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extreme distress, capable of propagating itself by contagion or infection?

Your description of the disease certainly appears to me the most graphic I have seen. rience, you will say, have I had of the disorder, to entitle me to form any opinion of the merits of that description? The disease has not prevailed, as an epi. demic, in Jamaica, since my arrival; and no disease, called by the name of yellow fever, exists, as you are aware, in the Levant. But a marsh fever, of a bilious kind, remittent in its type, and not inflammatory, but characterized by great nervous irritability, does exist in one of the eastern suburbs of Alexandria, and is called by the Arabs the date-tree fever, from the circumstance of the fever, at certain seasons, occurring whenever a village is surrounded by groves of datetrees. It prevails, likewise, in Damietta, in the neighbourhood of the rice.grounds, which are kept inundated during the growth of the plant; and this fever is called by the Levantine doctors, the pernicious fever (febre perniciosa), and, by us, bilious remittent fever, but in a form greatly aggravated by local circumstances. This fever is generally fatal from the seventh to the ninth day : it is ushered in with shiverings, vomiting, and great engagement either of the head or stomach, but seldom both these extreme symptoms at the same time. I have seen a great deal of this fever, and have been often exceedingly puzzled about it; sometimes from the black sordes about the teeth and lips, and other similar symptoms, having been inclined to treat it as typhus, or putrid fever. I am inclined to think that, if this was not the true yellow fever of the West Indies, it was a modification of it, or, in other

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words, that bilious remittent fever is only a milder form of yellow fever.

“ But the circumstance which principally induced me to write to you on the subject was, the extraordinary coincidence of your description of the symptoms and appearances of yellow fever, with that of those phenomena in plague, some account of which I have for. merly given in • Travels in the East.' I refer to that account with the hope of leading your attention to this subject, for the purpose of endeavouring to ascertain in what particulars those violent disorders resemble each other, and whether in both, the vital: powers are overwhelmed by the agency of a similar miasma, or are affected by those of a different nature in a similar manner.

“In my account of the plague, I endeavoured to show that the disease was one not of an inflammatory but of an asthenic congestive kind; that the miasma (whatever its nature might be) acted as a direct poison on the nervous system ; that the circulation was overpowered by its influence; and that congestion was the consequence of that depression of the nervous energy. The indication I contended was the restoration of that influence, and the removal of that congestion. Subsequent experience, or, at least, reflection, has put it strongly into my mind, that in all those violent forms of disease which are either epidemic or contagious, such as plague, cholera, yellow fever, and typhus gravior, where the vital powers are suddenly depressed, and the type of the disease is not inflammatory, the shock has been given by a specific poison (call it what sort of miasma we please, arising from the decomposition of animal or vegetable matter) to

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the nervous system : and it is not by sudden impressions on the vascular system that salutary effects are to be produced; I mean, it is not by extracting blood, except in such a moderate way as to relieve congestion, that the powers of life are to be rallied, or nature fitted to struggle with the miasma that oppresses it. With these sentiments you may imagine with what interest I read your remarks on the proximate cause of this disease. Instead of ascribing it, you say, to a general phlogistic diathesis, or to local inflammatory action, you are inclined to attribute the proximate cause of fever to disordered nervous action, and are of opinion that the poison accumulated in the body acts on the brain or medulla spinalis, which you consider the principal seat or source of life in the animal inachine.

“So far, Doctor, your experience of a disease, one of the most formidable of all others, and mine of one which probably stands next to it in point of virulence, have certainly traits of affinity which seem to me worthy of examining into. The symptoms, you say, of yellow fever are—nausea ; pain in the forehead, loins, and limbs; and pain in the epigastrium ; despondency and great prostration; thirst generally ardent; countenance of a dull red, resembling that of a drunken man ; the eyes suffused and watery, the temperature increased, but the heat evanescent; the skin often moist, but 'constricted; the tongue sometimes clean throughout the disease, but commonly covered in the progress of the fever with a thin yellow or brown sordes, but seldom dry; pulse from 90 to 110, sometimes full and soft, but in general obscure, and not unfrequently liquid ; then a remission always · within thirty-six hours; subsequently feverisbness, great restlessness and coma, vomiting of a sour, bitter ropy fluid, and increased pain about the epigastrium; yellowness of skin, hands purplish and cold, but great heat about the epigastrium; a cadaverous smell from the body; great thirst; dark hæmorrhage from the gums; the fluid from the stomach streaked, and finally like coffee-grounds ; delirium mild, and from which the patient could be easily roused; patches of purple over the body; hiccup ; paralysis of the muscles of deglutition ; small boils occasionally of the nature of carbuncles, about the elbows; coldness of extremities; countenance a sallow bloated withered look; either increased coma, or the senses retained to the last, many requiring by force to be kept in bed; great difficulty of breathing, and eventually death.

Now, do me the favour to put down this letter, and turn, as Abernethy would say, to page 251 of my book, vol. i. and, if you do not find, with few exceptions, those identical symptoms, and some even expressed in the same words, in the description I have attempted to give of plague, I am greatly mistaken. If the symptoms of the two diseases, in many important respects, prore similar, the treatment must be so likewise, with the exception of the greater necessity that exists in yellow fever, of obviating, at the onset, any tendency to determination to the brain. With this view of the disorders in question, I have ventured to make those queries I have addressed to you at the beginning of this letter.

Yours, my dear Sir,
Very truly,

"R. R. M."

The Doctor was labouring, at the time he received this letter, under an attack of letter-writing hatred, and preferred giving me the following oral answers to some of my queries :

Query-Did you ever see bilious remittent fever merge into yellow?

Answer-They are both types of one disease. I have seen the former become what is called yellow fever, and again become remittent towards the termination of the disease, when yellow fever usually proves most fatal.

Query-Do you consider yellow fever a contagious disease ?

Answer-I believe it is not contagious.

Query-Do you believe it may ever become so by local circumstances, of an unfavourable nature to the health of those about the sick ?

Answer--An ill-ventilated room, or a crowded ship, and want of cleanliness, for any length of time, I have no doubt might render it contagious.

Query-Are women less subject to it than men, or the aged than the young ?

Answer-Women, on account of their more temperate habits and less frequent exposure to the sun, are much less subject to it than men: young people, and new comers, are much more susceptible of the disease than the aged, and the accustomed to the climate.

Query—What time does it prevail ? and how is it influenced by climate?

Answer—From July to September, in the hottest months, it mostly prevails; but straggling cases of yellow fever are always to be found in Jamaica except in the mountainous districts, where at a certain elevation it is



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