81 



of fever. Its mode of accession is varied ; fever rages for a few 

 hours or a day, and then its phenomena begin to lower; a short 

 time elapses and there is but little outward token of the deep, silent 

 and destructive changes that are going on. Three or four days pass 

 and the prostration of muscular strength, loss of all elasticity, and 

 contractility of the tissues and muscular fibre ; the passive hemor- 

 rhages and rapid tendency to putrefaction proclaim at once its true 

 and distinctive character. 



"Here are four varieties of acute disease, peculiar, somewhat, to 

 certain terrestrial formations. Can any one possessed of candour 

 and ordinary reasoning powers, examine into their history and fail 

 to see the striking characteristic differences?" 



62. On the deeply interesting subject of congestive fever, Br. 

 Lewis expresses his views. He considers it, as we see in the pre- 

 ceding extracts, as one of the four varieties of acute disease, con- 

 cerning the characteristic differences of which there can be no 

 doubt, and elsewhere he describes it as a pure adynamic fever. In 

 a review of these articles, Dr. Boling, of Montgomery, Alabama, 

 sharply criticises this opinion, and with much force sustains his 

 views of its identity with other forms of malarial fever, only differ- 

 ing so far as the peculiar symptoms of congestion are concerned. 

 Dr. Hart considers congestive fever as in no way a peculiar disease, 

 or one to be treated on any fixed or invariable plan. His conclu- 

 sions are : 1st. That the summer and autumnal fevers of the South 

 and Southwest, are all more or less characterized by periodicity or 

 intermittence ; 2d. That they are all varieties of one and the same 

 disease ; 3d. That the symptoms are so various that no one plan of 

 treatment can be adopted ; each case to be treated with reference to 

 the symptoms. Dr. Bouchelle of Columbus, Mississippi,* ascribes 

 "the leading phenomena of this disease to derangement of the 

 organic system of nerves more particularly. The excitement is 

 irritable in its character, and in most cases so excessive that it 

 soon sinks the system into collapse unless moderated." To prevent 

 this, the proper remedies are narcotics and cold water. To prevent 

 recurrence, the most powerful combination is quinine and morphine. 

 He has never seen the disease assume any other type than the in- 

 termittent or remittent; unless the system sink under the first 

 paroxysm. The most robust seldom survive a second or third 



* New Orleans Medical and Surgical Journal, vol. iii. 



