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396 of the first, after two relapses, in each of which the fever was more severe than in the preceding attack, notwith- standing the very liberal and appa- rently beneficial use of wine, the strength was completely exhausted, the functions of the stomach failed completely, vomiting of a black mat- ter like coffee-grounds (very similar to what is described under the name of the black vomit in fevers of tropical cli- mates) came on, and the patient died at the end of the eleventh week. In both these cases, the aphthous state of the throat went off during the progress of the fever, and no other symptom of putrescency appeared. In a great pro- portion of cases, an abatement of the fever has taken place by the fourteenth day ; and in many instances, particu- larly in children, much earlier. In some cases, however, the change did not happen till the twenty-first day. In those in whom the fever proved fatal, death has, as far as I can learn, very rarely taken place at an early period of the disease, but generally at some time after the fourteenth day of its continuance. It is not easy to form any conjecture with regard to the causes of the dif- ferent degrees of severity of the fever in different individuals, for among a number affected, placed in the same circumstances, and apparently having derived it from the same contagion, it has been seen to exist in very va- rious states. The disease has, how- ever, been in general much milder among children than in adults, or in those who had passed the age of pu- berty ; and what appears rather re- markable, it has been in general more severe in those of the better classes whom it has attacked than among the poor. It has been among individuals in the better ranks of life, who had every advantage in their accommoda- tion and treatment, and who previously enjoyed a high state of health, that I have seen and heard of the most vio- lent and malignant cases of the fever. The typhus which has prevailed, has not appeared to have been of a very actively contagious nature ; for though in some few families and situ- ations, in circumstances peculiarly well adapted for the propagation of con- tagion, it spread very generally, yet, in other instances, where but very imperfect means of prevention could fee adopted, it affected only a small part of those exposed to it, and fre- quently did not proceed further than the individual first attacked. Dur- ing the last month, the number af- fected with it has considerably de- creased ; and there seems reason to hope, that a further abatement will take place with the continuance of the fine weather. The unusual circum- stances, however, of the prevalence of a contagious fever, though to an ex- tent which must appear exceedingly trifling, when compared with what takes place in other large towns, or even with what formerly existed in Edinburgh, and of its having attacked several individuals in the better ranks of life, to some of whom it proved fatal, have excited a considerable de- gree of anxiety in the minds of the public; and most unfounded alarms, and exaggerated reports, have spread abroad with regard to the extent and danger of the disease. The discussion which these have occasioned may not be without its use, as it leads to the consideration of the causes which pro- duce the fever, and of the means to be employed for arresting its progress. Among the various causes to which the prevalence of the fever has been attributed, the one which has excited most attention, is the great accumu- lation of the soil from the town, in the dunghills in its immediate neighbour- hood. It is true, that it is by no means sufficiently determined, what the cir- cumstances are under which typhus fever is generated, or whether, any more than small-pox or measles, it is ever excited except by a specific con- tagion ; but, as far as is known, there seems no reason to believe that a con- tagious fever is ever produced by the putrefaction of dead animal or veget- able matter ; and, in the present in- stance, I am aware of no facts which can tend to shew, that the effluvium from the dunghills has had any share in the production or spreading of the fever which has prevailed, while there are many circumstances which go far to establish that it has had no such effect. Besides, when it is considered, that it is universally acknowledged that close and ill ventilated houses, crowded with inhabitants, who, from poverty and want of employment, are debilitated in their bodies, and de- pressed in their minds, are situations most favourable to the propagation of contagious fever, that contagious fe- 1