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1847] His Views respecting the Nature of Yellow Fever. 449
Leone, and if all vessels contracting epidemic disease were to leave the station, and proceed directly to a colder climate, the ratio of mortality, and the permanent loss of health one year with another would be reduced at least nearly onehalf.” P. 178.
And here we must draw our narrative to a close. With a few remarks on the general history of that disease, which, as we have seen, is every now and then apt to prove so terrible a scourge to our brave seamen in their perilous duties-would that success commensurate with the peril incurred, not to say with the sacred justice of the cause, might reasonably be expected !-off the fatal coast of Africa, we shall conclude.
From the following passage it will be seen that the views of Dr. Bryson, respecting the nature of true Yellow Fever, and also upon the important question of its communicability or power of infectious propagation, correspond very exactly with those which we endeavoured to enforce in our last number. He first alludes to the confusion that has been introduced into the nosological returns of the navy, by the adoption of different names applied to the same disease by different medical Officers.
“The bilious remittent of one person was found to be the climatorial of another ; the endemic of a third was the typhus icterodes of a fourth; the adjectives ardent, yellow, congestive, inflammatory, had all been used in describing the same disease. A more simple phraseology was therefore, unless under peculiar circumstances, deemed advisable. The character of these fevers, in fact, is such that the synochal of one day may become a remittent on the next, and probably ere long terminate in an intermittent; the ephemeral of little force may suddenly become one of high vascular action; or at the same time, but in a different subject, pass rapidly through the stage of excitement, and at once enter upon the typhoid, while that which invades with great intensity of action may frequently be of ephemeral existence only. It is therefore obvious that it is not until the fever approaches its termination that it can be brought under any one of the previous heads; consequently in a practical point of view such visionary distinctions are of little or no importance. P. 250.
He then subjoins the important remark :
“ The fevers of Africa, strictly speaking, are only divisible into two kinds ; namely into the remittent and intermittent. The former, however, may be subdivided into the endemic, epidemic, and contagious; but as either of the former, as in the Bann, may be converted into the latter by improper ventilation, the depressing passions, and physical prostration, and as it-the contagious—does not originate or even exist for any length of time except under these conditions, the subdivision is again reduced to two heads—the endemic and epidemic, both of which are remittent, and both generally, according to their persistence, attended with more or less yellowness of the skin, and occasionally in the more severe cases with black-vomit. It becomes a question if the latter be not an aggravated type of the former, in consequence of the more general prevalence of a common exciting cause. Still, from its uncertain modes of invasion at distant periods ; from its apparent restriction to certain bounds; and from its greater severity, the appellative distinction, at least until the subject is better understood, remains strictly warrantable.” P. 250.
Notwithstanding the doubt expressed in the last sentence, the fair and legitimate deduction from all the statements of this volume appears to us to be, that the malignant or pestilential malady, known as the true or genuine Yel. low Fever is but an aggravated and epidemic form of the ordinary and endemic fever of the coast ; this having become-from causes which we but very ima
perfectly understand*-more of a continued type, and being then accompanied with symptoms that are clearly indicative of a dissolved or diffluent state of the blood. That Dr. Bryson regards it as of the nature of Typhus, would appear from his using such expressions as the following in reference to the disease as it existed on board different ships :-"the typhoid stage of yellow fever;" the fever was of “the nature of typhus icterodes ;" it was of " a typhoid character," &c. The deeply altered state of the circulating fluid is alluded to in various passages. For example, we read in one that "the blood, when drawn, is sometimes described as being very dark-coloured, and, when allowed to stand, was loose in its texture, neither shewing a buffy coat, nor separating into serum and crassamentum.” Many similar statements are made in other parts of the volume.
We need scarcely say that not the slightest countenance is given by anything which occurs in Dr. Bryson's Report to the doctrine of the yellow fever being a "nova pestis"; an idea originally suggested by Chisholm, and still, most strangely, believed in by Sir William Pym.
We ve seen that our author recognises the occasional and contingent infectiousness of the disease, by direct effluvia from the body of the sick. No warrant, however, is to be found in his work for the belief that it was ever conveyed or transmitted by fomites. The only instance, in which reference is made to this matter, occurs in the description of the outbreak of the pestilence at Ascension in 1838, soon after the arrival of the "Ætna,” the "Fo. rester," and the “Bonetta,” as mentioned in a preceding page. It was asserted, by certain of the inhabitants of the island, that the infection had been introduced by the clothes of the deceased officers having been sold to some of the people on shore. The following statement will remind the reader of Dr. McWilliam's evidence about the washerwomen at Bona Vista, as recorded in our last number.
“ Sergeant Warren most unquestionably made the most extensive purchases, and his wife took in washing; they both certainly died of the disease, but neither of them was attacked until a late period of the sickness, and both had been attending day and night in the crowded houses of their sick neighbours. Mrs. Scarisbrook was also an extensive purchaser; she was, however, the very last woman attacked, and her husband entirely escaped the disease. George Downes purchased some wearing apparel, which he took to his house, where he had a wife and three children; he has worn a thick watch coat that belonged to the late Lieutenant (who died of fever) on his night watch ever-since, yet neither he nor any of his family have been attacked. They probably owe their immunity simply and solely to their house being situated at a considerable distance to windward of the squares, and at an elevation of several hundred feet. In short, many who were purchasers escaped the disease, while others who did not make any purchases were attacked.” P. 133.
Had our space permitted, we should gladly have followed Dr. Bryson in his excellent remarks on the important question of the Treatment of
* However true this remark may be, as applied to the disease when prevailing epidemically, it is always to be remembered that, in all seasons, the ordinary coast fever will sometimes put on all the phenomena of the worst malignancy, when the men have been allowed to sleep on shore, and have been committing great excesses. These occasional cases, however, never exhibit any tendency to spread. 1847] Remarks on the Treatment of Yellow Fever. 451 Yellow Fever. We very strongly recommend every tropical practitioner to study them with attention. It is quite obvious that no inconsiderable amount of mischief has, not unfrequently, been done by the rash and injudicious adoption of over-active measures—the heroic method of treatment, as it has been absurdly termed-in a true blood-disease, such as the African pestilence unquestionably is. Does not the following statement read a useful lesson to the ultraist practitioner ? At the time when the " Eden” was suffering most severely from the fever, and her medical officer was one of the victims, “ the office of surgeon (there being no assistant) was then assumed by the captain, whose extensive knowledge and long experience of the African climate and diseases, rendered him peculiarly fitted to perform its duties. His treatment of this formidable disease, it is stated, was simple, but more successful than any that had hitherto been adopted. Having witnessed the frequent and fatal result of 'energetic treatment,' he had imbibed a kind of horror of bleeding, and, at the same time, a predilection in favour of mild measures, probably from observing the greater success that attended the simple means employed by the natives and resident Europeans. The abstraction of blood did not therefore form any part of his treatment. He commenced with some brisk purgative, and after its operation, patiently waited for a remission of the symptoms, when he exhibited quinine, and continued its use, until the patient got well; omitting to give it, however, if a paroxysm of fever in. tervened. When diarrhea supervened during convalescence, which was not unusual, he gave calomel until ptyalism was fully established ; after which the patient generally recovered rapidly."
Dr. Bryson dwells with marked emphasis on the pernicious results that have, in many instances, flowed from the too common practice of pushing the mercurial treatment to a most extravagant length. Even when salivation has been induced, and the system has therefore been brought under the influence of the medicine, no benefit has followed.
There seems to be no difference of opinion as to the propriety, nay the necessity, of administering the bark or quinine freely, whenever there is evidence of the accession of the apyretic stage. [Does not this circum. stance alone testify most strongly as to the real nature of the disease ?] But, alas ! in very many cases, there is no distinct cessation, scarcely an abatement, of the pyrexial symptoms, and all medication is utterly profitless. Hence the experienced naval surgeon will often have his mind much more intent upon precautionary and prophylactic, than upon (what are called) curative, measures ; for he knows well that, while much may frequently be done, by the timely adoption of appropriate hygienic means, for the prevention and arrest of malignant fever on board a ship, too often all his professional skill is of little or no avail when the enemy has once shewn itself among the crew. And here we must not omit to mention that several instances are recorded, in the Report now before us, of fever, if not arising directly from, at least being strikingly aggravated both in intensity and frequency by, causes within the vessel itself. The reader has only to refer to pages 224, 228, 229, and 230 to be convinced of this. It will be useful to notice a judicious caution, which Dr. Bryson gives to naval officers, touching this subject :
“ It would be well to avoid, under all ordinary circumstances, attempting to clear out a vessel on the spot where the disease originated; more particularly if there be reason to suppose it has arisen from a foul state of the holds, for by opening and disturbing the various matters contained in them, the cause must necessarily be let loose upon the men with increased force, while the latter, in a state of fear and despondency, being aware of the danger, are rendered more obnoxious to its influence, and brought, by the nature of their duties, more immediately within its sphere of action. It will be time enough, after the entire cessation of the disease, when by a change of climate and diet the general health of the ship's company has become invigorated, and when confidence has been restored, to commence the work of expurgation in the vessel. It is by no means uncommon for an epidemic to become aggravated by opening up the holds of a ship within the tropics.” P. 229. · In concluding our notice of this interesting Report, we would earnestly urge upon all young surgeons of our ships of war the great importance of their keeping an exact and regular account of the health of the crew, and of the origin, progress and decline of fevers and other constitutional diseases on board, with remarks on the influence of all causes, whether these be ab extra or ab intra, whether connected with the nature of the climate, the season of the year, the character of the men's occupations, or in their food or the state of the ship itself, &c. &c. To be of any decided utility, such observations must be continued not for a few weeks or months only, but for several years; for it is in this manner alone that we can ever reasonably hope to understand something more than we yet do of the true history of certain Epidemic diseases ;-—which, be it remembered, are only of occasional and of unforeseen occurrence, and not of an annual or constant prevalence. We say “ unforeseen,” because, as yet, there are scarcely any data to enable a medical man to form even a rational conjecture on the subject. But is it so utterly inconsistent with our knowledge of the operations of nature in respect of climatorial and other atmospheric conditions, that we must never entertain the hope that a discovery may yet be made by some carefully-observing and deep-reflecting medical philosopher to enable us to anticipate, in a measure at least, the recurrence of those fearful visitations of wide-spread disease, to which the term “pestilential” is usually applied ? We think not. At all events, nothing can even be expected to be done in this direction, unless there has been previously accumulated a large store of accurate facts and observations, perseveringly registered during a succession of many years. Hitherto this has been very imperfectly done; and the humiliating reflection abides with us, that we are just about as ignorant of almost everything appertaining to the history of Yellow Fever as our forefathers were.
Stroud on the Death of Christ.
A TREATISE ON THE Physical CAUSE OF THE DEATH OF
CARIST, AND ITS RELATION TO THE PRINCIPLES AND PRACTICE of CHRISTIANITY. By William Stroud, M.D. Pp. 496. Hamilton and Adams : London, 1847.
This is a remarkable work-remarkable alike for the subject of which it treats, and for the admirable manner in which it is written. It displays a great deal of professional research, and, at the same time, no ordinary scholarship in biblical as well as in classical literature. Everywhere it breathes a spirit of pure and elevated religious feeling; the main object and desire of the writer being evidently the simple discovery of Truth, and its practical application to the welfare of himself and others. He has sought to do good rather than to acquire fame, to improve and edify the heart of his readers even more than to enlighten and inform their understandings. His volume is obviously the fruit of long and patient study, and of deep and solemn meditation, such as the importance of its theme demanded. Dr. Stroud has read much, but he has thought more. While he has, with most praiseworthy diligence, perused the writings of very numerous authors on most of the topics connected with his argument, he has always kept his mind unfettered by any mere human authority; and thus he never fails to exercise an independent judgment of his own. His chief study has been the Holy Scriptures themselves; and to them, and to them alone, he appeals as the source of all divine instruction. So much for the general tone and and character of the present work. And here it may be necessary to guard the reader from supposing that it is more curious than instructive, more likely to attract by the singularity of its views than convince by the soundness of its reasonings, or edify by the piety of its reflections. The title of the book may possibly lead some readers to imagine that it deals in speculations that are, to say the least of them, profitless. But this is not the case. It has been no mere curiosity of learning that prompted the author to engage in the enquiry, no idle exercise of his mind, no love of notoriety or distinction. Dr. Stroud has had a much higher and more worthy motive to stimulate him at first, and to direct him throughout his labours. And, has he not found his reward? We feel confident that he has. His labour has not been in vain. He has anxiously sought for the truth; and a striking development of it has been manifested to him. The result of his researches has been, if not the discovery, at least the happy elucidation of certain points in the sacred narrative of our Lord's sufferings which were, before, imperfectly understood, and the right appreciation of which serves to throw very considerable light upon various parts of Holy Writ. This was the chief recompense he sought for; and, trifling though it may seem in the eyes of the multitude, it has a power of inward enjoyment and self-satisfaction which they are little aware of.
The chief object of the work is stated by Dr. Stroud himself to be
“To demonstrate an important physical fact connected with the death of Christ, and to point out its relation to the principles and practice of Christianity; but,