SPOTTED FEVER. 



363 



might hove contributed to produce the disease. But 

 it has never been shown that ergot was more abun- 

 dant in those years in which the epidemic prevailed, 

 than in others; and what is more conclusive, the 

 disease was not confined to those districts in which 

 rye was used for bread. We must, therefore, re- 

 gard the peculiar causes of spotted fever as alto- 

 gether unknown. 



There were two leading forms of the disease. 

 One was a simple fever of a peculiar character. The 

 other was complicated by local inflammation, but 

 still retaining the same general character as the 

 other. The more simple form began, like most 

 other fevers, with coldness, not generally with dis- 

 tinct shivering; pain in the head and hack, and 

 especially in the limbs ; prostration of strength, &c. 

 In the milder cases, this was followed, as in other 

 fevers, with some degree of reaction, manifested by 

 heat, and afterwards by sweating; but, unless aided 

 by proper remedies, the reaction was very imperfect ; 

 the coldness soon returned, with a peculiar want of 

 action over the whole system. The surface of the 

 body lost its peculiar elasticity, and had, in its 

 stead, a torpid, half-cedematous, doughy feeling. 

 Near the close of life, it was covered with a pro- 

 fuse perspiration. The stomach early became irrit- 

 able, and rejected whatever was put into it, though 

 without much vomiting of any thing else. The 

 prostration increased, and was accompanied by vio- 

 lent pains in the back or limbs, which frequently 

 changed from place to place, but without spasms of 

 any kind. In many cases delirium came on very 

 early. In most, as the strength of the patient 

 failed, the mind became obscured, and he died com- 

 atose. In the more severe form of the disease, this 

 comatose state followed the first attack, without 

 any intervention of a stage of reaction : the patient 

 became insensible, and died in a few hours. It was 

 generally in the severe form that the spots, or pete- 

 chia;, appeared, which gave the name of spotted 

 fever to the epidemic. They were not, however, 

 confined to the more violent, or to the fatal cases, 

 but were occasionally found in those which were 

 comparatively mild. Neither, on the other hand, 

 were they, by any means, general in the severer 

 cases. In the earlier periods of the epidemic, they 

 were much more common than towards the close of 

 its progress. When they did appear, the spots 

 were generally small blotches, caused by blood ex- 

 travasated into the cellular membrane under the 

 skin, of a dark purple colour. In many other cases 

 there was a slight eruption of a very different char- 

 acter, which seemed to be caused by the excited 

 state of the skin, where the diaphoretic and stimu- 

 lating mode of treatment was carried to a great 

 extent. 



About the beginning of the year 1812, the spot- 

 ted fever first began to assume a new form, in many 

 cases, by becoming complicated with some local in- 

 flammation. This inflammation was sometimes in 

 the throat, producing a species of cynanche ; but its 

 more common seat was some one or more of the 

 textures of the lungs. The fever, however, still 

 retained the same general character as before ; and 

 in most of the places where this form of the disease 

 prevailed, frequent cases of the more simple form 

 were intermingled with it. The cases with inflam- 

 mation were ushered in, rather more frequently 

 than the others, with a distinct chill; and this was 

 oftener, perhaps, followed by a distinct reaction ; 

 but the general disease did not in these, any more 

 than in the others, retain an inflammatory character . 



On the contrary, it ran speedily into a state of great 

 depression; and when death ensued, it seemed to 

 be less from the influence of the pulmonic symptoms, 

 than from the violence of the general disease. 

 There was pain in the chest, cough, and bloody ex- 

 pectoration; but these symptoms, although some- 

 times severe in the commencement of the disease, 

 rarely retained their prominence so long as to ap- 

 pear to exert a very important influence upon the 

 course of the disease, or to demand much considera- 

 tion in the treatment, beyond what was necessary 

 to give relief to the symptoms themselves. There 

 were many other varieties in the modifications of 

 the spotted fever, for it assumed a greater diversity 

 of forms and appearances than most diseases. It 

 was not always sudden and abrupt in its attack, as 

 we have here described it, but sometimes crept on 

 silently, slowly converting a slight indisposition 

 into a severe and often fatal disorder. In whatever 

 form it appeared, however, it preserved the same 

 general character of great prostration and debility. 



Little is known of its pathological character, ex- 

 cept what is learned by inferences from its descrip- 

 tion and history. Only a few examinations after 

 death were made, and these have done little to en- 

 lighten us in regard to the essential character of 

 the disease. Had they been more numerous, the 

 result would probably have been no more conclu- 

 sive, than that of similar observations, in respect to 

 the nature of fever in general. The blood was 

 found to remain fluid for some hours after death. It 

 consequently flowed to the depending parts, giving 

 a dark colour to the skin in those parts, which was 

 often mistaken by careless observers for putrefac- 

 tion. But putrefaction did not begin early after 

 death. The vessels of the brain, as might be ex- 

 pected from the comatose state which preceded 

 most of the deaths, were found to be turgid with 

 blood, and there was more or less effusion of serum 

 into the ventricles, and sometimes of lymph under 

 {he arachnoid. In the chest, the heart some- 

 times exhibited marks of disease ; its vessels being 

 peculiarly injected with blood. The lungs, in the 

 cases of simple spotted fever, were healthy. We 

 have seen few accounts of dissections in the pneu- 

 monic form of the disease. In some cases, ulcera- 

 tions, of a peculiar character, with v black, gangren- 

 ous edges, were found in the pleura of the lungs, 

 extending deep into the substance of the organ. 

 This appearance can hardly have existed except in 

 the severest form of pneumonic affection. But we 

 do not remember any description of marks of in- 

 flammation in the lungs, which did not involve the 

 serous membrane, although, from the symptoms, it 

 can hardly be doubted that many such cases existed. 

 The abdominal viscera were generally healthy. 

 The gall bladder and the urinary bladder were filled 

 with their appropriate fluids, showing that the se- 

 cretions had been carried on until death. The 

 result of our pathological observations is, that this 

 disease was a fever, having a peculiar tendency to 

 run rapidly into a state of great prostration and 

 debility, and often more or less complicated with 

 local inflammation of an erysipelatous character. 



The practice which had previously been applied 

 to ordinary fevers, was so entirely unsuccessful in 

 the treatment of spotted fever, that many of the 

 practitioners on whom the management of the dis- 

 ease at first devolved, seem early to have lost all 

 confidence, not only in such a course of practice, 

 but also in the resources of professional skill and 

 science, and for a time to have abandoned them- 



