Volume 1

A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases [...] with numerous prescriptions [...] a classification of diseases [...] a copious bibliography with references, and an appendix of approved formulæ [...] / by James Copland.

  • Copland, James, 1791-1870.
Date:
1858
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases [...] with numerous prescriptions [...] a classification of diseases [...] a copious bibliography with references, and an appendix of approved formulæ [...] / by James Copland. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    166/796 (page 146)
    39. The course also of haemagastric pestilence is generally different from that of yellow remittent fevers. The former malady is not only much more sudden in its seizure, but also more insidious, silent, continued, and rapid in its course, than the latter. The one, even in its most intense grades, as I have observed them in Africa, where they are most malig- nant, very rarely ending fatally before the 8th, 9th, or 10th day ; the other generally terminating life before the first of those days, and frequently as early as the second day. Mr. Fkaseh, whose experience of this pestilence in Gibraltar was fre- quent and extensive, observes that a variety of very striking symptoms, rarely seen in the fevers of the country — such as tremors and nervous agitations; singultus ; extraordinary mental aber- rations ; an unexampled range of hemorrhages; affection of the urinary evacuation, vomiiing be- coming seemingly vicarious of urinary discharge ; a peculiar odour perceptible on approaching the sick, this odour being presumed to occasion the infection of the healthy ; quick and perfect reco- veries from violent attacks, with little or no risk of relapse, or of consequent visceral diseases, — suffi- ciently distinguish this malady from all others. He further adds, that the seizure of this malady is characterised by peculiar dejection of counte- nance, pain in the orbits, often attended by a peculiar delirium, similar to the effects of nar- cotics, or of poison on the nervous system, causing algor, tremor, anxiety, sighing, singultus, and sud- den death. The course of it, he says, resembles that of the exanthemata, viz. a synochal stage of sixty hours, suddenly terminating in apyrexia, or running into malignant or putrid symptoms, unat- tended by remissions, but with vespertinal ex- acerbations, and with a fallacious calm, similar to that which marks mortification, and closing gene- rally, in fatal cases, before the seventh day ; re- covery protecting from a second attack. Whilst, on the contrary, endemic or yellow remittent fever is a disease of high arterial action (in the Medi- terranean), with that turgescence of countenance which usually attends pneumonia, with a general sense of fulness in the encephalon, and throbbing of the temple, but with little delirium; is much more prolonged in its course, and accompanied with heat of surface, and often with bilious yel- lowness ; sometimes terminates in intermittent fever, or in visceral disease; is very prone to re- lapse, and second attacks are common. (See art. Fever, §225, et seq.) 40. It is not only upon the characteristic symptoms, continued type, and course of this pesti- lence, compared with those of remittent fevers, that the diagnosis is to be based, but also upon the cause, origin, and propagation of it, — upon its infectious nature — infectious in the sense which I have attached to the term (see art. In- fection, § 13,16.), or contagious, without direct or immediate contact between affected and healthy persons; a properly admitted not to exist in re- spect of remittent fevers, even of the worst forms. This subject, however, as it involves the most im- portant considerations, and as having called forth the most virulent and ungenerous discussions, will receive a fuller consideration in its more appro- priate place. 41. B. Haemagastric pestilence differs from the ■plague, in being attended by more violent febrile excitement; in the absence of carbuncles and buboes, the lymphatic glands being enlarged only in the most intense and fatal cases, and in few instances only ; and in the occurrence of the black vomit, which is very rarely observed in the latter pestilence. Undue importance has been attached to the circumstance of the former appearing during a high degree of temperature, which would put a stop to plague ; for, although haemagastric pestilence generally requires a high range of heat, still it will often continue to pre- vail, after it has become epidemic, during very temperate states of the atmosphere. Doubtless, however, the plague will continue to prevail dur- ing low ranges of temperature — ranges which will altogether arrest the progress of the hajma- gastric pestilence. 42. C. The mdder cases of this malady are distin- guished with great difficulty from common continued fever; for some of these not infrequently assume the form of ephemeral fever, or of simple inflammatory fever ; others, that of bilious or gastric fever ; others, that of the seasoning or ardent fever of Europeans recently arrived in warm climates ; some resemble adynamic fever, and others true typhus. The predominant affection of a particular organ ; the more sthenically inflammatory character of all the symptoms, especially of the pulse ; the more dif- fused pain in the head and forehead ; the states of the eyes, of the evacuations, and of the skin, at- tending injlammatory fever, will readily distinguish it from this pestilence. When this fever occurs in Europeans lately arrived in a warm climate, or assumes a more intense form, or that of seasoning fever, the diagnosis may be much more difficult; especially when, as is not infrequently the case, much biliary derangement and gastric irritability are present. In these ca>es the conjunctiva and skin may become yellow ; and blood may be ex- uded in some instances from the digestive mucous surface, and impart a black grumous character to matters ejected from the stomach, or evacuated from the bowels. Here the diagnosis is difficult, particularly when such cases occur only occasion- ally. Still, the close observation of even a few cases will enable the physician to recognise the character of the disease, which is always preceded by distinct praemonitory symptoms, is inflamma- tory at the commencement, and is attended by a free discharge of bile — phenomena which are not met with in this pestilence. Seasoning fever is, moreover, of longer duration than this malady ; and in many localities, or during or subsequent to the rainy season, generally presents more or less, ' or lapses into, a remittent type, and is often fol- lowed by visceral disease—occurrences which are not met with in the haemagastric malady. 43. D. Haemagastric fever can hardly be con- founded with typhus or typhoid fevers, for the prominent symptoms, the course and duration of each, are altogether different. Dr. Bancroft, whose writings on this pestilence, and on the causes of pestilential diseases, have misled the inexperi- enced, and long mystified many, has stated the circumstances in which the former differs from the latter; but his statement (see p. 51. of his work) betrays a remarkable ignorance both of true vel- low fever and of typhus. Indeed I doubt much his having seen a case of true haemagastric fever when he published his Gulstonian Lectures, de- livered at the College of Physicians in 1805, and which constitutes the substance of his work on