Febrifuge

“ Miliary fever, febris purpurata, rubra and alba, is never epidemick, and is denied to be a primary disease; but is spurious, symptomatick, accessary, or fortuitous; it is very rare, and may be complicated with the nervous and putrid, and with small pox and measles. The miliaris alba is more frequent amongst the female sex, especially during the puerperal state, and in other females debilitated by fluor albus, and hemorrhages, of weak constitutions, delicate, prolifick. It sometimes exhibits previous symptoms of angina, pleurisy, catarrh, rheumatism, erysipelas. ”

“ But there is a grade of fever, which transcends in force that which produces inflammation. It occurs frequently in hydrophobia, dysentery, colic, and, baron Humboldt lately informed me, upon the authority of Dr. Comoto, of Vera Cruz, in the yellow fever of that city, when it proves fatal in a few hours after it attacks. In vain have physicians sought to discover, by dissections, the cause of fever in those cases, when followed by death, in the parts of the body in which it was supposed, from pain and other symptoms, to be principally seated. ”

“ Claiborne, in an ingenious inaugural dissertation, published in Philadelphia, in the year 1798, to be a misplaced state of malignant fever. Dr. Lind mentions likewise the timber of new ships as one of the sources of febrile diseases. The timber of soldiers' huts, and of the cabins of men who follow the business of making charcoal in the woods, often produce fevers, as soon as the bark begins to rot and fall from them, which is generally on the second year after they are erected. Fevers have been excited even by the exhalation from trees, that have been killed by being girdled in an old field. ”

“ The old practice with regard to fevers was to restore the patient to comfort as quickly as possible by getting rid of the fever, that is, by lowering his temperature to normal; at the present time the tendency in medicine is not so much to strive with the result of the poisoning as to seek to rid the body as quickly as possible of the poison and of its source. For that reason modern physicians are much less concerned with the degree of fever shown by the patient than with the extent to which the poisons in his body are being controlled or are becoming masters. ”

“ Definition.— A mosquito - conveyed specific fever occurring usually as a rapidly spreading epidemic and, in typical cases, characterized by a suddenly developed primary fever of about three days' duration, succeeded by a period of apyrexia— actual or relative —and this again by a milder secondary fever accompanied by a rubeoloid eruption. Throughout the febrile stages, and often subsequently, severe rheumatic-like pains are 9 prominent symptom. The disease in its active form lasts about a week and is attended with little, if any, mortality. ”

“ From the fact that parasites are present in the blood during apyrexia, and often in great abundance, it is evident that it is not the mere presence of the parasite in the blood corpuscle that causes the fever; most likely, as suggested, the pyrogenic agent is some toxin which is liberated and becomes free in the liquor sanguinis on the breaking up of the parasite. Consequently, we find that in remittent and continued types of malarial fevers segmenting parasites may be met with at all stages of the fever ”

“ Besides, the removal of the cause is the only radical fever-cure; chemical antiseptics merely palliate the symptoms, as a cloth mantle would smother a fire, till it gets strong enough to break out through cloth and all. Frost kills out flies where arsenic fails. By the refrigeration cure the zymotic disease-germs are, as it were, frozen out: the blood heat of the system is reduced below the temperature which is a condition of their development. The quinine-treatment is an attempt to poison them. ”

“ In those animals in which death occurs within a few days of infection the parasites become very numerous, and, after one or two oscillations of temperature, death occurs suddenly. In those animals in which death is delayed a very striking cachexia is established. There is a chronic recurring fever, the numbers of parasites visible in the blood being greatest during the febrile accessions; there is also a peculiar firm oedema from infiltration of coagulable lymph into the connective tissue of the neck, abdomen, sheath of penis, genitals, and limbs ”

“ It prevails chiefly in cool and cold weather, but is never epidemic; for the excreted matters which produce the fever do not float in the external atmosphere, nor are they communicated, so as to produce disease, more than a few feet from the persons who exhale them. They are sometimes communicated by means of the clothes which have been worn by the sick, and there have been instances in which the fever has been produced by persons who had not been confined by it, but who had previously been exposed to all the causes which generate it. ”

“ He shows, on the contrary, that the atmosphere of a room such as that spoken of in the passage just quoted must have the power of inducing fever in others besides the patient. He even says that "the poison formed by the exhalations given off from the living bodies of those affected by fever is by far the most potent febrile poison derived from animal origin."
Then, it might be asked, of what consequence is it to insist on the disease being non-contagious? If fever-patients can give fever to others, it is a mere matter of words whether you choose to call it "contagious" or "infectious." ”

“ Thus the introduction of another sensorial power, that of sensation, converts an intermittent fever into a continued one. If it be attended with strong pulse, it is termed febris sensitiva irritata, or pyrexia, or inflammation; if with a weak pulse, it is termed febris sensitiva inirritata, or typhus gravior, or malignant fever. The seat of the inflammation is in the glandular or capillary system, as it consists in the secretion of new fluids, or new fibres, which form new vessels, as they harden, like the silk of the silk-worm. ”

“ We have seen that the vegetable or animal poison may exist in sufficient intensity to produce fever on the slightest exposure to it, without the operation of any predisposing cause, in a body in the state of the soundest health, and endowed with the greatest degree of strength. Examples of this kind are but too frequent in tropical climates. In countries where the temperature never rises so high, and seldom continues so long, it is rare that fever is produced immediately, on exposure to the exciting cause. ”

“ However effectual it may be in destroying the volatile and foul excretions which are discharged from the human body in confined situations, as in filthy jails, hospitals, and ships, it is not calculated to oppose the seeds of a disease which exist in the atmosphere, and which are diffused over a large extent of city or country. Mr. Morveau ascribes great virtues to it, in checking the malignant fever [208] in Cadiz, in 1801, but from the time at which it was used, being late in the autumn, there is more reason to believe it had run its ordinary course, or that it was destroyed by cold weather. ”

“ In the worst forms of fever the blood gets so impure that it steams out, through the breath, vapors [450] which are able to produce the same kind of disease in other people, and which are, under these circumstances, termed infection. The infectious poison-vapors of fever get so strong when they are received into close rooms, and are not allowed to be blown away, that they often kill persons who breathe them in that state, very quickly. ”

“ The last instance of supposed contagion of the yellow fever is said to arise from the effluvia of a putrid body that has died of that disease. The effluvia in this case act either as the putrified excretions mentioned under the first head, or as an exciting cause upon miasmata, previously received into the system. A dead body, in a state of putrefaction from any other disease, would produce, under the same circumstances of season and predisposition, the same kind and degrees of fever. ”

“ Peculiarities.—The miliary fever, though not contagious, is an epidemic disease, and sometimes a critical symptom in the autumnal putrid fever. It generally commences its attack with a cold shivering, which is succeeded by intense heat, pain in the head and loins, oppression on the breast, and difficulty of breathing. An itching and prickling sensation is felt in the skin, which, between the seventh and fourteenth days, is covered with numerous small, red, and distinct pimples, that appear first on the neck and chest, and gradually spread over the whole body, excepting the face. ”

“ Pathology.—Yellow fever, dengue and phlebotomus fever have several important points in common, a circumstance suggestive of the possibility of a common or, at all events, a similar origin. Each is transmitted by an insect; their germs occur in the blood-stream and are ultramicroscopic; they are diseases of warm climates only; and, clinically, they are characterized by a short incubation period, a short and rapidly developed fever which is usually associated with relatively slow pulse and leucopenia, with relative decrease of the polynuclears. ”

“ The circumstances which seem to favour the communication of the yellow fever from one person to another, by means of what has been supposed to be contagion, are as follow:
1. A patient being attended in a small, filthy, and close room. The excretions of the body, when thus accumulated, undergo an additional putrefactive process, and acquire the same properties as those putrid animal matters which are known to produce malignant fevers. ”

“ In the more malignant form the fever runs high, 100° to 107° Fahr., and all the characteristic symptoms are well marked: dulness, sunken eyes, eruption on the skin, discharges from eyes, .nose and mouth, shivering fits, difficult breathing, dry, harsh cough, miliary eruptions on the gums, accumulation of bran-like exudate within the lips, fetid breath, with certain nervous phenomena, and dysenteric dejections. Death generally occurs in four or five days, the course of the disorder being more rapid with animals kept in sheds than with those living in the open, and in summer than in winter. ”

“ Recovery is practically invariable. Young rats are more susceptible than old rats. Immunity persists for many months.
Rabbits and guineapigs are refractory.
Immunity.—— Sabritschewsky in 1896 showed that when equal parts of spirochæte-infected blood, or serum, and normal serum are mixed, the spirochætes survive longer than when the infected blood is mixed with that of an individual who has recovered from relapsing fever. He accordingly concluded that the cause of the crisis in relapsing fever and of subsequent immunity was the development of a germicidal substance in the blood. ”

“ That such a cause exists, he proves from observing that “of any number of men, one half of whom go near a person ill of a fever, and the other half do not, a greater number of the former will be infected, in a short period afterwards, than in those who do not.” He says he has known, in such circumstances, seven out of nine infected with the disease. This infection is not discoverable by smell or any other organ of sense; neither can the greatest attention to cleanliness disarm it of its malignity. ”

“ After a few hours, or within a day, the fever begins to rise rapidly and is often associated with shivering attacks. The face now becomes hot and flushed, the conjunctivae markedly injected, the pupils dilated, and the eyes rather staring. The temperature is as a rule from 102° to 104°F., occasionally higher, with a tendency to rather marked remissions and, on the whole, of great irregularity of the fever curve. The pulse is rapid and shows early indications of the extreme toxic effect exercised upon the heart. Cardiac weakness is a marked feature of plague. ”

“ It is well known that the poison which, in a certain state of concentration, produces fever with the ordinary period of duration, in a higher state of concentration produces instantaneous death; and that, in certain climates and seasons, it is not uncommon for persons previously in sound and vigorous health, on exposure to that poison, to sicken and to die in a shorter space of time than is requisite, under ordinary circumstances, for the mere formation of the inflammatory process. ”

“ When the fit is prolonged and periodicity is marked by only a slight fall of temperature, a slight sweating, a slight feeling of chilliness, the fever is said to remit to be a remittent. Sometimes there is no remission; such a fever is said to be continued. It occasionally happens that two distinct pyrexial attacks come off the same day; such a fever is said to be double. All sorts of blendings of malignant infections, benign tertians, and quartans occur; in such the infection is said to be a mixed infection. ”

“ In like manner small-pox is a fever attended with a peculiar eruption upon the skin, which eruption modifies the disease in a very remarkable manner, and gives it a history and progress peculiarly its own; but it is as much a genuine fever as typhus, and ought no more to be taken out of this class on account of the eruption upon the skin, than scarlatina, which likewise modifies, in a very considerable degree, the whole train of febrile symptoms, and is attended with a peculiar condition of some exceedingly important internal organs. ”