Relapsing fever

“ At the present moment, when the subject of epidemics is attracting so much attention, it may be interesting to call attention to the more important diseases comprised under that head, and to point out some of the main facts connected with their origin and distribution. {422} The principal epidemic diseases, then, are: small-pox, scarlet-fever, measles, typhus, relapsing fever, Oriental plague, yellow fever, diarrhoea, typhoid or enteric fever, cholera, dysentery, ague and remittent fevers, influenza, the sweating sickness, and the dancing mania. ”

“ 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. ”

“ 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. ”

“ Venesection may be used in the distinct small-pox early in the disease, according to the strength or hardness of the pulse; and perhaps on the first day of the confluent small-pox, and even of the plague, before the sensorial power is exhausted by the violence of the arterial action? Cold air, and even washing or bathing in cold water, is a powerful means in perhaps all eruptive diseases attended with fever; as the quantity of eruption depends on the quantity of the fever, and the activity of the cutaneous vessels ”

“ The periodical pains in the head, eyes, ears, jaws, hips, and back, which occur in the sickly autumnal months, and which impart no fulness, force, nor frequency to the pulse, are all misplaced fevers. There are, besides these, many other local morbid affections, which are less suspected of belonging to febrile diseases. The nature of these states of fever may easily be understood, by recollecting one of the laws of sensation, that is, that certain impressions, which excite neither sensation nor motion in the part of the body to which they are applied, excite both in another part. ”

“ 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. ”

“ 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. ”

“ Relapse, or a return of the fever and other symptoms all over again, occurs in about ten per cent of the cases. This may happen more than once, and as many as five relapses have been recorded in one patient. A slight return of the fever for a day or two is often seen, owing to error in diet, excitement, or other imprudence after apparent recovery. Death may occur at any time from the first week, owing to complications or the action of the poison of the disease. Pneumonia, perforation of and bleeding from the bowels are the most frequent dangerous complications. ”

“ One attack usually confers immunity.
Symptoms.—Incubation is about three to four days. There may be a fore-warning period, but the attack is usually sudden, with chills, headache, backache, rise in fever, and general feverish symptoms, vomiting, and constipation. Early in this disease the face is flushed, while the conjunctiva and the mucous membrane lining the eyelids is congested and slightly jaundiced. Fever is 102 or 103 degrees, and falls gradually after one to three days. Pulse is slow, and while the temperature rises, it again falls. ”

“ We have already seen how, in the course of various diseases, the pulse is quickened, and the temperature raised, constituting that state which we commonly call fever, but as the local ailment subsides the fever disappears. There is, apart from smallpox, measles, and the other so-called eruptive fevers, only one real essential fever commonly met with in childhood, and that is what the doctors call typhoid fever. ”

“ 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. ”

“ A favorable termination is indicated by a gradual amelioration of all the symptoms, or sometimes by profuse perspiration, sudden cessation of nausea, rapid return of the pulse to its natural fullness and strength, or other marked event, which seems to indicate a crisis in the disease.
The symptoms of yellow fever vary exceedingly at different times, in different localities, and in different persons. Sometimes a person is smitten with the disease as with apoplexy, falls into a profound collapse, and dies in a few hours. ”

“ 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. ”

“ I wish these symptoms to be remembered by the reader. They will form the corner stone of a system which I hope will either eradicate the disease altogether, or render it as safe as an intermitting fever, or as the small-pox when it is received by inoculation.
Frequent as these precursors of the fever were, they were not universal. Many went to bed in good health, and awoke in the night with a chilly fit. [95] Many rose in the morning after regular and natural sleep, and were seized at their work, or after a walk, with a sudden and unexpected attack of the fever. ”

“ The effects of issues are still more to our purpose. We observe a plentiful discharge of matter from them every time the body is exposed to cold, and the febrile effects of it upon the system are thereby frequently obviated. How far a ratio exists between the degrees of inflammation and the discharge of matter from the arm, and the degrees of fever and eruption, must be determined by future and very accurate observations. If it should appear, that there are the least inflammation and smallest discharge, where there have been the highest fever and most copious eruption ”

“ These periods of metrical fever, so to speak, seem to come on without any apparent immediately exciting cause, and some people succumb to the disease, others do not, just the same as in the cases of cholera, influenza, plague, etc. ”

“ 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. ”

“ When the fever attacks suddenly, it always begins with an uneasy sensation of excessive cold, accompanied with debility and loss of appetite; frequently the cold is attended with shivering, oppression about the heart, and sickness at stomach, or vomiting.
Fevers are divided into continual, remitting, intermitting, and such as are attended with cutaneous eruption or topical inflammation, as the small-pox, erysipelas, &c. By a continual fever is meant 142that which never leaves the patient during the whole course of the disease, or which shews no remarkable increase or abatement in the symptoms. ”

“ 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. ”

“ The rigor stage is relatively less marked; the pyrexial stage is more prolonged, and is often characterized by a tendency to adynamic conditions, together with vomiting, intestinal catarrh, pains in the limbs, anorexia, severe headache, and depression. After apparent recovery from the fever there is a great proneness to relapse at more or less definite intervals of from eight to fourteen days. Such fevers are accompanied by rapid destruction of corpuscles, and are usually followed by marked cachexia. At any time in their course symptoms of the gravest character may declare themselves. ”

“ These differences are sometimes owing to diversities in the constitution and habits of the patient, sometimes to variations in the character of the epidemic, and are sometimes not readily explainable. One of these is the mild form, in which the symptoms are those of moderate fever, and in which the disease may run its course in seven days. In this form the temperature may never rise above 102° F., the eruption be absent or very scanty, and the characteristic stupor or dulness be wholly wanting. Unless complications arise recovery invariably takes place. ”

“ DEFINITION.—A continued fever, occurring in widely-extended epidemics, and due to a specific cause; it is characterized by early catarrh of the mucous membrane of the respiratory tract, and in many cases also of the digestive tract; by quickly oncoming debility out of proportion to the intensity of the fever and the catarrhal processes; and by nervous symptoms. There is a strong tendency to inflammatory complications, especially of the lungs. Uncomplicated cases are rarely fatal except in feeble and aged persons. An attack does not confer immunity from the disease in future epidemics. ”

“ 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. ”

“ And this is the true origin, in many cases, of typhus symptoms; of adynamic fever. The disease is allowed to take its own course; and the product of every fever, at a certain stage of its process, is adynamia: the physician does not perform his office; the disease advances; the restlessness increases; there is no sleep; delirium comes on; muscular tremor begins to be perceptible; the pulse rises; the sensibility diminishes ”

“ In fever we have the tissues and the walls of the blood vessels weakened, we have an increased current of more or less altered blood flowing through the vessels and stagnating in the capillaries, which need but an exciting cause to transform the passive congestion of fever into an active congestion and acute inflammation. These conditions become still more distinct when the fever is accompanied with a decided deterioration in the blood itself, as is seen in influenza, septicemia, and at the termination of severe pneumonias. ”

“ FEBRIS UNDULANS, MALTA FEVER, MEDITERRANEAN FEVER
Definition.— Undulant fever— a disease of low mortality, indefinite duration, and irregular course —is the result of infection by a specific germ, the Micrococcus melitensis. In its more typical form it is made up of a series of febrile attacks, each individual attack, after lasting one or more weeks, gradually subsiding into a period of absolute or relative apyrexia, also of uncertain duration. Common and characteristic complications are rheumatic-like affection of joints, profuse diaphoresis, anaemia, liability to orchitis and neuralgia. ”