach can retain it, if not, a teaspoon-full to be given by 
injection every three or four hours, and continued until sweat 
breaks out, and the patient is relieved within three or four hours 
from the attack. I usually give from eight to ten grains of sub- 
mureate hydrargyri, not with a view to purge on the first day, but 
'Art. 7. 18 
to act as a stimulus to the system and prepare the bowels to be 
moved by injection the next day, if the stimulants have had the 
desired effect, and the excitement of the system is such as to 
admit of an evacuation.