Malignant fever

“ In due time it began to be noticed that symptoms which many physicians made light of as a “fit of vapours” were really the beginning of a fever. Dr Blackmore, in an essay on the Plague written in 1721, admitted the ambiguity:
“For several days a malignant fever has so near a resemblance to one that is only hysterick, that many physicians and standers by, I am apt to believe, mistake the first for the last, and look upon a great and dangerous disease to be only the spleen, or a fit of the vapors, to the great hazard of the patient [108] .” ”

“ They have either copied or contradicted each other, in all their publications. Plagues and malignant fevers are still leagued with war and famine, in their ravages upon human life.
To prevent the formation and mortality of this fever, it will be necessary, when it makes its appearance in a city or country, to publish an account of those symptoms which I have called the precursors of the disease, and to exhort the people, as soon as they feel those symptoms, to have immediate [324] recourse to the remedies of purging or bleeding. ”

“ The plague, as has already mentioned, in its very severe state appears most commonly in the beginning of an epidemic season, and is neither very common nor very infectious. The most common mode in which it invades the patient is with the symptoms of a malignant fever; and of cases of this kind Dr. Russel has made up his five classes of patients, the first or deadly kind having been already described. In his second class, the next in malignity to the fatal kind, the disease made its attack with a slight shivering, succeeded by fever with giddiness, vomiting, head-ach, and sometimes looseness. ”

“ During the prevalence of a malignant fever, it will be unsafe to remove putrid matters. A plague was generated by an attempt to remove the filth which had accumulated on the banks of the waters which surround the city of Mantua, during the summer and autumnal months [18] . Even a shower of rain, by disturbing the green pellicle which is sometimes formed over putrid matters, I shall mention in another place, has let loose exhalations that have produced a pestilential disease. ”

“ 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. ”

“ A more aggravated degree of malignity will generate a greater quantity of infection, and, as it may be confined in a larger or smaller space, it will be less or more noxious. A fever332 may be called malignant, when, with the symptoms of debility, there is a cadaverous smell arising from the body, an unusual fœtor of the breath, stools, and other excretions, the tongue black and parched, the eye dusky or yellow, the countenance bloated and dejected, and the skin sallow. ”

“ A malignant fever began among the men, from which few escaped: for however mild or bad soever the flux was for which the person was sent to hospital, this fever almost surely supervened. The petechial spots, blotches, parotids, frequent mortifications, and the great mortality, characterized a pestilential malignity: in this it was worse than the true plague.... Of 14 mates employed about the hospital five died; and, excepting one or two, all the rest had been ill and in danger. The hospital lost nearly half of the patients ”

“ 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. ”

“ This he accounts for from the largeness of the dose of poisons compared with that of contagion; “but (says he) by diminishing the quantity to an appropriate amount, these noxious substances (the poisons) may be made to exhibit the course, duration, and nearly all the phenomena, of what is called a malignant fever. But, above all, the attention of physicians has been diverted from this analogy between miasmata and poisons, by the febrile part of the character which generally belongs to pestilential diseases, and which, in common apprehension, is constantly connected with them. ”

“ The distempers are fevers of the remitting or intermitting kind; for, though sometimes they may continue several days without sensible remission, yet they have in general a great tendency to it. If the season be very sickly, some are seized with a malignant fever, of which they soon die. The body is covered with blotches of a livid colour, and the corpse, in a few hours, turns quite livid and corrupted. At this time fluxes prevail, which may be called bilious or putrid, the better to distinguish them from others which are accompanied with inflammation of the bowels. ”

“ In some cases even the matter formed beneath the skin becomes in some degree contagious, at least so much so as to produce fever of the hectic or malignant kind, as soon as it has pierced through the skin, and has thus gained access to some kind of air; as the fresh puss of a common abscess; or the putrid pus of an abscess, which has been long confined; or of cancerous ulcers.
From this analogy there is reason to suspect, that the matter of all contagious diseases, whether with or without fever, is not infectious till it has acquired something from the air ”

“ He speaks also of a peculiarly fatal form, from which few or none recovered; it was characterised by “small black pustules” on the skin, probably the livid spots or “tokens” which came to be considered the peculiar mark of the plague, and were certainly the index of a malignant type of it, just as the corresponding haemorrhages are in pestilential fever (or typhus) and in yellow fever. The disease, he adds, was swift in doing its work: one day people were in high health and the next day dead and buried. ”

“ When once this Fever begins, it is observed to be of a contagious Nature, and (if proper Care is not taken) to affect those who attend the Sick, or who live in the same Room, and breathe the same Air with them.
Many Authors have reckoned the Malignant, Petechial, and Pestilential, to be distinct Species of Fevers; and have treated each of them under a particular Head. But Riverius [27] has very justly observed, that they all belong to the same pestilential Tribe, and only differ from one another in the Degree of Infection, [56] and the Violence of the Symptoms [28] ”

“ 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. ”

“ There is often a degree of virulence in the Asiatic plague, in the yellow fever, and in all the other forms of pestilential and malignant diseases, which altogether transcends the process of fever, and extinguishes life in a more summary manner. ”

“ Such deviations from uniformity in the works of Nature are universal. In the present instances, they no more invalidate the general proposition of malignant fevers being every where of domestic origin, than the exemption of Ireland from venomous reptiles, proves they are not generated in other countries, or that the pleurisy and rheumatism are not the effects of the alternate action of cold and heat upon the body, because hundreds, who have been exposed to them under equal circumstances, have not been affected by those diseases. ”

“ The term “pestilential” was technically applied to a kind of fever a degree worse than the “malignant.”
Willis, the earliest of the Restoration authorities on fevers, had three names in an ascending scale of severity—putrid, malignant and pestilential. The putrid fevers were what we might call idiopathic, engendered within the body in some way personal to the individual from “putrefaction” or fermentation of the humours; all the intermittents were included in that class, and the theory of their cure by bark was that the drug corrected putridity. ”

“ The contagion, -like that of typhus, appears to be most active in the immediate vicinity of the patient and to be greatly lessened by the access of fresh air. It is capable of being conveyed by clothing. The incubation of the disease is about one week. The symptoms of the fever then show themselves with great abruptness and violence by a rigor, accompanied with pains in the limbs and severe headache. ”

“ As a rule the disease begins with headache, stiffness of the neck and chilly sensations. There may be vomiting, and the temperature is raised. The mind is often confused, and the patient may be delirious. The skin eruption, which occurs especially on the back and about the joints, and which is responsible for the name “spotted fever,” is not very frequently seen, and can hardly ever be detected on a dark skin. In very bad cases there is violent delirium, laboured breathing, and a purulent discharge from the nostrils. ”

“ 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. ”

“ Few escape this exotick contagion, especially in childhood and in cities. It attacks the same persons but once in life; and, with us, is said to be most epidemick in winter.
Morbillous symptoms are fever, impaired appetite, heaviness of the head and eyes, somnolency, catarrh, acrid defluxion from the fauces, nose, and eyes, with hoarseness, sneezing, and lachrymation; short dry cough, and some difficulty in respiration. Prior to the eruption, there is generally anxiety about the breast, palpitation of the heart, itching of the face, peevishness, and considerable fever. ”

“ 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. ”

“ 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. ”

“ They had no other communication with the infected but through the tents.
“These,” says Pringle, “are instances of high malignity. The common course of the infection is slow, and only catching to those constantly confined to the bad air. Sometimes one will have this fever about him for several days before it confines him to his bed; others I have known complain for weeks of the same symptoms without any regular fever at all ”

“ 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. ”

“ There is no real immunity to malaria, it is a continuance of the infection, but the parasites are not in sufficient numbers to give rise to fever. If, however, the patient becomes chilled or fatigued or otherwise depressed, fever results. ”

“ They are at all times too serious to be left, with safety, in the hands of the domestic practitioner. Medical aid, therefore, should be instantly sought for, as much depends on proper management during the first stage of the fever. The approach of this disease may be known, by attending to the symptoms which precede the eruption, in the following order: First, the patient complains of shivering, with a sense of coldness, a thin watery discharge from the nose, hoarseness, cough, and a continued flow of tears from the eyes, which appear red and inflamed. ”