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AS IT PREVAILED IN THE CITY OF MONTGOMERY, 
ALABAMA, DURING THE SUMMER OF 1866: 
By R. FRASER MICHEL, M. E>. 
Read before the Medical and Surgical Society of Montgomery, Jan. 7, 1867. 
(Published by ordi r of the Society.) 
The city of Montgomery was visited during the past summer by an 
epidemic of break-bone fever, which taxed the energies of the profession 
to their ulmost extent. 
The reader will see, as we progress in the narrative, that we have 
correctly named the disease Many of the most prominent symptoms 
characterizing the summer and autumnal fever of the West India Islands, 
jn 1827, were absent, as well as those marking the epidemic which pre 
vailed in the southern sections of the United States in 1828. 
Prof. Dickson, from whose able pen we derive much that we know of 
dengue, is so clear in his symptomatology of this disease, that we incline 
to the opinion that the epidemic we have just passed through was not 
one of dengue, but rather resembled what Dr. llush has described as 
having occurred in Philadelphia in 1780, and Drs. Dickson, Wraj g, 
Happoldt and Arnold, as prevailing in Charleston and Savannah, in 185U. 
We concur fully in the opinion expressed by Dr. C. ilappoldt in 1 is 
inaugural dissertation, published in the Charleston Medical Journal :or 
1851, when lie says : “ If the essential and characteristic symptoms of 
dengue be, a fever of neaily uniform duration, preceded by arthritic 
inflammation, and succeeded, after an interval, generally regular, by a 
Secondary fever, which is almost invariably attended by a uniform erup- 
tion, and followed by violent pains of a rheumatic character, must it not 
be entirely distinct from a form of disease in which these s . mptoms aie 
either absent, or their order of succession entirely different.” 
The fiist case of break-bone fever in Montgomery, occurred on the 2 
7th of September, 18G6, in the practice of Dr. J., in the person of Mi* 
M. G., who had not left the city for some mouths prior to his attack. I 
was called on the morning of the eighth to see two cases ; one, a captain 
of a steamboat running between Mobile and Montgomery, the other, a 
lady just returned from the Springs, near Macon, Georgia, where she had 
been spending the summer. Here we see that, at the outset, three persons 
were attacke !, almost simultaneously, in the eastern, northern, and mid- 
dle part of our city ; and in ten days one hundred or more cases were 
under treatment. A sudden invasion, followed by such rapid develop- 
ment, that any attempt to trace the disease from patient to patient must 
necessarily end in failure. 
The last case we know of, terminated about the middle of November. 
The epidemic lasted seventy days, being at its height about the middle 
of October. There was hardly a family exempt; many in which not a 
member, white or black, escaped ;—not a house, from those crowning 
the beautiful hills which encircle our city, to the banks of the Alabama, 
but was visited by this searching malady. 
I may mention here, that prior to the occurrence of the epidemic, some 
of the physicians observed a few cases of scarlatina simplex ; these 
cases wrere easily managed, and occurred during the months of May and 
June. In July and August, we had intermittent and bilious remittent 
fever, the type of the latter unusually severe. It is a noteworthy coin- 
cidence that in 1850 the same thing was observed to have occurred in 
Charleston and Savannah ; and, as in 1850 Asiatic cholera again visited 
the North and West, as the cities of New York, Cincinnati and St. Louis 
can testify. 
Most of the cases began Avith fever, Avithout previous malaise or chill, 
accompanied by severe pain in the forehead and small of the back, hot 
dry skin, smoky eye, full but not very frequent pulse; tongue often 
clean, occasionally red, in most of the cases covered with a yellowish 
brown fur, without thirst. This condition usually lasted about eight 
hours, when the patient Avould complain of -violent muscular pains, more 
frequent in the lower than upper extremities, followed by intense nausea 
and vomiting, lasting about twelve hours; the pulse falling gradually 
to fifty or sixty beats in a minute. Profuse perspiration would then 
break out over the entire surface, a slight eruption make its appearance, 
the gastric disturbance disappear, the pains gradually subside, and the 
patient, though weak, be able to resume his usual avocations; fre- 
quently returning to his accustomed place at the desk or behind the 
counter, forty-eight hours after the invasion of the disease; 
indeed, recovering before a physician could be obtained. 
But Avhile this description is a true history of most of the cases (in 
the proportion at least of six out of ten), we observed others of a seArerer 
character. 
These graver cases of break-bone Arere preceded by malaise for two 3 
or three days, followed by chill more or less marked. And here we would 
call attention to the fact, that where the patient had passed through one 
or more attacks of malarial fever during the summer, he would not have 
simple rigor, but a severe chill, lasting in some instances at least an 
hour; then fever would supervene with its usual symptoms—pulse full, 
abrupt, rarely over one hundred to the minute ; skin hot, dry, with a 
reddish hue, indicating tendency to capillary congestion ; the heat so 
pungent, indeed, as to burn the hand when laid upon it. Eyes suffused 
and watery, pain upon moving these organs, especially when rolling them 
upwards, or when pressure was made upon them; sometimes intolerance 
of light was a prominent symptom. 
Pain in the head, frequently supra-orbital, though in some of 
the cases pain of a darting kind was experienced ; and as Dr. Wragg 
has described as existing in some of his cases in 1850, uso severe and 
darting that the patients said they felt as if a sharp instrument was 
thrust through the brain,” and terminating in many cases in delirium. 
Pains in the limbs, particularly in the lower extremities ; not confined, 
however, to the joints, but rather extending to the muscles. These 
pains were so severe as to prevent sleep, and several of our patients 
enjoyed no rest the first two nights of their attack 
The pain in the head produced great uneasiness in the region of the 
ear; and in certain cases a neuralgic affection of the fifth pair of nerves, 
was a characteristic symptom, giving rise to severe tic-douloureux, as 
■well as ear-ache, which was attended in some cases by slight deafness. 
The abdominal pains which we witnessed as occurring in the Charles- 
ton epidemic in 1850, and which very frequently induced us to believe 
that we had a case of gastritis or enteritis to deal with, were entirely 
absent in this epidemic, so far as we are able to discover; and the dysp- 
noea produced by intercostal pain, which was observed as an almost con- 
stant attendant of break-bone, in Charleston, in 1850, was never seen 
during the past summer. The tongue, which at first, was natural, soon 
became covered with a greyish-brown coating; and the foul, disgusting 
taste in the mouth, lasting, in many cases, a week after convalescence 
was established, beggars description—u Oh ! what a taste I have in my 
mouth!” was a constant exclamation. This symptom was, in some 
cases, attended by profuse salivation to such an extent as to cause some 
of our patients obstinately to insist that we had given mercurial prepara- 
tions in the course of our treatment. The continual spitting reminded 
us vei*y much of the Minorca fever of 1733 and 1748, as described by 
Cleghorn ; which, by the way, Dr. Rush regarded as similar to his epi- 
demic fever of 1780, (breakbone). In one instance (Dr. 0.), we are con- 
vinced at least a gallon of saliva was secreted in twenty-four hours. 
Much nausea and gagging occurring in all of these cases, and violent 
stomatitis sometimes supervening ; the abrasion of the buccal mucous local treatment,. We are particular in calling attention to this symptom 
(sore mouth), as in the epidemic in Charleston, in 1850, it was almost 
entirely absent. 
The sense of taste being so much deranged, we were not surprised to 
learn from some of our patients that odors were not recognisable, and in 
others that certain odors predominated ; for instance, one of our female 
patients told us that everything smelt like the muskmelon or cantelope. 
Her idiosyncrasy with regard to that delicious fruit tvas peculiar; she 
detested it extremely, and could detect one if concealed in any part of 
the house. The nausea in almost every instance was attended by pro- 
fuse bilious vomiting, in many cases very persistent, lasting from the 
chill until convalescence. 
What we have so far described may be regarded as the first stadium of 
the disease; in some cases this embraced a period of from six to twelve 
hours, in others from one to three days. We saw no case during the epi- 
demic in which this stage lasted more than three days; while we know 
that in 1850 we would frequently see it cover a space of five. The fever 
now subsiding, a perspiration would be observed covering the entire sur- 
face; sleep soon supervened of a refreshing character, but attended or 
followed by an eruption which would usually cover the face and fore- 
head, extending in some instances over the entire surface, and with it a 
feeling of formication, burning in the palms of the hands and soles of 
the feet. The perspiration just alluded to emitted a very disagreeable 
odor in some few cases. A professional friend informs us that one of 
his patients insisted upon continual change of bed linen, the odor, which 
he pronounced ‘‘intolerable,” he described as of a strongly urinous 
character. i 
The eruption varied in almost every case, resembling in many 
instances that of scarlet fever, and accompanied with a slight anginose 
embarrassment. Then again an erysipelatous blush would suffuse the 
face and hands ; so persistent in some cases as to excite the belief that 
desquamation must result; but passing off slowly during convalescence, 
leaving the cuticle uninjured. In other cases a lichenoid or miliary 
eruption, resembling prickly-heat or nettle-rash, with intense itching, 
would come out; and when this condition obtained in the young sub- 
ject, desquamation was sometimes extensive, affecting the tissues beneath 
the cuticle. A professional friend informs us that in one of his cases, 
his little patient lost the nails of the toes and fingers. We saw no cases 
resembling rubeola, or impetigo, no petechial, variolous, phlegmonoid, 
purpurous, or papular eruption. And while referring to petechia?, let 
us say we did not witness a case of haemorrhage (as we did in 1850), from 
the gums, fauces, stomach or bowels; nor d;d I hear of any during the 
epidemic, except a few cases of epistaxis. 
These eruptions occurred during the second stage in most of the 5 
febrile paroxysm, and extend even into convalescence. They had no 
special predilection for any particular part of the body, sometimes appear- 
ing on the forehead, face, and upper part of the chest, but just as often 
on the extremities or abdomen. In some instances there was no erup- 
tion to be observed, but towards the latter part of the epidemic there 
was hardly a case that did not present it in a well marked degree. 
Our attention was particularly directed to the eruption in the negro 
cases, from what Dr. Dickson observed with reference to this class ; and 
we endorse the fact that very few negroes suffered in this way. We attended 
twenty-three cases among the blacks, and only two presented an erup- 
tion. The erysipelatous blush alluded to above, in some instances 
covered the hands entirely, causing them to become extremely sensitive, 
so much so as to entirely prevent their use as prehensile organs. When 
there was any desquamation, of course the itching of the skin was pre- 
sent ; in some cases severe and intolerable, and attended with swelling 
of the face. 
The convalescence was slow, lasting a week or ten days, with ano- 
rexia. We saw no case during this epidemic which reminded us of the 
extremely slow convalescence of some of our cases of break-bone fever 
in Charleston, in 1850. It was not unusual then for a patient to take 
three weeks or a month to convalesce. Nor did any case under 
our care end in typhoid disease. There was no tottering or 
irregular locomotion; no staggering, uncertain walk, requiring the use 
of a crutch or stick, as we often see in dengue; no stiff affected gait, 
nothing peculiar. When you met a friend whose absence from bis 
accustomed occupation had been obseived, you could not tell by any 
external sign that he had had break-bone fever; you would only ascer- 
tain the fact by making inquiry to that effect. 
And now, the question naturally suggests itself, were there any cases 
of relapse? Very few, we answer, if any. We heard of none, at least, 
and would invite attention in passing, to the fact, that this was a 
common occurrence in the epidemic of break-bone fever in 1850. Dr. 
Wragg, in his able essay on this subject, says : “Another remarkable 
feature of this lever was the tendency to relapse, or the ease with 
which it was brought back by premature exercise, fatigue, or any kind 
of exposure. We have seen it recur under these circumstances, as often 
as three times, and on each return, with marked aggravation of all the 
symptoms. Qften, when the first attack had been exceedingly mild, the 
subsequent ones would be excessively severe, and always of longer 
duration than the first.v Here there is a marked difference between 
the two epidemics of 1850 and 1866 ; we, however, believe the diseases 
were the same, though in some features they may have differed. 
As during epidemics of Asiatic cholera, there are cases (if they can 
be called such) in which slight pain is felt in the abdomen, and even 
considerable borborigmus is apparent without any other symptoms 6 
characterizing this disease; so we saw many patients, who, with no 
fever, had some one or more of the signs of the epidemic disease, as 
vertigo, nausea, syncope, deafness, pain in the head, back and limbs, 
followed by lassitude, the eruption not appearing. We must call these 
cases break-bone fever without the fever, and we incline to the opinion 
that these symptoms were sufficient to give those who so suffered, 
immunity from the severer form of the disease during the epidemic. 
Persons of all ages were subject to the disease—the child at the breast, 
and the venerable elder of four score years, both male and female, 
white and black ; and it creafed surprise to see the aged recover so 
promptly from the effects of the malady; indeed, an old professional 
friend remarked, u that he was going down the hill very fast before he 
was attacked, but since he had recovered he felt better than he had 
been for years, and he believed he was a stronger man.” 
Some of the sequel® in the Charleston epidemic of 1850 were 
absent in this—for instance—the boils, carbuncles and abscesses were 
not found. The enlarged and deformed joints with extensive effusion 
were rarely seen. The remarkable loss of hair was not present in this 
epidemic, and even during the attack some of the symptoms of the 
Charleston break-bone were slight or totally wanting—for instance— 
the intense nervous trembling, which marked the onset of the disease, 
the jerking and twitching during the attack were not witnessed ; and, 
though one case of the disease was ushered in with convulsions, no death 
from this complication was recorded. We heard of no pregnant women 
aborting, as in dengue, from the suffering and pain induced by the 
fever, and though, as we have already noticed, audition was much 
impaired, no case of permanent deafness was observed. During the 
progress of the disease, we saw no case developing those hallucinations, 
resembling the demons of mania-a-potu, so painfully common in 1850. 
On the other hand, we would invite attention to the extreme debility 
and exhaustion in which our patients were left, resembling the epidemic 
just alluded to, and in some cases, when contrasted with the duration and 
want of intensity of the malady, truly surprising. In many cases the 
patient was even threatened with syncope, upon suddenly changing 
from the * horizontal to the erect position, showing the enfeebled 
condition of the heart. 
Pavi passu with the epidemic, we observed many cases of ophthalmia, 
some occurring among our break-bone patients, and appearing as a 
prominent symptom. Most of the cases engrafted upon the epidemic 
disease were quite severe and stubborn in. character—the lids 
extremely granulated, and in some of the severer cases, corneitis, 
sclerotitis, and even iritis, with great photophobia, were observed. 
Upon the causes of the epidemic we will have little to say. The 
atmospheric changes, prior to and during the epidemic, may lead those 
more conversant with meteorology to form some opinion, however, and 7 
we will, therefore, give as accurate an account of them as the limit of 
this paper will permit. 
The spring was peculiarly cold, much more so than is usually 
observed in this latitude, and the cool weather continued into June. 
We had, during this season more rain than usual, and the winds were 
from the southwest almost exclusively. After the middle of July, the 
weather became hot, and continued very hot until the middle of 
September. An old and observant citizen tells us that it was hotter in 
Montgomery during that period than he had ever felt it before, and he 
resided in the place forty-seven years. The thermometer ranged in 
mid-day between 90° and 95°. He called our attention to another fact 
in connection with this heat, worthy of notice. ‘‘That during that 
time we had less thunder and lightning than he had ever known before; ” 
an indication of the peculiar electrical condition of the atmosphere. 
The nights were oppressively hot, the thermometer, in the early part of 
the night, registering usually from 85° to 87° F. During this time, 
that is from the middle of July to the middle of September, the winds 
were westerly and easterly alternately. At! this time, the drought was 
excessive and destructive to vegetation, as the scanty crops demonstrate ; 
and, singular to relate, from the latter part of August to the middle of 
October, during certain spells, that is, when the wind would suddenly 
shift from west to east, heavy falls of rain ensued, deluging the country. 
Slight frost was observed in and around the city on the 5th of 
November, but not severe enough to destroy vegetation, and it was not 
until the night of the 21st of November, that the cold was intense 
enough to kill garden plants. Here our epidemic differed from dengue. 
It did not occur in a pleasant, cool and temperate season, nor did it 
select the winter or early spring, as is its wont, nor were any foggy 
mornings to be observed. 
Whilst treating of the causes of this disease, it is, perhaps, proper to 
add that we had an epidemic of small pox, beginning in the spring of 
1865, and ending in the spring of 1866. This, associated with what 
we have already mentioned, “ that several cases of scarlatina simplex 
occurred during May and June,” would lead us to ask, what impression 
this condition of things could make upon the atmosphere of Mont- 
gomery ? It appears to us that it would be very rational to believe, 
that if we had a fever, the skin would play a very/prominent and 
important part in its history. 
At this point, we would request the reader to examine the chai*acter of 
the summer and fall seasons in Charleston, in 1850, so clearly and 
accurately recorded by Dr. W. T. Wragg, in his paper on Break-bone 
P’ever, as well as the same seasons in Philadelphia, in 178C, 
described by Dr. Rush, and in Montgomery, in 1866, as now furnished 
by us ; and I think a striking parallel will be observed, or, to say the 
least, a very singular coincidence. 8 
During the epidemic, the usual intermittent and remittent fevers 
continued ; they were more extensive in their range, however, covering 
a much larger surface than ever before. Certain localities, which 
hitherto bad been regarded as healthy, and which were used as summer 
resorts by the citizens of Montgomery, were quite sickly this summer, 
and persons did not know where to take refuge to insure health. This 
condition of things (an epidemic of break-bone fever, accompanied by 
intermittent and remittent fever) was very embarrassing, and the 
physician could not be too cautious in pronouncing dogmatically upon 
the various cases which marshalled themselves before him for treatment, 
we saw many cases of the epidemic fever remitting and even intermitting. 
We now come to the most important part of our discussion—the 
pathology of the disease. This is always a difficult question to 
determine with regard to break-bone fever; the fact, that no deaths 
occurred, and that consequently no post-mortem examinations were 
made, is one reason of its obscurity. Xo death occurred from this 
disease during the epidemic, and nearly half the population were 
afflicted with it. 
We incline to the opinion already expressed by others, that the 
disease is located in the nervous system, and that, secondarily, the 
cutaneous surface becomes affected— a nervo-cutaneous affection. That 
the nervous system is first affected, I have no doubt: observe the pain, 
tremor, rigor, delirium and other phenomena already described; then 
the cutaneous system, as is demonstrated, first, by the feeble capillary 
circulation, the reddened surface, the eruptions, the desquamation, and 
the intolerable itching, almost always observed during convalescence. 
IIow any one can confound such a disease with yellow fever, when 
we consider the ursemic poisoning, the terrific haemorrhages from eyes, 
gums, stomach, and intestines and ovaries, which occur in the latter; 
or, on the other hand, with bilious remittent, so well characterized by 
its post-mortem appearances, the inflamed gastro-intestinal mucous 
membrane, the enlarged liver and engorged spleen, seems to us matter 
of surprise. No ! Break-bone fever is a peculiar affection, and one 
which deserves more notice than it has hitherto attracted. 
The epidemic may have been taken for dengue, and to this point we 
would invite special attention. Prof. Samuel Henry Dickson, thus 
describes dengue, page 606, vol. II : “ Dengue usually made its inva- 
sion with pain, stiffness, and swelling of some of the smaller joints, often 
of the muscles of a limb, rigidity of the neck, aching of the back and 
loins. These pains were followed, after an uncertain, though generally 
brief period, by headache, suffusion of the eyes ; abrupt, full, frequent 
pulse ; hot, pungent, dry skin, restlessness, thirst, and other tokens of 
febrile excitement. The fever did not remit, but declined and disap- 
peared in a great majority of cases on the second or third day. In this 
early stage the tongue was generally clean, and the stomuch quiet; but 9 
sometimes there was nausea or even vomiting, the determination to the 
head was occasionally violent. Instances occurred in which delirium 
was among the first symptoms, coming on at the commencement and 
enduring until the subsidence of the febrile paroxysm. At this time 
the skin lost its heat and dryness, becoming relaxed, with abundant 
perspiration, and the local pains were all lessened in degree. A sort of 
miliary eruption, or rash in some persons, attended this sweating stage, 
and in a few others preceded both the local pains and the fever. It 
was, however, as connected with this first stage of dengue, a very incon- 
stant symptom, seeming rather a coincidence than a symptom. The pains 
of the joints and muscles which, as has been said, were diminished in 
severity at the subsidence of the febrile exacerbation, did not go off 
entirely; a degree of swelling, stiffness, and tenderness of the affected 
parts remaining permanently, though varying much in intensity in dif- 
ferent individuals. This condition of things constituted a sort of decep- 
tive interval between what may be described as the first and second stages 
of this strange disease. Many now believed themselves to have passed 
through the attack, and attempted to resume their ordinary occupations ; 
but soon had occasion to discover that their sufferings were by no means 
at an end. On the third or fourth day, there being no fever present, or 
a very obscure degree of it, the tongue Avould begin to be coated with a 
yellowish fur, aud the stomach would become distressed, uneasy and irri- 
table. The patient was now low-spirited, fretful and anxious. Vomit- 
ing come on in some, with great langour, lassitude, debility, and restless- 
ness at night. This was regarded as the most oppressive and insuffera- 
ble of the stages of the malady. On the fifth or sixth day from the 
invasion, the period varying somewhat in different individuals, the 
annoying symptoms just described were relieved by the coming out of 
an abundant eruption, met with so constantly and in so very great pro- 
portion of the cases, that it clearly demands to be considered a charac- 
teristic and essential circumstance in the history of the disease. It con- 
sisted of minute papulae, somewhat elevated, of a florid red, and distri- 
buted in irregularly shaped patches ; the feet and hands being somewhat 
swollen, with a sense of numbness and thickening. It appeared first on 
the face, then on the trunk and thighs, gradually spreading to the 
extremities. It resembled scarlatina more than measles, in the hue and 
aspect of the skin, but was less diffused or confluent than either. When 
fully developed, it was attended with some itching and burning of the 
surface, and at this time a second febrile paroxysm came on, with return 
or aggravation of the muscular and arthritic pains. Inflammation and 
enlargement of the lymphatic glands in the neck, axilla and groin, 
attended in a good many cases ; these parts being apt to continue swol- 
len and painful for some time after convalescence was finally established 
In a few instances suppuration of these tumors took place. The erup- 
tion disappeared after two or three days’ duration, becoming gradually 10 
paler, with some desquamation of the cuticle. Of all the symptoms of 
dengue the affection of the joints was the most tenacious and trouble- 
some, adhering for weeks to some patients, and constituting a sort of 
permanent lameness or loss of mobility. Nay, even so late as 1835, some 
of the population of cities visited by this plague, persisted in speaking 
of the rheumatic or quasi-rheumatic decrepitude and pain under which 
they labored, as the effects of dengue. 
“ Pregnant women, when attacked, were very liable to abortion, and a 
remarkable number of miscarriages and premature labors occurred. A 
sore mouth was among the frequent symptoms, ulcers formed in the 
mouth. Dengue is to be classed properly among the exanthemata. It 
is an eruptive fever of distinct and specific character. Its essential 
symptoms are, in the first stage, a painful affection of the joints and 
muscles; and, in the second, divided by, an interval obvious and 
sufficiently regular, a cutaneous eruption. The arthritic inflammation 
of the first stages was attended by fever of the ordinary inflammatory 
type, of twenty-four to forty-eight hour’s duration. The eruption was 
preceded, as is usual in the exanthemata, by considerable gastric 
oppression, with nausea, and sometimes vomiting.” 
We must regard the epidemic we have described as differing in many 
respects from the dengue, so beautifully portrayed by that accom- 
plished scholar and physician, Prof. Dickson. 
Look carefully at the premonitory symptoms, the kind and severity 
of the pains, which marked the onset, continuance and termination of 
the two diseases. Observe the intermission, not accidental, not occurring 
by chance, but regular, never deviating, always coming to the relief of 
the sufferer, and to be counted with certainty by the hands of the clock. 
Then examine the secondary fever, accompanied always by an eruption 
ll that clearly demands to be considered a characteristic and essential 
circumstance in the history of the disease.” Look at the prompt con- 
valescence of dengue, with the deformed and enlarged joints, the patient 
staggering about, bald-headed, with stick in one hand or crutch in both— 
remark the common accident of abortions and premature labors, and 
then say if this condition of things resembles, however remotely, the 
epidemic we have just passed through. 
We believe that the fever described by Dickson, Wragg, Happoldt 
and Arnold, in 1850, is the disease we had to contend against this summer 
in Montgomery; beginning in the nervous and cutaneous system, and 
not in the ligamentous and fibrous. 
It may not be irrelevant to present at this point the description of 
the epidemic fever which occurred in Philadelphia in 1780, given by 
Dr. Rush : u It affected all ages and both sexes. Medical men would 
seem to have been specially liable to it. No other febrile disease was 
observed during its prevalence. It came on sometimes with rigor, 
seldom with a chill. Many instances occurred in which it was intro- 11 
duced by a delirium. The pains which accompanied it were excessively 
severe in the head, back and limbs ; in some they affected the neck and 
arms, and in one case produced a difficulty of moving the fingers of the 
right hand. Hence the disease wras sometimes believed to be a rheuma- 
tism, but its more general name among all classes of people was the 
break-bone fever. A nausea universally, and in certain instances vomit- 
ing attended. The pulse was full and quick, but never hard ; there was 
little or no thirst. A rash often appeared on the third or fourth day, 
accompanied by a burning in the palms of the hands and soles of the 
feet. Convalescence wras slow and tedious. The disease wras seldom 
fatal. The treatment required was singularly mild.” Now we see in 
this description of Ur. Rush, an almost accurate account of the fever we 
witnessed in the city of Montgomery, in 1866, and in Charleston, in 
1850. 
Frost (as it always has done), terminated the epidemic. After the 
middle of November we heard of no new case. No stranger coming 
into the atmosphere after frost, contracted the disease, although those 
who had spent the summer here were liable to an attack a few days after 
this truly welcome visitor. 
We do think it contagious ;—many cases found their way to the different 
villages and towns in the neighborhood, by railroad and stage, or slowly 
along the beautiful waters of the Alabama ; but we have heard no voice 
echoing its painful though harmless presence as epidemic in any of the 
garden spots of the State. 
The period of incubation varied from five days to a week ; though we 
knew of one patient who was attacked forty-eight hours after his arrival 
in Montgomery. 
The prognosis was, of course favorable, for when a disease never 
destroys life, or leaves any organ of the body seriously damaged, we are 
compelled, no matter how painful or seemingly severe it may be, to pro- 
nounce it harmless. 
We would remark, in this connection, that although cases of bilious 
remittent, some of them congestive, occurred during the summer, we 
heard of no case of break-bone assuming the congestive type; a fact 
worthy of special notice. 
With regard to the treatment of this disease, there is of course little to 
be said; almost all the physicians here treated it according to the 
medecine expectant. 
If we arrived in time to find our patient with chill, warm stimulating 
applications were made to the spine and extremities ; we preferred the 
spirits of turpentine. A warm foot-bath was an excellent adjuvant, and 
with a few blankets thrown over the patient, we awaited the cessation of 
this symptom. During the fever which followed, we did no more than 
attempt to relieve the troublesome symptoms as they arose. If our 12 
times by laxatives, a seidlitz.powder, or a dose of castor oil. In this 
stage refrigerants were freely used ; cool iced lemonade, and sponging the 
entire surface of the body with vinegar and water; cold applications to 
the head, as by shower-bath and ice in bladders to the frontal surface; 
frequently pepper plasters to the temples gave relief. The nausea and. 
vomiting was quieted by sinapisms over the epigastric region, and by 
the internal administration of magnesia or lime-Avater. When the fever 
was subsiding, a Avarm infusion of boneset was ordered ; or, what our 
patients preferred, hot lemonade In some of the cases Avhere an inter- 
mission in the febrile paroxysm was observed, the administration of 
fifteen grains of the sulphate of quinine in divided doses seemed to con- 
trol the disease, and to hasten convalescence. 
In those cases in Avhicli the throat Avas affected, a gargle of the chlo- 
rate of potash was advised, or our patient permitted to dissolve in the 
mouth every hour, until relieved, the chlorate of potash lozcnger pre- 
pared by Hegeman & Co. The detestable taste in the mouth, which 
persisted even after convalescence, is difficult of relief. We found that 
claret Avine, freely administered, gaAre more speedy relief than anything 
else. The administration of opium lessened the muscular pain, promoted 
the action of the skin, and induced sleep. To relieve the neuralgic pains, 
the sulphate of morphia injected hypodermically, proved eminently suc- 
cessful. The application of olive oil and lime Avater, as well as alkaline 
Avashes to the skin, were found the best agents to relieve the burning 
and itching of that sentient surface. 
The epidemic was certainly a mild one, when compared to that Ave wit- 
nessed in Charleston, South Carolina, in 1850; but in all its essential 
features, it resembled the latter so closely, that Ave think we must, without 
hesitation, class it with that form of epidemic fevers which so far seem 
exclusively confined to this Continent. The English and Trench writers 
say nothing of it. As a disease generally recognized, or of Avide-spread, 
or even occasional occurrence, it seems to be unknown in Europe. We 
have therefore thought it not unwise to put the account of this epidemic 
on record, if only for the sake of the future medical historian.