AN
ESSAY
HISTORY, CAUSES, AND  TREATMENT
TYPHUS FEVER:
TO WHICH THE
ANNUAL  PRIZE FOR THE YEAR 1828
WAS AWARDED BY THE
MEDICAL SOCIETY OF THE STATE OF NEW YORK.


            Bv Alfred T. Magill, M. D.,
                         •"  ...      '•
                 Of Winchester, Virginia.

     "Ex principiis nascitur probabilitas; ex factis vero Veritas."
            NEW YORK:
CHARLES S. FRANCIS—252 BROADWAY
                 1820. 
**"Cu
iV.
;C 
         ESSAY

                ON

TYPHUS  FEVER.
   The word Typhus, according to most writers, is derived
 from the Greek noun <ru<pof, stupor, a symptom which frequent-
 ly supervenes, sooner or later, in the progress of the disease;
 oftener, however, coming on  towards its termination, than
 existing in its earlier stages.  The learned and scientific
 Good, however, refers the derivation of the  term to the verb
 <ru<po, which  signifies "to smoulder," or "to  burn and smoke
 without a vent," and thinks it "admirably expressive of  the
 general nature of the fever to which it was applied at first,
 and which it designates at present; which burns not with
 open violence as the cauma, but with a sort of concealed and
 smothered flame."*   There are, however, various other  ap-
 pellations by which this fever is  known; such as the jail,
 camp, hospital, and ship fever.  It has also  been denomina-
 ted the putrid, malignant  fever, and from the frequent pre-
 sence of petechiae it is called, on the continent of Europe, fe-
 bris petechialis, and constitutes the contagious fever of Lind,
 the  febris  inirritativa of Darwin,  and the nervous fever of
 other writers.
  The history of this fever is rather obscure.  The ancient
 authors on medicine make no particular mention of it, from
 which we may conclude, that they were either unacquainted
with it, or, considering it merely as a variety of the common
fever of their respective countries, did not deem it worthy of
* Good's Study of Medicine, vol. 2, p. 123.
                1 
2
special notice.   Sydenham was probably the first medical
writer who described this disease, not, however, by the name
under which it is now known.   The account of it is contain-
ed in his " Essay on the rise of a new Fever."  He says, "As
soon as it began to thaw in February, 1685, the fever  I  in-
tend to treat of here appeared, which I esteem a new sort of
fever, and altogether unlike the fever of the eight foregoing
years."*   No one can read the symptoms of that fever as nar-
rated by  that great and  good man, without remarking the
striking  similarity  between  them  and the assemblage of
symptoms which constitute the typhus of the  present  day;
and, indeed, it has been considered as such by subsequent
vvriters.t  Sydenham does not mention  that this fever was
at all contagious, but attributed it  to a particular state or
constitution of the atmosphere.
  In the year 1577, more than one hundred years anterior
to the date of this fever described by  Sydenham, a disease
suddenly made  its appearance, during  the Black Assize at
Oxford, in the month of July.   This fever is generally cited
as an instance of jail  fever,  and as affording  incontestible
evidence of its contagious character.   The infection in this
instance  was supposed to have been  communicated by one
Rowland Jencks, a criminal, who "was arraigned and con-
demned in the presence of a great number of people to lose his
ears.  Judgment being passed, and  the  prisoner taken away,
there arose such an infectious damp or breath among the peo-
ple, that many there present, to the apprehension of most men
were there smothered ; and others so deeply infected that they
lived not many hours after."!  This fever is  no doubt one
of the instances alluded to by lord chancellor Bacon,  when
he says,  that "The most pernicious infection, next to  the
plague, is the smell of the jail, where  prisoners  have been
long, close, and nastily kept;  whereof we have had, in our
time, experience twice or thrice, when both the judges that
sat upon the jail, and numbers of those  who attended the bu-
siness, or were present, sickened upon  it and died."
   Nearly nine years subsequent to  this event,  an infectious
fever (as it was  called)  made  its appearance at Exeter, du-
ring the  assizes there, in March, 1586.   This fever was at-
tributed  by many to contagion  communicated by some Por-
  * Wallis's Syd., vol. 2, p. 315.
  f Wallis, in one of his notes to this essay, says, "Dr. Cullen considers
this as a species of typhus, but of the milder kind, and arranges it under
that genus by the name febris nova."
  i Bancroft on Fevers, p. 430. 
3
 tuguese seamen, "who had been some time before taken at
 sea, coming with fish from Newfoundland, and "cast into the
 deep pit and stinking dungeon" of the "goale of the castle
 of Exon;" and "had no change of apparell," but being left
 to lie " upon the ground without succour or reliefe, were soon
 infected."*  These persons, when brought into court for their
 trial, were supposed to have communicated the contagion to
 many of the individuals present.
   " From  that time (says Bancroft) I can discover no instance
 of any remarkable mortality or sickness, supposed to  have
 been produced by jail infection, until the year 1730,  (an in-
 terval of one hundred and fifty-three years,) when, at the
 Lent assizes, some prisoners, who had been removed  from
 Ilchester jail, to take their trial at Taunton, were believed
 to have  infected a part of the  court, and produced a conta-
 gious disease"t of which many died.
   Huxham, also,  mentions in vol. 2, p. 82,  of his work de
 Aere, &c., that a disease, which he  calls " Febris putrida,
 contagiosa ac pestifera valde,"  broke out at Launceton, in
 the month of April, 1742.  He says, "genita hoc in canceri-
 bus  febris  et per comitia provincialia  disseminata longe la-
 teque."
   In the year 1750, a fever made its appearance " during the
 sessions of the Old Bailey, which proved fatal to the lord
 mayor, and two of the judges, with several eminent and
 other persons, who, as was asserted, and is now generally be-
 lieved, were infected by the contagion of jail fever brought
 into the court from Newgate."^
   Previous, however,  to this occurrence at  the  Old Bailey,
 two  essays had appeared on the subject, from  the  pen of
 Ebenezer  Gilchrist, of Dumfries,  which  were published  in
 the fourth  and fifth volumes of the Edinburgh Medical Es-
 says and Observations.  He called it " nervous fever."   Nei-
 ther its origin nor  its  propagation was attributed by  him to
 contagion.
   A  considerable  time  after this, Huxham and sir John
 Pringle published their essays on typhus—Huxham under the
appellations of "slow  nervous fever" (febris lenta nervosa)
and  "malignant putrid  fever,"§ and  Pringle under that of
  * Bancroft, p. 434.
  f Ibid, p. 110.
  % Ibid, p. 111.
  § The "slow nervous fever" and the "malignant putrid fever" of Hux-
ham, are obviously only different grades of the same disease; they corres-
pond to the typhus mitior and gravier of nosologists. 
4
"jail or hospital fever/'  Both these writers were strenuous
advocates for the attribute of contagion as belonging to this
fever.   Subsequent to these publications we find much more
attention paid to this subject, and its pathology and causes
have  been investigated  with much ardor  and diligence.
Many of those who have written  on it have contended for its
being contagious ; some there are, however, who dissent from
this doctrine, and deny that  it  possesses any such property.
  This fever has been divided by nosologists into the typhus
mitior, (mild typhus or nervous fever,)  and typhus gravior, (ma-
lignant or putrid typhus ;) thus indicating its sometimes mild
and sometimes violent character.  This distinction appears
to us to be entirely useless.  It produces an unnecessary
multiplication of words ;  the same language  descriptive  of
one grade being applicable, with a  slight variation, to the
other; so much so,  that both can be  easily comprehended in
one general description,  and it,  moreover, leads to no good
practical result.  The typhus mitior and gravior being only
grades of the same disease,  are  to be treated exactly on the
same principles; and that physician who has not  sagacity
enough to discriminate between a mild and a severe fever,
will not have his intellectual vision brightened by such dis-
tinctions.   Independent,  however, of these reasons, we do
not think, in practice at least, that the distinction can always
be made.   However  easily  it  may be done in the  closet, it
will be found often  impossible at the bedside of the patient.
Every physician of much experience in this disease, will ac-
knowledge that, in a majority of cases, the symptoms are
such as to render it doubtful  to which grade they belong.
Wilson remarks, that " between  the worst  and mildest forms,
there are innumerable degrees which insensibly  run  into
each other;" thus rendering it impossible to draw a distinct
line of demarcation between them.   Those, therefore, who
are in favor of distinguishing typhus into grades, should car-
ry out this principle, and give  a  separate description of each
of its  "innumerable  degrees;"  for  there would be just as
much ground for this, in a practical point  of view, as there is
for the other; they should also extend this principle to other
fevers, for if this distinction  be necessary in typhus,  it is
equally so, for instance, in  yellow fever,  for it  also has  its
gradations of violence and  mildness.  Another objection to
it is this: the  different grades  of this fever are so readily
convertible into each other,  that, according to the treatment
pursued, what was  mitior today, may be gravior tomorrow,
and vice versa.  For these reasons we reject these distinctions,
which we consider arbitrary and usele-s. 
  Armstrong, in his unequalled work on typhus fever,* no-
tices three varieties instead of two.  He divides the disease
into the typhus of simple excitement, the inflammatory and
the congestive typhus; though we have the same objection
to his two first divisions, that we have to those of mitior and
gravior, yet, nevertheless, we think his  arrangement on the
whole better  than the other;  the phraseology which he em-
ploys to designate the different forms of this  disease is, we
think, preferable to that of  mitior. and gravior, inasmuch as
it expresses in itself the real character and pathology of the
disease, and strikes at the  root of those notions of debility
and putrescency as prominent features  of this fever, which
we derive from books,  and which are intimately associated
with all our reflections on it; and it moreover includes a form
of  the disease, which unquestionably demands a  separate
consideration, i. e. congestive  fever.  Until the publication of
his work, we had no distinct conception of the pathology of
congestive  fever; his post  mortem examinations, however,
have revealed its true character ; and his  graphic pen  has
delineated with so much accuracy its symptoms, that it can-
not fail to be recognized by even the most careless observer.
But though we prefer his arrangement to the other, we shall
adopt it only in part.  We will include his two first divisions
in one general description,  and then treat of congestive ty-
phus, under a separate  head.    We will now  proceed to an
enumeration of the symptoms of typhus.
   Symptoms.  This fever commences with the same symp-
toms which usher in-the attack of other febrile affections.f
A feeling of languor* and an indescribable sense of weariness
and dejection, are usually the  first links in the chain of symp-
toms which constitute  this disease; there  is also,  usually,
some slight gastric distress, sometimes amounting to nausea,
together  with a total loss  of appetite.  There  is, in some
cases, a cold creeping  sensation over the body; in others,
particularly when the attack is severe, this coldness amounts
  * We cannot mention this work, without expressing the unbounded ad-
miration we feel for the talents of him who composed it, and our conviction
of its great value.  If we were required to put our finger upon a volume,
containing the greatest amount of practical information on the diseases of
which it treats, we should unhesitatingly select it in preference to any work
with which we are acquainted.  The neatness, elegance, and perspicuity of
its style, the vast fund of practical instruction spread over its pages, and
the vital priuciple of genius which pervades every portion of it, has always
rendered its perusal, to us, an intellectual treat.
  f Pringle remarks, that "the disease  in the beginning is not easily dis-
tinguished from any common fever." 
t)
to rigor, alternating with quick and transient flushes of heat;
the face is pale, with some slight appearance of livor under
the eyes; and there is more or less of a load, pain, or giddi-
ness of the head—the  pulse at this time is generally weak,
low, and frequently irregular.   This assemblage of symp-
toms constitutes what has been  aptly termed by Armstrong
the  stage  of oppression.  This  may continue from  a  few
hours to as many days ; sooner or  later, however, evidences
of decided  reaction supervene.  The face  loses its paleness
and generally  becomes much flushed; the pulse increases
in frequency; in some cases it is tense and hard; the head-
ache becomes  excruciating,  and  the  mind is  often  over-
whelmed  with  delirium.   The skin grows very warm, and
the heat appears to have a penetrating quality.*   The thirst
becomes considerable, and, in some cases, almost unquench-
able.  In milder cases these symptoms  are  much less promi-
nent and severe: in such cases, the pulse, though quicker
than natural, is neither hard nor strong, and the uneasiness
of the head not near as great; the delirium, if present, is
seldom violent and uncontrollable as in the severer modifi-
cations of the disease.   Petechia} also frequently make their
appearance, though they are by no means peculiar to typhus,
but frequently occur in other  fevers; the mouth is parched
and dry, and the tongue, from  the beginning, is more or less
furred, and, in  the  progress of the  disease,  generally brown,
and sometimes black;  the bowels  are  often much  disposed
to constipation, and the secretions  and  excretions are much
charged ; the alvine discharges becoming dark and offensive,
and the odor of the breath and body very unpleasant.  After
a longer or shorter  time, varying  from the seventh  to  the
eighteenth  day,  and,  in severe cases, sometimes a much
shorter period, a change takes place in the character of the
disease ; what  Armstrong calls the stage of collapse  super-
venes, and if the patient has  been properly treated during
the period of excitement, it is  usually the beginning of a re-
turn to health,  which is indicated by an abatement of all the
  * Pringle notices this symptom.  " On first touching the skin," says he,
"the heat seems inconsiderable; but upon feeling the pulse for some time,
I have been sensible of an uncommon ardor, leaving an unpleasant sensa-
tion on my fingers for a few minutes after. The first time 1 observed this,
I referred it to the force of imagination, but was assured of the  reality by
repeated experiments, and by the testimony of others,  who, without know-
ing of my observation, had made the same remark."  Other physicians have
also mentioned it. Frank, in  allusion to it, says, "scepe manifeste acer
digitosque urens." It has been called by others a biting heat.  It is not.
however, peculiar to typhus, as we have observed it in other fevers. 
symptoms; but  if (particularly in  severe cases) the  fever
and topical  inflammation, which are almost always present in
such  cases, have not been kept in proper subjection, it is a
change pregnant with the utmost  danger to the patient;  the
delirium is  lost in profound stupor, the tongue becomes  ex-
ceedingly black and dry ; dark sordes collect about the teeth ;
subsultus tendinum,  and what have been  denominated symp-
toms of putrescency, appear; the petechiae, if present, turn
to a  dark  purple color ;  hemorrhages  from  the  stomach,
bowels, and kidneys, (the last making the urine dark,*) come
on, or "profuse ichorous and involuntary stools" soon extin-
guish  the remains  of life.   The patient, however, is some-
times carried off by convulsions.
   Prognosis.   In forming  our  prognosis of  the   probable
event of  this fever, we must not deduce  our  opinion from
any one symptom, however prominent it may be, but rather
from  mature deliberation upon the symptoms  taken collect-
ively : as the chief danger, not only in this, but in all fevers,
arises from the  disorganizing  effects of high and uncon-
trolled excitement,  upon some one of the vital  organs, it fol-
lows, that if this be  moderate, or if it  be even high, and we
find that we  can keep  it in due subjection, then  we may ra-
tionally anticipate a favorable termination ; but if neither of
these conditions obtain, then we may justly dread the event.
But to be more  particular: we may calculate on  recovery
when the delirium is slight, the strength  not much impaired,
the tongue  moist and beginning to clear, bowels loose and
easily operated on by medicine ; when deglutition is perform-
ed  without  difficulty, and  the respiration  is free and easy,f
with a soft and moist skin.  A  deafness  coming on during
the fever is considered by many a favorable sign.!
          ' Huxham says, "I have frequently seen the urine, in petechial fever,
        almost black."
          f Fordyce on Fever, page  221, observes, that, "although the patient
'       should be insensible to all external objects, although he should sleep very
        little, yet, if the deglutition and respiration should remain unimpaired, the
        patient is not to be despaired of;  it happens even that he most commonly
        recovers. But if he respires with great difficulty, or hardly at all, or if the
        deglutition be almost totally prevented, or if the attempt to swallow throws
        him into convulsive contractions, he rarely recovers."
          % We have mentioned deafness as one of the favorable symptoms in ty-
        phus, more upon the authority of others, than on our own conviction of its
        being such;  to us it clearly indicates a degree of fulness of the cerebral
        vessels, which, in our opinion, is much to be deprecated.  That it is owing
        to this cause is plain from its  being removed by evacuants, and by its re-
        turning  if these are discontinued.  Every physician  must have witnessed
        this.  Hippocrates testifies to this fact.  In section 4th, aphorism 28th, he 
8
  Besides the signs already mentioned, there  are what art-
called critical discharges.   Among the  most  frequent of
these, is  sweating; this evacuation was  at one time con-
sidered of so much importance in the  cure of fever, that it
was thought a sine qua non to recovery,* and accordingly the
most  heating and pernicious  means were  employed to force
this discharge.   This destructive and  irrational practice is
fortunately almost exploded  at the present time, and  physi-
cians now, with  the exception of using a few antimonials,
generally leave it to nature, who effects it best in  her  own
way.t
  The most frequent critical discharge is a diarrhoea; this,
when of a proper kind, very often terminates the  fever ; it
is always most  beneficial when the stools are bilious and
somewhat consistent;  profuse  liquid  and colliquative dis-
charges  always  do harm, and often irretrievably  prostrate
the patient  in a very short  time.   This  last description of
diarrhoea is, of course,  to be immediately  arrested; the first
kind  ought  rather  to be encouraged.   Hemorrhages, like-
wise, often prove  critical  in  this fever; the blood  may pro-
ceed  from the nose, stomach, or bowels.   Persons have been
often rescued from the grave, when given up as lost,  by the
opportune occurrence of hemorrhage  from the bowels, and
other parts; they should always  admonish the practitioner
to relieve nature from the necessity of resorting to this ha-
zardous  alternative, by using proper  depletion  in the first
stages of the disease; we say hazardous alternative, because
it often comes too late, and as often is excessive in quantity.
Hemorrhage only does good in typhus when  it occurs early
in the disease, before the constitution has been shattered by
the long  continuance of the fever.  This  fact did not  escape
the sagacious mind of the father of medicine.  In  one of his
remarks, " Q,uibus biliosae sunt egestiones, surditate superveniente cessant;
et, quibus surditas est, biliosis supervenientibus cessat."  Although, in the
first part of this aphorism, he seems to consider the cessation of the bilious
discharges as the eft'ect of the deafness, yet it is obvious from the latter part
of it, in which he says this deafness is removed by the recurrence of these
evacuations, that he had mistaken the cause for the effect.
  * Huxham declares that " he never once saw a malignant typhus cured,
till more or less sweat had issued."
  t To Sydenham the  praise is justly due for having put down the perni-
cious practice of endeavoring to force a perspiration, by the use of the most
heating and inflammatory measures,  and of substituting iu its place the
cooling and evacuating plan of treatment.  It constituted by no means the
least of his triumphs over the deep rooted prejudices of the times in which
he livpj. 
9
 aphorisms, he  says, that "livid, bloody,  foetid, and  bilious
 stools, coming  on in continued fevers, are alike unfavorable ;
 but a timely appearance of them beneficial."*
   This fever also terminates occasionally in glandular swell-
 ings.  Dr. Donald  Morris, in his work  on diseases of the
 army, observes, that "swellings of the parotid glands  ap-
 peared in many subjects towards the decline of the fever,
 which came  to suppuration and proved critical."   Pringle,
 and other writers, also mention their occurrence, and recom-
 mend an early incision to discharge the pus.
   Having enumerated  the  favorable  symptoms,  we  will
 now briefly  mention those which portend the approach of
 death. The bad signs are high delirium or deep stupor, subsul-
 tus tendinum, black, dry, and tremulous tongue, and inability
 to protrude it beyond the lips; difficult deglutition, and  im-
 peded respiration; weak,  irregular, and intermitting pulse;
 great restlessness, evinced by frequent attempts to get out of
 bed, or by continual tossing  from one side of it to another;
 the surface of the body bedewed with a cold sweat; frequent
 colliquative stools and hemorrhage from the mouth, ears,
 &c.;  sometimes the patient expires in convulsions.   Such
 is the dark catalogue of symptoms which declare death to be
 at hand.  Even these,  however, should not deter us from
 exertions to save life; persons sometimes  recover with near-
 ly all  the above mentioned desperate symptoms, and  the
 knowledge of this fact should teach  us the important  lesson
 never  to  abandon, as entirely hopeless,  any case of fever;
 appearances are sometimes fallacious,! and we should never
 fold our arms  in  inactivity, though  a combination  of  the
 worst symptoms exist.
   Pathology of Typhus.   Typhus fever has been for  a long
 time, and still is with too many, associated with the ideas of de-
 bility and putrescency as its standing and prominent  symp-
 toms.  The  prejudices on this head,  however, are beginning
 to lose some portion of their sway, in consequence  of  the
 flood of light which has been shed on the pathology  and
 treatment of typhus, by  some recent publications.  Among
these  the work by Armstrong stands conspicuous; the  ap-
 pearance of which  may be said to have constituted a new era
in the history of typhus.  But while bestowing due praise on
  *  "Excretiones in febribus non intermittentibus lividsc, et cruentse, et
graveolentes, et biliosae, omnes malae sunt.  At probe secedentes bona?."
  f  Hippocrates remarks, that " acutorum morborum incertae admodum. ac
fallaces sunt prsedictiones."
                            o 
10
this distinguished writer, let us not forget the illustrious Sy-
denham, whose  sagacious  and strong  mind, more than a
century and a half ago, discerned the true character of this
fever, and suggested a course of practice, which, though in a
great measure lost or forgotten amid the conflicting opinions
of subsequent writers, has been revived in the present  cen-
tury, and  is now, with but little variation, followed by all
those who do not still hold to  the doctrine of debility as be-
longing to this disease in  all its stages.  But to return to
the subject.  We will endeavor  to show, from  the various
circumstances and  phenomena incident to it, that,  so far
from being a disease of debility, it  is essentially one of ex-
citement, and frequently of inflammation as its consequence.
One form of typhus, (i. e. the congestive,) will not, of course,
be comprehended in this.
  A state of real debility is a  condition of the system which
is, generally, (we might say always,) the consequence of long
continued  excitement, or the more  gradual, though not less
certain, result of an insidious chronic affection, preying upon
some important and vital  viscus.  This  real debility is al-
ways increased by such remedies  as are termed evacuants,
and, on the contrary, is diminished by such means as add tone
to the system; but if, in the  commencement of a fever, a
person appears very weak, and if we find that the adminis-
tration of tonics and stimulants only increases the debility,
and, on the other hand, that evacuants, such as bleeding and
purging, lessen it, the legitimate conclusion from these facts
is, that this  weakness is not real, but only apparent.   This,
then, is the case with the  debility in the primary stages of
typhus; it is increased by  the exhibiting of stimulants and
lessened by evacuating measures.  Armstrong, whose experi-
ence was very great in this fever, bears testimony to this fact:
"In the first stages of typhus," says he, "the debility is only
apparent, and chiefly dependent upon the preternatural ac-
cumulations of blood in the veins about the head, heart, liver,
and other internal parts, while there is  less circulating upon
the external surface of  the body, than in a  natural  state.
In the second stage, the  debility is still only apparent, being
then the consequence of over excitement of the heart and
arteries ; but in the third and last stage, beyond all dispute,
the debility is real, as it is then  connected with  a general
collapse, which sooner or later succeeds to a state of febrile
excitement, as certainly as exhaustion follows a fit  of intoxi-
cation."  And a little farther on he says, that though " this
proposition is not evident at first  sight, yet it  is as certainly
true as any in physic, and  is proved from the debility in the 
11
first and second stages being increased by wine and cordials
and lessened by a spare regimen and evacuations."*
  Every  physician  must  have  witnessed  the  positively
strengthening effects of cathartics  in typhus  fevers,  before
the constitution  has been really debilitated by long continued
excitement.  A patient who has  been carried to the close
stool, after a copious evacuation from his bowels, is able to
get up, and walk without assistance to his bed.t   This in-
vigorating effect of purgatives in typhus and other fevers, is
of frequent occurrence, and is totally unaccountable upon the
supposition  of its being a  disease  of debility; we commit,
therefore, an egregious error when we mistake this  apparent
for  real debility.   In  the  strong language of Rush, "the
rlown who supposes the crooked appearance of a stick, when
thrust into a pail of water, to be  real, does  not err more
against the light, than  that physician errs against a law of
the animal economy, who mistakes the debility which arises
from  oppression for an exhausted  state of the system, and
attempts  to remove it  by stimulating means."  But  again,
if this disease be one of great debility, there are many of its
phenomena,  mentioned by those who advocate  this  very
theory, totally inexplicable, and indeed irreconcilable  with
this view of the disease.   We presume every one will  ad-
mit, that, if real debility be a characteristic  of this fever,
what are obviously debilitating discharges must increase this
symptom, and of course prove  prejudicial to the patient; but
that this is not the fact, we will endeavor to prove  from the
testimony of others.  Wilson observes, that a "spontaneous
flow of blood from different parts of the body,  we have seen,
is frequently attended  with an abatement,  or total  removal,
of the symptoms of synocha, and, what we should not a priori
have  expected, sometimes those of typhus;"! and in another
place, when speaking of typhus, he  says, " I have often seen
them (i. e. hemorrhages) attend a general abatement of the
symptoms." ||  We would ask Dr. Wilson how he can recon-
cile these facts with his notions of typhus fever ?
  * Armstrong on Typhus, p. 25.
  f This is also frequently observed in other fevers.  Dr. Bryce, in his ac-
count of the yellow fever on board the Busbridge Indiaman, in 1792, ob-
serves, that he has "often seen a man carried upon deck, perfectly delirious
with subsultus tendinum, and in a state of the greatest apparent debility,
who after one or two copious dark colored evacuations, has returned of him-
self,'and astonished at his newly acquired strength."
  X Wilson on Fever, vol. 1, p. 142.
  !| Ibid. p. 134. 
12
   The good effects of long continued and profuse sweating
in this fever cannot be  accounted for on the supposition of
typhus being a disease of debility.  We can well imagine
that the loss of quarts of fluid might be salutary in a disease
of high excitement, but it could never enter into our  con-
ception that the  same loss  would  be  beneficial to one who
was really and bona fide weak; and yet writers  mention the
good effects of several days' continuance of profuse perspira-
tion.*  A diarrhoea, also, as  was mentioned  before, is often
critical in this fever.  We have thus endeavored  to prove,
from the very character of the  debility in the first stages of
typhus, and from the phenomena and circumstances incident
to it, that the opinion of those who consider it a disease of
genuine debility, and, as such, requiring tonic and stimulating
remedies for its cure, is erroneous.
  We will  now take the opposite  side of the question, and
will endeavor to prove that it is a disease of excitement, and
often of inflammation as its consequence.  In the first place
we will observe, that all the circumstances and phenomena
of typhus already mentioned,  and which are  inexplicable
upon the ground of its being a disease  of debility, are easily
accounted for upon the supposition of its being a disease of
excitement and often of inflammation.   The opposite effects
of stimulants and evacuants in the first stages of typhus, the
relief afforded by hemorrhages, profuse and  long continued
sweating, diarrhoea, and the abundant  and free  discharge of
matter from glandular  swellings, are perfectly consonant to,
and exactly what we would  expect from, this  view of the
disease.  But we have still better  ground  for this  opinion:
post mortem examinations prove it to be correct; they esta-
blish, beyond doubt, that death in this fever  is  generally
produced  by the  destructive ravages of  inflammation on
some one organ or organs of our frame.  Many of the wri-
ters on this fever have recorded the results of their  dissec-
tions.  Pringle relates the appearances,  on dissection, of ten
persons who died of jail fever, in all of which, either inflam-
mation or its effects were plainly visible; a majority of them
had suppuration of the brain.   Thomas says,  "The usual
appearances on  dissection are, a softness and  flaccidity in
the solids ; a dissolved state of the fluids, particularly of the
blood ; collections of sanious  matter in the different cavities;
turgescence and inflammation of the thoracic and abdominal
  * Morris, in his treatise on diseases of the army, remarks, that the sweat-
ing often continued, with the best effects, for several days. Hoffman, also,
makes a similar statement. 
i:;
viscera; and  m  the interior parts of the brain  increased
vascularity  and  collections  of  serous fluid."*  Armstrong
mentions that his  post mortem  examinations always exhi-
bited the  appearances  or  consequences of  inflammation.
Dr. Dickson,  in  his account of the contagious fever which
prevailed in the Russian  fleet, observes,  "that the appear-
ances on dissection were strongly illustrative of the frequency
of visceral inflammation, in the fever which he saw and de-
scribed ; for the  brain, lungs, and  contents of the abdomen
were severally found  to  have been  attacked, among those
who were the victims of this disease."!  Ferriar also men-
tions  the appearance  on dissection of several persons who
had died of typhus, all exhibiting the most unequivocal evi-
dences  of inflammation.   These dissections  seem to have
made such an impression  on him that  he observes, after
having  mentioned  the  results of them, that "perhaps local
inflammation  is more frequently joined with typhus than we
are aware."f
  Other accounts of post mortem examinations, corrobora-
tive of the above, might be mentioned, but these are deemed
sufficient to establish, beyond doubt, the pathology of typhus,
and that  death in this fever is generally, if not  always, the
result of inflammation, disorganizing  some important part
of the animal machine.   So universally, indeed, have  the
traces of inflammation been observed in those  who die of
this  and other fevers, that  many  physicians  have adduced
it as  the cause  of fever.   Clutterbuck, Ploucquet,  Mills,
Marcus, Reid,|| and Broussais, are the great  advocates for
the local origin of fevers.   The latter, especially, a physician
of eminent  talents and much experience, has gained great
celebrity by the ingenuity and ability with which he sustains
his doctrine, and by the imposing array of talent which  has
flocked  to his  standard.  His doctrine is, that fever arises
from an inflammation  of  the mucous lining of the stomach
and bowels.
  It would be irrelevant to the object of this essay to attempt
any thing like a labored refutation of this  theory ;  which, en-
  '  Thomas's Practice, p. 49.
  t  Armstrong on Typhus, p. 154.
  X  Medical Histories, p. 76.
  ||  Clutterbuck  and  Mills locate the inflammation, which they consider
the cause of fever, in the brain.  Ploucquet contended that fever was sym-
pathetic of an inflammation of the brain, stomach, and intestines; and Reid
considered its seat to be the spine.  Professor Marcus, of Bavaria, taking a
more enlarged view of the  subject,  regarded all inflamed organs as equal
fai^ris o1' fever. 
14
forced with all the "zeal, energy, and talents which this ce-
lebrated school can bring into the field," has spread itself ex-
tensively over the continent of Europe, and,  having crossed
the waters of the Atlantic, can number among its supporters
many of the distinguished medical characters  of this country.
We are not among those, however, who assent to the truth
of this doctrine; on the contrary, we reject it unqualifiedly,
as being, in our opinion, utterly at war with the true patho-
logy and phenomena of fever.  We do not believe fever arises
from inflammation of the mucous membrane  of the stomach
for the following  reasons.  1st.  Because in  many cases we
have no evidence of its existence at  the  commencement of
fever, or for even  several days after ; and not  unfrequently
during the whole course of the disease, we  have no one symp-
tom indicative of  its presence.   2d. If inflammation of the
mucous  membrane of the stomach and bowels be the cause
of fever, then we should  always have, what but rarely exists,
some  degree of tenderness  of the epigastrium, and a con-
stant  mucous  diarrhoea; the latter  symptom,  particularly,
should be  present  in every case of fever ;  for it may be laid
down  as an almost invariable rule, that a part which in  a
healthy  state secretes a fluid, has that secretion increased
when  it becomes  inflamed;  this effect  we see produced in
the mucous membrane of the nose, larynx,  and  trachea in
catarrh, for example, which  consists  in an inflammation of
these  parts; and to cite  a case still more in point, we find it
to be strikingly the case in dysentery.   All acknowledge that
the mucous membrane of the intestines  is inflamed in this
disease, and we see increased secretion of mucus, the result
of it;  the  same thing happens when the lining membrane of
the bladder is inflamed; as we have not, therefore, this dis-
charge in typhus, in which inflammation of the mucous mem-
brane of the  stomach and bowels is assumed to exist, we
conclude that it is not present.   3d.  We cannot conceive in-
flammation to exist in the first  stage of fever; when the ac-
tion of the heart and arteries is comparatively weak and fee-
ble, and the blood, as a  necessary consequence of this weak-
ened action, accumulates in the venae cavae and their branches.
4th.  This very accumulation of blood about  the heart, inas-
much as it affords to it an increased  quantity of its  natural
and legitimate stimulus, is abundantly sufficient to produce a
reaction of this organ, or, in other words, to excite a fever,
without bringing in a cause (i. e. inflammation of the stomach
and bowels) which we cannot  conceive to exist under such
circumstances. And, 5th. Post mortem examinations do not
prove it;  they may, indeed, exhibit the evidences of inflam- 
15
rnation in the lining membrane of the stomach and bowels,
in the head, liver, lungs, spine,  &c.;  but this by no means
proves, that the inflammation which is found to have existed
in these  different parts was antecedent to and produced the
fever ; and if we admit  inflammation as a cause  of fever,
when found in the mucous membrane of the  stomach and
bowels after death, we must make the same admission when
this inflammation is discovered to have existed in other parts;
and, as a consequence of this,  we should have as many dif-
ferent seats of fever as there are viscera.  For these rea-
sons we reject the doctrine of Broussais and of all others who
contend  that  fever  has  "a local habitation;" and in doing
so we are sustained by the opinion of the most eminent pa-
thologists of the present  day.   Laennec affirms, that the or-
ganic changes which we  find  after  death from fever,  are
" evidemment posterieures a la fievre, et ne peuvent, par conse-
quent, etre regardes comme sa  cause."*
   The views of  those who would  limit the seat of fever to
some one viscus are very unphilosophicu!; "they narrow an
important  subject which disdains such petty limits."  Fever
is what Dr. Hosack, one of the most distinguished physicians
of this  country, describes it to be,  "a disease of the whole
system;  it appears no less in  all the faculties of the mind
than in all the functions of the body ;  it shows itself in every
organ of our frame, and affects every nerve and fibre of the
system ; the absorbing, the circulating, and excreting system
of vessels, are all affected by it; in a word, it is omnipresent;
it has no one pathognomonic symptom, but is constituted by
a concourse of symptoms, and  these  variously combined in
the various forms that fever  assumes, depending upon  the
cause whence it proceeds, and the condition of the body in
which it occurs."f
   In rejecting the doctrine of Broussais as to the local origin
of fever, we entirely concur with Armstrong in the opinion,
that inflammation is the  product of precedi lg excitement,
and that  its particular seat is determined by the previous
condition of the organ which it attacks ;  this  condition is  a
debility of  the  organ affected4  From  what  we have seen
we think the head is most frequently  affected.
  * Med. Chir. Review, Jan. 1825, p. 16.
  f Appendix to Thomas's Practice, p. 948.
  X Ferriar long ago advanced this opinion ; he says, that " during the in-
creased action of the circulating system, if any part of the body be originally
weak, or have been rendered infirm and irritable by preceding disease, con-
gestion and its consequence may be expected there."  Med. His. p. 150. 
lb'
   Congestive  Typhus.  Previous to the appearance of Dr-
Armstrong's  admirable  work on  typhus fever, this form of
the disease had not attracted the attention it merited from
physicians; and, in fact, we knew little or nothing of its na-
ture.  In the works of Sydenham we find the first particular
notice of  congestive  fever ; he relates  the circumstances
of one case only, but from  the confident tone in which he
spoke of what would be the effect  of  venesection in it, we
may fairly presume that he had met with cases of the like
description before.  In allusion  to this particular form of the
fever, he remarks, "that all the symptoms proceed  from na-
ture's being in a manner oppressed and overcome by the first
attack of the disease, so as not to be able to raise regular
symptoms adequate to the violence of the fever ; all the ap-
pearances being quite irregular.  For, the animal economy
being disordered, and in a manner destroyed, the fever is
thereby depressed, which in the true natural order generally
runs high.   I remember (continues  he) to have met with a
remarkable instance of  this, several years  ago, in a young
man I then attended; for though he seemed in a manner ex-
piring, yet the outward  parts felt  so cool, that I could not
persuade the  attendants  he had  a fever, which could not dis-
engage and show itself  clearly, because the vessels were so
full as to obstruct the motion of the blood."*  After the time
of Sydenham, no particular notice  appears to have been ta-
ken of congestive fever.  It is  true, that Drs. Jackson and
Clark, almost a century after, gave some imperfect account
of it; but until the appearance of Armstrong's work, our no-
tions of the nature of this fever were very obscure ; he has
the high merit of having clearly and ably elucidated its pa-
thology ; and of having  opened a new field  for  medical en-
quiry and research.   The disease, according to him, consists
in an engorgement or distension of the large internal veins;
and differs from  his other divisions of typhus in having no
stage of excitement or reaction of the  heart from the first
shock of the  disease.  We cannot  do  better than copy his
description of the symptoms of congestion; they are portray-
ed in his best style.   "The attacks (says  he) of  the most
dangerous forms of the congestive typhus are generally sud-
den, and marked by  many remarkable symptoms: an over-
powering lassitude ; feebleness of the lower limbs ; deep pain,
giddiness, a sense of weight in the encephalon; a dingy pal-
lidness  of the face; anxious breathing; damp, relaxed, or
* Wallis's Sydenham, vol. 2, p. 351 
17
   dry withered skin; and those peculiar conditions of the tem-
   perature which have been noticed above.*  The pulse is low,
   struggling, and variable; the stomach irritable; frequently
   there is an inability from the first to hold up the head;  and
   the mind is more often affected with  dulness, apprehension,
   and confusion, than with delirium.  The whole appearance
   of the sick impresses the attentive practitioner with the idea,
   that the system in  general, and the brain in particular, are
   oppressed by some extraordinary load.  Both the manner and
   look of the patients undergo early and great alterations;
   sometimes they slowly drawl out their words, or utter them
   in a hasty and yet imperfect mode, like people who slightly
   stammer when embarrassed; they not unfrequently seem
   as if stunned by a blow, half drunk, or lost in a reverie ; and
   at times have the bewildered aspect of persons suffering un-
   der the first shock of an overwhelming misfortune.   The eye
   is occasionally glassy and vacant, without  redness ; but  at
   other times it is heavy, watery, and streaked with blood,  as
   if from intoxication or want of sleep.  At the commencement
   the pulse  is often  less altered as to frequency than might
   reasonably be expected, yet in general it becomes very rapid
   towards the close;  the tongue is usually little altered in the
   first stage; but in the last, it is frequently rough,  foul, and
   brown; the bowels are mostly very torpid in the beginning,
   and the stools procured  dark and scanty ; whereas, in the
   last stage, the bowels are generally loose, and the stools co-
\   pious and involuntary.   Eructations  are not uncommon  at
   all times, and  the  epigastric region is often much inflated.
   On account of the general  torpor, the  secretions are dimi-
   nished or suppressed; and, as justly remarked by Dr. Robert
   Jackson, the skin is often in that peculiar state, that if blis-
   ters be applied, they either do not act at all, or so defective-
   ly, as to leave  the appearance as if the part had been seared
   by a heated iron.   Petechia? in general appear earlier  in
   these than in any other varieties of typhus; and in the last
   stage there are sometimes gangrenous spots on the  extremi-
   ties, oozings of blood from the mouth and nostrils, and he-
   morrhage from the bowels."!
     " There are comparatively milder forms of congestive ty-
   phus, in  some of which the patient walks about for a few
   days after the infection has begun to operate, and complains
   little, except of uneasiness of the head, loss of appetite, and
   languor,  appearing rather  paler  than when in health.   If
  v
 * " Shrivelled cool skin."       f Armstrong on Typhus, p. 74.
Vol.. I.—NEW  SERIES.      3 
18
 strictly attended to, however, by a medical observer, a change
 may usually be remarked in his whole demeanor; he cannot
 as steadily command his attention as before, is not only rest-
 less during the day, but watchful at nights, and  soon betrays
 an absence of mind or loss of memory.  At length he be-
 comes garrulous like a half drunken person, or talks incon-
 sistently with his former views  and character; after the lapse
 of a day or two the  mental confusion is most obvious to every
 one—he begins  to be unsteady in his  gait, and  has a heavy
 intoxicated cast of countenance.  If  carefully  examined at
 this period, his tongue will be found white, his  pulse small,
 quick, and perhaps irregular; his  breathing hurried;  his
 bowels slow ; his skin rather hot about the trunk, but coolish
 and damp on the extremities.   If the disease be allowed to
 proceed, without decided interruption, the hands shortly be-
 come tremulous, and the confusion of  mind passes into deli-
 rium ; yet there is still  a want of regular excitement, demon-
 strated by alternate flushing and paleness  of the face, the
 feebleness of the pulse, the unequal state of the whole circu-
 lation, the coolness  of the extremities, the partially concen-
 trated heat of the trunk,  and laxity of the skin.  Aural and
 visual deceptions succeed, and force the patient into violent
 exertions, and every attempt to overpower him by coercion
 tends to aggravate the delirium and sink the strength.  His
 tongue grows daily fouler and his debility greater; he begins
to pick the bed clothes; and, at last, petechiae and subsultus
 tendinum appear.  About this period, the general turbulence
 sometimes  unexpectedly  abates, and he may become as se-
 rene and rational, as to give hopes that a favorable crisis has
taken place; but the calm is most frequently deceitful, being
 soon followed by a universal collapse, in which death occurs,
 mostly without much struggling.  Several cases, nearly an-
swering to the above description, have fallen  under my no-
tice,  and I have  found, that if  opportunely and  properly en-
 countered, they may generally  be subdued;  but  that if over-
 looked or improperly  treated  in  the  commencement,  they
will commonly baffle the best directed measures."*   There
 are some other modifications of congestive  typhus, which it
 is deemed unnecessary to take up time and paper to relate,
 because from what  has been said the disease may be easily
detected in all its different shapes.
  Prognosis.   The  prognosis  in congestive typhus, is to be
 drawn from the character of all the symptoms present in the
* Armstrong on Typhus, p. 75. 
Ill
 disease.   If  these  should  become  worse, if the  delirium
 should  increase,  the  pulse  should  continue  to  sink,  the
 breathing to  grow worse, the skin become colder, and the
 stools be passed involuntarily, it will generally terminate fa-
 tally.   If, on  the  contrary, the reverse of this should  take
 place, then we may anticipate a favorable  termination.
   Pathology.   The nature of this  fever obviously consists in
 an accumulation of venous blood in the interior of the body.
 The cause of this fever, whatever it is,  acting either directly
 or indirectly on the heart,* produces weakened action  of this
 organ, and this latter necessarily causes an accumulation of
 blood in the venae cavae and their branches; less blood than
 usual being sent  to the surface, paleness  and shrinking of
 the features and surface of the body  is  the  necessary  conse-
 quence.   This state of the circulation, in  a  greater or less
 degree,  is common to the first stage of all fevers;  the  heart,
 however, usually reacts under the  pressure of venous  blood,
and  drives it with increased force  to the exterior, when  the
fulness of the features and the warmth  and color of the skin
return ;   but if, from any cause, the heart  should  fail in re-
   * When reflecting on the modus operandi of the remote cause of fever,
 we have often been astonished, that all writers on the subject should have
 fallen into the error of overlooking its effect upon the action of the heart:
 and to have confined  their observation to the effect  (secondary and  conse-
 cutive)  produced on the cutaneous vessels.   Thus Armstrong, in his essay
 on Scarlet Fever, says, " One of the most obvious operations of contagion,
 like that of dole, is a change of action  in the cutaneous vessels, and a re-
 coil of blood from the surface towards the centre."  Now, it is perfectly ob-
 vious that the action  of the cutaneous vessels is dependent on that of the
 heart; if the action of the latter is weak, so likewise will be  that  of the
 former—if strong or vigorous,  so will be that of the cutaneous vessels.  So
 long, therefore, as the heart preserves its action unimpaired, the cutaneous
 vessels must continue in the same state; but the moment that this is weak-
 ened, we then observe this " change of action in  the cutaneous vessels,"
 which Armstrong considers to be the primary and direct effect of the opera-
 tion of contagion, and the first link in the series of effects which constitutes
 fever.  In consequence of this weakened action of the heart, less than the
 usual quantity of blood  is sent to the surface, and as the skin is generally
 flushed,  and the features full and expanded, when this action is exalted and
 vigorous, in fever for example, so likewise when it is weakened we have pale-
 ness of the face and shrinking of the features and surface of the body.  The
 phraseology of Armstrong  is incorrect and calculated to mislead, when he
 says that  contagion produces  "a recoil of blood from the  surface towards
 the centre;" for it would seem from this that the cause of fever impressed
 upon the contents of the  cutaneous vessels a centripetal direction, which
 is palpally absurd.  The reader will find this subject most  ably discussed
 in a work on the practice of medicine by John E. Cooke, M. D., Professor
of the Practice of Medicine, in the University of Transylvania,  a book contain-
ing more souud and original views, and a more correct pathology, than any
with which we are acquainted. 
20
covering its energy, then we have a continuance of those
symptoms which characterize congestive  fever.  Whether,
however, the cause (i. e. weakened action of the heart) as-
signed for this  accumulation be the correct one or not, dis-
sections demonstrate beyond doubt its existence.  Armstrong
says, that " In  examining the bodies of some patients who
had died in the most concentrated attacks of congestive fe-
ver, I have found the right side of the heart loaded with dark
blood; and, in reflecting upon the phenomena of all, am now
inclined to believe, that their pathology is intimately concern-
ed with the functions of the  right ventricle.  For (continues
he) when the action of the right ventricle is diminished, and
when it is overloaded by too great an accumulation of blood,
it must, by consequence, occasion a remora of venous blood
in  distant organs ;  and a sufficient portion of red blood not
being thereby returned to the left ventricle, its action, also,
must be defective,  and its blood not sufficiently oxygenized
for the complete purposes of vitality."*  The whole of this
extract is highly valuable and important,  as establishing by
post  mortem examination the pathology of this form of fe-
ver ; but a part of it, we think, deserves particular attention,
inasmuch as it may serve to explain the cause of the sudden
deaths which frequently take place during the prevalence of
mortal epidemics.   I allude to that part in which he says,
that  " an accumulation of blood about the heart must produce
a remora of venous blood in distant organs."   Or, in other
words, if the right side of the heart be full and distended with
blood, this fulness must extend itself into the cavae and their
branches; following, therefore, the ramifications of the su-
perior cavae, we find this fulness and distension extending up
the jugulars, from thence through the  foramen lacerum into
the larger sinuses  of the dura mater;  when, therefore, this
accumulation is already very considerable, if, from any cause,
it  should suddenly increase,  it may produce such pressure on
the brain as to cause the person to drop down as if in apo-
plexy. Armstrong, indeed, says, that " the most violent forms
of the congestive  typhus, resemble apoplexy in their symp-
toms,  to which, indeed, they often have a near affinity in
their pathology."!   This is the best explanation we can of-
fer of those sudden and occasionally  instantaneous  deaths
which sometimes occur during the raging of violent fevers.
   Treatment of Typhus Fever.   As our opinion of the cha-
racter and pathology of typhus fever differs as entirely from
that of those who consider it a  disease of debility  in  all
* Essay on Typhus, p. 84.        + Ibid p. 81.
« 
■2\
its stagfes, so likewise will our treatment be almost diametri-
cally opposite.   We think that death not only in this, but in
all fevers, rarely arises from mere debility, but from the ef-
fects of too great excitement  and inflammation  upon some
part essential to life; our object, then,  is to keep  both the
one and the other, if present, in a state of proper subjuga-
tion, by the steady cooperation of those  remedies which are
in their character strictly antiphlogistic; and we think that
these,  when timely and judiciously  applied,  will seldom
fail in  producing the desired effect.   We do not wish to be
understood  as pursuing  exactly the same practice in  every
instance; for we know that cases often occur, in which it is
not necessary to bleed, or even to use very active purgation;
all we  wish to inculcate is, that the antiphlogistic  principle of
treatment is to be rigidly adhered to, whether the disease be
mild or severe ;  leaving to the judgment  of the physician the
proper adaptation of the means to the grade of the fever.
And first of
  Bloodletting.   The  great value of this  remedy in fevers
has been known almost since the origin of medical science,
and  though  amid  the  vicissitudes  and revolutions which
have been, and  are still going on, it has been  alternately
praised as of indispensable  utility,  and rejected as perni-
cious in the extreme,  its efficacy appears  now to be  indis-
putably established.  Some of the  ancient physicians were
much in the habit of using it.  Galen and Celsus thought it
one of the most valuable remedies in pestilential disorders,
and we are told by Prosper Albinus that the Egyptians let
blood in fevers of a putrid tendency.  The Arabian physi-
cians, also, frequently  made use of phlebotomy in the fevers
of that country.  The great advocate for bleeding in more
modern times is the great Sydenham ; he employed it freely
in many diseases, and used it in the  very fever now under
consideration.   After  contending for  the inflammatory na-
ture of the disease and the necessity of curing it  by "a suit-
able method and medicines," he says, that " in order to do
this, I  direct ten ounces of blood to be taken away  from the
arm, and, in effect, though the blood in this fever generally
resembles pleuritic blood, yet  it does not well bear  repeated
bleeding.   But if a difficulty of breathing or a violent pain in
the head in coughing, and other symptoms of this kind, show
the tendency of this disease to bastard peripneumony, bleed-
ing and purging are to be repeated, till the symptoms entire-
ly disappear."*   From this extract  we  learn, that  in  mild
* Wallis's Sydenham, vol. 2, p. 319. 
22
rases, "repeated bleeding" was not borne well; but that if
symptoms of local inflammation supervened, then the patient
was to be bled and purged, till the symptoms were removed.
These remarks  are strikingly applicable to the fever as it
appears at the  present day:  there are many cases  which
either do not require bleeding at all, or demand but the loss
of a small quantity; such cases, of course, would not  "well
bear repeated bleeding," but, on the other hand, cases occur,
such as related by Sydenham, in which we  must bleed  again
and again, until  the symptoms are subdued.
  Bleeding, in severe cases of typhus, must be used early in
order to derive full benefit from the  remedy.  If we discover
from the symptoms that an acute inflammation of some vital
viscus threatens the life of the patient, we cannot commence
our operations too soon.  We should draw blood pleno rivo,
and not rest satisfied with a small  dribbling stream ; the first
mode of bleeding is infinitely  preferable to the last,  as it  ef-
fects a more speedy reduction  of the pulse, and sooner brings
on a state of fainting,  which is much to be desired in very
violent cases, as it is accompanied with vast relief to the  in-
flamed organ.*  If the heart  should react under this loss of
blood,  and the  symptoms  of inflammation  reappear, we
should, without hesitation, open the vein a second time, and
bleed until the  patient is relieved.   It rarely happens that
bleeding thus early and decisively does not entirely remove
the inflammation; and though the febrile action may  conti-
nue for some days after, it is easily kept in check by the use
of purgatives, &,c.  This vigorous practice is only intended
for the most  exalted grades of this  fever.   It is every way
preferable to  the halfway temporizing  measures of  timid
physicians, who  will sooner bleed ten ounces every day for a
fortnight,  than, by one or two copious bleedings in the com-
mencement, extinguish the inflammation and sometimes the
fever at once ; and in this way producing much less debility,
than by pursuing  the  opposite and much more precarious
course.   We are by no means  to be deterred from this  treat-
ment by the  appearances of great debility which often pre-
sent themselves in the commencement of  this fever;  these
are deceptious;  beneath them lurks a disease of the  most
speedily fatal character ; which, if not unmasked and detect-
  * We have a striking example of the powerful effect of bleeding ad deli-
quium, or until a sensation of faintness or sickness is produced, in cases of
violent ophthalmia.  The tunica conjunctiva, which before was as red as the
presence of arterial  blood  could make it, will be found almost completely
blanched, and the pain and tension of the eye surprizingly relieved. 
23
 ed, will  soon destroy the patient.   The language of Arm-
 strong on this subject is full of wisdom.  " If the topical af-
 fection (says he) has been but of short continuance, and the
 vigor of the constitution be merely weighed down, and not
 really exhausted, let him discard the fears associated  with
 false doctrines,  and promptly abstract blood according to the
 seat and extent of the inflammation, and till local pain and
 general oppression be relieved."
   In severe and violent cases of typhus, there is scarcely any
 remission, but in the  milder, there is generally some little
 abatement of the symptoms; in such cases it is always best
 to use the lancet during the period of the greatest exacerba-
 tion, or acme of the fever.*
   We have before said that cases of fever  often occur,
 which do not require the  lancet at all; but that they might
 safely be trusted to remedies whose operation, though strict-
 ly antiphlogistic, were yet inferior in point of power to vene-
 section, such as cathartics, abstemious regimen, &c.  There
 are likewise many cases in which the symptoms of inflamma-
 tion are so slight, that though bleeding would  be  proper to
 lower arterial excitement and thus prevent an increase of the
 topical affection, yet a much smaller quantity will suffice for
 this purpose than in the more violent instances.
   We trust that in the remarks made on bleeding, we have
 not evinced an  overweening confidence in this remedy.  It
 is certainly one  of Herculean powers, and as such ought to
 be employed with caution.  We believe the reputation of this
 noble remedy has often suffered from its having been mis-
 timed, and from its having been used in  insufficient quantity.
 It is mistimed when it is used after inflammation has conti-
 nued for several days, and when  irreparable injury has been
 inflicted on some important part; under such circumstances,
 we need  not  say that bleeding will be unavailing;  nay,
 worse, it will only hasten death.   It is, also, often used in
insufficient quantity.   We are too  frequently palsied by ap-
prehensions of debilitating the patient too much; " But if our
fears be so great, and we take away so small a quantity of
blood, how is it  possible to judge exactly what good or mis-
chief bleeding may do ?  For, if a  disease (which requires
  * It is not a little singular that some  of the ancient physicians should
have recommended a different course; they thought that to open a vein in
the height of the fever was death; thus Celsus says, " si vehemensfebris
urgct, in ipso impetu ejus sanguinem mittere hominem jugulare est;  ex-
pectanda ergo intermissis." 
24
four pounds of blood to be taken away in order to its cure,
and yet but one is taken away) destroys the patient, it does
not, therefore, prove destructive because bleeding was used,
but because it was performed in an improper and, perhaps,
unreasonable  manner."*  We have quoted the remarks of
Botallus on bleeding in plague, because, we think, they are
equally applicable to typhus and  other fevers, and because
they illustrate in a forcible manner the inadequacy of small
bleedings to cure diseases which require copious abstractions
of this fluid for their removal.
  There are some symptoms of typhus which have been sup-
posed to indicate great debility, and a putrid tendency of the
fluids.    These are  petechiae  and a dissolved  state of the
blood.   These symptoms  have been supposed to forbid any
thing like  depletion, and  to demand an opposite course of
treatment.   We  do not deny that where  these symptoms
make their appearance  late in the fever, when the constitu-
tion has been shattered  by the  unrestrained continuance of a
mortal disease, depletory measures would be improper; but
we  by no means agree that they evince any thing like putrid-
ity  of the fluids or even a tendency to it;  this  we consider
to be totally incompatible with the laws of vitality.   When,
however, these symptoms show themselves early in the dis-
ease, we believe  that they indicate  a fever of unusual vio-
lence, and one which demands active and energetic  measures
for  its relief.  Sydenham thought that petechiae were indica-
tive of a highly inflammatory state of the system ; for, when
speaking of the benefits of a low diet and cooling regimen in
this fever,  he remarks, that " it must be  indispensably en-
joined, when the patient is attacked with a phrenzy, petechia,
purple spots, or any other sign of violent  inflammation, oc-
casioned by an overheating regimen."t   Petechiae are very
often brought out by such means as excite and inflame the
system.  Sydenham, to whom we always refer with pleasure,
remarks in his "  Essay on the rise of a new Fever," " that
petechiae frequently appear, occasioned  by an unreasonable      >
use of  cordials, and a hot regimen."!  De Haen, also, says,
that the German  physicians of his day, converted common
fevers, by the use of the " regimen calidissimum,"  " into the
petechial and miliary." ||  On the contrary, symptoms indi-
* Botallus on Plague.  Wallis's Syd. vol. 1, p. 130.
t Wallis's Syd. vol. 2, p. 325.
X Ibid, p. 317.
II Thes. Sist, p. 35. 
         cative  of a malignant putrid character, are  moderated or
         prevented  by pursuing an antiphlogistic and cooling plan of
         treatment.   In proof of this we have evidence handed down
         to us, by the bright luminaries of the profession in times that
         are gone.   Sydenham, after contrasting the two methods of
         treatment, says,  " so, likewise, if I find, in the  fever under
         consideration, that the more the patient is heated, the more
         he is disposed not only to phrenzy, purple spots, petechia, and
•         the like symptoms ; but farther, that the fever,  by this pro-
         cedure, is  attended with all sorts of irregular  and  violent
         symptoms; and,  on the other hand, if it appears that ano-
         ther patient, by treating  him  according to the method here
         proposed, (i. e. the antiphlogistic plan,) is quite free from such
         symptoms, reason shows that the latter method of practice is
         much the best."*   De Haen, who was a strong advocate for
         the inflammatory nature of this fever and, of course, for ve-
         nesection, says that petechiae  never appeared in it when he
         had the management of it from the beginning.  " Liceat ne
         addere, (says he,) quod et medici complures et ego in nosoco-
         mio, sive in vigore morborum, sive eorundem in fine, nun-
         quam nostris in aegris, quibus a principio affueramus arbitri,
         miliaria deterimus ;"t and in  the same work expresses his
«        belief, that  petechiae would  but seldom appear, even in the
         plague  itself, if the antiphlogistic method of Botallus and Sy-
         dendam was strictly followed.   Dr. Dickson,  in his remarks
         on the  contagious fever which prevailed on board the Rus-
         sian fleet, after mentioning that the appearances on dissec-
         tion of  those who died of this  fever were " strongly illustra-
         trative  of the frequency of visceral inflammation,"  observes
         " that from reflection on numerous facts, it seemed to him an
         * Wal. Syd. vol. 2. p. 354-5.
         f Although, in the above extract, the miliary eruption is mentioned as be-
       ing prevented from appearing by bleeding, &c,  yet as De Haen consider-
       ed this eruption as nearly the same with the petechiae, and that those means
t       which prevented the one would also  prevent the other from appearing, and
       that the same remedies would  equally remove both when present, we have
       taken the liberty to quote it in this place as  equally showing the effect of
       bleeding in preventing the appearance of petechias.  That De Haen consi-
       dered the petechial and  the miliary fever as very  nearly related, and that the
       remarks he made upon one were equally suited to the other, is perfectly ob-
       vious from the following extract taken from the end of his section de Febre
       Petechiali.  He says, "  Multa de petechiis dicenda supersunt;  maxime de
       iisdem tum proveniendis, antequam fiant; tum cum adsint, curandis; verum
       cum hoc quoque ad miliarium eruptionem pertineant, ipsaquemiliariumhis-
       toria earn pectuarum elucidet, atque explanet, una fidelia hunc utrumque
       parietem dealbabo." This quotation, we hope, will be a sufficient justifica-
       tion for using the above  extract as we have done. 
26
inevitable conclusion, that those  remedies which  arrest in-
flammation  at the commencement, prevent the graver and
malignant symptoms, which characterize the last stage of
such fevers ; and this conclusion was amply borne  out by the
results of his practice, since bleeding and purging at the be-
ginning were generally successful."*  Rush, in his  " Defence
of Bloodletting," remarks that Dr. Morton describes what
he called a  putrid fever, which was epidemic and fatal, in
the year 1678.  Dr. Sydenham, who practised in London at
the time, takes no notice of this fever.   " The reason of his
silence (says Rush) is obvious.   By copious bleeding, he pre-
vented the fever of that year from running on to  the gangre-
nous state, while Dr. Morton, by neglecting to bleed, created
the supposed  putrid fevers which he has described."   The
importance of this subject will, we hope, be a sufficient apo-
logy  for our having dwelt on it at some length.   We consi-
der it of great importance in a  practical point of view to have
correct notions on this subject. If we adopt the opinions of
those who consider the appearance of petechiae as at all times
denoting debility, and a tendency to putrefaction in  the fluids,
and on this account to be treated by tonics and stimulants, we
will most unquestionably do much injury.   From our own ex-
perience, and from the testimony of others, we firmly believe
that, when occurring early in the  fever, they indicate a high
grade of disease, which  must be combated by active mea-
sures of treatment^ and so long as the pulse  preserves its
strength, we may deplete regardless of their presence.
   As to  the dissolved state of  the blood, if it occurs early in
the disease, and the other symptoms do not forbid the use of
the lancet,  we  should  proceed as though it  did  not exist.
Rush considered it as indicating a highly inflammatory state
of the system.  In his history  of the yellow fever of 1793, he
says, "I paid no regard to the dissolved state of  the blood,
when it appeared on the first or second day of the disease,
but repeated  the  bleedings  afterwards in  every case, when
the pulse continued to indicate it.  It was common (says he)
to see sizy blood succeed that  which was dissolved."
  * Armstrong on Typhus, p. 154.
  t Doctor Rush, in his account of the yellow fever of 1793, remarks, that
" the presence of petechias did not deter me from repeated bloodletting,
when the pulse retained its fulness or tension." After mentioning instances
of its success, he says, " I find precedents in De Haen and Dr. Sydenham
in favor of the practice.   So far from viewing these eruptions as signs of
putrefaction, I considered them as marks of the highest possible inflamma-
tory diathesis. They disappeared in each of the above cases after bleeding. 
27
   Cathartics.   Cathartics, next to venesection, are, unques-
tionably, the most important remedies in this fever.  Unlike
bleeding, however,  they are not only admissible, but,  in a
greater or less degree, are demanded, in every grade and in
almost every stage of the disease.  The ancient physicians
were much in the habit of employing purgatives in fever and
other diseases ; the number of such articles then in use was
comparatively limited, and they were very rough in their ope-
ration.   Sydenham, in  more modern times, carried the prac-
tice of purging to a very considerable extent.  After his time,
however, and previous to the revival of the practice of purging
in typhus by Hamilton, cathartics had been in a great mea-
sure neglected in the cure of fever ;  particularly in that  un-
der consideration.  Brown, in accordance with his belief of
the asthenic character of typhus, of course, rejected them;
and  Cullen  placed but  little confidence in  them, and gene-
rally substituted enemata in their stead.
   We have said above that Hamilton revived the practice
of purging  in typhus.   This  assertion has not  been made
without  due consideration, and only from a conviction that
we ought, in matters of science and discovery, as in  other
things, to "render unto Caesar the things that are Caesar's."
Hamilton certainly deserves great credit for shaking himself
loose from the doctrines of his day;  but  he has no claims to
originality in prescribing purgatives in typhus fever.  If we
refer to Sydenham, we shall find that he used them freely;
and in the very disease now under consideration  placed his
chief reliance on bleeding and purging for its cure.  In his
" Essay on the rise of a new Fever," (which is, as was before
mentioned, the typhus of the present day,) after recommend-
ing the  use of purgatives and bleeding, he remarks that,
"the method  just recommended is  the best  I ever tried in
curing this fever; and  if it fails of effectually removing it,
at least brings it  to intermit, and then it  always yields to the
bark.   But as purging,  as it is here directed in order to
cure this fever, may perhaps seem detrimental to some per-
sons, I assert from  experience, that nothing  cools so much
and so surely  as purging  after bleeding."   After assigning
some reasons  for their beneficial effects, he says, " For these
reasons,  therefore, I hope I may assert, on good grounds,
that  the method of cure  above delivered, which consists in bleed-
ing and  purging, is the most effectual one to conquer most
kinds of fevers ;"*  and in other passages  he enforces  the
same practice.  It will  be seen from the above extracts, that
* Wallis's Sydenham, vol. 2, p. 344-5. 
nearly a century anterior to the time of Hamilton, Syden-
ham prescribed  purgatives  in  this disease from the  begin-
ning, and  recommended them, conjoined with venesection,
as the best cure for most kinds of fever.*
   Hamilton, it seems, was led  to the employment of  purga-
tives  by mere accident:  he says, "At  the time I was ap-
pointed physician to the Royal  Infirmary, the cure of  typhus
was thought to  consist  chiefly in the removal of atony and
spasm of the vessels of the surface of the body.  For this
purpose, among  other remedies weak antimonial wine and
nauseating  medicines were  freely given.  The state  of the
stomach and bowels, after  the exhibition of an emetic and
purgative on the first approach of the attack, was little re-
garded  in  the after  periods of  the  fever.   An occasional
stool was procured by a mild glyster, while a purgative me-
dicine  was given  with extreme  caution.   Apprehensions
were  entertained that the operation of a  purgative  would
rivet the spasm of  the extreme vessels, and  increase  debili-
ty, one of the  supposed  direct  causes  of death  in  fever.
These apprehensions  (continues he)  may still bias the prac-
tice of many, as they certainly  did  bias  mine, for a  long
time."  An  unusually  malignant typhus  fever, however,
breaking out in Edinburgh, in the summer of 1779, and being
unable to cure it by the mild antimonials, Hamilton was in-
duced to resort  to  the calx antimonii nitrata.  "This anti-
monial remedy (says he) was not ineffectual; but I remark-
ed that it was beneficial only when it moved the belly.  The
stools were black and foetid, and in general  copious.   On
the discharge of these the low  delirium,  tremors, floccitatio,
and subsultus  tendinum,  which  had  prevailed, abated  in
some cases; the tongue, which had  been  dry and furred,
became moister and cleaner, and a feeble creeping pulse ac-
quired a firmer  beat.   Reflecting afterwards on these cir-
  * It has, we think, been too much the custom to overlook the practice
of Sydenham, and to consider his great excellence to consist in his unri-
valled descriptions of acute diseases.  We, however, look upon his writings
in a very different light:  he certainly  deserves great credit for his accurate
account of diseases, but we by no means  consider it as his highest praise.
The improvement he made in the treatment of smallpox is enough to im-
mortalize any one man, and his mode of curing fevers and the phlegmasia?
has been but  little improved on even at  the present day.  There is one
striking instance in which his claims  to originality of treatment are almost
entirely overlooked, and  all the credit assigned to Hamilton. I allude to
the method of curing St. Vitus Dance.  He used identically the same rou-
tine of practice in this disease which is followed at the present day upon the
authority of Hamilton.  Any one may satisfy himself of the truth of this
by consulting  his works. 
29
cumstanccs, it occurred to me, as the purgative effect ap-
peared to have been the useful one, that any purgative medi-
cine might be substituted for the calx antimonii nitrata, and
that by this substitution, the unnecessary debilitation of an
exhausted  patient,  by  vomiting and sweating, might be
avoided."
  " More extended experience confirmed these conjectures ;
and I was gradually encouraged to employ purgative medi-
cines early in typhus, and to repeat them in the course of
the disease;  and after having long and strictly directed  my
attention to this point of practice, I am now thoroughly per-
suaded that the full and regular evacuation of the bowels re-
lieves the oppression of the stomach, and mitigates the other
symptoms of fever."*
  These extracts are interesting and useful,  as they give
the experience of an accomplished and practical physician ;
and as showing  the gradual dawning of light on  a mind
clouded and  fettered by the scholastic doctrines of the day.
  Huxham, however, anterior to the time of Hamilton, had
remarked the great and surprising relief experienced from
the free discharge of dark bilious matter from the  bowels.
In his essay on " malignant  putrid fever," he remarks, that
" unquestionably the bilious principle  is too greatly predomi-
nant in  all putrid,  malignant, and  petechial fevers.   The
gall bladder, and  biliary  ducts, are  always found  full of
black or green bile in those that die of pestilential diseases,
and so is  the stomach, duodenum,  &c.  Now, (continues
he,) if this putrid bile is not carried off, it grows more and
more corrupt, and causes vast anxiety, sickness at stomach,
pain, &c.; and, being reabsorbed into the blood, creates in-
finite evils, greatly irritates the genus nervosum, destroys the
crasis of the blood, and  turns the lymph into a corrosive
ichor.   When, therefore, there are signs of its being redun-
dant, it should be forthwith discharged by vomit or stool, as
nature points out.  1 have many times, with the greatest
pleasure, in these putrid fevers, seen an amazing change for
the better immediately succeed a fit of vomiting, and a stool
or two, when an inexpressible anxiety, load on the pracordia,
perpetual sickness, eructation, and singultus, had  preceded.
The extreme foulness of the tongue, and load at the stomach,
with a loathsome bitter taste, and a horrible offensive stink-
ing  breath, and  eructations, show the condition of  the sto-
mach ; and the  abominably foetid, black, bilious stools, the
necessity and advantage of that discharge."t   This extract
Hamilton on Purgatives, p. 29.    + Huxham on Fevers, p. 94. 
30
from Huxham, though  a  long one, is, we conceive, highly
valuable, inasmuch as it informs us of the state of the gall
bladder,  biliary ducts, stomach, and  duodenum, after death
from this fever, and  mentions the effect which a retention
and reabsorption of this dark  bile has upon the genus ner-
vosum.   The first points out  the indispensable  necessity
there is for cathartics, and the  last teaches us that many of
those  nervous symptoms  incident to the disease, and which
have been supposed to proceed from debility, and treated as
such, are to be attributed to a  retention of this black bile,
and can only be relieved by its evacuation.
  Even among those,  however, of the present day, who
agree upon the utility of free  purgation  in this fever, there
is much diversity of opinion as to the kind of cathartics which
are best  adapted for  this  purpose.  While some  proscribe
the use of calomel and all other active purges, and  rely on
laxatives almost  entirely  to effect the  evacuation  of the
bowels, there  are others who  look upon it as the  sheet an-
chor of hope,  not only in this,  but in most other fevers, and
prescribe it with a degree  of boldness and daring  perfectly
astonishing to those who are accustomed to administer it only
in  five or ten grain doses.   Either practice may be  carried
to  extremes, but  of the two,  in  severe  cases of fever, we
should greatly prefer  the bold exhibition of active  remedies
to  the  milk and  water practice of those  who would  alto-
gether exclude such  means  from the treatment  of fever.
We have always been the steady and  constant friend of the
use of  calomel in fever; but in  ordinary cases we believe its
moderate to  be just as beneficial as its extravagant  exhibi-
tion, with this advantage, that  there is less risk of producing
that painful, disgusting, and sometimes fatal affection of the
mouth, a salivation.   This  Hercules of the materia medi-
ca is not to be rashly dealt with, without often leaving behind
the most  lamentable and distressing consequences of its mal-
administration.   When judiciously used, however,  it may
truly be said to be an  invaluable remedy; there is no article
in the whole materia medica which so effectually discharges
that dark bilious matter, which affords so much relief in fe-
ver.  It is customary to combine it with some other cathartic,
and we know  of none better than  jalap; ten grains  of each
for an adult, administered every two hours, until the bowels
are freely evacuated,  constitutes as effectual a purge as can
be used.  This combination was much employed by Dr. Rush
in the yellow fever of 1793, and it was then called a dose for
a horse;  what would they who so called it have thought of
sixty grains of calomel as  a common dose ? Jalap, however, 
31
to some stomachs is so exceedingly nauseating and offensive,
that we are obliged to substitute something in its stead ; this
may be done  by adding the same amount of scammony to
the calomel, and administering it  in the same way.   Scam-
mony has hitherto been but little used on  account of its sup-
posed  drastic and harsh operation, but  from repeated expe-
rience we  can declare  that it is  less so  than jalap, and is
equally effectual in evacuating dark bilious matter.  Another
mode  that we have found very effectual  in evacuating the
bowels, and lowering the action of the heart and arteries, is
to administer calomel alone, and some  time afterwards give
a strong  infusion  of senna, with either Epsom or Glauber
salts.  This generally operates most copiously, the discharges
being  very thin; it is, therefore, only  suited to the beginning
of the disease,  when the strength is  but little impaired, and
to those of strong constitutions;  it is very apt to prostrate
the thin and delicate too much.   The  cathartics are to be
repeated  day after day,  until the fever is subdued; when,
however, it has continued for some time,  and the patient is
much  weakened, we  generally combine aloes with the  calo-
mel and  jalap, to  render the discharges more consistent.
The following is the  prescription in general use:
                Calomel, 3ss. \
                Jalap,    3i.   > M. D.  in  pil: xxx.
                Aloes,    3i.  )
Four or five of these pills given, and repeated  according to
circumstances,  will generally operate freely  enough.  The
" discharges produced by this combination, are much  more
consistent, and, of course, less debilitating, than those by ca-
lomel and jalap alone.   If, at any time  during the exhibition
of these pills, the mouth should become sore, the calomel must
for a while be  discontinued, and the same quantity of aloes
and jalap be given alone;  this combination is the very best
 substitute for calomel that we are acquainted with.  When
 the patient  is  fairly convalescent, it  is  necessary to pay
 much attention to his bowels, if they should not be sufficient-
 ly open; then two or three of the above mentioned pills ought
 to be  given.  There are, however, other articles, which, for
 this latter purpose, answer very well, such as castor oil, mag-
 nesia, &-C.
    The above practice is suited to those cases in which the
 bowels are  easily operated on.  Cases, however,  of  great
 torpor sometimes occur, in which it is impossible to obtain an
 operation by the usual doses.   In such, it is idle to limit our-
 selves to a certain number of grains;  we must exhibit ca-
 thartics in doses sufficiently large to purge, for without this the 
32
 patient will die; we believe that the safety of the patient in
 fever, depends upon a continued evacuation of bile from  the
 bowels, and keeping the action of the heart and arteries in
 proper control by the other antiphlogistic means; we must
 then judge of the necessity for an increase of the dose, by the
 effect  produced, and not by the number of grains  given.
 Fortunately cases of such extreme torpor of the bowels  are
 rare ;  but when they do occur, they are only to be  managed
 by the most bold and intrepid exhibition  of  medicines ; in
 the language of Hippocrates,  " ad extremos morbos,  ex-
 trema remedia sunt exquisite optima."  The next remedy in
 point of importance is
   Cold Water.   Cold water was much used, both internally
 and externally in fever,  by the Greek and Roman physicians,
 some of whom relied upon it exclusively as a means of cure.
 We find mentioned, by both Celsus and Galen, that Petro, a
 physician  who flourished a considerable time after the death
 of Hippocrates, attempted to cure fever by copious draughts
 of cold water.  It appears  from the description of his method,
 given by Celsus, that in cases of  fever, he first  caused  the
 patient to be covered with a good  deal of clothing, in order
that he might excite in him great heat and thirst,  and then
 commenced the profuse  administration of cold water.*
  The use of cold bath  was introduced at  Rome during  the
the reign  of what was called the methodic sect.  From its
having been first successfully used in the case of the emperor
Augustus, whose complaint had baffled all the usual applica-
tions, it acquired great reputation, and was subsequently used
with considerable boldness by some of the Greek and Roman
physicians.    The  Arabian physicians,  also, employed it
much, both internally and externally, in pestilential diseases.
 The practice, however, was, in progress of time, lost.  Du-
 ring the last century its  use was revived by doctors Jackson
and Wright.t The following  is Dr. Jackson's account of the
  * Liquidem apud antiquos quosque  ante Herophilum at Erasistratum,
maxime post Hippocratem fuit Petro quidem, qui febricitantem hominem
ubi acceperat, multis vestimentis operiebat, ut simul calorem ingentem si-
timque excitant.  Deinde ubi paulum remitti ceperat febris, aquam frigidum
potui dabat."  Celsus Lib. iii. e. g.
  f  We find it asserted in vol. i. p. 89 of Johnson's valuable work on Tro-
pical Climates, that "it has been practised in the Bengal remittent, time
immemorially, among the natives themselves, many a century before a
Jackson,  a Wright, or a Currie thought or wrote on the subject."  To
prove this, he introduces an extract from the Oriental Field Sports, by cap-
tain Williamson, which we will copy here.  " We  must, however, (says
captain Williamson,) do the natives the  justice to allow, that  the refngera- 
33
 circumstances which led him to the  employment of cold
 bathing.   He says, that "the first hints of this practice were
 accidental, and arose from  a conversation I had with the
 master  of the  vessel  in which I went passenger  to  the
 West Indies-   This person commanded a transport in the
 war of 1756, and was present at the siege of Havana.  As
 he was talking  one day of the state of the fleet, he mention-
 ed accidentally, that some men were sent aboard of his ship
 ill of fevers;  several of whom, he observed, jumped into the
 sea during the delirium  which attended the paroxysms of the
 disease.   Some of them, as  might be expected, were drown-
 ed ; but the most part of those who were  recovered from the
 waves  appeared  to be greatly benefited by the ducking.
 The fact,  which, from the veracity of  the man, I thought I
 could depend upon, struck me strongly, and I resolved in my
 own mind, to bring it to the  test of experiment as soon as an
 opportunity should offer.  Neither was  it long after my arri-
 val in Jamaica, that I  had  occasion to visit a sailor  whose
 situation seemed to justify such a trial.   The poor man was
 aboard of a ship, which lay  at anchor about a mile from the
 shore.  He had been ill two days;  the delirium  ran  high ;
 his eyes were red and inflamed ; his respiration was hurried;
 he was anxious and restless  in a high degree, while, together
 with those marks of excitement, he was occasionally languid
 and disposed to faint.   His skin being dirty,  furnished an
 ostensible  excuse for trying this remedy.  But it was pre-
 viously  thought  proper to draw some blood  from the arm;
 which being done, some  buckets of salt water were dashed on
 the shoulders.  He  was now laid in bed; a copious  sweat
 ensued, succeeded by a distinct remission and a total change
 in the nature of the symptoms."  After relating some other
instances of  its  astonishing  efficacy, he says, " I shall only
add, that I have tried the remedy, in various situations, al-
ways with  safety, generally with astonishing success ; so that
I cannot forbear recommending it even at an  early period, in
ting principle lately adopted by some of our leading physicians, owes its ori-
gin solely to the ancient practice of the Brahmins, or Hindoo priests,  of
whom the generality affect to be deeply skilled in pharmacy."  And he then
adds, " I believe that, if taken in time, few fevers would be found to degene-
rate into typhus, and that very seldom any determination towards the liver,
in acute  cases, would occur, were the refrigerating course to be adopted.
Often (says  he) have I known my servants, when attacked with  fever,  to
drink cold water in abundance, and to apply wetted cloths to their head, with
threat success.   The former has generally lowered the pulse considerably
by throwing out a strong perspiration, while the latter has given immediat-e
local relief."
;i 
34
the fevers of the West Indies."*  In the year 1777, Dr. Wil-
liam Wright, of Jamaica, published an account of the salu-
tary effect of ablution  with cold water upon  himself and
others, while laboring under severe fever.   This narrative of
Dr. Wright excited much interest and drew the attention of
many distinguished men to the subject.  Among others, Dr.
Jas. Currie, of Liverpool, entered into it with much zeal, and
soon after enjoyed extensive opportunities of testing its effica-
cy.  On the ninth of December a contagious fever made its
appearance in the Liverpool Infirmary, and spread itself ra-
pidly.  In this fever he, for the first time, commenced the use
of cold ablution, and out of seven cases treated  by it not one
died;  encouraged by his success in this first trial of the efficacy
of cold water, he continued to use it freely, both in hospital
and private practice, with extraordinary success;  and some
time after published his admirable work on the use of cold wa-
ter, in which are contained the  results of his extensive expe-
rience with it, and the rules which should guide  us in  its use.
   No one can peruse this volume without being convinced,
that cold water, when properly applied, is a most important
remedy in fever.  Its utility is not confined to  typhus; it is
equally serviceable in all fevers attended with increase of
heat and arterial action.   Its effect upon the pulse is astonish-
ing in many cases. We have often known the mere bathing
the arms and hands of a febrile patient reduce  the action of
the pulse ten or fifteen beats in the minute; and if this  par-
tial application of cold water has such an effect on the action
of the heart, how much  greater must be the effect of a cold
bath ?   We have many instances on record of its calming at
once  the most furious delirium;  persons in such a situation
have often jumped overboard a vessel into the sea, and been
taken up perfectly calm and rational, and with an almost
complete extinguishment of the fever.  With the many strong
instances recorded in various works, of its remarkable effi-
cacy in curing fever, it is justly a matter of surprize, that
physicians  so  seldom call its great powers into requisition.
It exercises a more immediate  control over the action of the
heart than bloodletting.  Dr. Currie mentions a striking in-
stance of the effect of cool air in reducing the pulse.  " In the
month of May, 1801, (says  he,) I was desired  to visit a pa-
tient ill of fever in Sparling street.  I found him in the tenth
or eleventh  day of the  disease, delirious  and  restless; the
surface of the body dry, and his heat 104° of Fahrenheit.
The room was close, and I  desired the only window in it to
* Jackson on Fevers. 
35
        be opened.  The wind from the northwest blew directly into
        this window, and the bed being situated between it and the
        chimney, a pretty brisk  stream of air passed over it.   The
        patient  had just  thrown oft* a considerable part of his bed
        clothes, and was exposed naked to the breeze.  I sat by him,
        with my finger on his pulse, watching the effect.  In a little
        time the pulse fell from 120 to 114 in the minute ;  he became
        more tranquil, and  soon  afterwards he sank into a quiet
        sleep, in which he remained when the water for affusion was
        prepared ; of course, we did not disturb him ;"* he remained
        exposed to this cold air until morning, when his pulse was
        found to be about 100, and his heat 101.
          Dr. Rush, in his  history of the yellow fever of 1793, re-
        lates a similar case  to the above.    " Dr. Griffits (says he)
        furnished a remarkable  instance of the influence of cool air
        on the fever.   Upon my visiting him, on the morning of the
        eighth of October, I found his  pulse so full and tense as  to
        indicate bleeding ; but after sitting a few minutes by his bed
        side, I perceived that the windows of his room had been shut
        in the night by his nurse on account of the coldness of the
        night air.  I desired that they might  be opened.  In ten mi-
        nutes afterwards the doctor's  pulse became so much slower
        and weaker that I advised the postponement of the bleeding,
        and  recommended a purge instead of it;" and in the  next
        page he remarks, that " cold water, when applied to the feet,
        as certainly reduces the pulse  in  force  and frequency,  as
        warm water applied in the same way produces contrary ef-
        fects upon it.   In an experiment which was made at my re-
        quest, by one of my pupils, by placing his feet  in cold pump
        water for a few  minutes, the pulse was reduced twenty-four
        strokes  in a minute, and became so  small  as  hardly to  be
        perceptible."   These facts teach us, that it  is the cold alone
        which is serviceable, since it has the same effect whether ap-
        plied in the shape of water or air; and they also  teach  us
        the powerful  influence it has over the actien  of the heart,
'        and the great value  of its proper use  in the cure of fever.
          Cold  water may be used either internally or externally, or
        in both ways.   It has been already mentioned that Petro re-
        lied  entirely on  copious drenching with  cold  water for the
        cure  of fever ; and  about the  middle of the  last  century
        (1752) a treatise was published on the internal use of  cold
        water,  under the title of " Febrifugum Magnum," by Dr.
        Hancock London.   The  most effectual way, however,  to
        derive full benefit from the action of cold, is to use it in  both
* Medical Reports, p. 259. 
3b'
ways ;  the same principle which would induce us to resort to
affusion, would also suggest its internal administration.  The
latter is generally so consonant with the patient's inclinations,
that there is usually no difficulty in its application, and, there-
fore, it should always be  recommended; the affusion,  how-
ever, is looked upon by society as disagreeable if not hazard-
ous, and hence, in proposing  such a remedy, we have gene-
rally to encounter much prejudice. In severe cases, peremp-
torily requiring the  use of active means, we should disregard
this feeling; but if otherwise, we may be satisfied with its
partial external application.  We can always have the feet,
arms, and hands  bathed in cold water, and cloths dipped in
the same applied to the stomach and head.  This  affords
very great relief, and ought never to be omitted.
  But  cold water is by no means to be used indiscriminately
in every case of fever;  neither is it to be used in all stages
of any fever ; the rules which  Currie has laid down on this
subject are excellent, and cannot  be followed too closely. If
we  obey strictly his directions,  we will always be prevented
from misapplying or doing injury  by its use. He gives  sepa-
rate rules for the external and internal use of cold water;
but as its effect, except in degree, is the  same when used
either  way, so one set of rules will answer as a guide for
both.   His first general rule  is, that " It may be used (either
internally or externally) when there is no sense of chillness pre-
sent, when the heat of the surface is steadily above what  is na-
tural, and when  there is no general or profuse perspiration."
We will now give the substance of the particular rules he has
laid down on this  subject.  1st. " Cold water is not  to be
used either internally or externally in the  cold  stage of the
paroxysm of fever, however urgent the thirst;" taken at
such times it increases the chillness and produces great weak-
ness of the pulse, and if used to any extent might cause the
death of the patient.   2d. When the hot stage is fairly form-
ed, and the  surface is dry and burning, cold  water may be
used both ways with the utmost freedom ;  frequent draughts
of  cold liquid, and its  external  application, under such cir-
cumstances, are highly grateful; they  diminish very  much
the heat of the body, and lessen considerably the volume and
frequency of the  pulse.  3d.  " It is also necessary to abstain
from the use of  cold water when the body is under profuse
perspiration, and this caution is more  important in propor-
tion to the continuance of this perspiration."
   We will finish what we have to say on the use of cold wa-
ter, by a few remarks on its modus operandi in  curing fever.
 And in the very commencement we cannot help expressing 
37
our surprize, that cold should ever have been considered as u
stimulant.  If it be such, then is Currie's general rule for the
use of cold water an absurdity; for a stimulant would do no
injury during the presence of a chill, and would be obviously
prejudicial in the heat and exacerbation of fever.  However
wild and imaginative Brown may have been in many of his
notions, his opinion that  cold can never act as a stimulant is
unquestionably correct.   It is so plain a matter that it is un-
necessary to argue much about it.   We will only state a few
positions, the  truth  of which none can  deny.   In  the first
place, if we take a  person  in  health and immerse him in
cold water, and then feel his pulse, we will invariably find it
small and weak, and it will continue so as long as he  remains
in the water.  2d. If we immerse a person laboring under a
chill, when the pulse is  already weak, it will  be rendered
much weaker and has sometimes  been extinguished.  3d.
Currie relates many cases of fever, in which the application
of cold greatly reduced the action of the heart; in one  case,
in a very short time, the  pulse was diminished eight  beats in
the minute; and in  the case mentioned by Rush, the  pulse
was lessened twenty-four strokes in a minute, by the immer-
sion of the feet in pump water.  These facts unquestionably
prove that cold has none of the properties of a stimulant,
since it weakens the pulse in a state of health, weakens it
still more when  already weak, as in a chill, and lessens very
much its volume and frequency when in a state of excitement,
as in fever. " But," say  the advocates for the stimulant pro-
perty of cold, " if you take a person out of the cold bath, his
pulse rises, his skin  becomes warm, and his cheeks  flushed,
and hence we argue that it stimulates the system."   In an-
swer to this, we remark,  that one might just as  well  contend
that brandy was sedative  in its character, because a man that
had been intoxicated by it was rendered  sober by  its  with-
drawal, as to argue that cold is a stimulant, because  the heat
reacted when removed from the sphere of its influence.   So
long as we keep a person in the cold bath, so long will his
pulse continue small and weak; but if we remove him from
the bath, then his pulse rises; and from what cause?  Surely
not  from  the  cold, because,  having been  withdrawn, it has,
of course, ceased to operate; but  from the increased  accu-
mulation of blood about  the right side of the heart,  which is
the necessary and inevitable result of its  weakened action,
which last is produced by the cold application.  We have
then a sufficient cause for this increased action  of the heart
and flushing of the  cheeks,  in the presence of an unusual
quantity of the heart's natural stimulus, without  attributing it 
3-
to cold, which, as we said above, has a directly contrary ef-
fect, so long as its application is kept  up.   These are some
of our reasons for considering cold not to be  a stimulant.
The same facts  or reasons, however, which  prove it not to
be stimulating in its properties, prove  it to be sedative in its
character.  It is from its operating in  this way, that we can
readily account for its extraordinary effect in fever.   It is by
diminishing suddenly and very greatly the action of the heart,
that a cold bath will calm, almost in an instant, the most ra-
ging and  unmanageable delirium.
  Blisters.   Much variety of opinion exists as to the utility
of blisters in fever.   While some recommend them early in
the disease,* others confine their application to its advanced
stage, and some there  are who reject them in toto;t and
there are others still, who think them only beneficial when
applied to relieve some  topical affection.   We  are among
the latter number.  In cases of fever  attended with inflam-
mation of some important part, we  have often witnessed  the
most remarkably good effects  from  their use, and  never  fail
to apply them under such circumstances.  We entirely agree
with those who deprecate their early application in continued
fever, not characterized by some local  affection, and even in
such cases we should always prefer using free depletion before
resorting  to them.  When applied without the presence of in-
flammation, they are  decidedly injurious ; they increase  the
fever and irritation of the patient, and often prove a source
of much torment to him.  The language  of Fordyce on this
subject is exceedingly judicious, and  ought to have great
weight with all those who believe that  experience is the best
teacher, particularly in  matters relating to medicine.  For-
dyce was probably as conversant with fever  as  any man of
his day, and therefore when he speaks we should listen with
attention.  He says, that " Whether exciting inflammation
has or has not the same effect in a regular continued fever,
which  it  has  in health, can  only be  known by making the
application to the body of a person affected with regular con-
tinued fever.   As far as the author's experience goes, when
  '  Lind remarks, that " In a moderate infectious fever, where the source of
infection is not very violent, if twenty patients be blistered, sixteen will next
morning be entirely free from headache, heat, pain, and fever."
  f  Dr. Moore, in his " Medical Sketches," observes, that " Notwithstand-
ing my having watched the effect of blisters with all the attention I am capa-
ble of, and formerly with a strong prepossession in their favor, I cannot as-
sert that I ever knew vesications of any use in this disease, (i.e. typhus;)
but I have frequently seen the patient teazed by their irritating quality, with-
out their seeming to have any other effect." 
39
any stimulus has been employed so as to produce inflamma-
tion, when the patient has become weak towards the end of
a continued  fever, the only difference  which has occurred
has been, that phlegmonous inflammation has not produced
hardness, fullness, and strength of the pulse, but both phleg-
monous inflammation and inflammation of the skin have occa-
sioned greater frequency of the pulse, have rendered it weaker
and smaller, and as in health have prevented sleep, and the
patient's taking the same quantity of nourishment, and have
depressed  and  deranged the whole system."*   Huxham, an
old author; and on this account many may think his opinions
not entitled to much weight,  though we are free to confess that
we think not the less of him for that reason, has some excellent
remarks on this subject.  " What I have said (observes he) of
volatile alcalious salts, leads to a reflection on the promiscu-
ous use of blisters  in these fevers, which by some are deemed
the only anchor of hope in such dangerous cases;  but I  think
they are many times too hastily and improperly applied, espe-
cially in the beginning, when the fever  runs  high, and doth
not demand a farther stimulant;  for the action of canthari-
des is not confined to the skin, but affects the whole nervous
and vascular system: now when the irritations and vibrations
are already too great, as frequently happens in the beginning
of such fevers, they  are very injudiciously  applied.  It is
true,  indeed, (continues he,) nature may sometimes want  a
spur, nay, often doth so, particularly towards the decline of
these fevers, when the  solids grow torpid, the circulation
languid, the spirits affete, and the sick  comatose; but in the
above circumstances  I have very many  times seen very per-
nicious  effects attend their too early application, as obstinate
pervigilium, delirium, suppression of urine, tremors, subsultus,
<fcc."t   We find  from this extract, that, though Huxham
disapproves of the use of blisters in  the early stage of fever,
yet he acknowledges the occasional necessity for their use in
the last; yet even under the circumstances he has mention-
ed, we  should  greatly prefer the use of sinapisms, because
they are  much more powerful and more immediate in their
effect, and are not so apt to produce a  troublesome and tor-
menting sore;  this last effect we  have  often known to occa-
sion  much fretfulness  and  pain  to the patient during  the
whole stage of convalescence.   Another objection to the use
of blisters in the last stage of this fever, when the debility
is extreme, is the probability of their producing gangrene in
the part to which they are applied.   Sir John Pringle, Clark,
* Fordyce on Fever, p. 270.    f Essay on Malignant Putrid Fevers. 
40
and Lind, and many others, bear testimony to this effect of
blisters, when applied to patients under such circumstances.
  From  the opinions of the distinguished  physicians which
we have  quoted, and from our own experience, we are justi-
fied in the conclusion  that blisters are inapplicable in the
early  stage of fever, and that they are rather of equivocal
benefit when applied in its advanced stages ; used, however,
at any stage to relieve topical inflammation, they are of emi-
nent service ;  they always do most good, however, when re-
sorted to after the pulse has been reduced by proper deple-
tion, and this, indeed, ought always to be done.
  When blisters are used to relieve local inflammation, they
should be applied immediately over the part affected, or if
this be impracticable, then as near to it as possible.   Blis-
ters frequently produce a very  unpleasant affection of the
bladder,  called strangury; this can be most generally re-
lieved by drinking freely of flax seed tea, barley water,  &c.;
if this should fail, we can recommend,  as an infallible reme-
dy, the injection of five, ten, or twenty grains of camphor,
suspended in about a gill of mucilage of gum arabic.
  Bark  and  Wine.   These two remedies  were  formerly
much relied on for the cure of typhus fever, and even at the
present day there are  many  who adhere to this  mode of
treating the disease.  It is, however, one of the relics of ex-
ploded error which will soon cease to exist, and is only  to be
found in those who are fettered by educational prejudices,
which they are unwilling or unable to break.   If this disease
be sthenic in its character, then it necessarily follows, that
tonics and stimulants are not the  proper remedies for its
cure.   We believe that bark is never necessary in this fever,
unless when  it changes to an intermittent type, and here it
may  be  given with excellent effect.   We suspect strongly
that when bark cures this or any other  disease of excitement,
it does so by acting as a purge; for we know that  when
given in any quantity it very frequently  acts in that way.
Bruce says that  bark cured the bilious fevers of Massuah
when it operated as a purge.  Stimulants we reject not  in
toto, but almost entirely in the cure of fever we feel the most
unrelenting prejudice against them ;  for it has fallen to our
lot  to see  many cases  in which  irreparable injury was pro-
duced by their improper and unreasonable exhibition.*  We
have  frequently known patients  stimulated into a delirium,
  * Stimulants are injurious in proportion to the violence of the fever, and
hence they are so destructive in the high grades of the autumnal fevers of
this country.  Rush deprecated, with all  his earnestness and enthusiasm. 
41
    and sometimes into apoplexy;  and we have known  them
    rescued from the latter  condition by the supervention of a
    free bilious diarrhoea, a most convincing proof that the sup-
    posed debility of the patient, to  counteract which stimulants
    were resorted to, did not demand such treatment.  It is that
    bugbear debility which frightens us into too early a resort to
    remedies of such  pernicious tendency;  and until we can di-
    vest ourselves of the fears arising from this delusive source,
    we will often do wrong by administering them at an impro-
    per period of the disease.
      However  strongly we may be  opposed to stimulants as
    constituting  a necessary part of  the general treatment  of fe-
    vers, we yet think them highly important in their proper
    place, and of indispensable utility under certain  circumstan-
    ces.  When a patient is very much prostrated from the long
    continuance  of fever, we may often unite, with great advan-
    tage, some stimulant to the means used for subduing the fever-
    Camphor and wine are the two  most frequently  resorted to.
    We greatly prefer the latter to any other kind of stimulant;  the
    camphor, when used in any quantity, almost always producing
    a most unpleasant delirium.  Of the different wines, Madei-
    ra is  much the best.  Armstrong says, that in the advanced
    stages of typhus he is in the habit of mixing milk with  the
    wine, and under this form he thinks it makes an excellent
    drink.
      It will be seen by the above remarks, that we are decided-
    ly opposed to stimulants, in every  stage of the fever, except
    under the circumstances mentioned.   The majority of  cases
    of typhus, when treated properly in the primary stages, will
    not often require the use of stimulants in the last.   Hamil-
    ton, some years after he commenced the purgative plan of
    treatment, says,  " I cannot, however, omit remarking, that
    for some years past I find wine less necessary in fevers than
    I formerly thought it was;"  and every  unprejudiced physi-
    cian,  who properly  employs depletory measures  in the  be-
    ginning of fever, will  acknowledge that stimulants are but
•   rarely necessary in the last stage.
      Of the Diet and Drinks.  We have chosen  to consider
    the subject  of regimen under a  separate  head,  because  we
    think that a proper regulation of  it has considerable influence
their exhibition in yellow fever, and some of the older authors also mention
their fatal effects in fevers.  Thus Shenkins, in speaking of the famous
Hungarian fever, which prevailed so extensively in Europe about the mid-
dle of the sixteenth century, says, "omnes qui vini potione non abstinue-
runt, interiere, adeo ut summa spes salvationis in viui abstinentia collocata
videtur."
                            0 
42
over the state and progress of the disease.  From much at-
tention to  this subject we are  convinced that fever is often
kept  up and  protracted by  improper articles of diet; the
friends of the patient usually betray such excessive anxiety
upon  this subject, are so much afraid of his dying from mere
inanition, and are generally so importunate in their intreaties
for more nourishment, and so much dissatisfied with a refu-
sal, that few physicians have fortitude enough to enforce the
dietetic plan as rigidly as they could wish, and as would best
comport with  the interests of their patients.   The rigid en-
forcement of a very low diet in fever is, we think, the  only
respect in which Broussais' practice ought to be followed.
   The ancient physicians were well aware of the great  im-
portance of a suitable  diet  in fever, and accordingly  paid
much attention to it.   Hippocrates permitted the patient to
drink freely of cooling beverages, and gave but little nourish-
ment  during the first days of the disease.  Erasistratus, who
lived  about two hundred years after Hippocrates, being of
opinion that fever, proceeded  from  too great plethora, enjoin-
ed a general and rigid abstinence upon his patients.   Ascle-
piades and his followers also prescribed abstinence, but limit-
ed its duration to three days; he permitted the  patient nei-
ther to eat nor drink during  this time, and says  that in this
way the fever was cured tuto celeriter etjucunde.  The prac-
tice of limiting the abstinence strictly to three days was dis-
tinguished by  the name of diatrition, and those who followed
it by the appellation of diatritarii.   We find, therefore, from
what  has been mentioned, that the ancient physicians thought
a proper diet a matter of considerable  importance in fever.
  The regimen during the fever should be of the lightest and
most  abstemious character.   We do not think that we can
well err by the utmost  strictness  on  this point; we should
literally starve the fever.  Animal food should be proscribed
as pernicious in the extreme.  A cup of barley water, or of
weak tea or coffee, twice a day, with a hard water  cracker,
if the patient should desire it, is generally sufficient for  him;
he  should  also be  allowed to drink freely of cooling beve-
rages, such as lemonade, apple water,  rice  water, currant
jelly water, toast and water,  balm tea, and cold water;  here
is variety enough to satisfy the  most wayward and capricious
appetite, and  which can be  indulged in freely without the
fear of injury.
  But it is not during the febrile state alone, that we should
be particular  about the diet of the patient; much  attention
to it  is also necessary during the stage of convalescence.
The  patient should be  permitted to return gradually to his 
43
former  mode of living, commencing  with the lightest  and
most digestible  articles of diet, such as  arrow root, sago,
tapioca, &c.  Animal food ought not to be allowed until he
is able  to walk about; a too early use of the latter is often
the cause of severe relapses, and we are earnestly cautioned
against it by most writers on fevers.  Thus Huxham, in his
account of the malignant fever which  prevailed at Plymouth
in the year 1740, remarks, that "If any  one made use  of a
flesh or a fish diet, before he had been very well purged, and
his recovery confirmed, he infallibly indulged himself herein
at the utmost danger of his life;" and  Dr. Poissonnier, in
his work on the maladies of seamen,  says, that "the  physi-
cians of Brest have observed, that the relapses  in the  ma-
lignant fevers which prevailed in their naval hospitals, were
as much the effect of a fault in the diet of the sick, as of the
contagious air to which they were exposed, and that as many
patients perished from this cause as from  the original fever.
For this reason light soups, with leguminous  vegetables in
them, panada, rice, seasoned with cinnamon, fresh eggs, <fcc,
are all they should be permitted to eat.   The use of flesh
should be forbidden for many days after  the entire  cure of
the disorder."*  In addition to the articles mentioned in the
latter part of this  quotation,  the patient  may be allowed to
eat moderately of ripe  fruit;  the pulp  of roasted apples is
very good; milk ancTbreacf may also be allowed "him.  There
is one circumstance, however, which  ought always to be at-
tended to during convalescence, which is, to keep the bowels
open;  if this does  not happen spontaneously, it must be ef-
fected by the use of laxatives ; this is  highly important, as it
lessens  greatly the danger of a relapse.   Armstrong says,
that he has seldom seen relapses in inflammatory diseases,
when the  bowels have been kept regular,  and the antiphlo-
gistic diet observed.
  We have now finished what we have to say on the treat-
ment of this form of typhus, and, from a review of it, it will
appear, that all the remedies mentioned concur in the same
tendency, i. e. to reduce the action of the heart and arteries,
and to  remove local inflammation  when present.   This
course of  treatment is the necessary and  unavoidable result
of the opinions we have adopted in relation to the pathology
of typhus ; if these are correct, if the  disease is really one of
excitement, and often of inflammation of some vital organ,
then it follows, that the antiphlogistic plan of treatment, dif-
ferently modified according to the grade of the fever, is the
' Maladies de Gens de Mer. vol. 1, p. 3-lfi. 
                           44

proper one.  Whether, however, the views of this disease,
inculcated by the great Sydenham, proclaimed and defended
in modern times by Armstrong and others, and embraced by
the humble author of this essay, be true or  not, time and
the increasing light of the science must decide.  The great
object  in our  profession certainly is, to ascertain the true
character of disease.  If our pathological views are correct,
then the practice  legitimately deducible therefrom must be
correct.  It is  one of the maxims of the great father of
medicine, that he who knows the nature of a  disease  knows
how to cure  it, or, as Celsus elegantly expresses it,  " Esti-
matio  causa?  saepe solvit morbum;"  and all  our  endeavors
should be directed  to this point.  Until this be accomplished,
our practice must partake somewhat  of  empiricism.
   Treatment  of Congestive Typhus.   It has been already
mentioned, that in this form of fever, the system does not
react from the first stage of oppression, but continues in this
state, in a greater or less degree, according  to the violence
of the cause producing it.  In some  cases the prostration is
complete; in others, there is a partial  and transitory reac-
tion.   From the appearances of great debility which present
themselves in the commencement of congestive typhus, it has
been customary to  treat it by the  administration of cordials
and stimulants; this treatment would  be proper enough if the
debility was real;  but if it is only apparent, if it be the result
of that change in the circulation which has been noticed in a
former part of this essay, and that (in the language of Arm-
strong) "it is no more to be accounted  positive exhaustion
than the loss of muscular power, which precedes and accom-
panies the  treating of genuine apoplexy, to  which, in fact,
this modification of typhus has often a most forcible  resem-
blance ;" then  it demands a different treatment.  If, then,
cordials and  stimulants are not to be relied on for the cure
of this form of typhus, (though we acknowledge that they are
occasionally very useful adjuvants to the other means,) what
is the proper  plan  of treatment ?  We answer, that our first
endeavor should be to remove some  portion  of that  blood,
which  is, (if we may use the expression,)  suffocating  the
heart's action, by abstracting blood from the system.   Under
such circumstances we frequently succeed in relieving the
heart,  in some  measure,  of its overwhelming load of blood,
and, as a necessary consequence of  this, raising  the  pulse;
this  appears very paradoxical, but  it is nevertheless true.
Sydenham gives a  remarkable instance of this effect of bleed-
ing upon the pulse.  In the  case of a  young man, whose
skin was so  cool  that he could not persuade the attendants 
45
he had a fever, and who appeared to be  almost expiring, he
drew blood freely, with the effect of raising the pulse to such
a degree, that it required three or four subsequent bleedings
to subdue it:  bleeding, however,  does not always have this
effect; it sometimes  weakens instead of raising  the pulse.
Its producing or not this latter effect is the test of its utility.
If the  pulse becomes more free and full under the loss  of
blood, then we may be certain  that it  is doing good; if, on
the other hand, it renders it more feeble and weak, we may
be equally assured that it is doing injury.   We should there-
fore always keep our finger on the pulse, and be guided  in
the quantity to be drawn, by its effect on the  beat of the ar-
tery ;  if it  should become more full and expanded, we may
suffer it to flow; if the reverse, it should be arrested  immedi-
ately.  It is often, however, extremely difficult to draw blood
in congestive  fever;  "the acting  of  the heart (says Arm-
strong) is often  so much overpowered in the first instance,
that the  blood merely trickles, or rather  oozes, from the
punctured vessel, for a considerable time, being much darker
and thicker than  natural;  yet when a few ounces have been
drawn, it usually flows with freedom,  and becomes finally  of
a brighter color.   Occasionally I have stood  over a patient
nearly half an hour before a stream of blood could be obtain-
ed from a vein, but at last it gushed out in a full current, and
wa  not as  easily restrained  as in ordinary cases.   Many a
life (continues he) might be lost by binding up the  arm too
hastily, and, therefore, the operator should persevere, until
he knows whether enough blood  can be obtained."   If we
cannot, however, procure blood from a vein, we must resort
to arteriotomy.
   The manner of drawing the blood is a matter of some im-
portance ; it should not be abstracted suddenly and by a large
orifice, but  gradually;* by proceeding in this  way the heart
   * Dr. Rush forcibly illustrates  the propriety of gradually abstracting
  blood, in certain states of malignant fever, by comparing the system to " a
  man struggling beneath a load of two hundred weight, who is able to lift but
  one hundred and seventy-five.  In order to assist him (says Rush) it will
  be to no purpose to attempt to infuse additional vigor into his muscles by
  the use of a whip,  or of strong drink.   Every exertion will serve only to
  waste his strength.  In this situation (supposing it impossible to divide the
  weight  which confines him  to the ground) let the pockets of this man be
  emptied of their contents, and let him be stripped of so much of his cloth-
  ing as to reduce his weight five and twenty or thirty pounds.   In this situa-
  tion he will rise from the ground; but if the weights be abstracted sudden-
  ly, while he is in the act of exertion, he will rise with a spring that will en-
danger  a second fall, and probably produce a temporary convulsion in his
  system.  Dy abstracting the weights from his body more gradually, he will 
it)
much more certainly recovers its power.  When the action
of the heart and arteries have become more free, we ought
then to  arrest the flow of blood, as any further loss might
again render this  action weak,  and place the patient in a
worse situation than  he was before the bleeding.   " When
both the pulse and the general circulation become manifestly
freer, (after bleeding,) with a warm moist skin, tepid diluents
should be the only beverage recommended; yet, when it still
remains oppressed, and the tide of the circulation does not
return to the surface,  and more especially if blood has been
freely drawn, some wine with warm water should be occa-
sionally exhibited, and  the patient speedily immersed  in a
bath strongly impregnated with  salt, and at least about the
temperature of 100° Fahrenheit's scale.  He should remain
in the bath till his skin becomes warm, and, on being removed,
it should be well  rubbed all  over with  hot flannels, and he
ought then to be laid in an aired bed, with bottles of warm
water at his feet.   This plan, together with tepid wine and
water occasionally, will often promote a flow of blood to-
wards the skin, and relieve the viscera from congestion."*
  But we are not to rely solely on  bleeding, the bath, &c.
in the cure of congestive fever.   After bleeding we should
immediately order large stimulating enemata, that the bowels
may, if possible, be at once evacuated;  and then commence
the use of cathartics.   Among them  calomel is  beyond all
comparison the  best; this given  alone, or in combination
with jalap, in doses sufficient to act freely on the bowels, will
often prove of immense utility.  One of the first triumphs of
the calomel and jalap practice, instituted by the great Rush
in the yellow fever of 1793, was the recovery of an apparent-
ly hopeless and desperate case of  congestive fever.   " The
patient (says he) had passed twelve hours, before I began to
give him  this medicine, without a pulse, and with a cold
sweat on all his limbs.  His  relations  had given  him over,
and one of his neighbors complained to me of my neglecting
to advise them to make immediate preparation for his fune-
ral.   But in this situation I did not despair of his recovery.
Dr.  Mitchell's account of the effect of purging in raising the
pulse, excited a hope that he might be saved, provided his
bowels could be opened.  I now committed the exhibition of
the purging medicine to  Mr. Stall, one of my pupils, who
mixed it and gave it with his own hands, three or four times

rise by degrees from the ground, and the system will accommodate itself in
such a manner to the diminution of its pressure, as to resume its erect form,
&c."
  * Armstrong on Tvphus. 
47
a day.  At length it operated and produced two copious fe-
tid stools.  His  pulse  rose immediately afterwards, and an
universal moisture on  his skin succeeded the cold sweat on
his limbs.  In a few days (continues he) he was out of dan-
ger,  and  soon afterwards appeared in the streets in good
health, as the first fruits of the efficacy of  mercurial purges
in yellow fever."  We have copied the whole of this case,
because of its very instructive and interesting character.  It
evinces in a striking degree the effect  evacuations from the
bowels have in  raising the pulse, and it should also teach
that no case, however bad in appearance, should be abandon-
ed as incurable : our motto indeed should be nil desperandum.
  The bowels, in congestive fever, are often extremely torpid,
and  require the  most powerful doses to rouse them to action.
This is one of the cases in which  we should disregard the in-
junctions of our materia medicas, and exhibit medicine in doses
commensurate with the violence and obstinacy of the disease.
  Armstrong has great confidence in the salivatory effects of
calomel.   We must confess  that we  believe it never does
good in  this way; the calomel, before it affects the mouth,
has  already won the victory over the disease.  The reason
why salivation has been thought to put an end to fever, is
the generally simultaneous appearance of  ptyalism and the
cessation of the fever; but we are fully convinced  that the
former is the result of the latter, and  not  that the latter is
produced by the former.   Salivation,  therefore, may gene-
rally be  considered as a good sign, as it is a proof that the
fever is either entirely subdued or very much on the wane.
  Our great confidence, therefore, in calomel is from its su-
perior efficacy in evacuating dark or green matter from the
bowels; and in this only we believe consists its beneficial ef-
fect  in fever.
  The only local remedy which we  have  found very useful
in cases  of congestive fever,  is the application of mustard
poultices or sinapisms  to the wrists, ancles, and pit of the
stomach.  When the  surface of the body is cool  and the
pulse very weak and low, these  sometimes produce an ex-
cellent effect ; they are, particularly in such cases, greatly pre-
ferable to blisters.
  Causes of Typhus Fever. We come now to a consideration of
the causes of typhus. This is a subject on which great diversity
of opinion exists even at the present day.  While some are of
opinion that it may arise from the putrefaction of animal mat-
ter, or from human effluvia, the result of crowding healthy per-
sons into confined and ill ventilated places; others contend that
it arises exclusively from, and is propagated by, a specific con- 
48
tagion; and there are others still who deny to it any such pro-
perty, and consider it merely as a variety of the common re-
mittent and continued fever, and, of course, as arising from the
same causes.
  We shall examine  these different opinions in succession,
with as much fairness  and impartiality as we can; and first,
of that opinion which attributes the origin of typhus fever to
animal putrefaction.  This has for a long time been consi-
dered not only as a  cause of the fever now under considera-
tion, but  of other fevers also.   Pringle  remarks, that " The
hospital and jail fever are to be considered as the same dis-
ease, and little, if at all, different from such as have arisen
after battles, when the bodies of the slain have been left un-
buried to rot upon  the field.  This, Galen  (continues Prin-
gle) notes as one of the causes of pestilential fevers."* There
is, however, such an abundance of evidence in refutation of
this  opinion, as "to leave no  loop or hinge to hang a  doubt
on."  Bancroft, in his  able and philosophical work on fevers,
has collected a mass of testimony to this effect, some of which
we shall  take the liberty to copy into this essay.   The most
remarkable fact which he relates, is the exhumation made in
the churchyard of the  Saints  Innocens, at Paris, in the year
1786.   " The churchyard of the  Saints Innocens, at Paris,
situated in  one of the  most populous quarters of the city, had
been made the depository of so many bodies, that, although
its area enclosed more than 1700  square toises, or near two
acres, yet the soil had been raised by them eight or ten feet
higher than the level of the adjoining streets; and upon the
most moderate calculation, considerably more than six hun-
dred thousand  bodies had  been buried in it, during the last
six  centuries; previous to which date, it was already a very
ancient  burial ground.  Numerous  complaints having been
made concerning the offensive smells, which arose from this
spot, and sometimes  penetrated  into the adjoining houses,
and  the public mind being greatly alarmed, it was at last de-
termined to forbid all future burials there, and to remove so
much of the superstratum as would reduce the surface to the
level of the streets.  This work was  undertaken  in 1786,
under the  superintendance of M. Thouret, a  physician of
eminence in Paris, and in two years he accomplished the re-
moval of that superstratum, almost the whole of which was im-
pregnated, or infected, as M. Thouret  styles it, with the re-
mains of carcases, and of quantities  of filth and  ordure,
thrown upon it from the adjoining houses."
f Observations on Jail or Hospital Fever, p. 320. 
   "The exhumations" (says M. Thouret) "were principally
 executed during the winter;  but a considerable part of them
 was  also carried  on during  the  greatest  heats of summer.
 They were  begun  with every possible care, and  with every
 known precaution; but they  were afterwards continued, al-
 most for the whole period of the operations, without employ-
 ing, it may  be said, any precaution whatever; yet no danger
 manifested itself in the whole course of our labors—no acci-
 dent occurred to disturb the public tranquility!"*
   The philanthropic John Howard, in his work on Lazarettos,
 p. 25, remarks, that "The governor, at  the French hospital
 at Smyrna,  told me, that in the last dreadful plague there,
 his house was rendered  almost intolerable  by an offensive
 scent, especially if he opened any of those  windows which
 looked toward the great burying ground, where numbers were
 left, every day, unburied; but that it  had no  effect on the
 health  of himself or  his  family.   An  opulent merchant,  in
 this city, adds he, likewise told me that he and his family had
 felt the same inconvenience, without any bad consequences."t
  In the Edinburgh Medical and Surgical Journal, of October,
 1810, is an  account, given by Dr. Chisholm, of a manufac-
 tory at  Conham, near  Bristol, destined for the  conversion
 of animal flesh into a substance resembling spermaceti, by
 cutting up dead horses, asses, dogs, &c. and  putting  their
 muscular parts into boxes with holes for the admission of
 water, and afterwards placing them in pits filled with water;
 while the entrails and useless  parts of many hundreds of car-
 casses, were left to putrefy on the  surface  of the  ground.
 The effluvia  of these putrefying animal matters were highly
offensive to the overseer of this manufactory, and to the work-
men employed  under  him, as well as to  others  within their
  * "It does not appear, after the fullest enquiry, that any febrile disorder
was ever produced by this immense mass of corruption, during the removals
made in 1786, or while it was suffered to remain as a burying ground.  The
grave diggers  were, indeed, sometimes thrown  down suddenly, and, for a
time, deprived of sense and motion, by the concentrated vapors  which
escaped, upon  accidentally breaking open, by their spades, the abdominal
viscera of  bodies, in an early  stage  of putrefaction.  These  vapors, also,
in a more diffused state, are said to have produced nausea, loss of appetite,
and, in a course of years, paleness of countenance, debility,  tremors, &c.
But fever of any kind, and much less contagious fever, does not appear to
have been  noticed, as resulting from  the offensive or putrid matters of this
churchyard, either to the grave diggers or to the neighboring inhabitants."
Bancroft, pages 93, 94, 95.
  f Bancroft, p. 97.
7 
reach, yet no injury was done to the health of any person du-
ring the two years in which these operations were continued."*
  In addition to these strong facts,  and many others equally
so, which we deem it unnecessary to mention, we may add that
in no one instance that we  have heard of, has  typhus  fever
been attributed to the concentrated and putrid effluvia arising
from the numerous dead bodies in the dissecting rooms at-
tached to the different medical  colleges in this and  other
countries.  These facts are considered sufficient to prove that
fever of no kind or description ever arises  from animal pu-
trefaction.
  The next assertion, that typhus  fever is produced by the
effluvia arising from crowding healthy persons into close and
ill ventilated places, is equally destitute of foundation.  This
is an almost universal opinion.  We can hardly take up any
work on the subject, in which we do not find this  set  down
as one of the causes of typhus.  Cullen,  Chisholm, Good,
and Wilson, all mention human effluvium as one of the causes
of this fever.  Cullen remarks, that "the effluvia constantly
arising from the human body, if long  retained in the same
place without being diffused in the atmosphere,  acquire a sin-
gular virulence; and in that state being applied to the bodies
of men, they become the cause of a  fever which is highly con-
tagious."   Chisholm  says,  "the cause, in  fact, of typhus, is,
I believe, an undefined change in the atmospheric air, brought
about by its confinement in a very limited  space, and inca-
pacity, in a great degree, of renewal, and the  respiration of
an  effluvium, emanating  from the persons inhabiting the
wretched close dwellings in which fever is found."t   Good,
when speaking of the causes of typhus, remarks,.that "its
common cause is febrile miasm,  issuing from the decompo-
sition of human effluvium, under the influence of the ordinary
auxiliaries of a close and stagnant atmosphere.":}:   Wilson,
likewise, says, that "the effluvia of the living  body, become
putrid by stagnation, are capable of producing it,"|| i. e. typhus
fever.  We see, therefore, that the  ablest writers on medicine
have adopted and published this opinion ; and when bolstered
up by such authority, it  is  not  surprizing that it should have
become  so  general.   Bancroft,  however,  by a series  of  the
 most undoubted and convincing facts, has completely over-
turned this opinion,  and has proved, beyond cavil or  doubt,
 that it is never productive of typhus fever.  We will select
 the most striking of the facts recorded on  this subject.
* Bancroft, p. 442.       t Study of Medicine, vol. 2, p. 124
f Ibid, p. 99.            || On Fevers, vol. 1, p. 154. 
51
            The people of the island of  Oonalaska inhabit jourts,
        or subterraneous dwellings, each common to many families,
        in which they live in horrible filthiness."  (Pennant's Arctic
        Zoology, vol. 1.)   "And the Samoiedes live in subterraneous
        dwellings, equally filthy, for almost nine months in the year,
        who are yet reported by travellers to be strong, active, and
        healthy.  In addition to all this filth, crowding, and want of
        ventilation, the food of these people may be considered as
        lil tie better than putrefaction itself."  Mr. Pennant, describing
        that of the  natives of Kamschatka, says, "their ambrosial
        repast is the huigal, or fish flung  into a pit, until it is quite
        rotten, when it is served up in a state of carrion, and with a
        stench that  is insupportable to every nose but that of a Kam-
        schatkan.*   These  people, notwithstanding their mode of
        living,  do,  with  the exception of the  scurvy,  enjoy good
        health.
           "The Greenlanders and Esquimaux appear, by the ac-
        counts of those celebrated navigators, Davis, Frobisher, Baf-
        fin, Henry Ellis, &c, as well as Bishop, Egede, and Crantz,
        to live during the greater part of the year  in very close, ill ven-
        tilated, and  crowded habitations, (without chimneys,) which,
        notwithstanding the great severity of the cold, they keep ex-
        tremely warm by their numbers and breath, assisted by a sin-
        gle burning lamp in each, and by excluding fresh air so com-
        pletely, that any other people would think themselves in dan-
        ger of being suffocated by the offensive vapors continually
        exhaling from the lungs and bodies of  the inhabitants, and
        which involve them as a thick fog; and yet fever of any kind
        is a rare disease among  these people, though,  like those of
        Kamschatka, &c. they are much disposed to scurvy."t
          Dr. Mathew Guthrie, physician at  St. Petersburgh, in a
        letter to Dr. Priestly, mentions, that "the Russian boor lives
        in a wooden house, caulked with moss, so as to  be snug and
        close.  It is furnished with an oven which answers the triple
        purpose of heating the house,  dressing the victuals, and sup-
        porting on its flat  top  the greasy  mattrass on which he and
i        his wife lie."
          "During  the long severe winter season, the cold prevents
        them from  airing this  habitation, so that the air cannot be
        very pure, considering  that four, five, or six people eat and
        sleep in one room, and undergo, during the night, a most
        staring process from the heat and closeness of their situation,
        insomuch that they have the appearance of being dipped in
        water, and raise a steam and smell in  the room, not offensive
' Banrrof'l, p. 100.
f Ibid, p. 101. 
52
 to themselves, but scarcely supportable to the person whom
 curiosity may lead thither."
   "Now, if it be considered that  this human effluvium must
 adhere to  every thing  in the room, especially to the sheep
 skins or mattrass on which they sleep, the moss in the walls,
 &c, and that the apartment is never ventilated for six months,
 at least; at the  same time that these people are living upon
 salt fish, and the whole  time without fresh vegetables, Sec.—
 if it be a fact that they  are, in spite of all these predisposing
 causes, strangers to putrid disease, it will sufficiently justify
 my first assertion, that  the regimen nature has  dictated to
 these people, is  highly antiseptic."
  Bancroft remarks, that  "Dr. Guthrie has stated these facts
 principally to show the supposed beneficial effects of the Rus-
 sian drink called quass, <fcc.; but I am entitled to avail myself
 of them for the  purpose of demonstrating that long confine-
 ment in close  unventilated houses, without chimneys, in an
 atmosphere replete  with  human effluvia,  and in very cold
 weather, when typhus or contagious fever is commonly most
 prevalent, does not produce that disease, it being, as will here-
 after  appear, unknown  in that part of the world."*   From
 these facts we learn that the  effluvia arising from the crowd-
 ing of healthy persons into close  and unventilated situations,
 in cold countries, at least, is not productive of fever ; and upon
 examination, we shall find that the same cause is  equally in-
 nocuous as regards the production of typhus fever in warmer
 regions of  the globe.
  The African slave ships present striking examples of this
fact.   " The poor wretches (says Lind, in his  treatise on jail
 distemper)  are crowded  together below the deck,  as close as
they possibly can lie, with only a small  separation between
the men and women; every night they are shut up under close
hatches, in  a sultry climate, barred down with iron to prevent
an insurrection;  and though some have  been suffocated by
the close confinement, or foul air, though they are subject to
the flux, and suffer  from a change of climate, yet an infec-
tion is scarce known among them; or if  an accidental fever,
occurring from the change of climate, should become infec-
tious, it is generally much more mild than in the opposite
situation,"  i. e. that of ragged felons under transportation.
Bancroft remarking upon this  statement, says,  "that Dr.
Lind, influenced, as he  was, by  the commonly received opi-
nions, mentions an infection (meaning fever) as being 'scarce
known' in the slave  ships, instead of asserting, as he might
* Bancroft, p. 102. 
5;J
have done with truth, that it is never known ; for, (continues
Bancroft,) after very extensive enquiries, I am fully convinced
that fever of any kind rarely occurs on board these vessels,
and contagious fever never."
  A striking instance of the harmlessness of the effluvia
arising from the excessive crowding of persons into confined
and close situations, may be found in the " Narrative of the
deportation to Cayenne," of J. J. Job. Aime, and one hundred
and ninety-two other persons, on board the Decade frigate,
in consequence of the  revolution  (in France)  of the  18th
Fructidor, (Sept.  4,) 1797, written by himself, and printed in
1800.  In this  narrative the writer says,  "we were placed in
the between decks, before the fore mast  and main mast, oc-
cupying  nearly one fourth of the superfices of the vessel,
having about four feet and a  half in height, and receiving no
light but by the scuttles; that is to say, by two openings of
three feet square."
  "In this place,the door of which was locked, were crowded
and squeezed together one hundred and ninety-three indivi-
duals, mostly aged and infirm.  We lay in two rows, one over
the other, forming, as it were, two stories, in hammocks of
coarse cloth, and  extremely narrow.   Those below could not
raise their heads  without hitting those above; neither could
any of us make the smallest  motion without disturbing his
neighbors; for we all touched each other, and not having the
least spare room,  formed, as it were, but one mass.  And that
nothing might be wanting to  increase the horror of our situa-
tion, as we were  not permitted to go out for  fourteen hours
together, (i. e.  from 6 P. M., until 7£ A.  M.,) and sometimes
more, tubs had been  placed in the  midst of us, where we
might satisfy the indispensable wants of nature ; and to get
to these  sorry receptacles, we were obliged to creep on our
bellies beneath the hammocks.  How insupportable then must
have been the infection of such a close confined place, which
was already poisoned  by our  own exhalations!   Indeed, the
air  which passed  from this hole was so hot and fetid, that the
sentinels placed  at the hatchways as our guard, demanded
that the time of their  duty, at so dangerous a post, might be
shortened."
  In addition to all this, they "were condemned to subsist on
the coarsest and the most disgusting half putrefied food," and
"to endure the greatest and most offensive personal filth."*
Yet, notwithstanding this combination of the most disgusting
and distressing circumstances imaginable, nothing like conta-
* Bancroft, p. 105-6. 
54
gious fever manifested itself, although they were kept in this
state for ninety-six days.   If " crowding, want of ventilation,
filthy clothing, and unwholesome, corrupting  food, together
with anxiety and dejection of mind,"  could have  generated
the contagion of typhus, it ought to have been present here
in its most concentrated state.
   Dr. Lind, in his essay on preserving the health of seamen,
says, that "the surgeon of the Panther (of sixty-four guns)
told me, that forty of her men had died of the scurvy on their
passage home," (from the West Indies,) "and that during
that time there were usually ninety patients in the sick apart-
ment.  The place appropriated for the sick was in the bay
of the ship, and had no pipe from the  ventilator, nor  any
scuttles cut through its sides for the admission of the fresh
air.  A number of patients, thus closely crowded together,
rendered the place so disagreeable and suffocating, that the
sick were in a manner stifled  for want of air.   The surgeon,
when visiting,  could  scarcely breathe in it, or remain for any
length of time, without being obliged to have recourse often
to the fresh air upon deck, and sometimes to spirits of harts-
horn, or to a glass of wine, for his immediate relief.  He ob-
served, that both the virulence  and mortality of the  scurvy
were heightened by the uncultivated air of the place in which
the sick, for several weeks,  had been confined; yet, out of
above a hundred patients  sent to the hospital by this surgeon,
not one  was remarked to have  any symptom of contagion
generated in that apartment."   This case is the stronger in
point, because the men thus crowded  together were in a dis-
eased state.   Many more facts of this kind might be men-
tioned, but these are deemed amply sufficient to satisfy the
most sceptical that human effluvium is not productive of con-
tagious fever.
   Of a  Specific Contagion as the Cause of  Typhus.  The
contagiousness or noncontagiousness of typhus fever, has been
the source of much, and occasionally bitter, controversy, be-
tween the members of the  medical profession.  Until the
present  century, few or none were found so bold as to ques-
tion its infectious character, and thus run counter to the preju-
dices, not only of the profession, but of society at large.
 Though, however, the doctrine of contagion, as an attribute
of typhus, remained for a long time unimpugned ; yet it finally
 came to be doubted, and  the noncontagionists can now num-
 ber as their friends a large proportion of the distinguished
 members of the profession.  One reason of our long  con-
 tinued and implicit credence in the contagiousness of typhus,
 may be found  in the very character of man.   ft is his nature 
55
to cling with great tenacity to long fostered and traditional
opinions, clothed as they are with the names and authority of
the venerable sages of other times; and he feels a pride in pre-
serving his opinions, when once formed, unchanged; and thus
it is that the prejudices of education, and the pride of consis-
tency of opinion, often blind us to the light of truth, and rivet
upon ns the chains of error.
  As it is a subject of much importance in many points of
view, we will enter into the merits of this question as fully
as the length of this essay will admit.   The vexations, em-
barrassments, and restrictions upon commercial intercourse,
produced by quarantine regulations, and the large and ex-
pensive establishments* in different countries for carrying
them into operation, and the delay and inconvenience to  in-
dividuals,  all demand that this question  should be rigidly
examined into, and settled finally one way or the other.   If,
upon strict scrutiny, it should be found  not to be contagious,
then the abolition  of quarantine establishments ought imme-
diately to follow.  If, however, after the most thorough and
impartial  examination,  it should  appear  to be  contagious,
the quarantine regulations cannot be too rigidly enforced.
  In discussing this subject, we shall in the first place con-
tend that typhus  fever has not the characteristics  of a con-
tagious disease; 2d, that it often  has occurred without the
presence of  contagion; and 3d,  that  it  often evinces  no
contagious character whatever.   1st. Typhus fever has not
the characteristics of a contagious disease.   All known con-
tagious diseases run a regular and determinate course, and
are  marked  by symptoms which unequivocally distinguish
them from other diseases.   Thus, smallpox, measles, chicken-
pox, and covvpox have each peculiar symptoms, which suc-
ceed each other in regular succession, and pursue an invaria-
ble and certain course, independently of the treatment used.
Thus, smallpox, for instance, though it may have its  symp-
toms ameliorated by a proper treatment, or the reverse may
take place by improper management, will, nevertheless, pass
through all its regular and determinate stages.  The  same
may be said of the other examples adduced.  Now, the ques-
tion may be asked, does typhus fever come up to this rule ?
We answer in the negative.  That it has no distinctly marked
pathognomonic symptoms, is evident from the fact, that dif-


  "  Maclean, in his work on Epidemics, vol. 1, p. 456, says, "In this coun-
try (i. e. England) they have cost the nation for the last fifteen years, inde-
pendently of the detention of ships, crews, passengers, and merchandize,
at least £300,000." 
56
ferent appellations are frequently given to the same fever by
different  physicians.   Thus, one will pronounce it to be the
common continued fever, another the genuine typhus, and a
third,  meeting with  an unusually violent case, would  call it
yellow fever;* and there is not a single symptom laid down
as belonging to typhus, which  is not to be met  with in other
fevers.
  Neither does it, like known  contagious diseases, run a de-
fined and determinate course.   It may last one, two, three,
or six weeks, according to  the treatment pursued.   Again,
the period at which morbid action is developed after  the  re-
ception of contagion, is determinate in contagious  diseases.
This is not the case in typhus fever, as contagionists say that
the infection may lie dormant during a period extending from
one  day to six months.t
  In the next place,  acknowledged contagious diseases affect
a person but once during his life; this is a  wise and  benefi-
cent law stamped upon them by the great author of creation
to prevent them from becoming universally prevalent.   " It
is the incapability of affecting  the  same person  more than
once which, in general contagious  diseases, sets  boundaries
to infection; and could alone, where no precautions are taken,
prevent communities from being extinguished.''^   Typhus
fever  does  not possess this characteristic; it  may, and fre-
quently does, attack the  same  person  repeatedly, and it is
obvious that  possessing, as it  unquestionably  does, this  at-
tribute, if you invest it also with the power of producing and
propagating itself by a specified contagion, no  human power
  * Dr. Carrathers, surgeon of the Malta, in his account of the typhus which
prevailed on board that vessel, and which is to be found in Trotter's "Medi-
cina Nautica," remarks, that  "many of the sick had yellowness of the skin,
insomuch that he suspected that the yellow fever had been introduced by
communication with a sickly ship from the West Indies !*'  See Cooke's
Practice, vol.  1, p. 497.
  f Bancroft says the fever may make its appearance six months after the
infection, and Haygarth expresses the same opinion.  We cannot help ap-
plying a remark of Dr. Armstrong's to  the opinions of B. and H. on this
subject.  He  says, " If an author is persuaded that there must be a specific
contagion as the cause of every fever resembling typhus, he will undoubtedly
go far to seek it."  The above named gentlemen prove the truth of this re-
mark, for they, with the most wonderful acuteness and sagacity, pretend to
have detected its operation six months after exposure to it. Unlike the bed
of Procrastes, which reduces  every thing to the same common size, they en-
dow contagion with the wonderful property of expanding or contracting,  so
as to embrace every case which may occur from one day to six months after
its application.  Does this diversity in the time of producing its effects, com-
port with our  ideas of something specific and unchangeable in its nature 1
Do the known contagions ever operate in this way ?
   J Maclean  on Epidemics, vol. 1, p. 100.
9r 
57
 could  prevent its spreading  almost over the whole human
 family.  Every person in health would be attacked, as often
 as he came within the infectious distance of any one laboring
 under the  disease.   Those only would escape who could pre-
 serve  themselves constantly beyond that distance, or were
 laboring under some malady higher, in degree, than the pre-
 vailing epidemic.  But, as disease spread, no person in health
 could continue long beyond the sphere of infection; and those
 who had been protected by diseases higher in degree, would,
 upon recovering, become liable to  be affected by the conta-
 gion.  It would observe a geometrical progression, diverging,
 as it were, from  the centre to every point of the circumfe-
 rence  of a city, a camp, an hospital, or a ship, while it had
 subjects to operate upon; i. e. while a single individual of the
 community remained alive it  would never cease.    Those
 who recovered would, again  and again, be seized; no person
 who remained within the pale of society could escape.   The
 malady would be communicated to  the most distant nations.
 Infection would proceed in a continued circle, until the whole
 human race was  extinguished."*  This  extract is a  highly
 wrought, though  true, account of what would be the effect of
 adding to the powers which typhus  has of repeatedly attack-
 ing the same person, that of being capable of generating and
 propagating  itself by contagion.   Inasmuch, therefore,  as
 typhus fever has no regular and pathognomonic symptoms,
 and as the  period at which the symptoms of disease are mani-
 fested, after infection, varies,  according to contagionists, from
 one day to six  months,  which is  inconsistent with our ideas
 of something specific in its character, and uniform in its ope-
 ration ; and as it is unlike all known contagious diseases,  in
 being capable of affecting the same person repeatedly, and
 does not spread until it becomes universal, which should be
the inevitable effect of uniting to this latter trait the proper-
 ty of contagion, we think, therefore, it must be admitted that
 it does not possess  the characteristics  of a contagious dis-
 ease.
  2d. That it  has  often  occurred  without the presence  of
 contagion.   To prove this second proposition, we will adduce
 facts mentioned by contagionists themselves.  It is presumed
that  as the advocates for contagion would not gratuitously
 and without good reason mention  facts subversive of their
own  opinions, that, therefore, these facts ought to have more
weight than would be attached to them  under other circum-
stances ; as a man is not to be suspected of insincerity or im-
* Maclean on Epidemics, vol. 1, p. 214-15.
               8 
58
proper bias when he gives evidence against himself.  But to
the testimony.
  Trotter, who was a zealous advocate for the  contagious
origin  of  typhus, mentions, in his Medicina Nautica, many
instances  of it, which could not be traced to contagion.   On
board the Niger, he says, "It first appeared among the ma-
rines, but  latterly affected the seamen.   Its origin could not
be exactly traced."*   In the Glory, also,  "We could not
trace it distinctly to its source."t   " No imported contagion
was  duly  authenticated"! as the cause  of the fever which
broke  out on  board the Edgar, while at sea.   Of that on
board the Pompey, at sea,  " No satisfactory account could be
obtained of its origin."||  Trotter says, Mr. Johnson remarks
in relation to the fever which occurred on board the Saturn,
"I could not trace this fever to any infection imported by any
of the people."^   In the Magnificent, the surgeon says, the
fever spread more than he had expected; " but still I cannot
trace it satisfactorily to a contagious cause."^[  Trotter says,
when speaking of the typhus on board the Captain, " No im-
ported contagion has been  suspected here."**   Of the same
on board  the Uranic, he says, "It does not appear that any
imported  contagion has been suspected as the cause of this
fever."tf   Speaking of the same vessel again, he says, " It
does not appear that  any imported contagion could be sus-
pected here."   In giving the result of his experience for
many years, he says, "It is very  certain that  this fever is
generally spread by contagion; but it is equally  certain, that
it frequently arises in places where there could be no suspicion
of communication with infected persons or clothing."%%   The
above  facts  are taken  from a  treatise on pathology and
therapeutics, by John  E. Cooke, M. D., professor, of Tran-
sylvania University, in which this  subject is discussed with
the most  masterly ability.  I shall mention but one more case
of this kind, to be found in Assalini's work on the Plague.
He says, that in the years 1799 and 1800, "An epidemic dis-
ease spread its ravages in  the hospitals of the army of Italy,
and  carried  off daily its numerous victims."    The  fever
spreading rapidly, and much alarm being created, "the pub-
lic authority (says he) thought proper to  consult  the school of
medicine  of Montpelier, which hastened to calm their inqui-
etude, and reanimate  their drooping spirits, by  proving that
this  fever, falsely  regarded as pestilential, was not at all dif-
* Medicina Nautica, vol. 1, p. 153.  f Ibid, p. 160.  J Ibid, vol. 3, p. 63.
H Ibid, p. 64.          § Ibid, p. 147.          H Ibid, p. 167.
•• Ibid,  p. 60.         ft Ibid, p. 151.         %\ Ibid, vol. 1, 2jZ. 
59
ferent  from the fever of hospitals, the typhus  carcerum of
Pringle, or the fevers of camps and armies, febris castrenis."
" With regard to  this disease, the majority attributed it to
rains and fogs.   A citizen of the environs of Antibcs assured
me,  that if this disease had taken place some  months before,
it  would, without  fail, have been attributed to the vessels
just  arrived from Egypt, and which had put ashore at Fre-
gus without performing quarantine."* These facts are deem-
ed sufficient to  prove  that typhus often  appears  without the
least reason to  suspect contagion as its cause.
  Physicians, however, aware of this fact, and  unwilling to
surrender their long cherished opinions, are driven to the ab-
surd alternative of supposing that typhus may have  a double
origin, or,  in other words, that the specific contagion of ty-
phus may  be produced by other causes  than itself.  Thus,
Gregory says, "there is nothing improbable  in  the supposi-
tion, that what originated in cold may be afterwards propa-
gated  by contagion."t  Dr. Adams, in  his work on morbid
poisons, inculcates the same opinion.  To these, and all si-
milar opinions, we will apply the language of Bancroft when
alluding  to that of Dr. Adams on this  subject.  He says,
" that Dr. Adams, who is accustomed and qualified to reason,
should have believed any thing so unphilosophical and incon-
gruous, would have been incomprehensible to me, if so many
others  had not discarded common sense on the subject of
contagion.   To represent a disease which is  notoriously con-
tagious, and propagated by contagion,  as capable  of being
produced by other, and those very different, means, is to mul-
tiply causes unnecessarily, and, therefore, unjustifiably; and
it moreover destroys the natural and just influence of causes
upon their effects, by making the same disease result from
very dissimilar causes; and, a little farther on, he observes,
that  " were it possible for typhus thus frequently and easily
to originate without contagion, and at the same time acquire
and  multiply itself by a  contagious quality, who could ever
hope to escape  the disease."!
  3d.  That it  often evinces no contagious character what-
ever.  Contagionists  themselves afford  evidence to this ef-
fect.   Trotter, in his Medicina Nautica, mentions  many in-
stances in which it was not  contagious.   "A  fever (says he)
of the typhus kind appeared among the gentlemen of the In-
vincible,  in Torbay, which  extended  to a number of cases.
* Assalini on the Plague, p. 39, 90, 91.
f Gregory's Practice of Physic, vol, 1, p. 55.
J Bancroft on Fevers, p. 340, 311. 
60
 Yet it is singular, that it did not  affect any of the seamen,
 although some of them attended their officer, who slept in
 the  gun room, and where  communication  with  the  ship's
 company was  not prevented."*   "The Niger has been ten
 weeks at sea; at leaving port four felaspes in fever happen-
 ed among men discharged from the Warlar. Mr. Burd does
 not assign any cause for these returns;  no infection  spread
 from them."f
  "We know of nothing (says Trotter) that can  propagate
 this  fever, but exhalations from the body.   But a patient in
 typhus was  sent from the Venerable to the hospital ship,
 with a faetor about  him, that exceeded every thing of the
 kind which  ever came within my knowledge.   After being
 washed and shifted, it still continued, and was perceived at
 a considerable distance.  He died in a few days ;  yet nobo-
 dy was infected from him, either in his own ship, or our hos-
 pital."!
  Speaking of the Charon hospital ship, Trotter says, "We
 had  in that hospital many malignant cases of typhus, and
 some deaths, yet no infection was ever spread there."||
  In 1790, a number of troops embarked on board the Gor-
 gon to go to New South Wales.   While lying in the  harbor
 of Portsmouth, typhus fever prevailed among the soldiers,
 and  several died.  " The troops lived on the lower deck, and
when the ports were shut at night, the exhalations from be-
 low naturally ascended through the gratings among the sail-
 ors; not one of them had the slightest  sign of infection."^
 The above facts are also derived from Cooke's work on pa-
 thology and therapeutics.
  In the instance already cited  from Assalini, of the fever
 which  attacked the army of Italy, in the Ligurian republic,
 it is  stated in a report made to the society of the school of
medicine at Paris,  that  "it is was of the nature of  jail fe-
ver,  and was not at  all contagious."^
  Wilson, in a note to page 156 of his chapter on continued
fevers, says, "It is  remarkable,  indeed, that we  sometimes
 meet with malignant fevers, which do not appear to be at all
contagious."   " Sometimes, (says he,) Dr. Lind observes, one
 man may be seized with the petechial or  with yellow fever,
while the rest  continue unaffected."  Dr. Lind gives  several
instances in  support of this observation.
  These facts prove that typhus fever is not, at least, always
* Trotter's Medicina Nautica, vol. 1, p. 109.      f Ibid, p. 164.
t Ibid, p. 195.         || Ibid, p. 179.         § Ibid, p. 210.
               II Assalini on the Plague. 
61
          contagious, and it is inconsistent with our ideas of a strictly
          contagious disease, that it  should at one time  possess this
          characteristic,  and at another be destitute of  it.  Known
          contagious diseases  are always  and invariably the same;
          they are contagious under all circumstances;  but typhus fe-
          ver has been shown not to be so; and, to use the language
          of Bancroft, "as the same disease, in suitable circumstances,
          is always, or never, contagious, we may safely  rely" on the
          numerous facts adduced, to  disprove the assertion, that con-
          tagion is one of the characteristics of typhus.
            The advocates,  however,  for the contagious nature of ty-
          phus, in  order to avoid the  inference legitimately deducible
          from the above facts, and others which exist, are driven to
          the necessity of reducing the question of its contagious cha-
          racter to very narrow limits.   They admit  that it does not
          evince this quality in situations where there  is a  free circula-
          tion of pure atmosphere ;* but contend  that it possesses it in
          the  impure atmosphere of close, filthy, and  unventilated
          apartments.  The fact of its attacking many persons in suc-
          cession under such circumstances, has been assumed as suf-
          ficient ground for  a  belief in its contagious character; but
          this surely only proves the existence of some general cause
          acting on all in those circumstances, and not that the disease
*         is communicated from one to the other by means of a speci-
          fic contagion.   That general cause is unquestionably the im-
          pure atmosphere itself; for, if an individual laboring under
          typhus is removed out of the foul air, he does not propagate
          the  disease; but  the impure  atmosphere  will continue to
          produce it in most of those  subjected to its influence.   The
          circumstances, then, under which alone contagionists say that
          typhus is infectious, being of themselves capable of produ-
          cing it, or exciting it, are in them already predisposed ; but
          it is unnecessary  and unphilosophical to  assign that  as  a
          cause of the fever, which is acknowledged to be only opera-
          tive during the  presence  of causes which, without this, are
          capable of producing it.  We do not think, therefore, that
          contagionists can sustain themselves on this ground.  Under
          the next head of this essay  we will speak more particularly
          of the cause of this impure  atmosphere, which  we consider
          as alone capable of producing this fever.
            We have now finished what we have to say  on this  part
  * It was from a knowledge and conviction of this fact, that infirmaries and
houses of recovery were established in England.  These institutions for
the reception of the wretched paupers of that country, were the result of the
philanthropic labors of Feiriar, Percival, and  others; and will constitute a
lasting monument to their memory and reputation. 
62
of the subject.   We trust that  we have established to the
satisfaction of every unprejudiced  mind, the three positions
for which we have contended.  1st,  that typhus fever has
not the characteristics of a contagious disease; 2d, that it
has often occurred without the presence of contagion; and
3d, that it often evinces  no contagious  character whatever.
If we have even proved the last of our  positions, then  Ban-
croft and his disciples at  least  ought to admit the justice  of
out conclusion  that  it is never  contagious, as he uses the
same train of arguments against  the contagious nature  of
yellow fever, and comes to the same conclusion in regard  to
it, from the facts he had  collected upon that subject.
  There are, it is true, some  apparently strong facts on re-
cord in proof of its  infectious nature, but we  believe  that
they cannot stand the test  of rigid  scrutiny.   The fevers
which occurred at the black assize, at Oxford, in 1577, and
at the Old Bailey, in 1750, are always held up as evidences
of its contagious character; but no one can read the remarks
of Bancroft upon them, without being convinced of their utter
want of claim to be considered  in this light.   To notice all
the instances of this kind to be found in books, would  swell
this essay far beyond reasonable limits,  and  we shall there-
fore not attempt it.
  We  will now, in the  last place, examine the opinion  of        '
those who deny that typhus fever possesses the  property  of
contagion, and who consider  it  as a mere variety of the
continued and remittent fever, and of course as arising from
the same causes.
  We are among those who entertain this opinion; and from
a close and impartial examination  of  all the facts and argu-
ments bearing on the question, are perfectly satisfied of its
correctness.   In order to render  this subject as  clear as pos-
sible, we will in the first place endeavor to show "that typhus
fever arises in situations  in which  miasmata abound."   2d.
" That  the symptoms of typhus are  those of autumnal  or
miasmatic fevers!"  3d. "That  typhus  fever appears  in
company with miasmatic diseases, and  that they are mutu-
ally convertible into one another."* Before proceeding, how-
ever, to a consideration of the different  heads of this part of
the subject, it will be just  and proper to remark, that we shall
stand indebted to Dr. Cooke's  admirable essay on the causes
of typhus, contained in the first  volume of his work on pa-
thology and therapeutics, for most  of the facts to be mention-
ed on this subject.  The author of the above mentioned work
* Cooke's Pathology and Therapeutics, vol. 1, p. 450. 
63
has so completely covered the whole ground of controversy,
and so perfectly exhausted the subject, that but little else is
left for others to do, than merely to draw upon the rich store-
house  of facts, collected by his unceasing and indefatigable
industry.
  1st. Typhus  fever arises  in situations  where miasmata
abound.   Currie mentions, "that the corporation of Liver-
pool,  being about to  apply  to  parliament  for  powers  to
improve the streets and police of the  town, requested  the
physicians of  the  Infirmary  and Dispensary to  suggest to
them such alterations as might contribute to the health and
comfort of the inhabitants.*   The physicians took this re-
quest  into serious consideration, and presented a report of
considerable extent, including a view of the causes of  the
uncommon sickness of the two preceding years,  and of the
measures requisite to prevent its recurrence, and to remove the
frequency of contagion in the habitations  of the poor."   The
physicians consulted, and pointed out the necessity of enforcing
cleanliness in the streets, to which end  an improvement of
the pavement was represented to  be essential; and they par-
ticularly advised a general  review of the common sewers,
and an improvement of their structure, on the  principles of
the report on this particular subject, addressed by them to
the mayor and magistrates, in 1788.  They further advised,
that effectual provision should  be  made  for  draining the
grounds within the liberties,  and  particularly to the north of
the town.  " Repeated remonstrances (the words of the re-
port) have been made for the last twenty years,  on the col-
lections  of standing  water,   including  filth  of every kind,
which are suffered to  remain in the district which extends
along the termination of the streets, from  St. Paul's square
to Byron  street, and to which the low  fevers, which in the
autumnal months especially  infect these streets, are princi-
pally to be imputed."!  In this instance, the physicians, with
a view to prevent the recurrence of the  "low fevers" which
had prevailed so widely during the two  preceding years, re-
commend  the  removal of those circumstances, which are
every where fruitful in the production of miasmatic exhala-
tions.                                              .   .
  At page 23, Currie mentions another fact, clearly evincing
the miasmatic origin of typhus fever.   He says—" The 30th
regiment, as is usual with troops in Liverpool, was billeted
in the town, but paraded and  mounted guard in the fort, situa-
ted north of the town,  on the banks of the river.   The gene-
* Currie's Med. Reports, p. 216.        t Ibid, p. 247. 
64
ral guard room had been used, previous to the arrival of the
30th, as a place of confinement for deserters:  it was extreme-
ly close and  dirty, and  under it was  a cellar, which in the
winter had been full  of water.   This water was now half
evaporated, and from the surface issued offensive  exhala-
tions."  In a dark, narrow, and unventilated cell of the guard
room, it was usual to^confine such men as were sent to the
guard for misbehavior; and  about the 20th of May, 1792,
several  men  had been  shut up  in this place on account of
drunkenness,  and suffered to remain there twenty-four hours,
under the debility that  succeeds intoxication.   The typhus
or jail fever made its appearance in two of these men about
the first of June, and  spread  with great rapidity.*  All the
precautions used, by  cleansing  and  ventilating the guard
room, were ineffectual  in  preventing the progress of the
fever.   The weather  was at  this time wet,  and extremely
cold for the season : the men on guard could not be prevailed
on to remain  in the  open air; and, from passing the night in
the infected guard room, several of the privates of the suc-
cessive  reliefs caught the infection, and fell  ill on the 10th,
11th, and 12th  of the month.*   We here find that all at-
tempts at arresting the fever by washing and ventilation,
were in vain; and  why ?  because the source of the  fever
obviously was the "offensive exhalations"  from  the cellar
under the guard room;  and it was not  until the guard room
was shut up, and the soldiers removed to "a temporary shed
erected  in its  stead," that the fever ceased.
  Dr. Ferriar, of Manchester, in England, in his address to
the police on the best  means for the prevention of fevers,
remarks, "that during  the late  epidemic, it was observed
that the fever (i. e.  typhus) prevailed  most in  streets which
were not drained, or in which  dunghills were suffered  to.
accumulate, or  where the blood and garbage from slaughter
houses were  allowed to stagnate."  These facts, and  many
others of a similar import which we might mention, unques-
tionably prove that typhus fever  arises on land, in situations
where miasmata must abound.
  It has also frequently appeared in ships at sea; and after
a full and rigid examination  of  the many instances of the
kind to  be met  with in books, we think we  can venture to
assert that in every instance, where the circumstances at-
tending its origin and progress in such situations are detail-
ed,  they will be found abundantly  sufficient to  produce
fever, without bringing  in contagion to account for it.   One
* Currie's Med. Reports, p. £5. 
65
of two things will be generally found to exist; either that the
state of the vessel as regards filth, &c. is such as would pro-
bably of itself give rise to febrific exhalation;  or, that the-
crew has been exposed to miasmata on land, and being thus
predisposed to fever, the exposure to bad weather, the incle-
mencies of a  sea voyage, and the fatigue incident to such si-
tuations, act  as existing causes, and fever is the result.
  2d. That the symptoms of typhus are those of autumnal
or miasmatic fevers.   Under this head we shall say but lit-
tle, because we believe that no one will  question its truth,
who examines  into it with any  degree  of attention.   Dr.
Armstrong, in speaking of the identity of the remittent and
typhus fevers, remarks, that the remittent and typhus fever
from malaria or marsh effluvium, " has a combination of symp-
toms exactly similar to those which occur in continued typhus
fever, and which, as a combination, occur in no two other af-
fections whatever."*   They both commence with a stage of
oppression or weakened action of the heart; in both this first
stage occasionally continues unchanged, and constitutes then
the congestive  fever; but in both the heart generally reacts
from  this first  stage of oppression, and  produces  the open
form of fever, the succeeding symptoms in each being de-
pendent on the degree of this reaction, and the previous state
of the different organs of the body.
  The general symptoms in both are, therefore, alike, and
if we  descend to an examination of particular symptoms, we
shall  find none which exclusively belong to typhus.  Pete-
chia?, which are so common in typhus, as to have given it a
name, occur  also in other fevers.   Rush mentions their fre-
quent appearance in the yellow fever of 1793, and almost
every practitioner of any experience has often met with them
in the autumnal fever of this country.
  Yellowness of the skin is a frequent symptom of miasma-
tic fevers.  It also often occurs in typhus fever.   Mr. Caru-
thers, surgeon  of the Malta, in his  account of the typhus
which had appeared in that vessel, says,  that "  many of the
sick had yellowness of the skin, insomuch that he suspected
that the yellow fever had been introduced by communication
with a sickly ship from the West Indies."t  In reference to
the above statement, Trotter remarks that " Icterus is not
an  unfrequent  symptom in typhus; it was particularly re-
marked among our seamen in the warm  summer of 1794 ;"|
and in vol. 1, p. 259, he says, " I have often seen the eyes and
• Medico-Chirurgical Review, September No., 1822, p. 395.
f Trotter's Medicina Nautica, vol. 3, p. 215.     X Ibid, p. 218.
                        9 
66
 skin, with  the urine, as deeply tinged with bile in typhus,
 as I have remarked them in the yellow fever of the West In-
 dies."
  We will now proceed to the consideration of the third and
 last division of this part of our subject, which is, "That ty-
 phus fever appears in company with miasmatic diseases, and
 that they are mutually convertible into  each other."  To
 prove this we shall resort to the testimony of those who were
 perfectly familiar with the disease in all its different forms.
  It is now generally acknowledged that dysentery is but a
 form of our autumnal bilious fever, and, of course, that it ori-
 ginates from the same cause, or, in other words, that  it is,
 what the unnerring sagacity of Sydenham  long since pro-
 nounced it, a " febris introversa." Typhus fever, then, often
 appears in company with this disease.   Pringle, in his ac-
 count of the diseases of the army when in Germany, in the
 year 1743, says, "The state  of those at Feckenheim has
 been already mentioned; there the hospital fever and dysen-
 tery grew daily worse."*
  Trotter says, the ship Reasonable arrived at Spithead in
 January, 1794, and "landed upwards of a hundred very ill
 of typhus  and  dysentery."  " A  considerable  number of
 cases of flux and (typhus) fever, were received from the Gi-
braltar."!
  At page 192, of vol. 1, of his Medicina Nautica, Trotter
says, "There  were a larger number of bad cases of typhus,
ague, and dysentery,  than usually come to a naval hospital
at one time.  From the same transport, and in the same re-
giment, were brought people of the three diseases just men-
tioned ;" and in vol. 2, p. 14, he says, on board the Powerful,
 "a dysentery was associated with the fever."
  It also appears in company with remittent and intermittent
fevers, which are confessed by all to be produced by mias-
matic exhalation, and is often converted into them, and vice
versa.
  There is an abundance of evidence in proof of this.   Trot-
ter says, " I have seen a family where the father was labor-
ing  under an obstinate tertian,  while the mother and some of
the children were ill in bed with typhus."  "Nay, I have con-
stantly remarked in those  ships where contagion prevailed,
that many cases of regular intermittents  and remittents oc-
casionally appeared.   When they increased in proportion to
 the  number of the continued type, and the latter becoming
 milder in its attack, I consider it as an infallible sign that the
* Pringle on Diseases, p. 25.   f Trotter's Med. Nautica, vol. 1, p. 58. 
67
power of the infection was on the decline, and would be
speedily subdued."*
   " The attacks of fever," says Trotter, " since leaving Cork,
had been more numerous than on the preceding week.  They
were both of the continued and intermitting types."!
   About the beginning of March, the infection seemed to be
on the decline; which appeared from the attacks being less
severe;  some cases of the remittent and intermittent type
were now observed.^
   "The sick list consisted of seventeen venereal patients,
and seven in fever, some of them regular tertians.   Some
were every morning discharged to duty, and others added in
the course of the day, in both the continued and intermittent
forms." ||
   " Those cases (of  typhus) which have  occurred latterly,
have  been slight, with a general intermittent tendency."^
   " The Royal George did not seem to suffer much from the
infection."   " They assumed a bilious  remittent form."^[
   Trotter says, "It is not easy to trace those circumstances,
which occasionally convert an intermittent or remittent fever
into a continued type, (or typhus,) and vice versa.  There
must, however, be something in their disposition very much
alike; for, wherever we find the typhus affecting a number
of people at  a time, we also find cases  of the remittent  and
intermittent form."**
   Ferriar mentions one instance of the conversion of typhus
into intermittent fever.   "In one case," says he, "where a
typhus was unusually  protracted, after several hazardous de-
terminations to the stomach and bowels, the fever assumed
the form of an intermittent."tt
   Trotter, in speaking of the  typhus on board the Valiant,
says,  " the cases were becoming milder;  in some it put on
the intermittent form, which showed that it  was now on the
decline."!!
   Dr. Armstrong, in a short essay on the origin, nature, and
prevention of typhus fever, published in 1822, made a public
recantation of the opinion he had long entertained relative to
the contagion of typhus, and adopted that of its miasmatic
origin, and its identity  with intermittent  and remittent fevers.
The following account of  the reasons of his change  of  opi-
nion, is taken from the Medico-Chirurgical Review, Septem-
ber number,  1822.  " Dr. Armstrong states, (says the  Re-
* Trotter's Med. Naut. vol.1, p. 185.  f Ibid, p. 311.    t Ibid, p. 187.
|| Ibid, p. 188.   § Ibid, p. 70.     H Ibid, p. 8S.     ** Ibid, p. 311.
ff Ferriar's Med. Histories, p. 82.   XX Trotter's Med. Naut., vol.1, p. 66. 
68
view,) that in 1819 he attended a patient laboring  under an
intermittent fever, which, in its progress, put on a  remittent
character, and ultimately a continued form and typhoid type,
accompanied by very malignant symptoms.   This case made
a deep impression on his mind, and inclined him to ask, whe-
ther intermittent, remittent, and typhus fevers,  might  not
possibly be  modifications of one and the same disease.   Up
to this period, Dr. A. had firmly believed that human conta-
gion was the sole cause of genuine typhus fever ; but a doubt
having been excited, he determined, if possible, to divest his
mind of all former bias, and investigate the subject aborigine.
In  the course of the three succeeding  years, a very great
number of typhus cases have fallen under his notice, and the
result of  his  observations  is a decided conviction," "that
what the Italians vaguely call  malaria,  and the English, as
vaguely, marsh effluvium, is  the  primary  source  of  typhus fe-
ver."  In the next page  the Review continues the  subject,
and says, "In tracing back many of the cases,  Dr. A. found
that they had commenced as intermittents ;  he has seen the
remittent run into the continued typhus, and the continued
typhus become remittent or intermittent."*
   What stronger testimony can any one require to prove the
identity of any two diseases, than the fact of their frequent
conversion into each other ?  We have cited abundance of evi-
dence to prove that this frequently takes place in typhus and
acknowledged miasmatic diseases, and it is a fact, too, which
cannot be evaded,  unless by those who are absurd enough to
contend, that a disease which they say is one sui generis and
specific in its character, can change to one entirely different
in its nature and origin.  If there be any such persons, we
will only ask them, if smallpox was  ever known  to  change
into measles, or vice versa,  or cowpox into chickenpox ?
   It has been the common opinion for  a long  time, that ty-
phus fever is a disease exclusively of the winter season, and
hence the  conclusion that  it cannot arise from marsh  efflu-
vium, because  the latter requires for its production, the co-
operation  of heat with moisture.  We, however, deny the
 fact of its being a disease  only of the  winter season, and a
  * This repudiation of a long cherished and favorite opinion is highly ho-
norable to Dr. Armstrong; it shows a mind truly independent and devoted
to truth, and clearly proves that he will not cling to an error, when convinced
of its being such, merely for the sake of consistency of opinion.  Oh si sic
omnes.  It, moreover, speaks volumes against the contagious nature of  ty-
phus.  Dr. Armstrong never would have left the ranks where  he had long
fought as the most distinguished champion, without the most strong and
irresistible reasons for his conversion. 
69
reference to the different works on the subject will support
us in the denial.  Currie and Trotter mention many instances
of its appearance and most extensive prevalence during the
hot weather of summer and autumn, and Armstrong says he
has known it to prevail during the greatest heats of summer.
'Tis true, that it prevails almost every winter, more or less,
among the poor population of almost all the large cities both
in England and this country; but, upon enquiry, it will be
found, that those attacked have most generally been exposed
to the sources of miasmatic exhalation during the preceding
summer or autumn, and having thus acquired a predisposi-
tion to disease, the complicated and depressing miseries of
poverty and want act as powerful exciting causes, and fever
is produced.
   We have now finished the  subject of these pages; we can-
not, however, say to our own satisfaction.  We are conscious
that much has  been left unsaid, the ordinary limits of an es-
say not admitting of any thing like a wide range of discus-
sion.  We have endeavored to cull from the various works
on the subject, the most striking and prominent facts bearing
on the different subjects embraced in  this  essay.  A consi-
derable portion of it has been devoted to an  examination of
the different assumed causes of typhus, because we consider
the possession of correct notions on this subject a matter of
very great importance.  Whether the  conclusions we have
arrived at are  correct or not, must be left to the decision of
others.
THE END. 
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