Page:The American Cyclopædia (1879) Volume VII.djvu/177

FEVERS 169 occurrence, during the progress of the disease, of dark or purple spots which are caused by small extravasations of blood in the skin. As these spots (petechia) occur in only a certain proportion of cases, and are present in other affections, the name spotted fever is not ap- propriate. Differences of opinion as to the nature and proper treatment of the disease first mentioned gave rise to a violent con- troversy, in reference to which see the fol- lowing publications: Miner and Tully's "Es- says on Fever and other Subjects" (1823); Miner, "Typhus Syncopalis' 1 (1825); North and Strong on "Spotted Fever;" report of a committee of the Massachusetts medical so- ciety in its " Transactions," vol. ii. ; Gallup on the "Epidemics of Vermont;" and Hale on the " Spotted Fever in Gardiner." 6. He- lapsing Fever. Another of the continued fe- vers, now known by this name, has prevailed at different times in England, Ireland, and Scotland, but is rare on the continent of Eu- rope. It prevailed among the English and French troops in the Crimea during the war with Russia. In this country it never prevailed to any extent prior to the winter of 1869-"TO, during which and the following summer it ex- isted as an epidemic in New York and other large cities. The disease was evidently im- ported by foreign immigrants. It is undoubt- edly a contagious disease, but not highly so ; considerable exposure seems to be required. The infecting distance is restricted to a limited area, and it is not certain that the contagium is transported by means of fomites. The prevalence of the disease is aided much by cooperating causes, namely, destitution, depri- vation, and deficient alimentation. From the apparent influence of the latter, the disease has been called "famine fever" and "hun- ger pest." It is developed abruptly, and usu- ally commences with a well pronounced chill, which is at once followed by more or less in- crease of the heat of the body, with frequency of the pulse, and the usual concomitants of the febrile state. Frequently the patient per- spires freely soon after the commencement of the fever. In most cases the fever is intense, the thermometer in the armpit showing a tem- perature frequently from 103 to 105, con- tinuing with but little fluctuation until the paroxysm ends ; that is, for a period varying, in the great majority of cases, from five to seven days. Exceptionally the duration of this paroxysm is as brief as two, or as long as twelve, days. The febrile state subsides abruptly at the end of the paroxysm, when the temperature, together with the pulse, some- times falls below the standard of health, re- turning to this standard after a day or two. The patient remains free from fever for a period varying from two to twelve days, the average duration being about seven days. Then occurs another paroxysm of fever, the intensity of which is sometimes greater and sometimes less than that of the primary one. This relapsing paroxysm varies usually from three to five days, exceptionally lasting only a single day, or extending even to ten days. The relapse is occasionally wanting, and in rare cases a third, a fourth, or even a fifth relapse has been observed. During the paroxysm nau- sea and vomiting are apt to be more or less prominent as symptoms. Sometimes blood is vomited, and hence, among a variety of names, the disease has heretofore been called mild yellow fever. Jaundice occurs in a small pro- portion of cases. Pain in the joints and in the muscles of the loins and limbs is usually a marked feature of this fever. Delirium rarely occurs. There is no characteristic eruption. Important complications are of very unfrequent occurrence. The mortality from this disease is slight, varying in different collections of cases from 2 to 4 per cent. In the fatal cases the death is sometimes due to complications or antecedent diseases; but instances of sudden death from syncope have been repeatedly ob- served, and also from coma and convulsions following suppression of the urine. Persons who have experienced the disease are not ex- empt from subsequent attacks. The fever can- not be cut short by any known means. The first consideration in the treatment is the tem- perature. Relief is obtained by the direct ab- straction of heat through baths, the wet pack or sponging, and by antipyretic remedies. The palliation of the muscular and arthritic pain is the next object of treatment, requiring the use of opiates. Further indications relate to the kidneys, if their action be deficient, and to ali- mentation. The dietetic management, espe- cially when the patient has been insufficiently nourished, is highly important ; and, as in the treatment of other fevers, milk should consti- tute the basis of the diet. 7. Epidemic Ery- sipelas. A fever called epidemic erysipelatous fever, or epidemic erysipelas, and popularly known in some parts of the country by the name of black tongue, prevailed extensively in the New England and the middle, west- ern, and southern states, from 1841 to 1846. Erysipelas often occurred during the course of the disease, but not in the majority of cases; it appeared in different situations, was more or less extensive, and was apt to lead to suppuration, gangrene, and sloughing. In- flammation of the throat (pharyngitis) was a very constant local affection. The disease was not unfrequently complicated with inflamma- tion of serous membranes (pleuritis, peritonitis, and meningitis), and with pneumonia. Sup- puration of the glands of the neck was not uncommon. The mortality was large, owing to the complications just named. Laryngitis and oadema of the glottis were other complica- tions leading to a fatal result. Irrespective of the danger connected with the local affections, the disease was mild, running its course in five or six days. Bleeding and other so-called antiphlogistic measures of treatment appeared to be hurtful. Tonic and supporting measures