THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 MRS. PRUDENCE W. KOFOID 
 
PNEUMONIA: 
 
 ITS SUPPOSED CONNECTION, 
 
 PATHOLOGICAL AND ETIOLOGICAL, 
 
 WITH 
 
 AUTUMNAL FEVEES; 
 
 INCLUDING 
 
 AN INQUIRY INTO THE EXISTENCE AND MORBID AGENCY 
 
 MALARIA 
 
 BY 
 
 R. LA ROCHE, M. D., 
 
 MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY; OP THE AMERICAN MEDICAL ASSOCIATION; 
 
 FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA ; CORRESPONDING MEMBER 
 
 OF THE IMPERIAL ACADEMY OF MEDICINE, AND FOREIGN ASSOCIATE OF THE 
 
 MEDICAL SOCIETY OF EMULATION, OF PARIS J OF THE ACADEMIES OF 
 
 SCIENCES OF TURIN, COPENHAGEN, STOCKHOLM, AND NANCY; OF 
 
 THE MEDICAL SOCIETIES OF MARSEILLES, LYONS, 
 
 ETC., ETC. 
 
 PHILADELPHIA: 
 BLANC HARD AND LEA. 
 
 1854. 
 
Entered according to the Act of Congress, in the year 1854, by 
 BLANCHARD AND LEA, 
 
 in the Office of the Clerk of the District Court of the United States in and for the 
 Eastern District of Pennsylvania. 
 
 PHILADELPHIA: 
 
 T. K. AND T. G. COLLINS, PRINTERS. 
 
TO CHARLES D. MEIGS, M.D. 
 
 DEAK DOCTOR : 
 
 To no one more appropriately than to yourself can I dedi 
 cate this volume. The innumerable marks of friendly, and indeed 
 affectionate regard, I have received at your hands, and the devoted 
 professional care you have taken of me and mine, by day and by 
 night, during a period extending over more than a quarter of a 
 century, and amid many painful trials through which a kind Provi 
 dence has enabled me to pass, entitle you to this trifling return. 
 May I trust you will receive it as a token of the sincere affection 
 I entertain for you ? Greatly do I wish I could know, or even 
 think, that the volume which I here place before you were fully 
 worthy of your acceptance. Before one line of it was prepared for 
 publication in its present form, I had decided, as by the result of 
 an instinctive impulse, to enhance its value by placing your honoured 
 name at its head; and no one who can appreciate the feeling which 
 prompted me, will needs be told that I have striven on that account 
 to render the book what it ought to be. The effort may possibly 
 I. fear will certainly be thought by intelligent medical readers to 
 have proved abortive. The results of my thoughts and researches, 
 of my serious reflections and careful observations, may perhaps fail 
 to meet the expectations of even the few indulgent professional 
 friends who were apprised of my intention to appear before the 
 public in this, to me, new capacity. But, should my volume meet 
 the fate which many like it have suffered, and many more deserve 
 to suffer, at the hands of the tribunal to whose decision all produc 
 tions of the kind must be submitted should it be soon consigned 
 to oblivion I shall feel neither disappointment nor regret, provided 
 I can be certain that you have received some gratification at my 
 having selected you as its sponsor. Would it could prove the 
 worthy rival of the great, and unfortunately unfinished work of 
 
iv LETTER TO CHARLES D. MEIGS. 
 
 our common illustrious friend, the late Dr. Drake, whose loss we 
 cannot cease to deplore, and of whose reputation every member of 
 our profession in this country must be proud. But this I could no 
 more hope than you could expect ; and I must be satisfied if my 
 unpretending production can be read by you, and other medical 
 men whose opinions are entitled to confidence, with some mani 
 festation of approbation. 
 
 It cannot but be a matter of astonishment to you, who know 
 something of my tastes and habits, and of the tardiness and even 
 reluctance I have heretofore shown in preparing for publication 
 materials long ago collected and arranged on a favourite and im 
 portant subject, that I should so unexpectedly alter my course, and 
 place before the public a work treating of a topic on which, two 
 years ago, I had no more intention of writing than I have now of 
 composing a practical treatise on your specialty. But so it is 
 Uhomme propose, et Dieu dispose. Here I am laying aside the results 
 of a labour of years, and troubling that very same public with a 
 work of questionable interest on a subject only indirectly connected 
 with that of my former researches. A fc\v words in explanation 
 of my reasons for so acting may not be out of place. 
 
 The present volume, like some better ones, has grown to its 
 actual respectable dimensions from very small beginnings. The 
 first step in its production was the writing of a friendly letter of a 
 dozen pages, to a most valued friend, who holds an important posi 
 tion among the physicians and teachers of a distant State, in review 
 of a clever essay by him, on Pneumonia. In the course of a cor 
 respondence which ensued on the subject, I prepared and for 
 warded another and much longer letter, in which some of the views 
 set forth by him were critically examined. Soon after, those com 
 munications were, at the suggestion of several friends, converted into 
 Essays, and published in successive issues of the Charleston Medical 
 Journal. There they attracted the attention of some physicians, 
 whose views on the various topics treated of coincide with mine, 
 and were noticed with commendation in a few medical periodicals. 
 From various quarters, I received the advice to publish them in a col 
 lected and more permanent form. I shall not stop to inquire whether 
 this advice was impartial, or whether it was not rather founded on 
 an unmerited estimate of the importance of the Essays, resulting 
 from the disturbing influence which personal attachment is so apt 
 to create under circumstances of the kind ; for on a question con- 
 
LETTER TO CHARLES D. MEIGS. V 
 
 cerning the value of my own production, I leave the decision to 
 others. But, however this may be, after some hesitation, I yielded, 
 perhaps unwisely, to that advice, and lost no time in preparing the 
 whole for the press cutting out, adding, rearranging, and often 
 rewriting. I am not sure that by these changes I have improved 
 the original publication. On that score, indeed, I have had mis 
 givings, and at times entertained serious thoughts of consigning the 
 whole to the flames. But again I submitted to the decision of those 
 in whose judgment I repose confidence. Encouraged by their opin 
 ion, I dare hope that if, by acting as I have done, no improvement 
 in the original text has been effected, I shall, at least, not be taxed 
 with having augmented the many blemishes it already contained. 
 
 "While entertaining this hope, I cannot help fearing that my pro 
 fessional readers, and yourself among them, will disapprove of the 
 result of my labours, when it is perceived that, instead of curtailing 
 the many redundances, omitting the facts of doubtful importance, 
 abridging the lengthy statements, and expunging a large amount of 
 the references embodied in the original publication, I have added 
 fresh materials to the stock. Not less do I fear that I shall be 
 censured for not having taken adequate pains to elaborate the 
 whole, to class properly and clearly the various topics examined, to 
 avoid enlarging unduly on some points, and slurring over others, 
 as well as to correct and polish the language. 
 
 But although ready to admit that in these matters the volume is 
 amenable to the censure of tasteful readers, and fairly exposed to 
 the lash of the critic, I cannot but think that those who honour me 
 with an attentive perusal, will abate somewhat of the severity of 
 this judgment, when they reflect that the main object of the work 
 was, not to produce an elegant and finished composition, but to 
 point out the erroneousness of views entertained by respectable 
 writers on certain pathological and etiological subjects; that this 
 could not be more successfully done than by accumulating as many 
 facts as possible, with a view to sustain each limb of the argu 
 ment; and that, in order to impress on the mind of the inquirer an 
 idea of the appositeness and authenticity of those facts, and to 
 enable him to verify their accuracy, it would be advantageous to 
 give them mostly in the language of their reporters, and to state 
 exactly where the records of theni were to be found. 
 
 In reference to the want of artistic skill displayed throughout 
 the entire volume, I can only express my regret. No one is more 
 
vi LETTER TO CHARLES D. MEIGS. 
 
 aware of the defect than myself. Nor shall I deny that the charge 
 respecting the absence of a proper classification, and the dispropor- . 
 tionate extent allotted to some of the subjects treated of, at the ex 
 pense of others, is well founded. I feel especially that I might, 
 without detriment, have disconnected the long inquiry relative to 
 the existence and morbific agency of malaria in the production of 
 autumnal fevers from the rest of the work, have given it a separate 
 and independent form, and published it apart ; or, what would per 
 haps have been still better, omitted it altogether; and, taking for 
 granted what is not far from the truth that nearly every one 
 admits the existence and agency of a febrile poison, have proceeded 
 in the argument without troubling myself with the denials of a few 
 opponents. Such might, perhaps, have been my course, but I 
 thought otherwise at the time; and, indeed, think so still. In order 
 to sustain the position I had assumed, it was necessary to show 
 that pneumonia, which some writers regard as a mere form of 
 autumnal fevers, arises from causes distinct from those to which the 
 latter diseases are due ; and it appeared to me that this could not 
 be better done than by first inquiring what those causes really 
 were, and then showing that, while pulmonary inflammation is pro 
 duced by a certain set of agencies, the fevers in question are the 
 offspring of a specific gaseous poison. But, at the same time, it 
 occurred to me that, as some of the advocates of the identity of 
 those diseases disbelieved the existence and ignored the agency of 
 this poison, my task would be unfinished were I not to demon 
 strate their errors on this point. Influenced by these views, I set 
 to work ; facts, and what I may, perhaps wrongfully, consider argu* 
 ments, accumulated under my pen, and the result has been the 
 strange compound I to-day lay before you, and for the many im 
 perfections of which I solicit your kind indulgence. 
 
 I need not tell you for you will easily perceive on casting 
 your eyes over the following pages that I have not aimed 
 at offering anything new ; that it has not been my object to 
 start a new theory or hypothesis, and to establish it on grounds, 
 and by facts, heretofore unknown, and by the help of arguments 
 equally unheard of. So. far from this, I have no hesitation in 
 stating that the idea of claiming credit for originality has never 
 entered my mind. All the credit to which I think myself entitled 
 if any can be legitimately considered due lo me is for having 
 collected, within a comparatively small compass, the main facts 
 
LETTER TO CHARLES D. MEIGS. vii 
 
 bearing on the question at issue, derived from reliable sources in 
 various sections of the globe, and from the results of my own per 
 sonal observation ; for having examined, to the best of my ability, 
 the subject in all its bearings; for having demonstrated, in as for 
 cible a way as I have been able, that the idea of the identity under 
 consideration is founded on insufficient and incorrect data, and is* 
 in fact, little more than a dream of the imagination; and, at the 
 same time, for having proved that etiologists who regard the various 
 forms of autumnal fevers as due to the action of particular poisons 
 floating in the atmosphere of specific localities, have just cause for 
 entertaining that belief. This, I repeat, is all I have attempted to 
 perform. 
 
 Nature has, I think, given me a decided taste for certain inves 
 tigations a large share of power of application some degree* of 
 aptness, as I have been told, to observe and reason correctly. At 
 the same time, circumstances have often been such as to allow me 
 leisure to indulge my inclination for research; while, during the 
 third part of a century that I have been attached to the medical 
 profession, my opportunities for observation have neither been few 
 nor neglected. But to originality of thought, or the ability to make 
 striking discoveries, I can lay no claim. Indeed, were I so gifted, 
 I am not sure that I should not endeavour to restrain the exercise 
 of these powers, for fear of entering into the boundless field of hy 
 pothesis. On this subject my mind has long been made up; and 
 from all I have seen, I can entertain no doubt, that more good is 
 to be effected by a patient accumulation and comparison of im 
 portant facts, and by endeavouring to draw from the whole correct 
 philosophical deductions, than by adopting a different course, too 
 common among the professional writers of this country and else 
 where ; who, discarding the results of the experience of former 
 and present times, and relying exclusively on their own too often 
 scanty observations, make up for their other deficiencies by an 
 indulgence in : theoretical explanations ; and sneer at the patient, 
 slow, and cautious observer, and the erudite student. That the 
 tendency to the course here adverted to is displayed by a goodly 
 number of physicians among us is, as you know full well, too true to 
 be denied. It,.has long been to me, and to others on whose natural 
 good sense, souud.iudgment, and medical scholarship we may rely, 
 a source of deep solicitude ; threatening, as it does, if allowed to 
 continue unchecked, to affect injuriously our literary and scientific 
 
Vlll LETTER TO CHARLES D. MEIGS. 
 
 character, and to retard the advancement of useful professional 
 knowledge among us. The picture I have drawn is not exaggerated ; 
 and the history of medicine clearly shows that those who have im 
 proved the scientific and practical department of our art, have, with 
 few exceptions, been men, not of lively imagination and inventive 
 powers of mind, but careful and industrious observers; men of 
 sound judgment, and of well-read and cultivated minds. 
 
 Indeed, this subject is so important and interesting, that I trust 
 it will justify my taking this opportunity to offer a few remarks on 
 some of the leading circumstances which have exercised an injurious 
 influence on medical literature and professional knowledge in this 
 country, and which it ought to be the aim of every true votary of 
 our art to modify and remove. 
 
 Compared with that of Europe, whether of Germany, France, 
 England, or even Italy, the medical literature of the United 
 States may be said to be as yet in a state of infancy. This is true 
 both as regards the number of original publications which issue 
 from the press, and their practical importance, scientific character, 
 or literary merit. It would be unnecessary, and out of place, to 
 dwell here on the causes which have contributed to produce this 
 result; but, be they what they may, that result is placed beyond 
 the possibility of doubt; for no professional reader can have failed 
 to perceive that, although original treatises, monographs, and elabo 
 rate essays on various branches of medical science, have appeared 
 on this side of the Atlantic, their number is comparatively limited; 
 and it is a fact which no one here will venture to deny that, while 
 some of these would do honour to any country, the greater number 
 are not of such a character as to entitle them to general commenda 
 tion and lasting attention. Not less readily will it be admitted, by 
 those who take an expansive survey of the minor medical produc 
 tions of this country, such as original essays of small size, either 
 issued in a separate form, or as contributions to periodical journals, 
 that, although more numerous than the former class, they seldom 
 add anything to the character of our professional literature, and ex 
 hibit even less merit, both in reference to the matter they contain, 
 and the manner in which they are written, than might have been 
 anticipated when we consider the multitude of physicians scat 
 tered over the vast extent of this country, the unlimited opportu 
 nities for collecting observations of interest and value within their 
 reach, as well as the sound sense and the capacity for practical and 
 
LETTER TO CHARLES D. MEIGS. ix 
 
 scientific investigation which form attributes of the American mind. 
 With these facts before him, every American physician who is alive 
 to the honour, dignity, and interest of his profession, will unite in 
 the opinion that we have, so far as medical literature is concerned, 
 a character, not to uphold merely, but to establish; and that conse 
 quently it behooves him, while neglecting no means to improve 
 himself in the various branches of medical science, to shun care 
 fully, and to reprove in others, every practice which may, in any 
 degree, retard the accomplishment of so desirable an end. 
 
 It would be impossible, in the space allowed me on this occasion, 
 to point out in detail the several baneful influences here alluded to ; 
 let it suffice to dwell on two of the more prominent. It is not un 
 common to find inexperienced medical writers in this country as, 
 indeed, elsewhere hazarding, on physiological, pathological, etio- 
 logical, or practical subjects, opinions completely at variance with 
 those which the enlightened portion of medical men, throughout 
 the civilized world, regard as placed Beyond the reach of cavil or 
 disputation, or, at least, as entitled to the most respectful considera 
 tion. Some, in their dissent from the current opinion of the medi 
 cal world, content themselves with throwing out a simple conjecture, 
 or perchance pronouncing a positive statement. Others, more am 
 bitious, bring forward a complex theory, or do not hesitate to enter 
 upon systematic developments. Nor is it less common to find these 
 scientific aspirants upholding their novelties by an ostentatious dis 
 play of argument, by an appeal to collateral illustrations, and by a 
 triumphant reference to facts of a more or less apposite character ; 
 the whole seasoned with a confident and uncompromising assertion 
 of the legitimacy of their deductions, and with a decided, sometimes 
 contemptuous, condemnation of the views entertained on the same 
 subjects by all preceding or contemporary writers. As might be 
 foreseen, such attempts at innovation, the detailed enumeration of 
 which would form an amusing chapter in the history of oar profes 
 sion, have so far, with occasional exceptions, failed to produce the 
 effects intended, and to command general and continuous atten 
 tion. 
 
 Novel explanations of known phenomena are offered; analogies 
 or differences heretofore unthought of, are pointed out and insisted 
 upon ; effects are ascribed to causes, which before were unsuspected 
 of producing them ; while, on the other hand, the agency of morbid 
 influences, universally regarded as occasioning certain phenomena, 
 
X LETTER TO CHARLES D. MEIGS. 
 
 is denied ; remedies are asserted to possess powers very different 
 from those usually attributed to them ; superiority of success is 
 claimed for modes of treatment which experienced practitioners 
 have been taught to view with suspicion ; but all in vain. The 
 reader, if not a novice in medical literature, and a tyro in profes 
 sional knowledge, is not slow to discover the small degree of reli 
 ance which can be placed on such attempts at innovation ; and 
 finds that the theories or hypotheses so pompously and confidently 
 set* forth, so far from being satisfactory, and likely to answer the 
 purpose of their authors, are generally of a loose, crude, and un- 
 philosophical character; in many cases evidently the offspring of 
 men who are young in years and young in experience, who are 
 richer in self-esteem and assurance than discretion and learning ; 
 of men whose minds are immature, untrained, and ill stored. He 
 finds that they are founded on hastily collected and ill-digested 
 observations, cemented together by illogical or overstrained reason 
 ings, and though fit, perhaps, for the edification of young beginners, 
 are unworthy of serious consideration on the part of men of mature 
 age, and sound and extensive acquirements. 
 
 Not unfrequently, the well-informed reader recognizes in the 
 proposed novelty some old acquaintance, which after having 
 enjoyed, at some bygone time, an ephemeral reputation, had dis 
 appeared under the lash of the reviewer, or sunk into oblivion 
 from an innate want of vital force is now once rnore^brought forth, 
 in a more or less modified garb, to glitter for a short moment in the 
 eyes of the unskilled, and, of course, soon to meet a fate similar to 
 that it had already encountered. Even when he finds, in such 
 lucubrations, something calculated to amuse or interest, or some 
 times, perchance, to seduco him momentarily from the more rational 
 opinions he had before entertained, he in a brief while becomes 
 sensible of his error, and reverts to his former faith. If he does not 
 forget what he has just read, he at least views it in the same light as 
 other vagaries, of which the annals of medicine, both on this and on 
 the other side of the Atlantic, furnish many a curious example. 
 With such facts before him, he cannot be regarded as over fastidious 
 if he unite in sentiment with those who maintain that the stuff of 
 which medical reformers and leaders in scientific advancement are 
 made is a rare product; that in all parts of the world, and here, per 
 haps, more than elsewhere, readiness and smartness have but too 
 often been mistaken for strong power of thought, and superficial in- 
 
LETTER TO CHAELES D. MEIGS. Xl 
 
 formation has taken the place of sound and accurate learning ; that 
 in a field where men of well-disciplined and well-stored minds, and 
 rich in accurate observation men who have within their reach 
 the means of testing the statements of other investigators, whose 
 standing is equal to their own men who live, as it were, in an 
 atmosphere of science, have failed ; it is scarcely to be expected 
 that individuals of ordinary capacity, with little experience, and as 
 little reading, who are unused to accurate processes of scientific 
 investigation and close induction, and who possibly move within 
 localities where opportunities for prosecuting the requisite researches 
 on a sufficiently enlarged scale are, in a great measure, wanting, will 
 reap laurels, and assume a conspicuous place in the ranks of medi 
 cal reformers, <y add greatly to the stock of useful knowledge. 
 
 The cause of these successive and repeated efforts at revolution 
 izing the science in some or all of its parts, of this reluctance to 
 pursue the common track, and of this disposition to discard 
 opinions long entertained, and to substitute others of a contrary 
 character, need not be made here the subject of detailed examina 
 tion. That in some cases the result is due solely, or in a great 
 measure, to a craving after notoriety to the ambitious desire to be 
 pointed out by medical or rather by unprofessional men, as authors 
 of brilliant discoveries, and as gifted agents of scientific and practi 
 cal improvements; in other words, that the guiding impulse is 
 more frequently the desire for personal advancement and pecuniary 
 gain, than a due regard for the interest of science, we have every 
 reason to conclude. Equally true is it, that we may sometimes 
 trace this result to the mere desire of gratifying the innocent and 
 harmless vanity to which some individuals, especially young medi 
 cal men, fresh from the schools, are keenly alive, that of seeing their 
 names in print; more particularly if they can so appear in con 
 nection with something really or seemingly new, and calculated to 
 attract attention. These lucubrations, though of no earthly value 
 to any one in a scientific or other point of view, are to their pro- 
 rnulgators objects of vast importance; and hence the desire to see 
 them spread out in the pages of a medical journal, side by side 
 with the contributions of older and better known physicians. We 
 may also suppose that, in some instances, it is the offspring of the 
 foible which nature has infused into the composition of some happy 
 individuals, who imagine themselves endowed with the faculty of 
 unravelling the most intricate mysteries of the science, and of 
 
xii LETTER TO CHARLES D. MEIGS. 
 
 discovering truths heretofore concealed from the notice of medical 
 investigators from the days of Hippocrates to the present; and 
 who fancy they can explain all professional questions, however 
 complex and apparently foreign to their ordinary pursuits or their 
 opportunities of inquiry, in a more lucid, natural, and satisfactory 
 way than any of their predecessors or contemporaries. 
 
 Such is the probable explanation in many instances. But the 
 medical world is occasionally startled by the appearance of hypotheses 
 and theories, both crude and untenable, and sometimes of more 
 than problematical originality, by a very different class of men. 
 The hypotheses to which allusion is here made are promulgated 
 with unflinching confidence by individuals to whom, from the 
 distinguished position they have reached in the racks of the pro 
 fession, from the respectable character of their intellectual endow 
 ments, from the extent of their general and medical acquirements, 
 no less than from the high standing of their moral character, we 
 cannot justly attribute selfish considerations, youthful vanity, or 
 the monomania of authorship ; and who might have been expected 
 to abstain from the attempt to stem the current of received opinions, 
 and to aspire to the honours awarded to true medical reformers, and 
 correct exponents of new views. In these, the cause must be sought, 
 sometimes in the want of a proper balance between the fancy and the 
 judgment, a defect which leads the individual to mistake ingenious 
 flights of the imagination, odd notions, and whimsicalities, for correct 
 inferences from enlarged and accurate observations. In others, it is 
 to be found in a disposition, not uncommon even among otherwise 
 clever men, to discard received opinions whenever, in their estima 
 tions, these do not prove satisfactory on all points, however shadowy 
 may be the grounds of dissatisfaction, and to fly at once to the most 
 opposite modes of explanation. 
 
 In a different class, we must seek the explanation in a restless 
 tendency, not unfrequently exhibited by individuals whose minds, 
 though naturally good and well cultivated, have, nevertheless, 
 not been thoroughly trained in the school of severe induction, to 
 jump hastily at conclusions and to draw inferences without having 
 collected, analyzed, and compared a sufficient number of facts, 
 bearing directly or indirectly on the point at issue. Sometimes we 
 find it in a disinclination to examine the subject in all its bear 
 ings; in a deficiency in the power ^appreciating the full force of 
 facts and circumstances militating against the views adopted, or a too 
 
LETTER TO CHARLES 1). MEIGS. Xlll 
 
 habitual tendency to undervalue the authority of those by whom 
 they are adduced. Again, it is traced to an inability to discover the 
 connection existing as cause and effect, between the phenomena 
 to which attention is called ; and quite as frequently, to a scanty 
 acquaintance with what has been already written on the subject on 
 which the author proposes to enlighten the medical public. 
 
 It has been remarked by competent judges, that the first thing 
 an individual should attend to, who undertakes to write on pro 
 fessional topics, especially when he fancies he has discovered new 
 truths, or devised a theory respecting the reciprocal relations of 
 facts already known, which is more acceptable than any anteriorly 
 received, is to make himself familiar with all that has been written 
 on the subject. "When the observer," says Sprengle, " whatever be 
 the extent of his genius, has, nevertheless, not enough of erudition 
 to be acquainted with the observations of his predecessors, he runs 
 the risk of repeating what has already been said a hundred times 
 before, and of publishing it as his own discovery. Hence, the 
 advantages of true erudition." 1 
 
 Well would it be for aspiring reformers and discoverers, abroad 
 and at home, were they to take heed of the sage advice of the 
 great historian of medicine. By enlarging the sphere of their pro 
 fessional erudition beyond a few text and other works of easy 
 access, or the numbers of some periodical journals, they would pos 
 sibly be deterred from laying before the medical world the products 
 of their unimportant cogitations, and the results of their imperfect 
 observations, seeing that others, differing but little from them, had 
 been presented perhaps more forcibly and clearly before, and 
 had been long refuted or disproved, or passed by without comment 
 or sign of approbation; thus saving themselves the risk of disap 
 pointment, perhaps mortification, and sparing to others a vast 
 amount of useless reading. 
 
 Easy as it may be to account for the manifestation of the pro 
 pensity in question among the several classes of physicians just 
 passed in review, yet instances occasionally present themselves, in 
 which opinions of an unsatisfactory, untenable not to say extrava 
 gant character, often of more than doubtful originality, and which, 
 if proved to be well founded, would overturn all our previous and 
 long established vie.ws, are thrown out, and boldly and confidently 
 
 1 Handbook^ Pathology, vol. i. 
 
XIV LETTER TO CHAKLE3 D. MEIGS. 
 
 asserted, in quarters where none of the explanatory reasons above 
 enumerated would seem to apply. 
 
 These opinions originate with individuals in whom the imagina 
 tive powers have always appeared to be properly tempered by 
 sound judgment; who have not, in other matters, evinced a tend 
 ency to adopt hasty and far-fetched conclusions; whose field of 
 observation has been ample, and assiduously and profitably culti 
 vated ; whose search after information on collateral branches of 
 knowledge has never been neglected ; and by whom care has evi 
 dently been taken to render themselves familiar with a large share 
 of the writings of the best authors. These stand apart from all 
 other innovators, and might properly be made here the subject of 
 some remarks ; but, from want of room, and the fear of exhausting 
 the patience of the reader, which has been already too heavily 
 taxed, I must resign into other and abler hands the*duty of clear 
 ing up the mystery which this manifestation of the tendency of 
 which I am speaking is so well calculated to create. 
 
 It is needless to illustrate the correctness of these remarks by a 
 detailed account of instances in which the propensity in ques 
 tion has been indulged to a greater or less degree. Cases, in which 
 facts and views long familiar to well-read physicians have been 
 seriously presented as new, or cases in which the strangest vagaries 
 have been launched forth, and strenuously maintained, will doubt 
 less present themselves to the mind of every reader, who will find 
 no difficulty in placing the authors of them in some one or other of 
 the categories above enumerated. 
 
 It is important that the aspirant to professional fame, who places 
 himself before the public in the capacity of author, should carefully 
 avoid every attempt, or semblance of an attempt, to pass off as his 
 own, in whole or in part, what in reality belongs to others. In 
 other words, too much care cannot be taken by medical writers to 
 shield themselves from the accusation of plagiarism; whether in 
 reference to points of doctrine or to facts, or whether it applies to 
 the language in which the borrowed materials are conveyed. Many 
 a reputation, otherwise unassailable, has been greatly stained by a 
 single act of literary pilfering. Such acts -are of course dishonour 
 able, and should, like every other illicit appropriation, be shunned 
 by all men endowed with a proper share of moral sense ; and unhesi 
 tatingly exposed by every medical man, who is alive to the honour 
 
LETTER TO CHARLES D. MEIGS. XV 
 
 and dignity of his profession, and who necessarily feels that the 
 commission of such acts must, if frequently repeated, and allowed 
 to pass unnoticed, cast a shade over the reputation of the medical 
 literature of the country, and make it an object of derision with 
 European writers. Far be it from us to affirm that such irregulari 
 ties are not committed on the other side of the Atlantic. Were 
 this the proper place, many and curious cases in point might be 
 collected from the productions of the English and French medical 
 press. But on these we need not dwell. It is sufficient for us to 
 guard our own reputation. Depredations of this sort in Europe can 
 prove no valid excuse for their commission on this side of the At 
 lantic. Let European writers steal from each other, and from us, if 
 they think fit. The theft will disgrace the culprit, but in no way 
 reflect injuriously on the medical literature of the country at large ; 
 which is too rich, in original works of merit to be seriously affected by 
 a few transgressions of this sort. But, in the name of all that is manly 
 and honourable, let us not lay ourselves open to such accusations. 
 "We may doubtless congratulate ourselves that thus far acts of de 
 cided plagiarism have not been exceedingly numerous among us. 
 Yet, while doing so, it cannot be concealed that several have already 
 been committed; that some occasionally come to light, and that a 
 few of those detected are of a barefaced and even monstrous charac 
 ter, and have proceeded from quarters where they might have been 
 least expected to originate. Let us hope that such transgressions 
 will not be repeated, and that, if repeated, their authors will be ex 
 posed and consigned to the contempt of their professional brethren. 
 Too much care cannot be taken to put a stop to such proceedings; 
 for their effect on the reputation of our infant medical literature 
 must necessarily be of the most baneful character. If the physi 
 cians of this country frequently steal from European writers, or from 
 each other, all confidence in their integrity will be lost. He who 
 can attempt to deceive in respect to his claims to authorship ; he 
 who can stoop to the disgraceful act of purloining the thoughts of 
 his brethren; he who reproduces them in the same way and in the 
 same words as the rightful owner, without acknowledgment, ex 
 poses himself to the danger of being suspected of dishonest deal 
 ings in all his subsequent literary labours ; while his misdemeanors 
 cast a stigma on the professional body to which he belongs, reflect 
 injuriously on the scanty literature of the land, and may naturally 
 
XVI LETTER TO CHARLES D. MEIGS. 
 
 cause the productions of other and more honest writers to be re 
 ceived with caution, or to be overlooked entirely, lest they also 
 may be a transcript of works already known. 
 
 But I have said more than I had intended, and, soliciting your 
 indulgence for my loquacity, 
 
 I remain, rny dear Doctor, 
 
 Very affectionately and gratefully, 
 Your friend, 
 
 R LA ROCHE. 
 
 WASHINGTON SQUARE : 
 
 January 12, 1854. 
 
CONTENTS. 
 
 CHAPTER I. 
 
 PAGE 
 
 BELIEF IN THE CONNECTION OF PNEUMONIA WITH AUTUMNAL FEVERS LONG ENTER 
 TAINED. ............. 33 
 
 Pneumonia common where fevers seldom or never are seen ... 56 
 Pneumonia not necessarily prevalent where fevers are common . . 61 
 The two diseases prevail in different seasons ...... 68 
 
 They appear under the influence of opposite winds . . . .73 
 
 Pneumonia is of yearly occurrence not always so fevers . . .77 
 Their altitudinal range is not the same . 80 
 
 CHAPTER II. 
 
 EXISTENCE AND MORBID AGENCY OF MALARIA 101 
 
 The agency of malaria not universally admitted . . . . .110 
 
 Objections made to the agency of malaria, various . . . .112 
 
 The appearance of fever where there are no marshes does not disprove 
 the agency of malaria . . . . . . . . .113 
 
 The non-detection of malaria in the atmosphere no proof of its non- 
 existence and agency . . . . . . . . .116 
 
 Fever not due to the action of any known gases . . . . .118 
 
 Not true that nothing is found in the atmosphere of sickly localities . 120 
 Chemists not more successful in discovering other morbid poisons in the 
 atmosphere ........... 124 
 
 Nature and condition of fever localities lead to the opinion of the exist 
 ence of malaria .......... 128 
 
 The danger of an attack of fever increased in proportion to proximity to 
 such localities . . . . . . . . . . .130 
 
 These effects are not due to heat alone . . . . . . .134 
 
 Fevers are not the effects of humidity alone . . . . . .139 
 
 A high dew-point not sufficient to account for the occurrence of fever . 163 
 Heat and humidity combined not the efficient cause of fever . . .168 
 Vicissitudes of temperature will not account for the occurrence of 
 periodic fever . . . . . . . . . . .169 
 
 The attack is sometimes too sudden, and follows on too transient an ex 
 posure to infected regions, without appreciable atmospheric vicissitudes, 
 to be the effect of these or any other kindred cause . . . .173 
 
 Fever not the effect of a particular electrical state of atmosphere . . 177 
 
 2 
 
xviii CONTENTS. 
 
 PAGE 
 
 The preceding facts lead to the belief in a poisonous agent floating in the 
 
 atmosphere . . . . . . . . . - . . 177 
 
 The innocuousness of some marshes, and of localities similar to those that 
 
 are sickly, no proof of the non-existence or non-agency of malaria . 178 
 
 The exemption may be explained in various ways ..... 184 
 
 Elevation 187 
 
 Degree of heat 191 
 
 Sheltering from the action of the sun . . . . . . .194 
 
 Free ventilation ........... 194 
 
 Humidity of the soil . 198 
 
 CHAPTER III. 
 
 EXISTENCE AND MORBID AGENCY OF MALARIA, CONTINUED ..... 201 
 
 Occurrences on shipboard prove the agency of malaria .... 201 
 
 The cause of fever wafted by winds passing over sickly localities . . 209 
 The effects of drying, overflowing, and reclaiming marshy ftnd sickly 
 
 localities, and vice versa, prove the existence and agency of malaria . 220 
 
 The first effects of clearing land, c. injurious . . ... . 221 
 
 Partial draining injurious ......... 223 
 
 Injurious effects of the overflow of land ...... 224 
 
 Bad effects of copious rains followed by great and desiccating heat . 234 
 
 Injurious effects of upturning the earth in hot weather .... 238 
 
 Beneficial effects of complete drainage ....... 244 
 
 As cities enlarge and improve, malarial fevers decrease in them . . 254 
 Beneficial effects obtained from the draining of marshes prove the exist 
 ence and morbific agency of malaria ....... 258 
 
 The effects of covering sickly places with water lead to the same belief . 260 
 
 CHAPTER IV. 
 
 EXISTENCE AND MORBID AGENCY OF MALARIA, CONTINUED ..... 265 
 
 The effect of the " washing" of sickly places lead to the same belief . 265 
 Some forms of malarial fevers resemble diseases produced by putrid sub 
 stances introduced into the circulation . . . . . .271 
 
 The geological formation of sickly localities, and the plants growing 
 
 therein, c., lead to a belief in the malarial doctrine .... 273 
 
 Cause more effective near the surface of the earth than at a distance . 274 
 
 Cause of fevers destroyed or mitigated by sanative measures . . 275 
 
 Cause arrested by trees, c. ......... 278 
 
 Fever arrested by removing sources of infection ..... 283 
 
 Fever sometimes connected Avith the existence of certain fogs or mists . 284 
 
 The stagnant water of marshes injurious to health .... 285 
 
 A paludal atmosphere enfeebles health ....... 287 
 
 Effect of a paludal atmosphere on the duration of life .... 291 
 
 Cau.se of fever produces an impress of greater or less strength on all 
 
 placed under its influence ......... 293 
 
CONTENTS. XIX 
 
 PAGH 
 
 The cause of autumnal fevers produce an impress on the lower order of 
 
 animals and on vegetables ......... 295 
 
 The great diffusion and mortality of autumnal fevers is explained only on 
 
 the supposition of the cause being a gaseous poison .... 298 
 
 Autumnal fevers under the influence of various exciting causes . . 304 
 The malarial origin of such fevers confirmed by the violent manner the 
 
 cause often acts .......... 305 
 
 The cause of fever extends its action to the ibetus in utero . . . 305 
 The cause of autumnal fever appears to be neutralized by the poison of 
 
 some zymotic diseases which have no effect on common complaints . 308 
 
 Cause of autumnal fever antagonistic to that of some other diseases . 310 
 Other objections urged against the malarial origin of periodic or autumnal 
 
 fevers , 320 
 
 CHAPTER V . 
 
 PNEUMONIA AND AUTUMNAL FEVER COMPARED IN REFERENCE TO THEIR CAUSES, 
 MODE OF PROGRESSION, SYMPTOMS, ANATOMICAL CHARACTERS, AND THE CIR 
 CUMSTANCES BY WHICH THEY ARE INFLUENCED ...... 335 
 
 The causes of autumnal fevers and pneumonia are different . . . 335 
 Causes of pneumonia .......... 347 
 
 Autumnal fevers, if not produced like other zymotic diseases, are localized 
 in certain places ; not so pneumonia ....... 354. 
 
 The opinion is incorrect, for it leads to the inference that the same cause 
 produces diseases differing widely in symptoms and anatomical cha 
 racters 358 
 
 Affinity of morbific and therapeutic agents for special organs not to be 
 denied ............ 359 
 
 Distinctive symptoms and pathological conditions different in pneumonia 
 and malarial fevers .......... 361 
 
 Odour of the surface peculiar in some malarial diseases ; not so in pneu 
 monia ............ 370 
 
 The condition of the urine different in the two diseases . . . 374 
 
 Anatomical characters different in the two diseases .... 377 
 
 The t\vo diseases differ widely as regards the duration of the process of 
 incubation ........... 380 
 
 Process of latency governed by definite laws ...... 387 
 
 In some forms of autumnal fever the susceptibility of the system exhausted 
 by one attack not so in pneumonia ....... 395 
 
 CHAPTER VI. 
 
 PNEUMONIA AND AUTUMNAL FEVERS COMPARED IN REFERENCE TO THE POWERS OF 
 ACCLIMATIZATION AGES, SEXES, AND RACES OF THOSE AFFECTED: PREVALENCE 
 OF THE TWO DISEASES AT THE SAME TIME, AND IN RAPID SUCCESSION, NO PROOF 
 OF IDENTITY ............. 403 
 
 The power of acclimatization does not extend to pneumonia . . . 403 
 
XX CONTENTS. 
 
 PAGE 
 
 Pneumonia and autumnal fevers affect different races . . . .411 
 
 Difference of susceptibility of the two sexes . . . . . .418 
 
 Difference of susceptibility of the two diseases at different periods of life 421 
 Effects of the passions and emotions in the two diseases . . . 425 
 The prevalence of the two diseases at the same time and in rapid succes 
 sion no proof of identity ......... 428 
 
 Pneumonia and autumnal fevers are not convertible diseases . , 438 
 
 CHAPTER VII. 
 
 PNEUMONIA AND AUTUMNAL FEVERS, ALTHOUGH INDEPENDENT OF EACH OTHER, AS 
 REGARDS NATURE AND CAUSE, COMBINE TOGETHER, AND FORM, LIKE OTHER COM 
 PLAINTS, HYBRID DISEASES, WHICH MUST NOT BE CONSIDERED AS PECULIAR 
 FORMS OF EITHER ............ 437 
 
 Cases of pneumonia marked by symptoms appertaining to autumnal 
 fever, are the results of complications ...... 437 
 
 The complication of diseases more or less distinct in their nature, and the 
 modifying influence of epidemic over other complaints, are well known 
 to etiologists and pathologists ........ 452 
 
 Diseases arising from various species of malaria mix together and form 
 compounds ........... 461 
 
 Diseases due to specific contagious poisons amalgamate together, or with 
 other complaints, and form hybrid complaints, or exist together in the 
 same subject ........... 465 
 
 Pneumonia, like other inflammations, sometimes assume a periodic type, 
 independently of a malarial influence ...... 468 
 
 The success of the anti-periodic treatment in pneumonia supposing it 
 true no proof of the identity in question ... . 471 
 
 The hypothesis of the identity of pneumonia with autumnal fever not 
 supported by facts and solid arguments 480 
 
PNEUMONIA 
 
 AND 
 
 AUTUMNAL FEVERS. 
 
 CHAPTER I. 
 
 BELIEF IN THE CONNECTION OF PNEUMONIA WITH 
 AUTUMNAL FEVERS LONG ENTERTAINED. 
 
 THE idea of a close connection, as regards both causation and 
 nature, between thoracic inflammations and malarial fevers of vari 
 ous grades and types, has long been entertained, and continues 
 ev r en now to be advocated by writers of respectable standing. 
 Casually suggested, or openly avowed and sustained at various pe 
 riods by professional authorities on the other side of the Atlantic, 
 it has met with special favour in this country, particularly in our 
 Southern and Southwestern States, where it now enlists many 
 warm and uncompromising defenders. Singular as it may appear 
 to modern etiologists and pathologists, that a connection of the 
 kind should have been made the subject of serious consideration 
 by our forefathers, and still more, that it should receive the sanction 
 of physicians of the present age, it requires but a slight acquaint 
 ance with the medical literature of past and present times, to be 
 aware of the reality of the fact. To those who have not directed 
 their attention to the subject, a few references to the writings of 
 preceding and contemporary authors may not be unacceptable. 
 
 The retrospect, if not otherwise serviceable, may do some good 
 by contributing to open the eyes of the modern advocates of this 
 belief, to the fact that they are treading on ground already and 
 frequently travelled over and as frequently abandoned ; and that, 
 consequently, whatever credit they may expect for the ingenuity 
 displayed in its support, they must sedulously avoid laying claims 
 3 
 
34 PNEUMONIA AND 
 
 to originality ; while in the progress of our inquiries, enough, it is 
 hoped, will be said to shake their belief in the infallibility of their 
 views, and to lead them to turn their attention to objects more 
 worthy of serious investigation. I would hope, at the same time, 
 to guard unprejudiced readers against adopting without mature 
 examination, all that has been or may be said in opposition to the 
 independent existence of the aforesaid diseases. 
 
 If we open the records of medicine, and inquire into the views 
 entertained at various times respecting the sources of febrile com 
 plaints, more particularly of that variety now classed under the 
 denomination of periodic or autumnal, we shall find, that the sup 
 position of their being produced by morbid agencies of a general 
 character, but differing materially from the mere changes in the 
 ordinary and sensible qualities of the atmosphere to which inflam 
 matory diseases of membranous and parenchymatous parts are 
 usually due, may be traced to a very early period, and that, passing 
 through successive ages to the present time, it has finally assumed 
 the shape of a distinct theory. By some writers they are attributed to 
 various mysterious constitutions of atmosphere. Others see in them 
 the effects of peculiar conditions of the surrounding medium certain 
 secret influences appertaining in a special manner to each separate 
 season. Others, again, speak of exhalations issuing from the bowels 
 of the earth ; while another, and more numerous set, refer them to 
 miasmata exhaled from organic matter animal or vegetable, or 
 both in a state of decomposition. But although autumnal fevers 
 remittent and intermittent were at a remote period, and to this 
 day continue to be, considered as the offspring of a distinct or spe 
 cific cause, or of some peculiar modification of ordinary morbific 
 agencies, the theory has not escaped opposition. So far from this, it 
 is not uncommon to find medical writers of former and even modern 
 times, upholding the opinion, that thoracic and other phlegmasiae 
 some forms of them, at least arise from causes identical with, or 
 closely allied to those that give rise- to the above-mentioned variety 
 of idiopathic fevers ; or rather viewing the latter as often produced by 
 causes known to occasion common inflammation and vice versa" and 
 as a natural consequence regarding them all as mere modifications of 
 one and the same disease. Now, without reverting to the numerous 
 illustrations of the latter opinion, scattered through the valuable vo 
 lumes handed down to us by the physicians of Greece and Kome, but 
 coming down at once to the seventeenth century, we find that Eamaz- 
 
AUTUMNAL FEVEKS. 35 
 
 zini ascribes the apoplexies, quinsies, catarrhs, pleurisies, and in 
 flammations of the lungs, which occurred extensively at Modena 
 in 1691, to the same unhealthy state of the air, induced by the 
 wet condition of the soil and subsequent desiccating action of the 
 sun, to which he refers the intermitting fevers of spring, and the 
 double tertians and semi-tertians of summer and autumn. In some 
 of the epidemics described by others predecessors and contempo 
 raries of Lancisi febrific exhalations are represented as giving 
 rise to diseases which they call dysentery, apoplexy, rheumatism, 
 and peripneumonia. Lancisi 1 himself, in tracing the history and 
 progress of an epidemic of rheumatism which prevailed at Kome 
 in the year 1709, ascribes it to a like cause. The disease spread 
 extensively, contemporaneously with the usual fevers of the sea 
 son. Many of the cases were characterized by inflammation of 
 the throat, of the windpipe, the pleura, the lungs, &c., all -of which 
 are referred to the operation of the same cause which gave rise 
 to the fever. The same Lancisi admitted that fevers occasionally 
 arise from a cause distinct from miasmal exhalation; the un genial 
 north winds, and the intemperies resulting therefrom ; the very 
 morbid influences which he recognizes as productive of pneumonic, 
 rheumatic, and other inflammations. 
 
 By Sydenham, similar views, respecting the pathological and eti- 
 ological identity of the diseases in question, were evidently enter 
 tained. To this eminent physician and accurate observer, the doc 
 trine of the malarial origin of endemic or epidemic fevers does not 
 appear to have been known; or if known, to have proved admissi 
 ble. Sydenham speaks, it is true, of exhalations from the bowels 
 of the earth, as the productive agent of epidemics ; but, far from 
 apportioning them to the production of autumnal fevers exclusively, 
 and attributing other diseases to different morbific influences, he 
 seems to view them simply as the cause of, or an adjunct, to those 
 general modifications of the atmosphere which, under the name of 
 medical constitutions and latterly of meteorations, have been the sub 
 ject of so much comment, and to which he refers all epidemic dis 
 eases, whether of a strictly febrile character, or marked by thoracic 
 inflammation. He nowhere attributes fevers to a special cause ex 
 haling from the surface of the earth itself, or from extraneous sub 
 stances existing thereon, in the sense referred to by Lancisi and 
 
 1 De Noxiis Paludum Effluviis, Op. ii. 103. 
 
36 PNEUMONIA AND 
 
 subsequent writers. His readers will recollect the remarks he 
 makes under the head of " Epidemics." There are different con 
 stitutions in different years. They originate neither in their heat 
 nor their cold, their wet nor their drought ; but they depend upon 
 certain hidden and inexplicable changes within the bowels of the 
 earth. By the effluvia from these, the atmosphere becomes contami 
 nate, and the bodies of men are predisposed and determined, as 
 the case may be, to this or that complaint. This continues during 
 the continuance of this or that constitution, which, after the cycle 
 of a few years, gives ground and makes way for another. 1 But 
 they will recollect at the same time, that the remarks of the En 
 glish Hippocrates applied to epidemics generally, as well to the 
 epidemic cough of 1675, with pleurisy and peripneumony, as to 
 the continued and intermittent fevers of other years. In all, the 
 terrestrial effluvia was supposed to predispose the system to a par 
 ticular form of disease, which other causes, differing but little from 
 each other, whatever the characters of the epidemic might be, ex 
 cited into action. They were all, therefore, regarded as closely allied 
 to each other with reference to causation. Indeed, we have proof 
 enough in the accounts Sydenham gives us of the epidemic consti 
 tutions of various seasons of 1674-1675, for example that he re 
 garded the cases of pleurisy and pneumonia, which then occurred, as 
 "really and substantially nothing more than peculiar forms" of the 
 reigning fever. " Sometimes," he remarks, " it (the fever) attacked 
 the head, sometimes the bowels. It everywhere put on the symp 
 toms of the particular part affected. Such was the case till the end 
 of October. At that time the weather, which had been as warm 
 and as mild as summer, suddenly changed to wet and cold. This 
 brought on coughs and catarrhs, which were more numerous than 
 I remember them to have been. What, however, is of more im 
 portance, is the fact that upon these coughs supervened the station 
 ary fever of the year ; and this having once taken its hold, increased, 
 and varied in some of its symptoms from- the fever of the previous 
 part of the year. The attack of the previous fever had been chiefly 
 determined towards the head and bowels. That of the present was 
 towards the lungs and pleura, and as such gave rise to symptoms 
 of pneumonia and pleurisy." 2 In 1675, "the coughs paved the way 
 to fever, and passed without difficulty into it. Meanwhile, just as 
 
 1 Works, i. 33-4 ; Ed. of Sydenliam Society. 2 Ibid. 205. 
 
AUTUMNAL FEVERS. 37 
 
 the coughs helped the constitution in producing the fever, so also 
 was the fever determined by the coughs to the lungs and pleura. 
 These it attacked just as, a week before, it had attacked the head. 
 This sudden change inclined the unthinking to consider the fever 
 as an essential pleurisy, or an essential peripneumony. Yet it was 
 neither more nor less than what it had been throughout." 1 
 
 Even at a time when, with the progress of knowledge, febrile 
 complaints began to be more definitely traced to separate and spe 
 cial causes distinct from those occasioning parenchymatous and mem 
 branous inflammations of the lungs, some authors of repute, from 
 whom better things might have been expected, continued to refer 
 these certain forms of them at least especially when they spread 
 extensively, and presented unusual phenomena and a tendency to 
 assume a periodic type, to the same agencies as usually give rise to 
 epidemic and endemic fevers. Of this we have an example in no 
 less a man than Cleghorn, who, in his account of the bilious pleu 
 risy which spread epidemically in Minorca during the latter part of 
 1745 and beginning of 1746, and forms the subject of one of the 
 most interesting chapters of his invaluable work, expresses himself 
 on that matter in terms that can scarcely be misunderstood. 2 
 
 The disease commenced like an ague fit, with shivering and 
 shaking ; flying pains ; bilious vomiting and purging, succeeded by 
 quick breathing; immoderate thirst; inward heat; headache, and 
 fever. It observed a remittent type, and on the third or beginning 
 of the fourth day, there was frequently a great remission; some 
 times a total cessation of every violent symptom. 
 
 But, on the fourth or fifth, the disease was aggravated, and the 
 patient expired in a day or two, either suffocated or raving mad. 
 In another place, this distinguished observer remarks that " the anni 
 versary epidemical fevers in Minorca may be divided into two classes 
 the summer and winter fevers. The former break out in June and 
 July, and cease about Januar}^ or somewhat sooner. The latter 
 seldom appear before November, and are rarely seen after the 
 summer solstice. Both these classes of f. vers, and indeed almost all 
 others which happen in that climate, whether primary or symp- 
 tomatical diseases, may be termed periodical, having remissions at 
 intervals more or less considerable. But those of the summer gene- 
 
 1 Works, i. 22G; Ed. of Sydenham Society. 
 
 2 Observations on the Epidemic Diseases in Minorca, 257-261. 
 
38 PNEUMONIA AND 
 
 rally assume some one or other of the tertian types, being worse one 
 day and better the next, alternately ; whereas, the winter fevers, 
 though they often counterfeit tertians, especially in their beginning, 
 yet, for the most part, have exacerbations equally strong every day. 
 It may likewise be remarked that as the summer fevers are gene 
 rally complicated with fluxes and painful obstructions in the chylo- 
 poietic viscera, so are those of the winter with coughs, catarrhs, and 
 topical inflammations of the vital organs; the brain; the lungs ; 
 the heart itself." 
 
 Pleurisy, therefore, according to this view of the subject, is 
 nothing more nor less than a modification of marsh or periodic 
 fever, or a form of the disease of which common periodic fever con 
 stitutes another form ; the difference between them depending on 
 difference of the parts pathologically implicated, and this in its turn 
 being due to the difference of the particular atmospheric influence 
 giving rise to the disease; the cold of winter being the exciting cause 
 of the one form, and the heat of summer the exciting cause of the 
 form peculiar to that season. Indeed, we cannot discover that Cleg- 
 horn anywhere attributes pulmonary inflammations and fevers to 
 separate and specifically different causes, or alludes to anything more 
 than atmospheric influences, and that he regarded those diseases as 
 essentially different in a pathological point of view. As the one 
 declines the other appears. The former is the chief among the 
 vernal epidemics, as the other is constantly foremost among the 
 autumnal. They are, to all intents and purpose?, one and the same 
 disease ; the only difference being in the local affections that may 
 supervene during their course, and by which they may be compli 
 cated ; a diversity itself due to peculiar thermometric changes. 
 
 Long after Cleghorn, Dr. Wells advocated the opinion of the 
 existence of a connection between malarial fevers and inflamma 
 tory diseases of the lungs. Whether, however, this connection was 
 thought by him to imply the existence of a close pathological and 
 etiological alliance or identity, is a question I have not been able 
 to find out. It was founded on the circumstance that the two dis 
 eases exist at the same time, or succeed each other ; and that those 
 who have the one disease in one season, are liable to have the other 
 in the next. Thus, Dr. Wells was told by his preceptor, Dr. Gar 
 den, who had practised in South Carolina, that he had found that 
 those who suffered severely in the autumn from intermittents, were 
 the most liable to pleurisy in the spring. "Dr. Chalmers, another 
 
AUTUMNAL FEVERS. 39 
 
 physician of South Carolina (Essay on Fevers), has said that nothing 
 more frequently happens in that country than the accession of an 
 intermittent a day or two after the removal of a pleurisy. In the 
 year 1777, 1 saw the remark of Dr. Garden confirmed in a regiment 
 of soldiers, stationed in Guelderland, part of which had been quar 
 tered the preceding autumn in Zealand. In a report made by Dr. 
 Blane, Dr. Borland, and Dr. Lempriere, to the British Government, 
 in October, 1809, on the sickness of our troops in Zealand, it is 
 mentioned, on the authority of the inhabitants, that such of our 
 soldiers as had suffered from intermittents in the autumn would 
 run the risk of being cut off by inflammatory diseases in the winter 
 and spring. No mention, indeed, is made of the particular kinds 
 which would then prevail ; but what is said of their fatality, seems 
 to show that inflammations of the chest were chiefly referred to ; 
 and, at an/^ate, it is certain that these diseases must have been 
 included under the general term inflammatory." Dr. Wells farther 
 appeals to Huxham (20), to show that fevers sometimes are rife and 
 contemporary w,ith epidemic pleurisies and peripneumonies ; also 
 to Cleghorn, for the fact that, at Minorca, pleurisies are generally 
 the chief among the vernal epidemics, as tertian intermittents are 
 constantly among the autumnal ; and, in addition, states, on the 
 authority of Drs. Weeks, of Sussex, and Harrison, of Horncastle, as 
 well as his own, that, with the decrease of intermittents in some 
 parts of England and London, there has been a like decrease of 
 pleurisies. 1 
 
 Those who in Italy, England, France, and this country, deny or 
 doubt the agency of malaria in the production of periodic fever, 
 though not all, so far as I know, going the length of regarding 
 pneumonia and other thoracic diseases as nothing more than pecu 
 liar forms of such fevers, cannot but believe in their close alliance 
 with these, viewing, as they do, the latter as proceeding from the 
 agency of much the same causes as occasion the former. " That a 
 residence in marshy countries, says one of these writers, subjects to 
 intermittent fevers, is an undeniable fact ; and that they who live 
 on broken, hilly districts, are liable to pulmonary diseases is also 
 unquestionable. If locality explain the latter, it may equally ex 
 plain the former, without recurrence to imaginary agencies. In the 
 same county of Lincoln, in England, the inhabitants of the fens are 
 
 1 Trans, of a Soc. for the Improvement of Med.-Chir. Knowledge, iii. 5 
 
 37-0 
 
40 PNEUMOXIA AND 
 
 sufferers from intermittent fevers ; those of the wolds or hills, are 
 obnoxious to catarrh, pleurisies, and phthisis. If an exchange be 
 made of habitation in those two cases, there will be exchange of 
 diseases. Why then demand miasm as a cause of fever, and refuse 
 it as a cause of pulmonary disorders ?" 1 As the writer regards au 
 tumnal fevers, from the simple intermittent to the malignant yellow 
 as produced by heat, cold, humidity, atmospheric vicissitudes, and 
 the like, and as he cannot attribute pulmonary inflammation to other 
 agencies, it follows that, according to him, the same causes may give 
 rise to both sets of diseases, which hence, cannot differ essentially in 
 a pathological point of view. 
 
 Dr. Kush and his disciples may not always have said, in positive 
 terms, that pneumonia, pleurisy, and other kindred affections, are 
 really and substantially peculiar forms of periodic fever, and no 
 thing more ; they may not have attributed them all to the same 
 morbid agencies ; but in upholding the doctrine of the unity of 
 disease, and the applicableness of the same treatment modified 
 only in point of energy, and as regards the use of particular means, 
 by the condition of the system at large, and the nature of the 
 parts affected they admitted the pathological identity of pneumonia 
 with periodic fevers, considering them both as constitutional dis 
 eases, which assume different forms according to the nature of the 
 local derangements by which they may be accompanied, but remain 
 always fundamentally the same. Hence we find that eminent phy 
 sician remarking: "There is but one exciting cause of fever, and 
 that is stimulus. Heat, alternating with cold, marsh and human 
 miasmata, contagion and poisons of all kinds, intemperance, pas 
 sions of the mind, bruises, burns, and the like, all act by a stimulating 
 power only, in producing fever. This proposition is of great appli 
 cation, inasmuch as it cuts the sinews of the division of diseases 
 from their remote causes. Thus it establishes the sameness of a 
 pleurisy, whether it be excited by heat succeeding cold, or by the 
 contagion of the smallpox and measles, or by the miasmata of the 
 yellow fever." "There is but one fever. However different the pre 
 disposing, remote, or exciting causes of fever may be, whether de 
 bility from obstruction or action, whether heat or cold, succeeding 
 to each other, whether marsh or human miasmata, whether intem 
 perance, a fright, or a fall, still, I repeat, there can be but one 
 
 1 Bell on Miasm. Philadelphia Mod. and Phys. Journ. ii. 3 1C, N. S. 
 
AUTUMNAL FEVERS. 41 
 
 fever." 1 A little farther on, lie makes several forms or states of 
 fevers. Of these, the eighteenth is the pulmonary, which includes 
 true and bastard pneumony, acute and chronic catarrh, etc. 
 
 Morton, Lauder, Sauvages, Alibert, Mongellaz, Chauffard, Com- 
 paretti, Gouzee, Daniell, Evans, Abloing, Brera, Matthei, Bailly, and 
 others, to whom I shall again have occasion to refer, describe a 
 pneumonic form of intermittent fever, or periodic form of pulmonary 
 inflammation, produced by the same cause as ordinary intermittents, 
 and thereby, like the preceding writers, acknowledge the identity 
 of both sets of phenomena represented in the compound. 
 
 Not very different were the views of the late Dr. Robert Jackson, 
 of the English Army, whose writings on the yelloAV fever of the 
 West Indies, and South Coast of Spain, as also his volumes on the 
 remedial effects of cold affusion in febrile diseases and on contagious 
 fevers have enjoyed, and continue to enjoy, a merited reputation. 
 Fever, according to this distinguished author, is a form of changed 
 or perverted organic action, "that is, a new form of life impressed 
 on the minuter series of organic capillaries, varied in expression 
 according to the-, varied structure of the series upon which the act 
 is principally manifested." "The diseased act is liable to change, 
 or to suffer transfer from one series to another, in various ways 
 and manners, and at various points of time ; and thus to exhibit 
 within the limit of the total duration, a scene of fluctuation and 
 uncertainty which is more or less embarrassing to the observer." 2 
 After stating that he considers endemic fever, whether it appears 
 in the torrid or temperate zones of the earth, to be radically one 
 disease, he remarks : " As the act, whether progressive or re 
 gressive, varies under contingencies, so it changes mode, or 
 suffers transfer from one series to another at certain periods of its 
 course, to such an extent and in such manner as to appear totally 
 unlike itself. The modes of febrile action are, as now observed, 
 numerous, and, as superficially varied, totally unlike one another. 
 The author considers them as resting on a common base, conse 
 quently as one disease." So much for endemic fevers the cause has 
 the same base in all parts of the earth, modified by circumstances 
 of locality in different districts of similar latitudes, so as to present 
 considerable diversity of appearance in its visible operation. It is 
 
 1 Outlines of the Phenomena of Fever, Works, iii. 9, 10. 
 
 2 A Sketch of the History and Cure of Febrile Diseases, i. 10, 11, 15. Lond. 1820. 
 
42 PNEUMONIA AND 
 
 also modified by elevation, exposure, and the revolution of seasons, 
 circumstances of subjects, &c. Farther on, Dr. Jackson says: "The 
 outline of the history and cure of fever, which is given in the pre 
 ceding pages, applies to fever as a disease of the organic system 
 acting on a general base. Fevers, I am aware, rarely occur at any 
 time, where some one part does not suffer more prominently than 
 others in all stages of the course ; but the term general is here affixed 
 to that form of the disease where the predominance is fluctuating 
 and contingent; /oca/, where it is prominent at the commencement, 
 and where it continues uniformly prominent throughout. The 
 cause which produces inequality in the force and mode of the per 
 verted movements, which are excited by the action of the cause of 
 fever in the different organs of the system, is necessarily obscure. 
 I do not pretend to explain it, and I only take leave to suggest, that 
 it is apparently connected with the unequal conditicfll of organic 
 sensibility existing at the time the morbid cause is applied, or that 
 it explodes into action ; a condition constitutional or contingent, as 
 depending upon the operation of general or contingent causes to 
 which the movements of animal life are exposed." 1 
 
 We have, then, according to this view, fevers, which are diseases 
 of the whole system, without determinate and permanent local de 
 terminations ; and fevers also of the whole system, but which, un 
 like the former, manifest their action more permanently in particular 
 organs : among the latter, we have the forms of fever located in the 
 inferior or abdominal cavity ; the gastric, choleric, dysenteric. The 
 forms of fever with local action in the superior or cranial cavity ; 
 the forms of fever with local disease in the organs of the thoracic 
 cavity the pneumonic, the cardiac, and catarrhal ; and the forms 
 of fever with external local action the ophthalmic and ulcerative. 
 All these forms are produced by the same causes, though some are 
 more particularly noted to owe their origin to exhalations from the 
 soil, more generally or more partially diffused ; all are mere modi 
 fications of one and the same disease. 
 
 " The pneumonic," adds Dr. Jackson, " is an important, and, in 
 some countries, a frequent form of the action of a febrile cause. It 
 is more common, according to the laws of the annual revolution, in 
 some seasons of the year than in others ; and it is sometimes epi 
 demic in seasons and places to which it does not seem to belong." 2 
 
 1 Op. cit. ii. 1, 2, &c. 2 Ibid. p. 83. 
 
AUTUMNAL FEVERS. 43 
 
 If anything were required to show that all those febrile diseases 
 with local determinations were placed by Dr. Jackson on the same 
 footing, pathologically and etiologically, with the non-local forms, 
 it might be derived from the fact that, while including, as we have 
 seen, dysentery and some other complaints among the former, he 
 remarks, after stating that on plains near the sea-coast, muddy rivers, 
 bayous, and other foul grounds, the product of the cause is usually 
 remittent, sometimes intermittent: " The action of the morbid cause, 
 instead of being what is commonly called febrile, is not unfre- 
 quently dysenteric ; sometimes eruptive and ulcerative on dry, 
 bare, rocky, and hilly positions near the sea-coast, or in positions 
 where water flows with a rapid course." 
 
 Dr. Macculloch, 1 though furnishing no proof of the correctness 
 of his opinion, and admitting that, of very much of what he states he 
 has no personal knowledge, includes among the diseases produced by 
 malaria, and which consequently he considers as mere modifications 
 of the legitimate products of that cause, angina, asthma, oedema of 
 the lungs, and catarrh reaching to peripneumony. Copland, in his 
 article catarrh, 2 echoes Macculloch, so far, at least, as the latter 
 disease is concerned, and, under another head, refers catarrhal fever 
 to the same cause as intermittents, enlarged spleen, torpid states of 
 the liver, and rheumatic attacks, i. e. to " miasms from decayed 
 vegetable matter, aided by moisture, in temperate ranges of atmo 
 spheric heat." 
 
 An intelligent writer of our own country, the late Dr. Yaughan, 
 of Wilmington (Delaware), in an Essay on the diseases of that 
 State, alluding to those of winter and spring, remarks that a respite 
 is then obtained from the attacks of ague, and a new order of dis 
 eases arises from sudden transitions of temperature. The general 
 character of the prevailing complaint is peripneumonia notha, in the 
 majority of cases ; but too much stress, he thinks, is laid on the 
 local affection, and too little on the general state of the system ; and 
 he farther maintains that, from the state of the pulse, the frequent 
 sighing in respiration, the tendency of the fever to assume a tertian 
 type, the early appearance of the hippocratic countenance, " it be 
 longed to the genus of autumnal fevers, varied by the casualties of 
 the atmosphere." " It may be said that this is too far strained, and 
 that frost destroys marsh miasmata as a tropical plant. Granted : 
 
 1 On Malaria, 442. 2 Vol. i. 272. 
 
44 PNEUMONIA AND 
 
 when the ponds are covered with ice, exhalation is overpowered ; 
 but if these fevers suffer a common fate with their causes, why do 
 intermittents exist or occur in winter, and winter quartans, the most 
 obstinate of the whole tribe? Why do valetudinarians suffer re 
 lapses in the frosts of January and February ? And why are per- 
 sons on a removal from a marshy to a high country attacked with 
 the endemial fevers of the fens, if the remote cause be not dormant 
 in the system, and excited into action by a concurrence of predispos 
 ing causes? These facts, I presume, substantiate the position that 
 our winter diseases are but varied forms of the autumnal fever." 1 
 
 In an account of the diseases which occurred at Fort Gibson (Ar 
 kansas), during the last quarter of 1833, Dr. Forry states, on the 
 authority of Dr. Pitcher, and Dr. Wharton, of the army, that most 
 of the cases pleurisies, cholera, rheumatism partook of the inter 
 mittent character, and adds : " The strict periodicity of these affec 
 tions, and their subjection to the same remedies which are found to 
 arrest the course of intermittent fever, implf a close alliance, if not 
 a common origin." 2 
 
 We might embrace, in this category, no less an authority than 
 Broussais, and even the greater number of his more enthusiastic 
 disciples ; for, with them, all fevers, whether of a continued, remit 
 tent, or intermittent type, are nothing more than so many varieties 
 of one and the same pathological condition ; inflammatory irritation 
 having its seat in one and the same tissue the gastro-enteritic mucous 
 membrane. This gastro-enteritis, with the various complications 
 that may supervene, are, they say, produced by the action of cold 
 alone, or, as is more frequently the case, combined with humidity, 
 or through the agency of atmospheric vicissitudes ; or, as regards 
 some forms of the disease, of malarial exhalations. But, whichever 
 .of these may be the efficient agent heat, cold, humidity, vicissitudes, 
 or malaria the effect is the same. It is always gastro-enteritis, 
 whether with or without the addition of inflammatory irritation in 
 other organs or tissues. There is nothing specific in the cause, 
 and, as a natural consequence, nothing specific in the effect which 
 that cause produces. Heat, cold, malaria, may go a different way 
 about it, but the change they induce in the system is similar, and 
 that change is effected in the gastro-enteritic mucous membrane. 
 One or other of the pyrexia3 is the consequence ; the difference be- 
 
 1 New York Med. ilcpos. iv. 130. 2 Climate of the U. S. 18G. 
 
AUTUMNAL FEVERS. 45 
 
 tween them being due to a variety of concomitant circumstances, 
 connected with external influences or personal peculiarities. Pneu 
 monia, and other inflammations, parenchymatous, serous or mucous, 
 differ in nothing from the other form of disease ; they are, it is true, 
 more frequently produced by cold and atmospheric vicissitudes than 
 by malaria. But the effect, after all, is only inflammation; and, as 
 the latter presents nothing specific in its character, whatever be 
 the part it may show itself in, it follows that these diseases differ in 
 nothing from the former mentioned, except as regards the parts 
 inflamed ; the difference being due to the mere circumstance that, 
 at the approach of winter, or during the prevalence of atmospheric 
 vicissitudes, the thoracic organs take on more readily the inflam 
 matory action, while at other periods the gastro-enteritic apparatus 
 is more frequently affected. 
 
 More recently, Dr. H. A. Kamsey, of Kaysville, Geo., in an Essay 
 on Pneumonia, published in the early part of 1851, has advanced 
 much the same views, Regarding the disease as the product of the 
 same causes as occasion intermittents, and hence, as identical 
 with these. 1 And at a still later period, Dr. A. P. Merrill, Pro 
 fessor of Materia Medica and Therapeutics, in the Medical School 
 of Memphis, Tenn., in an Essay on Pneumonia, originally inserted 
 in the number for July, 1851, of the New Orleans Med. and Surg. 
 Journ., but more recently issued in pamphlet form, conjointly 
 with two other essays, has adopted a similar theory, relative to 
 the connection in question. Asserting it more positively, and with 
 much greater distinctness than has been done by the generality of 
 modern writers, and regarding it as fully sanctioned by the results 
 of a long experience, acquired in the South, he lays down as an 
 indisputable fact, that pneumonia, though sometimes appearing as 
 an idiopathic affection, is most generally whether it prevail spora 
 dically or as an epidemic really and substantially nothing more 
 than a peculiar form of remittent and intermittent fever, in which 
 the lungs, from sudden transitions of temperature, are made to bear 
 the burden of local disease. 
 
 Other authorities, equally respectable, both at home and abroad, 2 
 
 1 A Practical Essay upon the Symptomatology, Etiology, Vital Statistics, and 
 Treatment of Pneumonia. Charleston Medical Journal and Review, vi. 1, etc. 
 
 2 Baronius, Pleuro-pneumonia, Ann. 1633. Bovillat, Mem. sur les pleuro-pneu- 
 monies epidemiques, 556. Good, Study of Med. ii. 424. Hugh Williamson, Med. 
 Register, iii. 453. Boott, Life of Armstrong, ii. 41, 290-1, 416. Yates, an Essay on 
 
46 PNEUMONIA AND 
 
 might easily be found, to swell the list of the advocates of the views 
 in question ; but the preceding will amply suffice to show that these, 
 whether having reference to a few exceptional cases of pneumonic 
 inflammation, or to the disease as it appears always and every 
 where, and as it presents its legitimate characters, have long enlisted 
 the attention of medical inquirers, and continue to enumerate warm 
 supporters. 1 
 
 When we come to inquire into the grounds upon which the 
 opinion of this close alliance or identity, both as regards the patho 
 logy or etiology of those two classes of diseases is predicated, we find 
 that, with the exception of Sydenham, according to whom the differ 
 ence of one epidemic disease from another depended on a variety of 
 atmospheric constitutions, and who contented himself with describing 
 the symptoms, progression, &c. of the complaints he observed and 
 
 the Bilious Fever prevailing in the State of New York. Albany, 1813, s p. 27. Med. 
 and Phil. Register, iii. 488. Sarcone, Histoire Raisonnee des Maladies Observers 
 a Naples pendant le cours entier de 1 Annee 1764, i. 124-202. 
 
 1 A writer in one of the Western Medical Journals (Ohio Medical and Surgical 
 Journal, i. 508) remarks, that Malaria, besides giving rise to all varieties and species 
 of acute febrile disorders from the highest sthenic to the lowest asthenic grade, 
 induces many obscure and anomalous forms of disease, and frequently imparts 
 new features and tendencies to every disorder that may come within the sphere 
 of its influence. That it makes its impressions primarily on the cerebra spinal 
 system, can hardly, as he thinks, admit of a doubt. The morbid impression there 
 made may be transmitted to the extremity of the nerves taking their origin in that 
 system, and there develop its evidences, in the form of some 1 * functional or organic 
 derangement. "The viscera of the chest, abdomen, and pelvis, and the fibrous 
 cellular tissues, may in this way become the seat of disease, from reflected malarious 
 impressions. Such cases are common. Many affections of the heart, stomach, intes 
 tines, and liver, and in females uterine disorders, are of this character. They have 
 been imperfectly recognized and described by authors as "Irregular and masked In 
 termittent," "Complications," c. This exciting cause may restrict its action solely 
 to the nervous system, and has been known to originate or complicate with every 
 species embraced in Cullen s class NEUROSES, from Apoplexy down to Hysteria. In 
 other instances, it may take a wider range, and show its effects under the forms of 
 irritation, inflammation, and I might properly add, every disorder to which the human 
 family is subject." In all cases of malignant erysipelas that have come within the 
 experience of this writer, "it has participated largely, either as an exciting or modi 
 fying cause." To the Western physician, it is added, under whose observation malaria 
 is daily producing such effects, their diagnosis is often a source of perplexity ; while 
 to the members of the medical profession in the Eastern States, "who know nothing 
 of such diseases, except from books and lectures, it is a perfect stumbling-block." 
 
 The writer of these remarks is Professor of Physical Diagnosis and Theory and 
 Practice of Medicine in a Western medical college. 
 
AUTUMNAL FEVERS. 47 
 
 troubled himself very little about their pathological or phenomenal 
 relationship ; and of Dr. Kush, with whom the idea of the alliance 
 in question was the natural offspring of his doctrine of the unity of 
 diseases ; most of the writers we have cited, from Cleghorn down 
 ward, dwell on the circumstance, that the two diseases periodic 
 fever and pneumonic inflammation are found to prevail simultane 
 ously in the same localities, or to succeed to each other ; that while 
 pulmonary inflammation often occurs in summer and autumn, when 
 fevers are rife, so the latter even intermittent^ appear also in 
 winter and spring, when the former usually prevails extensively. 
 
 With Dr. Kamsey, whose observations were principally made 
 during an epidemic . of pneumonia which swept over Lincoln 
 County, Georgia, in 1845, the proof lies principally in this: that 
 families who have b een formerly healthy at other points, become 
 affected by intermittent, febrile, and pneumonic diseases, by moving 
 to a malarious location, and subsequently healthy by removing from 
 it ; that on that remarkable occasion, when out of a population of 
 seven thousand, three hundred died of the disease, and when out of 
 one hundred and seventy cases he attended it was his good fortune 
 "not to have sustained the loss of a single one," most of the cases 
 occurred along the course of the streams, and at those points which 
 rarely escape chill and fever ; that when it occurred elsewhere it 
 could be accounted for by the fluctuations of the seasons, manure- 
 piles, swamps, &C.; which then and now exist throughout the country 
 to a greater or less extent, " carrying with their effluvia, through 
 the medium of the winds, the emanations of disease (pneumonia of 
 course among these) and the seeds of death," and that, in ordinary 
 times, "those who make most manure, and have their lots closest to 
 their houses, have most cases of pneumonia." Pp. 12-16. 
 
 Dr. Merrill, who has recently taken a leading part in the defence 
 of the opinion in question, and who, on more accounts than one, 
 deserves to be listened to with respect, on this or any other subject 
 connected with the diseases of our Southern States, rather boldly 
 assumes the point, than attempts to prove it, and remarks : " These 
 fevers occupy the attention of the physician, in some of their vari 
 ous shapes, at all seasons of the year, both in town and country ; 
 and they have been characterized, at various times and in various 
 places, by a great multiplicity of names." Again: "This protean 
 character of our fevers arises in part from the season of the year, 
 and the localities in which they occur ; but mainly from the organs 
 
48 PNEUMONIA AND 
 
 of the body which become involved in the diseased action, the pre 
 dominance of inflammation or congestion, and the character of their 
 periodicity. In the spring we are apt to find these diseases assuming 
 names which have reference more particularly to this periodicity 
 and general pathology. As summer comes on, the greater implica 
 tion of the hepatic organs changes the name, or adds an epithet to 
 designate a prominent symptom. In autumn, the chylopoietic 
 viscera become more strikingly involved in the diseased action, and 
 this again is indicated by an ever-changing nomenclature. But when 
 winter approaches, and the subjects are exposed to sudden transi 
 tions of temperature, the thoracic viscera are called upon to bear 
 the burden of local disease, and then it is that the names pleurisy, 
 pneumonia, pneumonia typhoides, pneumonia biliosa, , pleuro-pneu- 
 monia, bilious pleurisy, lung ffever, etc., become- familiar." 
 
 After a pointed allusion to writers of books On 4jie practice of 
 medicine, and teachers who " find a complicated sjfctem of noso 
 logy a very convenient loop upon which to hang their learned dis 
 quisitions;" as well as to physicians in practice, who "derive advan 
 tage from an exercise of ingenuity and tact, in suiting the names of 
 prevailing diseases to the phases of popular prejudice, and in ex 
 plaining their want of success, without implicating the infallibility 
 of their skill ;" and also to the erudition displayed in arranging the 
 nosology of "Southern fever into forty or fifty different varieties, 
 deriving a technical name for each of them, from the classical lore 
 of the schools, and from the more vulgar vernacular of modern 
 tongues," etc., Dr. M. adds: "Let us talk as learnedly, and refine, 
 discriminate, and vary our nomenclature as we may, to suit the 
 fashion of the times, when we come to deal with plain facts, as they 
 are presented to us in practice, this whole class of diseases to which 
 I have here alluded will be found to take its appropriate place 
 under the plain designation periodic fever. We know very little 
 of the causes which produce it ; but we meet with it every month of 
 the year, and generally it varies in appearance and symptoms only 
 as it varies in degree of violence, and as the different organs of the 
 body become more or less implicated. Now it so happens, and we 
 need not attempt here to give the reasons why, that the stomach 
 and brain become more involved in the diseased action in summer, 
 and the lungs and the other thoracic contents, in winter." "These 
 local affections, whichever may for the time predominate, do not, in 
 any material respect, change the character of the constitutional dis- 
 
AUTUMNAL FEVERS. 49 
 
 ease, it is a periodic fever still, and requires the anti-periodic treat 
 ment." "In all its forms and modifications, we can never lose sight 
 of the important fact that the disease is one of periodicity and self- 
 limitation. Its uniform paroxysmal character points to the use of 
 one great remedy, upon which, in all cases, whenever (wherever?) 
 the local lesion may appear, we must place our main dependence 
 for relief," care being taken, however, to remove those lesions by 
 appropriate means. 
 
 All this is plain enough, and leaves no doubt as to the import of 
 the views under examination, of the principal grounds on which 
 they are founded, and of the mode of practice to which they are 
 intended to lead. Pneumonia must, henceforward, be classed among 
 the various diseases which, from a peculiar phenomenon they exhibit, 
 and the peculiar treatment they call fbr, take their appropriate place 
 under the plaift designation ; of periodic fever. Pathologists, opening 
 their eyes to tie light once more shed upon the subject, must cease 
 to consider pneumonia, except in &few cases, as an idiopathic disease 
 separate from and independent of all others. They must learn to 
 view it as only a form of another complaint; in other words, as a 
 periodic fever in disguise. Its occurrence at the same time, and 
 in the same place with periodic fevers ; its succeeding to or pre 
 ceding these ; its presenting periods of exacerbation and remission, 
 and its being benefited,, when these fluctuations occur, by remedies, 
 quinia particularly, which exercise an anti-periodic power, establish 
 beyond the possibility of doubt the important fact of the close alli 
 ance between, if not common origin of, those diseases. All the 
 diseases so classed, pneumonia, pleurisy, pneumonia typhoides, 
 pneumonia biliosa, as indeed, hepatitis, phrenitis, gastritis, are pro 
 ducts of the same causes that occasion remittent, intermittent, yel 
 low fevers, plague, Asiatic cholera, and typhoid fever the difference 
 depending on temperature, atmospheric vicissitudes, and the like. 1 
 
 1 In former publications, Dr. Merrill has expressed the opinion that yellow fever 
 differs in nothing but degree of violence from the common autumnal remittent, 
 and arises from precisely the same causes. I need scarcely remark that many others, 
 in this country and elsewhere, have entertained, and continue to entertain, similar 
 views on the subject. For this reason, and because, while discarding all such opinions 
 relative to the pathological and etiological unity of these two forms of fevers, I regard 
 yellow fever, as also common autumnal fevers, as the products of aerial poisons the 
 
 1 "Yellow Fever of Natchez," in 1823, Philadelphia Med. and Phys. Journ. ix. 235; "Yellow Fever of 
 Natchez," in 1825, A". A. Med and Surg. Journ. ii. 217. 
 
50 PNEUMONIA AND 
 
 Autumnal fever it is argued being met with every month of 
 the year, the cause, whatever it may be, must exist all the year 
 round, uninfluenced, in regard to its creation or disappearance, by 
 changes of season, atmospheric phenomena, etc. Like every other 
 form of fever, pneumonia must be viewed as a general disease of 
 the whole system, but evincing a strong determination of diseased 
 action to some particular organ in the instance before us, to the 
 lungs the difference depending on season, weather, and other kin 
 dred circumstances. Thes$ local affections, whichever may for the 
 time predominate, do not, in any material respect, change the cha 
 racter of the constitutional disease it is a periodical disease still, 
 and requires the anti-periodic treatment. The pneumonia of all 
 writers is, strictly speaking, only the pneumonic form of periodic 
 fever ; and while we are devoting our .best skill and energy to 
 relieve the local affection, we must not lose sight of the fact that 
 we are dealing with a constitutional complaint a periodic fever. 
 Though it cannot be denied that pneumo^a sometimes appears 
 among us, as an idiopathic affection, we are justified in concluding 
 that the thoracic inflammations, which show themselves in this 
 country generally, sometimes sporadically, and frequently with epi 
 demic violence, are really and substantially nothing more than a 
 peculiar form of intermittent and remittent fever. In a word, pe- 
 
 results of local infection of kindred though not identical nature, I shall, throughout 
 these pages, treat of them all under the generic name of malarial diseases. They all 
 belong to that family of zymotic diseases (those due to morbific ferments), which, 
 unlike others of the same class, which are due to contagious viruses, arise from local 
 sources of infection ; in other words, in which the morbific emanations in connection 
 with which they arise, act not only as predisposing, but as exciting causes also. The 
 admission that these diseases belong to the one class of zymotics and arise from fer 
 ments, by no means necessarily carries along with it the idea of pathological identity. 
 
 For similar reasons I may occasionally refer to typhoid fever in connection with the 
 cause of the former, for that disease would appear to arise, sometimes at least, from, 
 or to be associated in its production or propagation with, morbid agencies somewhat 
 allied to those from which autumnal fevers generally spring. Besides it is viewed, 
 with what degree of propriety I shall not stop here to inquire, by some of our South 
 ern physicians, to say nothing of some few in the North, and a small set in England, 
 as only a peculiar form the continued of common autumnal fevers, and not as a 
 special and specific disease. 
 
 Finally, I shall, for the same reason, refer to the oriental plague as a malarial dis 
 ease ; for it is not unusually acknowledged, by high authorities too, to arise or to be 
 greatly under the influences of exhalations of a malarial character; and is, besides, 
 regarded by some writers of this country more particularly as another form of common 
 remittent autumnal fevers. 
 
AUTUMNAL FEVERS. 51 
 
 riodie fever is a protean disease, which sometimes, owing to sundry 
 adventitious circumstances, attacks one set of organs, sometimes 
 another. When it exercises its deleterious influence on the pul 
 monary organs, it gives rise to their inflammation or congestion, 
 and occasions the disease we denominate pneumonia, pleurisy, etc. 
 But, whatever be the part affected by it, it is always the same con 
 stitutional disease, and invariably calls for the same general treat 
 ment. Medical writers and medical teachers may amuse themselves 
 in classifying diseases according to their supposed differences in 
 regard to seat, phenomena, and nature ; they may exercise their in 
 genuity and tact in suiting the names of prevailing diseases to the 
 phases of popular prejudice ; or display vast erudition in discrimi 
 nating the different varieties of southern fevers, and arranging their 
 nosology; they may prate about these matters as much as they 
 please, but, by so doing, they only afford the proof that they have 
 not carefully imbued themselves with the principles of the Baconian 
 philosophy, and that tBeir whole system, of the pathology, practice, 
 etiology and physiology of fevers and febrile affection is erroneous 
 founded on preconceived notions, and not upon facts and induc 
 tions. For it is now proved, to the satisfaction of a few observers, 
 more sharp-sighted than the very large majority of their brethren 
 in both hemispheres, that this whole class of diseases takes its ap 
 propriate place under the plain designation, periodic fever ; that all 
 the varieties of that class, which, for certain reasons, well known to 
 the reader, have been held, heretofore, as distinct from each other 
 typhus, typhoid, intermittent, remittent, yellow, etc. are really 
 and substantially one and the same disease, and that in the same 
 category must now be placed pneumonia, pleurisy, etc. 
 
 Such are the views entertained to some extent in former days, 
 and revived on a rather more extensive scale in recent times, rela 
 tively to the close affinity or the identity pathological and etio- 
 logical of two classes of diseases which the profession generally, 
 both here and elsewhere, have found ample reason to regard as 
 totally distinct from, and independent of each other. Examined 
 in whatever point of view we please, analyzed as closely and 
 minutely as it is in our power to do, the whole argument in 
 favour of those views setting aside what flows from the peculiar 
 theoretical notions of some of their advocates relative to the unity 
 or relationship of all diseases and stripping it of all the hors d oeuvres, 
 and hypothetical assumptions, and doubtful assertions by which it is 
 
52 PNEUMONIA AND 
 
 accompanied, and to a great extent disfigured, the opinion in ques 
 tion resolves itself always into a very narrow compass, and is found 
 to rest on a few points already referred to. It may be stated thus: 
 the two classes of diseases, pneumonia and autumnal or periodic 
 fevers, prevail either simultaneously or consecutively in the same 
 locality conclusion : they must be due to the operation of the same 
 causes, and therefore are identical in nature. The periodic element 
 is more or less strongly marked in the various grades of autumnal 
 fevers; the same element is sometimes detected in pneumonia con 
 clusion : the latter disease to say nothing of many others of the 
 same class whether it shows itself sporadically or epidemically, is 
 really and substantially nothing more than a^eculiar form of remit 
 tent and intermittent fever. Pneumonia soi^etimes yields to the 
 action of the same remedies which are four#i to check the course of 
 autumnal or periodic fevers conclusion : thfi similarity of results 
 obtained from the same treatment in both clashes of diseases, implies 
 a close alliance between them, or, indeed^., a .common origin and 
 pathological identity. Pneumtrtiia must be viewed as a general 
 disease of the whole system, but evincing a determination of morbid 
 action to the lungs; the same may be said of autumnal fevers, 
 with the exception that the local determination t$kes place in some 
 other part conclusion : both these classes of diseases being consti 
 tutional, and the difference of the local effects depending on fortui 
 tous and secondary circumstances, they^are. produced by the same 
 causes, and are identical in nature. 
 
 It is evident, from what precedes, that the ,Kip&erii advocates of 
 the theory, or rather hypothesis in question , for it scarcely de 
 serves the name of theory, may fortify their cause by an appeal to 
 the imposing phalanx of authorities above referred to. ISTo one 
 will deny that among these several are found who are entitled, 
 for many reasons, to the unbounded regard of the profession at 
 large, and are destined to occupy an honourable position in the 
 annals of our science. Neither can we doubt that others among 
 them perhaps a large number deserve to be treated with courtesy, 
 manifesting, as they generally do, practical good sense, a commend 
 able amount of professional attainments, and no inconsiderable share 
 of ingenuity and smartness. But however numerous the advocates 
 of the hypothesis undoubtedly are, and whatever may be the degree 
 of respect to which their opinions on this and other subjects is enti 
 tled, it need scarcely be observed that, in what has been adduced 
 
AUTUMNAL FEVERS. 53 
 
 in its support by them, we cannot discover sufficient reason to acqui 
 esce in .its correctness ; while the circumstances under which some 
 of the writers quoted were placed, and the opportunity for accurate 
 observation and close and careful induction, and the degree of pro 
 fessional scholarship possessed by others, were not such as to ren 
 der their verdict on pathological and etiological points beyond the 
 reach of criticism, and to silence opposition on the part of sub 
 sequent inquirers. Some, and perhaps the most distinguished, 
 flourished at a time when pathological and etiological knowledge 
 was at too low an ebb to^ induce us to look to them for the settle 
 ment of questions of the kind. Others, though living at a period 
 less remote from our ^>wn, do not appear to have sufficiently quali 
 fied themselves -by diligent inquiry, and extensive and close study, 
 to justify their pretensfejis to enlighten the medical world on sub 
 jects of this nature; %hile others, again, who recently have thought 
 fit to revive the hypothesis; have evidently taken but a one-sided 
 and contracted view of the matter, and allowed themselves some 
 times to be swayed in their infe*r%nces by favourite and fanciful 
 hobbies. 
 
 Under such circumstances the subject might, and perhaps ought 
 to have been allowed to drop. But the importance of the question 
 thus raised ; the stir it has occasioned among the physicians of some 
 sections of this country, and the fair professional standing of some 
 of its modern supporters, bave induced me to investigate it with all 
 the care and attention of which I am capable. The result of this 
 investigation hasten unfavourable; and so far from leading me to 
 lend a willing ear to the connection under consideration, has only 
 tended to confirm me in the opinion I have always held on the sub 
 ject. It has done more ; for I have thereby been induced to adopt 
 conclusions diametrically adverse to those of which I have pre 
 sented an outline. Now, more than ever, I regard these as faulty 
 in a scientific point of view, and leading to pathological deductions 
 not only erroneous and at variance with long admitted principles, 
 but occasionally glaringly illogical. I hold them to be in direct 
 opposition to facts which are, or ought to be familiar to every ob 
 servant and well-read physician. I hold them to evince a total 
 oversight of all established opinions respecting the causes of the 
 several diseases thus placed in juxtaposition. I hold also that, how 
 ever plausible these conclusions may seem to be, they have not been 
 supported, as far as I can perceive, by a single fact or argument 
 
54 PNEUMONIA AND 
 
 calculated, when properly sifted, to satisfy a careful inquirer, and 
 to which a ready answer may not be found. I hold all this ; and 
 see, with regret, that the whole subject has been presented in a man 
 ner evincing a decided disposition to set at naught, as worthless, 
 the observations and inferences of all preceding and contemporary 
 writers who entertain adverse views, and not unfrequently in a tren 
 chant and contemptuous tone, from which none, not even those 
 whom the medical world has never ceased to treat with courtesy, 
 and view in the light of standard authorities, are allowed to escape. 
 For these reasons, and considering also that these opinion s are likely 
 to lead, if adopted and acted upon, especially by inexperienced 
 physicians, to a hazardous practice ; bearing in r#ind, besides, that, 
 from the influential position which some of their advocates occupy, 
 there is reason to fear they may continue to maj$e converts, not 
 only among medical students, but among -that cl^jss of professional 
 readers unfortunately too large among us who are easily seduced 
 by real or supposed novelties, and fanciful or whimsical notions ; and 
 convinced, in addition, of the necessity of ascertaining, without loss 
 of time, the value of dogmas bearing directly or indirectly on prac 
 tical points, when presented and enforced by men of note and repu 
 tation, I propose to devote this volume to a survey of the facts and 
 arguments that may be adduced, and thus to test, in its various 
 details, the hypothesis to which attention has been called, and see 
 how far it is deserving of our adoption. 
 
 The reader will easily perceive that, bcf<3& the advocates of the 
 identity of the two diseases can successfully sustain the position 
 they have assumed, it will be necessary for them to show that au 
 tumnal fevers and pneumonia are produced by the same causes ; 
 that they prevail in the same places, and during the same seasons 
 of the year ; that their existence and diffusion are promoted by the 
 same agencies ; that they are arrested by similar means ; that they 
 exercise their effects on the same classes of individuals ; that they 
 present similar or kindred symptoms; that they affect the same 
 organs, and produce the same or analogous changes in the fluids 
 and soli Jrf ; that they are governed by the same laws ; and that they 
 present other points of approximation invariably found to be pos 
 sessed by diseases between which there exists the close connection 
 claimed in the instance before us. Unless they can succeed in 
 attaining these objects, their opinion must fall, and the independence 
 of those diseases be admitted. It becomes necessary, therefore, 
 
AUTUMNAL FEVERS. 55 
 
 to take up each of those subjects separately, and to ascertain how 
 far they may be appealed to in respect to the question at issue. 
 
 As we have seen, it is admitted that pneumonia is sometimes an 
 idiopathic affection, caused, of course, in such cases, by atmospheric 
 vicissitudes, or other kindred morbid influences, and unconnected 
 with any complaint except ordinary phlegmasise. But, while admit 
 ting thus much, it is contended that, in the majority of instances, 
 the disease must be referred to a different origin, and viewed as 
 simply symptomatic ; that it is a mere form of another complaint, 
 and would not, it may b presumed, exist if the causes of the latter, 
 whatever they may be, did not exercise their baneful influence. It 
 is suggested that t lie combination of phenomena, which impressed 
 the common observer with the idea that he beheld a special and in 
 dependent complaint, was - fallacious really nothing more than a 
 cloak, serving t(y *disgufee a disease which, in its natural state, 
 assumes a different dress; and that, while with infantile simplicity 
 we fancied we had before us a disease of well-known pathological 
 character, it turns out that we were dealing with one of a totally 
 different kind, in which the affection of the lungs constituted an 
 accidental and unessential element. 
 
 All this may prove acceptable in certain quarters; it may be 
 regarded as plausible by some, or even as well founded and per 
 fectly unanswerable. But, so far as I am concerned, I have no 
 hesitation in stating, as the result of my personal observations, aided 
 by extensive inquiry -^hd close reflection, that pneumonia is not 
 sometimes but always an idiopathic disease, whether it occurs spo 
 radically or epidemically; whether in the South, in the North, in 
 the East, or in the West; whether in fever districts, or in fever 
 seasons, or in places or at periods of the year free from periodical 
 fevers; and that it is due to causes perfectly distinct from those to 
 which such fevers owe their origin. I believe this; and believe, 
 besides, that even were pneumonia produced at times by the legiti 
 mate causes of fevers, such cases would not be any more symptomatic 
 than those that are due to the ordinary causes of the disease ; for 
 these do not act directly and primarily on the lungs any more than 
 the others would do, supposing them capable of giving rise to the 
 effect in question. And as in either circumstance the primary im 
 pression is received by some other part of the system, and thence 
 reflected on the pulmonary organs, the two sorts of cases must be 
 placed on the same footing, arid be all primary or all secondary. Of 
 
56 PNEUMONIA AND 
 
 course we must exclude from the cases thus referred to, those pro 
 duced by traumatic or mechanical injuries, and agencies acting 
 directly on the lungs, for these might, strictly speaking, be called 
 symptomatic. It may, perhaps, also be proper to exclude some of 
 those in which symptoms of pneumonia show themselves during the 
 progress of other diseases, or after extensive surgical operations or 
 wounds. I say in some, for while in these the inflammation of the 
 lungs is secondary, and merely the effect of sympathetic irritations, 
 which may and do arise in a variety of dissimilar complaints, and are 
 somewhat influenced by the nature of the cause giving rise to them; 
 in others, the pneumonia may properly be called ifliopathic, inas 
 much as it is independent for its causation of the agency giving rise 
 to the prior complaint, being produced by the same causes which 
 would have given rise to it had no such disease, operation, or wound 
 preceded. But, whatever be the mode of origin of suck cases, many 
 of which properly belong to a category to which attention will be 
 called by and by, it may safely be maintained that pneumonia, when 
 ever it shows itself ab initio, is idiopathic, that it is always produced 
 by its appropriate causes, and, what is more to our present purpose, 
 that it is independent for its origin of those morbid agencies to which 
 autumnal fevers are due ; that it is not less independent of such 
 fevers in a pathological point of view, and that it cannot, therefore, 
 be lowered to the rank of a peculiar form of that class of diseases. 
 
 1. Pneumonia common where fevers seldom or never are seen. It is 
 scarcely necessary to remark that inflammatory affections of the 
 substance, and lining, and covering membranes of the lungs, prevail 
 very extensively in places where remittent, intermittent, and other 
 fevers of kindred nature are not observed, and during seasons of the 
 year when, if the ordinary causes of fever had at any time exercised 
 their influence, they have been effectually or temporarily checked. 
 With us, pneumonia prevails, during certain periods of the year, in 
 localities where autumnal fevers, especially intermittents, rarely if 
 ever originate. In Philadelphia and the same may be said of 
 other large cities such a thing as a case of the latter disease is 
 seldom encountered. When the disease does present itself, it is 
 usually seen among individuals who have taken it elsewhere. On 
 the other hand, in our extreme suburbs and in the surrounding 
 open country, where remittents and intermittents are sometimes 
 quite rife, and always, except in winter, more or less noticed, pneu- 
 
AUTUMNAL FEVERS. 57 
 
 monia is not much more common than we find it to be in the city 
 proper; not more so, at least, than can be accounted for by the 
 greater exposure of the inhabitants to atmospheric vicissitudes and 
 other known causes of the disease. Within the limits of the bills 
 of mortality, including the city proper, where periodic fevers are 
 scarcely ever seen, and a few only of the fever districts, the propor 
 tion of deaths from inflammation of the lungs and bronchire, in 
 thirteen years, 1836-1848, amounted to 1 in 11.7. 1 Again, in the 
 cities of our Middle States, the yellow fever, which, as we have 
 seen, approximates to, without however being identical with, ordi 
 nary autumnal fevers, shows itself only in certain confined and 
 peculiarly circumstanced localities, especially along and near the 
 wharves. Now if there are facts to show that pneumonia is more 
 common in such localities, during sickly seasons or at any other 
 time, than ii* other places where the fever never reaches, unless 
 imported, an experience of upward of thirty years has not enabled 
 me to discover them, and I am sure no one has been more fortunate 
 than myself on* that score. Most American medical readers know, 
 or if they do not, a perusal, among others, of Dr. Holmes s excel 
 lent Dissertation on Intermittent Fevers will teach them, that this 
 disease is of rare occurrence in New England, except in certain 
 circumscribed localities to be noticed by and by, and that it has 
 disappeared in places where some years ago it prevailed more or less 
 extensively. It may be remarked, also, that in other localities of this 
 country, and in various cities and rural districts of France, England, 
 Tuscany, Lucca, and other parts of Europe, to which I shall have 
 occasion to call attention as I proceed, inter mittents, which before 
 had spread extensively, have so effectually been chased away, by 
 the judicious application of hygienic means, as to be now but rarely 
 encountered. But while such has been the case with regard to 
 malarial fevers, we are perfectly safe in affirming that pneumonias 
 have not disappeared together with the former from any of those 
 spots of New England, which have so much improved in point of 
 salubrity; that the disease prevails over the whole region now as it 
 did formerly, and that hence there are few physicians better ac 
 quainted with its phenomena than our brethren of the Eastern 
 States. Among our troops in the military posts on the coast of 
 New England, the ratio treated per thousand of mean strength, 
 
 1 Trans, of Coll. of Pliys. ii. 375. 
 
58 PNEUMONIA AND 
 
 amounts, according to Forry, to 41. 1 On a mean strength of 3,138, 
 there were 233 cases of catarrh and influenza, 22 of pneumonia, and 
 26 of pleurisy. 2 
 
 Nor is it less certain that the same remarks are applicable to 
 the localities in Europe above referred to; for there pneumonias 
 continue to prevail as extensively and fatally as when their insa 
 lubrity from malarious influences was most noted. Take Paris 
 and London as examples. According to Dr. Lombard, pneumonia 
 constitutes, in the former, one-fourteenth* part of the diseases of 
 adult subjects, while in children the proportion varies from one- 
 fourth to one-fifth. 3 The correctness of this estimate is confirmed, 
 so far as regards adults, by the results, obtained by Grisolle, who, on 
 comparing, during three years, the frequency of that disease, rela 
 tively to that of all other internal complaints, in the hospitals of that 
 city, found that the former constituted the fourteenth, fifteenth, or 
 seventeenth part of acute and chronic complaints. In asylums for old 
 people, the average proportion of pneumonias .appears to vary from 
 one-sixth to one-seventh. 4 To thfe it may bemadded, as corroborative 
 of the extreme frequency of pneumonia in Paris, that the average 
 mortality in the ten years, 1837-1848, from pulmonary catarrh, 
 amounted to 2,222, and that from pneumonia to 2,037. 5 I arn aware 
 that a contrary statement has been made in regard to London and 
 other parts of England. Dr. Wells, as ^fcfehSve seen, insists on the 
 decrease of thoracic inflammation in that city since the diminished 
 prevalence of malarial fevers, and appeals t$> other physicians for 
 the occurrence of a similar result elsewhere. A Mr. Weeks, of 
 Sussex, informed him that genuine pleurisies were not seen there 
 now as formerly. Dr. Wells farther refers to Dr. Harrison, of Horn- 
 castle, who mentions incidentally, in different parts of An Essay on 
 the Rot in Sheep, that both agues and acute inflammation of the 
 lungs are less common in Leicestershire than they used to be. "Ac 
 cording to Sydenham," Dr. Wells continues, " no disease was in his 
 time more frequent than pleurisy. At present, a physician in con 
 siderable practice here may pass several years without seeing a 
 single legitimate instance of it." Dr. Wells, it is true, finds that Dr. 
 Willan, in his Report on the Diseases in London, from 1796 to 1800, 
 makes frequent mention of thoracic inflammations ; but he believes 
 
 1 Forry; Climate of U. S. 238. 2 Ibid. 242. 
 
 3 Archives Gen. de Medecine, xxv. 68. 4 Traite dc la Pneumonic, 127. 
 
 5 Trebuchet; Ann. d llygil-ne, xlvi. 20. 
 
AUTUMNAL FEVERS. 59 
 
 that that eminent physician must have called diseases by the name 
 of pleurisy which differed considerably, in regard to the mode of 
 treatment they required, from the same complaint referred to by 
 Sydenham ; and closes with the remark that the instances of acute 
 inflammation of the contents of the chest which fell under his ob 
 servation, in London, were almost solely peripneumonias, in which 
 copious bleeding was less clearly indicated, and was attended with 
 less benefit than commonly happens in pleurisies ; and one-half, per 
 haps, of these instances, %hich were not numerous, supervened to 
 acute rheumatism. 1 
 
 Without stopping to examine how far the reasons assigned by Dr. 
 Wells for doubting the frequency of thoracic inflammation in London 
 are correct, and without denying the possibility of the decrease of 
 pleurisy in Sussex or Horncastle, I may remark that the statements 
 of eminent writers ^hcl statisticians do not bear that physician out 
 in his conclusions. According to Dr. Farr, who has devoted much 
 attention to the subject, 2 while in all. England the mortality from 
 pneumonia amounted in 1838 to a^Dout one twenty -fifth part of the 
 whole number of deaths, and to about one-twentieth of those from in 
 ternal diseasespn London the proportion amounted to about one- 
 fifteenth of the whole deaths, and one-thirteenth of those from 
 internal complaints.* In London, the average deaths from 1820 to 
 1831, inclusive, occasip&lj&foy inflammation of the lungs and pleu 
 risy, amounted to 2,077. 3 v ln 1839, while the deaths from those dis 
 eases in England and Wales amounted to one in 18.01 of the mor 
 tality from all causes excepting external violence, the loss in London 
 was one in one hundred and twenty-nine, being 3,687 from pneumo 
 nia, and sixty-five from pleurisy. In 1840, the proportion did not 
 differ very materially from this. Sir Gilbert Blane states that, dur 
 ing ten years service at St. Thomas s Hospital, he attended upwards 
 of 320 cases of pulmonary inflammation, and 192 of intermittent 
 fever. In private practice, during another period of ten years, 1795 
 to 1806, he attended, out of 8,160 cases of various diseases, 145 of 
 pulmonic inflammation, and only twenty-five of intermittent. 4 
 
 Other facts lead to the same conclusions. If we turn to Nova 
 
 1 Transactions of a Society for the Diffusion of Med.-Ch. Knowledge, iii. 539-541. 
 
 2 W. Farr, First Annual Report of the Registrar-General of Births, Marriages, &c. 
 London, 1839, p. 168. 
 
 3 Marshall, Mortality of London, last table. 
 
 4 Select Dissertations, i. 205-247. 
 
60 PNEUMONIA AND 
 
 Scotia, Malta, Bermuda, and Gibraltar, and examine how matters 
 stand there in relation to the question before us, we shall find 
 that malarial fevers are rarely encountered, while both residents and 
 visitors suffer extensively from pneumonia. In Gibraltar, Dr. Hen- 
 nen 1 states that malarial fevers seldom show themselves, while the 
 mortality from pulmonary inflammation is very large. 2 The tables 
 furnished by Major TiiHock, show that, in an aggregate strength of 
 60,269, the admission^ among the troops for quotidian, tertian, 
 and remittent fevers, amounted in nineteen years, 1819-1836 (ex 
 clusive of cases occurring during the yellow fever epidemic of 1828), 
 to 616, and for yellow fever to four. At the same time, the number of 
 cases of inflammation of the lungs reached 2,515, and of pleurisy 
 twenty-eight, or 2,543 ; giving an average of 42.3 per 1,000. 3 In 
 Malta, with a strength of 40,826, trie admission^ for periodic fevers 
 (intermittents and remittents) amounted to 69o, or seventeen per 
 1,000 ; those for inflammation of the lungs to 1,370 ; and for pleu 
 risy, to twenty-one total, 1,391.; or thirty per 1,000; 4 the mortality 
 being one-fifteenth of the whole. 5 In Bermuda, in an aggregate 
 strength of 11,721, those same fevers intermittent and remittent 
 amounted to forty-six, and inflammation of the lungs and pleurisy 
 to 441, or seventeen per 1,000. In Nova. Scotia and New Bruns 
 wick, malarial fevers figure in the tS^|s $>r 52, while inflammation 
 of the lungs presents an aggregate of I,o05, to which must be 
 added seventy-two cases of pleurisy, w^ichj the strength being 
 44,120, gives us a proportion of thirty-n>e per 1,000. It is proper 
 to state that I have excluded, in this comparison, the common con- 
 
 1 Topography of the Mediterranean, 490. 
 
 2 Ibid. 498. 
 
 3 Mortality of the British Army, pp. 7-1 1. 
 
 4 At page 64, Major Tullock states that, from 1830 to 1836, the aggregate strength 
 at Gibraltar being 22,868, 655 cases of pneumonia and pleurisy were admitted, or 
 twenty-nine per 1,000. At Malta, the strength being 15,031, the cases amounted to 
 456, or 30.3 per 1,000. At page 17, we have the following table, which exhibits at a 
 glance those proportions in 19 years : 
 
 Aggregate strength Admission 
 
 Pneumonia. in 20 years. 1 . and PI. Per 1 ,000 
 
 Gibraltar, ... . 60,269 2,543 42 
 
 Malta, 40,826 1,391 34 
 
 Ionia Island, 70,293 2,272 32 
 
 Bermuda, 11,721 441 37 
 
 Nova Scotia and New Brunswick, . 44,120 1,577 35 
 
 5 Mortality of the British Army, pp. 22, 23. 
 
AUTUMNAL FEVERS. 61 
 
 tinned fever mentioned in the reports. Its origin from the malaria 
 of common autumnal fever is doubtful, and being found to prevail in 
 the most diversified climates, it may be viewed as the typhoid fever 
 of most modern writers. At Constantine, in Africa, paludal fevers 
 are not common, and, according to Dr. A^.tonini, physician in chief 
 of the French army of occupation, when they appeared among the 
 soldiers, they had most generally been take^p. elsewhere. Thoracic 
 inflammations, on the contrary, are very frequently noticed 1 in that 
 vicinity. Pneumonias are very common in Chili, at all seasons of 
 the year, though more particularly during the spring months. On 
 the other hand, intermittents and other forms of malarial fevers are 
 there rarely encountered. 2 
 
 The city of Turin, in Italy, is exempt from those fevers ; but 
 pneumonia is of common occurrence. 3 Similar observations have 
 been made at Genoa. 4 Sweden, except in some few of its southern 
 and alluvial districts is, like several other northern countries, free 
 from malarial fevers. But so frequently is pneumonia encountered 
 there that, by Hoffman, it was viewed in the light of an endemic. 5 
 
 2. Pneumonia not necessarily prevalent where fevers are common. 
 If now we reverse the proposition, and inquire into the frequency 
 of pneumonia in malarious an& fever localities a frequency which 
 we might reasonably expeclHl) occur, were the causes of the dis 
 eases and their pathology the same we shall find little reason 
 to admit the corre&nefe- of the hypothesis under examination. 
 Hippocrates, it is true, may be, and indeed has been, appealed to 
 in support of the fact that pneumonia is of common occurrence 
 in paludal countries; and there is no doubt that if his testimony 
 can avail in the settlement of this matter, and be considered con 
 clusive, the advocates of the opinion in question may congratulate 
 themselves, for the language of the Coan physician is explicit: 
 "And I wish to give an account of the other kinds of waters, 
 namely, of such as are wholesome, and such as are unwholesome, 
 and what bad and what good effects may be derived from, water, 
 for water contributes much towards health. Such waters, then, 
 
 1 Boudin, Georgia Med. 80. 
 
 2 Lafargue; Bulletin de 1 Academia de Medecine, xvii. 178-203. 
 
 3 Mem. de 1 Acad. de Med. xiv. 230-1. 
 
 4 Ann. d Hyg. xxx. 58 ; xxxv. 5 ; xxxvi. 304. 
 
 5 Williams ; Cyclop, of Pract. Med. iii. 408. 
 
62 PNEUMONIA AND 
 
 as are marshy, stagnant, and belong to lakes, are necessarily hot 
 in summer, thick, and have a strong smell, since they have no 
 current ; but being constantly supplied by rain-water, and the sun 
 heating them, they necessarily want their proper colour, are 
 unwholesome, and form bile; in winter they become congealed, 
 cold, and muddy with the snow and ice, so that they are most apt 
 to engender phlegm and bring on hoarseness; those who drink 
 them have large and obstructed spleens; their bellies are hard, 
 emaciated, and hot ; and their shoulders, collar-bones, and faces are 
 emaciated." " This disease is habitual to them both in summer and 
 in winter; and, in addition, they are very subject to dropsies of a 
 most fatal character ; and, in summer, dysenteries, diarrhoeas, and 
 protracted quartans frequently seize them ; and these diseases, when 
 prolonged, dispose such constitutions to dropsies, and thus prove 
 fatal. These are the diseases which attkck them in summer ; but, 
 in winter, younger persons are, .liable to pneumonic and maniacal 
 affections ; and older persons to ardent fevers from hardness of the 
 belly." 1 
 
 In our days, the statement has received, the sanction of no less an 
 authority than the great Joseph Frank, from wj;om we learn that, 
 in the course of an extensive practice, he never saw so large a num 
 ber and so great a variety of pneumonias as among the peasant 
 inhabitants of the rice fields of the canton of Te^sino, where paludal 
 fevers are endemic. 2 But facts in abundance may be collected to 
 show that though under some circumstances pneumonia may pre 
 vail frequently, or even extensively, in local&ies^bject to malarial 
 fevers as the environs of Strasburg, Pavia, Padua, Kome, Naples, 
 the vicinity of Vesuvius, as well as in many parts of this country will 
 attest it frequently happens that in such localities, even where 
 the paludal cause exercises its baneful effects with great energy, 
 inflammation of the lungs is comparatively rare, and in some 
 scarcely encountered. Indeed, there are not wanting reasons to 
 justify the opinion that, on the point in question, the father of medi 
 cine must be regarded as an unsafe guide, and that his statement 
 should be received with great caution. For, though in the marshy 
 districts of Greece, inflammatory affections of the lungs may, for 
 what we know, have been frequently seen by him a fact which, 
 as we shall see, recent observations do not tend to confirm the 
 
 1 Adams s transl. i. 195-6 ; Airs, Waters, and Places ; Littre s trans, ii. 29. 
 
 2 Praxeo s Med. ii. pt. ii. 315. 
 
AUTUMNAL FEVEKS. 63 
 
 cases so noticed were, probably, in most instances, nothing more 
 than severe catarrhal affections. In saying this, I trust I shall not 
 be considered as undervaluing the merits of this truly extraordi 
 nary man ; but, whatever may have been the remarkable powers of 
 observation he possessed, it is not to be supposed that his diagno- 
 stical proficiency was such as to enable him invariably to discri 
 minate with accuracy between catarrh and true parenchymatous 
 inflammation of the lungs. 
 
 Dr. Forry, in his account of the climate of the United States, 
 remarks of pneumonia, pleurisy, and catarrh, that they are " inva 
 riably less prevalent in the moist and changeable climate peculiar to 
 the sea-coast and large lakes, than in the dry atmosphere of the 
 opposite locality-;" 1 and we all know that it is precisely in the 
 former localities that fever abounds. In the northern division, the 
 average number of cases. -of pneumonia in 1,000 was found to be 
 45 ; that of intermittent and remittent fevers, 231. In the middle 
 division, the averages in, l,000 were 74.5 of pneumonia, and 739 of 
 fevers ; and, in the southern division, the average of pneumonia in 
 1,000 was 43, and of fevier 5$8. 2 
 
 In the East Indies, where jungle and remittent fevers are com 
 mon, pneumonia.4f scarcely known. Desportes, while quoting the 
 old aphorism, cattidum pectori amicum, frigidum inimicum, informs 
 us that the disease is less frequent in St. Domingo, one of the 
 most malarial of the West India Islands, than in France. 3 
 
 In the Windward and Leeward islands, as well as in Jamaica, where 
 sources of malariaj&ibokad, and where fevers, in consequence, con 
 stitute near one-halt of the prevailing diseases, pneumonia, so far 
 from being a common complaint, is rarely encountered. In the 
 former command, an average military strength of 4,333, gave, in 
 twenty years, 1817-37, 62,163. Of these, 24,607 were quotidians; 
 1,973 tertians; 133 quartans; 17,799 remittents, and 774 yellow 
 fever. This makes a total of 45,286 malarial fevers, the balance 
 being common continued (typhoid ?), typhus, and synochus. During 
 the same period, inflammation of the lungs furnished a quota of 
 only 1,941, and pleurisy of 34. 4 In the Jamaica command, with 
 an average military strength of 2,578, the number of fever cases 
 were no less than 46,922, or 910 per 1,000. Of these cases, not 
 
 1 Climate of the United States, 359. 2 Ibid. 233, 277, 284. 
 
 3 Maladies de St. Domingue, i. 32. 
 
 4 Tullock, Med. Statistics of Brit. Army, 7, 8. 
 
64 PXEUMONIA A:ND 
 
 less than 6,090 were intermittents, or 38,393 remittents, and 20 yel 
 low fever ; the total being 44,503 autumnal or periodic cases. 1 Dr. 
 Kufz, in a communication made to Dr. Grisolle, 2 states, as the result 
 of his personal observation, that pneumonia is very uncommon at 
 Martinique. 
 
 "Although we encounter in Senegal," says Thevenot, "the greater 
 number of the pathological changes incident to temperate climates, 
 and although endemic diseases there differ in nothing but fre 
 quency and severity from our own, yet the^e are some which will 
 command almost exclusively our attention, because they prevail 
 much more frequently than all others. Eemittent and intermittent 
 fevers, dysentery, hepatitis and nervous- colic .constitute the most 
 dangerous enemies of Europeans. \ At j$ie ame time inflammation 
 of the thoracic organs, though no,t unknown, is rare, and in a list of 
 952 cases of disease, treated from Juljyl$37, t& July, 1838, mala 
 rial fevers amounted to 509, while vpleufigies and pjeuro-pneumo- 
 nias did not reach ab<*ve 5." 3 At Bone, in Africa, as we learn 
 from Dr. Maillot, pneumonia is an excessively rare disease ; while 
 malarial fevers, on the contrary, abound to an unprecedented de 
 gree. Of 3,765 cases of disease treated by him from 9th Febru 
 ary, 1834, to 15th March, 1835, only 6 were affected with pleuro- 
 pneumonia. 4 In Upper Canada, where malarial exhalations, and, as 
 a consequence, autumnal and periodic %vers abound much more 
 than in the lower section of that countrj|^neumonia prevails much 
 less extensively. The proportion of the latter disease in Upper 
 Canada, per 1,000, is noted by Major Tullock at 60; in Lower Ca 
 nada at 30 ; while the proportion of intermittent fevers per 1,000 
 in the former was 178, and of remittent 12; and the proportion of 
 intermittents in the latter was only 26 per 1,000, and of remit 
 tents I. 5 In French Guiana, and especially at Cayenne, where 
 malarial fevers are proverbially common, and the climate is justly 
 considered in consequence as excessively insalubrious, thoracic in 
 flammations are rarely encountered. 6 It is true that Campet tells 
 us a very different story on the subject. But he admits that such 
 
 1 Tullock, Med. Statistics of Brit. Army, 46, 47. 
 
 2 Traite de la Pneumonie, 132. 
 
 3 Tr. des Maladies des Europeans, dans les pays Ckauds, 232, 240. 
 
 4 Trait<$ des Fievres Intermittentes, 114. 
 
 5 Opera, cit. 27, B ; 29, B. 
 
 6 Segond Apcr9u sur le Climat et les Maladies de Cayenne, 1831, quoted by Gri 
 solle, 133. 
 
AUTUMNAL FEVERS. 65 
 
 inflammations are principally rife among the slaves who do field 
 work, are destitute of proper clothing, and sleep on planks in 
 badly constructed huts, where, unless protected by large fires, they 
 are apt to suffer during the low temperature of the night and break 
 of day. 1 
 
 Similar are the results obtained on the western coast of Africa, 
 almost every point of which may be regarded as a hotbed of mala 
 rial fevers. From Major Tullock, we learn that the Sierra Leone 
 command presented, in a, total number of 5,489 cases of disease, 
 2,600 of fever. Of .these, 948 were of intermittents, and 1,601 of 
 remittents, which, with 51. of common continued, were in the pro 
 portion of 1,411 per 1,000 of mean strength. In the list, the affec 
 tions of the lungs figure^ f$r 103, being in the proportion of 56 per 
 1,000; and pneumonia fcVl5>-, or per 1,000. 2 In conclusion, I 
 may here mention arfact, t0-w)hichjGrrisolle ]aas. already called atten 
 tion, that Monfalcon, in biar treatise- on marsheg, though pointing out 
 the frequency of pulmonary catarrh in pali*dal localities, nowhere 
 enumerates pneumonia among the diseases peculiar to them ; 3 and 
 that Nepple, though asserting the fact in positive terms, disproves his 
 own statement by showing, that in a total of 1,352 cases of disease, 
 admitted into the wards of the Hospital of Montluel (Ain) during 
 the course of four years, intermittent and remittent fevers furnished 
 not less than three-seven<th|L of the whole, while pneumonia came in 
 for only one-sixteenth. 4 ^^the Ionian Islands, with an aggregate 
 military strength of 70,293, the cases of malarial fevers in twenty 
 years, 1817-1836, amounted to 16,252, being in the proportion of 
 230.5 per 1,000, while the cases of pneumonia and pleurisy amounted 
 to 2,272, or 31.2 per 1,000. 5 
 
 Again, in some parts of the south of Spain, where acute inflam 
 mation of the lungs is rarely encountered, paludal fevers, on the 
 contrary, are very prevalent, and constitute, with gastro-enteritic 
 and hepatic inflammation, the great bulk of the diseases of the 
 country. 6 Dr. Roux calls attention to the fact of the small propor 
 tion of thoracic affections, acute and chronic, in the Morea, where 
 paludal localities extend far and wide, and where malarial fevers 
 are necessarily abundant. " In France," he remarks, " at this season 
 
 1 Maladies des Pays Chauds, 210, 2T1. 
 
 2 Mortality of the British Army, 8-10. Ibid. 500. 
 
 4 Nepple, Essai sur les F. Int. et Remit. 15, 297. 5 Tullock, 32, 34, 35. 
 
 6 Boudin, Geog. Med. 85. 
 
 5 
 
66 PNEUMONIA AND 
 
 of the year (January), if we were to collect an equal number of sick 
 in a hospital ward, we should hear little else than the sound of 
 cough, and many convalescents would present, at the moment of 
 their discharge, the sequelae of some thoracic affection. Here, no 
 thing of the kind occurs." 1 Few countMes suffer more from mala 
 rial fevers, intermittents and .remittents, than the Island of Ceylon. 2 
 Statistical returns of the diseases observed there among Europeans, 
 show that pneumonia forms but a small item in the list, the number 
 of cases being only sj^th of that of all diseases, acute and chronic. 3 
 Dr. Davy also states that diseases of the lungs are exceedingly un 
 common in that island, both among Europeans and natives. Asthma 
 and pneumonia now and then occur (p. 491). According to Dr. 
 Marshall, the proporiign of deaths among the troops from all dis 
 eases and from pneumonia, frorjj^ l^JB tto 1820, inclusive, was as 
 follows : 
 
 
 From all diseases. 
 
 From pneumonia. 
 
 1816 
 
 . . . v . . 63 , 
 
 2 
 
 
 1817 
 
 57 
 
 7 
 
 
 1818 
 
 513 
 
 6 
 
 
 1819 
 
 310 
 
 6 
 
 
 1820 
 
 139 
 
 8 
 
 
 This gives us a total of 1,082 from all diseases, and of 29 from 
 pneumonia, or 1 in 37.27. 
 
 During a period of three years, extending from 21st of December 
 to 20th of the same month, 1817-1818, 1818-1819, and 1819-1820, 
 the number of cases among European troops treated in the hospi 
 tals of Badula and Kandy, were as follows : 
 
 First Period. BADULA. KANDY. 
 
 Fever, intermittent, .... 224 746 
 
 " remittent 163 337 
 
 " common continued . 000 104 
 
 Pneumonia 4 16 
 
 Second Period. 
 
 Fever, intermittent .... 86 170 
 
 " remittent 94 83 
 
 " common continued . . 00 84 
 
 Pneumonia 2 00 
 
 1 Hist. Mod. de 1 Armee Francaise en Moree, 84. 
 
 2 Davy: An Account of the Interior of Ceylon, 4to. 493. Marshall, Notes on the 
 Med. Top. of Ceylon, 39. 3 Grisolle, 130. 
 
AUTUMNAL FEVERS. 67 
 
 Period. BADULA. 
 
 KANDY. 
 
 Fever, intermittent .... 
 
 20 
 
 11 
 
 " remittent 
 
 13 
 
 3 
 
 " common continued . 
 
 * 00 
 
 108 
 
 Pneumonia 
 
 1 
 
 14 
 
 We have here, in three years, a total of 2,246 cases of endemic 
 fevers of various types ; while pneumonia figures in the list for 37, 
 or 1 in about 61. 
 
 It is to be remarked that the few cases of pneumonia observed, 
 occur principally, if not exclusively, among the Malay, Indian, and 
 Caffre tribes; the Europeans, who are most liable to endemic fevers, 
 being comparatively but little liable to the disease. 1 
 
 But these facts must suffice.. So far as thefy go, they seem con 
 clusive ; and with suitable-de$e&eirfe to the authority of writers who 
 entertain sentiments different from those which it is my object to 
 uphold, I cannot think I hazard much when expressing the opinion 
 that the impartial reader, after perusing what precedes, will acknow 
 ledge that it will puzzle them, talented and ingenious as some of 
 them undoubtedly are, to reconcile those facts with the hypothesis 
 set forth regarding the identity of pneumonia with malarial fevers. 
 Let them, if possible, account -for the aforesaid circumstances the 
 absence of malarial fever where pneumonia is rife ; and the exten 
 sive prevalence of the former in localities where the latter is either 
 not of remarkable frequency, or scarcely seen at all the cessation 
 of the one and continuance of the other and say how all this could 
 be brought about, if the inflammation of the lungs, in the disease in 
 question, were due to the agency of the cause producing those 
 fevers ; in other words, if pneumonia were really and substantiallv 
 nothing more than a peculiar form of remittent and intermittent 
 fever. "Were the etiological connection and pathological dependence 
 such as maintained, we should expect to find that the cause, if dif 
 fused in such localities to an extent, and possessed of a degree of 
 energy, sufficient to produce a large number of cases of pneumonia, 
 or, as others would say, of the pneumonic form of autumnal fever, 
 would also give rise to a greater or less number of cases of the other 
 and more legitimate and characteristic forms of those fevers. This 
 would .be the more natural to anticipate, because the climatorial 
 influences noted in those favored spots where fevers have never 
 
 1 Notes on the Med. Topog. of the Interior of Ceylon, 92-129. 
 
68 PNEUMONIA AND 
 
 prevailed, or have long ceased to do so, are not different from those 
 under the empire of which such fevers everywhere appear ; or have 
 remained the same amid all the changes that have occurred in 
 regard to their prevalence; the only difference consisting in 
 the absence or removal of certain terrestrial or local conditions, 
 which, whatever be the nature of their association with the ordinary 
 forms of the supposed protean disease, have apparently nothing in 
 the world to do with the existence of what is now maintained to be 
 simply another form of the same. The result being different 
 pneumonia occurrin^where autumnal fever has never originated, 
 or where, if it has done so, it now seldom if ever prevails we are 
 warranted in concluding that the ^causes of the two diseases are 
 different ; that the one may exist without the other ; that when the 
 two diseases show themselves at the* ( same time, and in the same 
 locality, two sets of causes necessarily exercise their baneful in 
 fluences and produce, not one disease assuming different forms, and 
 presenting different aspects, but two distinct complaints; and that, 
 consequently, pneumonia cannot justly bef held up as forming part 
 and parcel of autumnal fevers, which, as regards etiology, are 
 governed by very different laws, and influenced by very different 
 
 3. The two diseases prevail in different seasons. The contrast 
 between the two diseases is particularly striking as regards 
 the seasons in which they mostly prevail. ":As the name usually 
 affixed to malarial fevers indicates, the latter is, in our latitudes 
 especially, a disease of autumn. It seldom appears before the 
 middle or close of summer, and ceases on the accession of win 
 ter. Its existence in an epidemic form in temperate regions, is 
 never known to occur in the spring of the year ; cases that occur 
 in that season, or in winter, being accounted for without having 
 recourse to the supposition of the development then of the efficient 
 cause. It never shows itself in winter, and if it appear early in 
 summer which is seldom the case the occurrence is only noticed 
 under peculiar circumstances of atmosphere existing during the 
 preceding months, and which invest these with the characteristic con 
 ditions appertaining to autumn. It is emphatically a disease of hot 
 weather, requiring for its production a continuance for some time 
 previous of high atmospheric heat. It appears, generally, some weeks 
 after the hottest month; the period being retarded as we proceed 
 
AUTUMNAL FEVERS. 69 
 
 north. For the same reasons it may readily be understood to be a 
 disease of hot latitudes, prevailing, as it does, violently and almost 
 perpetually within the tropics, and ceasing long before we reach 
 the polar circle. Dr. Drake, who has npted all these circumstances, 
 has, from extensive observations, arrived ^at the conclusion that, 
 with the decrease of yearly and summer heat, other conditions re 
 maining unchanged, there is an abatement of fever. Taking the 
 heat of summer alone into consideration, he thinks we may assume 
 that a summer temperature of sixty degrees is necessary to the 
 production of fever ; that it will not prevail ^s an epidemic where 
 the temperature of that season falls below sixty-five degrees ; and 
 that, if the other conditions favouring its production are deficient, 
 it will cease before those reductions of temperature have been 
 reached. 1 
 
 In the Mediterranean stations, the admissions into the hospital, 
 and the deaths, average nearly twice as high between July and 
 October as during any similar number of months in the year. 2 In 
 Spain and Portugal, the $i$kly season, in malarial districts, is from 
 July to September. 3 The fever of Kome, in general, is held to 
 begin with the great heats about the end of June. The Roman 
 people have fixed on St. Peter s day as the exact period of its out 
 break, and it reigns from then till it is put a stop to by the equi 
 noctial or autumnal rains of September. The readers of Horace 
 will recollect that, in Jiis time, July was notorious for its insalu 
 brity. " Adducit febpes et testamenta resignat." 
 
 In this country and in Canada it commences in July or August, 
 and ends, in the south in November or December, and in the north 
 about October. In England, much the same results are obtained. 4 
 
 In hot latitudes, where the heat is almost constant, the fever, if 
 not constant also, commences earlier than in our latitudes, and lasts 
 later when not put a stop to by unusual agencies. On the African 
 coast it exists to some extent at all seasons ; but is formidable from 
 April to November, and especially rife from July to the last-men 
 tioned month. In Senegal, thundershowers commence towards the 
 close of April, or beginning of May, and continue to the middle of 
 July, when the rains set in. This season (hivernage) lasts to the end 
 
 1 A Systematic Treatise on the Principal Diseases of the Interior Valley of North 
 America, 712. 
 
 2 Williams, on Morbid Poisons, ii. 460. 3 Macgregor, Med.-Chir. Tr. vi. 387. 
 4 Williams, op. ci(. Watson, 445. 
 
70 PNEUMONIA AND 
 
 of October or beginning of November. It is at this period (the 
 hottest of the year) that remittent fevers usually make their appear 
 ance. 1 In the West Indies, also, the period of the greatest liability 
 is between July and December, when the hottest weather, com 
 bined with considerably moisture prevails. In Bengal, fever com 
 mences in August, and^ntinues till November. 2 In Ceylon, the 
 months of June, July, "an<f August are, in general, the period of 
 the year when the greatest sickness prevails. 3 In a word, the 
 epoch of appearance and disappearance may vary in different 
 localities according t^ iJie situation of these, and their position 
 relative to fche equator, and the consequent modification in the 
 period of the <fcsons ; but everywhere endemic or autumnal fevers 
 break out, or are most rife, during or shortly after the hottest 
 weather. "i 
 
 So far as regards the yellow fever$ the disease may still more 
 appropriately be denominated one of hot weather; requiring, as it 
 does, a higher average temperature during the summer months 
 not less than between 76 and 80 degrees (Fahr.). It manifests itself 
 in no climate where the temperature i& below that average, and 
 ceases to appear long before we reach the limits assigned to ordi 
 nary periodic fevers. In our climate it has commenced as early as 
 June. Such was the case in this city in -1799, and in Charleston in 
 1837. We even find that in the year 1732 & appeared in the latter 
 city as early as May. In 1852, one death by yellow fever was re 
 ported in May, and another in June. Bi 1819, the disease broke 
 out in this city about the end of June. Such, was the case in New 
 Orleans in 1848. But instances of this kind are rare, and when 
 they occur, the progress is at first slow, and the disease presents 
 more the character of a sporadic than of an epidemic visitation. 
 More frequently, the fever breaks out about the middle or end of 
 July, often in August, and sometimes as late as September. Thus 
 it began its epidemic career in the course of July, in Philadelphia, 
 in 1747, 1794, 1797, 1802, 1803, 1805, and 1820; in Norfolk, in 
 1800, and 1821 ; in Providence (E. I.), in 1805 ; at Brooklyn (N. Y.), 
 in 1809 ; in New York, in 1799, and 1803 ; at Woodville (Miss.), in 
 1845 ; in New Orleans, in 1817, 1844, 1847, and 1853 ; Eodney, in 
 1847 ; Boston, 1798, and 1819. Our epidemics of 1699, 1762, 1793, 
 
 1 Levacher, 48. 2 ciark on Long Voyages, i. 110. 
 
 3 Marshall, Topography and Diseases of Ceylon, 89. 
 
AUTUMNAL FEVERS. 71 
 
 1798, commenced in August, as did also those of Charleston, in 1732, 
 1739, 1745, 1748, 1849, 1852; of Baltimore, in 1798; of New 
 York, in 1791, 1797; of Providence, in 1798, and 1800; of New 
 London, in 1798 ; of Boston, in 1819 ; of Wilmington (Del.), in 
 1798, and 1800 ; of Natchez, in 1817, 1819, \823, and 1825 ; of New 
 Orleans, in 1819 ; of St. Augustine, in 1839 ^of Mobile, in 1819, 1843,, 
 and 1847 ; and of Yicksburg, in 1847. In Gibraltar, Leghorn, and 
 the various cities of Spain where he fever has prevailed as Medina, 
 Sidonia, Malaga, Antiquar, Cadiz, Barcelona, Xeres, &c., the period 
 of appearance has varied from July to Seplfermber ; never earlier nor 
 later. But in Europe, as in this country, at whatever |ime the dis 
 ease may break out, it ceases as an epidemic, or cv^| altogether in 
 October, November, or December. 
 
 In the West Indies, and on the African coast, it makes its ap 
 pearance, as might easily ha^e been foreseen from the greater pre 
 cocity of the 4iot season, at an earlier period than it usually does 
 in this country and in Europe i while in some years, owing to the 
 greater encroachment of hot weather on the autumnal months, it 
 breaks out later than it $oes in temperate latitudes the period 
 varying from April (or even earlier, as was- the case at Granada, in 
 1793, when it showed itself in February) to the middle or close of 
 September. 
 
 If we now turn to pneumonia, we shall find that the period of its 
 prevalence is very different from that of the disease just referred to. 
 Hippocrates, some three t&ousand years ago, and Areteus after him, 
 pointed out the winter as the season in which the disease manifests 
 itself most commonly, and subsequent writers have generally united 
 in that sentiment. Sydenham, it is true, and after him the learned 
 commentator of Boerhaave, affirmed, as the result of their observa 
 tions, that the disease attains its maximum between spring and 
 summer. But the statement has not always been confirmed by 
 subsequent authorities in this country and Europe. According to 
 Chomel, pneumonia is more particularly rife in winter, spring, and 
 the commencement of summer, and is rarely seen at the close of 
 the latter season and during the autumn. Of 97 cases observed by 
 that writer and Louis, at the Charity Hospital of Paris, 81 occurred 
 between February and August, and 16 only daring the other 
 months. 1 Of 357 cases recorded by Leroux, and cited by Grisolle, 
 
 J Diet, de Med. xvii. 210, 1st ed. 
 
72 PNEUMONIA AND 
 
 116 occurred in winter, 137 in -spring, 58 in summer, and 44 in 
 autumn. Andral states that the disease prevails mainly in the spring 
 months March, April, and May. 1 The following are the results 
 obtained by Grisolle in an examination of 296 cases: 
 
 January 20 
 
 February .... 40 
 
 March .... . 47 
 
 April 62 
 
 May 40 
 
 June . 8 
 
 July 13 
 
 August 3 
 
 September .... 5 
 
 October 2 
 
 November . . . . 22 
 
 December 34 
 
 Admitting this to be a fair representation of the comparative 
 monthly freqi^n<a|f of the disease , among adults in Paris, it follows 
 that pneumonia attains its maximum in April. Next come in order 
 of frequency, March, February, and May ; then December, Novem 
 ber, and January ; while August and October present the smallest 
 number of cases. 2 Hourman and, J)echambre, cited by Grisolle, who 
 investigated the subject among -the aged inmates of the Salpetriere, 
 found the cases more numerous in March. 3 At Geneva, on the con 
 trary, the disease often attains its maximum ill May ; 4 while among 
 children, Eilliet and Barthez point out February as the month of 
 greatest frequency a result modifie^, doubtless, as Grisolle re 
 marks, by the circumstance that the fluenza was then existing in 
 Paris. Facts very similar to those suited are recorded as being 
 usually observed in England, in the more northern and southern 
 districts of Europe, at Malta, in Bermuda, Nova Scotia, Canada, 
 and in every part of this country and South America. 5 Every 
 where, among adults, children, and old people, idiopathic or primi 
 tive pneumonia appears to attain the maximum of frequency at 
 the close of winter and in the spring, especially during the months 
 of March and April. Next in point of frequency is the winter; 
 while the disease, though not unknown in summer, is comparatively 
 
 1 Mcd. Clinique, i. 513. 2 Grisolle, 137. 
 
 3 Op. cit. and Archives, xii. 2d series. 30. 
 
 4 Essai Statistique sur la Mortalite du Canton de Geneve, Ann. d llyg. xxiii. 51. 
 
 5 Williams, Cycl. of Pract. Med. iii. 407; J. Frank, 311; Andral, i. 513; Tullock, 
 44, B ; Wilson Philip, Tr. on Symptom. Fever, 204 ; Briquet, Arch. Gen. vii. 3d s. 482 ; 
 Ramsay, Charleston Journ. vi. 1, 2; Bell and Stokes, ii. 207; Smith on Epid. 
 80; Johnson and Harris, Trans. Am. Med. Assoc. v. 373; Gerhard, Amcr. Journ. 
 1834; Ed. F. Williams, Stethoscope, ii. 544; Lafargue, Bulletin de 1 Acad. xvii. 198 
 
AUTUMNAL FEVERS. 73 
 
 of rare occurrence during that season, and perhaps still more so 
 during the autumnal months. 
 
 Grisolle mentions farther, that .of thirteen epidemics of pneu 
 monia, the authenticity of which cannot be contested, seven com 
 menced in spring, four in winter, one in autumn, and one in 
 summer. 1 The epidemics noticed in this country have usually 
 commenced in winter, and prevailed in thaj season and spring, the 
 latter often furnishing the greatest number of the cases. 
 
 4. They appear under the influence of opposite winds. It is not to 
 be forgotten that the two diseases do not usually manifest them 
 selves under the influence of the same order of winds. So far as 
 regards malarial fevers, not a little in this mat^r mill depend on 
 the nature of the surface over which the wind may happen to pass 
 before reaching the locality where the disease prevails; for at the 
 proper period of the year, other things being favourable, fever 
 will appear, as we shall see, in connection with any currents which 
 waft the air from neighbouring surfaces where the elaboration of 
 the morbific cause is going on. Edinburgh is supposed to derive 
 fever through the agency of the east wind, which blows it from 
 Holland. The same wind wafts malaria from Essex to London. 
 The north-east wind blows ^malarial fever into some portions of 
 Home. Generally speakingjaftie western coast of Italy contains a 
 more extensive elaborating Surface than the eastern, in consequence 
 of which, other circumstances being equal, the western currents are 
 more prolific of fever than their antagonists. The same thing, and 
 for the same reason, occurs in Europe generally, from the fron 
 tiers of Asia to the other extremity of that continent. In Batavia, 
 the north-east wind, which is very prevalent during July, August, 
 and September, is highly unfavourable to health. 2 So are the north 
 winds at New Orleans during summer, 3 and the east and west winds, 
 at the Havana. 4 In Normandy, at Berniere, an unusual course 
 of south-west winds blowing across a pestiferous region, and con 
 spiring with a hot summer, caused several violent epidemics. 5 In 
 London, the south-east winds are apparently unfavourable for the 
 same reason. 6 The same thing occurs in Dutch Guiana. 
 
 1 Op. cit. 139. 2 HorsefielJ, Med. Mus. i. 79. 
 
 3 Report on Fever of 1819, p. 50; Chabert, viii. pp. 9, 26. 
 
 4 Osgood, 29. 5 Macculloch on Malaria, 351. 
 6 Second Report of Loud. Commissioners, 40. 
 
74 PNEUMONIA AND 
 
 " Yellow fever," says Dr. Bone, " prevails on Brimstone Hill, St. 
 Kitts, when the strong north winds that have swept foul ground on 
 Mount Misere impinge upon the persons in the ill-constructed bar 
 racks and out-buildings on that hill. And in Tobago, Dominica, 
 Grenada, St. Vincents, and in all the hilly uncleared islands of the 
 West Indies, strong north and east winds and rain, impinging upon 
 the troops and their families in ill-constructed barracks, are causes 
 of the disease." 1 "In St. Domingo," says Desportes, "the acclimated 
 inhabitants regard the north wind as unwholesome, while the south 
 wind is very j>etaiicious to new-comers. This is particularly noted 
 in the plain of the Cape, because the nort^-east and north-north-east 
 winds, before reaching it, pass over a large surface of marshy locali 
 ties, from the effdct of the exhalations of which the natives, who are 
 proof against seasoning fevers, are no.t exempt." 2 
 
 In this city and country, instances of the kind might be cited in 
 abundance ; but they, as well fes many others, will find a more 
 appropriate place in another part of the pre|^at volume. 
 
 But however true it may be that particular currents of winds 
 exercise a baneful influence in the way mentioned, it is not less a 
 fact which experience will everywhere confirm, that the existence 
 of malarial fevers has almost invariably been connected, in tem 
 perate regions particularly, with the prevalence, during a greater or 
 shorter space of time, of southerly currents, and that the influence 
 that these exercise is not necessarily, and in some forms of the 
 disease is very seldom, dependent on the malarial nature of the 
 localities over which they happen to pass. Nor could this well be 
 otherwise ; for these fevers require for their development the long 
 continuance of a range of thermometrical heat, which could seldom 
 be obtained during the prevalence of opposite currents. Under the 
 influence of these winds, whether from due south, or from the 
 neighboring points, S. E., E. S. E., or S. W., accompanied, as they 
 are, with heat, and in many, if not most malarious regions, with hu 
 midity, fever originates and spreads to a greater or less extent; 
 while from a change of these to other winds blowing from the 
 opposite points of the compass, as N., N. W., or N. E., there results 
 a beneficial change in the healthfulness of the infected locality ; 
 a diminished prevalence, or even a cessation of the fever. In 
 tropical climates, where the most frequent variations are from 
 
 1 Essay, 15. 2 Maladies dc St. Dominguc, vol. i. i!l. 
 
AUTUMNAL FEVERS. 75 
 
 E. S. E. to E. N. E., and where the wind never remains long at N. 
 E. or S. E., and rarely blows from due north or due south, the pre 
 vailing current is always attended with considerable heat and moist 
 ure ; and with few exceptions, when the wind blows from the west 
 longer than usual, and when the heat is nevertheless very great, 
 as at Martinique < in 1839, l the prevalence of**fever is very usually 
 associated with south-east or easterly currents. 2 One of the writers 
 to whom I have referred below, and whose ample experience and 
 great accuracy of observation cannot be doubted, remarks on the 
 subject : "The development of the yellow fever in th% West Indies, 
 in a great number of me& at . the same time, in different parts, at 
 a distance from each other, on a level with the sea, or slightly above, 
 on board vessels in port or at sea, coincides so exactly with the in 
 crease of heat and humidity, and with the prevalence of the south 
 winds, that it is impossible not to recognize in these meteorological 
 conditions the true cause of the epidemics of yellow fever. The 
 effect here is intimati$^ and necessarily connected with its cause. 
 The production and extension of- yellow fever under the prolonged 
 influence of the south winds, is a fact observed by every one ; so in 
 evitable, indeed, that it can be* predict&d without fear of ever being 
 mistaken. This action of the south winds is felt here by everything 
 that breathes. They produce undefmable effects on our senses. 
 We feel them in bed, or sifting at the desk ; they enervate, cause 
 oppression, and depress the spirits. To say in what these atmo 
 spherical alterations, the effects of which are so much to be dreaded, 
 consist, and to seek to determine their specific nature, is doubtless 
 a task beyond the faculty of man." "It is a fact, I cannot say it too 
 often, that yellow fever is never developed in the same manner as 
 other epidemics, but by and under the influence of the south winds. 
 When this general cause fails, the yellow fever only exists in cer 
 tain restricted places, or only a few sporadic cases appear here and 
 there, as occurred in 1819 and 1820. There were only, in all, forty- 
 two men attacked by the yellow fever in the Hospital of Fort 
 Royal in 1820, and yet, notwithstanding, the garrison, including sol- 
 
 1 Rufz, 29, 54. 
 
 2 Desportes, 19; Lcmpriere, i. IT; Bally, 361; Gilbert, 12; Humboldt, 765; Ro- 
 choux, 113; Lefort, Du Quinquina et de la Saignee, c. p. 66; Ib. Mem. sur la non 
 Cont. de la F. J. 9; Leblond, 81; Lind on Seamen, 67; Dariste, 33; Arnold, 26; 
 Savaresi, 189, 242-3; Moreau de St. Mery, 716; Chiskolm, 88; Chervion Kept, on 
 Rufz, 45 ; Catel, 20 ; Olivet, 6 ; Vincent, 7. 
 
76 PNEUMONIA AND 
 
 diers, seamen, and military workmen, was very numerous ; but in 
 that year the wind did not blow from the south, or only occasion 
 ally, and never more than twenty -four hours at a time. It may, 
 moreover, be remarked that this injurious influence of the south 
 wind, or of winds from neighbouring points of the compass, is ob 
 served under the same parallels Q latitude or in corresponding 
 parts of our hemisphere." 
 
 In temperate regions, the concurrence of southerly winds would 
 seem to be even more requisite than it is i& : the West Indies, be 
 cause, in these^the long continuance of the degree of heat necessary 
 for the elaboration of the malarial poison may and does exist, as is 
 seen during sem sickly season, without the aid of such currents ; 
 whereas, in the former region, the tempe$$ire seldom if ever attains 
 the degree alluded to, or remains at* re long, except under the in 
 fluence of the south wind or it$ collaterals. Indeed, it is doubtful 
 whether, in our latitudes, fever% of a malignant character, particu 
 larly, have often been found to prevail under *> very different con 
 dition of aerial currents. It was under the influence of the warm 
 winds that the fever described by Hippocrates, and which is so 
 closely allied to the worst forms of the malarial fevers of Algeria 
 and our Southern States, appeared. Tt|je yellow fever of Anda 
 lusia, Cadiz, Carthagena, and other cities of Spain, has almost in 
 variably shown itself during the prevalence, or after a prolonged 
 continuance, of the Levanter, or east wind, which is both hot and 
 damp. Such has also been generally the case at Gibraltar. 1 In 
 Italy, the south and south-west winds are the usual attendants on 
 fever periods. 2 In Sicily, matters are not very different. 3 In like 
 manner, in this city, and other parts of the United States, the yel 
 low and other forms or varieties of malarial fevers, usually, if not 
 always, break out and prevail during the continuance of south or 
 some other hot winds. 4 In a word, the production and continuance 
 
 1 Tullock s Report, 4; London Quarterly Rev. Ixvi. 135, 6; Vance s Rep. in Pym, 
 60; Fellows on Pestilential Fever, 13, 15, 469; Berthe Fievre J. 51 ; Parisct, F. J. de 
 Cadiz, 96 ; Gilkrest, Cycl. of Practical Med. ii. 279 ; O Halloran on Yel. Fev. of Spain, 
 14; Wilson, Fev. of Gibraltar, Chervin s Translation, 9; Rochoux, 113; Gilpin, 
 Med.-Chir. Trans, v. 339; Bally, 363; Amiel, in Johnson on Trop. Cl. 260; Town- 
 send s Spain, 340 ; Maclean on Epidemics, ii. 485. 
 
 2 Carricre, Climat de 1 Italie, 462 ; Valentin, Voy. Mdd. 45 ; Baglivi, Opera Omnia, 
 157-8; Edinburgh Rev. xxxvi. 542. 3 Boyle, Edinb. J. viii. 178. 
 
 4 Caldwell on Malaria, 135 ; Ib. Med. Repos. vii. 144-5 ; Barnwell, 366 ; S. Jackson, 
 40; Waring, 23; N. 0. Kept, for 1839, 156; La Revue Mod. for 1840, 322; Rand. 
 
AUTUMNAL FEVERS. 77 
 
 of autumnal fevers periodic and yellow, is usually connected with 
 the prevalence of southerly winds ; and on inquiry it will be found 
 that in instances when a different result was obtained, the thermo 
 meter had nevertheless ranged high.- r 
 
 Now, how do matters stand in that respect as regards pneumo 
 nia ? If, in some localities, as at Gibraltar, for example, the disease 
 prevails most usually during those periods of the "year when west 
 erly winds are predominant ; if the disease also is found to occur 
 more frequently in ol&er places under the influence of different 
 currents, it may be laid down as a genetal rule, tha^ north, north 
 east, and north-west winds are those during the prevalence of 
 which thoracic inflammations are more frequently .developed. Such 
 was found to be the casfcjjji the north of Italy and Germany by 
 J. Frank. 1 Le Pecque de la" Gloture 2 made similar observations in 
 Normandy, as did also Hourmann l&nd Deckambre, 3 and Grisolle, 4 
 at Paris. Of fifty-four cases of th# disease observed by the latter 
 author, fifteen occurred with a north-east wind ; eleven with north 
 west ; three with north wind ; five with south-east ; eight with 
 south-west, and eight during -a perfect calm. Hippocrates, long ago, 
 noted the prevalence of pneumonia under the influence of north 
 and north-east currents in Greece. " But the following is the con 
 dition of cities which have the opposite exposure, namely, to cold 
 winds, between the summer settings and the summer risings of the 
 sun, and to which those winds are peculiar, and which are sheltered 
 from the south and the hot breezes." " The diseases which prevail 
 epidemically with them are pleurisies, and those which are called 
 acute diseases." 5 Similar results have been noted in England, 6 in 
 Nova Scotia, and Bermuda ; and it can scarcely be necessary to add 
 that in this country pneumonia is almost invariably associated with 
 the prevalence of northerly currents N., N. E., N. W., or west. 
 
 5. Pneumonia is of yearly occurrence not always so fevers. In 
 connection with this subject, it may be mentioned that in places lia- 
 
 Med. Repos. ii. 466; Valentin, 85-6, 89; Fev. of Baltimore in 1819, 95; Archer, 
 Recorder, v. 61 ; Bailey, 55 ; Townsend, 55 ; Merrill, Phil. J. ix. 233 ; Barton, Fev. 
 of N. 0. in 1833, p. 9. 
 
 1 Op. tit. 312. 2 Malad. Epid. 1st pt. 15. 
 
 3 Arch. Gen. 2d s. xii. 30. 4 Op. tit. 141. 
 
 5 Airs, Waters, and Places; Syd. Soc. Ed. i. 193; Littrg s Tr. ii. 19-21. 
 
 6 Cyclop, of Pract. Mod. iii. 407. 
 
78 PNEUMONIA AND 
 
 ble to pneumonia, the appearance of the disease is of yearly occur 
 rence. The cases may fluctuate in respect to their number. There 
 may be comparatively few o#e year and many on another occasion. 
 At other times, the disease may assume the character of an epidemic. 
 But nowhere and on no occasion has -it been known to disappear 
 during the whole of ttye season at&^hich it usually prevails, or 
 during an entire year ; still less ha$ it been known to fail entirely 
 during a series of ^ears, and to recommence its course as here 
 tofore after a long period of repo^S. Nor does it suddenly visit 
 localities to which it had Before been a stranger; and, after scourg 
 ing them for one or more seasons, disappear and be seen no more. 
 The disease, beiiisg the offspring of <jau$es which, as we shall see by 
 and by, are strictly local in their .chsracler and dependent on parti 
 cular states of tht sensible qualities of tjBitmosph x ere, which do 
 not differ very materially in the same localities in successive years, 
 must, and does consequently, show itself more or less extensively 
 at each return of its appropriate season witj^ouf being much, if at all, 
 influenced in the frequency of its manifestation, far less prevented 
 entirely, by modificatjja^ in the condition of the soil or of surround 
 ing objects. 
 
 But while such is the case in relation to pneumonia, a different 
 result obtains in regard to autumnal or periodic fevers of various 
 grades and types. Every one knows in |^is country that although 
 the bilious remittent fever, the endemic of many localities from one 
 extremity to the other of our vast republic, appears in such places 
 to a greater or less extent, every year at stated periods, seasons 
 occur at which it does so in so trifling a degree as to attract little 
 notice ; and others again when it does not show itself at all. On 
 the other hand, it is a fact, placed beyond the reach of doubt, that 
 the disease is sometimes observed to spread extensively over a large 
 expanse of country, attacking places that had been for several or 
 many years almost or completely exempt from its ravages. Such 
 was the case in 1822, and a few succeeding years, when the disease 
 swept over immense tracts of country, in many portions of which it 
 had not been heard of for many years before. Similar observations 
 have been made in different parts of Europe, England, France, Spain, 
 Italy. In the West Indies, many facts might be adduced in proof. 
 Chisholm, in the 18th volume of Duncan s Medical Commentaries, 
 describes an epidemic of remittent fever which occurred in the 
 vicinity of St. George, Grenada, in 1792 ; on which occasion the 
 
AUTUMNAL FEVERS. 79 
 
 disease spread in an unprecedented manner, and attacked spots 
 heretofore viewed as salubrious. The following remarks by Dr. 
 Imray, in relation to the endemic of f)ominica, will apply equally 
 to the fevers of other islands : " The causes of our endemic fevers 
 reside permanently in some4ocalities ; but in certain seasons, remit 
 tent and intermittent fevers "t*eot>me prevalent throughout the island." 
 " Though the causes from whidb periodic fevers originate are per 
 manent in the country, yet do they not always operate with the 
 same energy. Sometimes thes^ morbific agencies remain in almost 
 a quiescent state, andnfevers occur comparatively rarely. At other 
 times, they manifest unusual activity, and then we have remittent 
 and intermittent fever in abundance." 1 ty 
 
 Still more striking are trfe intervals observed between the epi 
 demic manifestations ojfSjJellow fever, the elaboration of the cause 
 of which is of much less frequent occurrence than that of ordinary 
 autumnal pyrexia. When the disease broke out at Charleston in 
 1792, it had not preVaile^l there .during the long period of 37 years. 
 It did not reign in that city from 1807 to 1817, from 1830 to 
 1838, or from 1839 to 1849, and has seldom at any epoch, from 
 1690 to this day, prevailed in two successive years. 2 In New 
 York, it has shown itself often at long intervals; the years of 
 epidemic there having been 1741, 1743, 1751, 1762, 1791, 1795, 
 1796, 1798, 1804, 1805, 19, 1822. In this city, it did not prevail 
 from 1699 to 1742. It next showed itself in 1747, 1749, 1762. 
 From the latter year to 1793, a period of 81 years, there was a com 
 plete repose. The disease again showed itself in 1794, 1797, 1798, 
 1799, 1802, 1803, and 1805, and lastly in 1820. From the last- 
 mentioned year to the present, 1853 when the fever again made its 
 appearance, in a mild epidemic form, the number of cases not hav 
 ing reached above 170 the city remained free from it. During 
 some of these intervals, sporadic cases occasionally, but very rarely, 
 presented themselves. Kindred occurrences have been observed in 
 Boston, New Orleans, Mobile, Baltimore, and others of our cities ; 
 in some of which, indeed, the disease has occurred on a few occa 
 sions only. "When it broke out at Cadiz, in 1800, it had not been 
 seen there for 36 years ; the last visitation being that mentioned by 
 Lind as having occurred in 1764. Barcelona, which suffered so 
 
 1 Observations on the Character of Endemic Fever in the Island of Dominica, Edin. 
 Journ. Ixx. 284. 
 
 2 Simons, Charleston Journ. vi. 779. , 
 
80 PNEUMONIA AND 
 
 severely in 1821, had not been visited by it since 1803. It had not 
 been seen at Gibraltar for a century, at the time of its outbreak in 
 1804. At Vera Cruz, the city was free from 1776 to 1794. If 
 we except Sir W. Pym, and a few others of the same school, physi 
 cians who are conversant with the yellow fever of the West Indies, 
 whether they be continent or absolute contagionists or anti-con- 
 tagionists, have, from the days of Towne and Desportes to our own, 
 admitted and continue to admit that the disease, such as it exists 
 there, is a native of the soil, and prevails more frequently than 
 anywhere else. And yet there is not "one among them who does not 
 know that the fever is not of annual occurrence in those islands. 
 Sporadic cases dl^btless occur frequently during some seasons. At 
 others, howeve^j they are seldom seen ; and at some again, they 
 are almost, if not altogether, unknown. JLf we open Desportes s 
 excellent work on the Diseases qf St. Domingo, we shall find that in 
 the course of the fourteen years he resided at the Cape, the place 
 was free from the fever duripg five. 1 At Martinique, yellow 
 fever did not appear from 1827 to 1838. Grenada, when visited 
 in 1793 by the epidemic described by Chisholm, had not suffered 
 for 31 years. Dominica was also exempt from 1817-1821 to 1838. 
 Georgetown, Demerara, suffered severely in 1793 ; next, in 1803 ; 
 then in 1819. From that year to 1837 the disease did not show 
 itself in the epidemic, if indeed in any form. 2 
 
 "We find malarial fevers starting up even in times not character 
 ized by the existence of an epidemic constitution ; sometimes from a 
 slight change in the local condition of the soil or of surrounding 
 and sheltering objects, in spots where it had not been seen before. 
 Fever has for years gradually impinged on the city of Kome. It is 
 to this day spreading, and every year reaches some parts of the city 
 where it was before unknown. 
 
 On the other hand, from the operation of causes which it is not 
 necessary to enumerate, fever, as we have already seen, diminishes 
 or even disappears from localities where it had before prevailed 
 more or less extensively. 
 
 6. Their altitudinal range is not the same. Every one acquainted 
 with the habitat of autumnal or periodic fever must be aware that 
 
 1 Chervin, De I identite" des Fievres d origine Paludeenne de differens type, 5-83. 
 
 2 Frost, Med. Repos. 12 and 13; Blair, Some Account of the Last Yellow Fever 
 Epidemic of British Guiana, 28. 
 
AUTUMNAL FEVERS. 81 
 
 its cause is not exhaled, or, if so, is inoperative beyond a certain 
 degree of elevation above the level of the sea ; an effect due, like 
 that resulting from Northern latitudes, to the absence of the aver 
 age of temperature required for the elaboration of the cause in 
 question, or for rendering the system^redisposed to its impress. 
 But whatever be the elevation afc which i% shows itself, its usual 
 places of abode are valleys, plain surfaces, the banks of streams, 
 lakes, and the like ; while it very commonly spares high and 
 well- aired situations. If it attack these which J occasionally 
 the case the effect is often clue to the cnuse being wafted thither 
 by the wind, and sometimes, though more rarely, to the existence 
 in the vicinity of sources ibf morbific exhalations, (fliof a soil which 
 from its natural constitution is calculated, independently of true 
 marshy conditions, to give rise to such exhalations. As regards 
 the yellow fever, the altitudinal range, of which is below that of 
 ordinary autumnal or periodic fevers, it. has.iiever been known to 
 appear on high, and rarely on hilly .situations. Indeed, it has sel 
 dom, if ever, shown itself in any other than localities of a very 
 opposite character. On this subject, however, I shall have occasion 
 to dwell in detail in the next chapter, and need not say more about 
 it at present. 
 
 If, with these facts before us, we inquire how matters stand in 
 relation to pneumonia, we shall find that, on this point, as on the 
 several others already examined, the disease differs widely from 
 autumnal and periodic fevers. For, while the latter cease to appear 
 in localities situated at a certain degree of elevation above the level 
 of the sea, in the same way as they do at certain degrees of latitude, 
 no elevation of the kind has as yet been pointed out as forming a 
 barrier to the production of pneumonic inflammation. Let fever 
 stop as an epidemic, or endemic, or as a sporadic disease, where it 
 may, the inhabitants of places where the cessation occurs, or of those 
 situated beyond that limit, continue to suffer from thoracic inflam 
 mation, just as extensively and severely as those below, if, indeed, 
 they do not to a greater extent. "While fevers, whatever be the 
 elevation above the level of the sea at which they prevail, make 
 their appearance principally in the localities specified, and seldom, 
 except under special circumstances, break out in high and well-aired 
 situations, pneumonia, though not a stranger to low grounds, val 
 leys, and the like, prevails as widely, if not more so, on mountains, 
 hills, and other similar spots. To prove this by a reference to a 
 6 
 
82 PNEUMONIA AND 
 
 large number of examples, would be a work of supererogation; 
 for there can scarcely be found a physician who is not perfectly con 
 versant with the fact. We know how subject the low grounds and 
 miry river banks of Africa are to fever. On elevated localities, 
 which in some places are comparatively free from that disease, the 
 inhabitants are sufferers from pneumonia. This is the case in the 
 island of Fernando Po, and other places. 1 Grisolle, though not 
 prepared to admit the injurious ejects of great terrestrial altitude 
 in the production of pneumonia, cites the instance of a body of 
 French troops encamped from the 15th of December to the 15th of 
 May, on Mount Cenis, where malarial fevers are not common, if at 
 all known. Among these troops, pneumonia constituted one-fourth 
 part of the disease! from which they suffered. 2 During the year 
 1850, pneumonia in children prevailed to a considerable extent in 
 all its various forms in West Philadelphia. Dr. Pugh, who reports 
 the occurrence, adds : " And I, think I may ^ay, at least as far as 
 my practice or knowledge extended, that tjie 1 disease was not in 
 fluenced by locality, but was quite as common on high as low 
 grounds." The same physician remarks*- that fever in the same 
 season extended from the locks of the Schuylkill Navigation Com 
 pany to Chestnut Street, and about five squares West of Market 
 Street Bridge. " I think it may be asserted with safety that the 
 farther we go West, or the more elevated-* the ground becomes, the 
 less of that malady will be found." 3 Here then we see, in the one 
 case, pneumonia prevailing most extensively on one of the highest 
 ridges of the Alps, where fever does not appear, and in the other, 
 while fever ceases in proportion as we ascend from the Schuylkill, 
 pneumonia is not influenced in its frequency by the change of lo 
 cality. Not different are the results obtained in other elevated and 
 mountainous regions of this country. " The elevation and coolness 
 of the Alleghany," says another reporter, " secures the inhabitants 
 entirely from the fevers peculiar to those of the first-mentioned 
 division (that comprising low alluvial land, bordering the Juniata 
 River), while they suffer most from those of a pleuritic, pneumonic, 
 and rheumatic character." 4 
 
 Dr. Williams 5 remarks : " Elevated districts are perhaps the more 
 
 1 Daniel, Topogr. and Dis. of Guinea, 137-453. 
 
 2 P. 135. 
 
 3 Transact, of Pa. State Mod. Soc. i. 47. 
 
 4 Rep. of the Blair Cy. Med. Soc. Tr. St. Med. Soc. i. 105. 
 Cyclop, of Pract. Med. 3, 407. 
 
AUTUMNAL FEVERS. 83 
 
 liable to pneumonia because they are more exposed and colder, 
 whereas the humid air of low valleys, while it diminishes the inten 
 sity of the cold, relaxes more the mucous surfaces, and renders them 
 the weaker points of the circulation." 
 
 $ 
 
 7. Fevers influenced by nature of soil not so pneumonia,. Autumnal 
 or periodic fevers, as every medical inquirer must know, are found 
 to originate mostly, if not exclusively, in localities the soil of which 
 presents peculiar geological characters, and is composed, in great 
 part at least, of organic elements of a particular kind, or contains 
 on its surface, or at a short distance beneath, substances more or 
 less foreign to its composition, but -giving rise, when acted upon by 
 certain thermometrical, hygrometrfcal, and ottter influences, to the 
 evolvement of poisonous exhalations. Experience has shown, also, 
 that the cause of such fevers, whatever be its nature, possesses 
 different degrees of affinity for the many substances over which it 
 passes when wafted Tfe aerial currents ; that tbese substances act, as 
 it were, as so many attracting or repelling causes, tending to limit or 
 extend the sphere of its morbid agency ; and that hence while 
 fever, the efficient cause of which is evolved at some distance, 
 abounds on a given stratum of soil, it spares individuals residing 
 on strata of a different character. What the peculiarities of locali 
 ties thus afflicted are, wili be stated in a subsequent part of these 
 inquiries. Suffice it here to say, that, wherever they are found to 
 exist, hygrometrical, thermometrical, and other influences aiding, 
 fevers will also be found to originate, and often to abound. As 
 regards pneumonia, I am not aware, and greatly doubt, that any 
 facts entitled to our respect have as yet been pointed out calculated 
 to connect the origin or prevalence of the disease with any geologi 
 cal formation, the peculiar composition of the soil, or the particular 
 substances which may be spread on or placed beneath the surface 
 of the latter. 
 
 8. Fevers arrested by frost not so pneumonia. Nor is it less essen 
 tial to remark, in opposition to the views under examination, and 
 in support of those here maintained, that in places where malarial 
 fevers prevail during a certain period of the year, they are almost 
 suddenly put a stop to, whatever be their forms or types inter- 
 mittents, remittents, and yellow by the advent of frost. After the 
 
84 PNEUMONIA AND 
 
 occurrence of the latter, localities which before were unhealthy 
 to such an extent as not to be visited with impunity, especially at 
 night become free from suph fevers, and from all diseases of a 
 malarial origin. 
 
 Now, as by the thermometric change in question, the morbid 
 agent that had given rise to totumnal fevers has been destroyed, 
 as proved by the cessation of its legitimate effects, and as, while this 
 takes place in regard to fever, pneumonia is undisturbed as to its 
 prevalence, or, indeed, is even increased in point of frequency, it is 
 natural to conclude that the cases of pneumonia which continue to 
 show themselves as heretofore, after the occurrence of that change, 
 cannot be referred to the baneful agency of the cause in question, 
 but are due to the operation of some other morbific influence, over 
 which frost exercises no control, and differing, consequently, in its 
 nature, from the former. If we admit t^ig, w^jfe, cannot err in admit 
 ting, also, .that the same causes which gave ris^ to cases of pneumo 
 nia, occurring after a stop has -be.en put to autumnal fevers by frost, 
 must have occas!(kied the caseof that disease(,^Jbserved during the 
 prevalence of such fevers and anterior to the advent of frost. If the 
 cause which produced pneumonia after that event must, for reasons 
 stated, differ essentially from that occasioning the fevers whose 
 career has thus been arrested, the cause giving rise to the cases that 
 appeared during the fever season must alsb be different from the 
 febrile poison; and we hence arrive at *$ie conclusion, already ad 
 verted to, that, when the two diseases show themselves together in 
 the same place, two different sets of causes are at work, and from 
 this difference of cause we have reason to infer the existence of a 
 difference in the nature of the diseases produced ; and that, when 
 pneumonia is followed by, or succeeds to, fevers, it is not influenced 
 in its production by the causes to which these are due. 
 
 I am not ignorant of the fact that the salutary effects here 
 ascribed to frost, of putting a stop to autumnal fevers, has been called 
 in question. I am aware that, in proof of the fallacy, it is remarked 
 that such fevers are encountered every month of the year ; that 
 they prevail, more or less, all the year round ; and, consequently, I 
 am prepared to be met with the objection that, such being the con 
 tinued prevalence of the disease, in cold as well as in warm weather, 
 any argument against the etiological and pathological connection of 
 pneumonia with autumnal fevers, founded on the supposed cessation 
 
AUTUMNAL FEVERS. 85 
 
 of the latter through, the effect of a reduction of atmospheric tem 
 perature to the freezing point, must be set aside. 
 
 How far such an objection will infh^ence those who have paid due 
 attention to the subject, I need not inquire. Having, however, ad 
 duced the fact of that cessation, as one well established and militating 
 strongly against the views under examination, I must be allowed 
 to show, were it only for the benefit of those who venture on the 
 denial, that what I have said in the matter is not a dream of the 
 imagination " a sheer assumption, worthy of one who is behind 
 the times" but has received the sanction of the highest medical 
 authorities, in all parts of the world. Now, that in hot or very mild 
 climates, malarial fevers may, and often do, continue to prevail, 
 more or less, all the year round, is a position which, as every one 
 conversant with. the subject knows, will admit of no doubt. But the 
 fact of such a contiiiuariicp of the disease in those climates does 
 not in any way impaj^ th^ correctness of the statement made re 
 specting the aforesaid power of fro^t ; the explanation of the differ 
 ence being easily foiyad in the circumstance, that in those climates 
 the cold of winter does not prevail in sufficient force, or continue 
 long enough, to produce the effect contended for, and decided frost 
 never or seldom occurs at all. But, be this as it may in regard to 
 the climates mentioned, it is indubitably true, that whenever, in a 
 miasmatic district, the tnermometer descends to the freezing point, 
 and there remains awhile, the progress of malarial fever is arrested. 
 In this vicinity, among others, every one, from the learned physician 
 to the gossiping granny, knows full well that the accession of severe 
 cold weather, and particularly of black frost, is sure to be marked 
 by a cessation of the fevers in question, and that, in the few cases 
 that present themselves after that event, the attack is ascribable to 
 that power of dormancy, by virtue of which the cause of some 
 diseases remains, for a greater or less length of time, latent in the 
 system after exposure, and which, in some forms of fever, may be 
 prolonged for weeks and even months. Had I space and leisure to 
 enlarge much on this subject, and, indeed, were it necessary, I 
 could demonstrate, by means of numerous quotations, that such is 
 the case also in other parts of this country, and in foreign lands 
 in every place, indeed, where the cold of winter is well marked or 
 the frost severe. A few references will be sufficient. Thus, in 
 regard to periodical fevers, the fact of their cessation, through the 
 effect of cold or frost, is recorded in the writings of the physicians 
 
86 PNEUMONIA AND 
 
 of our northern and middle States, and .of Canada: Eush, 1 Currie, 2 
 Potter, 3 Caldwell, 4 E. II. Smith, 5 J. M. Smith, 6 Wood, 7 Coventry, 8 
 Vaughan, 9 Lee, 10 Usher Parsons, 11 Agnew, 12 Lucas, 13 Stratton. 14 
 In the South, South-west, and West, we find it mentioned and in 
 sisted upon by Taylor, 15 Eamsay, 16 Hansford, 17 Thompson, 18 Wa 
 ring, 19 Arnel, 20 Prior, 21 Smelt, 22 Dunbar, 23 Staley, 24 Dickson, 25 Hil- 
 dreth, 26 Drake, 27 Simons, 28 Grant, 29 Cooke. 30 Cross we the Atlantic, 
 we find the same thing taught by Sydenham, 31 Lancisi, 32 Cleghorn, 33 
 Bartholin, 34 Bancroft, 36 Williams, 36 Copland, 37 Macculloch, 38 Monfal- 
 con, 39 Eigaud de Lisle, 40 E. Hamilton, 41 Sir J. Pringle, 42 F. Home, 43 
 G. Brown, 44 Tournon, 45 Bailly, 46 Sir Ch. Morgan, 47 Sir James Clark, 48 
 Booth, 49 Carriere, 50 De Eenzi, 51 Jacquot. 52 In fact, it is mentioned 
 
 1 Non. Cont. of Yellow Fever, Med.. Repos. vi. 162. 
 
 2 On Bilious Fever, 13, 21 ; Med. and Philos. Register, i. 181, 195. 
 
 3 On Contagion, 16. 
 
 4 On Miasma, J6; Med. and Phys. Mem. fl800), 2%. 
 
 5 Webster s (||lle$fcion, 107. 6 On Epidemics, 71. 
 
 7 Pract. of Med. i. 142, 267. 
 
 8 On Lake Fever, N. Y. Med. and Phys. J. in. 15; Tr. of Med. Soc. of the State 
 of N. Y. for 1825, 42. 
 
 9 Med. Repos. iv. 130. 10 Med. Repos. iii. 252. 
 
 11 On Malaria (Essays), 200. 12 Med. Recorder, vi. 138. 
 
 13 Med. Recorder, v. 420. 14 Edinb. Med. and Surg. J. Ixiv. 105. 
 
 15 Webster s Collection, 148. 16 History of South Carolina, ii. 55-6. 
 
 17 Webster s Collection, 148. 18 Chapman s Journal, x. 106. 
 
 19 N. A. Med. and Surg. J. i. 5 ; ix. 375. Med. and Philos. Register, ii. 10. 
 
 21 In Potter, op. cit. 16. Med. Repos. ix. 127. 
 
 23 Med. Repos. viii. 258. ** Med. Recorder, v. 460. 
 
 25 Am. J. ii. 64. 
 
 26 Med. Repos. xi. 345; Chapman s J. ix. 109. 
 
 27 Topog. and Dis. of the Valley of the Miss. 608, 713. 
 
 28 Charleston J. iv. 543. Am. J. July, 1853, 112. 
 30 Med. Record, vii. 453. 31 Works, ii. 191. 
 
 32 De Noxiis Paludum Effluviis, 46. 33 Dis. of Minorca, 133. 
 
 34 Hist. Anatomicarum, 72. 
 
 35 Tr. on Yellow Fever, 292, 407; Sequel to do. 91. 
 
 36 On Morbid Poisons, ii. 460. Vol. i. 759; ii. 1100. 
 
 38 On Malaria, 155. 39 Traite" des Marais, 345. 
 
 40 In Johnson on Trop. Cl. 313. 41 On Marsh Remit. Fever, 28, 32. 
 
 42 Dis. of the Army, 14, 116, 172. 43 Med. Facts and Observations, 46, 76. 
 
 44 Cyclop, of Pract. Med. ii. 235. 45 Etudes sur Rome, i. 203. 
 
 46 Traite des F. Int. Pernicieuses, 134. 47 Lady Morgan s Italy, i. 439, ii. 106. 
 
 48 Med. Notes on Italy, 80-3. 
 
 49 Life of Dr. Armstrong, i. 258, ii. 295, 597. 
 
 50 Du Climat. de 1 Italic, 371. 
 
 51 Oss. Sulla Topog. Med. del Regno di Napoli, 68; Miasmi Paludosi, 21. 
 
 52 Des F. a Quinquina, 38. 
 
AUTUMNAL FEVERS. 87 
 
 as a well-known and indisputable phenomenon, by all who have 
 written on the periodic fevers of England, Holland, Flanders, 
 France, Italy, Spain, etc. Nay, in the West Indies themselves, the 
 healthy season is the cool season, and the continuance of periodic 
 fevers during the winter months is in direct proportion to the con 
 tinuance of heat. In warm winters fever continues; in cool ones it 
 disappears in great measure, or completely. The researches of Dr. 
 Drake, in reference to the Valley of the Mississippi, show that, with 
 the decrease of yearly and summer heat, other conditions continuing 
 unchanged, there is an abatement of the fever ; that a summer tem 
 perature of 60 is necessary to the production of fever, and the 
 latter will not prevail as an epidemic when the temperature of that 
 season falls below 65; finally, that if the other conditions favour 
 ing its production are deficient, it will cease before those reductions 
 of temperature have bee^n reached. "According to these conclu 
 sions, the fever will occ^r in winter, at all places where that season 
 has a mean temperature of 60 or. upwards, as at $T.Q$jjl Cruz, Tam- 
 pico, Havana, Key West, Tampa Bay and Fort King, and it is well 
 known that cases do occur at those places, in that season ; but in 
 other places, where the winter heat barely rises over 60, they are 
 few in number. At New Orleans, and generally under the 30th 
 parallel, where the mean winter heat is as low as 50, the fever is 
 suspended." 
 
 Dr. Drake farther says: "But the seasons are made up of months, 
 and we are here brought to consider its connection with their re 
 spective temperatures. Up to Tampa Bay, every winter month 
 rises above 60 degrees ; but at New Orleans, or the 30th parallel, 
 only the nine months from March to November have that tempe 
 rature ; and as we advance to the north, the number of months hav 
 ing it constantly decreases. Thus, at St. Louis, it is attained by 
 five months only, from May to September inclusive ; at Fort Snel- 
 ling, by four; at Fort Brady, by three; at Montreal, by four; at 
 Quebec, by three. In advancing farther north, June and Septem 
 ber fall below it ; and finally, in the distant north, July and August, 
 or the entire year. Long before this reduction is reached by those 
 two months, however, the fever ceases ; and, therefore, it results 
 that a continuance for more than two months of a heat equal to 60 
 degrees is necessary to the development of the fever." " It appears, 
 from all that has been said, that within the tropics autumnal fevers 
 occur throughout the year, and that, as we move northerly, the 
 
88 PNEUMONIA AND 
 
 duration of its prevalence shortens, by it$ beginning later in spring, 
 and terminating earlier in autumn. March and November first 
 escape, then April and May on the one hand, and October on the 
 other lastly, June and September." 1 
 
 So much for endemic periodic fever. If we turn to the yellow 
 fever, we shall find that kindred results are obtained. That in 
 some sickly seasons, in this part of the country as well as in Eu 
 rope, cases are sometimes met with several days, or (as in the 
 South) some weeks after cold weather has set in, is true. But such 
 results are rare, in the North particularly ; and they are most gene 
 rally the effect of the breaking out of the disease in persons who 
 had imbibed the seeds of it prior to the fall of the thermometer. 
 But here as elsewhere at the North and the South the disease 
 invariably ceases as an epidemic, after a frost sufficiently severe to 
 kill the leaves of trees and annual plants. 
 
 Dr. Kush, 2 speaking of our yellchy fever, says : " It is completely 
 destroyed by frost." Dr. Cufrie 3 remarks, in reference to the epi 
 demic of 1793 : " AS the weather became cold and frosty, its declen 
 sion was so rapid that it appeared as if extinguished by a miracle." 
 In 1797, the Academy of Medicine 4 derived an argument in favor 
 of the identity of yellow and bilious fevers, from the fact that they 
 were both uniformly checked and destroyed by the same causes 
 heavy rains and frost. And if the reader will examine the records 
 of all the other epidemics by which this city has been visited those 
 of 1699, 1741, 1747, 1794, 1797, 1798, 1799, 1805, and 1820 he 
 will find that they were all put a stop to, more or less suddenly, by 
 the occurrence of similar changes of temperature. 
 
 Drs. Harrison, 5 Thomas, 6 Gros, 7 etc., of New Orleans, inform us 
 that the fever of that city ceases as an epidemic after the occurrence 
 of frost. Drs. Moultrie, 8 Lining, 9 Campbell, 10 Chalmers, 11 Ramsay, 12 
 Harris, 13 of Charleston, tell us much the same thing, relative to 
 
 1 Drake, 714. 
 
 2 Facts intended to prove the Yellow Fever not to be contagious, Works, iv. 155. 
 See also vol. iii. 98-9, 100, 201 ; vol. iv. 8, 45, 95. 
 
 3 P. 2. 
 
 4 Letters to the Governor of Pensylvania, etc. 3. 
 
 5 Remarks on the Yellow Fever, New Orleans Journal, Sept. 1845, 130. 
 
 6 Essai sur la F. J. d Amerique, 110. 
 
 7 llapport, etc. 6, 01. 8 French Translation, 5. 
 9 Essays and Observations of Edinb. ii. 409. I0 See Watts, 249. 
 
 11 Climate of S. C. ii. 00. 12 Med. Kepos. iv. 219. 
 
 13 Barton s Journal, ii. 29. 
 
AUTUMNAL FEVERS. 89 
 
 the fever of that city, which invariably ceases on the accession of 
 frost or severe cold. Nor do we find matters take a different 
 turn in that respect at Natchez. Of the epidemic of 1817, we are 
 told by Dr. Perlee, 1 that " on the 9th of November there occurred 
 a severe frost, which at once arrested its progress, and permitted 
 the inhabitants to return in safety to their homes." 
 
 The same writer, in his account of the epidemic of 1819, informs 
 us that the weather became cool in the middle of November, and 
 the disease began to subside. About the first of December, there 
 having been a moderate frost, the Board of Health quickly informed 
 the inhabitants that they could return to their homes with, a reason 
 able prospect of safety. 2 In reference to the epidemic of 1823, 
 the most disastrous by which that city was visited, Dr. Merrill 
 remarks: "During the night of the 31st of October, a very great 
 change took place in the weather. . The wind changed suddenly 
 from the south to the north-west, \ud th^ thermometer fell from 
 78 to 28 degrees in about sixteen hours. * On the 1st of November 
 it was considered safe to return to the city." 3 In testimony of the 
 salutary effect of frost on that occasion, we have the farther autho 
 rity of Dr. Monette. 4 In 1825, the disease continued, with little 
 abatement, until the 26th of October, when, as Dr. Merrill 5 states, 
 " we had a heavy shower of rain. The next day the wind changed 
 to north-west, and blew strong and cold, and during the succeeding 
 night the thermometer fell to 34 degrees, which induced many fami 
 lies to return to the city." 6 Dr. Monette also remarks that the dis 
 ease continued its ravages until checked by frost and cold weather, 
 about the 28th of October. 7 From the same writer we learn that, 
 in 1837, "the disease continued to spread gradually, and with occa 
 sional abatements, until checked by frost, about the 25th of Novem 
 ber." 8 It may not be improper to remark that Dr. Merrill says, in 
 relation to Memphis, that if the grading there "has fallen short of 
 creating an epidemic of quite as grave a character as similar causes 
 have elsewhere, it may be owing to the modifying influences of a 
 few timely showers of rain or an early frost." 9 I have now before 
 
 1 Philad. Med. and Phys. Journ. iii. 6. 2 Ibid. 10. 
 3 Ibid. ix. 255. 4 Observations, 65. 
 
 5 Ibid. Essay, 59. 6 ^ A. Med. and Surg. Journ. ii. 220. 
 
 7 Essay, 02 ; Observ. 67. 8 Observations, 70 ; Essay, 75. 
 
 9 Public Address on the Health and Mortality of Memphis, Memphis Medical Re 
 corder, i. 90. 
 
90 PNEUMONIA AND 
 
 me a list of about ninety good and substantial authorities, who 
 describe the yellow fever as it has appeared epidemically in Boston, 
 Xew York, Providence, Wilmington, Baltimore, Norfolk, Frank 
 lin, Vicksburg, Alexandria, Galliopolis, Gibraltar, Barcelona, Ca 
 diz; who all, like the authorities already mentioned, in connection 
 with the disease as it has shown itself in this city, New Orleans, 
 Charleston, and Natchez, impart to us information which I recom 
 mend to the particular notice of those who deny the destroying and 
 purifying agency of frost, of severe cold, or blasts of northerly 
 winds. 1 I must also recommend to their attention those instances, 
 
 1 Dalmas, 39; Caldwell (Fever of 1805),- 51; Ibid. Memoirs (1800), 200; ditto of 
 1826, 124; Bally, 313, 314; Campbell, in Watts s Med. and Surg. Reg. 249; Moul- 
 trie, French Trans. 5; Monette, 1st edit. 50, 60, G3 ; Ibid. 2d edit, 7, 63, 65, 67, 70; 
 Thomas, 110, 2d edit. 14 ; Potter on Contagion, 25 ; Osgood, 17 ; Hosack, Febrile Con 
 tagion, 10; Facts, etc., by>the College of Phys. 4; Diet, des Sc. Med. xv. 357; 
 Davidge, 69 ; Caisergue, 194; YalentiA, 88 ; ^Harrison, New Orleans Journ. ii. 130; 
 Chalmers, Climate of South Carolina, ii. 60; Bancroft, 292, 407, 425; Ibid. Sequel, 
 89, 91 ; Selden and Whitehead, Med : Repos. iv. 129, 836 ; Chisholm, Letter to Dr. 
 Hay-garth, 177; Currie, Med. Register, i. 181 ; "Report of Philad. Acad. of Med, 7; 
 Med. Rep. i. 406; Hardi, Fever of New York in 1798, 13 ; Ibid. 1822, 67, 68; Con- 
 die and Folwell, Fever of Philadelphia in 1798, 81 ; Currie, Fever of 1799, 25 ; Ibid. 
 on Bilious Fever, 15; Halphen, 62; Brown (S.), 26, 108; Pierquin, 40, 60; Townsend 
 On Black Vomit, 30; Ibid. Fever of New York in 1822, 257-8; Palloni, Sulla Febbre 
 Gialla, etc. 20; Dariste, 31 ; Jackson (Sam.), Fever of Philadelphia in 1820, 24; Let 
 ters on the Fever of Baltimore in 1819, 80, 113; Addom s Dissertation, 7; Hosack s 
 Essays, i. 292; Shecut, 94, 100; Copland, iii. 169; Report on Fever of N. 0. in 1820, 
 6 ; New York Report of Quarantine, 44 ; Stone, New Orleans Journ. ii. 551 ; Pym, 2, 
 8, 216; Ibid. 2d edit, 2, 65; Smith (J. M.), 81, 90, 91 ; Burnett (Sir W.), 342 ; Blane, 
 (Sir G.), Dissertations, ii. 152, 155; Caillot, 107; Barton (Ed.), Fever of New Orleans 
 in 1833, 6, 9; Chervin, Report on Mem. by Rufz, 77; Ibid. Letter to Monfalcon, 17, 
 18; Forry, Climate of U. S. 290; Bayley, Letters from Health Office, 9; Amicl in 
 Johnson on Trop. Cl. 270 ; Ibid. Edinb. Med. and Surg. Journ. xxxv. 276 ; Robert, 
 Guide Sanitaire, i. 43; Physical Inquiry, etc. (N. Y.), 25; Gillkrest, Cyclop, of Pract, 
 Med. ii. 279 ; Lining, Edinb. Essays, ii. 409 ; Smith, Edinb. Med. and Surg. Journ. 
 xxxv. 40; Wood, i. 296; Chapman, Med. and Phys. Journ. ix. 135; Merrill, ibid. ix. 
 255 ; Ibid. North Am. Med. and Surg. Journ. ii. 220 ; Townsend on Plague and Yel 
 low Fever, New York Journ. ii. 46 ; Emlen, N. A. Mod. and Surg. Journ. v. 328 ; 
 Humboldt s New Spain, ii. 765; Fever of New York in 1805, Med. Repos. ix. 213; 
 Yaughan, Fever of Wilmington, 12, 20; Wheaton, Med. Rcpos. x. 335; Harris 
 (Tucker), Barton s Jounr. ii. 29; Monro, Med. Repos. iii. 136; Ramsay, ibid. iv. 219; 
 Seaman, ibid. iv. 249; Opinion of the Medical Faculty of Baltimore on Fever of 1800, 
 Med. Repos. iv. 353; Archer, Med. Recorder, v. 61 ; Bond (Thomas), Lecture, N. A. 
 Journ. iv. 271; Deveze, 197; Brent, Med. Repos. ii. 390; Rayer, Fever of Barcelona, 
 43, 48; Audouard, 414; Pariset, Relat. Hist. 93; Miller (Kdw.), Rep. 88, 106; 
 O lFalloran, 118: Drake, 608; Reese (Meredith), Observations on the Epidemic of 
 1819, as it appeared in a part of the city of Baltimore, 46. 
 
AUTUMNAL FEVERS. 91 
 
 not difficult to be found, of vessels infected with yellow fever, and 
 which have been rendered healthy, often rapidly, on reaching a cold 
 climate, and passing through the ordeal of frosty weather. 1 
 
 " In the event of a ship s company being attacked by fever," says 
 Dr. Bryson (227), "whether from external or internal causes, which 
 shows a disposition to become general, and to assume a malignant 
 form, characterized by intensity of action, early yellowness of the 
 skin, and black vomit, it will be of the greatest importance for the 
 safety of all on board, that she should immediately quit the locality 
 where the disease originated, and proceed, with all possible haste, 
 to some colder region ; if in the south, to the southward, and, if in 
 the north, to the northward, avoiding the neutral ground between 
 the trade winds. The great utility of this measure was practically 
 tested by the Yqstal in 1885, when her crew were assailed by fever 
 at Port Royal, in Jamaica, which dijj not cease, although she was 
 shifted from the inside to the keys* on the -outside of the harbor, 
 nor until after she had^gone far Beyond the precincts of the island, 
 and entered the twenty-sevenih degree of north latitude on her way 
 to Bermuda. The crew of the same vessel, although not the same 
 men, after having been paid off and recommissioned, were again 
 violently attacked by fever whilst cruizing among the windward 
 islands of the West Indies in the latter part of 1839. Instead of 
 running at once to the northward, she proceeded to Carlisle Bay, 
 where she remained about a fortnight ; during that time the disease 
 evidently increased in malignancy, and carried off a considerable 
 number of men. She was then directed to proceed to the north 
 ward, and again the disease disappeared a few days after she had 
 crossed the tropics. The ship s company of the Vesuvius were 
 promptly relieved of an invasion of fever by her being ordered 
 from Sacrificios, where it was contracted, to Halifax." 
 
 These facts, observed in such divers places, and attested by so 
 many respectable and even eminent authorities, and which ought 
 to be, and I have little doubt are, familiar to the disbelievers in the 
 efficacy of frost in arresting the progress of malarial fevers, taken 
 in connection with the statements made by Humboldt, in reference 
 to Yera Cruz, that the vomito or yellow fever seldom begins to 
 
 1 Trotter, i. 357; Caillot, 114; Doughty, 25; Ferguson s Rccol. 143; Keraudren, 
 18; Pym, 2cl edit. Go, 127 ; Bryson, Report on the Climate and Principal Diseases of 
 the African Station, 50; Barrington, Am. Journ. xii. 309; Waring, Med. Repos. iv. 
 1, 234; Allan, Edinb. Monthly Journ. xi. 32<>. See also cases of the Gen. Green, Med. 
 Reposit. iv. 1, 234 ; of the U. S. Ship Hornet, Am. Journ. xii. 307. 
 
92 PNEUMONIA AND 
 
 prevail there before the average temperature of the early months 
 reaches to .twenty-four degrees of centigrade thermometer (75.2 
 degrees of Fahr.) ; that in December, January, and February, when 
 the heat remains below that limit, and the cold is often very sharp, 
 the disease usually disappears completely ; that the latter declines 
 sometimes very suddenly, through the effects of the north winds 
 (los nortes), an observation also made in more southern climates ; l 
 that the later these continue to blow in the spring, the later the 
 fever makes its appearance ; and the sooner they commence in the 
 autumn, the less apprehension is felt respecting its continuance ; 2 
 all this, I say, should suffice to carry conviction to all unprejudiced 
 minds. * 
 
 Nay, more, it may be mentioned, in farther corroboration of what 
 precedes, that the history of the Oriental Plague, whatever may 
 have been its course in some places, and under special circum 
 stances as, for example, at Aleppo whatever may be the usual 
 order of events in Egypt and Smyrna, and however the disease 
 may have comported itself during casual epidemics in other cities 
 of Europe and Asia, furnishes additional illustrations of the power 
 of cold and frost, in checking the progress of malarial complaints, 
 among which that disease must undeniably be classed. 
 
 The epidemic of London, in 1665, was arrested in December by 
 frost. 3 " Like everything else, too, in nature," says Sydenham, in 
 speaking of the plague, " it has its proper ^periods of increase and 
 decline ; it takes birth at the period given above (when spring 
 passes into summer), and it rises towards maturity as the year ad 
 vances ; with the decline of the year it declines also. Finally, the 
 frosts of winter transform the atmosphere into a state unpropitious 
 to its existence." 4 The epidemic of Marseilles, in 1720, ceased on 
 the approach of winter. 5 At Erzeroum, the capital of Armenia, the 
 disease, in 18-10, broke out in June, and in 1841, in August. In 
 both instances, it was put a stop to by the severe cold of winter. 6 
 The plague epidemics of Constantinople invariably commence in 
 the summer season, and are effectually cut short by frost. 7 Yolney, 
 
 1 Catcl, 8, 9; Pym, 2, 8, 210; Caillot, 106; Dariste, 31. 
 
 2 Humboldt, 4th ed. 705. 
 
 3 Hancock, Laws of Contagion, 91 ; Hodges, Loitnologia, 5, 27. 
 
 4 Vol. i. 100, ed. of Syd. Soc. 5 Bertram.!, Peste de Marseilles, 255. 
 
 6 Report of Academy of Medicine, 81. 
 
 7 Brayer, Neuf aris a Constantinople, ii. 77 ; Clot Bey, Traite de la Peste, 225 ; 
 Rapport fait u 1 Acad. Roy. de Mod. CoO. 
 
AUTUMNAL FEVERS. 93 
 
 who, among others, has noted the fact of the cessation of the disease 
 on the accession of winter, says, properly: "The winter destroys 
 the plague at Constantinople, because the cold is there very severe. 
 The summer lights it up, because the heat is damp." In Russia 
 and Poland, the same result has been noticed. Tf in Egypt, and 
 other hot latitudes, the disease usually prevails in winter com 
 mencing in November and ceasing in June it is because that season 
 is warm and damp. But even there, as we gather from no less an 
 authority than Desgenettes, 1 while the south winds, as well as 
 hot and damp air favour, if they do not occasion its development, 
 the north winds, and the extremes of cold or heat, put an almost 
 complete stop to it. Much the same statements are made by Lar- 
 rey, 2 Clot Bey, 3 Assalini, 4 and Pugnet? 
 
 Mr. E. Robertson, who, during a long stay in Syria, paid 
 much attention to the subject of the etiology of the plague, says 
 that the disease in Turkey and Lowe/JEgypt can only exist in a 
 temperature between sixty and eighty degrees (Fahr.), "a lower or 
 higher either modifying or utterly destroying that atmospheric con 
 stitution, or those other occult causes, giving rise to its origin and 
 propagation." 6 Nor can the occasional continuance of the plague 
 at Aleppo, as we learn from the admirable accounts of the disease 
 handed down to us by Drs. Alexander and Patrick Russell, 7 through 
 the Avinter, after the accession of frost, and even a fall of snow, be 
 cited as militating against the view here maintained. Such instances 
 of continuance were isolated and exceptional. In general, the dis 
 ease has there ceased before the accession of winter often during 
 the months of August, September, and October having begun to 
 decline in July ; and frequently it has ceased later on the appearance 
 of cold. In those instances, as in 1762, 8 when different results were 
 obtained, the cases were few in number, and it is not unreasonable 
 to attribute them partly to the latency of the poison in the system 
 of persons exposed to its influence previous to the change of weather, 
 and partly to the short continuance of a temperature sufficiently 
 
 1 Hist, Med. de 1 Armee d Orient, 248. 
 
 2 Campagnes d Egypt, 330. 3 De la Peste, Obscrvee en Orient, 2G6. 
 
 4 Observations on the Disease called the Plague, &c. 42. 
 
 5 Mem. sur les Fievres de Mauvais Caractere, c. 204. 
 
 6 Medical Notes on Syria, Edinburgh Journal, Ixii. 331. 
 
 7 The Natural History of Aleppo, 2d ed. iv. London, 1794; A Treatise on the 
 Plague of Aleppo in 1700, 17(51, and 1702. London. 1791. 
 
 8 A Treatise, &c. 44. 
 
94 PNEUMONIA AND 
 
 low to destroy completely the poison, which broke out anew on the 
 accession of heat. 1 It is true that, in the neighbouring villages, 
 caves, and grottoes, the disease continued some time in winter, after 
 having ceased in the city ; but in these places it showed itself ex 
 clusively among the poorer classes, whose habitations, from the 
 mode of their construction, their want of proper ventilation, the 
 filthy condition in which they were kept, and the great heat in 
 which their inmates indulged, may well be supposed to have re 
 tained the poison in sufficient force, if not to have been hotbeds of 
 the pestilence, during the comparatively moderate and short winter 
 of that country, where, according to Dr. A. Eussell, the thermometer, 
 in a series of nine years, varied, in October, from 51 to 84 ; in No 
 vember, 44 to 65 ; in December, 40 to 55 ; January, from 34 to 57; in 
 February, from 48 to 55 ; in ^rch, from 44 to 67 ; in April, from 
 56 to 82 ; while in May it mounted up frpp. 67 to 92. To this it 
 may be added that, in most purees where the plague has prevailed 
 during the winter months, as in Egypt, at Malta, Toulon, Aix, 
 Venice, Messina, &c., that season is not characterized by severe or 
 long-continued cold weather, arid a hard bleak frost is seldom if 
 ever experienced. 
 
 If, nevertheless, the statement of the purifying agency in question 
 is still denied if, while acknowledging, what no one can justifiably 
 impugn, the truth of the events recorded, it is maintained that, in 
 the association of the accession of frost with the cessation of fever, 
 we are to recognize nothing but the occurrence of a fortuitous coin 
 cidence, we must admit that the frequency of that coincidence, and 
 its manifestation in so many and diversified places, is to be viewed 
 as a matter of the utmost astonishment, seeing that everywhere the 
 one event is sure to follow closely on the heels of the other. 
 
 As an offset to this it has been remarked that, in the Havana, 
 the same thing happens without frost ; and that hence, when the 
 latter occurs in any place, at the close of the epidemic season, we 
 have no right to affirm that it produced the effect assigned to it. 
 This cessation of fever without the aid of frost may be true. In 
 deed, I know full well that it is annually observed in tropical 
 climates not only in the Havana and other parts of Cuba, but in 
 the West Indies generally, and on the coast of tropical America 
 and of Africa. Nor could it be otherwise. There frost or intense 
 
 1 A Treatise, &c. 45. 
 
AUTUMNAL FEVERS. 95 
 
 cold is a thing never heard of, and yet fever epidemics come to an 
 end. I know, also, that it has occasionally occurred in some parts 
 of Europe, in the United States, and even in this very city. I know 
 full well, besides, that in some epidemic visitations, observed in 
 both tropical and extra -tropical regions, the disease has stopped, not 
 only before the accession of frost, or cold or cool weather, but even 
 before the cessation of great heat. None will be disposed to deny 
 such occurrences, who have perused attentively the history of 
 West India epidemics, and of those that appeared in this city in 
 1803, in Mobile and New Orleans in 1848, as described by Drs. 
 Caldwell, Nott, and Fenner, and in Leghorn, in 1801, as related by 
 Palloni. But these facts, true as they doubtless are, do not in the 
 least invalidate the reality of the power which I have, in common 
 with so many others, ascribed tdUeold and frost ; for, from the 
 circumstance that yello^ffever has sometimes stopped in this coun 
 try, and usually ceases completely, "SJia great measure, in tropical 
 regions, without the aid of frost, and sometimes before a cessation 
 of high atmospheric heat, we cannot argue that frost, or severe 
 cold, when occurring before the^fever has been arrested in its 
 epidemic course, will not produce that effect. This cessation 
 often is too instantaneous, and is, besides, too constantly noticed, 
 after its occurrence, to be ascribed to any other agency. The two 
 results are not incompatible. While, therefore, we maintain that 
 the effect arises most usually from the last-mentioned cause, we 
 admit, what experience has sufficiently demonstrated, that the same 
 beneficial change is also produced through other agencies heavy 
 rains, violent storms, heavy winds, especially from the north, desic 
 cating and long-continued heat and droughts, and not unfrequently 
 from the want of subjects susceptible to the morbific impression of 
 the poison ; and that, at times, it is brought about by a change in 
 the epidemic meteor ation, the evolution of ozone in the atmosphere, 
 or some other purifying influence, the nature of which has so far 
 eluded our researches ; a change which, as Dr. Smith 1 remarks, is, 
 in effect, equivalent to the reduction of the temperature to 32 of 
 Fahrenheit. The same effects have been noticed in other forms of 
 malarial fevers; and every one is familiar with the fact that, in 
 Egypt, where, for reasons mentioned, the plague prevails during 
 the winter months, it stops in June, under the empire of the same 
 
 1 On Epidemics, 174. 
 
96 PNEUMONIA AND 
 
 parching heat which in that country arrests the progress of animal 
 putrefaction. But, I repeat, were these occurrences more frequent 
 than we know them really to be, they could not serve to counter 
 balance and overthrow all that has been said in support of the 
 agency ascribed to frost and severe cold, in arresting the progress 
 of yellow and other malarial fevers. 
 
 rent are the results obtained in regard to pneumonia. 
 
 plain enough to those who bear in mind what is known 
 of the causes, habitat, and usual periods of prevalence of that dis 
 ease, the occurrence of frost, or the accession of cold weather has 
 never put a stop to it. So far from it, while such a favourable change 
 is thus experienced, as regards the prevalence of fevers through 
 the means in question, it^ ^und that pneumonic inflammations, 
 instead of disappearing ii|^ the former, continue to show them 
 selves as though nothing jiad occurred. Indeed, whatever may 
 be the tendency tt* the disfeas^iik-any locality whether the num 
 ber of cases be very large of srnojjH, and whether they occur in 
 summer or autumn the attacks multiply on the accession of the 
 very influences whiol^&d put a stop to the other complaint ; while, 
 after prevailing during*- the winter and spring, and taking the place, 
 as it were, during those seasons, of that class of fevers to which 
 attention has been all along called, their reign is, in its turn, more 
 or less effectually arrested by the return of the atmospheric condi 
 tions under the empire of which those fevers are developed. Let 
 pneumonia prevail on board of a ship in some warm latitude a 
 thing which has occasionally occurred and it may be doubted 
 whether the commander would gain much by steering north and 
 reaching the banks of Newfoundland. The one disease, pneumonia, 
 belongs more specially, as we have seen, to winter and early spring, 
 and, if not arrested completely, is at least greatly diminished, in 
 point of frequency, by the return of heat. The other is a disease 
 of summer and autumn, and is diminished by cool weather and 
 arrested by frost. Nothing could be more different. It affords a 
 strong illustration of the correctness of a remark long ago made by 
 Hippocrates, that the diseases of winter are put a stop to by sum 
 mer, and those of summer by winter. They are, to a certain extent, 
 antipodal or antagonistic. At any rate, the occurrence above 
 stated the cessation of fever through the instrumentality of frost, 
 
 o *j 
 
 and the continuance or increase of pneumonia after the accession of 
 the latter, cannot be regarded otherwise than as an event the very 
 
AUTUMNAL FEVERS. 97 
 
 opposite of that which might be anticipated were the diseases off 
 springs of one and the same cause, and were the latter, pneumonia, 
 really and substantially nothing more than a peculiar form of re 
 mittent and intermittent fever. To affirm this, in the face of the 
 facts just mentioned, it will be necessary to put the syllogism thus : 
 Autumnal fevers are arrested by severe cold and frost; pneumonia 
 is unaffected by such atmospheric changes, or even 
 rife after their occurrence; ergo, autumnal fevers and 
 are identical, or the latter is only a peculiar form oft the other. 
 Again : Fevers appear and prevail in hot weather ; tfe reign of 
 pneumonia ceases on the accession of such weather ; ergo, the two 
 diseases are the same ; and he who ventures to deny their identity, 
 gives proof of being sadly behind thJLi^g., and ought, without loss 
 of time, to imbue himself with the -pphciples of the Baconian 
 philosophy. . , 
 
 Writers who uphold the opinion luideH: examination will not, I 
 trust, strive to strengthen the ppsitibn they have assumed, by in 
 sisting on the circumstance that as pneumonia which, they say, 
 is really and substantially nothing more tM^. *a peculiar form of 
 autumnal fevers continues to appear after the accession of cold and 
 frost has put a stop to the ordinary forms of the latter, etiologists, 
 who maintain that the cause of febrile diseases generally is destroyed 
 by a reduction of temperature below the freezing point, on the 
 ground that such diseases disappear after that atmospherical change, 
 are open to the charge of hazarding an assumption and reaching 
 a conclusion unwarranted by the premises ; inasmuch as all that 
 may justly be deduced from the phenomena observed is, that some 
 forms of periodic fever, not all, are arrested by the advent of cold ; 
 and that the cause has been merely so modified as to cease to pro 
 duce a certain form of the disease, while it continues to possess its 
 original power of occasioning certain other forms. The force of 
 this objection few will feel disposed to admit ; for, before it can be 
 used with success in the settlement of the question at issue, it would 
 be first necessary to demonstrate a real identity or close alliance, in 
 a pathological or symptomatological point of view, between pure 
 pneumonia and malarial fevers. But this, as I need scarcely remark, 
 has not as yet been and never can be done. I shall have occasion 
 to recur to the subject more in detail hereafter. 
 
 Of necessity, if periodic fevers are arrested by frost and cold, 
 this salutary effect is due to the destruction, by this reduction of 
 7 
 
98 PNEUMONIA AXD 
 
 temperature, of the cause of the disease, or to the sudden removal 
 of one or more of the elements which enter into the composition of 
 that cause. Of the nature of the latter I can entertain no doubt. 
 In common with many a clever man, from time immemorial to the 
 present day, I take it to be nothing more nor less than malarious 
 exhalations poisonous particles, floating in the atmosphere, and 
 arising from peculiar changes in various organic substances in a 
 state of decomposition. But, exclaim some of the advocates of the 
 opinion under examination, all that has been said about this de 
 struction of the cause of febrile affections admitting, for the sake 
 of argument, that these do cease on the accession of frost is an 
 assumption ; for we cannot show that a thing is destroyed, the exist 
 ence of which has not been proved. Far be it from the author of 
 this volume to insist on the possibility of frost destroying a thing 
 which has no existence ; jmcl if it can ever be proved that the morbific 
 cause in question must be placed in that category, I shall certainly 
 feel no disposition to say anything more about it. But, has this 
 been done? So far from it, we look in vain, in what has been 
 written on the subject, for anything calculated to disprove the ex 
 istence and morbid agency of malaria, and yet this ought to have 
 been well established before it could justly be adduced against a 
 belief in the destructive power ascribed to frost, and the mode in 
 which it is stated to exercise its salutary effects. 
 
 For my part, with due deference to the judgment and learning 
 of those who entertain an adverse opinion, I have no hesitation in 
 saying that the more I examine the subject, the more I am con 
 vinced that those who ignore the existence of malarious exhala 
 tions, and deny their morbific agency, labour under a great error, 
 and contend for what they cannot prove. Nay, more I am con 
 vinced that autumnal and endemic fevers, of genuine character, are 
 never due to any other cause than such exhalations. Believing this, 
 and holding, at the same time, what every one knows to be true, that 
 pneumonic inflammations are due to very different agencies, it may 
 not be improper, in order farther to show the fallacy of the views of 
 those who insist on the close connection between those diseases, to 
 dwell on some of the leading facts and arguments on which a belief 
 in the existence of such exhalations, and in the peculiar and specific 
 effects ascribed to them, is founded. I am aware that, as regards 
 several of the advocates of the connection mentioned, the task is 
 unnecessary, inasmuch as they admit the existence and morbid 
 
AUTUMNAL FEVERS. 99 
 
 agency of malaria ; and that, while regarding periodic or autumnal 
 fevers, of all grades and types, as caused by the latter, they do 
 not hesitate to recognize in pneumonia a similarity of origin ; some 
 applying the doctrine to all manifestations of that disease ; others, 
 perhaps the greater number, restricting it to certain cases, charac 
 terized by periodical changes, and cured by remedies found success 
 ful in intermittent fevers. By others, however, a different opinion 
 is entertained on the subject; and while some among them content 
 themselves with remaining in doubt as to the propriety of admit 
 ting the existence of a specific febrile poison, others offer a decided 
 and uncompromising opposition to the malarial origin of fever, 
 holding all that has been said in its support to be a mere effect of 
 a disordered imagination, and an hypothesis unworthy of this age 
 of progress. The importance of the subject in its bearing upon the 
 question more particularly before us, will be my excuse for enter 
 ing upon the examination of it in detail. But I must reserve it 
 for a separate chapter. 
 

CHAPTER II. 
 
 y 
 
 EXISTENCE AND MORBID AGENCY OF MALARIA. 
 
 IN the preceding chapter, attention was called to various facts 
 militating against the opinion entertained, both in olden and mo 
 dern times, by some, medical writers, respecting a supposed close 
 connection, pathological and etiological, between pneumonia and 
 periodic fevers. In the prosecution of the inquiry, I was led to a 
 consideration of some circumstances connected with the causation 
 of the latter diseases, and, in so doing, touched frequently upon 
 the subject of malaria, which was spoken of as the long admitted 
 efficient agent in their production. Of the antiquity of this opinion, 
 and of its very general adoption at the present day, few need be told. 
 
 Hippocrates was of the opinion that diseases in general may be 
 said to arise either from the food we eat, or the air we breathe. 
 When, therefore, a disease seized on a multitude of persons of dif 
 ferent ages, sexes, and habits, he inferred that it must arise from the 
 latter cause. Animals, he says, are under the influence of the air. 
 Hence, in all probability, the source of diseases must not be 
 sought elsewhere whenever it enters the body, either in excess, in 
 deficient quantity, too suddenly, or contaminated with morbific 
 miasmata. Of epidemic fevers, the cause resides in the air. If, 
 under such circumstances, all animals are not affected at the same 
 time, and only one species suffers from the disease, it is because all 
 things, bodies, natures, aliments, are not alike, and what is proper 
 or improper for one species, is not necessarily equally so for other 
 species. When, therefore, the air is infected with miasms that are 
 enemies of human nature, men are sick ; when, on the contrary, the 
 air becomes injurious to some other species of animals, the latter 
 alone is affected. (De Flatilus, sects. 5, 6.) In his treatise on 
 Airs, Waters, and Places, he attributes the greater part of the in 
 jurious effects of stagnant streams, and marshy situation, to drink 
 ing of the water therein found (sects. 7, 8, 10, 15). But there is 
 
102 PNEUMONIA AND 
 
 much in that famous treatise which especially when taken in con 
 nection with, what the author remarks in his Discourse on Winds, 
 just quoted, i. e. that with all we eat or drink, air finds entrance 
 into the body, and injures it when tainted with miasma leads us to 
 infer that, in his opinion, such waters do not affect the human sys 
 tem injuriously, simply by being ingested, but sometimes also by 
 the miasma contained in or evolved from it. But whether, by the 
 term miasma, he understood the marsh or terrestrial effluvia of 
 modern times, is a question decided in the negative by some, and 
 which others, as Dr. Adams, 1 consider as impossible to be determined. 
 For my part, I am inclined to believe apart from the references 
 already made that the great Greek observer, though not pointing 
 out distinctly the effects pf marsh effluvia in engendering the 
 periodic fevers he so w^ll describes, and having formed no 
 just conception of their nature and precise sources, recognized 
 the existence of miasma as $- separate morbific agent; for he com 
 mences the meteorological year from the decline of the summer 
 preceding the year in which the epidemic he is about to describe 
 occurs, and speaks of diseases arising from a certain succession of 
 seasons. Now, as a determinate series of intemperies of several 
 seasons cannot produce a special and well-defined effect on the sys 
 tem, otherwise than through the medium of exhalations of some sort 
 from the earth, which are by them occasioned, we cannot greatly 
 err in inferring that he had such exhalations in his mind when using 
 the term. Hence it is, Hippocrates applies to the cause of epidemics 
 the name of something divine an expression which Galen, in his com 
 mentaries on the epidemics, regards as meaning alterations and affec 
 tions of the air arising from the influence of the stars. Nor is it less 
 probable he included under that same name an invisible fluid float 
 ing in the atmosphere, and occasioning in it the alteration and affec 
 tion above alluded to ; for he advocated the opinion of Pythagoras 
 and Heraclitus, that all that exists under a sensible form arises from 
 invisible corpuscles. But, however this may be, it is not to be for 
 gotten that neither Hippocrates, nor his contemporaries, were igno 
 rant of the fact that the atmosphere in the vicinity of marshes and 
 large rivers in warm climates is unwholesome to the inhabitants ; 2 
 that in his aphorisms he refers diseases to the changes of seasons 
 and variations of temperature occurring during these ; and that, in 
 
 1 Transl. i. 3-19 ; Syd. Soc. Ed. 2 Treatise on Regimen, ii. 2. 
 
AUTUMNAL FEVERS. 103 
 
 the third book of his Epidemics, he ascribes the fatal or pestilential 
 disease observed by him, on a particular occasion, to the preter 
 natural and unwholesome state of the atmosphere. 
 
 Indeed, that a knowledge of the deleterious effects of certain con 
 ditions of the air in producing fever existed among the contempo 
 raries or immediate successors of Hippocrates ; that they knew full 
 well that such an unwholesome air was the result of something 
 extraneous, more particularly exhaling from marshy surfaces ; and 
 that they were fully aware of the advantage and necessity of 
 changing the physical conditions of these, may be inferred from 
 many of the allegorical expressions in which they were so wont to 
 indulge, as well as from some passages in the writings of ancient 
 philosophers and historians. In accordance with the custom just 
 alluded to, of resorting to allegorical expressions to convey important 
 truths and salutary admonitions, and to communicate useful know 
 ledge, the ancient Greeks often employed the words monster, serpent, 
 venomous beasts, as emblematic of marshes, and of the poisonous 
 and fatal air issuing from them. It is in this sense, doubtless, as was 
 long ago surmised, that we are to understand the fictions concerning 
 the hydra, the chersydra, and the monster python, slain by Apollo; 
 derived, as those words are, the one from the Greek root, meaning 
 putrefaction or corruption ; the others from the word water. Thus 
 it is they personified the many -headed hydra under the emblem 
 of a huge water-snake, whose poisonous breath infected the air, and 
 imparted disease to animals that breathed it. Nor are we less jus 
 tified in inferring that the terms hydra and chersydra were allego- 
 rically employed to designate the two and opposite conditions of 
 marshes the one, in which these are covered with water, the other 
 in which they are left bare hydra representing the snake con 
 cealed in the bosom of the stagnant and miry fluid, and chersydra 
 meaning the desiccation, in hot seasons and regions, of those locali 
 ties, when they give issue to an air more virulent and poisonous 
 than that connected with their overflow. Every one recollects the 
 story of Hydra, the celebrated monster which infested the neigh 
 borhood of the lake of Lerna, in the Peloponnesus, with its number 
 less heads one hundred, according to Diodorus Siculus; fifty, agree 
 ably to Simonides ; and nine, if we may credit Apollodorus and 
 presenting this remarkable peculiarity, that the central head was 
 immortal; and, as regards the others, as one was cut off , two imme 
 diately grew up, if the wound was not cauterized by fire. It was one 
 of the labours of Hercules to destroy this dreadful monster ; an ope- 
 
10-i PNEUMONIA AND 
 
 ration he easily effected with the assistance of lolaus, who applied 
 burning iron to the wound as soon as each head was cut off. The 
 allegory appears so plain as to induce many modern writers to 
 adopt the views above expressed, and to consider this fable as a 
 symbolical representation of the clearing and draining of the Pelo 
 ponnesus by the first authors of civilization. It was so regarded by 
 some of the ancient writers themselves; for Antipater, the stoic, 
 speaks of the "exhalations from the damp or wet earth rising up 
 like a winding stream with a Vurning force, and, after having been 
 heated, darting down again in the way of a deadly serpent, poi 
 soning and infecting everything by means of its corrupting agency." 
 "Not without reason," he adds, "did Heraclitus give the name of 
 arrow of Apollo to the rays of the sun, for they beget corruption 
 in the dampness of the soil. Hercules, the greatest subduer of the 
 foggy atmosphere in times* pastf was placed among the gods, for 
 having destroyed the hydra; in other words, for having reclaimed 
 the marshy desert." 
 
 Such being the case, we may infer that the early Greeks, though 
 doubtless far from possessing correct notions as to the nature of 
 malaria, as understood at the present day, or having an insight into 
 its laws, were perfectly conversant with the deleterious effects of 
 marshy surfaces; and aw r are, also, that the diseases incidental to 
 such localities, are due not to changes in the sensible qualities of 
 the atmosphere, but to a peculiar condition of the latter arising from 
 the admixture of a poisonous element issuing from the stagnant 
 water of marshes, and rendered still more baneful by the partial 
 desiccation of the miry surface. The history of Empedocles, and 
 more particularly of the means he employed to arrest the pestilence 
 by which the city of Selinonte was ravaged, to which I shall have 
 occasion to revert in a future chapter, would seem to prove, beyond 
 doubt, that he at least was fully aware of the agency of noxious ex 
 halations in the production of febrile diseases. 
 
 At a period less remote from our own, the Romans, without hav 
 ing a very clear idea of the manner in which malaria is pro 
 duced, expressed opinions and offered explanations of facts, which 
 would do no discredit to modern etiologists ; for though differ 
 ing as to what the tiling exactly was which exhaled from marshes 
 (considered as a philosophical rather than practical question), con 
 taminated the atmosphere, and caused sickness, and though indulging 
 in a variety of whimsical opinions on the subject, enough is found 
 in their writings to show that they had recognized the unhealthiness 
 
AUTUMNAL FEVERS. 105 
 
 of marshes and marshy surfaces, and ascribed the effect to some 
 thing beyond modifications in the sensible qualities of the atmo 
 sphere. Lucretius, who, though only a poet, may reasonably be 
 supposed to have reflected, in his Rerum Natures, the scientific 
 views of the professional men of his time, observes (vers. 1,100), that 
 the cause of epidemic and pestilential diseases may be referred to 
 one or other of two sources : first, to the atmosphere, through the 
 agency of germs wafted to the sickly place by the winds, in the 
 same way that these impel clouds from place to place ; or, secondly, 
 to the earth itself, when the latter, through means of long-continued 
 rains and strong atmospheric intemperies, covered over with water 
 and heated by the rays of the sun, undergoes, together with the 
 remains of organic substances spread >t>ver its surface, the putre 
 factive process, and thereby gives vent to miasms and germs analo 
 gous to those before mentioned a wafted from other places. Virgil 
 sings of the emptiness of the city of Acerrse, whose population 
 had been thinned by the sluggish course of the Eiver Clanius et 
 vacuis Clanius non cequus Acerris. Varro ascribed the mischief to 
 swarms of insects. "It is worthy of remark in marshy places," he 
 says, "that, as they dry up, there are produced certain very small 
 insects, too minute for observation by the eye ; which, being taken 
 into the body by the mouth and nostrils, are the cause of difficult 
 diseases." 1 
 
 Columella writes that "a marsh ought not to be in the neigh 
 bourhood of buildings, nor military way, because, when acted upon 
 by heat, it ejects a baleful poison, and engenders animals armed with 
 troublesome stings, which settle upon us in the thickest swarms. 
 Then, too, it emits the venomous hosts of water-snakes and ser 
 pents, freed from their winter s slime, mud, and fermentative col- 
 luvies ; and from these there arise frequently obscure diseases, 
 whose causes have not been investigated, even by physicians. 2 
 When we come to inquire what these obscure diseases were, we. 
 find that they consisted of the several varieties of autumnal fevers. 
 
 Palladius is of opinion that "a marsh is to be avoided upon every 
 principle, especially on the south or west, or if it usually dries up 
 in summer, because it generates pestilence and hostile animals." 3 
 Vitruvius says that "the vicinity of marshes ought to be shunned, 
 because when the morning breezes reach the house, with the rising 
 
 1 De Re Rustica, lib. i. cap. 12. 2 De Ee Rustica, lib. i. cap. 5. 
 
 3 De Re Rustica, lib. i. tit. 7. 
 
106 PNEUMONIA AND 
 
 sun, they bring with them mists and exhalations tainted with the 
 poison of the marshy brood. And this mixture of venom with 
 fog is conveyed by the winds to the bodies of the inhabitants, and 
 renders the place pestilential." 1 
 
 Diodorus Siculus (xiv.) states that, at the siege of Syracuse, the 
 Carthaginians, being encamped in the immediate vicinity of an 
 infectious marsh, and exposed to the thick and heavy vapours issuing 
 therefrom, and being moreover accumulated on a low and humid 
 locality, a pestilential fever broke out among them, and gave rise 
 to a large mortality. To the same cause he attributes the plague 
 of Athens (xii. 58). Galen attributes the origin of epidemics to 
 the state of the atmosphere, at least in a great measure, but he also 
 maintains that the nature of the country may contribute to the same 
 effect; as, for example, its vicinity to a gulf like the Charonean, from 
 which miasmata are exhalec^ I^rom these the air is tainted, and 
 diseases are produced. Tntis, in many passages of his Commentaries 
 on the Epidemics of Hippocrates, he Abates that such diseases are to be 
 referred to the first of these causes the condition of the country in 
 which they prevail; and in another work, he openly and explicitly 
 states that, for the most part, they are derived from the atmosphere 
 being tainted with putrid exhalations. He ascribed a large share 
 of agency in the production of the impurity of the air to intense 
 heat and the decomposition of organic substances, observing that 
 the putrefaction of dead bodies left unburnt on a field of battle, in 
 hot weather, is a fruitful cause of pestilence, under which name 
 wide-spreading fevers of various grades were then included, and 
 adds that, in other cases, the impurity is occasioned by the exha 
 lations of certain marshes or lakes in the summer season. 2 
 
 Judging from the little he says of epidemics, Celsus may be 
 regarded as having entertained opinions similar to those of Hip 
 pocrates. 3 
 
 Not very different is the opinion of Paulus ./Egineta : " The 
 nature of the country will also often occasion common diseases, 
 either from its lying adjacent to marshes, or to some deep pit which 
 emits a deleterious and pernicious exhalation." 4 
 
 According to Hally Abbas (Theor. v. 2), the principal causes of a 
 pestilential state of the atmosphere are, the nature of the country 
 
 1 Arclut. lib. i. cap. iv. 2 De Febribus Diff. lib. i. cap. 4. 
 
 3 De Re Medicina, i. 47 ; Paris edit. 
 
 4 The Seven Books of Paulus ^Egineta ; Adams s transl. i. 273. 
 
AUTUMNAL FEVERS. 107 
 
 and the season of the year. The former cause produces its effects 
 through means of the effluvia arising from corrupted fruits, pot 
 herbs, &c., or the miasmata from marshes, cloacas or dead bodies, 
 whether of men or cattle. Avicenna (iv. 1, 4) differed little from 
 Galen, attributing fevers to a humid and warm state of the atmo 
 sphere, the stagnant air of caverns, the miasmata of lakes and 
 marshes, and the effluvia from dead bodies. Avenzoar also 
 attributes epidemic diseases to a humid and warm state of the 
 atmosphere, effluvia from dead bodies, stagnant air, the miasmata 
 from stagnant and corrupted waters, and unwholesome food (iii. 
 1, 3). 
 
 The summer and autumnal fevers of Kome and the adjoining 
 territory attracted the notice of and are. often alluded to by Livy, 
 Strabo, Dionysius, Dio Cassius, and others ; and sufficient was said 
 on the subject to show that already at ^very early period the cause, 
 though not thoroughly understood, was not viewed as similar to 
 those giving rise to ordinary di^ases, but very generally ascribed 
 to an impure state of the atmosphere, the effect often of the over 
 flow of the Tiber, and of other kindred occurrences. The opinion 
 of the production of fevers through the agency of exhalations gave 
 way to the fantasies of the Middle Ages occult causes, conjunction 
 of the planets, &c. "Whatever was left of it was almost completely 
 absorbed or chased away by the doctrine of the contagium, which, 
 in the hands of its talented originator, Fracastorius, and of his many 
 followers, was made to explain almost every epidemic disease. 
 Though at all times experiencing opposition from writers, who, like 
 Montanus and Yaleriola, adhered more or less strictly to the views 
 of their ancient masters, the doctrine of contagion may be said to 
 have remained in the ascendant till the days of Fernelius, 2 to whom 
 credit is due for having been the first, after the renewal of letters, 
 to show the influence of contaminated air in the production of epi 
 demics, and, as M. Eochoux has well remarked (p. 125), laid down 
 the doctrine of miasmatic infection in a way which leaves scarcely 
 anything to desire. Niccola Massa, Alphani, Porteus, Pare, Pisa- 
 nelli, advocated opinions relative to the causes of autumnal fevers 
 not very different from those generally entertained at the present 
 day. 
 
 Indeed, almost all the Galenics, down to Sennertus, comprehended 
 
 1 See Adams s Commentaries on Paulus ^Egineta, i. 276, &c. 
 
 2 Universa Medicina, &c., De abditis rerurn causis, lib. ii. 497, 1552. 
 
108 PNEUMONIA AND 
 
 the universal noxiousness of muddy and swampy places, under the 
 naked words evaporation, exhalation, and emanation, and ascribed 
 it to certain poisonous qualities of the air. Fracastorius him 
 self states that, in 1528, a pestilential fever prevailed extensively in 
 Italy, and was caused by an extraordinary overflow of the Po, and 
 consequent formation of numerous marshes. 1 Prosper Alpinus, who 
 practised in Egypt from 1580 to 1584, ascribed the plague of that 
 country to morbid exhalations. In reference to the pestilential 
 fever of Alexandria, he remarks .that opinions varied as to its cause. 
 By some it was attributed to. putrid exhalations arising from the 
 lake of Mareotis, and conveyed to the city by the winds. Other 
 physicians referred them to putrid and poisonous exhalations min 
 gling with the ajr, and arising from putrid and bad water contained 
 in reservoirs under the city, which were filled during the overflow 
 ing of the Nile, in order to afford a supply to the inhabitants 
 throughout the year. 2 The agency of marshes, pools, pits for mace 
 rating hemp, unburied bodies of men and animals, and similar 
 sources of contamination of th^r atmosphere, " are familiarly men 
 tioned by a writer who calls himself Troiio Lancetta, and who 
 published at Venice, on the 16th of June, 1632, a short treatise on 
 a pestilence then prevailing at Venice, and on the means of arrest 
 ing its progress." 3 Eamazzini pointed out very accurately the 
 causes of the epidemic fevers which for several years prevailed in 
 and about Modena toward the close of the seventeenth century, 
 attributing them to the action of an atmosphere tainted with many 
 acid and earthy exhalations rising from a muddy, and, as it were, a 
 fermented soil. 4 Bontius, who practised for several years at Batavia, 
 prior to 1631, describing the state of the air, says: "It is rendered 
 insalubrious, not only from its heat and moisture the promoters of 
 putridity but also by the stagnant and marshy places with which 
 the country abounds ; and the wind, blowing from the mountains, 
 bring to the city from these marshes, dense, fetid, and poisonous 
 exhalations, which corrupt the air." 5 Sylvius (De le Boe) traced an 
 epidemic which broke out at Leyden in his time to the stagnant 
 
 1 De Morbis Contagiosis, lib. ii. cap. vii. in Opera Omnia, 100. 
 
 2 De Medicina ^Egyptiorum, lib. i. cap. 14; 256. Paris, 1G45. 
 
 3 Ed. Med. J. Ixxviii. 231. 
 
 4 De constitutione anni 1690, de Epidemia quoe Mimitensis agris ct Yicinarum rc- 
 gionem, &c. Modena, 1691, 4to. 
 
 5 De Medicina Indorum, Dialogus, i. 13. 
 
AUTUMNAL FEVEKS. 109 
 
 and corrupted waters from which exhaled noxious vapours, which 
 remain in the lower part of the atmosphere. 1 Hoffman, when treat 
 ing of the evil results of a moist atmosphere, says : " The cause of 
 all these accidents is justly and properly traced to the atmosphere, 
 rendered sluggish, heavy, and destitute of elasticity, by marsh 
 effluvia." 
 
 Baglivi, whose work on the practice of physic was written about 
 the close of the seventeenth century, remarks on this subject : " The 
 Eoman air is likewise foul and unwholesome not in all places, 
 indeed, but those chiefly where houses are wanting, and the air is 
 slow and unmoved ; and, above all,, in such places as lie upon the 
 Tiber, or, like valleys, are hedged Jn by mountains, or are exposed 
 to the exhalations that rise from old ruinous walls* vaults, and the 
 rubbish of the ancient edifices. Hence, il is manifest that the quar 
 ter of the Circus Maximus, lying between the Palatine and Aventine, 
 the Tiber and Ostiaii Gate, is very unwholesome and pernicious." 2 
 
 About the same period, Chirac, 5n describing the epidemic of 
 malignant or yellow fever which, prevailed at Eochefort in 1694. 
 and was then designated under tlie name of plague, says of that 
 place, that it is situated on the Eiver Charente, and is sheltered 
 from the north wind by a high hill and the remains of a thick 
 wood. On the east side is situated a large meadow, which is almost 
 annually overflowed by the river, and thereby converted into 
 marshes filled with muddy and stinking water. These marshes dry 
 up during the summer, and impart to the air of the port a smell of 
 burnt powder, especially towards evening, when the dew begins to 
 fall. To these exhalations which he regards as always extremely 
 dangerous Chirac attributed the fever in question. This inference 
 he considered natural, because he had before his eyes the results of 
 observations made annually in all paludal countries, " whose inha 
 bitants are scourged by malignant fevers, which there break out, 
 almost every summer, when the marshes are dried up, and the air 
 becomes surcharged with the indigestible and offensive sulphurs 
 which exhale from the mud. 3 By Porzio and others attention was 
 called, about the same time or not long after, to the Hungarian 
 fever. Finally, Lancisi, collecting all the facts and information 
 already possessed, and adding many he himself had amassed during 
 
 1 Oratio dc affectus epidemic! Leidensis causis naturalibus dicta, 1670. 12mo. 
 
 2 Opera Omnia : Venitiis, 1754, 81. 
 
 3 Traite des Fievres Maligues, &c. i. 31, 141, 147. 
 
110 PNEUMONIA AND 
 
 a period of observation of thirty years, made them illustrate the 
 etiology of epidemic and endemic diseases in general, which he 
 ascribes, as every one knows, to marsh and other exhalations. 1 
 
 From that day to the present, the existence of a poisonous mat 
 ter floating in the atmosphere of febriferous localities, and its spe 
 cial agency in the production of autumnal fevers, have been admit 
 ted by professional men of all countries. The sources whence it is 
 derived, the atmospheric conditions which favour, retard, or prevent 
 its development, and the laws by which it is governed, have been in 
 vestigated; its geographical tfffei altitudinal limits have been traced ; 
 the baneful influence it exercises* the various characters it assumes 
 as shown by the diversified forms of fever it produces the modifi 
 cations it imparts to other complaints, and the particular mode of 
 treatment it renders necessary, have been pointed out in many 
 didactic works, and in more numerous publications of less pre 
 tension. 
 
 t- 
 
 The agency of malaria not universally admitted. It is scarcely 
 necessary to remark, that however evidently well founded the in 
 ference respecting this agency has appeared to professional ob 
 servers in all parts of the world; however universally, indeed, the 
 doctrine which ascribes autumnal or periodic fevers, of all grades 
 and types, to the morbific influence of malarial exhalations, has 
 been recognized, during along succession of years, as placed beyond 
 the possibility of doubt or disputation, its advocates have not been 
 left in undisturbed possession of the field. Doubts as to its correct 
 ness have been expressed ; objections have been raised ; and, by 
 more than one writer, the very existence of malaria, or its agency 
 in the production of autumnal fever, has been denied. And why 
 should it be otherwise? The reader must be aware that it would 
 be difficult to discover an admitted fact in practice, or a correct or 
 plausible point in theory, whether on pathology or etiology, which 
 has not, at some time, or in some place, encountered greater or less 
 opposition, or whose correctness has not been flatly denied. Who 
 does not know that the doctrine of the circulation met for years 
 with the most strenuous opposition, and could not obtain a footing 
 in some of the most renowned schools of Europe ? The remedial 
 effects of antimony, of mercury, of the lancet, and other therapeutic 
 
 1 De Noxiis Paludum Effluviis. Dissertatio de Nativis, deque adventitiis Roman! 
 coeli qualitatibus, 16. 
 
AUTUMNAL FEVERS. Ill 
 
 agents, have been violently opposed, and given rise to wars which, 
 though less imaginary, appear almost as ludicrous to us as those 
 which, as we are told, raged between the big endians and the little 
 endians. The specificity of morbid action has been scoffed at, and 
 the hypothesis of the unity of all diseases extolled, even by the 
 clearest intellects. The utility, first of inoculation, and next of vac 
 cination, has encountered more t]ian one virulent opponent, and the 
 danger of the latter process has been insisted upon in volumes of 
 large dimensions. Professional men are found in this nineteenth cen 
 tury, who, discarding the results of the^&ccumulated experience of a 
 hundred successive generations, embrace the absurdities of homoeop 
 athy, and seriously believe in the wonderful effects of a decillionth 
 part of a grain of si-lex or charcoal. Hydropathy enumerates warm 
 partisans among physicians in Europe and this country; and surely, 
 if such has been and continues to be the case in relation to the seve 
 ral subjects mentioned, We cannot be surprised at finding the ques 
 tion of the existence or morbid agency* of malaria sharing the same 
 fate. Hence, in Italy, Giannini, 1 Folchi, 2 Santarelli, 3 and Mienzi, 4 
 have exerted themselves to controvert the long-received views on 
 the subject. In France, the same opposition has been made by 
 Lafont-Gouzy, 5 Eamel, 6 and Keveille Parise. 7 
 
 In England, Armstrong, 8 Hopkins, 9 Calvert, Pritchett, 10 Sir 
 James Murray, 11 and Dundas, 12 have inscribed themselves among the 
 opponents of malaria. In this country, too, the existence of this 
 agent has been denied by Kumph, 13 Strobbart, 14 Jones, 15 Lee, 16 Gay- 
 
 1 Delia Natura della febbri, cap. 2, vol. i. 110, 2d ed. ; French translation of d. 
 i. 220. 
 
 2 Sull Origine delle Intermittent! di Roma e sua Campania. Roma, 1828. See 
 N. A. J. v. for a translation of this Essay. 
 
 3 Ricerche Interno alia causa delle Febbre Perniciosa dominento nello Stato Ro 
 mano, 32. 4 Sopra cegenesi delle febbri Interm. Roma, 1844. 
 
 5 Caracteres Propres, Pre"servatifs et Remedes des Contagions, 1822. See Monfal- 
 con, 47, note. 
 
 6 De PInfluence des Marais et des Etangs sur le Sante des Hommes. Paris, 1802. 
 Monfalcon, 527. 
 
 7 Journal General de Medecine, xcvii. 105. 
 
 8 The Influence of Climate on the Human Constitution, 33. 
 
 9 London and Edinb. Philos. Magazine, 3d series, No. 86. 
 
 10 Some Account of the African Remittent Fever, 109. 
 
 11 Dublin Medical Press, Nov. 27, 1844. I2 Sketches of Brazil, 154. 
 
 13 Some Thoughts on Malaria, and Doubts as to its Existence as a Source of Disease. 
 Charleston J. iii. 37. 14 Thoughts on Malaria. Charleston J. vi. 661. 
 
 15 Boston J. ii. 376. 1G Forry, Climates of the U. S. 109. 
 
112 PNEUMONIA AND 
 
 ley, 1 Bell, 2 Merrill, 3 and a few others ; while everywhere writers 
 are encountered, who, though not openly striving to disprove the 
 special agency of morbid exhalations, say nothing about them, and 
 content themselves with looking to other causes to account for the 
 occurrence of fever. 
 
 Objections made to the agency of malaria, various. But while 
 all these various writers unite in rejecting or ignoring the exist 
 ence of malaria, they differ widely as regards the substitute they 
 propose. The one refers all the mischief to the action of heat 
 on the system. A second considers atmospheric or terrestrial 
 humidity as the efficient agent. A third explains all the pheno 
 mena by means of atmospheric vicissitudes heat by day, cold by 
 night. Then again, we are told that the true cause of periodic fevers 
 must be sought in a low K 4ej-point; or in the action of fogs or of 
 visible dews, " the phenori^|pp|)f which are, in fact, all the pretended 
 laws of miasma ;" or in tfe& ^fpnence or deficiency of atmospheric 
 electricity, or in the presence of some particular and well-known 
 gas. There are not even wanting those who think that unnutri- 
 tious food exercises a more powerful agency in the production of 
 periodic fever than any other cause. On all these several and diver 
 sified hypotheses much has been written. Facts, and, when possible, 
 experiments have been appealed to; learning and ingenuity have 
 often been displayed ; but from all I have read and seen on the 
 subject, I am inclined to the opinion that the opponents of malaria 
 have left the question precisely where they found it, and that, so far 
 from adducing anything calculated to disprove the existence of that 
 poison, or establishing the correctness of their own views, they have 
 done much to involve the whole subject in inextricable confusion, 
 by constantly confounding the predisposing and exciting influence 
 with the efficient cause of those diseases, and raising the former to 
 the dignity of the latter. Convinced of this, and of the existence 
 of malaria as a distinct morbific agent ; regarding it as the special 
 cause of autumnal fevers, and as completely independent of and 
 distinct from those influences which give rise to pneumonic inflam- 
 
 1 Am. Med. J. N. S. xvii. 53. 
 
 2 On Miasm as an alleged Cause of Fever. Philad. J. of Medical and Physical Sc. 
 ii. N. S. 274. 
 
 3 Address to the Memphis Med. Soc. on the Sanitary Condition of that City. Mem 
 phis Med. Recorder, i. 99. 
 
AUTUMNAL FEVERS. 113 
 
 mation, and, as a consequence, being persuaded that the reality of 
 this agency, if satisfactorily established, must lend a powerful aid 
 in the refutation of the views under examination, I propose in the 
 present chapter, and before proceeding farther in the matter under 
 consideration, to examine somewhat in detail the leading facts and 
 arguments on which the malarial doctrine rests, and to note a few 
 of the objections that have been raised against it. 
 
 The appearance of fever where tJiere are no marshes does not disprove 
 the agency of malaria. By those who reject this doctrine, it is not 
 unfrequently urged in a tone of confident triumph that its advocates 
 ascribe to rnarsh miasma those very fevers which we meet with in 
 their most malignant forms in situations where there are no marshes 
 existing; arid that this is pertinaciously followed up, although con 
 tradicted by every day s experiejace.^, Hence, they add, if fevers 
 arise without marshe$, there can be rjp^Dpriety in referring them 
 to the agency of these, when they^jlp^li to exist in sickly locali 
 ties, for the sickness would in all probability have arisen had they 
 not been situated there. All thi$.at first sight appears plausible 
 enough, and may prove perfectly satisfactory to those who are not 
 well posted up on questions of the kind ; but, 011 examination, the 
 objection will be found to rest on very insecure foundation. For 
 when we come to inquire by whom periodic fevers are referred ex 
 clusively to the effluvia of marshes, and especially by whom the 
 opinion is obstinately maintained, we easily discover that no 
 thing of the kind is insisted upon by any physician of respectable 
 authority ; by no one, indeed, who has directed his thoughts seriously 
 to the etiology of febrile complaints. Doubtless, a large majority 
 of medical writers and inquirers maintain that certain forms of 
 fever are the products of marsh exhalations properly so called. 
 Doubtless, also, other forms of the same disease, including the ma 
 lignant, are as generally regarded as due to the action of exhala 
 tions of some sort. But no one, or at least few, among those whose 
 opinions are worth recording, think nowadays, or have thought 
 for years back, of viewing the existence of a marsh as a sine qua 
 non, and of pertinaciously affirming that febrile miasmata can only 
 be evolved from a paludal soil. Those, therefore, who raise an 
 outcry against the absurdity of such an opinion, and tax their oppo 
 nents with generally entertaining it ; those especially, who, like Dr. 
 Dundas, and others of the same school, write long dissertations 
 8 
 
114 PNEUMONIA AND 
 
 with, the view to set the world right on the subject, lose much valu 
 able time, which might be more profitably employed in making 
 themselves well acquainted with the true state of the question a 
 point about which some of them appear to be lamentably deficient 
 than in refuting opinions which, if ever entertained, have long since 
 been abandoned. 
 
 That such is really the case, that the opinion which ascribes all 
 fevers to the exhalations of marshes solely, is not entertained, admits 
 of no doubt. Even Dr. Bancroft, whose work appeared some forty 
 years ago, and would almost seem, like some others on the same 
 subject, to have been writter^nvith a view to mystify the reader on 
 some parts of its contents, continually confounding together, as he 
 does, several distinct fevers, and applying to them the one name of 
 yellow fever ; even Dr. Bancroft, I say, takes pains to explain that 
 in joining the epithet raarsh. or marshy (which he almost invariably 
 does) to the term miasnma,ftxhalation, effluvia, &c., and in con 
 sidering them as a cause of fever, he does not mean to intimate that 
 such miasmata, &c., are emitted solely by marshes, it being certain 
 that they frequently arise from soils in a different state, but only to 
 designate the quality of those vapours which are eminently the pro 
 duct of marshy ground. Other writers have pointed out the impro 
 priety of viewing malaria as the production of marshy surfaces 
 exclusively, as it arises often in arid places destitute of swampy 
 surfaces. 1 Lancisi himself, the systematize! of the knowledge of 
 the times on malarial effluvia, the discoverer of important facts, and 
 the able expounder of etiological observations, who is often referred 
 to, but seldom read, was very far from believing that intermittent 
 and remittent fevers, which he knew full well were only modifica 
 tions of each other, proceed from the emanations of marshy grounds 
 alone. On this subject he expresses himself very decidedly. 2 He 
 had observed, and he records, that from the soil covered by the ruins 
 of houses, temples, and public buildings, from grounds rendered damp 
 and filthy by the obstructions of drains and sewers, by the over 
 flowing of the Tiber, &c., fever had arisen and prevailed extensively. 
 The writings of Chervin, 3 Boudin, 4 Nepple, 5 Maillot, 6 Segond, 7 
 
 1 J. Johnson on Tr. Clim. 24; Bryson, 190. 
 
 2 De Xoxiis Paludum Effluvius, Oper. i. 73. 
 
 3 De 1 Identite" des Fievres, d Origiue Paludeenues. 4 Geographic Medicale. 
 
 5 Trait 6 des Fievres Interm. Simples et Pernicieuses. 
 
 6 Traite des Fievres ou Irritations Cereb. Spin. Interm. 
 
 7 Mem. sur les Fievres de Cayence. 
 
AUTUMNAL FEVERS. 115 
 
 Faure, 1 &c., which are usually referred to in support of the strictly 
 paludal origin of fevers generally, will show that, even in the opi 
 nion of these authors, malarial exhalations of various degrees of 
 virulence may, and do often proceed from surfaces presenting cha 
 racters very different from those appertaining to ordinary marshes. 
 Indeed, at the present day, this existence of malarial exhalations, 
 and their efficiency in the production of fever, independently of the 
 presence of marshes, properly so called, and their elimination from 
 sources of various nature, and differing much in external appear 
 ance, is almost universally admitted quite so, I think, by all who 
 have taken pains to investigate the subject in all its bearings; for, 
 while they are firmly convinced of the reality of the morbific 
 agency of such effluvia, they know that fevers prevail sometimes 
 even in arid places with want of surface water, where the soil is 
 rocky, or sandy, parched, and deficient^in vegetation, and where, in 
 a word, circumstances generally arjjf frv> appearance at least, unfa 
 vourable to the decay of organic matter". On this subject, the facts 
 recorded by Ferguson, J. Davy, Craigie, Brown, Currie, Humboldt, 
 and others, can leave no doubt. 2 Nay more, it is almost as gene- 
 rally acknowledged, that the malignant forms of such diseases are 
 never produced by the effluvia of genuine marshes, but are the 
 products of other miasmal sources; while, on the contrary, fevers 
 known to arise from marsh exhalations, are never produced by the 
 effluvia which occasion the other forms of the disease. Hence, 
 when ordinary or malignant autumnal fevers occur in places where 
 no marshes properly so called exist, it is of no avail to cite the 
 absence of these as an evidence of erroneous conclusions, far less 
 of absurdity, on the part of those who attribute such fevers to mias 
 matic exhalations. The latter writers know, fully as well as their 
 opponents, that the existence of a marsh is not indispensable to the 
 manifestation of the effect in question; but, unlike them, they are 
 perfectly aware of the fact that morbific effluvia, of the most deadly 
 character, too, may and do arise from sources which bear no resem- 
 
 1 Des Fievres Intcrm. et Cont. 1833, and Gaz. Med. 1840. 
 
 2 Ferguson on Marsh Poison, in vol. of Recollections, 185 ; Davy on Topography of 
 Mediterranean, ii. 247, 248 ; Humboldt, Personal Narrative, iii. ; Charles Darwin, 
 Voyage of a Naturalist, ii. 129; Carpenter on Periodicity, New Orleans Journal, iii. 
 420 ; Gildwell, Essay on Malaria, 60, 61 ; Craigie, Practice of Physic, i. 87 ; Brown, 
 Med. Essays, 33, 3 J ; Currie on Bilious Fever, 55 ; Tullock, Sickness, &c. of British 
 Armv on West Coast of Africa, 4, &c. 
 
116 PNEUMONIA AND 
 
 blance to a marsh. In the words of an intelligent writer, we may 
 say : " Marshes and swamps are for from being the only sources of 
 miasmata." " The foul shores of the sea ; the moist slime and mud 
 of the banks of great rivers, and of mill-ponds ; the mire and mud 
 in the unpaved streets, ditches, lanes, and passages of great towns 
 and cities, villages, &c., particularly the cellars and damp abodes 
 where the poorer classes are most frequently doomed to dwell the 
 moats of garrisons, &c. ; the soil where certain hospitals, barracks, 
 or encampments are situated ; the wells and cellars, damp cells and 
 dungeons of prisons, and the holds of ships, are all calculated to 
 emit pyrexial effluvia from the moist earth, mud, and filth, which 
 are mostly to be found within their precincts." 1 
 
 The non-detection of malaria in the atmosphere no proof of its non- 
 existence and agency. It has been urged time after time, in oppo 
 sition to the malarial or%j.n of fever, that the existence of the 
 effluvia, to the agency of which the disease is ascribed, has never 
 been proved that their presence in the atmosphere has been in 
 ferred from the effects observed, rather than positively demon 
 strated that they have so far eluded detection ; and that the air of 
 sickly localities, whenever subjected to chemical analysis, has been 
 found to contain the same ingredients, and in nearly the same pro 
 portions, as that of salubrious places. Much of this is doubtless 
 true, and will not be denied by any one who has endeavoured to 
 make himself acquainted with the state of knowledge on the sub 
 ject. All are aware, for the fact has been often referred to, that the 
 experiments of Gattoni, and others, led to the conclusion that the 
 air of the marshes of Fuentes is as pure as that of Mount Legone, 2 
 one of the Grison Alps, at an elevation of 8,040 feet above the 
 level of the sea. They are aware that, at Martinique, Moreau do 
 Jonnes found no difference between the chemical composition of 
 the air of Mount Tartanson, at a height of some six hundred feet 
 above the level of the sea, and of the valley of Case Navire ; and that 
 the atmosphere of the wards of the hospital of Fort Royal, during 
 the prevalence of yellow fever, differed from neither. 3 They know 
 that Julia de Fontenelle could detect no deleterious gases or foreign 
 chemical ingredients in the atmosphere of infected localities that 
 
 1 Blackmore on Infection, 92. 
 
 2 Memoirs de la Societe de Medecinc, x. 109. Art. VI. 
 
 3 Monographic de la Fievre Jaune, 229. 
 
AUTUMNAL FEVERS. 117 
 
 the latter did not vary from that of healthy places in any of the 
 principles which chemical analysis enables us to discover a result 
 he obtained in the marshes of Cercle near Narbonne, at the pond 
 of Pudre, at Salces, Salanque, Capestang, Cette, at Barcelona during 
 the fever of 1821, and at Paris during the cholera of 1833. 1 They 
 also know that a distinguished chemist and professor in the school of 
 Montpellier, Berard, reached the same conclusions from his experi 
 ments on the pestiferous air of the marshes on the coast of Cette; 2 
 and that Desaye obtained the same elements in the most confined 
 marshes as on the most exposed hills. 3 
 
 They are aware that, according to more recent authorities, the 
 proportion of oxygen is the same in very high regions as it is near 
 the surface of the earth. 4 They are, besides, conversant with the 
 fact that, in more than one hundred analyses made in Paris and its 
 environs, the least quantity of oxygen found was 20.913 ; the great 
 est, 20.999, and the mean, 20.96; that a$%lontpellier, Lyons, Berlin, 
 Madrid, in Normandy, and Switzerland, the quantity varied from 
 20.903 to 21.000; that in the port of Toulon, in the middle of the 
 Mediterranean, at Algiers, in the Atlantic, between Liverpool and 
 Yera Cruz, the results were the same; that in the village of Gualla- 
 bamba (Republic of Equador), the quantity was discovered to be 
 20.960, and on the summit of Pichincha, 20.949 : 20.988 ; that, in 
 eleven specimens of air collected in the southern seas, only two 
 gave results differing somewhat from the above that of the Gulf 
 of Bengal, where the quantity was 20.46 : 20.45 ; and of Ganges, 
 where it amounted to 20.390 : 20.387 ; and that in the Polar Seas, 
 according to Captain Boss, similar observations Avere made in re 
 spect to the composition of the atmosphere. 5 They perceive from 
 these results, as well as from those obtained by Levy and Brunsen, 
 that the variations in the composition of the atmosphere, wheresoever 
 examined, are exceedingly limited, the difference in regard to the 
 volume of oxygen being from 20.9 to 21 ; that the composition of 
 the air is the same in the highest attainable strata of the latter as 
 on the surface of the earth ; and that if, in some instances, espe- 
 
 1 Recherches Hist. Chim. et M<$d. sur Fair Mare cageux, 91, c. See also his trans 
 lation of Mojon s Essay on the Aninialcular Origin of Cholera. 3, 4. 
 
 2 Julia, op. cit. 93. 3 Cyclop, of Pract. Med. iii. 60. 
 
 4 Becquerel, Des Climats et de 1 Influence qu ils exercent sur les Sols boises, &c. 
 2, 3, 4. 
 
 5 llegnault, Comptes Rendus, &c., de 1 Academic des Sciences, xxxiv. 867. 
 
118 PNEUMONIA AND 
 
 cially in hot climates, the quantity of oxygen lowers to 20.3, with a 
 variation of about 0.020 of its volume, it may be doubtful whether 
 such a small difference can have any influence on the phenomena of 
 organic life or on health. 
 
 " The Almighty," says a well-informed writer, " has not permitted 
 the chemist to discover the nature of such attenuated exhalations : 
 they elude all detection ; for if he take a volume of stagnant air 
 from the foul plague Avard of an Egyptian hospital, Avhere croAvds 
 of living and cadaverous beings are hourly stricken with the ago 
 nies of death, his analysis will prove it to contain the exact propor 
 tion by weight and by measure of elements and compounds, as 
 those contained in an equal volume of a balmy breeze taken from 
 a free and open English valley, Avhere all are smiling Avith the in 
 estimable blessing of health, and glowing with its bronzed and 
 ruddy hues." 1 
 
 Fever not due to the action of any known gases. AAvare of all these 
 failures in the attempt to refer th| cause of fever to any dispropor 
 tion in the natural gaseous compounds of the atmosphere, \ve can 
 find no difficulty in acknowledging the erroneousness of such opin 
 ions as that of Dr. Currie, Avho, basing his conclusion on sundry 
 long-forgotten experiments of Vanbreden, thought that the insalu 
 brity of low and moist places is not owing to invisible miasma or 
 noxious effluvia, but to a deficiency of oxygen resulting from ani 
 mal and vegetable decomposition ; 2 or of the once famous doctrine 
 of the Septon an undiscovered compound of azote and oxygen, as 
 propounded and defended by the late Professor Mitchell, of NCAV 
 York ; or more recently, of the theories of our countryman, Kumph, 
 of Giannmi, and others too numerous to mention. Few, also, who 
 have reflected seriously on the subject will feel disposed to lend a 
 willing ear to the theory which, teaches that the cause of fever must 
 be sought in the admixture, in minute or larger proportion, of sun 
 dry gases, with or without addition of other substances carbon 
 ated hydrogen, carbonic acid gas, ammoniacal gas, hydrosulphuric 
 acid gas, phosphuretted hydrogen, &c. ; 3 for, Avere it true, that these 
 
 1 Griffith s Chemistry of the Four Seasons, 225, 226. 
 
 2 Philadelphia Philosophical Transactions, iv. 135. 
 
 3 Ramazzini; Volta Opera, 3 Florence, 1816; Dumas; Pallas, 210; Faust, Amer. 
 Journ. vi. 38; Thenard and Dupuytren in Monfalcon, 54; Baumes, Emanations 
 Marecageuses, in Monfalcon, 53, 54; Deslandes, Diet, de Mod. prat, article Emanation; 
 
AUTUMNAL FEVERS. 119 
 
 gases have been, or may be, detected in the atmosphere of sickly 
 localities, it would not follow that we must ascribe fever to their 
 agency, seeing that though often unpleasant to the smell, and some 
 times injurious or even fatal in their tendencies, they do not pro 
 duce phenomena analogous to those of the diseases in question, 
 even when absorbed in large quantities ; while those they do occa 
 sion present always a widely different garb ; and that, as they do 
 not produce the symptoms of true pyrexial complaints when ab 
 sorbed in large quantities, they are not likely to occasion them 
 when received in such small proportion as to elude detection. If 
 they were the legitimate cause of fever, and the active agents of 
 miasma, it is impossible to understand how the fact could not have 
 been demonstrated during wide-spreading and highly malignant 
 epidemics, when the cause was acting with intense energy, and must 
 have existed in sufficiently large proportion to be detected by some 
 or other of the means within our^^ifSpb:. It should be borne in 
 mind, too, that, when fatal, their effects are rapid, often instanta 
 neous ; that when, on the contrary, they do not occasion death, the 
 immediate results very usually pass off, leaving the sufferer some 
 times more or less debilitated, but without one febrile symptom ; 
 and that many of them are appreciable to the senses, and if existing 
 in injurious proportions, would soon be detected. It is not less 
 true, and to the purpose, that such gases may be produced or exist 
 anywhere, in sickly as in healthy localities; while fevers, on the 
 other hand, occur in certain places only, within certain latitudes, and 
 under special circumstances; that, in many situations, where fever 
 prevails extensively, the existence of some of those gases, to any 
 notable or injurious amount, has not only not been demonstrated, 
 but is impossible, or improbable ; and vice versa, that, in places where 
 they are abundantly produced, fever never shows itself. Even 
 hydrosulphurous acid gas itself, on which so much has been said 
 lately in France by M. Chevreul, in England by Daniel, and in this 
 country by Dr. Gardiner, in its relation to the etiology of autumnal 
 fevers, will not be found, on reflection, to afford much aid in account 
 ing for those diseases. True, it may be, as Chevreul has shown 
 by direct and positive experiments, that this gas is formed by 
 
 Balme, Traite dc la Contagion, 305; Chevreul, Bulletin de 1 Acad. de Mod. xviii. 692 ; 
 Daniell, Lond. Med. Gaz. xxviii. 609, 700; Gardiner, Amor. Journ. X. S. v. 279; Me- 
 lier, Mem. de 1 Acad. de Med. xiii. 492; Carriere, Le Climat de Pltalie, 311, 312; 
 Humboldt, Personal Nar. iii. 188. 
 
120 PNEUMONIA AND 
 
 the action of the sulphnrets contained in water or the earth on 
 organic matter, whether animal or vegetable, with which they come 
 in contact (by which these nearly insoluble and inoffensive sub 
 stances are converted, through means of the combination of oxygen 
 with the azotized matter, into soluble sulphurets), a result which has 
 enabled M. Fontan 1 to explain the formation of sulphurous mineral 
 waters. True it is, also, that those sulphates, together with organic 
 matter, are found in most, if not in all sickly localities, and hence 
 that the gas in question is also encountered there in a greater or 
 less amount ; but it is not less true that, in many places, subject to 
 fevers, and during wide -spreading febrile epidemics, of various 
 forms, from the simple intermittent to the malignant yellow, the 
 presence of this supposed agent is not evident to the senses, or to 
 chemical reagents, and must, if it exist at all, do so in so small a pro 
 portion as to be inert. It s.bpiild be borne in mind, besides, that 
 hydrosulphuric acid gas pro^s innocuous in factories and bathing 
 establishments 2 where it abounds; and that its presence in the 
 African rivers and circumambient air, on which so much stress was 
 laid by Dr. Daniell and others, 3 has been positively disproved 
 water newly taken up, or kept in bottles, hermetically closed, never 
 giving evident signs of that presence, which is evidently due, after 
 awhile, to the putrefaction of the organic matter contained in the 
 water. 4 In a word, there is not the most distant probability that 
 malaria will ever be found to owe its morbific agency to, or consist 
 in any extraneous gas floating in the atmosphere, or, that fevers are 
 due to an excess or deficiency of one or more of the known con 
 stituents of the latter. 
 
 Not true that noticing is found in the atmosphere of sickly localities. 
 All this we must admit ; but while doing so, we can find no valid 
 reason for denying the very existence of a specific febrific cause ; 
 for from the circumstance that malaria cannot justly be identified 
 with any of the gases above mentioned, it does not follow that the 
 
 1 Bulletin do 1 Acad. x. 602, &c. 
 
 2 Annales d llygiene, xi. 2 ( JO ; Brocchi Stato Fisico di Roma, 254, &c. ; J. K. Mit 
 chell, 28. 
 
 3 Loc. cit. 
 
 4 M Williams, Medical History of the Expedition to the Niger, &c. 172; Tritchett, 
 Some Accounts of the African Remittent Fever, 117; Kdin. Journ. (> >, 442; Arm 
 strong, Sulphuretted Hydr. and its Antidotes, Naut. Mag. 1842, 378, &c. 
 
AUTUMNAL FEVERS. 121 
 
 atmosphere of sickly localities contains no extraneous material to 
 which autumnal fevers are to be ascribed. Certain it is, that those 
 who enter into the investigations unbiased by preconceived notions 
 will not lose sight of certain facts which will probably one day be 
 found entitled to the particular attention of the medical inquirer, 
 and lead ultimately to useful conclusions on this important matter 
 not, perhaps, by giving us at once correct notions respecting the 
 real nature of the cause, or enabling us to seize the poisonous mat 
 ter and subject it to chemical analysis, but by determining its gene 
 ral nature and the class of substances to which it belongs. The 
 medical reader will recollect that %foscati, the first who suggested 
 the idea of condensing the water dissolved in the atmosphere of 
 insalubrious places with a view to discover the effluvial principle, 
 obtained by that process, in sundry experiments he instituted at 
 Milan, on the air of rice grounds, au d of the wards of the large 
 hospital of that city, deposits of a^Jbcculent matter, emitting a 
 cadaverous odour. 1 Brocchi, at Rome, found albuminous flakes (ani 
 mal matter) in the dews of the Pontine marshes. 2 In 1812, Rigaud 
 de Lisle, experimenting on the marshes of Languedoc and Pro 
 vence, collected a quantity of the dews which, when examined 
 some five or six months after by Yauquelin, was found to contain 
 flakes of animal matter; while the experiment of the former on fresh 
 dews, collected from marshy surfaces, gave a somewhat different re 
 sult, exhibiting, as they did, common air without admixture of any 
 gas, but containing alkaline salts, with vegetable and animal sub 
 stances. 3 Dumas, and before him Yolta, found an organic substance 
 combined with the gases disengaged from stagnant water. Julia 
 de Fontenelle and Herpin, obtained results differing but little from 
 those recorded by Brocchi, so far as regards the flocculent or in 
 organic matter, while in common dew nothing of the kind was 
 discovered. 4 Agreeably to the first of these experimenters, the 
 air of marshes may be inodorous, but if kept six months, it 
 acquires a nauseous smell an effect not noticed in common air. 5 
 Ozanam also found "a substance apparently mucous, which emitted 
 
 1 Compendio di Cognoz. Veterin, 81; Monfalcon, 59; Levy, Hygiene, 2d ed. i. 444. 
 
 2 Dello Stato Fisico del Suolo di Roma, 259-275. 
 
 3 Annnles Cliniques de la Soc. Trat, de Montpellier, xliv. 286; Julia, loc. cit. 83-84. 
 An account of these experiments was addressed to Pictet, and published in the 
 Bibliotheque Universclle. 
 
 4 Julia, 80-7. 5 Ibid. 90. 
 
122 PNEUMONIA AND 
 
 a very fetid odour." 1 Boussingault, whose experiments were made 
 in the department of Ain (France), in 1819, and subsequently in 
 South America, on the banks of the Taricagua, and at Cartago, 
 in the valley of the River Cauca, 2 demonstrated also the presence 
 of organic matter in the air deposited with the dew. This matter 
 imparted a dark hue to concentrated sulphuric acid exposed to 
 miasmata during the night the quantity varying according to 
 the unhealthiness of the seasons at which the experiments were 
 made. Thenard and Dupuytren found that the carburetted hy 
 drogen obtained from marshy grounds, when passed through 
 water, deposited therein a peculiar putrescible matter a result 
 not obtained from the same gas disengaged in the ordinary way. 3 
 In a communication made to the French Academy of Sciences, in 
 1847, respecting sundry observations and experiments made by 
 him on the condensation of ..fogs and dews, M. Gasparn states that 
 from these a peculiar matt^^was- obtained, which, on trial, was 
 found detrimental to health, and fatal to sheep. The same results 
 were obtained by M. Malagutti, an Italian chemist. 4 
 
 In 1828, Messrs. Meirieu condensed the dews collected over cer 
 tain marshes situate in the department of the Gard, and obtained 
 therefrom a peculiar substance possessing acid properties. 5 
 
 Liebig tells us that "all the observations made upon gaseous 
 contagious matters, prove that they also are in a state of decompo 
 sition. When vessels filled with ice are placed in air impregnated 
 with gaseous contagious matter, their outer surfaces become covered 
 with water containing a certain quantity of this matter in solution. 
 This water soon becomes turbid, and, in common language, putre 
 fies ; or, to describe the change more correctly, the state of decom 
 position of the dissolved contagious matter is completed in the 
 water. " 5 Finally, a physician of our own. country, Dr. Hume, Pro 
 fessor of Elemental Philosophy in the State Military Academy of 
 
 1 Hist. MecL des Maladies Epid. i. 
 
 2 Recherches sur la composition de 1 atmosphere, sur la possibilite do constater 
 rexistence des Miasmes, Ann. dc Chiniic et de Phys. Ivii. 148, &c. ; Guz. Med. Aug. 
 1C, 1834; Am. J. xv. 544; do. xix. 203; Archives, 2d S. v. G41. 
 
 a Monfalcon, 54. 
 
 4 Becquerel, Traite d llygiene, 174, 183; Gaz. Med. de Paris, ii. 3d series, 1817, 
 p. 22; Anglada, Traite de la Contagion, i. 34-5. 
 
 5 Influence des Miames Marecageux, sur I Economic Animale, Montpellicr, 1820, 
 p. 0, referred to by Anglada, op. cit. p. 34. 
 
 6 Agricultural Chemistry, Loud. ed. 373 ; Am. cd. 407. 
 
AUTUMNAL FEVERS. 123 
 
 Charleston, during some experiments made by him in that city a few 
 years ago, discovered the existence of an organic matter suspended 
 in the atmosphere of localities infected with the poison of the yellow 
 fever. "Whether animal or vegetable," says Dr. II., "it is impos 
 sible to determine ; but I am inclined to suspect the presence of 
 both, as the odour was more like that of animal matter, while the 
 charring and subsequent combustion of the carbon was indicative of 
 vegetables. The positive detection of organic matter in the con 
 densed water of a presumed infected cellar, in a decidedly infected 
 district, is a new fact in the etiology of the disease, arid points dis 
 tinctly to the origin of our yellow fever." 1 
 
 Whether, in the present state of knowledge on the subject, we 
 can unhesitatingly connect the production of malarial fevers of all 
 grades and types, with the existence of azotized flakes in the atmo 
 sphere attributing, with Julia (pp. 1%J>, 153), JTourcroy, 2 and others, 
 the morbid effects noticed in sickly -JiUfclities to particles of animal 
 and vegetable matter in a state of putrefaction, and mixed with, 
 and floating in, the air I will not pretend to decide in a very posi 
 tive manner. Perhaps the fact adduced on some occasions, that 
 analogous discoveries have been made in air issuing from noted 
 sources of vegetable and animal putrefactions, and which, neverthe 
 less, did not give rise to malarial fevers, and that, on the contrary, 
 chemists have not unfrequently failed to detect azotized flakes in the 
 air of localities where fever prevails more or less extensively, may 
 deter us from regarding them as exclusive agents in the production 
 of those diseases. But be this as it may, the results obtained in a 
 large majority of the trials made in various situations, prove very 
 clearly that in marshy places, during the precipitation of dew, flakes 
 of organic matter are deposited with it ; that, in many instances, a 
 similar matter has been obtained in the atmosphere of infected 
 places; and surely the frequency of the occurrence, taken in con 
 nection with other circumstances that will be noticed presently, 
 justifies the conclusion that the researches of chemists have not 
 been as barren of results as is usually affirmed by the opponents of 
 malaria, and that the azotized matter obtained during the prevalence 
 of fever may very reasonably be supposed to have some agency in 
 the production of the latter. 
 
 1 Charleston Mcd. J. v. 24-6. 
 
 2 Putrefaction des Substances Animales, quoted by Julia, 122. 
 
124 PNEUMONIA AND 
 
 Chemists not more successful in discovering other morbid poisons in 
 the atmosphere. But let us admit that chemists have failed, in all 
 places, and under all circumstances, to detect in the atmosphere of 
 insalubrious localities something tangible to which the causation of 
 fever may j ustly be ascribed ; let us also admit, for the sake of argu 
 ment, that there exists no connection, as cause and effect, between 
 the azotized and putrid flakes above referred to, and the diseases in 
 question, and that we are as far off now as our forefathers were 
 centuries ago, from the possibility of demonstrating, in a satisfactory 
 manner, the nature of the malarial poison, and to prove its inde 
 pendent existence; it is doubtful, as every attentive reader will 
 perceive, whether the opponents of the malarial origin of autumnal 
 fevers can derive from that acknowledgment an overwhelming and 
 convincing argument in favour of their views. He must at once see, 
 that if we deny the existence of febrile miasmata on the ground 
 that no one has as yet satisfactorily succeeded in detecting them 
 in the atmosphere, we shall be called upon to make, for the same 
 reason, and for the sake of consistency, other denials, for which, I 
 presume, few physicians, whatever be their opinions on the subject 
 before us, can be prepared. Let us not forget that no one has as 
 yet been able to detect the poison of other zymotic diseases small 
 pox, scarlatina, measles, influenza, hooping-cough, typhus, Asiatic 
 cholera, plague, &c., contagious or otherwise and yet we know that 
 they must at times float in the air, since they produce their respect 
 ive morbid effects in individuals who breathe that tainted medium; 
 and under circumstances, too, which forbid the supposition that 
 those attacked could have received the infection by direct exposure 
 to, or contact with, the sick. Liebig, with all the facilities afforded 
 by the appliances of the Giessen laboratory, and all the uncommon 
 dexterity and analyzing powers he is known to possess, tried the 
 experiment, but failed. The aroma of flowers, and other odorous 
 substances, betray their presence in the atmosphere, through their 
 effects on the olfactory nerves ; and yet, Cavendish and other able 
 operators found no difference between pure air and that in contact 
 with such substances ; and were it not for he effects in question, and 
 sometimes for the impression they produce on the nervous system 
 at large, they would remain undiscovered. We are told by Lind, 
 that turners, in working the wood of the rnanchineel tree, would 
 be severely affected, did they not securely guard against breathing 
 its poison. A field of poppies has been known to induce a sleepy 
 
AUTUMNAL FEVERS. 125 
 
 disposition in the bystanders. Van Swieten, in the early part of 
 his life, suffered repeatedly a temporary loss of memory from the 
 vicinity of a plant to him. 1 The air collected in the wards of the 
 hospitals of Milan, Paris, Barcelona, and other places, in dissecting- 
 rooms, in knackeries, in cemeteries, in the galleries of a crowded 
 theatre, from cesspools, culverts, stables, or collections of putrid 
 meat, must naturally be supposed to be impure ; nevertheless, as 
 seen, it does not differ from the common atmosphere in any mate 
 rial point. In some of these instances, a little ammonia or carbonic 
 acid may be found ; but the result is not constant, and is, besides, 
 of no importance, 2 for the deleterious properties of infection con 
 tinue unimpaired after these substances have been removed. Nor 
 can chemists discover any difference between the pure air of the 
 loftiest mountain ranges, and the air through which a dog can tell 
 that a horse, a fox, or a man has passed. 3 Experiments have made 
 it clear that some morbific vapours may be diffused in the atmo 
 sphere in such attenuated proportions as not to be detected by the 
 smell or by chemical analysis, and yet occasion baneful and even 
 deadly effects, not only on some of the lower order of animals, but 
 also on the more elevated in the zoological scale. 
 
 In addition, it may be remarked that medicines, even purgatives, 
 are sometimes found to act through the medium of the air, in which 
 they cannot, on analysis, be detected. In all these instances, the 
 substances in question, though defying the scrutinizing efforts of 
 the experimental chemist, are well known to exist in the atmo 
 sphere ; some by their peculiar odour, others by having been placed 
 there purposely, and most of them by their effects on the economy ; 
 and, surely, if such is the case in regard to those substances, there 
 can be no reason to refuse admitting others possessing toxicolo- 
 gical properties the same privilege of concealment, and to deny 
 their presence on the score of their not being detected on chemical 
 analysis, seeing, as we do, that effects, palpable enough in all con 
 science, follow closely on exposure to an atmosphere which many 
 circumstances lead us to regard as being contaminated. From 
 analogy, therefore, we may conclude, that though escaping, in con 
 sequence of their inodorousness, and the inefficiency of our means 
 of analysis, the notice of casual observers, and no less the researches 
 
 1 Means of Preserving the Health of Seamen, 24-5, note. 
 
 2 Guyton Morveau, Ann. de Chimie, xxxix. 84. 
 
 3 Barton, Report to the State Medical Society of the State of Louisiana, 26. 
 
126 PNEUMONIA AND 
 
 of the chemist; malarial effluvia may, nevertheless, float in the 
 atmosphere, in sufficient amount and in a sufficient state of con 
 centration to manifest their presence by occasioning their specific 
 morbid effects febrile diseases in individuals exposed to the in 
 fluence of the atmosphere which they serve to contaminate. 
 
 To those who adduce such an objection, it may be remarked that 
 no one will venture to doubt or deny the existence, in the matter 
 obtained from a variolous or vaccine pustule, or in the pus of a 
 chancre, or in any other animal poison, of a particular virus capa 
 ble of infecting the system, and reproducing in it a specific disease 
 similar to that whence that virus proceeds. The variolous matter 
 produces smallpox, the vaccine matter occasions cowpox, the pus 
 of chancre gives rise to syphilis, c. Well, let them inquire how 
 far chemistry has gone in the way of discovering the nature of 
 these particular poisons, and the particular element through which 
 they derive their toxicoj.ogical powers, and they will find little 
 calculated to satisfy their curiosity. On this subject the science, 
 so far, has not effected much more than it has in regard to the 
 atmosphere of malarial localities. The analysis of the pustules of 
 mild and simple smallpox, gives only fibrine, mucus, hydrochlorate 
 of soda, sulphate of potassa, phosphate of lime, and water. That of 
 pus furnished by smallpox complicated with petechial eruptions, 
 gives the following materials: Fibrine, mucus, hydrochlorate of 
 soda, hydrocyanuret of soda, sulphate of potassa, phosphate of lime, 
 and water. 1 
 
 Not one of these materials can by itself produce smallpox, how 
 ever introduced into the system. Combine them together artifi 
 cially, in whatever proportion you please, and you will not be likely 
 to occasion the effect. And yet they are the only materials found 
 by the chemist; while the particular something which imparts an in 
 dividuality to the poison, and constitutes it a specific agent, has 
 fled. \Vill any one deny, on that account, its presence during the 
 analysis? The same may be said in relation to vaccine, the pre 
 dominating elements of which consist in water and albumen ; though, 
 on more minute examination, it is found to contain a matter similar 
 to osmazome, chlorate of sodium, chlorate of potassa, and phosphate 
 of lime. Here, again, the peculiar something has vanished. 2 Similar 
 
 1 Journal de Cliimic Medicale, 1828, iv. 488; Anglada, Tr. de la Contagion, i. 205. 
 
 2 L lleriticr, Traite dc Cliiraic Pathologique, 612; Anglada, i. 204. 
 
AUTUMNAL FEVERS. 127 
 
 remarks are applicable to the virus of chancre, of gonorrhoea, of 
 hydrophobia, of glanders, as also to the extensive class of vege 
 table poisons, all of which, when chemically analyzed, furnish, in 
 various combinations and in various proportions the first the ordi 
 nary constituent elements of animal, the other those of vegetable 
 substances but in no instance present us with the peculiar ingre 
 dient which imparts to each of those products its specific poisonous 
 property. 
 
 Again, it has been said that the blood of individuals affected with 
 measles communicates the disease, when inserted into incisions 
 made in the skin, and kept there by mieans of cotton. I say, it has 
 been said ; for though the experiments which Dr. Francis Home, of 
 Edinburgh, instituted on the subject, about the middle of the last 
 century, and those of Speranza, during the epidemic of Milan, in 
 1822, would seem to justify the conclusion, and though the high 
 authority of Stoll may be adduced in its favour, 1 the success of this 
 inoculation is yet open to doubt. But, admitting it to be true, and 
 admitting, also, what can scarcely be denied, that in measles, as well 
 as in the whole tribe of zymotic diseases, the blood is the vehicle of 
 the poison, in some form or other, it is a well-ascertained fact that, 
 in the present state of the science, chemistry is powerless in its en 
 deavours to discover in that fluid any anomalous element, in the 
 least indicative of the presence there of the toxicological agent to 
 which the disease is due. 2 Examine also the blood of individuals 
 labouring under scarlatina, smallpox, vaccine, typhus, typhoid, 
 cholera, or other disorders in which a peculiar poison has been at 
 work, and the fluid has been morbidly affected, and you will be 
 sure to fail to discover in it traces of the presence of that poison, 
 of whose existence, nevertheless, there can be no doubt. In such 
 blood the quantity of water, fibrine, corpuscles or residue of the 
 serum may vary more or less from that contained in the healthy 
 fluid. The solidity of the clot may differ, 3 but in no instance can 
 we detect the specific materies rnorli. 
 
 It is not a little surprising, if not amusing, to find that while, 
 by ignoring the presence in the atmosphere of a particular matter 
 which, by its poisonous property, is supposed to give rise to fever, 
 
 1 Aphorism 583, p. 202. 
 
 2 See the experiments of Andral and Gavnrret, and of Becquerel and Rodier: see 
 also Bouchat, Maladies Contagieuses, Gaz. Mod. 18-18; Simon, i. 300. 
 
 3 Simon, i. 288, 298, 325. 
 
128 PNEUMONIA AND 
 
 and to which the name of malaria has been applied; in other words, 
 while, by denying a separate existence to febrile effluvia, on the 
 ground that chemistry has not succeeded in detecting them, the 
 disbelievers in that poison seem anxious to vindicate the character 
 of the science for infallibility, or at least to uphold the idea that 
 it has reached, on the subject in question, its culminating point, and 
 that its not having succeeded in attaining the object in view, indi 
 cates positively the impossibility of this ever being effected, profes 
 sional chemists of the highest eminence, so far from carrying their 
 pretensions that high, acknowledge the deficiency of their present 
 means, admit that their science is yet in its infancy, and do not 
 hesitate to say that the want of success in the detection of malarial 
 emanations is not to be taken as an evidence of the non-existence 
 of these. The celebrated author of the Statique Chimique, Bertholet, 
 somewhere says: "Besides its constituent parts, the atmospheric air 
 may contain in solution different substances, which assume in it 
 the elastic form, and of which some are principles of odours ; but so 
 far these emanations have eluded chemical means, which can destroy 
 some, but not detect them." 1 Similar admissions are made by Eas- 
 pail, 2 Muldor, Van Gaens, 3 and others ; but by none more clearly 
 than Sir H. Davy, who, while expressing the conviction that, by the 
 progress of chemistry and physiology, success will ultimately be 
 obtained on this point, says : " That a specific matter of contagion 
 has not been detected by chemical means in the atmosphere of 
 marshes, does not prove its non-existence. We know so little of 
 those agents that affect the human constitution, that it is of no use 
 to reason on the subject." 4 
 
 Nature and condition of fever localities lead to the opinion of the 
 existence of malaria. The opinion which ascribes autumnal fevers to 
 the contamination of the atmosphere by poisonous effluvia, receives 
 not a little support from their very frequent association with pecu 
 liar characters and conditions of the localities where they are noticed, 
 and from their absence or cessation where those characters and con 
 ditions are wanting, or have been removed by artificial or other 
 means. Whenever we encounter such localities characterized by 
 a geological formation of tertiary and cretaceous secondary deposit 
 
 i Vol. i. 2 Hist. Nat. de la Santo et cle la Maladie, i. 40. 
 
 3 Quoted by Harrison, New Orleans Journal, ii. 582. 
 
 4 Consolation in Travel, Works, ix. 582. 
 
AUTUMNAL FEVERS. 129 
 
 with argillaceous and rich alluvial soil more or less impervious 
 to water ; or where, whatever be the appearance of the soil, water 
 is found at a very short distance from the surface ; or where the 
 latter is dotted with marshy fields, and traversed "by sluggish 
 streams ; or by swampy, low, flat level land, as along the banks of 
 lakes and winding streams; or by level plains, ravines, or deep 
 valleys, either dried or drying on the surface, after having been 
 thoroughly wet, and perchance encased between mountain eleva 
 tions, covered, as in India, with, jungles; or, in the West Indies, with 
 impenetrable mangroves or thick forests, and containing a large 
 amount of organic remains there we may be very certain to meet 
 with fever. "It is a safe generalization to affirm," says Dr. Drake (p. 
 709), " that, all other circumstances being equal, autumnal fever pre 
 vails most where the amount of organic matter is greatest, and least 
 where it is least. In localities thus characterized, I repeat, we may 
 almost certainly count on meeting with malarial fever in some one 
 or other of its varied forms, after a certain continuance of high 
 atmospheric heat. In others, differently circumstanced, we may 
 safely anticipate an exemption from that disease. 1 The salt marshes 
 of Normandy about Doll, for example; the soil along the Medi 
 terranean coast of France ; the shores of the Adriatic, of Greece, 
 and of Sicily; those of Sardinia, of Spain, of Crimea; the lagunes 
 of Holland, from the Walcheren to Groningen; the soil of Flanders; 
 the Pontine marshes of the Pontifical States, and the campagna in 
 the vicinity of Kome; the maremme of Tuscany, Lucca, and the 
 Mantuan; the soil of the Bresse, of Sologne, of Dombes, of the 
 vicinity of Camargue, Aigues Mortes, Marenne, Brouage, Eoche- 
 fort, and other parts of France ; the coasts of Batavia and Mada 
 gascar; the alluvial districts of the western and eastern coasts of 
 Africa ; those of Algiers, and of India ; a large portion of the United 
 States, from the Delaware to the Mississippi on the Atlantic coast ; 
 along the margins of the lakes, the Mississippi Eiver, and other 
 western streams; a large surface in South America and in the West 
 
 1 What is termed peat boo:, or peat moss, is said not to be productive of malaria. 
 Many parts of Scotland and Ireland, that are occupied by large tracts of marsh, in 
 which peat moss abounds, are completely free from these fevers. The disease is never 
 seen among the inhabitants near the country of the Dismal Swamp, on the frontier of 
 Virginia and North Carolina. In them, the vegetable matter is subcarbonized, and 
 hence insusceptible of decomposition. It is known to possess peculiar antiseptic 
 qualities, which not only preserve trees and other vegetable, but animal substances, 
 from putrefaction. See Acton s Treatise on Moss Earth. 
 
 9 
 
130 PNEUMONIA AND 
 
 India Islands; along the sea-coast, or the borders of tropical streams 
 or lakes ; the river banks and low flat surfaces of Hungary ; the 
 morasses of Upland, the plains of Scanea, Sudermania, and Gothia; 
 all these localities, and many more that might, if necessary, be men 
 tioned, and which are or should be familiar to every one who has 
 made paludal or autumnal fever the subject of inquiry, are in 
 point. They all present some one or more of the characteristics 
 pointed out, and are all, at particular seasons of the year, and under 
 certain atmospheric conditions, the seat of febrile affections; while 
 other places, sometimes at no great distance, but of a different 
 geological formation less swampy or less rich in organic materials, 
 and possessing a different soil are, though similarly circumstanced 
 in other particulars, free from the disease. All these facts serve to 
 illustrate the almost constant connection existing, as cause and 
 effect, between the kind of locality to which I have referred and 
 the disease in question. 
 
 Nor is it less certain Chat the yellow fever proper is traced almost 
 invariably to city districts noted for filth and imperfect ventilation ; 
 to the vicinity of ships, docks, or wharves; to narrow and confined 
 courts and alleys not far from these; to collections of substances, 
 animal and vegetable, in a state of decomposition, &c. Instances to 
 that effect have been too frequently observed, and are too well 
 authenticated to be denied ; while the connection between the 
 existence of places of the particular kind mentioned, and the ap 
 pearance of that form of fever, is too constantly found to prevail, 
 to be considered simply in the light of a coincidence. 
 
 The danger of an attack of fever increased in proportion to proximity 
 to such localities. If we approach to, or remain some length of 
 time occasionally only a few hours or moments in those locali 
 ties, or in their immediate vicinity, we are stricken down with 
 fever; if we avoid them, we escape. The South Carolinian gives 
 up his plantation residence in summer, and removes to Charleston 
 or to the mountains, where he is safe from the country fever. Let 
 him visit his estate before the advent of frost, and especially let 
 him sleep there, and he runs great risk of an attack. In yellow 
 fever seasons, strangers must leave or abstain from entering the 
 city; if they venture into it, they will in all probability have the 
 disease. With us, in Philadelphia as with the residents of other 
 cities of the Middle and neighbouring States, and of some parts of 
 
AUTUMNAL FEVERS. 131 
 
 Europe where infected districts are of limited extent, the disease 
 is restricted to individuals who venture within the bounds of these. 
 At a very few paces from the sickly spot to which they penetrated, 
 and where they doubtless imbibed the seeds of the fever, people 
 move about, business is transacted with perfect impunity, and 
 everything often looks precisely as if the city were not the seat of 
 an epidemic. By avoiding our river banks, or our meadow or 
 marshy land, by remaining within the limits of the city, or select 
 ing high and dry situations in the country, Philadelphians, like 
 Charlestonians, keep free from chills and fever, or remittents; by 
 adopting a different course, they expose themselves to an attack. 
 On the coast of the West Indies, and of Africa, as well, indeed, 
 as in this country and Europe, vessels remain healthy so long as 
 they keep at a distance from land. 1 But woe to them if, during the 
 sickly season, they approach the shore, or enter the river streams. 
 The moment they do that they become liable to the disease. Lind, 
 in his work on preserving the health of selimen, states that when 
 Commodore Long s squadron, in the months of July and August, 
 1744, lay off the mouth of the Tiber, it was observed that one or 
 two of the ships which lay nearest the shore began to be affected 
 by the pernicious vapour from the land; whilst some others, tying 
 farther out at sea, at but a very small distance from the former, had 
 not a man sick at the same time. (P. 67.) While in the autumn of 
 1852, many British steamers and vessels of war had the yellow 
 fever for going into port at St. Thomas. "Another of her ma 
 jesty s ships, the Devastation, was at St. Thomas, but did not come 
 into the harbour, keeping, however, only about a mile off the town, 
 and remained intact. 2 
 
 " I have known." Sir Gr. Blane remarks, " a hundred yards in a 
 road make a difference in the health of a ship at anchor, by her be 
 ing under the lea of marshes in one situation and not in the other." 3 
 
 1 Lind. on Hot Climates, 138-178-9; Ibid, on Seamen, 78; Trotter, i. 456; Eouppe, 
 65 English translation, 09; Rush, iii. 83; Bancroft, 171; Ib. Sequel, 166; Clark on 
 Long Voyages, i. 124; Moseley. 57; IT. McLean, 26; Ferguson s Recollections, 151; 
 Gillespie, 20; Fontana, 12; Bally, 455; Pringie, 57, 98; Chervin s Letter to Dr. 
 Monfalcon, 12; Burnett, 264-274; Calchvell s Prize Diss. 139; Caldwell s Essay on 
 Mai. in Boston Journ. 510; Williams s Morbid Poisons, ii. 446; Smith, Edinburgh 
 Journ. xxxv. 49; Amiel, Edinburgh Journ. xxxv. 264; Johnson, Charleston Journ. 
 iv. 160. 
 
 2 Wibleri and Harvey on Yellow Fever, Lancet, April, 1853, Am. ed. 322. 
 
 3 Diseases of Seamen, 228. 
 
132 PNEUMONIA AND 
 
 It is stated by masters of ships that during the prevalence of the 
 late fever epidemic in Brazil, though they came direct from Europe, 
 and held communication with no vessel of any kind on their pas 
 sage, the disease made its appearance on board their ships as soon 
 as they approached the coast, and came within the influence of the 
 land breeze. Dr. Gavin states that when the yellow fever broke 
 out in Georgetown, Demarara, at the end of 1851, some seamen 
 arriving from Europe were attacked with the disease on Hearing the 
 coast and getting into the muddy water, some days before their 
 arrival in harbour. 1 
 
 Lind states, in his well-known work on Hot Climates, that "many 
 persons escaped the yellow fever which prevailed in Pensacola, in 
 1765, by retiring to the ships^ which lay in the harbour." (179.) In 
 another place the author remarks: "When the violent and fatal 
 sickness raged at Cadiz, in 1764, it did not extend its influence to 
 any ship which lay at a distance from the city." His majesty s 
 ship, the Tweed, which was then at anchor in Cadiz Bay, like others, 
 escaped. All the sick that were sent on board recovered, no bad 
 symptoms appearing in their fever, " while a disease similar to the 
 black vomit and the yellow fever, and equally mortal, depopulated 
 that large city." (Ib. 178.) Commodore Mitchell s fleet, which 
 anchored in the year 1747, between South Bevel and and Walche- 
 ren, were perfectly healthy, while the soldiers, on shore, at the same 
 time, and at no great distance, were sorely afflicted with fever." 2 
 
 Dr. Rush says, of the epidemic of 1793: "I heard of some sea 
 faring people who lived on board their vessels, who escaped the 
 disease." 3 Dr. Caldwell remarks "that marsh malaria cannot reach 
 the crew of a ship lying at anchor but a cable length from the 
 shore, where it is generated:" and adds: "Similar facts may be col 
 lected from the history of yellow fever in our own country. During 
 the prevalence of that disease in Philadelphia, many individuals, 
 and several whole families, are known to have retreated to vessels 
 lying not more than from two hundred to two hundred and fifty 
 yards from the wharves, and to have remained healthv. In New 
 York and Baltimore like instances have occurred." 1 
 
 Who is unacquainted with the fact, noticed in diverse latitudes, 
 
 1 Second Report on Quarantine, pp. 14, 1-3; London, 1852. 
 
 2 Priugle, llouppe, and Lind. 3 (>p. cit. 
 4 Prize Dissertation, Boston Journ. iii. p. -310. 
 
AUTUMNAL FEVERS. 133 
 
 that wliile, in vessels at a short distance from infected localities, 
 those who remain on board are exempted from fever, the boat 
 crews, who, from the nature of their duties, are obliged to ex 
 plore the river banks, those who land on business or for recreation, 
 are, especially if they sleep on shore, sooner or later attacked. 1 
 
 On the other hand, vessels that are infected in such localities lose 
 the fever (if they themselves do not contain sources of infection) by 
 shifting their position, and anchoring at a distance sometimes at a 
 very short one from the shore; or by going to sea, and thereby 
 placing themselves beyond the influence of the land air. The 
 morbific agency (in Georgetown, Demerara) seemed to move in 
 shifting swarms or vortices, hovering over a vessel here and there. 
 "Thus, in the beginning of 1839, the .Thomas King lay in the divi 
 sion A, between Kingston and Wighari s Stellings. In one week 
 she lost four hands. She unmoored, and took her station outside, 
 or to the leeward of the Louisa Baillie; the mortality ceased, and 
 the health of the crew became re-established. The Louisa Baillie. 
 that had been right abreast, and sheltered by the Thomas King be 
 fore the unmooring, and had no deatlt, although several cases of 
 fever, which readily yielded to treatment, became soon very sickly: 
 she lost four men, after which she shifted her moorings, and the 
 mortality then ceased in her also. 2 These effects have been observed 
 on frequent occasions in Europe, in the West Indies, on the coast 
 of Africa, as well as on our western lakes. 3 
 
 I am informed by Mr. Martin, surgeon of the Cananeuch, a Gui 
 nea trader (Dr. Lincl states) that when he was in Gambia River, in 
 company with four other ships, the men in one of those ships were 
 daily taken ill of fevers and fluxes, and several of them delirious ; 
 while all the English in the other ships and in the factories were in 
 
 1 Eadenock, Med. Ohs. and Inq. iv. 157-8; Trotter, Med. Naut. ii. 80; Bally, Ty 
 phus d Am. 455 ; Clark on Long Voy. i. 38-40 ; Boyle, 75 ; Rouppe, pp. 05, 75 ; Gil- 
 lespie, 20; J. Hunter, 17; Valentin, 77; Galliot, 200; Bancroft, 172; Ibid. Sequel, 
 106; J. Wilson, GO; Fontana, 12; Blanc on Seamen, 92, 892; Lind. 100, 108, 184, 
 102, 195; Lind. on Seamen, 78, 77-8; J. Johnson, 03-5, 127, 134; J. Wilson, Stat. 
 of Brit. W. I. Squadron, 85; Bryson, 151, &c. &c. ; Burnett, 188-225, 208; Smith, 
 Edinburgh Journ. xxxv. 18, 47, 50 ; Alien. Edinburgh Monthly Journ. Aug. 1847 ; Bry 
 son, Stat, Hep. on the Health of the (Brit.) Navy, 215, 220, 230. 
 
 2 Blair, 80. 
 
 3 Lind. 200; Ibid, on Seamen, 85; Ferguson s Becol. 143; Trotter, i. 358; Hunter, 
 10; Keruudren, 18; H. McLean, 20; Eufz. Report, by Cherviu, CO; Usher Parsons s 
 Dissertations, 203; Cooke, Med. Recorder, vii. 451. 
 
134 PNEUMONIA AND 
 
 perfect health ; but upon removing that ship about half a league 
 from her first anchorage, which was too near some swamps, her men 
 became as healthy as those in the other ships. 1 
 
 Sir G. Blanc remarks : " When ships watered at Rockfort (Ja 
 maica), they found that if they anchored close to the shore, so as 
 to smell the land air, the health of the men was affected ; but upon 
 removing two cables length no inconvenience was perceived." 2 
 
 These effects are not due to heat alone. Now, how is all this to 
 be accounted for ? Notwithstanding all that has been said to the 
 contrary by Towne, 3 Poissonniere, 4 Madrid, 5 llosack, 6 Tommasini, 7 
 Faure, 8 Yatable, 9 Girardin, 10 Bertaud, 11 Bourdon, 12 Dickinson, 13 and 
 many others, we may safely affirm that excessive, great, or long- 
 continued heat, will certainty not do so. Unaided by a more effi 
 cient morbific agent it has in no instance been found to occasion a 
 remittent, an intermittent, a yellow or a pestilential fever. It is 
 a well-ascertained fact that in many localities where the heat is 
 intense, fever is seldom if at all observed, while it prevails more 
 or less extensively in places where the temperature is considerably 
 lower. The summer heat of the southern portion of the great 
 desert is very great ; but, as Dr. Drake remarks, those who traverse 
 it, and keep at a distance from its watercourses, pass the season 
 unaffected. The same writer calls attention to the fact that the 
 sandy banks of Pensacola Bay, from its entrance up to the town of 
 Pensacola, suffer but little; while at the head of the bay, where 
 extensive alluvial deposits have been made, the fever has been so 
 constant and fatal as to prevent permanent settlement. Yet the 
 temperature of both localities is the same, for they are but ten miles 
 apart. In some localities, as the Antilles generally, fevers are said 
 
 I Liml on Hot Climates, 180. 2 Diseases of Seamen, 178. 
 
 5 A Treatise on the Diseases most frequent in the West Indies; and herein more 
 particularly of those which occurred in Barbadoes. Loud. 17-0, 11. 
 
 4 Traitc des Ficvres de St. Domiugue. Paris, 1780, oO. 
 
 5 Ensayo Analitico Sobrc la Naturaliza, Causas y Cnracion de las Culentnras, &c. 
 ILtbana, 1*21, pt. ii. 1. 6 Practice of Medicine, 300. 
 
 7 Sulla Febbre di Livorno, 1804; Sulla Febbre Ci.illa Americana, \ 84, i. 108. 
 
 8 Fievres Intermittentcs et Continues, &c. 43, 44. 
 
 9 Ann. Maritimes, 1S*2S, 830. 10 K.ssai sur la F. J. 44. 
 
 II Dissertation sur les Maladies quo les Medecins de St. Dominguc out appelte 
 Pierre Jaime, 7. 
 
 12 Considerations sur la Prophylactique de la Firvre Jaime. 7. 
 
 13 Observations on the Inflam. Endemic, &c. or Yellow Fever, 84, &c. 
 
AUTUMNAL FEVEES. 135 
 
 to be now more rife than they were formerly, though the tempera 
 ture was not lower then than it is at the present day. The savan 
 nahs or natural prairies of French Guiana, the arid deserts of Peru, 
 and a large portion of Spanish Guiana, furnish us with examples of 
 the sort. 1 Thermo metrical observations made in the plains of Meta, 
 situate on the east side of the oriental Cordilleras and in the valley 
 of the Magnaline on the west of the same ridge, exhibit great simi 
 larity of temperature, yet the former is remarkable for insalubrity, 
 while the latter is free from fever. 2 
 
 The range of the thermometer in Antigua and Barbadoes, is 
 rather higher than in Dominica, Tobago, Jamaica, or the Bahamas: 
 yet we find that the troops in the latter stations suffer nearly three 
 times as much as those in the former. 3 The yellow fever does not 
 prevail on Pigeon Island, but is of common occurrence in the town 
 of Castries, 4 though the temperature is much the same in both 
 places. While common in some parts jjf the coast of Africa, the 
 same disease is rare in Senegal. 5 It is rare also in Cayenne, which 
 is, to say the least, as hot as any place within the tropics. 6 Panuco, 
 and the plains of Coro and Cumana, and the coast of Coromandel 
 and of Onixa, cited by Humboldt, 7 as well as the coast of Malabar, 
 the deserts of Arabia, and of the Diabakie 8 are rarely the seat of 
 malarial fevers, especially of those of a malignant character. The 
 same may be said of Lima, Brazil, Peru, 9 the savannas or natural 
 prairies of French and a large portion of Spanish Guiana, 10 where, in 
 spite of excessive and long-continued heat, this fever does not exist. 
 
 The prevalence of and mortality from fever have also been found 
 in the same place far greater in some seasons than in others the 
 temperature remaining nearly the same; 11 and it has originated and 
 prevailed in some situations as well in the West Indies, in Africa, 
 in Europe, as in this country nearly as often when the range of 
 the thermometer was at the minimum of tropical heat as at the 
 maximum. 12 
 
 1 Leblond, 6, 02-4-5. 
 
 2 Boussingault, Annnles do Cliimic, Ivii. 153. 
 
 3 Report on Mortality in British Army, 101. 
 
 4 Pugnet, 342. 5 Tbevenot, 244. 
 6 Bajon Mem. sur Cayenne, 29, 59. 7 Volume i. 02. 
 
 8 Bonneau et Sulpici, llecberches sur la Cont. de la F. J. 10. 
 
 9 Vicaire, Annales Maritimes, Oct. 1831, 298-9. I0 Leblond, 0, 02-4-5. 
 
 11 Sickness, &c., in British Army, 5, 101 ; Craigie s Practice, i. 224-0. 
 
 12 Report of Sickness of British Army, 20 ; Cartwright s Recorder, ix. 220 ; Blair, 52. 
 
136 PNEUMONIA AND 
 
 This want of necessary connection, as cause and effect, between 
 high atmospherical heat and fever common autumnal and yellow 
 has been pointed out by a large number of writers on these 
 diseases as they show themselves in various parts of the globe. 1 
 
 Again, heat is greater in cities than in the surrounding country, 
 and yet malarial fevers are more frequently encountered in the 
 latter than in the former. And if the cause of yellow fever is more 
 frequently evolved in cities, it is because it requires a higher de 
 gree of temperature. But even this will not serve to disprove my 
 position ; for, during the existence of the disease, many localities in 
 the close vicinity of, and just as hot as, the part infected, remain 
 healthy. Indeed, in insalubrious regions fevers are more particu 
 larly rife, not during the hottest months of the season, but some time 
 after, when the average temperature has lowered in a notable degree. 
 Such has been found to be the case in Gibraltar, 2 in France, 3 in this 
 city, 4 in Charleston, 5 Barcelona, 6 the West Indies, 7 Algeria, 8 &c. 
 It may be mentioned, also, that fevers often cease long before the 
 cessation of hot weather when, indeed, the temperature has reached 
 its highest point. We know that such is the case in relation to the 
 Egyptian plague, and that it has occurred also at Dantzic, Toulon, 
 and Stockholm. 9 "There broke out a plague in Venice." says 
 Matth. Yillani, an eye-witness (Lib. i. Historiar.), "in the year 
 1348, in the month of March. It was at its height in April and 
 May. It began to decline in July, and ended in August ; so that a 
 plague will end in hot weather." 10 The occurrence has been noted 
 in reference to the yellow fever; and in South America, this coun- 
 
 1 Copland, iii. 151; Bryson, 197; Dazille, Mnlad. des Negres, 8, &c. ; Ibid, des 
 Pays Chauds, 4; J. Wilson, 00-7; Boyle, Ed. J. viii. 173; Warren, 8 ; Dariste, 32; 
 Osgood, 18; Good, ii. 108; Chisholm, ii. 2(54; Dalrnas, 38; Bully, 327; Gillkrest, 279; 
 Musgrave, Med. Ch. Tr. ix. 121; Imray, Ed. J. liii. 92; Chalmers,!. 22; Lining:, 
 ii. 407; Townsend, 377; Hosack, ii. 29; Chervin, translation of Wilson on Fever of 
 Gibraltar, 9; Sir J. Fellowes, 417; Hunter, 13; Ferguson, Med. Ch. Tr. viii. 142; 
 Evans, 45; Davy, Notes to Blair, 52; Drake, 712-3. 
 
 2 Report of Sickness in Mediterranean Station, 65. 
 
 3 Ncpplc, Fievre Interin. 135. 
 
 4 Emlen, N. A. Journ. v. 328 ; Carey, 7. 
 
 5 Lining, op. cit. ii. 410. 6 Rochoux, 110; Pariset. 475. 
 
 7 Williamson, Med. and Misccl. Obs. on West Indies, i. 210, 211; Pinckard, Notes 
 on the West Indies, ii. 485; 11. Jackson, Sketches, 9, 10, 11. 
 
 8 Jacquot, DCS F. a Quinquina, 19; Haspel, Maladies do 1 Algeria, i. 07. 
 
 9 A Treatise on the Plague and Pestilential Fever, 10, 11. Lond. 1751. 
 
 10 Ibid. 
 
AUTUMNAL FEVERS. 137 
 
 try, Europe, and elsewhere, the same observation has been made, so 
 far as regards ordinary fevers. 1 To this it may be added that, in 
 localities where fevers have been driven away through the opera 
 tion of judicious hygienic measures, the effect was not attended 
 with a diminution of atmospheric temperature; that some forms of 
 autumnal periodic fevers are restricted to very circumscribed locali 
 ties, where the heat is no greater than in the immediate vicinity; and 
 that when it breaks out in a ship and spares others close by, or 
 when it ceases in a vessel on the latter s shifting its position, we 
 cannot presume that a difference of temperature can have had any 
 thing to do with the difference of the results observed. 
 
 The following statements, derived from a report recently pub 
 lished by Mr. Lorin Blodget, who has charge of the meteorological 
 department of the Smithsonian Institution at Washington, may be 
 appropriately placed here. 2 
 
 Few summers in this country have been characterized by greater 
 heat than the one we have just passed through. The excess has 
 prevailed from New Hampshire to Savannah in Georgia. The first 
 general high temperatures of the season occurred on the 3d to the 
 5th of June, extending from Montreal to Florida, but sparing the 
 west generally. At the south, its maximum, from Chapel Hill, N. 
 C., to Savannah, Ga., was 92; and at the north, from Montreal to 
 New York, 83. From the 14th to the 18th, the heat was excessive 
 and general. It commenced at the extreme west on the 12th and 
 13th, and did not extend beyond Camclen, S. C. It rose from 90 
 to 94 in Ohio, Kentucky, and westward in the same latitudes. 
 From the 20th to the 23d, there was another general excess of tem 
 perature less than the preceding in the extreme north, and with a 
 considerable fall there on the 22d ; but quite unusual and long-con 
 tinued at almost every other part of the country. The maxima 
 varied from the 20th to the 23d, and ranged from 90 to 97. The 
 maximum of 95, was probably general from New York to Savan 
 nah on the 23d. Lastly, a most extraordinary extreme of heat 
 occurred on the 29th and 30th. The extreme was central in the 
 
 1 Leblond, 184; Puguet, 342; Rush, iv. 155; Deveze, 117; Emlen, loc. clt. 329; 
 Chisholm, i. 294 ; Xott, Charleston Journ. iii. 5 ; Fenncr, N. 0. Journ. v. 203 ; Cald- 
 well, Repos. vii. 149, 153; Palloni, 33. 
 
 2 On the Climatic Conditions of the Summer of 1853, most directly affecting its 
 sanatory character. New York Journal of Mcd, Nov. 1853, p. 813, &c. 
 
138 PNEUMONIA AND 
 
 latitude of Washington, and was limited at Savannah, on the south, 
 and Burlington, Vt, on the north. It attained 96 to 98 in Ten 
 nessee, Kentucky, and southern Ohio, and 77.5 to 102 at Wash 
 ington, and eastern Virginia, and North Carolina. This is without 
 any parallel in the records of temperature at Washington, and is 
 several degrees above any recorded temperature at New Orleans, 
 Mobile, and Savannah. 
 
 The temperature of July was also high, and slightly above the 
 normal mean in most parts of the United States. The excessive 
 heat of the last days of June was prolonged through the 1st and 2d 
 of July at 94: in Virginia, at the south, and the range was generally 
 high in this city and south, where it was again at 92 to 84. The 
 temperature was at or above 90 after the middle of the month only 
 in the central part of Georgia and Alabama, and west in the lati 
 tude of Washington to Texas, for two or three days about the 20th, 
 and again about the close of the month. 
 
 t^j 
 
 In August, a period of general excessive heat occurred, begin 
 ning, as usual, at the west, and reaching 90 in several places on 
 the 7th and 8th. The maxima in Illinois and the adjacent States 
 were 70 to 90 from the 8th to the 13th; in Ohio and Kentucky, 
 nearly the same ; and passing eastward a little later through Penn 
 sylvania, the district of greatest excess was central at New York, 
 from the 12th to the 14th. The temperature at one place south 
 reached 90. Later in the month, from the 25th to the 31st, the 
 heat was unusually great in the south-west, Texas, the Cherokee 
 Territory, and Mississippi, with an extraordinary reverse in Iowa 
 and the adjoining States. 
 
 Indeed, the summer of 1853 has been remarkable for its climatic 
 conditions, and the extreme of temperature was much more strik 
 ing than usual. Yet, though epidemics of yellow fever, which re 
 quire a continuance of high temperature, prevailed in more places 
 than has been the case in this country for the last thirty years, 
 many other places that have suffered from the disease on former 
 occasions, as Savannah, Baltimore, and New York, for example, 
 and where the temperature was unusually high, and even exceeded 
 that of Philadelphia, escaped. 
 
 In the latter city, too, though the mean temperature of the three 
 summer months was 76.76, or nearly four above the common 
 average, such a heat could not be considered as alone the cause of 
 the disease from which we suffered; for it has been exceeded, ac- 
 
AUTUMXAL FEVERS. 69 
 
 cording to the records of the last sixty -four years, on two occasions 
 in 1798, when the fever prevailed, and in 1838, when the city 
 was entirely free from it. It must be added that, notwithstanding 
 the unusual heat of the season, we do not find that ordinary au 
 tumnal fevers were anywhere more rife, or that they extended over 
 a wider expanse of country than usual ; indeed, many localities 
 have remained healthier than in cooler seasons. 
 
 Heat, in a word, may be, and is, to a certain extent, requisite to 
 promote the formation of other agencies ; it is doubtless essential 
 to farther the evolution of the poison which gives rise to the disease, 
 as everything connected with the appearance of the latter proves 
 its production in hot weather; its absence in cold, and its disap 
 pearance on the accession of frost ; heat may act, besides, as an 
 exciting cause ; but alone it cannot occasion the peculiar form of 
 fever under consideration. It requires materials to act upon, and 
 from which, aided by other influences, it may extricate an efficient 
 cause. That high and long-continued heat may, and does often, by 
 its action on individuals unaccustomed to its effects, produce fever, 
 is doubtless true, and perfectly well known to all physicians ac 
 quainted with the complaints of hot climates ; but the disease thus 
 produced is different from true malarial fevers. More frequently it 
 gives rise to other groups of morbid phenomena more or less 
 distressing, violent, and dangerous cerebral inflammations, or con 
 gestions, visceral inflammations, inflammatory angiotenic fevers; 
 but these phenomena are in no way analogous to those character 
 izing the regular and specific pyrexiaa under consideration. 
 
 Fevers are not the effects of humidity alone. Neither can we jus 
 tifiably attribute the effects in question to excess of visible moisture 7 
 either of the soil or of the atmosphere, whether produced by rain, 
 or local or accidental causes ; or to a high dew-point, or to fogs 
 and dews alone, without the co-operation of some other and more 
 efficient morbific agent. This view of the etiology of autumnal 
 fevers has been advocated by respectable authorities, at home and 
 abroad. Dr. Bell, of this city, informs us that he long had doubts 
 as to the existence or agency of miasma, founded principally on 
 the circumstance that fevers that are usually treated as endemical, 
 not unfrequently become epidemical, and that this extension of 
 such diseases is not pretended to be explained by an extrication of 
 more miasma than usual, but bv <rreat irregularities in the seasons, 
 
110 PNEUMONIA AND 
 
 and abnormal vicissitudes in the weather. The perusal of G-iannini 
 on Fevers, gave him additional reasons for distrusting the fashion 
 able theory a result which must appear strange to any one who 
 has seriously examined the work. But when he became acquainted 
 with the valuable experiments and observations of Dr. Wells on 
 Dew, and " discovered that all the pretended laws of miasm were, 
 in fact, the phenomena of dew, which latter we could accurately 
 notice, while the separate existence of the former, or its independent 
 action, were never demonstrated," he could not hesitate to abandon 
 his belief in a doctrine not supported by fair induction from ob 
 served facts ; ] thus, let it be remarked, arriving, from the same data, 
 at conclusions very different from those which Dr. Wells reached ; 
 for that distinguished physician never dreamed of denying the 
 existence and morbific effects of miasm. 
 
 The opinion of the main agency of humidity in the production 
 of fever was also warmly supported in England by Fordyce. By 
 this distinguished writer, whose Dissertations on Fever are among 
 the most valuable works on the subject in our language, it was ad 
 mitted that if water is applied in a mass, " that is to say, if a man 
 immerses the whole, or any part of his body in water, of the tem 
 perature of the atmosphere, in which he remains some time ; or if 
 he throws water of such heat into his stomach," he is not found to 
 be more frequently afterwards affected with fever than other indi 
 viduals not so exposed ; but if the air has particles of water floating 
 in it, thus constituting mist or fog, or otherwise rendering it moist, 
 and a man has continued for some time in such an air, fever very 
 frequently follows. Moisture, therefore, must be the cause of fever. 
 "Some," he remarks, " have contended that the application of water 
 suspended in the atmosphere in the form of moisture, does not pro 
 duce fever. If those who hold this doctrine " were to live a year or 
 two in Batavia, they would be convinced, by fatal experience, that 
 men living in a moist atmosphere are more frequently affected with, 
 fever than a dry one." "Men, wearing any moist covering, have been 
 more frequently affected with fever than those who have worn 
 clothes not moistened with water." Some may escape ; but that is 
 no proof of the harmlessness of such exposure : and " the many ob 
 servations of men being immediately seized with fever, as well as 
 other diseases, after being exposed to moisture, more frequently 
 
 1 Bell on Miasm, 277. 
 
AUTUMNAL FEVERS. 141 
 
 than those who have worn clothes free from all moisture (the other 
 circumstances being the same), which have been both recorded in 
 the annals of medicine, and have come under the author s inspec 
 tion, give as full evidence that moist clothes are capable of producing 
 fever as any that can be generally procured with regard to the 
 causes of diseases." 
 
 " Moisture in the air," Dr. Fordyce continues, "or of the covering 
 of the body, produces more fevers the warmer the atmosphere. But 
 moisture produces fever in all temperatures. The Dutch have 
 endeavoured to make the country of Batavia resemble Holland in 
 the immense number of its canals. The consequent moisture of 
 the atmosphere is very great in both places ; but, although fevers 
 therefore frequently occur in Holland, they bear no comparison in 
 number to those which happen in Batavia, where the fatality (owing 
 to the moisture and heat of the climate) is so great that it is won 
 derful any person should ever approach that settlement, but from 
 the absolute impossibility of otherwise obtaining water or food." 
 
 Fordyce was well aware that " when the air is moist, in conse 
 quence of water evaporating from a marshy country, or from canals 
 in which the water is stagnating, or moving with a very slow motion, 
 fevers more frequently arise than when the moisture proceeds from 
 the sea, large lakes, or rivers confined within their banks, and run 
 ning with a considerable . degree of rapidity." But this, according 
 to him, is no argument against the correctness of his views ; for 
 instances may be cited in which the disease occurred in situations 
 where the decomposition of animal and vegetable substances, such 
 as occurs in marshes, could not be suspected. Thus, in the war 
 which took place in Flanders in the years 1710 and 1711, "an 
 army encamped upon a pure sand, in which water was found in 
 digging less than a foot deep, and occasioned a great moisture in 
 the air, exhibited in a few days numbers of fevers, although the 
 army was perfectly healthy before, and no more fevers were pro 
 duced on shifting their ground. There are a vast many other 
 instances of the same thing having taken place. Besides, fever has 
 often arisen immediately in persons sitting in rooms the floors of 
 which had just been moistened with pure water. Although, there 
 fore, substances arising from putrefying animal or vegetable matters, 
 in marshes, or other stagnant waters, render the vapour arising from 
 them the more dangerous ; yet it does not follow from thence that 
 the particles of the water forming the moisture of the atmosphere, 
 
142 PNEUMONIA AND 
 
 may not of themselves be the cause of the disease." 1 In his Fourth 
 Dissertation, Dr. Fordyce reverts to the same views, and says: 
 "These diseases have been produced in countries where the water 
 was found at only a foot or two under the surface of the earth, 
 whence the moisture has arisen and contaminated the air so as to 
 occasion^, these diseases, while the soil has been perfectly dry, and 
 there has not been the least appearance of putrefaction, the country 
 being clear from woods. In this case it could be nothing but the 
 moisture that produced the disease. One instance of this occurs in 
 the encampment of the English army in the war about the year 
 17-io, in a sandy plain in Flanders. Another in a region of Peru, 
 where water is everywhere to be found at about seventeen inches 
 below the surface of the earth, .though the country itself is barren 
 for the want of water, and uninhabitable from the number of dysen 
 teries and semi-tertians which take place in it." 2 
 
 That fevers frequently occur during rainy seasons, and are, in 
 deed, ordinarily encountered in damp localities, where rain is com 
 mon and falls abundantly ; where the soil, previously dry, has been 
 rendered wet by some of the causes referred to, rain, freshets, over 
 flows, &c.; or where the dew-point is high, and vesicular humid 
 ity generally or often noticed, or considerable at the time ; that 
 they often make their appearances at the first set in of the rains, 
 the country prior to this having been dry and healthy ; and that 
 hence a certain degree of humidity appears to be necessary to the 
 development of the disease the wetting, in contradistinction to the 
 drying process, proving injurious to health by exciting the fevers in 
 question are facts which no one need be told. It is true, also, that 
 in many instances, if not in all, long-continued and thorough terres 
 trial humidity, or saturation of the soil, has been found to precede 
 epidemic manifestations of yellow and some other forms of malarial 
 fevers; and, on the other hand, that a complete absence of such 
 humidity, a thorough desiccation of the soil to a great depth, as well 
 as an excessive dry ness of the atmosphere, are inimical to the pro 
 duction and continued prevalence of those diseases. Facts to that 
 effect have been observed and recorded in this country, in South 
 America, in the West Indies, in Africa, Europe, and Asia, They 
 are true as regards both ordinary autumnal or periodic fevers, and 
 malignant yellow fever. The humidity of the "West Indies, of must 
 
 1 Five Dissertations on Fever, i. 76, 79. Am. ed. 2 Ibid. Am. eel. -)51. 
 
AUTUMNAL FEVERS. 143 
 
 parts of our Southern States and of the coast of Africa, is prover 
 bial; and we know, not only that these are all fever regions, but 
 that the outbreak of the disease coincides often with a wet season, 
 and with the manifestation of increased moisture. 
 
 The following remarks of Lind, relative to the African coast, will 
 apply to many other places: "The large rivers in the dry season 
 being confined within narrow bounds, leave a great part of their 
 channels uncovered, which, having their moisture totally exhaled, 
 become a solid hard crust ; no sooner do the rains fall than this long- 
 parched crust of earth and clay gradually softens, and the ground, 
 which before had not the least smell, begins to emit a stench, which 
 in four or five weeks becomes exceedingly noisome. At this time, 
 the sickness is generally most violent." 1 
 
 In tropical regions, the sickly or fever season corresponds with 
 that of the rains. In the French colonies, it is denominated hiver- 
 nage. The latter is the period in which the sun heats the portion 
 of the zodiac situated on the side of the equinoxial line where the 
 rains prevail. The hivernage is consequently in reality the summer 
 of such sections of tropical regions where it is observed. When 
 the sun crosses the line, the rainy season necessarily changes side ; 
 and with the accession of wet weather we have the advent of fever. 2 
 
 The connection of humidity with fever the necessity of the 
 former for the production of the latter is exemplified by the oc 
 currences at Tampico in 1836. The rains commence there in July, 
 and are followed by intense heat. This is the period of yellow 
 fever. In the above-mentioned year the rainy season commenced 
 two months later than usual, and there was a corresponding delay 
 in the appearance of the disease. 3 
 
 In Bengal, the rainy season commences in June and continues 
 until October; the remainder of the year is healthy and pleasant. 
 During the rains, the rich and fertile country is almost quite covered 
 by the overflowing of the Ganges, and converted, as it were, into a 
 large pool of water. Diseases rage among the Europeans in the 
 months of July, August, September, and October, consequently 
 during the rainy or wet season. 4 
 
 1 Hot Climates, 54. 
 
 2 Becquerel, Des Climats ct do 1 Influence qu exerccnt les Sols Boise?, &c. 124. 
 
 3 Goupille.au, Bulletin de FAcad. i. 456 ; Ibid. iii. 306. 
 
 4 Lind, Hot Climates, 91 ; Shannon, Practical Obs., &c. on Diseases of Hot Climates, 
 74 ; J. Johnson on Tropical Climates, 59. 
 
144 PNEUMONIA AND 
 
 That the deleterious influence of the atmosphere is aggravated 
 bv an undue degree of moisture, has been found on more occasions 
 than one. The following instance is derived from Dr. Home s Dis 
 sertation on Kemittent Fever. This intelligent physician, who 
 served in Flanders during Marlborough s campaign, and was sur 
 geon to Colonel Cope s dragoons, observed that while the cavalry 
 were cantoned, in 1748, in the unhealthy ground about Bois-le-Duc, 
 the number of the sick corresponded with the dampness of their 
 situation and of the air. To settle the point, he procured a good 
 hygrometer, by which he carefully measured, daily, the degree of 
 moisture or dryness in the air ; and, upon comparing his tables with 
 the register kept of the sick, he found that the progress of the dis 
 ease kept pace, as far, he says, as anything of the kind can do, to 
 the humidity of the air. 1 r < It is proper to remark that the observa 
 tions of Dr. Home on this subject were in the malarial districts of 
 the country, and that th& greater degrees of moisture, which he 
 found to increase the disease, occurred in the vicinity of marshes. 2 
 
 But experience has shown that this is far from being always the 
 case. Indeed, we find that the reverse often occurs, or, at least, 
 that humidity, whether atmospheric or terrestrial whether pro 
 duced by one or other of the sources mentioned, is not, alone and 
 per se, sufficient to produce the effect in question. Fevers appear 
 in seasons and times of dryness, when the soil, on the surface at 
 least, is parched for want of rain; when there are no fogs, and little 
 dew. On the other hand, they fail to show themselves under cir 
 cumstances of an opposite character, and are often arrested in their 
 epidemic course by the very means that are supposed to be by 
 themselves, and without concurrent aid from other conditions of 
 
 1 Dissert. 14; I hid. Metl. Facts and Observations, 61, G2 ; Lind on Seamen, 72. 
 
 2 "From the 2 ( ,Hh, 0. S., of June, to the 12th, 0. S., of July, we had not one man 
 taken bad. During this time, the air was never very moist, though not so dry as 
 what it used to be in my tent during the d;iy-timc in camp. So that, taking day and 
 night together, the moisture of my room surpassed the moisture of my tent. On the 
 evening of the 12th, my hydrometer fell very low, and the air was considerably 
 damper than ever I had yet seen it in quarters. From this very night this present 
 distemper began in our regiment; for that night three were seized witli it. It con 
 tinued for eight days damp weather ; and the number of those taken bad every day 
 increased. The ten days that followed were drier ; during which time not so many 
 were taken bad as before. Two days then followed of damp weather; in which time 
 our number increased. Then, on the weather turning drier, the disease abated. 
 The same e<-ual pace did this disease keep afterwards with the moisture of the air." 
 (Pp. Gl, (12.) 
 
AUTUMNAL FEVERS. 145 
 
 atmosphere, instrumental in their production. Major Tullock, in his 
 excellent Report on the sickness of the British troops in the West 
 Indies, after remarking that the inference of the connection as 
 cause and effect between humidity and disease, derives plausibility 
 from various facts in the history of tropical fevers, especially their 
 great prevalence along the sea-coast, at the outlet of rivers, and in 
 the vicinity of swampy level ground, adds that this hypothesis 
 seems at variance with the facts noticed : " For, if the mortality of 
 the troops depended materially on the influence of moisture, we 
 might expect it to attain its maximum in those stations where the 
 fall of rain was the greatest ; whereas, the average mortality of the 
 troops in Jamaica is at least double that which prevails among 
 those in British Guiana, though the quantity of rain -which falls 
 in that island is little more than half as great ; and in the preced 
 ing pages there are adduced many instances in which epidemic 
 fever has broken out, and raged with great violence, at a period 
 when no rain had fallen for several months ; nay, in some stations 
 a dry, in others a wet season, is looked on as the most unhealthy 
 an anomaly not likely to occur if excess of moisture was uni 
 formly an essential cause of insalubrity." 1 
 
 Madeira, the Canary Islands not far from the coast of Africa 
 the islands of St. Antonio and St. Nicholas, are healthy, though 
 humid ; while Fernando Po, Princes, and St. Thomas islands, riot far 
 from these, are, like Senegal, unhealthy. Barbadoes, St. Christopher, 
 and Bermuda, though at no great distance from fever countries, 
 are healthy ; and, while St. Lucia is unhealthy to a degree, Pigeon 
 Island, which is not less humid than the opposite coast, is free from 
 febrile diseases. Dr. Hollo calls attention to the circumstance, that 
 some of the troops that landed in, 1778 at St. Lucia, and were en 
 camped at the Vigie, were there exposed to fatigue, constant rain, 
 and changes from heat to cold, and yet they were not sickly. They 
 were thence removed to the windward of the Carenage, where, to 
 the former causes, were added marshy exhalations. They then 
 became subject to fevers, from which they were once more freed by 
 resuming their former position. 2 
 
 Ileberden many years since remarked that the air is often fully 
 saturated with moisture, and could not be more filled by the vapour 
 arising from a chamber covered with water; and yet, he adds, 
 
 1 P. 101. 2 Diseases of the Army at St. Lucia, 07. 
 
 10 
 
146 PNEUMONIA AND 
 
 " neither is any epidemical distemper produced by it, nor are those 
 remarkably aggravated with which the sick happen at the time to 
 be afflicted. The air from rivers and from the sea, is probably 
 more replenished with vapours than inland countries cleared of their 
 woods, yet they are generally healthier." 1 Dr. Ferguson has shown, 
 from undeniable facts, that mere humidity from fresh water is not 
 productive of fever. 2 He remarks that water kept in stone tanks, 
 or anywhere, so that it can be preserved in bulk without being 
 absorbed by the surrounding soil, is not productive of disease. 
 One of the healthiest quarters in the West Indies, according to that 
 able physician, is that of the field officers on Berkshire Hill, St. 
 Vincent, the bedroom of which is placed immediately over a deep 
 stone reservoir of water. A block-house in Demerara, reported to 
 be one of the healthiest quarters there, is similarly situated; and it 
 is known to all that the fresh water laid in for a ship s crew, how 
 ever much in contact with their sleeping-places, produces nothing 
 like marsh fever amongst them. Similar statements relative to the 
 innocuousness of fresh water will be found in the works of Mc 
 Lean, 3 Lempriere, 4 Bancroft, 5 Belcher, 6 K. Jackson, 7 Pugnet, 8 Dick- 
 son, 9 Drake, and others. 10 
 
 In speaking of Fort Augusta and Port Eoyal, Jamaica, Dr. Hun 
 ter remarks that simple moisture is harmless, " at least as far as 
 relates to the production of fevers, of which the two last-mentioned 
 places may be given as examples, for they are nearly surrounded 
 with water on all sides. It is true," he adds, " the air is perfectly 
 clear, yet it must be loaded with moisture in consequence of the 
 great heat of the sun acting upon the water. But the vapour arising 
 from water is harmless, even when rendered more an object of our 
 senses, by being condensed into .fogs and clouds. The parish of 
 St. Thomas in the Vale, is every night covered with a thick fog, 
 
 1 Med. Tr. by the College of Physicians of London, ii. 523-4. 
 
 2 Med. Ch. Tr. viii. 129. 
 
 3 An Inquiry into the Nature and Causes of the great Mortality among the Troops 
 at St. Domingo. London, 1797 ; 24-25. 
 
 4 Practical Observations on the Diseases of the Army in Jamaica in 1792-1797, 
 ii. 5, 6. 
 
 5 An Essay on the Disease called Yellow Fever, 243. 
 
 6 Edinb. Med. and Surg. Journal, xxiii. 47. 
 
 7 A Sketch of the Hist, and Cure of Febrile Diseases, 11. 
 
 8 Memoire sur les Fievres de Mauvais Caractere, 342-3. 
 
 9 New York Med. Journal, Sept. 1841 ; 175. 
 
 10 Diseases of the Valley of the Mississippi, &c. i. 010, 711. 
 
AUTUMNAL FEVERS. 147 
 
 owing to the rivers which pass through it sending forth vapours, 
 which in daytime are perfectly transparent, but towards evening, by 
 the cool air coming from the neighbouring mountains, they are con 
 densed, and remain visible till next day s sun disperses them, with 
 out, however, being at all unwholesome." 1 Other facts lead to the 
 same conclusions. In an excellent report on the epidemics of 
 France during the years 1841-1846, by M. Gaultier de Claubry, 
 mention is made of a small commune St. Jean de Losne situate 
 in a valley of the Department of Cote d ? 0r, along the banks of the 
 Saone, and near the canal which unites this river to the Ehine. 
 This commune, from its position, is much exposed to fogs, and 
 remarkable for its great humidity. Nevertheless, it is usually free 
 from periodic diseases. In 1843, however, it was visited by an 
 epidemic of intermittent fever, which was easily traced to other 
 causes, and could not be due to the hygrometrical condition of the 
 atmosphere, which at other periods failed to produce that effect. 2 
 
 M. Madier, who practised at St. Andeol*a small town in France, 
 says of fogs : " We are exposed to them at all times, especially 
 during the spring and autumn. The fogs, which show themselves 
 after a few days of dry weather, and when a light rain has fallen 
 the day before, have a very strong earthy smell ; but when they 
 appear after a rain which has penetrated the soil to the depth of 
 a few inches, they do not emit any odour. I have not noticed that 
 fogs, in whatever season they may prevail, have exercised an in 
 jurious effect on individuals in health, and given rise to any par 
 ticular disease." 3 Let it be remarked that the country around this 
 town is not marshy. 
 
 If fogs and heavy dews were of themselves, and without the 
 concurrent aid of other and more efficient agencies, the active in 
 struments in the production of fevers, there would be no difference 
 whence they came. The effect would be the same whether they 
 arose in elevated and mountainous regions or in valleys and plains. 
 Fever would be noticed in all moist and foggy countries in the 
 "Western Highlands or Cornwall, more than in Norfolkshire or 
 Lincolnshire, as also in every place where dews are heavy ; and, on 
 the other hand, localities, where fogs and dews are not observed, 
 
 1 Obs. on the Dis. of the Army in Jamaica, 13, 14. 
 
 2 Mem. de 1 Acad. de Medecine, xiv. 120. 
 
 3 Mem. sur la Topographia Med. du Bourg St. Andeol; Mem. de la Soc. Royale, 
 v. 78. 
 
148 PNEUMONIA AND 
 
 would not be the seat of febrile complaints. Now, we know that 
 this is not the case. These atmospheric conditions are not the pro 
 ducts of malarial localities only. Dew, for example, will be abund 
 ant wherever vegetation is rich, and may, like fogs, be seen as well 
 on hill-tops, where no malaria exists, as on low ground, where it is 
 copiously evolved ; or both may prevail in a place during healthy 
 seasons, and be less or not more observed during sickly ones. This 
 is no fancy on my part ; for if the reader inquires into the matter, 
 he will easily find that everywhere localities present themselves, 
 which, like those referred to by Dr. Hunter, are subject to fogs and 
 heavy dews, and yet notwithstanding are healthy ; while, in nume 
 rous instances, fever has broken out under meteorological condi 
 tions which forbid the possibility of its being referred to such 
 agencies. Thus, the banks of some streams in this country, and 
 not a few at a short distance, ijrom our city, though the seat of heavy 
 fogs and dews, are sel8dm Visited by autumnal fevers, not as fre 
 quently so, certainly, as other ki&dred localities differently circum 
 stanced. Such is the case with the upper part of the Wissahicon, 
 where, notwithstanding the fogs and dew observed in certain seasons, 
 malarial diseases are not known. The city of Charleston furnishes 
 us with an interesting illustration of the want of connection between 
 the degree of evaporation and condensation and the production of 
 malarial fevers. During July, August, and September, of the fever 
 year of 1849, the evaporation was much higher than it was in the 
 non-malarial years of a series extending from 1845 to 1852 inclu 
 sive, amounting to 1,485. But in 1852, which was highly malarial, 
 the evaporation did not exceed 1,454, while in 1850 it was 1,418; 
 a difference too trifling to justify us in investing it with importance. 
 As to the degree of condensation, it amounted, in 1849, to 173 ; 
 contrasting with what took place during the two non-malarial years 
 of 1850 and 1851, when it was 111 and 81. On the other hand, the 
 sickly year of 1852 gives us an amount of only 83 ; only two de 
 grees higher than 1850, and 28 lower than 1851. 1 
 
 Were fogs and mists the efficient and active cause of fever, we 
 might expect to find the disease prevailing in other seasons besides 
 that in which it almost exclusively shows itself; and yet in regions 
 visited by it, the humidity produced by, or connected with, the 
 thaws and fogs of the spring, and which, in many instances, is as 
 
 1 Hume, Charleston Journal, viii. 67. 
 
AUTUMNAL FEVERS. 149 
 
 considerable as, if not even more so than, at the sickly period, 
 proves perfectly innocuous, heat being often at the time considerable. 
 
 The waters of the Gulf Stream flow with great rapidity near the 
 banks of Newfoundland, bringing with them a temperature of from 
 six to twelve degrees warmer than that of the superincumbent 
 atmosphere, and of the sea itself in that part of the ocean according 
 to the season of the year. This superior heat in the Gulf Stream, 
 as is remarked by Dr. Bancroft, aided by its motion, produces 
 a copious evaporation of aqueous particles from the surface, which 
 are immediately condensed by the coldness of the air, so as to pro 
 duce those fogs which, during summer, prevail on the Newfound 
 land station, to a greater excess, probably, than in any other part 
 of the globe. 1 Mr. Cassini, as quoted by Bancroft, states, in the 
 account he has given of his voyage to Newfoundland, that "it is 
 difficult for one who has never been thjere, to form an idea of the 
 life the fishermen lead at the Great BaJak. "^t must be no less power 
 ful a motive than the thirst after gam*which can prevail upon these 
 poor wretches to spend six months between the sky and water, in 
 a climate where they are almost always excluded from the sight 
 of the sun, and constantly breathing so thick a fog that they can 
 hardly see from one end of the ship to the other." Yet, notwith 
 standing, the men so employed are remarkably healthy and free 
 from fever. "The island," says Major Tullock, "has been long 
 noted for the frequent and dense fogs which prevail along its banks, 
 and often continue during a great part of the summer. None of 
 these agencies, however, seem to operate prejudicially on the health 
 of the inhabitants, among whom the mortality is on a lower scale 
 than on any portion of the American continent. 2 
 
 When, with these facts before us, we bear in mind that fogs, 
 vapours, and dews are only injurious so far as the production of 
 fever is concerned in localities that are marshy or swampy, or 
 that possess a soil composed of materials capable of furnishing ma 
 larial exhalations in other words, in situations where fevers often 
 prevail without the aid of such hygrometrical phenomena, or in 
 those open to the free admission and active agency of winds pass 
 ing, before reaching them, over surfaces of that kind, as is the case 
 with the smokes of the African coast ; we cannot resist the conclu- 
 
 1 Essay on Yellow Fever, 180, note. 
 
 2 Report on Sickness of Troops in British America, 35-6 ; Lind on Hot Cl. 30-1. 
 
150 PNEUMONIA AXD 
 
 sion that, when such fogs, vapours, and dews exist in sickly districts, 
 they act merely as predisposing or exciting causes, and as vehicles 
 of the poisonous agent, and should not be regarded in the light of 
 the efficient cause of the disease. 
 
 In addition, it may be remarked that, in the large majority of 
 places subject to fever, the disease makes its appearance not at the 
 height of the rainy season, when the moisture of the atmosphere 
 must be greatest, but at the commencement and close of it, when 
 the soil is moistened without being drenched, or after it has become 
 somewhat dried. Nor should we forget that vessels at a short distance 
 from the coast remain healthy, and take the fever by approaching 
 near, though the humidity in the former situation was, if anything, 
 greater than in the latter ; that some forms of fever are more pre 
 valent and assume a more malignant character during dry weather, 
 and even during droughts ; that in yellow fever regions, seasons 
 marked by much rain nave often proved the healthiest; that, in 
 some localities, in proportion as the humidity of the climate has 
 lessened, fever manifestations have increased ; and that the disease 
 is sometimes checked by heavy rains. 
 
 We have here, therefore, the reverse of what was said above of 
 the injurious effects of the wetting process ; for while the latter, by 
 its operations on localities more or less dry and parched, gives rise 
 to fever, the same disease is often an attendant on, and a result of, 
 the drying process] not making its appearance until the surface, 
 after having been covered or saturated with water, is becoming, 
 through the evaporating agency of heat, to a considerable extent de 
 siccated; excess of dryness and excess of moisture being alike inim 
 ical to the production of the febrile cause. In neither of these two 
 processes can we admit, therefore, a monopoly in regard to the 
 power of giving rise to that dire effect ; and the very fact of two 
 influences of such antagonistic characters exercising that power, 
 under opposite local circumstances, must naturally lead to the infer 
 ence that the result in question is obtained, not in virtue of any 
 morbific influence dependent on a wetting or drying operation, 
 abstractly considered, but on the change they each occasion in 
 the soil of the locality thereby rendered sickly, or in the organic 
 materials placed on its surface ; drying them in the one case when 
 too wet, and moistening them in the other when too dry. If we 
 admit this, we must admit also that as the effect is obtained in none 
 but localities of the peculiar kind already mentioned, and as neither 
 
AUTUMNAL FEVERS. 151 
 
 the wetting nor the drying process exercises any morbific influence 
 of the kind alluded to, under different conditions of soil or local 
 ity, that effect, when produced, must be due, not to a little more or 
 a little less dryness, either of which, as we have seen, may exist 
 in salubrious situations, but to the extrication from that soil or the 
 materials scattered over it, of some peculiar agent which operates 
 as a poison on individuals exposed to its influence. 
 
 But let this be as it may for the present, with the above facts 
 before us, we can better appreciate the pertinency of Major Tul- 
 lock s remarks, already referred to, that " in some stations a dry, in 
 others a wet season is looked on as the most unhealthy." Long 
 before Major Tullock s days, Dazille had recorded the same ob 
 servation in a passage strangely mistranslated by Dr. Rush, and 
 handed down, in all its imperfections, by several successive writers. 
 " It is during dry weather that diseases pfr eyail at Cayenne ; on the 
 contrary, it is during the rainy season tfiat they spread in St. Do 
 mingo. The reason of this difference is that at Cayenne, during 
 the period of rains, the marshes contain a sufficient quantity of 
 water to be preserved from corruption, and to be renewed gradually 
 by the flow and ebb of the sea. When once the rainy season is over, 
 the waters become stagnant and in a state of corruption, and occa 
 sion by their putrefaction that of a large quantity of insects and 
 animalcules, the effluvia from which are exhaled in the atmosphere, 
 thence pass, through means of respiration, into the lungs, and carry 
 into the humours the germ of the diseases which afflict the inhabitants 
 of the vicinity." 1 An accurate observer of modern times states, in 
 reference to the malarial fevers of Europe: " The most unhealthy 
 years, in humid districts, are those noted for excessive heat, or great 
 and long-continued dryness ; while in dry localities, the most sickly 
 are the rainy years." 2 
 
 The following facts illustrate the injurious effects of the drying 
 process: 
 
 In India, during the unwholesome season, as stated by Bishop 
 Heber, in the account of his journey through that country, all 
 living things leave the pestiferous region, and man dare not venture 
 abroad. " Yet, during the time of the heaviest rains, while the water 
 falls in torrents, and the cloudy sky tends to prevent evaporation 
 from the ground, the forest may be passed with tolerable safety. It 
 
 1 Dazille, Maladies des Xegres, 10. 2 Villerme, Annales d Hygiene, xi. 347. 
 
152 PNEUMONIA AND 
 
 is in the extreme heat, and immediately after the rains have ceased, 
 in May, the latter end of August, and the early part of September, 
 that it is most deadly." Of another pestiferous locality an intelligent 
 writer remarks: "The different seasons of the year have consider 
 able influence upon the unhealthiness of Batavia. On this subject 
 erroneous notions have been laid before the public. The rainy 
 season, during the months of January, February, March, and April, 
 has generally been represented as the most unhealthy. This is 
 owing to an error in observation. During the rainy season, the 
 rivers and canals are plentifully supplied with water, which flows 
 through them with considerable rapidity ; most of the lower marshy 
 situations are entirely inundated with water, by which the existing 
 putrefaction is either very much checked or entirely prevented." In 
 June, the marshes and canals begin to dry up, and with this the 
 unhealthiness commences. In July and August, the dryness and 
 exposure of the latter are still greater, and the disease is rife. "This 
 is the season of death &nd destruction." In October, the dryness, 
 etc., being more excessive, and the materials of decomposition being 
 more thoroughly destroyed, the disease decreases and becomes less 
 malignant. In November and December the effect is still greater. 1 
 According to the observations made by M. Don, chief civil engi 
 neer at Algiers, as quoted by M. Becquerel, from the Annuaire 
 Meteorologique de la France (1850), and embracing a period of ten 
 years, from 1887 to 1847, rain in that country increases from 
 August to December, and decreases from January to July; the 
 maximum being in December (175.444 millimetres), and the mini 
 mum in July (0.150 millimetres). The dryness commences in May, 
 and continues to the end of September, sometimes to October. 
 
 The 1st quarter from 1st December to 28th February, 451.594 
 " 2d " " 1st March to 31st May, 211.380 
 
 " 3d " " 1st June to 31st August, 015.175 
 
 " 4th " " 1st September to 30th November, 261.088 
 
 From this, we perceive that one quarter is very wet, that an 
 other quarter is very dry, and that these are separated by two 
 quarters differing but little from each other in respect to the 
 amount of rain. 2 
 
 1 Horsefield, An Account of a Voyage to Batavia in the Year 1800, Coxe s Med. 
 Mus. v. 78. 
 
 2 Becquerel, Des Climates, &c. 174, 175. 
 
AUTUMNAL FEVEKS. 153 
 
 Dr. Haspel, 1 whose observations were made in the province of 
 Oran, divides the year into four periods. The first commences in 
 March and ends in June. At this period but little rain falls. The 
 second embraces July, August, and September. It is characterized 
 by much dryness. The third period commences in October and 
 ends during the course of December. Kain now commences, and 
 falls in showers, which, with the torrents flowing from the Atlas, 
 submerge the plains. The fourth period comprises the latter half 
 of December, the whole of January and February, and the begin 
 ning of March. It is characterized by much rain, which sometimes 
 commences at the close of November, and recurs at longer or 
 shorter intervals till the close of the following April. 
 
 Now, on referring to the highly interesting work just mentioned, 
 and to others on the same subject, it will be found that at Algiers, 
 as in other kindred climates, the spring months are healthy; while 
 the dry and parching weather of July, August, and September is 
 extremely unhealthy. Fevers then abound, assume the remittent 
 type, and become often pseudo-continued, and malignant. In the 
 third period, which, as we have seen, is wet, malarial fevers, though 
 becoming more severe and complicated, lessen in frequency. Dur 
 ing the fourth and still wetter period they disappear nearly if not 
 completely; showing themselves only in individuals who have been 
 attacked in the preceding summer or autumn. 
 
 Of the years 1845 to 1852 inclusive, the last and 1849 were the 
 only ones during which the yellow fever prevailed at Charleston. 
 In 1852, the quantity of rain which fell during July amounted to 
 6.95 inches; August furnished 4.21, and September 12.27; mak 
 ing a total of 23.43. In the year 1849, July gave 6.35, August 
 5.16, and September 6.27 ; total 17.78. But while the quantity in 
 the first of these two sickly seasons exceeded considerably several 
 of the healthy years of the series, it was only 0.68 greater than 
 the quantity in 1847, when no fever prevailed ; while the amount 
 that year (22.75) and in 1845 (19.71) exceeded that in 1849 by 
 several inches. So far as Charleston is concerned, therefore, though, 
 as remarked by Dr. Hume, from whom these facts are derived, the 
 yellow fever has never appeared in a non-pluvial season, showing that 
 some degree of humidity is required ; yet the facts mentioned, and 
 many others that could be gathered from Dr. Chalmers s account of 
 
 1 Maladies de 1 Alserie, i. 28. 
 
154 PNEUMONIA AND 
 
 the climate of South Carolina, pluvial seasons are not necessarily 
 accompanied by fever. 1 In 1752, 27.45 inches fell during July, 
 August, and September; and yet, notwithstanding, the season was 
 healthy. 
 
 In Louisiana, while some of the most humid and wet localities 
 are little affected by intermittents, others, differently circumstanced 
 in that respect, are highly subject to the disease. Such is the case 
 in East Feliciana, and the parishes lying to the east of it. " These 
 parishes consist of high lands, which constitute a portion of that 
 bluff-formation of the south, and have an elevation of from one 
 hundred to two hundred and fifty feet above the level of the Missis 
 sippi Kiver at that point. The lands are generally thin, and covered 
 either with open forests qf the long-leaf pine, or with those of oak, 
 beech, and other trees, intermixed with a growth of loblolly pine, 
 and other species." " In this region, the climate is obviously drier 
 than in the low landgf of the* delta, as is shown by hygrometrical 
 tables, as well as by the fact that here the Spanish moss is scarcely 
 met with, while in the low lands it covers every tree, and the 
 growth of this plant is a good hygrometrical index. Notwithstand 
 ing the favourable aspect of these regions, as respects health, the 
 inhabitants are very subject to ague and fever." 
 
 This connection of dryness with unhealthiness had not escaped 
 the notice of Lord Bacon, who remarks : " The general opinion is, 
 that years hot and moist are most pestilent ; upon the superficial 
 ground that heat and moisture cause putrefaction. In England, it 
 is found not true ; for many times there have been good plagues in 
 dry years. Whereas, the cause may be, for that drought, in the 
 bodies of islanders habituated to moist airs, doth exasperate the 
 humours and maketh them more apt to putrefy or inflame ; besides, 
 it tainteth the waters commonly, and maketh them less wholesome. 
 And again, in Barbary, the plagues break up in the summer when 
 the weather is hot and dry." 3 
 
 The fever which prevailed at Copenhagen, in 1652, and is de 
 scribed by Bartholin, began in autumn, after an unusually hot 
 and dry summer. 4 In 1669, Ley den was visited by a like fever. 
 The spring and beginning of summer were cold, but the remainder 
 
 1 Hume on Causes of Yellow Fever, Charleston Journ. viii. G4. 
 
 2 Carpenter, New Orleans Journ. iii. 429. 
 
 3 Bacon, Nat. Hist, Cent. iv. Exper. 883. 
 
 4 Hist. Anatomia, Bar. Cent. ii. hist. 56. 
 
AUTUMNAL FEVERS. 155 
 
 of summer and the autumn were unusually hot, with little or no 
 rain. 1 " It is remarkable," says Pringle, " that pestilential diseases 
 have frequently occurred in dry and hot summers, and agreeably 
 to this, I have observed that most sickly seasons in the field have 
 been attended with the greatest heat and the least rain." 2 Hippoc 
 rates himself has left his testimony on this subject, for he mentions 
 remittent fevers as having been common in summer and autumn, 
 and most prevalent when wet springs with southerly winds were 
 succeeded by hot and close summers. 3 
 
 The example of Sicily is apposite. Light rains in autumn are 
 there unhealthy, evidently from their moistening the earth, which 
 previously had been dried effectually and to a great depth by the 
 heat of summer, and thereby putting it in a state capable of evolving 
 febrific effluvia. Whereas, nothing is as salutary as heavy rains 
 about the middle of September, which not only mitigate the heat, 
 but, by covering or saturating the earth, pu%a stop to the produc 
 tion of the cause of fever. 4 The country is penetrated in several 
 directions by ridges of primitive hills of considerable height, and 
 apparently a continuation of the Apennines. Between these are 
 numerous watercourses, which are dry in summer, and occasionally 
 filled by torrents in winter. They are denominated fiumwri, by the 
 natives, and are used as roads in the dry season. Many of them are 
 extremely unhealthy in the latter part of summer and in autumn, 
 and infected by malaria. Much of this unhealthiness, however, de 
 pends on the state of the season. A very dry season will, while 
 parching the surface of the earth, put an obstacle to the production 
 of the cause of fever, and render the country healthy. The same 
 effect is produced by a very wet season, which, by saturating the 
 earth and completely filling up the fiumari, and covering their 
 sickly beds, puts a stop to the extrication of the febrific cause. 
 Fever there is rife only at periods when the soil is partially satu 
 rated, and principally while the drying process is going on, or when, 
 after having been parched and completely dried, it is moistened by 
 moderate rains. In situations where, from peculiar local circum 
 stances, complete desiccation does not occur, and the ground is only 
 
 1 Silvius de la Boe Prax. Med. Append, tract, x. Oratio de affectus epidemici 
 Leidcnsis causis naturalibus dicta. Leyd. 1670. 12mo. 
 
 2 Dis. of the Army, 81, part 2, chap. ii. 
 
 3 Epidemics, lib. iii. Sect. 3. 
 
 4 Irvine, Observ. upon Diseases of Sicily, 2. 
 
156 PNEUMONIA AND 
 
 partly freed from water, as at Lentini, around which the country is 
 marshy, with a considerable lake in the vicinity, or, among other 
 places in the large foumart which bounds Messina on the northern 
 side, where the stream disappears in the gravel, and, percolating 
 under the surface to the sea, fresh water is found at a foot depth, 
 fever prevails every year, and at all seasons. 1 In Sardinia, too, 
 fever rages from June to September. In some summers there is a 
 want of rain for four or. five months, and then it is that sickness 
 exerts its utmost violence. 2 
 
 Senegal is proverbial for the wide and extensive prevalence of 
 periodic fevers. There, as in many other places, the country is 
 healthy during the height of the rainy season, when the soil, like 
 that of Egypt, is nearly all covered over with water, and the moist 
 ure of the atmosphere is necessarily considerable. During the 
 drying process which succeeds to this condition of things, and com 
 mences about the mddle of September, the soil gradually becomes 
 uncovered, and soon adorned with the richest vegetation ; while in 
 its moist state, it remains for some time exposed to the influence of 
 the burning sun. This is the period of fevers. These extend far 
 and wide, and continue to prevail until, through the effects of heat 
 and other agencies, the desiccation of the soil and the dryness of 
 the atmosphere become complete. As soon as these results are 
 obtained, the country once more becomes healthy. 3 
 
 In several of the fluvial basins within the torrid zone, or on its 
 margins, the rainy season is the period of health and the dry season 
 that of disease. See what takes place in the district of Lower 
 Egypt. There the dry season, when the Nile is low, and the coun 
 try is moistened solely by irrigation, is febriferous. In May and 
 June the majestic river begins to rise, and the increase of the 
 water, and consequently of the humidity of the soil, is hailed as the 
 sign of approaching salubrity. 4 
 
 1 Irvine, Observ. upon Diseases of Sicily, 3, 4, 5. 
 
 2 Lind, 31. 3 Thcvenot, op. cil. 21, 25, 48. 
 
 4 Prosp. Alpines, De Morb. JEgj r pt, lib. i. cap. xiv. ; Craigie, Pract. i. 81 ; Volney, 
 Voy. en Egypt, i. 213; Macculloch on Malaria, 107; Sir James McGrigor, Sketches, 1. 
 
 The researches of M. Villerme on the influence of marshes on the duration of life, l 
 have led to interesting conclusions, a summary of which may be appropriately placed 
 here. In the eight most marshy departments of France (Ain, Charente Infcrieure, 
 Card, Gironde, Herault, Bouches du llhone, Var, and Vendee), where epidemics of 
 
 An. d Hvg. xi. 340, &c. 
 
AUTUMNAL FEVERS. 157 
 
 We have seen that, in Bengal, the sickly is the rainy season, and 
 that fevers are rife when the country is wet. It appears, how 
 ever, that the moisture must keep within certain bounds. It is 
 remarked that the more complete the inundation, the more healthy 
 are the inhabitants, till the fall of the waters, in November and 
 December, expose a number of miry and slimy marshes to the 
 action of a still powerful sun, when those who are in their neigh 
 bourhood are sure to come in for a share of remittents and inter- 
 mittents. 1 The same effects that are noticed in Bengalese, after the 
 waters begin to fall, take place when the inundation has been con 
 siderable enough to cover the country. "When the rains are late 
 
 periodic fever reign annually during two, three, or four months, the mortality among 
 children under four years of age is much greater in August, September, and October, 
 when fever prevails, than in January, February, and March; while the whole number 
 of deaths among individuals, from four years old to one hundred, always attains its 
 maximum in winter ; in other words, the influence of mar&hel ..""on young children is 
 such, supposing the effect to be produced by one cause only, that in every thousand 
 deaths of young children which take place in healthy districts, 1,546 occur in the 
 aforesaid eight departments. The baneful influence of marshes in the above-men 
 tioned classes will appear still more striking, if we compare the mortality which 
 occurs in paludal districts during the spring or the commencement of summer, when 
 it is least, with that which occurs during August, September, and October, when it is 
 largest ; for it will be found that for every death noted in the first period, we have in, 
 each of the three other mentioned months, according to the localities, two, three, four, 
 sometimes five, and even six. In the aforesaid eight most marshy departments, the 
 number of deaths occasioned by paludal exhalations, among very young children, is 
 greater in September; while the mortality from the same cause among other indi 
 viduals, reaches its maximum in October. But although, as we have seen, the loss 
 among children in those eight departments, considered together, is largest in Septem 
 ber, we find that, in the departments of Ain and la Vendee, the least southern of the 
 sez-ies, and those in which the desiccation of the marshes is effected at a later period, 
 the most fatal month is October. In the other departments, the period of that 
 maximum is earlier in the ratio of their southerly situation, or in proportion to the 
 earliness of the desiccation of the marshes. Indeed, the period at which these are 
 dry, as well as that of the prevalence of the disease, and of the large mortality they 
 occasion, advances in the south of our hemisphere, and is retarded in the north. 
 When the march of the seasons advances, or is retarded ; when the drying up of the 
 marshes is longer in being effected, or is accomplished with greater rapidity, the 
 greater mortality they produce commences earlier or later, and continues iu the 
 autumn long after the hot weather, or ceases during the continuance of them. M. 
 Villerme properly remarks that, as the maximum of the mortality among children in 
 the marshy departments, and an increased mortality at other periods of life, constantly 
 coincides with the period of desiccation, complete or partial, of the marshes, and not 
 with that of the greatest heat, it follows that this effect must be ascribed more to 
 that desiccation than to a high degree of temperature. 
 1 Johnson on Tropical Climates, 43. 
 
158 PNEUMONIA AND 
 
 in setting in, many people are suddenly cut off by the intense heat 
 of the sun in June and July. But this is nothing compared to the 
 havoc produced by a sudden and premature cessation of the rains, 
 or Bursautty, as they are called. In this last case, an immense sur 
 face of slime and feculence is all at once exposed to the rays of a 
 vertical sun." " The consequence is that the profuse exhalation of 
 miasmata spreads pestilence in every direction." 1 
 
 The air on the flat country which stretches along the eastern and 
 northern coast of the island of Ceylon, is very dry and hot, during 
 the south-west monsoon. Showers rarely occur there during the 
 months of May and October. During the influence of this mon 
 soon, a hot land wind blows from the interior towards the eastern 
 and northern coast of the island. This wind sets in about the 
 middle of May, and blows, with but little intermission, till the end 
 of August. In the other months of the year, there are regular sea 
 and land breezes. While tha land wind prevails, there are but 
 rarely any sea breezes. The land wind often blows day and night 
 for several weeks together, without much abatement ; it is always 
 very dry and hot. Dr. Marshall, from whose work on the medical 
 topography of the interior of that country I quote, states, in an 
 other page, that the above provinces are remarkable for insalubrity. 
 The late king of Kandy sometimes took advantage of the pestilen 
 tial atmosphere of these districts, and transported thither the chiefs 
 whom he considered disaffected to his interest. Few of the inhabi 
 tants escape the influence of the fever during the sickly season 
 (pp. 6, 40). Dr. John Davy, in like manner, informs us, that fevers 
 are rife in Ceylon during the season of dry weather (p. 75). Dr. 
 Kollo mentions that the greater part of the regular remittents that 
 prevailed at St. Lucia did so during the rains, when the pools and 
 marshes were filled ; and that the most dangerous remittents ap 
 peared after their slimy surfaces became exposed and dry. 2 Dr. 
 Copland states that the ditch around the ramparts of Geneva was 
 once drained, and sickness prevailed in the vicinity, but disap 
 peared when it was again filled. 3 
 
 Dr. W. Ferguson, whose name has become indissolubly connected 
 with the subject of miasma, and who, though erring in pushing his 
 notions as to the necessity of a dried surface farther than is war- 
 
 1 Johnson on Tropical Climates, 44. 2 Op, tit. 69, 70. 
 
 3 Diet. i. 703, Endemic Diseases. 
 
AUTUMNAL FEVERS. 159 
 
 ranted by a survey of all the facts we possess, and ignoring the 
 agency of the decomposition of organic substances (to say nothing 
 of the inconsistency of denying in one place this agency, and in 
 another referring the fever which occurred on board of the Regalia, 
 to the decomposition of a quantity of green wood stowed away in 
 the hold of the vessel) has added considerably to the stock of our 
 knowledge in relation to the sources of that poison, and furnished 
 many facts corroborating the views here advocated. The English 
 army suffered much from endemic fever, under the remittent and 
 intermittent forms, at Rosendaal and Oosterhout, in Holland, in 
 1799. The summer had been hot and dry, and the soil, which was 
 a level plain of sand, presented a perfectly dry surface. But on 
 digging, it was universally found to be percolated with water to 
 within a few inches of the surface. In 1799, the army, under the 
 Duke of York, remained the whole autumn in the most pestiferous 
 portion of that unhealthy country without suffering in any remark 
 able degree from fever. But the summer had been wet and cold. 
 It rained constantly, and the whole country was nearly flooded with 
 water. In 1810, the British army at Walcheren, on a soil as similar 
 as possible, and not more pestiferous, suffered considerably from 
 fever. But the soil, after having been thoroughly wet, had passed 
 the ordeal of a hot and dry summer, by which the surface was 
 partially desiccated. In Portugal and Spain, during the campaign 
 of 1809, Dr. Ferguson found the hilly ravines that had lately been 
 watercourses, but were now dried up by a continuance of several 
 weeks of very hot weather, to be very unhealthy. The same results 
 obtained during the retreat into the plains of Estremadura, along 
 the course of the Guadiana River (after the battle of Talavera). 
 The country, which we may presume had been wet, was then arid 
 and dry. The river itself, and all the smaller streams, had, in fact, 
 ceased to be streams, and were no more than lines of detached pools, 
 in the courses that had formerly been rivers. The Alentejo land, 
 opposite Lisbon, is dry, superficially flat and sandy, and very un 
 healthy. So also is Salvatora, a large village about a mile inland. 
 " The country around is perfectly open, though very low, and 
 flooded with water during the whole of the rainy season ; but at 
 the time of the periodical sickness, it is always most distressingly 
 dry." " Cividad Rodrigo affords another illustration of the same. 
 It is situated on a rocky bank of the River Agueda, a remarkably 
 clear stream ; but the approach to it, on the side of Portugal, is 
 
160 PXEUMOXIA AND 
 
 through a bare, hollow country, that has been likened to the dried- 
 11 p bed of an extensive lake ; and upon more than one occasion, 
 when this low land, after having been flooded in the rainy season, 
 has become as dry as a brick-ground, with the vegetation utterly 
 burned up, there arose fevers to our troops, which, for malignity of 
 type, could only be matched by those before mentioned on the 
 Guadiana." Corea, in Spanish Estremadura, on the banks of the 
 Alagon, is highly unhealthy. Yet at the time the British troops 
 suffered there, the shores of the river seemed perfectly dry, and 
 there was not an aquatic weed, nor a speck, nor a line of marsh to 
 be seen within miles of the town, nor anything but dry, bare, and 
 clear savanna. From the foregoing facts, as Dr. Ferguson remarks, 
 it will be seen that, in the most unhealthy parts of Spain, we may 
 in vain, towards the close of the summer, look for lakes, marshes, 
 ditches, or pools. Spain, generally speaking, is then, though as 
 prolific of endemic fever as Walcheren, beyond all doubt, one of 
 the driest countries in Europe, and it is not till it has again been 
 made one of the wettest, by the periodical rains, that it can be called 
 healthy or habitable with any degree of safety. 
 
 Dr. Ferguson s observations in the West Indies led him to the 
 same conclusions. " It might there be seen, that the same deep, 
 marshy country which the rains made perfectly healthy, as if by 
 deluging a dry well, was speedily converted, under the drying pro 
 cess of a vertical sun, into a hotbed of pestiferous miasmata. Thus, 
 in the Island of St. Lucia, the most unwholesome town of Castries, 
 at the bottom of the Carenage, which is altogether embosomed in 
 a deep mangrove fern, became perfectly healthy under the periodic 
 rains ; while the garrison, on the hill of Morne Fortune, imme 
 diately above it, within half cannon-shot, began to be affected with 
 remittent fever. The two localities within this short distance 
 evidently changed places in respect to health. The top and 
 shoulders of the hill had been cleared of wood, and during a con 
 tinuance of dry weather, the garrison had no source of disease 
 within itself; but this was amply, though but temporarily supplied, 
 as soon as the rains had saturated the soil on which it stood. Thus, 
 an uncommonly rainy season at Barbadoes seldom failed, in that 
 perfectly dry and well-cleared country, to induce for a time general 
 sickness ; while at Trinidad, which is almost all swampy, and the 
 centre of the island may be called a sea of swamp, where it always 
 rains at least nine months of the year if it only rained eight, or 
 
AUTUMNAL FEVERS. 161 
 
 if at any time there was a cessation of the preserving rains, the 
 worst kind of remittent fevers were sure to make their appearance. 
 General dryness of soil, however, is far from being the ordinary 
 characteristic of our West India colonies. The swamp is too often 
 exposed to the continued operation of a tropical sun, and its ap 
 proach to dryness is the harbinger of disease and death to the 
 inhabitants of its vicinity. On the whole, it may truly be said, 
 that although excessive rains will evidently cause the acknowledged 
 wholesome and unwholesome soils to change places for a time, in 
 respect to health, a year of stunted vegetation, through dry seasons, 
 and uncommon drought, is infallibly a year of pestilence to the 
 greater part of the West India Colonies." 1 In all cases, however, 
 previous saturation of the soil is necessary to insure the effect, and 
 fever ceases when the exsiccation is thorough and complete. . 
 
 On all these points, other facts, numerous and authentic, may be 
 found in other writers on the fevers of Europe, of the West Indies, 
 of Mexico, South America, Africa, and this country. 2 Indeed, we can 
 scarcely open a book, large or small, which treats of the subject in 
 extenso or incidentally, without finding therein a repetition of the 
 same story absence of fever during excess of terrestrial humidity ; 
 
 1 Marsh Poison ; see Notes and Recol. of a Professional Life, 186, 198. 
 
 2 Baglivi, 157-0; Ramazzini, Opera Oninia, London, 1717; Rochoux, 11; Berthe, 
 51, 156; Pariset, 177; Fellowes, 13, 32, 35; Boyle, Ed. J. viii. 178; Beam, Tr. of 
 Med. Soc. Lond. v. 335; Report on Gibraltar Fever, 4; Caillot, 121; Furlong, Med.- 
 Chir. Rev. xxv. 290 ; Valentin, 87, 89 ; Lempriere, i. 26, 31 ; ii. 47, 48, 49 ; Des- 
 portes, i. 52, 80, 86, 87; Ferguson, Med.-Ch. Tr. viii. 130-1; II. M Lean, 25, 72; 
 Gillespie, 20, 137; Johnson, Trop. Cl. 362; Dazille, Mai. des Negres, 10; Firmin, 
 Mai. de Surinam, 3, 18; Bancroft, 200, 314; Edinb. J. Ixiii. 448; Ibid., Ixix. 132; 
 Bally, 304, 363 ; Hillary, 146-7 ; Jackson, Outlines, 92 ; Tullock s Rep. 64 ; Gilbert, 
 4, 50, 69: Rufz, 10, 29 ; Catel, 9 ; Beguerie, 10; J. Clark, 75 ; Towne, 8; Leblond, 229; 
 Imray, Ed. J. liii. 93; Ixiv. 331; Pinkard, ii. 486; Henderson, 8; Arnold, 31, 148, 
 174; Chisholm, i. 145, 294; ii. 196; Humboldt, 765; Boussingault, An. de Chimie, 
 Ivii. 151; Boteler (Voy. of Disc, by Capt.), i. 137, 155, 156, 356; Pallas, 109; Prit- 
 chett, 266; M Williams, 176; Boyle, 6, 44, 123; Brit, and For. Med.-Chir. Rev. i. 
 382 ; Jacquot, 14; Simon s Kept, to Bd. of II. of Charleston, 6, 10, 18; Watts, Med. 
 Reg. of N. Y. 278; Barton, 13; Revue Med., 1840, 322; Merrill, Chapman J. ix. 
 233, 240; Ibid. N. 0. J. viii. 7 ; Ibid. N. A. J. ii. 218; Rush, iv. 154; Chabert, 20; 
 Lining, ii. 407; Townsend, 263; Barton s J. ii. 22; Drake, 717; Gros, 5; Johnson, 
 Charleston J. iv. 155; Hulse, Maryland J., Jan. 1841, 392; Thomas, 18, 63, 213; 
 Pendleton, Charleston J. vii. 449 ; Merrill, Address on. Health and Mortality of Mem 
 phis, Recorder, i. 88 ; Bonnet, Tr. des Fievres In term. 304 ; Craigie, Pract. of Med. 
 i. 82; ii. 171; Villerme, An. d llyg. xi. 349, 350; Goupilleau, Bulletin de 1 Acad. i. 
 456; iii. 306; Sigand, Du Climat et des Mai. du Brezil, 70-2. 
 
 11 
 
162 PNEUMONIA AND 
 
 occurrence of the disease under the influence of the drying process ; 
 again, absence of fever when the exsiccation of the soil is complete, 
 and penetrates to a considerable depth, and every particle of moist 
 ure has been destroyed; and afterward reappearance of disease 
 during the wetting period. 
 
 It must be remarked besides, and more especially in reference to 
 the facts adduced by Dr. Fordyce, in support of the power of 
 moisture in producing fever, that most of the instances in which 
 the disease is supposed to have arisen from that cause, occurred in 
 situations more or less characterized by a marshy condition of the 
 soil. Of all known localities, Batavia is the last that should have 
 been selected as illustrative of the febrific agency of simple moisture. 
 "It is impossible," says our countryman, Dr. Ilorsefield, who was 
 well acquainted with the country, " for the imagination to conceive 
 a situation more favourable to the production of marsh miasmata 
 than that of Batavia." " If human industry and ingenuity should 
 be exerted in planning and constructing a laboratory for the pro 
 duction of pestilential vapours, a situation exactly resembling that 
 of Batavia and its environs would be the result." 1 The same may 
 be said of many other fever districts where moisture is sufficiently 
 considerable to be made the subject of notice; whenever the disease 
 shows itself in localities which, though not containing marshes pro 
 perly speaking, are in that condition, we may be sure to find the 
 soil presenting these peculiarities, which elsewhere are associated 
 with the advent of fever, and act injuriously without the necessary 
 coexistence of a notable amount of moisture. Here, consequently, 
 the latter cannot be held up as the efficient morbific agent. It may 
 be added that the instances mentioned by Dr. Fordyce, relating to a 
 soil of pure sand, in which water was found in digging less than a 
 foot deep, and occasioned a great moisture in the air, whence arose 
 numbers of fevers ; in which the soil while giving passage to the 
 excess of moisture adverted to remained perfectly dry, and in which 
 there did not exist the least portion of organic matter susceptible 
 of decomposition, may be regarded as of a very questionable cha 
 racter, none of them being mentioned on the authority of any re 
 sponsible writer, and some conflicting in the most positive manner 
 with well-ascertained facts. 2 
 
 1 American Med. Museum, i. 77. 
 
 2 To Mr. Blodget, to whose Report on the Condition of the Summer of 1853, refer- 
 
AUTUMNAL FEVERS. 163 
 
 A IdgJi dew-point not sufficient to account for the occurrence of fever. 
 For more reasons than one, objection may be made to much 
 
 ence has already been made, we are indebted for the following statements relative to 
 the hygrometrical state of the atmosphere. 
 
 The heats of June, in the summer of 1853, were remarkably dry. The fraction of 
 saturation was at a mean of about 50 in the north-east, and but 40 to 45 in the inte 
 rior ; and in Texas, during the hot days, from the 14th to the 17th, though much higher 
 at Pensacola and the extreme south, where the heat was not so great from the 20tli 
 to the 23d ; the rate was about the same in the districts of excessive heat. On the 
 29th and 30th, the percentage was but 35 to 40 in the narrow district through Ten 
 nessee, Kentucky, and Virginia, which marked 100 as the maximum of temperature. 
 
 The first two days of July were a continuation of the condition of the last of June. 
 The remainder of the month was not unusual in its hygrometric character gene 
 rally, though at New Orleans the evidences of high saturation are given in the profuse 
 and constant rains of the middle of the day, preceded by a hot and oppressive morn 
 ing. The great heat of August was most remarkable in its hygrometric condition, also, 
 and universally attended with a high fraction of saturation ; at Washington, it was 50 
 to GO ; and at New York, where, whatever may have been the sickness and mortality, 
 they did not arise from malarial fevers, and where no yellow fever occurred, the fraction 
 of saturation was near 70 per cent, at 2 P. M., and almost at saturation morning and 
 evening. 
 
 Kains in August were excessive. 
 
 The temperature of evaporation at New York in August was from 80 to 84, being 
 higher than the maximum temperature of evaporation at New Orleans at any time in 
 1852, by two degrees ; at the latter place, it reached 82 but once in that year ; with 
 the exception of New Orleans and New York, at this limited period, the heats of the 
 summer, though extreme, have been attended with a low humidity. 
 
 In June, the amount of rain was much less than usual generally ; in July, it was 
 particularly large at Philadelphia, and southward to Florida, where it was 11. 5 
 inches. In Alabama, and at New Orleans, the amount was nearly as great, and in 
 Iowa and Wisconsin, it was again large from 6 to 8 inches. In some places, there 
 were severe droughts, as in eastern Ohio, western Pennsylvania, arid New York. In 
 August, the rains were excessive from the lower part of New Hampshire to northern 
 New Jersey ; at Bloomfield, New Jersey, and New York, the amount falling was 12 
 inches. From Baltimore to Savannah, also, the amount was large, being from 5 to 
 6.5 inches, .and about 1 J inches more than usual, the amount being about 3.5 inches. 
 The last days of July, and the first days of August, gave an excessive precipitation 
 in eastern Pennsylvania and New York, New Jersey, etc. These flooding rains, which 
 gave in some instances 4 to 8 inches in depth of water in a single storm, of a few 
 hours, attended very warm weather, and immediately preceded the heats of the 12th to 
 the 14th of August. These were also followed by profuse rains, and the whole period 
 from the 25th of July to the 15th of August seemed a substitution of a tropical 
 climate for the usually elastic one, in the space of country referred to. New York 
 Journal of Medicine, November, 1853. 
 
 Now it must be remarked that the hygrometrical conditions here referred to, ex 
 tended over a large surface of country, and that while some localities suffered severely 
 from malarial fevers, of various grades and types, others similarly circumstanced in 
 point of humidity, evaporation, and rain, escaped unscathed. To this agent, therefore, 
 we cannot look for the efficient cause of the disease, even when it is combined with 
 high atmospheric heat. 
 
164 PNEUMONIA AND 
 
 of the theory set forth by our countryman, Dr. C. A. Lee, who, 
 without discountenancing or disproving the existence of an aerial, 
 intangible poison, looks for the main and most efficient cause of 
 fever not, as some have done, in an excess of visible humidity alone, 
 but principally in a high dew-point, however produced (60 degrees 
 at least), which, as he thinks, acts injuriously in some measure, by 
 checking the elimination of that poison from the system, and 
 thereby giving it efficiency, but chiefly (and, as we may presume, 
 exclusively in cases in which the poison does not exist, supposing 
 the occurrence possible, which Dr. L. does not say), by interrupting, 
 to a greater or less extent, the healthy function of the lungs and 
 skin, preventing a perfect decarbonization of, and a sufficient supply 
 of oxygen to, the blood carrying off the vitreous electricity which 
 acts as a vital stimulus, and, as a consequence, increasing the secre 
 tion of bile. 1 Still less disposed must we be to give our sanction 
 to the views suggested, and so ingeniously supported by Mr. T. 
 Hopkins, of Manchester, who seems to ignore malaria altogether, 
 and attempts to identify it and a high dew-point, accounting for the 
 production of fevers solely by the check thereby given to evapora 
 tion from the surface of the body. 2 
 
 That a high dew-point has a tendency to produce injurious effects 
 on the system; that it is often found to exist in unhealthy localities, 
 or during pestilential times ; and that it must assist somewhat in the 
 development of autumnal and periodic fevers, are facts which no 
 one will question. But that it plays the all-important part in the 
 causation of those diseases attributed to it by Dr. Lee, and particu 
 larly by Mr. Hopkins, is far from being demonstrated. Were the be 
 lief correct, we should expect to find that a high dew-point reach 
 ing to at least 60 degrees is always attended with the occurrence of 
 malarial fever in one or other of its various forms ; that countries 
 or seasons in which the dew-point is high, are necessarily insalubri 
 ous; that this condition is proportioned to the elevation of the dew- 
 point; and that, on the contrary, localities in which the degree is low, 
 are as necessarily healthy. Now let us inquire how far facts will 
 bear us out on these points. We have seen that fevers, even of a 
 
 1 Forry, Climate of the U. S. 112, 113. In a note, appended by Dr. Lee to the 
 article Intermittent Fever, of Copland s Medical Dictionary, he is quite orthodox on 
 the subject of Malaria, the existence and morbific agency of which he fully admits. 
 Not one word is there said about the dew-point. 
 
 2 Loud, and Edinb. Phil. Mag. 3d S. No. 80, Feb. 1839; An. d llygiene, 25. 
 
AUTUMNAL FEVERS. 165 
 
 severe and malignant character, have not urifrequently broken out, 
 and spread extensively, in places where but little visible humidity 
 existed ; where the soil was arid, dry, and cracked, and everything 
 upon it was parched in consequence of long-continued and severe 
 drought; where the absence of rain was not compensated by fogs 
 and dews, and where, as a natural result, the dew-point was found, 
 or might be inferred, not to have reached very high. We have 
 seen, on the other hand, that the same or other places, have re 
 mained exempt from those diseases, under hygrometrical condi 
 tions of an opposite character, combined with a degree of heat well 
 calculated to promote an excess of atmospheric moisture, visible 
 and invisible ; and when, from these circumstances, the dew-point, 
 if not positively ascertained to have been high, may, with perfect 
 propriety be supposed, in the absence of direct observation, to have 
 risen considerably. It may be remarked, also, that in places sub 
 ject to occasional visitations of autumnal fever of various grades of 
 intensity, sickly seasons are not necessarily characterized by a higher 
 dew-point than the corresponding periods of other years in which 
 the disease does not make its appearance. 
 
 In Demerara, the height of the dew-point in ordinarjr seasons differs 
 but slightly from that to which it reached during the prevalence of 
 the fever of 1837-1845. In 18-43, the mean degree was 73.8, vary 
 ing from 72. (Feb.) to 74.9 (July, Aug., Nov.) In 1844, the average 
 height was 75.1, with a variation of from 73.3 (Dec.) to 76.0 (May). 
 In 1845, eight months give us a mean of 74.6 from 73.0 (Jan.) to 
 76.0 (April), while, in 1846, the year after the cessation of the dis 
 ease, the mean dew-point was 74.4, with a variation of from 70.8 
 (Feb.) to 7-6.2 (May and June). 1 
 
 The following table of the dew-points during the months of June, 
 July, August, September, October, and November, from 1845 to 
 1851, and July, August, and September, 1852 inclusive, at Charles 
 ton, S. C., will show to those who are aware that the yellow fever 
 prevailed there during only two of those years (1849 and 1852), 
 that the difference in regard to the saturation of the atmosphere 
 during sickly and healthful seasons is but trifling, and cannot alone 
 account for the production or absence of the disease ; and, indeed, 
 that the results obtained are very different from those that might 
 have been expected did a high dew-point and fever stand in the 
 relation of cause and effect. 2 
 
 1 Blair, op. cit. 120. 2 Hume, Charleston Journal, v. 10 ; viii. 67. 
 
166 PNEUMONIA AND 
 
 
 June. 
 
 July. 
 
 Aug. 
 
 Sept. 
 
 Oct. 
 
 Nov. 
 
 1845 
 
 69.46 
 
 72,77 
 
 71.96 
 
 66.00 
 
 54.61 
 
 41.00 
 
 1846 
 
 70.83 
 
 72.82 
 
 75.64 
 
 70.66 
 
 59.22 
 
 50.46 
 
 1847 
 
 71.74 
 
 73.39 
 
 74.23 
 
 68.20 
 
 58.67 
 
 53.53 
 
 1848 
 
 70.26 
 
 73.00 
 
 72.09 
 
 66.26 
 
 58.74 
 
 44.80 
 
 1849 
 
 73.46 
 
 70.77 
 
 72.71 
 
 66.00 
 
 60.93 
 
 53.13 
 
 1850 
 
 67.86 
 
 75.03 
 
 74.93 
 
 69.70 
 
 55.00 
 
 50.86 
 
 1851 
 
 70.73 
 
 74.38 
 
 74.67 
 
 65.13 
 
 57.41 
 
 48.23 
 
 1852 
 
 
 73.20 
 
 68.77 
 
 68. 
 
 
 
 Thus the average dew-point in June and October of the sickly 
 year of 1849, was higher than in the corresponding months of any 
 year of the series ; but when we examine the results obtained in. 
 the other months, matters are found to take a different turn. For 
 while in July, 1849, the average was 70.77, and in 1852, 73.20, we 
 have a higher point than in the former in each of the other years 
 of the series, and a higher one than in 1852, in the same month of 
 1847, 1850, and 1851. The average in August, 1846, 1847, 1850, 
 and 1851, was higher than in 1849, and higher than in 1852 in 
 every year of the series. September in 1846, 1847, 1848, and 1850, 
 gave a higher point than in 1849, while the amount in 1852 was 
 exceeded by that in 1846, 1847, and 1850. 
 
 In New Orleans, where the average annual dew-point, calculated 
 on a basis of eight years, was found to be 63.56 (observed at 12 
 o clock), June being 73.95; July, 75.42; August, 75.59; September, 
 73.63 ; October, 62.73 ; November, 54.27 ; the year 1849, during 
 which both the yellow fever and cholera prevailed extensively, 
 presents an average for the twelve months of 63.71 : June, 74.43 ; 
 July, 75.53; August, 76.75; September, 73.78; October, 61.16; 
 November, 57.71. 1 Indeed, the physicians of Louisiana have had 
 frequent opportunities to observe the dew-point for months together 
 only a few degrees below the atmospheric temperature, without, 
 however, suffering from any extraordinary prevalence of intermit- 
 tents. 2 
 
 The above statements show, that the mean dew-point of the 
 summer in Charleston and New Orleans, is several degrees above 
 that of the autumnal season, when fevers are more apt to be pre 
 valent. In the latter city, the excess amounted to near nine 
 degrees. In Charleston, the difference between the mean dew-point 
 
 1 Southern Mecl. Repts. i. 100 ; ii. 148. 2 Carpenter, N. 0. J. iii. 428. 
 
AUTUMNAL FEVERS. 167 
 
 of the three summer months of the seven years specified, and that 
 of the three following months, reached above fourteen degrees. 
 Dr. Gardner, in his essay on the dew-point, states the excess, in the 
 United States generally, to be upwards of fifteen degrees. It is 
 evident, also, from facts mentioned already, and from many others 
 that might, if necessary, be added, that in all parts of this and other 
 countries in localities frequently or occasionally visited by yellow 
 or other forms of malarial, fever a dew-point of sixty or more 
 degrees is often experienced months together without ill health, 
 although the temperature be such as to promote the production of 
 disease. On the other hand, as Dr. Gardner properly remarks, the 
 fens of Lincolnshire, Walcheren, the marshes of Holland, are pesti 
 ferous with a dew-point of less than fifty degrees. 1 
 
 From these circumstances, viewed in connection with the fact so 
 often referred to, that fevers occur in .ships and circumscribed 
 localities, while other ships and localities in the immediate vicinity, 
 and placed under like meteorological influences, remain exempt ; 
 that the alleged effects are not found to be produced by a saturated 
 atmosphere in the higher latitudes; that seamen at sea are exposed 
 with perfect impunity to an atmosphere saturated with moisture, and 
 are attacked only when they land, indicate plainly the impropriety 
 of attaching too much weight to the hypothesis in question, and 
 must debar us from the possibility of connecting, as efficient cause 
 and effect, a high dew-point and malarial fevers of various grades. 
 The impropriety of the belief is farther proved by circumstances 
 which Dr. Gardner appears to have established, i. e. that the de 
 tention of the insensible vapour from the lungs or the skin, by a 
 high point, is much less considerable than it is represented by those 
 who have urged the theory ; that the dew-point in insalubrious 
 places is often much lower than is thought, and that a high point 
 does not arrest the separation of carbonic acid and the other con 
 stituents of sweat. Let us examine the effects produced as we may, 
 and concede to a high dew-point what extent of agency soever we 
 may think to be warranted by the nature of the facts observed, as 
 well as by the well-known influence of atmospheric moisture, we 
 arrive always at the conclusion that something more is necessary 
 to enable us to account for the development of fever; that, by itself, 
 a high dew-point will not occasion the disease ; that, therefore, its 
 
 1 American Journal, ii. N. S. 107. 
 
168 PNEUMONIA AND 
 
 agency is of a secondary character, and consists, perhaps, as Dr. Lee 
 supposes, in checking the elimination of the febrific poison, but more 
 surely in predisposing the system to the action of the true efficient 
 cause, by hindering a natural escape from the blood of those materials 
 which constitute the liability to the disease, or maintaining them in 
 a condition favourable to the morbid change ; as, also, like visible 
 humidity, in promoting, when aided by other influences, those re 
 actions, between the remains of organic and inorganic matters on 
 which the evolution of the morbific agent depends. 
 
 Heat and humidity combined not the efficient cause of fever. From 
 the foregoing facts and considerations, we may conclude that neither 
 heat nor moisture, when acting separately, can be productive of 
 autumnal and kindred fevers. Equally objectionable is the be 
 lief that such diseases arise from the combined influence of those 
 two agencies. In most of the instances mentioned, humidity, when it 
 existed, was associated witn atmospheric heat, and yet the combina 
 tion failed to prove injurious. Dr. Drake remarks, in corroboration, 
 that autumnal fever seldom appears on board of vessels which 
 cruise in the Gulf of Mexico, although the air, at the temperature 
 of 80, is nearly saturated with vapour ; that the inhabitants of Key 
 West, who breathe a similar atmosphere, are much less afflicted 
 with the fever than those on the Peninsula of Florida, several 
 degrees farther north ; that the pine woods around the Gulf of 
 Mexico, at the distance of only two or three miles from the estua 
 ries of the rivers, are places of retreat from fever, although there 
 is a sea and land breeze which tends to equalize the humid atmo 
 sphere ; that the inhabitants of the Balize suffer less from the fever 
 than those along the rivers of the interior of Louisiana, two or three 
 degrees farther north, notwithstanding they are immersed in an 
 atmosphere of great heat and vapour; that, at our different salt 
 works, the operatives spend their lives in a hot atmosphere, satu 
 rated with vapour, and yet, on the whole, are more exempt from 
 fever than the surrounding population; and, lastly, that in some of 
 our manufacturing establishments, the in -door artisans and opera 
 tives labour in a heated atmosphere supersaturated with vapour, 
 but remain free from autumnal fever. To this it may be added, 
 that in the plains of Meta, situate on the east side of the Cordilleras, 
 fever does not prevail extensively, while in the valley of the Mag- 
 nalena, on the west of those mountains, it is of almost constant 
 
AUTUMNAL FEVEKS. 169 
 
 occurrence ; yet the state of the barometer, as well as the hygro- 
 metrical variations, are the same in both places. 1 
 
 These various facts, showing the innocuousness of the combination 
 in question, lead to the inference that, when the prevalence of fever 
 happens to be associated with the existence of heat and moisture 
 combined, the cause of the disease is not to be sought in the latter, 
 inasmuch, particularly, as we find that febrile complaints occur 
 often, and spread widely and fatally, without any such combination. 
 Humidity, therefore, if instrumental in producing fever and no 
 one will deny the fact must, as already stated, act in a secondary 
 capacity ; and, instead of being regarded as the efficient cause when 
 alone or combined with heat, must be viewed as merely aiding in 
 the elimination of the latter, and predisposing the system to its 
 morbid effects. 
 
 Vicissitudes of temperature icill not account for the occurrence of periodic 
 fever. Neither can we admit the propriety of referring the efficient 
 cause of autumnal and kindred fevers to the difference of tempera 
 ture between clay and night, or to mere atmospheric vicissitudes 
 the succession of cool or cold nights to hot days ; nor the sudden 
 exposure of the body, at any period of the twenty-four hours, to a 
 low degree of temperature after it has been placed for a greater or 
 less extent of time under the influence of a high degree. The 
 agency of such vicissitudes were noticed as early as the days of 
 Hippocrates. Hoffman sets them down as the general remote cause 
 of epidemic fevers, and after him, several writers, among whom 
 Broussais 2 and Dr. Dundas 3 figure conspicuously, have laid much 
 stress on their efficiency, and displayed considerable ingenuity, in 
 endeavouring to explain the manner in which the morbid effects 
 are brought about. But after carefully examining what the advo 
 cates of the opinion have adduced in its support, it appears to me 
 that were atmospheric vicissitudes the efficient agent in the pro 
 duction of periodic and other forms of malarial fever, we might 
 expect to find these diseases prevailing principally in seasons in 
 which the number of dew or cold nights following on hot days is 
 greatest. We should be justified also in expecting malarial fevers 
 
 1 Boussingault, An. de Chiraie, Ivii. 153-4. 
 
 2 Commentaires des Propositions, No. 227, pp. 6723. 
 
 3 Sketches of Brazil ; including New Views on Tropical and European Fevers. 
 London, 1852, 205. 
 
170 PNEUMONIA AND 
 
 to occur not once or occasionally, but frequently, if not univers 
 ally, whenever the supposed cause manifests itself; or, rather, it 
 ought to be found that every time such fevers prevail sporadic 
 ally or epidemically the difference of temperature between day 
 and night is greater than in healthy seasons. We should besides 
 expect to find them appearing, not sporadically only, but in an epi 
 demic form, as well in clean, well-paved, and well-aired cities, where 
 atmospherical vicissitudes are as apt to be felt as elsewhere, as on 
 the borders of creeks, rivers, and lakes, and in meadow lands, in 
 level plains or marshy localities ; and whenever a man whose body 
 lias been overheated is suddenly exposed to a cold atmosphere, or 
 plunged into a cold bath, he ought to be regarded as no less liable 
 to suffer from an intermittent, a remittent, or a yellow fever, of the 
 most legitimate kind, than from a pleurisy, a catarrh, or any other 
 kindred disease. But so far from this being the case, experience 
 shows that fevers occur and prevail extensively in situations where, 
 and at periods when, such vicissitudes are not felt at all, or are so 
 to too inconsiderable an extent to be productive of the baneful 
 effects ascribed to them ; and, on the other hand, that those diseases 
 are either seldom felt or completely unknown in localities where 
 or seasons when, sudden changes of temperature, or the contrast 
 between night and day, are as common and noted as, if not more 
 so than, in places, and at times remarkable for insalubrity. 
 Surely a morbid agent which, if it really exercises any influence in 
 the production of autumnal fevers, does so only in localities of a 
 special kind, where, let it be remembered, those fevers often appear 
 and even abound without its aid ; an agent which habitually fails 
 to produce those same fevers in localities of a different kind ; which 
 produces the effect ascribed to it only in a certain season of the 
 year, however manifestly it may show itself at other periods, and 
 whose known ordinary products everywhere and at all times, are 
 diseases very different in every respect from those in question ; 
 such an agent, I say, cannot lay a just claim to be held in the light 
 of the efficient or necessary cause of the latter. 
 
 The climate of Newfoundland is marked by sudden and fre 
 quent vicissitudes of atmosphere ; notwithstanding which, however, 
 fevers are scarcely known there, even among those most exposed. 1 
 The whole coast of this continent, from one extremity to the 
 
 J Tullock, Sickness, &c. of British Army iu British America, 35. 
 
AUTUMNAL FEVERS. 171 
 
 other, is proverbial for the frequency, suddenness, and extent of 
 such changes ; and yet, while some localities are annually the seat 
 of the pyrexial complaints under consideration, others, equally sub 
 ject to the former, remain untouched by the disease. Nay, vicissi 
 tudes, if really the efficient cause of malarial fevers, appear to be 
 whimsical in their operations. See, for example, how they com 
 port themselves in Charleston. The autumnal seasons of 18-49 and 
 1852 were decidedly malarial. During the months of July, August, 
 and September of the first, the number of nights of dew, with high 
 temperature during the day, amounted to 51, and far exceeded that 
 of 1845-8 and 1851, and by 8 that of 1850, in neither of which 
 years did the yellow fever prevail. So far, therefore, there seems 
 to be some connection as cause and effect between cold nights with, 
 hot days and fever. But when we come to inquire into the results 
 obtained in 1852 which was a decidedly malarial year, as evi 
 denced by the occurrence of both the yellow fever and dengue, we 
 find that the number of dew-nights amounted only to 39, or 4 less 
 than in 1850, when there was no malarial developments, and the 
 range of the temperature was greater. For this fact, we are in 
 debted to Dr. Hume, 1 already referred to. The range in 1849, dur 
 ing July, August, and September, amounted to 1,524 degrees (the 
 minimum or night temperature being 63.92, and the maximum or 
 dry temperature being 79.16), and exceeded by far that of 1845 
 6-7-8-50-51. But the range in 1852 was only 1,284 (minimum 
 66.25, maximum 78.91), being only 26 degrees higher than the 
 range of 1851, and less by .82 than that of 1850, when the mini 
 mum was 68.00, and the maximum 81.58. In a word, the resem 
 blance of 1850 and 1851 with 1852, is too striking in this and 
 other respects, to make us attach much importance to this point. 2 
 
 It may not be improper to remark, 1st, that persons who take 
 the fever are seldom sensible of having felt the effects of atmo 
 spheric vicissitudes, and often have been placed, purposely or acci 
 dentally, beyond the possibility of experiencing these supposing 
 them to occur. 2d. That the cold, incident to such vicissitudes, acts 
 on organs different from those concerned in the development of pe 
 riodic or malarial fevers. Producing its first impress on the skin, 
 it affects most frequently those parts which act as supplements to 
 that eliminating tissue the lungs, and the urinary passages. Other 
 
 1 Charleston Journal, viii, 67, 2 Hume, op. cit. 58. 
 
172 PNEUMONIA AND 
 
 parts, of course even the abdominal viscera are sometimes impli 
 cated, but the symptoms which then occur bear no resemblance to 
 those of autumnal fevers, unless other causes have co-operated. 
 That the cold felt under the circumstances is instrumental in ex 
 citing or multiplying attacks of malarial fevers, is no doubt true ; 
 but it does in regard to these diseases what it effects in regard to 
 many other complaints; and it would be wrong, from its agency in 
 those cases, to argue that it is the efficient cause of the disease ; for, 
 alone, it cannot give rise to anything of the kind. More rational is 
 it to view it as having simply aroused from its slumbers a morbific 
 influence floating in and impressing the system in a slow and invisi 
 ble manner, and requiring, for its outward manifestatioD, the dis 
 turbing influence of some other agency. The same result attends 
 the action of atmospheric vicissitudes in regard to diseases of a 
 specific nature, and which no one would have the hardihood to 
 ascribe solely to such a cause. What the latter does as respects 
 malarial fevers, it does, for example, in regard to mercurial ptya- 
 lism in persons whose systems have been impregnated with mer 
 cury; but in whom the affection of the mouth has not yet been 
 developed. In such instances, exposure to atmospheric vicissi 
 tudes to cold, however applied, especially when the system has 
 been previously heated will hasten and increase the elimination 
 of the poison, and salivation will be established. The same remarks 
 apply equally well to hydrophobia, which has not unfrequently 
 been developed through the agency of the cause in question. 
 Nothing is more dangerous than the action of atmospheric vicissi 
 tudes, or cold, 011 individuals bitten by the lanceolated trigono- 
 cephalus of the Antilles. The same injurious effect is said to be 
 experienced by individuals who have been exposed to the action 
 of the mancinella and the Rhus toxicodendron. 1 
 
 In all these instances of change from heat to cold, the latter has 
 acted simply as an exciting cause, and must be ranked with, for it 
 acts much in the same way as, several other agencies intemperance 
 in eating or drinking, venereal excesses, exciting and depressing 
 passions of the mind, &c. which no one in his senses can feel dis 
 posed to regard as capable of producing periodic or malarial fevers, 
 any more than of producing ptyalism or hydrophobia. 
 
 1 Bouclin, Gcog. Mod. 07. 
 
AUTUMNAL FEVERS. 173 
 
 The attack is sometimes too sudden, and follows on too transient an ex 
 posure to infected regions, without appreciable atmospheric vicissitudes, 
 to be the effect of these or any oilier kindred cause. It is not less 
 true that the attack comes on often too suddenly, is too palpably 
 connected with a transient exposure to an unhealthy spot ; and 
 appears under circumstances which too evidently shut out the idea 
 that atmospheric vicissitudes have had an agency in its production, 
 to justify us in viewing these in the light of the efficient cause of 
 the disease. Who has not seen or read of persons being seized 
 with intermittent, remittent, or yellow fever, after a single and mo 
 mentary exposure, not at night only, but sometimes during the day, 
 to the atmosphere of infected localities, who, before such exposure, 
 had borne, with perfect impunity, as thousands of other indivi 
 duals were continuing to do, the thermometriqfil vicissitudes of 
 neighbouring localities. The facts on the subject mentioned by 
 Humboldt, respecting persons taking the yellow fever in conse 
 quence of passing through Yera Cruz in a litter, with a view to 
 embark, are familiar to most readers, 1 and others of similar im 
 port may be easily gathered from the annals of periodic fevers. 
 I could, if necessary, relate several instances of individuals who 
 have been seized with yellow fever after remaining but an hour or 
 two in the city of Havana. The history of all our epidemics fur 
 nish us with examples of the sort. In 1798, Dr. Cooper, who was 
 residing at Bush Hill, imprudently visited the infected district, and 
 was a short time after attacked. During the fever of 1820, in this 
 city, a young man, residing in a healthy district, jumped over the bar 
 ricades, walked through the deserted streets for a few moments, and 
 paid the penalty of his imprudence. " If my own frequent observa 
 tions," says Macculloch, " show that fever may be induced within 
 half an hour after exposure to malaria, and that a single inspira 
 tion, in the space of a very few seconds, is amply sufficient for the 
 purpose, this is also an opinion most decidedly stated by many 
 French and Italian physicians, whose experience and acuteness will 
 not be questioned. It is equally the opinion of others elsewhere, 
 not physicians, and therefore without the bias which might be 
 suspected in such cases; of military, and chiefly of naval men, 
 whose observations have been founded on the momentary and 
 transitory effects of a breeze of wind, and especially of a land-wind 
 
 1 Nouvelle Espagne, 4to. ed. 778-4. 
 
174: PNEUMONIA AND 
 
 blowing off to sea. In France and Italy, to confirm this, instances 
 are known and recorded, of labourers dying instantaneously from 
 merely sitting or lying clown on the ground, and of others who, 
 from looking into a ditch or drain, have been struck dead by that 
 poison, which, of course in a minor degree, has merely produced a 
 fever." 1 But as these statements may be objected to on the score of 
 the tendency to exaggeration with which Macculloch has, perhaps 
 not unjustly, so often been charged, it may not be improper to re 
 mark that the fact of infection after transient exposure, derives 
 ample support from the asseverations of other writers whose testi 
 mony cannot be impugned. Lancisi relates that of a party of 
 thirty gentlemen and ladies of rank in Rome, who made an excur 
 sion towards the mouth of the Tiber, the wind suddenly shifted, 
 and blew from the south over the marshes, when twenty-nine were 
 soon seized with a tertian fever. 2 " The marines," says Lind, " who 
 were three times a week exercised early in the morning on South 
 Sea Beach (in 1765), from the effect of the stagnant water of an 
 adjoining morass, suffered much. Half a dozen of them at a time 
 were frequently taken ill in their ranks, when under arms; some 
 were seized with such a giddiness in the head that they could 
 scarcely stand; others fell down speechless, and, upon recovering 
 their senses, complained of a violent headache. "When such pa 
 tients were received into the hospital, some few had a regular ague, 
 but far the greater number laboured under a remitting fever, in 
 which sometimes, indeed, there was no perceptible remission for 
 several days." 3 Ferguson says, of Monk s Hill : " It was the 
 duty of the white troops, in both these forts, to take the guard and 
 duties of the dock-yard amongst the marshes below, and so pestife 
 rous was their atmosphere that it often occurred to a well-seasoned 
 soldier, mounting the night-guard in perfect health, to be seized 
 with furious delirium while standing sentry, and, when carried back 
 to his barracks on Monk Hill, to expire in all the horrors of the 
 black vomit, within less than thirty hours of the first attack." 4 
 The same writer states that, during the advance of the British army 
 from Oporto in 1809, the troops took up their bivouac in the dried- 
 
 1 Essay on Remittent Fever, &c. i. 16. 
 
 2 De Nox. Palud. Effl. lib. ii. cap. 3. 
 
 3 Dis. of Hot. dim. 24, 5. See, also, 32, 89; 159-100; 240-242. Ib. on Sea 
 men, 81. 
 
 4 Marsh Poison, in vol. of Recollections, 1945. 
 
AUTUMNAL FEVEES. 175 
 
 up beds of the mountain streams. These localities proved highly 
 unhealthy, and several of the men were seized with violent remittent 
 fever before they could move from the bivouac the following morn 
 ing. 1 Dr. Celle, in his Hygiene des Pays Ghauds (79), relates the fol 
 lowing instance of the sudden influence of miasma: " In 1844, eight 
 soldiers, an officer, and a custom-house agent, were sent from San 
 Bias to the environs to surprise a convoy of silver which had been 
 reported as about being embarked by contraband. They con 
 cealed themselves in a thicket, close to a marsh. An hour after, 
 they were all seized with vertigo, nausea, vomiting, and an exces 
 sively violent chill ; in such a way, indeed, that the convoy passed 
 without one of the men being able to rise from the ground to seize 
 it." The same writer states that similar occurrences are noticed 
 among the soldiers and custom-house officers stationed at the en 
 trance of the port of Mazatlan. The station is situate between the 
 sea and a marsh. The men are on duty during twenty-four hours 
 only, yet, at the end of this short time, it generally happens in the 
 rainy season that they all return with fever or dysentery (80). " It 
 is a curious thing," says an official document, " to see six men sent 
 ashore in perfect health, return on board ten minutes after, all six 
 labouring under fever." 2 Nepple relates the history of eight men 
 who, during the hot weather of August, 1825, were employed in 
 thrashing in a barn situate in the immediate vicinity of a source of 
 infection near the town of Montluel. They were all seized the same 
 day with intermittent fever of greater or less violence. 3 
 
 Before the English raised the blockade (of Batavia) parties of 
 men and officers were sent on shore at Edam, to blow up and de 
 stroy the works and buildings on the island, which operations de 
 tained them about half the night there. Most of them were shortly 
 afterwards attacked with the fever. 4 Mr. Lander, surgeon to Lord 
 Eothe s regiment of horse, communicated the following informa 
 tion to Sir John Pringle : Most of the men were first taken ill 
 upon their return from forage ; for, the regiment being cantoned 
 upon the right and left of St. Michael s Gestel (their principal 
 quarters), close upon the inundations, and many of the quarters 
 being above two leagues from Bois-le-duc, where the magazines 
 
 1 Ibid. 2 Admiralty Reports. 
 
 3 Fievres Intermittentes, 142. See, for other cases of similar kind, Second Rep. of 
 Lond. Commiss. for 1848, 96; Bryson, 205; Johnson on Trop. Climates, 127. 
 
 4 Johnson on Tropical Climates, 134. 
 
176 PNEUMONIA AND 
 
 were kept, the men were obliged to set out about four in the 
 morning, in order to get back before the greatest heat of the day. 
 At this early hour, the meadows and marshes on each side of the 
 road were covered with a thick fog of an offensive smell, which 
 Mr. L. considered as the chief cause of the sickness. For, although 
 the party generally returned before noon, several among them were 
 already in a fever, and some actually delirious ; nay, a few on their 
 way home were so suddenly taken with a frenzy, as to throw 
 themselves from their trusses into the water, imagining that they 
 were to swim to their quarters. 1 
 
 Mr. Grainger, in his testimony before "the London Commis 
 sioners," quotes a letter from a medical practitioner: "I was passing 
 the drain-grating at the corner of Union and Bond Street, when I 
 perceived a most faint and disagreeable smell arising from it. Being 
 immediately attacked with nausea and an indescribable sensation of 
 illness, I at once returned home, and drank half a wineglassful of 
 brandy. After a short time the indisposition appeared to pass away, 
 but the peculiar smell of the drain still remained in iny nostrils. I 
 had to visit a patient near Manchester Square, that evening, and 
 whilst in the house, I felt so ill that I immediately returned home 
 and went to bed. At that time my head ached violently. I had 
 nausea, pain in my back, and an unpleasant taste in my mouth. 2 " 
 
 All these cases, and others equally striking, which it would be 
 easy to adduce, show, beyond the possibility of denial, that periodic 
 or autumnal fevers, of all grades and forms from the most trifling 
 to the most malignant are often produced almost suddenly by the 
 shortest possible exposure to sickly localities ; and it is certainly 
 difficult to understand how atmospheric vicissitudes can alone be 
 looked upon as the chief agent in the production of such diversified 
 effects ; seeing especially that the morbid changes to which they 
 usually give rise differ materially from those under present con 
 sideration. Add to this, that atmospheric vicissitudes are not 
 greater, and cannot be more deleterious near to, or to the wind 
 ward of a morass, than at a short distance from, or to the leeward 
 of it; along the margin of a lake or river, than on its surface a few 
 hundred rods off; in a sickly port than at a short distance outside ; 
 and that, if they produce the fever in the former, there is no reason 
 why they should not do so equally well in the latter. 
 
 1 Tringle, 177-8. 2 Kept, 1848, 96. 
 
AUTUMNAL FEVERS. 177 
 
 Fever not the effect of a particular electrical state of atmosphere. 
 Not more satisfactory is the hypothesis that the efficient and neces 
 sary cause of autumnal fever must be sought in some particular elec 
 trical or magnetic state of the atmosphere. On this subject we 
 know too little to form even a plausible conjecture ; and I hazard 
 nothing in affirming that the various theories of Giannini, Mur 
 ray, Craig, Shecut, Eumph, Pallas, and others, have failed to 
 satisfy medical inquirers of sound judgment. The sphere of pre 
 valence of the disease is often circumscribed within such narrow 
 and well-defined boundaries, that it is difficult to perceive the pro 
 priety of regarding it as due to any modification in an agent of the 
 general and wide-spread character, necessarily possessed by the 
 one under consideration. This modification, whatever it may be, 
 whether it consist in an excess or deficiency of the fluid, extends 
 far and wide, and cannot fail to exercise its influence, as well at a 
 distance from, as within the precincts of, the sickly district; and 
 were the theory correct, we should not hear of, and every day see, 
 instances of fever being arrested by a street, a wall, or the like ; or 
 extending its ravages over a very limited surface of ground, in a 
 single ship, or side of a ship, on one side of a street, &c. The same 
 modification in the electricity of the atmosphere must have existed 
 beyond those narrow limits; and if it were the sole cause of the fever 
 on one side of the barrier, it would in all probability have produced 
 a similar effect on the other. Some other agent, then, must have 
 been at work in the former, which did not exist in the latter. It 
 matters not whether the sickly locality covers a small area of 
 ground, or extends over a wide surface, the necessity of that pecu 
 liar agent must be admitted ; and while it would be improper to 
 deny that a modified state of atmospheric or terrestrial electricity 
 exercises an influence in the formation of the supposed agent, and, 
 in addition, predisposes the system to be morbidly affected by it, 
 we must necessarily absolve it from the charge of acting as the sole 
 efficient cause of the disease. 
 
 The preceding facts lead to the lelief in a poisonous agent floating 
 in the atmosphere. All the above hypotheses failing to account for 
 the effects in question, we are naturally led to the admission that they 
 are produced by the morbific influence of some special agent ; and 
 when we take into consideration all the circumstances attending the 
 appearance of febrile diseases, the circumscribed sphere of their 
 12 
 
178 PNEUMONIA AND 
 
 prevalence, the suddenness of their attack, the character of their 
 phenomena, &c., we may safely say that there is nothing left but to 
 attribute them to the action of some poison dissolved or suspended 
 in, and contaminating the air of the infected locality; which poison, 
 while doubtless requiring for its development and dissemination a 
 certain degree of heat and terrestrial and atmospheric moisture, a 
 certain amount of nightly condensation after evaporation, and the 
 presence of fermenting or decomposing materials, cannot be pro 
 duced by either of these agencies alone ; and, though undetected by 
 the chemist, betrays its presence by producing on those exposed to 
 its influence the peculiar morbid changes characterizing fever. 
 
 The innociwusness of some marshes, and of localities similar to those 
 that are sickly, no proof of the non-existence or non-agency of malaria. 
 That marshes and swampy surfaces using these terms in their more 
 enlarged sense collections of organic substances in a state of de 
 composition, &c., do not occasion the effect in question always and 
 everyiuhere; that ships at sea and in port, though often superabund 
 antly filled with such materials of decomposition, are not invariably 
 the seat of febrile developments in a sporadic, and especially in an 
 epidemic form, all must know who have paid attention to the sub 
 ject. During particular seasons, in places presenting some of the 
 peculiar characteristics specified, cases of fever abound. During 
 others, and sometimes during a succession of seasons, the disease 
 is scarcely, if at all seen. In the quebradas of Peru, fevers are 
 often general, and assume the garb of wide-spreading and malignant 
 epidemics. This continues a year or two, during which the mortal 
 ity becomes very considerable. At the end of that time a favoura 
 ble change takes place, and the country once more becomes healthy. 1 
 
 In a medical report of the House of Kecovery of Dublin for 
 1829, Dr. O Brien says : "Intermittent fever has been a rare disease 
 in Dublin, and, we may add, in Ireland. During a period of twenty 
 years, through which the author s experience extends, a few inci 
 dental cases only of the disease occurred, from time to time, in his 
 hospital and dispensary practice, and those few were persons who 
 brought the disease from England. A singular revolution has 
 taken place in Dublin for the last two years with respect to inter 
 mittent and continued fevers ; the latter disease, which, for a cen- 
 
 1 Ulloa, Mem. Fhilos. i. 245. 
 
AUTUMNAL FEVERS. 179 
 
 tury, had been the constant scourge of this city, has considerably 
 declined, and intermittent fever has sprung up, and occupied its 
 place. For the last four months, however, up to February, 1830, 
 intermittent fever has again disappeared, and I am happy to say, 
 without a corresponding increase of continued fever." 1 
 
 I shall not stop to show that the same alternation of healthy and 
 sickly periods in localities where, from the nature of the soil, and 
 some of their external conditions, fever might at first sight be ex 
 pected to arise annually, has been noticed in this country and else 
 where. The task would offer no difficulty, for facts to the point 
 could be abundantly supplied by the Transactions of our State 
 Medical Society, 2 and a variety of works of easy access. But the 
 subject has already been alluded to, and may be reverted to again 
 under a different head, and must, besides, be familiar to all well- 
 informed and observant physicians. 
 
 It not unfrequently happens that in localities where, from the 
 character of the soil, or the nature and condition of the substance 
 by which the surface is covered, as well as from the heat and moist 
 ure of the climate, febrile complaints might be expected to occur, 
 they are, nevertheless, seldom or never encountered. We have 
 already seen that many parts of Scotland and Ireland that are 
 occupied by large tracts of peat moss are completely free from 
 these fevers, and that the disease is never seen among the inhabi 
 tants of the country bordering on the Dismal Swamp between Vir 
 ginia and North Carolina. The numerous and extensive marshes 
 of Sweden, somewhat beyond the sixtieth degree of latitude, of 
 Norway, of Eussia near St. Petersburg, for example of Laponia, 
 &c., have, it is said, little influence on the mortality or salubrity of 
 those regions ; intermittents and remittents not being endemic there; 3 
 and every one knows that, whatever be the condition of the towns 
 and cities of these regions, or of Northern Europe generally, yellow 
 fever, properly so called, has never, except perhaps at Copenhagen 
 and even this is open to doubt made its appearance there. 
 
 Intermittents are almost unknown on the banks of the Khine from 
 its source to Chur. Making their appearance near this place, they 
 
 1 Dublin Med. Trans. N. S. i. 330-1. 
 
 2 See Trans, of Med. Soc. of the State of Pennsylvania, ii. 51, 93. 
 
 3 Monfalcon, 2G ; Acerbi Viaggio al Capo Norte ; Brocchi, op. cit. 277 ; Brit, and 
 For. Med.-Chir. Rev. x. 367; Bovidin, An. d Hygiene, xxxiii. 116; Bang. Prax. 
 
 Med. 36. 
 
180 PNEUMONIA AND 
 
 continue to show themselves as far as Maienfeld, where they again 
 disappear, to break out anew, and prevail from Strasburg to Bingen. 
 A.t this spot they once more are lost sight of, and are not seen 
 before reaching Cologne, and especially the delta of the above-men 
 tioned river. 1 
 
 On the summit of the group of Calabrian mountains, denominated 
 La Sila, the larger portion of which, formerly covered with forests, 
 is at present under culture, are to be found extensive marshy 
 localities. One of these, situate in the valley of the Crocifisso, 
 between Cecio and Camiliati, is very large. From these marshes 
 arise thick fogs, which float on the surface to the height of many 
 feet, and continue to do so till dissipated by the action of the sun ; 
 yet the peasants sleep with perfect impunity along the margin of 
 these marshes during summer and autumn, and the proprietors re 
 side there the whole of that time in the Hotel or Casino of Cecio. 2 
 
 It will be found that,"fn cold climates, periodic or malarial fevers, 
 generally considered, diminish in frequency in proportion to the 
 elevation of the latitude, but that in so doing they conform less to 
 the direction of the parallels than to that of the isothermal lines. M. 
 Boudin, 3 who has called attention particularly to this circumstance, 
 remarks that, though but little prevalent at St. Petersburg, which, 
 nevertheless, is surrounded with marshes and situate under the 
 59 of north latitude, they cease to exist in Asia towards the 57, 
 whilst in Sweden, they show themselves as far as the 63 of the 
 same latitude, and even reach, somewhat farther in a westerly 
 direction, the Shetland Islands, and even Iceland. From this, it 
 results that the northern limit of intermittent fever is in some 
 measure represented by the isothermal line determined by an 
 annual temperature of 5 centigrade, with a mean of in winter, 
 and 10 in summer ; and that this line lowers in Central Asia and 
 in North America below the 50 of north latitude; whilst between 
 those two continents and on the Atlantic Ocean it rises as high 
 as the 67 of the same latitude. 
 
 The marshy grounds on the south-west coast of Ceylon, between 
 Negombo and Galle, do not seem to exercise much influence in the 
 production of fever. Again, the island of Mauritius, in the Eastern 
 hemisphere, resembles Jamaica in its physical characters. The 
 
 1 Boudin, Fiovrcs Intcrmittentes, 58. 
 
 2 Brocchi Stratto Fiscio del Suollo di Romn, &c. 278. 
 
 3 Geographic Medicalc, 10. 
 
AUTUMNAL FEVERS. 181 
 
 temperature is the same ; it lies nearly in the same latitude, but to 
 the south of the line ; morasses and marshy land occur as frequently 
 in the one as in the other, and yet periodic fevers are rare in the 
 Mauritius, and the mortality small from this cause ; while, in 
 Jamaica, the reverse is the case, remittent fever being a common 
 and fatal disease. 1 
 
 In many parts of New England, as far as the St. Lawrence, New 
 Brunswick, Nova Scotia, and Lower Canada, Forts Moultrie, and 
 Munroe, Hancock Barracks, West Point, etc., fever is seldom, if 
 ever noticed, though, judging from the external appearances and 
 position of those localities, some of which are at the outlet of rivers, 
 and exposed to that combination of mud and marsh, regarded as 
 its prolific source in other parts, there is nothing by which we can 
 account for the exemption. 2 Dr. Drake, who has paid considerable 
 attention to this subject, remarks that the geographical limits of 
 fevers in this country are east of the Appalachian Mountains below 
 the 83 of latitude, beyond which those mountains do not extend. 
 Below that parallel, it has no eastern limit but the Atlantic Ocean. 
 South-west, the Cordilleras of Mexico and the Southern Eocky 
 Mountains, constitute its boundaries. In higher latitudes, it ceases 
 in the great plains of our western desert, long before we reach 
 those mountains. It is almost unknown at the distance of three 
 hundred miles from the western boundary of the States of Missouri 
 and Iowa, above the latitude of 37 N. To the north, it does not 
 prevail as an epidemic beyond the 44 parallel, and ceases to occur 
 even sporadically about the 47. 3 
 
 Dr. Carpenter states that on the bayous of the Louisiana delta, 
 Lafourche and Terrebonne, for example, the habitable land is limited 
 to narrow strips, of from a few hundred feet to a mile in width, 
 which form the banks of the streams, and follow their windings, 
 and which are surrounded on all sides by swamps and marshes, in 
 some places, and in others, open and exposed ; yet, notwithstanding, 
 these regions are more exempt from fevers than almost any other 
 portion of the State. 4 Diseases arising from malaria might be 
 expected to be very prevalent in the valley of the Sacramento, 
 containing, as it does, thousands of acres of land subject to annual 
 overflow, and from which there is no escape for the water, except 
 
 1 Tullock, Sickness and Mortality of British Army, 1G, 45. B. 
 
 2 Forry, op. cit. 278-0. 3 Op. tit. 704. 
 4 Carpenter 011 Periodicity, N. 0. J. iii. 429. 
 
182 PNEUMONIA AND 
 
 by the slow process of evaporation, under the rays of an intensely 
 hot sun ; yet, notwithstanding this, cases of intermittent fever are 
 comparatively rare in this part of the valley. A few mild cases of 
 intermittent fever occurred in the neighbourhood of the city last 
 spring ; but they appeared to be confined to low localities which 
 are situate in the immediate vicinity of stagnant water. 1 
 
 Dr. Tilton, in a communication to Dr. Currie, states that the 
 town of Lewes, on Cape Henlopen, in the State of Delaware, is so 
 salubrious, that the inhabitants are the longest-lived in the State, 
 and persons affected with enlarged spleen, and obstructed viscera, 
 from repeated atjacks of fevers, are speedily restored to health by a 
 residence there. Yet, the Cape is perfectly surrounded with marshes. 
 The same thing is observed at Bombay Hook, another town of the 
 same State. 2 
 
 But such facts, and numerous instances of vessels, which, though 
 filthy in the extreme, remain free from fever, upon which Dr. Dun- 
 das and other opponents of the doctrine of malaria seem to attach 
 so much importance, do not, true as many of them doubtless are, 
 militate against the views here advocated. Neither can much be 
 made out of the fact, often, adduced, that the true yellow fever has sel 
 dom prevailed farther south than the Amazon Kiver, which divides 
 Brazil from Guiana, though materials for decomposition, terrestrial 
 and atmospheric humidity, and high temperature, exist to as great 
 an extent south as north of that point ; that its proper soil is to be 
 found in the West Indies, on a small portion of the coast of South, 
 and a larger one of North America, and of "Western and Eastern 
 Africa, embracing an area which extends from the aforesaid river to 
 Charleston in one direction, and from Barbadoes to Tampico in 
 another to say nothing of its appearing occasionally as low as New 
 York, or even Boston, as well as in some parts of southern Eu 
 rope; that the disease, indeed, can scarcely be said to appear south 
 of the equatorial line, sparing the Atlantic and Pacific coasts of 
 America, south of the Amazon ; and that it seldom or never ap 
 pears in the East Indies, where, notwithstanding all that Valentin, 
 Efirth, Pugnet, Lind, Bancroft, Chervin, and many others may have 
 said to the contrary, autumnal fever assumes the character of the 
 bilious remittent, and not of the true typhus icterodes. 
 
 1 Blalce, On the Climate and Diseases of California, N. 0. J. ix. 510. 
 
 2 Currie ; Hist. Account of the Climate and Diseases of the United States, 211, 218. 
 
AUTUMNAL FEVERS. 183 
 
 In reference to the argument against the malarial origin of fever 
 derived from the exemption from the disease in question beyond 
 the limits thus assigned to it, it may be remarked that, admitting 
 the statements on which it is predicated to be correct, the exemp 
 tion in question could not be used successfully to disprove the 
 necessity of morbid exhalations in the production of the fever ; for, 
 if it be true that such exhalations which must exist south as they 
 do at the equator and north of it do not give rise to the disease 
 beyond the limits mentioned, the opponents of malaria will have to 
 explain how it happens that the causes to which they assign it, and 
 which they must allow exist in as full force on one side as on the 
 other of the line, do not occasion the effect. If such causes are, from 
 some unexplainable influence, incapable of producing that form of 
 fever south of that line, while they occasion it in the other direc 
 tion, there is no reason why the same may not be the case with 
 respect to exhalations. But we may go farther, and deny the state 
 ments respecting the absence of yellow fever south of the equator ; 
 for, though it be true that in South America the disease is not of 
 such frequent occurrence as in the West Indies, and on the coast 
 of America at or north of the line though in India the fever sel 
 dom, if ever, appears in its legitimate garb, there are not wanting 
 facts, of the most unequivocal character, to show that yellow fever 
 has made its appearance, and prevailed extensively and fatally be 
 yond the southern limits mentioned. Of course it will not be denied 
 that such has often been the case on the African coast. The epi 
 demics of Sierra Leone, Ascension, Boa Yista, &c., are there to settle 
 that point. Turn we to the American continent, and we shall find 
 that the fever has prevailed at Guayaquil j 1 that it has shown itself at 
 Callao; 2 and that it has not spared Montevideo. 3 Nor should it be 
 forgotten, that the very first epidemic of yellow fever of which we 
 have the records, occurred in the southern hemisphere at Olinda, 
 in Brazil where it is said to have exercised its baneful effects 
 from 1687 to 169-i; 4 and, agreeably to the fanciful notions of the 
 importationists, to have been communicated to vessels from Siam, 
 
 1 De la Condamine, Voyage a 1 Equateur, Paris, 1751, iv. Ulloa, Voyage Historique 
 de 1 Amcrique Meridionale, ii. 149 (1752). 
 
 2 Leblond, Observ. sur la Fievre Jaune, 200. 
 
 3 Humboldt, Essai Politique, iv. 503, 8v. ed, 
 
 4 Fcrreyra da llosa, Tratado unico da constitui9ao pestilencial de Pernambuco, em 
 Lisboa, 1094. 
 
184 PNEUMONIA AND 
 
 which in their turn introduced it into Martinique. I am aware 
 that doubts may be entertained as to the real icterode nature of 
 that fever, and I myself am not free from misgivings on the sub 
 ject; but, admitting it to have been nothing more than a severe 
 form of bilious remittent fever with typhoid tendencies, some of 
 the cases observed on that memorable occasion presented the de 
 cided characters of true yellow fever, thereby showing the possi 
 bility of the occurrence in question. Since then, we learn from 
 Sigaud that, during his residence at Eio, he saw five well-marked 
 cases of the disease. 1 Add to this that the events of the last few 
 years are of a nature to convince the most skeptical of the possi 
 bility of true yellow fever occurring in that hemisphere; for no one 
 is ignorant of the fact that the fever broke out at Bahia, in Brazil, 
 and soon after at Bio Janeiro, where it pursued the epidemic course 
 it pursues everywhere. 
 
 But these facts, to say nothing of the circumstance that the dis 
 ease observed by Fontana 2 and others on the East India coast, pre 
 sented the characteristic marks of yellow fever, will be sufficient to 
 disprove the statements referred to, and to convince us that the 
 same causes which occasion the disease on one side of the line may 
 do so equally well on the other. If, therefore, we find the disease 
 less apt to prevail in some places than in others, and if a like 
 exemption as regards the other forms of malarial fevers is noted in 
 various localities, we are not from that circumstance warranted in 
 denying the febriferous power of malaria, for, on examination, it 
 will be found to arise from the operation of well-known influencing 
 agencies. 
 
 The exemption may le explained in various icays. Sometimes it is 
 due to the high elevation above the level of the sea of the place so 
 exempted. At another time, the effect is attributable to the ab 
 sence of a sufficiently high and long-continued atmospheric heat. 
 In other instances, the circumstance is due to a very perfect and 
 constant ventilation, and a very rarefied and pure character of 
 atmosphere. In some instances, again, it may be explained by the 
 peculiar geological character of the soil ; the quantity and the qua 
 lity of the surface-water ; or the proportion of sulphates the latter 
 
 1 Du Climat ct ties Maladies du Brezil, 258. 
 
 2 DCS maladies qui attaquent les Europdens dans les pays cliauds, 72-3. 
 
AUTUMNAL FEVERS. 185 
 
 contains in solution. Sometimes, also, it is due to the rapidity of 
 the river currents, the excessive and rapid dryness of the atmosphere 
 during the hot season, the existence and extensive prevalence of 
 refreshing and purifying winds, and often to the degree of desicca 
 tion the surface has attained by natural or artificial means, the 
 degree of cultivation to which it has been carried, and other agencies 
 of like import, as well as by the extent to which it is sheltered, 
 by rich foliage and other means, from the action of the sun. So 
 far as ships are concerned, the freedom from fever will often be 
 found ascribable to the latitude in which they may be navigating, 
 to the early period of the year in which they may be at sea, or 
 otherwise employed ; or, to the absence of an epidemic constitution 
 of atmosphere. 
 
 In the examination of the subject, none of these contingencies 
 should be overlooked. Experience has shown that there is an 
 altitudinal range, varying in different parts and according to the 
 peculiar form of the disease, beyond which, owing to the greater 
 rarefaction of the air, peculiarity of temperature, or other circum 
 stances, the elimination of the febrile poison does not take place, 
 or the latter is rendered inert; that a certain range and continued 
 elevation of the thermometer is required for its development ; and 
 that free ventilation, and strong unimpeded currents of wind are 
 inimical to its morbid agency. Experience has shown in addition, 
 that while, as we have seen, an argillaceous soil is prone to the 
 development of fever, a region of primary formation, with a sandy, 
 calcareous, arid, and sterile soil, allowing no stagnant water, and 
 containing only a small proportion of organic remains, is usually 
 exempt from the disease ; that, in not a few instances, the passage 
 from a fever to a healthy locality takes place within circumscribed 
 boundaries, and is indicated by a difference in the geological for 
 mation of the soil ; and that, if exceptions to this occur, the ex 
 planation is easily found in the fact that the cause of the disease 
 has been wafted from some pestiferous region, to a locality which, 
 otherwise, would have remained unaffected ; or in the circumstance 
 that the calcareous structure of the sickly spot, though naturally 
 of a kind not subject to fever, is covered over, extensively or in 
 spots, with a more or less thick coating of rich absorbent soil, 
 possesses an argillaceous substratum, or presents depressions, in 
 which water stagnates, and the process of decomposition takes 
 place. Again, experience has shown that water containing a small 
 
186 PNEUMONIA AND 
 
 amount of sulphates, is less injurious to health, and less prone to 
 favour the formation of malaria, than that which is richer in those 
 materials ; while on examination, it is found that the vegetable 
 matter contained in peat moss is subcarbonized, and necessarily 
 unsusceptible of decomposition ; that such moss, as already stated, 
 is known to possess peculiar antiseptic qualities, which, by impart 
 ing to it the power of preserving not only trees and other vegetable 
 but animal substances from putrefaction, renders it unfit to evolve 
 the efficient cause of periodic fevers. 
 
 See the remarkable contrast noticed in the relative prevalence of 
 agues in New England, New Brunswick, and Nova Scotia, on the 
 one hand, and on the other, in the region of the great lakes on either 
 the American or British soil. This contrast, resulting from the ab 
 sence of such fevers in the former region, and its great prevalence 
 in the latter finds no explanation, as Dr. Forry well remarks, in 
 any difference of climate as regards temperature and moisture ; 
 but the solution must be sought in the modification of climate 
 arising from geological formation and the nature of soil. " Now, 
 as the region of New England, as far as the St. Lawrence, with 
 little exception, has a primitive formation, with a sandy, sterile 
 soil, whilst that of the lakes consists of a secondary formation, 
 having, not urifrequently, an alluvial superstratum, composed of 
 a rich vegetable mould from three to six feet deep, it is not diffi 
 cult to deduce the correct inference. In the former, the geologi 
 cal structure is destitute of organic remains, and the little con 
 tained in the sandy soil does not find enough moisture to induce 
 the necessary chemical action ; while in the latter, not only is the 
 geological formation of secondary origin, but the deep, rich soil is 
 sufficiently humid, when a high temperature acts upon the organic 
 remains with which it abounds, for the development of the morbid 
 poison called malaria." 1 
 
 The fact that some marshy surfaces, which are supposed to 
 give rise to fevers by means of the exhalations issuing from them, 
 prove completely, or to a great extent, innocuous in certain sea 
 sons, and even during a succession of years, cannot be urged as 
 an argument in favour of the denial of the malarial cause of fever, 
 finding, as it does, a ready explanation in the absence, during those 
 seasons of exemption, of the thermometrical and hygrometrical 
 
 1 Forry, Climate of the United States, 280. 
 
AUTUMNAL FEVERS. 187 
 
 conditions, which experience has taught us to regard as essential to 
 the evolution of the poison, as well as, often, in the absence of that 
 peculiar state of atmosphere to which the name of epidemic, con 
 stitution, or meteoration has been applied ; and the agency of which, 
 in diffusing and enhancing the virulence of the cause of certain 
 diseases explain it as we may, and extraordinary as it may appear 
 it would be just as reasonable to doubt, as to doubt the existence 
 of those fevers themselves. 
 
 Elevation. In regard to elevation not that to which the cause 
 of fever, and of course fever itself can be carried, for we shall see 
 that much may be done in that way ; it is a fact of common 
 notoriety that it exercises a marked influence," not only on the form 
 and type of the disease, but even on its very existence ; an influ 
 ence not very dissimilar from that which, as already pointed out, is 
 occasioned by geographical latitude. If fevers decreased in frequency 
 in proportion as we proceed in a northern direction ; if at last we 
 reach a latitude where they cease to manifest themselves; so, in like 
 manner, as we ascend from the level of the sea, they are found to 
 diminish in frequency till at last we arrive at a degree of elevation 
 varying according to many concomitant circumstances, where 
 localities which, in lower regions, would be sure to be more or less 
 infested with malarial fevers may be visited and inhabited with 
 entire impunity. 
 
 We have already seen that the marshes on the summit of the 
 Calabrian Mountains do not possess febriferous powers. In other 
 parts of Italy, though some places, as Sezza, Norma, Sermonetto, at 
 an elevation of from 230 to 300 metres, are unhealthy, Monte Mario, 
 near Eome, at a height of between 130 to 150 metres (about 495 
 feet), and Tivoli, at one of 208 metres (about 690 feet), are free 
 from the fever which scourges the neighbouring localities. 1 Much, 
 of course, will depend on the direction of the wind, the mode of 
 exposure, and other local circumstances. As a general rule, accord 
 ing to Tournon, when we reach a height of from 120 to 150 metres 
 above the level of the plain, we enter the salubrious zone, 2 whatever 
 may be the nature of the localities so situate. Monfalcon (p. 75) 
 agrees with those who fix the limits at four or five hundred metres 
 
 1 Tournon, Etudes Statistiques sur Rome, i. 209 ; Julia, 25, 2G ; Brcyslack, Voy. 
 dans la Campanic, ii. 
 
 2 Tournon, ibid. 209; Carriere, 314 (note). 
 
188 PNEUMONIA AXD 
 
 1,167 to 1,667 feet. The Italians are well aware of this advan 
 tage of elevation ; for, according to them, in ascending, we pass 
 gradually from the aria passima to the cativa ; thence to the sospetta; 
 then to the sufficiente ; to the buona ; and, finally, to the find o 
 ottima. 
 
 The mountains of Corsica, 1 of Tyrol, 2 and of Switzerland, 3 are 
 in like manner exempt from the same diseases, while the valleys 
 and low lands are severely afflicted ; and yet, in the former, sources 
 of marsh exhalations are not wanting. Maroon Town and Phoenix 
 Park (Jamaica), each at a height of 2,000 feet, are remarkable for 
 healthiness. 4 The inner Cabrite and the outer Cabrite the first at 
 430 and the latter 590 feet of elevation have also been found very 
 healthy. In Grenada, Morne Cardigan, 500 feet, and Kichmond 
 Heights 730 feet, are not sickly. 5 Mount Demoulin, near Roseau, in 
 the Island of Dominica, at an elevation of 1,500 feet, has been inva 
 riably free from yellow fever. 6 The same immunity has been 
 noticed in St. Domingo, in the mountainous parts of which, what 
 ever be the condition of the soil, this disease does not prevail. 7 The 
 same fever has made its appearance, in 1812, and other occasions, 
 on Brimstone Hill, St. Christopher, at an elevation of 700 feet, 8 and 
 four times (1817, 1825, 1827, and 1831) at Stoney Hill, Jamaica, 
 the height of which is 1,360 feet. 9 But these are generally healthy, 
 and free from ordinary fever. In Mexico, according to Humboldt, 
 the farm of the Encero, the height of which is 928 metres, forms 
 the superior limits of the vomito, 10 and the same disease scarcely 
 ever passes beyond the ridge of mountains that separate La Guayra 
 from the valley of Caraccas. 11 
 
 Major Tullock, while remarking that mere elevation to a height 
 of 600 or 700 feet, does not secure a healthy position, as demon 
 strated by the instances of Fort St. George, at Toboga, of Morne 
 Fortune, at St. Lucia, and of Mount Bruce, at Dominica, where, 
 indeed, the results were the reverse of salutary, adds that it is 
 proved beyond a doubt that, "at an elevation of 2,000 or 2,500 feet, 
 
 1 Heurteloup, Tr. de Giannini, i. 269 (note). 
 
 2 Zimmerman, de 1 Expericnce, i. 10G. 
 
 3 Bosquillon, Tr. de Cullen, i. 70. 
 
 4 Imray, Ed. J. Ixx. 200 ; Arnold, 192 ; Statist. Kept, of Sickness, &c. fi3. 
 
 5 Hunter, 307. 6 Imray, Edinb. J. Ixiv. 340 ; Lind, 224. 
 
 7 Bally, 326, 335 ; Dalmas, 64, 65 ; Gilbert, 102. 
 
 8 11. Jackson, Sketch, i. 10. 9 Tullock s Kept, 59. 
 
 10 Xouvelle Espagne, 771. Humboldt, Pers. Nar. iii. 392-5. 
 
AUTUMNAL FEVEKS. 189 
 
 they are likely to be wholly exempt from that disease, or to 
 encounter it in so very modified a form, that the mortality from all 
 causes will not, on the average of a series of years, materially 
 exceed that to which an equal number of European troops would 
 be subject in the capital of their native country." 1 Bally also gives 
 to the yellow fever an analogous altitudinal limit. 2 
 
 In this county, the yellow fever is never known to prevail in 
 very high situations, whatever may be the condition of the localities. 
 As regards ordinary autumnal fever, the exemption is noticed from 
 one end of the continent to the other. The city of Mexico, and 
 the surrounding country, is never visited by the fever which 
 scourges the land near the level of the sea. " The inhabitants 
 among the sources of the Kenawba and Tennessee Rivers, on the 
 Appalachian Mountains, at a medium elevation of nearly three 
 thousand feet, are almost exempt, while those who occupy the 
 valleys under the same parallels are affected ; and farther north, 
 at half that elevation, where the Alleghany and Genesee Rivers 
 have their sources, the disease is almost unknown, while on the 
 shores of Lake Ontario, directly north, it prevails. Finally, the 
 constantly increasing elevation of the desert to the west of the 
 Mississippi is, no doubt, one cause of the disappearance of the 
 fever under the same parallels in which it prevails on the banks 
 of that river." 3 
 
 Assilini, in his treatise on the Plague, remarks that, during all the 
 epidemic fevers, and even the most dreadful plagues, there have 
 been, in those cities and provinces where such diseases were raging, 
 some healthy spots. "The citadel of Cairo presents," he states, "one 
 example. It has been observed that the inhabitants of this fort 
 and its environs have always escaped from the plague, even from 
 that of the year 1791. If the inhabitants of this fort, in spite of 
 their daily intercourse with those of the city, were preserved from 
 this disease, it must be because the damp and infected air which 
 had destroyed the health of the inhabitants of lower Cairo, had not 
 sufficient elevation to reach to the highest part of the citadel and 
 its environs, and consequently could not impair the health of those 
 who lived there." (Pp. 58-9.) Just as probable is it that the exha 
 lations giving rise to that form of fever cannot be eliminated in 
 that high and salubrious situation. In the year 1835, when the 
 
 1 Oj). cit. 103. 2 Typhus d Amerique, 025, 6. 3 Drake, 715. 
 
190 PNEUMONIA AND 
 
 disease committed such ravages in the same city, the citadel was 
 again preserved, as well also as the village of Loumeldik, the situa 
 tion of which is sufficiently high to overlook the whole Peninsula. 1 
 As regards the cause of the diminution and cessation of iniasmal 
 
 O 
 
 fevers at certain degrees of terrestrial altitude, it will be unnecessary 
 to enter at any length in this place. The effect may be due in 
 some measure to a diminished atmospheric pressure. But many 
 circumstances induce the belief that the explanation must be sought 
 principally in the diminished or low temperature which forms a 
 characteristic of high localities; for it is a well-ascertained fact 
 that, except in cases where the soil expands into extensive plains, 
 and the irradiation of caloric which ensues counterbalances the 
 cold incident to such positions, the elevation of the soil is invari 
 ably attended by a diminution of temperature. It has been com 
 puted that a perpendicular elevation of from three hundred to four 
 hundred feet produces a decrease of heat equal to that attendant on 
 an approach of one or two degrees toward the poles. Fuster, in his 
 highly interesting work on the Diseases of France, calls attention to 
 the fact that, under the line, a degree of cold is generally found 
 to correspond to an elevation of 219 metres or 730 feet ; in the 
 temperate zone, to 174 metres or 580 feet; in winter, to 70 metres 
 or 233 J feet less than in summer; and at seven o clock of the morn 
 ing to 60 metres or 200 feet less than at five o clock of the afternoon. 
 In Paris, during the hot season, when the ground is nearly as much 
 heated as it is in tropical regions, it was ascertained by Gay-Lussac, 
 at the time of his aerostatic ascension, that at a height of 7,000 
 metres, or 23,333J feet, a degree of cold corresponded to an eleva 
 tion of only 174 metres or 500 feet. 2 
 
 Supposing these statements to be correct, it follows, as M. Boudin 
 remarks, that, at the 46th degree of N. latitude, an elevation of 
 2,000 metres or 6, 6 6 6f feet, would give us the temperature of Lapo- 
 nia. 3 With this before us, we can understand that febrile complaints, 
 which are found to diminish in point of frequency as we proceed in a 
 northerly direction, and finally disappear when we reach a certain 
 point, will equally cease to exist at a given height above the level 
 of the sea. 
 
 1 Clot Bey, Do la Pcstc, 223 ; Braycr, Neuf Annees a Constantinople, i. 357. 
 
 2 Fuster, DCS maladies de la France dans leurs rapports avec les saisons, &c. 33. 
 
 3 Op. cit. 35. 
 
AUTUMNAL FEVERS. 191 
 
 This will appear the more natural when we take into considera 
 tion the effect of temperature on the production and dissemination 
 of these complaints, for, as Dr. Forry has well remarked, the meteor 
 ology of heat is intimately connected with the laws of malarial dis 
 eases in the relation of cause and effect. 1 
 
 Degree of heat. Experience teaches us that, although heat alone 
 cannot be viewed as the efficient cause of autumnal or periodic 
 fevers, a certain range and permanence of elevation of temperature 
 are necessary to insure the development of the disease ; and that, 
 unless this obtains, the latter does not make its appearance, how 
 ever favourable in appearance the soil and localities may be to the 
 production of morbid exhalations. It has already been seen that 
 fever rarely prevails in cold climates, and then only during hot 
 weather; that in temperate latitudes it never shows itself in the 
 winter season, but breaks out towards the middle of summer ; that 
 a temperature of sixty degrees is necessary for its manifestation; 
 that it will not prevail as an epidemic where the temperature of 
 that season falls below 65, and that it disappears on the accession 
 of frost. 2 The necessity of a still higher temperature, continued 
 during a certain time, has been found requisite to insure the pro 
 duction of true yellow fever ; for, whatever be the condition of the 
 localities where it generally breaks out and prevails, the occurrence 
 fails unless the thermometer marks a high degree of heat, and con 
 tinues to give a certain average during weeks or months. We all 
 know the average summer temperature of the tropics the proper 
 soil of the disease. Nowhere, whether in Africa, the West Indies, or 
 on the South American coast, does it fall under 80. In our Southern 
 States, where the winter season is characterized by cool weather, the 
 summer heat approaches to that of tropical regions ; and when the 
 fever, which, as is known, is not there of annual occurrence, breaks 
 out, it does so generally in seasons when the range of the thermo 
 meter equals that of the West Indies and Vera Cruz. Such has been 
 the case at New Orleans, Mobile, Natchez, Charleston, and Savannah. 3 
 
 1 Climate of U. S. 277. , 2 Drake, 715. 
 
 3 Gros, 5 ; Thomas, 62, 78, 109 ; Barton, Fev. of N. 0. in 1833, pp. 4, 5 ; Baxter, Med. 
 Repository, xxi. 3; Kept, on Fever at N. 0. in 1819, 6, ib. for 1839, Journ. of Med. 
 Soc. 156; ib. for Fcv. of 1820, for 4; Shecut Med. Essay, 77, 93, 103; Tooley, Fever 
 of Natchez, in 1823, p. 7 ; Giraruin, 51 ; Merrill, N. A. J. ii. 237, ib. Med. and Phys. 
 Journ. ix. 233; Monnett, 11, 35; Chabert, 23: Perlee, Med. and Phys. J. iii. 17; 
 
192 PNEUMONIA AND 
 
 Nor is this less the case in our Middle States, where the summer 
 temperature likewise approximates closely to that of the torrid 
 zone, for there the fever has scarcely ever appeared, unless the 
 mean temperature has reached or approached to 80. This has been 
 observed at Norfolk, Baltimore, New York, Providence, and Bos 
 ton. It was also early pointed out in this city, and has been noticed 
 in all the epidemics that have prevailed here from 1699, to the pre 
 sent year. All this the reader will easily find by referring to the 
 writings of Valentin, 1 Whitehead and Selden, 2 Archer, 3 Dal mas, 4 
 Miller, 5 Seaman, 6 Bayley, 7 Townsend, 8 Drysdale, 9 Wheaton, 10 
 Brown, 11 Cadwallader Evans, 12 Caldwell, 13 Deveze, 14 Chapman, 15 
 Folwell, 16 Ffirth, 17 Bush, 18 and others. 19 Sir Gilbert Blane has 
 called attention to the same fact, in relation to the yellow fever of 
 Europe, 20 and his observations are fully confirmed by those of every 
 writer on the epidemics of Cadiz, Barcelona, Gibraltar, Leghorn, 
 Xeres, Seville, Carthagena, Marseilles, &c., where the appearance 
 and prevalence of the fever has, as elsewhere, invariably been asso 
 ciated with a mean temperature, in every way equal to that observed 
 during sickly seasons within the tropics. 21 
 
 Cartwright, Mcd. Recorder, ix. G ; Dickson, Med. and Phys. J. iii. 251 ; ib. Eclectic 
 J. iv. 112; Simon s Address, 3 ; ib. Kept. 10; Chalmers, Climate of S. C. i. 164 ; Moul- 
 trie, French Translation, 8 ; Ramsay, Hist, of S. C. ii. 83 ; Lining, Edinb. Essays, ii. 
 409; Dupre*, Am. J. (N. S.) ii. 382 ; Waring, 20; Tucker, Barton s J. ii. 22 ; Fenner, 
 N. 0. J. Sept. 1848, p. 194. 
 
 1 Fievre Jaune, 85, 6. 2 Med. Repos. iv. 129. 
 
 3 Med. Recorder, v. 61. 4 Fievre Jaune, 30, 38. 
 
 5 Works, 118, 110, 433. 6 Webster s Collection, 1, 2. 
 
 7 Fever of N. Y. in 1795, p. 124. 8 Fever of N. Y. in 1822, p. 259. 
 
 9 Med. Museum, i. 31. )0 Med. Repos. x. 329. 
 
 11 Med. Repos. ii. 360, 467; Treatise on Fever of Boston, in 1798, p. 26. 
 
 12 Ecclect. Repertory, vii. 425 ; and Med. Recorder, i. 139. 
 
 13 Med. Mem. (1826), 87. 14 Op. cit. 116. 
 
 15 Med. and Phys. Journ. viii. 356. 16 Fev. of Phila. in 1798, pp. 13-22; ib. 
 
 1797, p. 48. 
 
 17 Treatise on Mai. Fev. 21, 2, 3, 4. 
 
 18 Works, iii. 41, 49, 120. 
 
 19 Emlcn, N. A. Journ. v. 329; S. Jackson, Fev. of 1820, pp. 12, 13; Watts, N.Y. Med. 
 Reg. 30; Carey, Fever of 1793, Meteor. Tables; Med. Repos. ii. 406; Curric, Fever 
 of 1793, p. 15 ; Smith, on Epidemics, 78; Currie, Fevers of 1798, pp. 2, 4, 5, 37, 8 ; 
 Ib. 1798, p. 29; Hill, Fevers of Wilmington, N. C. Recorder, v. 87; Hardie, Fever of 
 N. Y. in 1798, end of vol. ; Revere, Fever of Baltimore, in 1819, Recorder, iii. 217. 
 
 20 Dissertations, ii. 155. 
 
 21 Fellows, 33, 244, 565 ; Amiel, in Johnson, Trop. Climates, 250 ; Pariset, Fievre de 
 Barcelona, 12, 185; Robert, Guide. Sanit. 110,111, 742; O Halloran, 122; Burnett, 
 Fever of Mcdit. 2C5 ; Tomniasini, sect. 161, ii. 483; Bally, 323; Rayer, 23; Hock- 
 
AUTUMNAL FEVERS. 193 
 
 The necessity of a high degree of atmospheric heat for the extri 
 cation or production of the febrile cause out of the materials from 
 which it is usually found to be obtained, is every day illustrated in 
 Italy, for there, as elsewhere, marshes or collections of putrescent 
 substances, which are, to all external appearances, in a fit state to 
 evolve the poison, and even to emit vaporous effluvia offensive to 
 the olfactory nerves, remain innocuous so long as the thermometer 
 does not reach a high point. " Thus," says Thouvenelle, " in the 
 marshy lagunes of Venice, during the very low tides of January 
 and February, the air of the capital is infected with an hepatic and 
 miry odour during ebb-tide. Nothing is seen at the bottom of 
 the canals of the city, and all around the latter, but fetid and black 
 mud. And yet, notwithstanding, the health of the inhabitants was 
 not seen to be affected in a way to justify its being attributed to 
 that cause." 1 
 
 " If the temperature," says Dr. McCormack, "prove habitually 
 below 80, whatever be the exuberance of vegetation or the quan 
 tity of marsh land, malaria is never generated. Malaria does not 
 subsist in the north of England, nor in Scotland, nor in Ireland, 
 nor in Sweden, Denmark, or Norway, nor in the colder parts of 
 Europe, Asia, North and South America; in fine, nowhere, so long 
 as the temperature a few degrees more or less keeps below 80. 
 Let it rise above this, and thereupon we have malaria, and periodic 
 fever in all its forms." " If the summer temperature in Ireland 
 ranged habitually from 80 to 100, paludal fever would prove 
 even more frequent and destructive than ever continued fever was 
 known to be. In point of fact, some low-lying ranges of the uncul 
 tivated land near Dublin and Belfast, were said, during hot sum 
 mers, thirty or forty years ago, to be productive of malaria; but 
 there is nothing of the kind now, and intermitting fever is rarely 
 witnessed in Ireland, except in persons who have been abroad, or 
 the poor serfs who go to reap the harvests in the marshes of Essex 
 and Lincolnshire." 2 
 
 oux, 110, 111; Audouard, 44; Arejula, 132, 133, 134; Lind, 91; Berthe, 154, 324; 
 Vance in Pym, 64 ; Tullock, Rep. on Sickness of Troops in Medit, 4, D. ; Caisergue s, 
 18, 19; Pierquin, Trad, de Mem. &c. sur la F. Jaune de Barcelonne, 40; Blin, Trad, 
 du Rapport sur la Mai. Epid. &c. Cadiz, 1800, p. 4 ; Doughty, Observ. on Yellow 
 Fever, 180, &c. 
 
 Climat de 1 Italie, iv. 212. 
 
 2 McCormack on Malaria, Edinb. Med. J. Iv. 372. 
 
 13 
 
194 PNEUMONIA AND 
 
 Sheltering from the action of the sun. Much of the baneful effects 
 of marshes and fresh surfaces are prevented, especially in temperate 
 latitudes, by their being sheltered from the action of the sun. Mr. 
 Fleurian cle Bellevue, in a communication to the Academy of 
 Sciences, shows, as the result of his observations in France and 
 southern Italy, that when marshes are well furnished with water, 
 and covered with trees planted very close to each other on the banks 
 and causeways, so as to shelter them from the action of the sun, 
 they are as innocuous during summer as the best soil, well dried, 
 and in full cultivation. The mortality, in such localities, is 1 to 42, 
 or 46 ; while, in other places, where marshes are dried, and the soil 
 of these is argillaceous, compact, horizontal, and divested of trees 
 as, for example, in natural prairies that are very dry during sum 
 mer, and on which rain water remains stagnant some days, the loss 
 is 1 in 25, 20, or even 16. This is conformable to the results of 
 experience in this and many other countries, where it is found that 
 marshes, or new soil, which are completely sheltered from solar 
 heat by a full growth of woods and thick foliage, may remain per 
 fectly or comparatively healthy. It has long been found, as we 
 shall have occasion to show more clearly as we proceed, that in the 
 midst of compact forests, the sun never reaches the surface, its rays 
 being fully intercepted by a thick growth of trees, cypress, juniper, 
 magnolia, reeds, &c. In such places, however apparently calculated 
 they appear to furnish morbid exhalations, intermittents, nevertheless, 
 do not prevail. Dr. Williamson, who, like many others, has called 
 attention to this fact, remarks that families who live in the Dismal 
 Swamp of North Carolina, employed in making shingles, without a 
 perch of clear or dry ground, enjoy more health than people who 
 live on their new plantations, near the river or swamps. 1 That the 
 effect is justly attributable to the cause mentioned, may be inferred 
 from the fact that, on the removal of the means of shelter, fever 
 makes its appearance. But of this more hereafter. 
 
 Free ventilation. Again, experience has shown that free ventila 
 tion, and strong unimpeded currents of wind, are inimical to the 
 generation of malarial exhalations, consequently to the production 
 of fever ; that where the wind blows freely and strongly, or finds 
 no obstacles from surrounding objects, and where, in consequence, 
 
 1 Hist of North Carolina, ii. 192. 
 
AUTUMNAL FEVERS. 195 
 
 the air is quickly renewed, localities which otherwise might be 
 expected to be fruitful sources of fever, may be visited or inhabited 
 with impunity, while similar places become insalubrious, if the air 
 is stagnant. " Calms," says Dr. Drake, " permit the exhalations 
 from foul localities to accumulate in the atmosphere which rests 
 over them ; but all winds operate to disperse and dilute them with 
 purer air ; in doing which they may promote the salubrity of one 
 spot and diminish that of another." 1 It is of daily observation, 
 especially in warm climates, and in hot seasons in temperate coun 
 tries, or in localities subject to periodic fevers, that these assume a 
 severe character, and even spread epidemically when the air has 
 long been undisturbed by winds or thunderstorms. The late Pro 
 fessor Halle, long one of the magnates of the Medical School of 
 Paris, in an able report on the condition of the River Bievre, near 
 that city, pointed out the fact that the pernicious effects of the fetid 
 exhalations issuing from the banks of that river, are harmless in 
 situations where the atmosphere circulates freely and is renewed 
 by strong and unimpeded currents. 2 This injurious effect of a 
 stagnant state of the atmosphere was noticed as early as the 
 time of Hippocrates, who alludes to it in the third book of his 
 epidemics, and has been dwelled upon, on just grounds, by many 
 \vriters on the fevers of the West Indies, of South America, this 
 country, and Europe. 3 
 
 In many parts of country India, and other hot regions, for 
 example fever prevails widely where it should least be expected ; 
 on high mountains. But these are covered with lofty woods, or 
 thick jungles. There the surface of the earth is constantly strewed, 
 particularly in autumn, with organic remains, and kept moist by 
 rain or dews. The lower stratum becomes impregnated with effluvia, 
 
 1 Op. cit. 587. 2 Mem. do la Societe de Medecine, x. 78. 
 
 3 Le Blond, 7, 16, 19, 10G ; Clark on Long Voyages, i. 5; Imray, Edinb. J. liii. 
 92; Lempriere, i. 17; llufz, 31, 32; Hep. on Sickness, &c. of Br. A. 102; Merrill, 
 Mod. and Phys. J. ix. 233; Villerme, an. d Hyg. xi. 349; Celle, Hyg. des Pays 
 Chauds, 20; Baglivi, Op. Om. 81; N. Y. Med. Repos. ii. 403; Vincent, Fievre J. 7; 
 Ralph, Edinb. Med.-Chir. Trans, ii. 55, GO ; Copland, End. Influences, Diet. i. 759, 
 Am. ed. ; J. Clark on Y. F. 49, 50, 57; Monfalcon, 92; Deveze, 134; Galliot, 108; 
 Van Swietcn, v. 160; Hancock, 78; Diemerbroeck, cap. 3, 5; Caldwell, Med. Repos. 
 vii. 144,5; Thouvcnclle, op. cit. i. 180; Jameson, Dublin Med. J. N. S. xvi. 332; 
 Wilson, Treatise on Fevers, i 79, Am. ed. ; Zimmerman on Experience, ii. 391 ; 
 Ainslie, Smith, and Christy, Fev. of Coiinbatori, 60-77; Rep. of London Gen. Board 
 of Health on Sewer Water, &c. 8 ; Dundas, Sketches of Brazil, 245, 340. 
 
196 PNEUMONIA AND 
 
 which are seldom agitated by breezes, or rarefied by the sun s rays. 
 Dr. James Johnson, who has noticed this, remarks that among the 
 lofty forests and impenetrable jungles of Ceylon, fever prevails ex 
 tensively. " It is under the branches of these shrubs," (in Ceylon,) 
 says Lord Valentin, "that the fatal jungle fever is probably gene 
 rated. Not a breath of air can pass through ; and the confined ex 
 halations from black vegetable mud, acquire a highly deleterious 
 quality, affecting both the air and the water." 1 
 
 Many of the bays and inlets in the West Indies, while they derive 
 their security, also derive their unwholesome air through the agency 
 of the hills surrounding them, which gives them an atmosphere little 
 agitated by winds, and in which, consequently, the morbid exhala 
 tions from the marshes which are situate along their banks, may 
 well be supposed to continue suspended, accumulate, concentrated 
 by heat, and become infinitely more pernicious. Dr. Chisholm, 
 among others, while calling attention to this fact, and to the cor 
 rectness of the explanation, adduces several cases in illustration. 
 The French have, therefore, not inappropriately denominated these 
 situations " lieux etouffes." 2 After mentioning that the state of the 
 atmosphere during September, and the first two weeks of October, 
 favoured the accumulation of the miasmata in this city during the 
 memorable epidemic of 1793, Dr. Eush remarks, that the register 
 of the weather shows how little the air was agitated by winds 
 during the above time. " In vain," he says, " were the changes in 
 the moon expected to alter the state of the air. The light of the 
 morning mocked the hopes that were raised by "a cloudy sky in 
 the evening." He very truly observes that, " however inoffensive 
 uniform heat, when agitated by gentle breezes may be, there is no 
 record of a dry, warm, and stagnating air having existed for a 
 length of time without producing disease." 3 
 
 Indeed, all regular and fresh currents of air have the effect of 
 sustaining the healthiness of malarious localities, which, in their 
 absence, would be more or less the seat of febrile complaints. In 
 this country, cases in point might be gathered without the least 
 difficulty as regards common periodic fever ; and every physician 
 among us knows full well for the fact is proverbial that the 
 yellow fever usually breaks out and is most rife in places noted for 
 
 1 Travels, ii. 
 
 2 Manual of the Climate, &c. of Tropical Countries, &c. 20. 
 
 3 Works, iii. 86, 87. 
 
AUTUMNAL FEVERS. 197 
 
 want of due ventilation, while it requires but a slight acquaintance 
 with medical literature to know, that the same observation has 
 been made in respect to this disease everywhere, and that a similar 
 remark is applicable to the oriental plague. In all places, they pre 
 vail and are most rife and malignant in narrow, close streets and 
 alleys, and the poisons to which they are due, if formed, are soon 
 dissipated and rendered inert in open and well-aired situations. 
 
 It may be affirmed, without much fear of error, that it is through 
 the agency of the trade-wind alone, which blows almost constantly 
 from east to west, that the greater part of the West Indies is ren 
 dered habitable. When this purifying influence is withheld, either 
 through the circumstances of season, or when it cannot be made to 
 sweep the land on account of the intervention of high hills, as is 
 the case on the leeward shore of a portion of Gruadaloupe, Mar 
 tinique, and other islands, the consequences are most fatal. 1 Every 
 one must know that, in tropical regions generally, localities situate 
 in the midst of extensive forests and deep valleys, are, in general, 
 very unhealthy. In the woods, the wind is felt only by the tops 
 of the trees, and it not unfrequently happens that, while the former 
 blows with sufficient violence to break the upper parts of heavy 
 trees, scarcely a breath of air is felt on the surface below. " We 
 cannot form an idea," says M. Celle, 2 " of the fetid odour which 
 exhales everywhere in some of those extensive and damp forests. 
 Scarcely can the sun force its way through the thick foliage; and, 
 when it chances to shine through some opening, the luminous 
 column is almost opaque from the large admixture of vapour and 
 miasmatic effluvia with the atmospheric air. At night, the exhala 
 tions increase, and combine with those of the preceding day ; for 
 the wind here never replaces the mephitic by a pure air. In the 
 hot season of tropical regions the exhalations attain the maximum 
 of intensity. In this season, too, we find the foliage thickest, and 
 best calculated to prevent the free passage of the wind. Hence, the 
 inhabitants of the forests are then annually decimated by malarial 
 fevers. The same thing occurs in deep valleys, where the winds 
 do not penetrate beyond the superior strata of the atmosphere, and 
 cannot, therefore, renew the inferior ones. Nothing but violent 
 storms, accompanied by heavy rains, can disturb and renew the 
 
 1 Ferguson, Notes and Recollections, 201. 
 
 2 Hygiene Pratique des Pays Chauds, 20-23. 
 
198 PNEUMONIA AND 
 
 heavy and impure atmosphere. Hence, the soil of the valleys, 
 when not marshy, is healthier in the rainy and stormy season than 
 in April, May, and June, when the predominant winds of the sea 
 son begin to decline in force, and the air becomes cloudy and calm. 
 As the counterpart of this, I might call attention to the complete 
 or comparative innocuousness of marshy localities exposed to fre 
 quent and strong currents of air ; and also to the circumstance that 
 the exemption from fever of elevated positions appears evidently 
 due, in great measure, to the free and unimpeded ventilation which 
 there prevails. But this would lead us too far. 
 
 Humidity of the soil. After all that has been said in the preced 
 ing pages relative to the share of agency exercised by terrestrial 
 humidity in the production of autumnal fever; of the absence of 
 these when the earth and the dead organic substances by which it 
 may happen to be covered is completely and thoroughly dried ; of 
 the outbreak of sickness on the reoccurrence of rain, or of a tempo 
 rary overflow, by which a certain degree of moisture is furnished ; 
 and of the absence or cessation of the disease where the moisture 
 is from what cause soever in excess, it is unnecessary to point 
 out, in any detail, the influence which the quantity of surface water 
 exercises in modifying the degree of unhealthiness of marshy sur 
 faces, and regular morasses or swamps. Enough has been adduced 
 to show that the innocuousness of these, on which the opponents of 
 malaria have dwelt with so much complacency, is sometimes due 
 to the circumstance that such localities are so desiccated as no 
 longer to be the source of morbid exhalation; and much more fre 
 quently to their being deluged with water, and so completely 
 covered over that the organic matters subject to decomposition are 
 thoroughly soaked, or effectually shielded from the action of the 
 sun. Some marshes are often, or even generally in that condition. 
 Others cease to be the source of infection after heavy showers of 
 rain, or during the height of the rainy season, or immediately after 
 a freshet ; and examples are not wanting, in this country and else 
 where, to show that marshy surfaces that are periodically covered 
 under the influence of the rise and fall of the tides, are seldom the 
 source of febrile exhalations. 
 
 The foregoing facts will go far to account for the circumstance of 
 the poison contended for not being generated, or if generated not 
 being detrimental to salubrity under all conditions of soil, tempera- 
 
AUTUMNAL FEVERS. 199 
 
 ture, &c. They show that the cause of periodic fevers requires for 
 its development, besides particular materials to be acted upon by 
 external influences, and which abound in certain geological forma 
 tions and soils of particular kinds, or which are at times collected 
 on the surface of the earth, accidentally or otherwise, a certain de 
 gree and continuance of atmospheric heat, and a certain amount of 
 terrestrial humidity neither too much nor too little ; a complete 
 saturation and complete desiccation of the soil or its contents, 
 being alike inimical to the manifestation of the effects to which 
 that cause gives origin. 
 
 But these facts, and many others that precede, do more. They 
 lend a powerful support to the opinion which ascribes fever to the 
 agency of a gaseous poison ; for they tend to connect this febrile 
 principle with the usual products of the decomposition of organic 
 materials, showing, as they do, that this principle or poison requires 
 for its generation the action of the very same agencies which are 
 necessary for that decomposition. Precisely as takes place relative 
 to the febrile cause, ordinary decomposition of organic matter 
 requires a more or less prolonged continuance and a certain degree 
 of atmospheric heat. Equally necessary is it that there should be 
 a certain amount of moisture. Similarly true is it that an excess 
 of the latter prevents or arrests decomposition ; and that a total 
 absence of it will have the same effect. Like the febrile cause, the 
 putrefactive change is promoted by a calm and close state of the 
 atmosphere, and retarded, prevented, or modified by free ventila 
 tion and elevated situations. Now, when we find the cause of 
 fever requiring for its development the action of the very agencies 
 which are necessary to insure the development of the gaseous pro 
 ducts of decomposition when we find that without these agencies, 
 applied in certain proportions, neither those gaseous products nor 
 the efficient cause of fever will manifest themselves; and that in 
 all instances in which the latter is produced, as shown by the 
 occurrence of fever, materials capable, when acted upon by the 
 agencies in question, of giving rise to the evolvement of the gaseous 
 products of decomposition organic matter in various conditions 
 and states of modification exist ; and that the total absence of those 
 materials whatsoever be the degree of heat, and of terrestrial and 
 atmospheric moisture carries along with it an absence of fever, 
 we can have no reason to doubt the propriety of admitting that 
 the cause of the disease bears a close analogy to the aforesaid 
 
200 PNEUMONIA AND AUTUMNAL FEVERS. 
 
 gaseous products ; and that if in regard to the former, heat, hu 
 midity, and other agencies, acting in given proportions and in 
 concert, on animal or vegetable matters, give rise to the evolve- 
 ment of certain gaseous substances, the febrile poison, which in like 
 manner requires for its development the action of the same agencies, 
 as also the existence of kindred organic matter, must necessarily 
 consist also of some modification of a similar kind of gaseous 
 substance. 
 
CHAPTER III. 
 
 EXISTENCE AND MORBID AGENCY OF MALARIA, 
 CONTINUED. 
 
 Occurrences on shipboard prove the agency of malaria. The medical 
 literature of Europe and this country abounds in facts of a nature 
 well calculated to establish, in a satisfactory manner, the existence 
 and morbific agency of malaria ; and in the presence of which it is 
 difficult to conceive how any observing, reflecting, and unbiased 
 physician can refuse to recognize the connection as cause and 
 effect between that poison and fever. When they venture on the 
 denial of that connection, the opponents of the malarial origin of 
 autumnal fevers must forget, for we cannot suppose them ignorant 
 of, the eventful occurrences on board of the United States ships 
 General Greene, Macedonia, Peacock, Hornet, and Enterprise ; of the 
 French ships Ege rie, Messager, and Euriale ; and of the English 
 vessels Bann, Eden, Eclair, Iphigenia, Primrose, Dasher, Dart, Pique, 
 Regalia, Driver, Rattlesnake, Childers, and Pyramus. In each of 
 these, and in many others which could be cited, malignant fever 
 originated and prevailed widely, and was traced in a way not to be 
 questioned, to miasmata exhaled from the contents of the holds or 
 from the timbers of the vessels. 1 
 
 In most of these cases the disease broke out in vessels that had 
 sailed from, or were lying in ports, where, if it ever had prevailed it 
 did not do so at the time, or had not for some or even many years 
 before ; and when, therefore, it could not have been derived through 
 the effect of contagion, or the influence of common atmospheric 
 causes ; for these, had they produced the effect in question on in 
 dividuals on board, would not probably have spared those on shore. 
 In some, the fever appeared at sea during a cruise or passage, and 
 
 1 See an Essay on the subject by the present writer, in Am. J. of Med. Sc. for 
 April, 1853. 
 
202 PNEUMONIA AND 
 
 far from any contaminated spot; and in not a few instances, while 
 the vessels infected were severely visited by the disease, others 
 situate close by, in port or at sea, or on the same cruising ground, 
 and which, had not the cause been located in the vessels themselves, 
 would in all probability have been affected like the former, remained 
 uninjured. That the disease in the vessels mentioned derived its 
 origin from effluvia evolved on board, and not from ordinary atmo 
 spheric influences or a contagious principle, we may infer from the 
 circumstance that none of the sick who were landed from vessels so 
 infected and received into hospital wards in various places, were 
 found, in a single instance, to communicate it to those around; no 
 one from on board carried the disease on shore, while nearly every 
 individual who ventured on board sooner or later was attacked. 
 In many instances exposure to the effluvia issuing during the cleans 
 ing and purifying process from the hold, of ships heretofore un- 
 contaminated, or very long free from the fever, after the crew had 
 been dismissed, and when no one was left on board to communicate 
 disease, has been, not in tropical and fever regions only, but in 
 temperate climates also, the cause of the most concentrated and 
 fatal form of the malady; while other individuals, who were placed 
 under the influence of the same general morbid agencies as the 
 former, escaped the infection by avoiding such exposure. 
 
 Whether the latter proceed from effluvia issuing from the bilge- 
 water, the timber of the ship, the filth of the hold, or the cargo, the 
 existence of the cause within the precincts of the ship particularly 
 in the hold is rendered evident not only by the circumstances 
 already mentioned, but by the limited space and the particular spots 
 to which it is confined at the outset, or throughout the whole dura 
 tion of the epidemic. The disease (yellow fever) usually or very 
 frequently makes its appearance, and is more severe, in the vicinity 
 of the pumps and main hatchway. This is exemplified by the oc 
 currences on board of the General Greene, the Macedonia, the Rattle 
 snake, the Rainbow, the Force, the Skipjack, the Ferret, the Scylla, 
 the Lively, and the Isis, and is nothing more than what might have 
 been expected; for there the keel is most dependent, the water 
 draining from other parts is accumulated, and the heat is most 
 intense. Thus, in English frigates, the first cases, and the largest 
 rate of mortality, have in many instances been found to occur in 
 the berths of the midshipmen and marines, which, in such vessels, are 
 placed on each side of the pumps and main hatchway. We are 
 
AUTUMNAL FEVERS. 203 
 
 told by Dr. Wilson, that the subsequent progress of the disease 
 depends on the trim of the vessel and the inclination of the keel 
 from the horizontal position the fever spreading in the most de 
 pendent parts. In almost all cases, the disease prevails more, arid 
 the risk of infection is greater, in the lower than in the upper deck. 
 It is sometimes confined to one end or one side of the vessel. 
 Take the following as an illustration. 
 
 "In the Rattlesnake, the fever was first manifested near the main 
 hatchway ; the marines and the midshipmen of one berth, suffered 
 its earliest and most severe effects. Afterwards, it proceeded for 
 ward rapidly, but pretty regularly, till it had affected almost the 
 entire ship s company ; but it did not go beyond the steerage in the 
 opposite direction, no one being attacked in the gun-room except 
 the. purser, and I have good reason to conclude that in his case it 
 was derived from the shore." "But its local origin and limited 
 range of action were most strikingly exemplified in the berths of 
 the midshipmen, and other officers of that class. They were placed 
 exactly opposite to each other, with the pumps at equal distances 
 between them. Only one gentleman was affected in the starboard 
 berth, while every member of the larboard berth was laid up nearly 
 at the same time. The hatch of the pump-well is opposite to, and 
 within three feet of the larboard berth. The members of that berth 
 were generally the junior officers of their class, and were, therefore, 
 it may be said, most susceptible of the disease ; but when it is re 
 membered how extensively it prevailed, and how indiscriminately 
 it attacked persons of all ages and temperaments among the ship s 
 company, after every allowance is made for the greater susceptibility 
 of these young gentlemen, the exemption of the others, senior only 
 by a few years, is too striking and complete to be accounted for by 
 their former service, or by any accidents which can reasonably be 
 supposed to have affected them. It can fairly be attributed only to 
 their not having been exposed to the cause of the disease with the 
 same concentration of power, or permanence of operation, as the 
 others ; and here the contiguity of the pump-well hatch to the lar 
 board berth cannot be overlooked." 1 
 
 When we bear in mind the particular condition of the vessels 
 in which the yellow fever makes its appearance, as well as the 
 thcrmometrical and other influences in connection with which it 
 
 1 Wilson, Memoirs of West Indian Fevers, 159, 160. 
 
204 PNEUMONIA AND 
 
 breaks out and prevails, and compare the results of those various 
 circumstances with such as are obtained on land from kindred local 
 conditions, under the modifying agency of the same meteorological 
 influences, we shall find no valid reason for refusing to admit the 
 relationship as cause and effect between the product of the decom 
 position which necessarily ensues and the disease which, affecting only 
 individuals exposed to it, spares those who keep aloof. At the same 
 time, we discover a satisfactory explanation of the manner in which 
 these results are brought about. As the disease requires invariably 
 for its production a long continuance of high atmospheric heat, and 
 as it is, on that account, most generally encountered in tropical, or 
 during the hot season of temperate climates, we can readily under 
 stand why it more frequently occurs on board of ships in the former. 
 Besides, such vessels usually contain materials susceptible of decom 
 position, and which, when acted upon by the high temperature they 
 there encounter, are soon productive of noxious exhalations. In mer 
 chant and other ^vessels engaged in the West India, South American, 
 or African trades, the cargoes consist almost exclusively of articles 
 susceptible of fermentation or putrefaction ; while the same vessels, 
 as well as ships of war, are apt to be ballasted with materials alike 
 liable to those injurious changes, and which, together with portions 
 of articles provided for food, chips of wood, shavings, and dirt of 
 all kinds that inevitably find their way sometimes in unaccountable 
 quantities into the holds of vessels, where, meeting with more or 
 less moisture, supplied by leakage, or the water used for purposes 
 of cleansing or purification, or the drippings of the casks, or other 
 sources, they form a mass which, under the influence of intense 
 heat and a still atmosphere, becomes the source of concentrated 
 miasmata. By one well versed in all matters of the kind, we are 
 reminded that it is not always possible to account for the dirt and 
 rubbish which may be found in the bottom of a ship. 
 
 " Fragments of wood, vegetable substances, and dirt of all kinds, 
 however, gravitate by the formation of the vessel towards the 
 kelson or limbers ; where, by the heat of the climate and the 
 action of the salt-water, they rapidly decay, and form a blackish 
 mud, not dissimilar to that observed among the roots of mangrove 
 thickets on the banks of the rivers within the influence of the 
 tides ; it sometimes even acquires a consistence sufficient to block 
 up the passage of the limbers. In small vessels, with a flying deck, 
 there is less difficulty in accounting for the presence of foreign. 
 
AUTUMNAL FEVERS. 205 
 
 matters in the hold ; dust, fluids of various kinds, the sweepings and 
 scrapings of the decks, and a thousand other things, will find their 
 way there, notwithstanding the greatest care, both on the part of 
 the officers and men, although the latter, nevertheless, are frequently 
 wilfully careless in this matter." "In steam-ships, the difficulty is 
 still greater, in consequence of the boilers and engines occupying a 
 large portion of the floor of the hold, which cannot be got at. All 
 this filth, in the concentrated state mentioned, may, and often does, 
 exist in vessels, although the decks and other parts apparent to the 
 eye are clean. In them, the cause of offence, though hidden, is not 
 less real than in vessels differently conditioned, and proves often 
 detrimental to health before it is suspected to exist. Of course, all 
 foul ships are not necessarily unhealthy ; but those that escape are 
 the exceptions." 1 
 
 Nor is it less worthy of remark that the very timber of which 
 vessels are constructed, especially when green or not perfectly 
 seasoned, may be, and has not unfrequently been, when acted upon 
 by the high temperature of tropical climates, the source of disease 
 an effect that could not be produced otherwise than through the 
 morbid agency of noxious effluvia resulting from the action of heat 
 on such materials. At any rate, such a condition of vessels has not 
 unfrequently been associated, in hot climates, with the development 
 of the most malignant form of the disease; and, judging from what 
 has been noticed on land of the effect of exhalations from kindred 
 sources of infection, or at sea, from the stowage of damp green 
 wood, we cannot err greatly when attributing the mischief, in the 
 instances in question, to the decomposition of the ship s timbers. 
 On this subject, the facts related by Dickson, Wilson, Eochoux, and 
 others, leave no doubt, or, at the very least, merit serious consider 
 ation. The unhealthiness of ships built of green timber has 
 been noticed from time immemorial, and it will be found on exami 
 nation that severe epidemics have, on various occasions, been traced 
 to the stowage of a quantity of green wood in the hold of vessels. 
 This was strikingly the case in the English war-ship Regalia, for the 
 medical account of which we are indebted to Dr. Ferguson, 2 and in 
 the French brig Messager, referred to by Dr. Rochoux. 3 
 
 We all know, also, how offensive the bilge-water becomes from 
 
 1 Bryson, 223. 2 Medico-Chir. Trans, viii. 108. 
 
 3 Recherches sur les Diffurentes Maladies qu on Appelle Fievre Jaune, 61. 
 
206 PNEUMONIA AND 
 
 admixture with the filth of the vessel ; or the great tendency that 
 the water, which finds its way by leakage or otherwise into the 
 hold, has of being decomposed ; sometimes owing to its original 
 impure state, at others, to its combination with the fresh-water pro 
 ceeding from the drippings of the casks, &c. It is not to be denied 
 that such a condition of the bilge-water is not necessarily connected 
 with the appearance of disease on board of ships ; cases having 
 been adduced in which the foulest and most offensive water has 
 proved innocuous ; while disease has raged where the odour was 
 hardly, if at all, perceptible. But such cases, which find their pro 
 totypes on land, where localities noted for filthy pools escape, and 
 where the appearance of malarial fevers is sometimes connected 
 with an apparently pure condition of the water partially covering 
 marshy swamps, or with an absence of mud or filth, are not fre 
 quently met with in fever seasons and latitudes. More generally 
 the re verse takes place; and even were this not the case, the appear 
 ance of the disease may still be due to internal miasmata issuing 
 from other sources of infection existing on board ; or, again, the 
 water, though completely or almost inodorous, clear, and apparently 
 pure, may nevertheless contain in solution those particles of 
 poisonous matter which produces the fever. Nor does it neces 
 sarily follow, as some writers seem to imagine, 1 that the healthiness 
 of foul ships in southern or other latitudes disproves the opinion 
 of the connection as cause and effect between exhalations from 
 sources of organic decomposition and fever. Of course, all foul 
 ships are not necessarily unhealthy all vessels containing vegetable 
 and other matters in a state of incipient or decided decomposition, 
 lying in southern ports or navigating southern waters, even in 
 warm weather, are not all expected to suffer from fever. For, 
 besides that, in good logic, a negation can go but little way in 
 disproving the many well-authenticated facts we possess, in favour of 
 a different conclusion, sources of vegetable and other decomposition 
 on board of ships, are under the control of some of the same 
 agencies, which, as we have seen, modify the effects of like sources 
 of contamination on land. They require, before they can generate 
 fever, to be acted upon by high atmospherical heat; that this heat 
 should continue a certain length of time ; that the season should 
 be that in which the fever usually prevails; and that there should 
 
 1 Memphis Med. Recorder, ii. 
 
AUTUMNAL FEVERS. 207 
 
 exist -a suitable epidemic constitution of the atmosphere. Remove 
 all these contingencies, and foul ships will generally be found to 
 remain healthy. In the contrary case, those that escape arc, as Dr. 
 Bryson has remarked, the exceptions. 
 
 Be this as it may, the connection as cause and effect between 
 sources of miasmal effluvia and fever, is conclusively established 
 by the example of those vessels in which the spread of the yellow 
 fever was arrested, even in tropical climates, or during the hot 
 season of temperate regions, by a resort to a thorough process of 
 expurgation. In the Dart, Pyrarnus, Dasher, and Regalia, the 
 history of which has been referred to in detail elsewhere, 1 the fever 
 was arrested. In reference to the first-named of those vessels, Dr. 
 Dickson remarks : " So many people were taken ill, after going on 
 board this vessel, lying guardship at Barbadoes, that it was difficult 
 to account for it, except on the principle of contagion, until the 
 peculiar construction of the ship, viz. her being divided into com 
 partments below, so as to prevent the circulation of air and the 
 stowage of the water in bulk, were adverted to, and on examining 
 the large tanks or cisterns, their bottoms were found covered with 
 an offensive slimy mud or deposition." 2 On the removal of some 
 of these causes, the knocking clown of the bulkheads, and the 
 cleansing out of the cisterns, the fever was put a stop to. 
 
 On opening the hold of the Pyramus, the effluvia which issued 
 surpassed anything Dr. Hartle had ever witnessed, and affected every 
 one exposed to its influence. The quantity of filth which was taken 
 out was sufficient to fill four large mud-boats, consisting of shavings 
 mixed with coal-tar and the water ; which, in consequence of the 
 choking of the pumps, had accumulated under the limber-planks. 
 All the cases Avhich occurred during the process of expurgation 
 w r ere easily traced to exposure to this bog ; and Dr. Hartle very 
 justly refuses to refer the disease to the influence of English Harbour, 
 inasmuch as other ships of the squadron that lay much longer there 
 escaped the infection. It may not be amiss to remark that the sick 
 of this ship were landed and placed in the capstern of Antigua 
 dock-yard on the 15th of January ; that between that day and "the 
 80th, only eighteen cases occurred; but that on the 31st, six fresh 
 attacks were added to the list, and the disease again appeared with 
 increased violence and malignity." Dr. Hartle adds: "This sudden 
 
 1 Am. Jouru. April, 18-53. 2 Kept, in Bancroft s Sequel, 208, 9. 
 
208 PNEUMONIA AND 
 
 reappearance and violence of the disease induced me to believe that 
 the people had some communication with the ship, which was then 
 undergoing a general expurgation. This, with a little trouble, I 
 ascertained to be the case." Changes were made in the distribution 
 of the convalescents and the rest of the crew, and the disease was 
 put a stop to completely. The crew re-embarked on the 14th of 
 March in excellent health, and remained so. 1 
 
 On taking up the limber-boards of the Dasher, says Dr. Hartle, 
 "the noxious effluvia surpassed anything that I had before expe 
 rienced, and it was with difficulty that the blacks, who were accus 
 tomed to this work, could remain. The ship-carpenter, who had 
 been constantly accustomed to work in the dock-yard, and on many 
 such occasions, assured me that he had not before experienced so 
 putrid a smell from any ship s hold. Between the timbers there 
 was a collection of carpenters shavings, &c., in great quantities. 
 These had so completely choked up the limber-holes that the water 
 could not pass to the well of the pump, and lay stagnant. The 
 vegetable matter was, therefore, in a state of decomposition, and this, 
 acted on by high atmospheric temperature, became neither more 
 nor less than a marsh in the centre of the ship." " That the fever," 
 continues Dr. Hartle, "was generated on board, by noxious effluvia 
 received into crowded and badly- ventilated berths, is, I think, fully 
 proved ; for the moment the crew and marines were removed from 
 the sphere of this hidden enemy, the disease ceased." Nothing like 
 the most distant appearance of contagion could be traced; for none 
 but those residing on board the ship, or exposed to the effluvium 
 from her hold, prior to her expurgation, suffered by the fever. 2 
 
 That the cause of the fever resided in the hold of the Kegalia, is 
 proved by the fact that the cleansing of that part proved particularly 
 injurious to those exposed; and that, while the fumigation of the 
 ship proved of no avail in purifying it, the fever ceased when she 
 was completely cleansed, and, with her hatchways closed, her whole 
 hold had been exposed to the concentrated heat of many stoves. 
 In the case of the Trinidad at Barbadoes, mentioned by Dr. James 
 Johnson, 3 the fever disappeared as soon as the hold was washed and 
 cleansed, the dirt, filth, and stagnant water removed, and scuttles 
 
 1 Facts and Observations in Refutation of Sir G. B. Blanc s Doctrines as to the Con 
 tagion of Yellow Fever, by A. Musgrave, Appendix B., Med. Ch. Rev. and Journ. iv. 
 774. 
 
 2 Musgrave, op. cit. 774. 3 Trop. dim. 164, 1st ed. 
 
AUTUMXAL FEVERS. 209 
 
 cut for better ventilation. To this, let me add that some officers, by 
 the early adoption of proper hygienic measures, particularly of those 
 calculated to insure cleanliness and prevent the accumulation of 
 sources of impure exhalations, have succeeded in guarding their 
 vessels, under the most unpromising circumstances, against the de 
 velopment of fever. While other ships were sorely visited by the 
 disease, Captain Smith, of the British Navy, never had it in those 
 under his command, during long service in the Mediterranean. Like 
 him, many other commanders have preserved their crews by having 
 "the hold of their vessels washed out daily by means of plugs, till 
 the water came out perfectly clear, so that an accumulation of filth 
 could not take place." 1 
 
 Here, then, we have proofs as positive as can be desired; limita 
 tion of the disease to the precincts, or to only one part of some 
 vessel; infection by going on board; escape by remaining 
 aloof; great mortality among the crew or passengers, and im 
 munity among those of other vessels close by ; the existence in the 
 former of materials in a state of decomposition, or of green wood; 
 and their absence in the latter; the arrest of the disease by the 
 adoption of a proper system of expurgation, and lastly, its preven 
 tion by proper purifying measures. We perceive that yellow, or 
 malignant fever the disease produced on those occasions, and which 
 constitutes one of the forms of autumnal and epidemic pyrexise 
 is the result of effluvia; and certainly, if one of the varieties of 
 these effluvia can give rise on shipboard to one form of such com 
 plaints, and that form too the most formidable, we may justifiably 
 infer that the same form of fever, when it breaks out on land, 
 does so through the agency of similar effluvia ; and, as a natural con 
 sequence, that other and milder pyrexial complaints must be the 
 morbid products of causes, which, though not of an identical are 
 of a kindred character. 
 
 The cause of fever wo/ted ~by winds passing over sickly localities. 
 But we are not restricted to this inductive process for materials 
 with which to establish or fortify the position here assumed respect 
 ing the malarial origin of autumnal fevers. Facts for that purpose 
 may be gathered from all parts of the habitable world, and have 
 been recorded from the remotest period to the present day, in the 
 history of the disease. 
 
 1 Lond. Mod. Geog. ix. 890. 
 
 14 
 
210 PNEUMONIA AND 
 
 Without dwelling anew on the circumstance that fever abounds 
 more or less in places where the soil is low, alluvial, flat, humid, 
 and filled with organic matters in a state of decomposition ; and, on 
 the other hand, that it is little, if at all known, where contrary cha 
 racters prevail, I may call attention to the fact that certain locali 
 ties rural districts, towns or cities which themselves do not con 
 tain any of the elements of unhealthiness, and, under ordinary cir 
 cumstances, remain free from autumnal or periodic fevers, become, 
 at times, the seat of the latter, when so placed to the leeward of infected 
 districts as to receive from these, through the agency of the wind, 
 the pestiferous miasmata evolved from their marshy surfaces. Facts, 
 indeed, might easily be accumulated to show that, in many fenny 
 portions of this globe, each locality has its favourable and its un 
 favourable winds. 1 With the latter, fever abounds ; with the for 
 mer, it diminishes or disappears ; and it is found that this difference 
 depends on the position of the marshy or infectious surface rela 
 tive to that locality, and also on the circumstance that, in the one 
 case, those winds pass over the source of the effluvia before reach 
 ing the sickly place ; while, in the other, they take a contrary 
 course, and leave the latter untouched. I might dwell on the case 
 recorded of Empedocles, who, having observed that the sterility of 
 the soil, and the plague from which Sicily so frequently suffered, 
 were caused by a southerly wind, which reached the suffering dis 
 trict through the interstices of the neighbouring mountains, di 
 rected them to be closed, and, by this means, put a stop to the ill 
 effects in question. 2 But it will be more satisfactory to cite a few 
 better authenticated instances which have been noticed in more 
 modern times. 
 
 On the west side of the town of Marenne, in France, are situated 
 vast marshes. When the wind blows from the north, north-east, 
 or east in other words, in such a way as to preserve the town 
 from the miasmata issuing from those marshes, fevers are rarely 
 encountered. When reversely, the wind blows from the west, 
 south-west, or south, i. e. so as to pass over those paludal surfaces 
 before reaching the town, fevers make their appearance in the latter. 
 On the contrary, at Saint Agnant, situate opposite to Marenne, and 
 on the other side of the marshes, matters take a different turn. 
 
 1 Melier, M6m. do 1 Acad. de Mod. xiii. 671 ; Jaquot, 18-30, 39, 48. 
 
 2 Leclerc, Hist, de la Mcd. 93. Sprengl, Hist, de la Med. i. 244. 
 
AUTUMNAL FEVERS. 211 
 
 There, during the prevalence of the east wind, the town becomes 
 sickly, while it ceases to be so when the opposite currents set in. 
 The city of Rochefort owes its present unhealthiness in the autumn 
 to the circumstance that the S. W. wind, which predominates at 
 that season, passes, before reaching it, over the extensive and pesti 
 ferous marshes of Brouage. 1 The S. S. W. wind, by passing over 
 the basin of the Anthion, opposite to Corne, in the department of 
 Marne and Loire which, in 1843, was, from a variety of circum 
 stances, in a fit condition for the elimination of miasmal exhalations 
 occasioned that year a pestiferous infection in all the neighbour 
 ing localities exposed to its influence. 2 At Bayniere, in Normandy, 
 an unusual course of N". W. winds, blowing across the marshes, 
 and conspiring with a hot summer, caused very severe epidemics 
 in 1809 and 1810. 3 
 
 The Yelabrum, at Rome, the district of St. Peter, the surface ex 
 tending from the Tiber to the foot of the Janiculus, and the Trasta- 
 vere generally, from the southern extremity of that mount to the 
 dependencies of the Vatican, are the only unhealthy spots of that 
 district, and are evidently indebted for the fever to the poison 
 which, exhaling from the site of the ancient city, reaches them with 
 facility through the agency of the south winds. These are unim 
 peded in their course thence by hills or other similar obstacles, 
 while they find no means of escape when once they have arrived 
 there. 4 Lancisi, 5 Baglivi, 6 Rigault de 1 Isle, 7 and other writers may 
 be referred to, in testimony of the unfavourable influence of the 
 S. E. wind on the salubrity of those parts of Rome which lie to the 
 leeward of the aforesaid pestiferous region, and of neighbouring 
 marshes ; and of the healthiness of other localities, differently situ 
 ated. The stagnant water of Lake Aguano exhales deleterious 
 effluvia, which are wafted back, in a north-eastern direction, by the 
 opposite wind, on to two villages, and even to the convent of Ca- 
 
 1 Mem. de la Soc. Roy. de Med. viii. 281. Melier, Mem. de 1 Acad. de M6d. xiii. 
 671-2. 
 
 2 Gaultier de Claubry, Rapport sur les Epidemics, &c. Mem. deTAcad. xiii. 
 119,120. 
 
 3 Macculloch, 357. 
 
 4 Carriere, Climat de 1 Italie, 372; see Am. J. July, 1851, p. 163. 
 
 5 De Nox. Palud. Effluv. lib. 2, cap. 3. De Nativis Coeli, Rom. qualitalibus, iv. 157-8. 
 
 6 Prac. Med. lib. i. cap. xv. Op. Om. 80. 
 
 7 See in Johnson Trop. Cl. 315; see, also, Lind on Hot Climates, 30; the same on 
 Seamen, G7 ; Monfalcon, 77. 
 
212 PNEUMONIA AND 
 
 maldules, situate a league off, on a high mountain, and there gives 
 rise to fever, from which other localities of the vicinity are exempt. 1 
 In several parts of Italy, as also in Corsica, France, and many 
 other places, chains of hills, free from morasses, but placed in a line 
 with them, and in the face of a wind which carries to them their 
 emanations, were entirely depopulated and rendered uninhabitable. 
 "Such is the malignity of a marsh lying to the south," says Lancisi, 
 "that, although towns are built upon the tops of hills, exhalations 
 are wafted thither, with all their mischievous properties, by the 
 southern and south-western winds. Grondolpho affords a fact in 
 full illustration of this, for the Lake Turnus lay formerly below it, 
 full to the south. From this the air was vitiated, although the 
 prospect was not injured at all. The ill. effects of this were so 
 serious, that Pope Paul V. could correct them in no other way 
 than by draining the lake to dry ness. In commemoration of which, 
 the following inscription in marble is to be seen in front of the 
 government-house at Gondolpho: "In the year of our Lord, 1611, 
 Pope Paul V., finding the town to be on the decline from the 
 scarcity of water, and the noxious exhalations of Lake Turnus, con 
 tributed to its health and joy by bringing water hither from the 
 distance of three miles, and by drying up the lake, in the seventh 
 year of his pontificate." 2 
 
 The marshes of Mantua, Ferrara, Noverra, Verseuil, afford simi 
 lar examples of the effects of winds in transferring the cause of 
 fever from one spot to another. In Venice, the north-east wind is 
 healthy, and blows the miasmata of the lagunes on the continent. 
 The opposite winds, on the contrary, waft those miasmata, as well 
 as those of the Lido, and of the mouths of the rivers that open into 
 the former, over the city, and fever, in the exposed districts, is the 
 consequence. 3 On the occurrence of an east wind there is always 
 an increase of febrile diseases in London, which is attributed, in 
 great measure, to the influence of marshes in distant parts. Marsh 
 fever is not unfrequently noticed in the neighbourhood of Tavistock 
 Square, and other places in the hollow of the northern district, 
 which affords free access to the deleterious west winds. The eastern 
 side of Blackheath is invariably afflicted with these winds, and dis- 
 
 1 Valentin, Voy. Med. en Italic, 45; Cyclop, of Tract, Mod. iii. 64; Monfalcon, 79. 
 
 2 Nox. Palud. Effluv. lib. i. cap. v. 20. Monfalcon, 79 ; Brown in Cyclop, of Pract. 
 Med. iii. 04. Thouvenelle, Climat de 1 Italic, iv. 1 } G3. 
 
 3 Carriere, 459, 403. 
 
AUTUMNAL FEVERS. 213 
 
 ease is the consequence. A northern wind, blowing over the Essex 
 marshes, often produces agues on the other side of the river. The 
 east wind, which blows from Essex towards London, invariably 
 carries it (fever) on for many miles, as all susceptible persons expe 
 rience. At the east end of London, it reaches all through Finsbury 
 division and White Chapel, and is even brought at the back of the 
 Strand, along the river. 1 It is a well-known fact, "that in the 
 southern section of the United States, where the prevailing winds 
 of summer and autumn are from the south and west, the dwellers 
 on those sides of marshes, swamps, rivers, and mill-ponds, are often 
 in the enjoyment of good health, while the people on the opposite 
 sides, although farther, perhaps, from the laboratory of the poison, 
 are victims to fever." 2 At Eatonton (Gra.), some thirty years ago, 
 bilious fever carried off many inhabitants. The disease was satis 
 factorily traced to a mill-pond, about a mile east of the village, 
 remarkable for its filth, and which, having run dry, was exposed to 
 the summer s sun. From this point, the concentrated poison was 
 swept, by easterly winds, to the village. The village of Mount 
 Zion, Hancock County (Ga.), was, in like manner, severely afflicted 
 by autumnal fever. Just previous, an easterly wind prevailed for 
 several weeks, which blew directly across Beaver Dam Creek, 
 nearly a mile distant, whose marshes had become dry under the 
 autumnal sun. 3 During the severe epidemics of 1821 and 1822, in 
 this State, it was observed " that the persons residing on the north 
 and west of streams of water were peculiarly obnoxious to attacks, 
 while those residing on the south side, in the immediate vicinity, 
 were comparatively exempt." The explanation may be found in the 
 fact that, for nearly two months of that summer, the prevailing- 
 winds blew from the south, with some slight and short excep 
 tions. 4 
 
 "Since the month of July, 1843," says M. Gaultier de Claubry, 
 in one of his excellent reports on the epidemics of France, " inter 
 mittent fevers, which were originally sporadic in the commune of 
 Orville-la-Mer, have assumed the epidemic character, and reached 
 every part of the place, as well the habitations of the rich as those 
 
 1 Edinb. Rev. xxxvi. 542. Second Hep. of the London Commissioners, 1848, p 40. 
 Rep. on the Drainage of the Lands forming the Sites of Towns, 5. London, 1852. 
 
 2 Caldwell on Malaria, 135. 
 
 3 Pendleton, Charleston Med. J. vii. 450. 
 
 4 Rep. of the Burks Co. Med. Soc, in Tr. of Tennsyl. State Med. Soc. ii. 93. 
 
214 PNEUMONIA AND 
 
 of the poor. The N. 1ST. E. wind, which has continually prevailed, 
 by passing over the pond (situated at some distance), has wafted the 
 paludal miasmata which are there formed into the principal street 
 of Orville, which faces the source of the infectious atmosphere." 1 
 
 The east wind which passes over the marshes of Echats, carries 
 every autumn periodic fevers, often of a pernicious character, to 
 the banks of the Saone as far as Trevoux, at the distance of two 
 leagues from the river. 2 
 
 Intermittent and bilious fevers often prevail at Macuto, and at 
 Caravalleda (South America) ; and when, from time to time, the sea 
 breeze is interrupted by a westerly wind, the little Bay of Coria 
 sends an air, loaded with putrid emanations, towards the coast of 
 La Guayra, notwithstanding the rampart opposed by Cape Blanco. 3 
 Again, the situation of the Laguna of Campoma (a grea* meer, which 
 is divided, in dry weather, into three basins, situate to the north 
 west of Cariaco, near the extremity of the gulf of that name), ren 
 ders the north wind, which, blows frequently after sunset, very 
 pernicious to the inhabitants of that little town. 4 
 
 At the Naval Asylum, near this city, where fever is of very 
 common occurrence at the usual season, one wing of the building 
 is much more frequently afflicted by it than the other, evidently 
 owing to the fact of its being more exposed to the S. W. wind, 
 which passes over the marshy banks of the Schuylkill Kiver. 
 Among several other instances of the same kind that could be men 
 tioned, I select the following, for which I am indebted to a highly 
 valued friend in Charleston. The hospital, formerly at Fort John 
 son, was located on the margin of the marsh upon a high sandy 
 ridge, with a small depression or basin on the western side of it. 
 About three hundred to four hundred yards south-west, were 
 several ponds surrounded by the wild myrtle, cedars, swamp oak, 
 and short-leaf pine. When my informant took medical charge of 
 the station, he learned that his predecessors were of the opinion 
 that the western half of the hospital was unhealthy. Such was 
 the report of the day, and observations subsequently made con 
 firmed the opinion of those gentlemen. For example, it was found 
 that persons placed in the western rooms were attacked with inter- 
 
 1 Mem. cle 1 Aoad. de Mod. xiv. 123. 
 
 2 Groffier, Mem. sur I insalubrit6 de la partie Meridional e du Dept. de 1 Ain, 19, 
 Fodcve, v. 152. 
 
 3 Humboldt, Personal Nar. iii. S99, * Ibid. 108. 
 
AUTUMNAL FEVERS. 215 
 
 mittents, from which some with difficulty recovered, the disease 
 assuming all the violence of what is commonly known in Charleston 
 as country fever. The observations were made for several seasons, 
 and with the same results. "The hospital was removed to Sullivan 
 Island, and the location occupied by private residences, which are 
 at certain seasons liable to intermittents. The season after the 
 hospital was abandoned by the government, and before its removal, 
 it was occupied by several families of planters from the interior. 
 Those who inhabited the western half of the building were dan 
 gerously ill, while the residents of the eastern escaped." " In 
 1845, a fearful epidemic among children at this settlement (diph- 
 therite or membranous sore throat) made its appearance. In the 
 village of Johnsonville, the mortality was terrible for so small a 
 community ; while, on the United States side of this line, there 
 was not a single case of the disease amongst a population of forty- 
 nine children, most of whom were subject to every exposure, and 
 living almost entirely upon salt provisions. This line of malarial 
 demarcation was well denned at Fort Johnson, and the boundary 
 of health and disease could be narrowed down to a very limited 
 compass." 
 
 In an account of the medical topography and diseases of Miami 
 County, Ohio, Dr. Volney Dorsey remarks: "The same observation 
 may be made here which is said to hold good throughout the West, 
 that those persons inhabiting the eastern side of streams are more 
 liable to miasmatic fevers than those located on the western border. 
 This, it is believed, is attributable to the fact that most of the 
 streams overflow their banks in the winter and spring, and are 
 almost entirely dried up in the summer and fall, and as at this 
 season westerly winds prevail, the rniasm produced by the burning 
 sun acting on the decaying vegetable matter along their course is 
 driven on to the eastern banks. Many lofty and picturesque 
 situations on the eastern side of the Miami Kiver are thus rendered 
 uninhabitable from the yearly recurrence of autumnal, inter 
 mitting, and remitting fevers." 1 
 
 Such facts are, indeed, familiar to our physicians to those espe 
 cially who practise in rural districts; for they every day find that, 
 during fever seasons, one side of watercourses is generally more 
 sickly than the other, and that the difference depends on the course 
 
 1 Trans. Am. Med. As. v. 450. 
 
21.6 PNEUMONIA AND 
 
 of the wind. Dr. Pendleton, to whose essay on the topography and 
 diseases of middle Georgia I have already several times referred, 
 informs us, that he has frequently, in the course of his practice, 
 known fevers to prevail on one side of a creek for days together, 
 while the other was entirely exempt a circumstance, he rightly 
 thinks, in no way to be accounted for but by the drift of malaria. 
 
 In Freetown, Sierra Leone, the agency of the wind in conveying 
 the cause of periodic fevers remittents and inter mittents is very 
 satisfactorily demonstrated. Here, as in most other sections of 
 tropical regions, these diseases become numerous and frequent after 
 the descent of the first rain. At this period the wind generally 
 blows from the northward and eastward, and consequently bears 
 from the Bullom shore, or the north bank of the Mitomba the 
 countless stagnant pools and extensive marshy tracts which, 
 loaded with decomposing vegetable matter, have been so graphi 
 cally described by Mr. Boyle a large quantum of the noxious 
 vapours therein generated. The direct agency of the wind in con 
 veying these vapours is established by the fact that, at the 
 approach of the dry season, when again the formation of malaria 
 is active, the winds but rarely blow from the swampy Bullom, and 
 fevers are less frequent in their occurrence and decidedly less fatal 
 in their consequences. 2 
 
 Trincomalia (Ceylon) and very many other places might be 
 mentioned is never sickly while the north-east monsoon prevails, 
 and does not become so till the south-west wind reaches it from the 
 opposite shore of the island, after having passed over a great extent 
 of low, wooded, and very unwholesome country. 3 
 
 1 Charleston Med. J. vii. 450. 
 
 2 Boyle, Tract. Med. Hist. Ace. of the Western Coast of Africa, 124, 120 ; see also 
 p. 44. 
 
 3 Davy s account of Ceylon, 76, 4to. 
 
 It not unfrequcntly happens that the cause of the disease, while wafted to a 
 considerable height above marshy surfaces, and there producing its usual effects, 
 spares, to a greater or less extent, individuals residing in the close vicinity of, arid on 
 a level with, the source of the infection ; or at least does not affect them more exten 
 sively or severely than the former. This has been noticed in various parts of 
 France, Italy, this country, and the West Indies (Monfalcon, p. 80). Experiments 
 made in France, more than half a century ago, leave no room to doubt that the result 
 is due to the upward tendency of effluvia, under the influence of the wind ; and of 
 their being arrested in their horizontal migration by the heights they encounter. In 
 the insalubrious localities of the Bresse, white linen sheets were attached to high 
 steeples on the most elevated hills of the vicinity, and an equal number suspended to 
 
AUTUMNAL FEVERS. 217 
 
 Other instances of like import, relative to the effect in question, 
 as observed in Algeria, Batavia, South America, Africa, the West 
 Indies, Borneo, Spain, and this country, are on record, and might 
 easily be adduced. 1 But these must suffice. "When taken in con 
 nection with those instances which, though generally disbelieved, 
 appear, nevertheless, to rest on respectable authority, of the febrile 
 cause being wafted in the common atmosphere to the distance of 
 several miles even from Holland to England, as believed by Mac- 
 culloch 2 and others; 3 of ships receiving the infection at a great dis 
 tance from land not less than three thousand feet, according to Sir 
 Gilbert Blane; 4 and of fevers being derived, as already stated, at 
 Rochefort, from the marshes of Bronage, situate four or five miles 
 off; when, I say, the preceding instances are taken in connection 
 with these facts, as also with the circumstances noticed in Europe, 
 from the frontiers of Asia to the other extremity of that continent, 
 though particularly in Italy, that, as the western coast presents a 
 larger surface of infectious marshes, so malarial fevers, other things 
 being equal, prevail more extensively under the influence of south 
 west winds than of the opposite currents, they cannot but place the 
 question of the morbific effect, at a distance, of winds passing over 
 pestiferous localities, beyond the possibility of doubt. If we admit 
 
 poles ten or twelve feet high, placed in the lowest fields. After the lapse of a certain 
 number of days and nights, all these sheets were carefully examined, when it was 
 found that the latter were merely damp ; while the former exhibited black, green, 
 yellow, and livid spots. The experiment was repeated several times, and at various 
 seasons of the year, and always with the same results. (Ib. 81.) 
 
 1 Jacquot, Recherches, sur les causes des fievres a quinquina, 18, 36, 39, 48; Lind, 
 op. cit. 113; Osgood, 29; Horsefield, Med. Museum, i. 79; R, Jackson, Sketch, i. 
 11 ; ib. Outlines, 77 ; and Treatise, 412; Smelt, Med. Repos. vii. 125 ; J. Johnson, 84, 
 93, 153 ; Leblond, 81 ; Rush, Fev. of 1780, iv. 232 ; Evans, 24; Ferguson Recoil. 194; 
 Blane, 252; Davidge, 68; Boussingault, An. de Chimie, Ivii. ; Rochoux, 113; Bally, 361 ; 
 Gilbert, 12 ; Humboldt, 765 ; Lefort, de la Saignee, 66 ; Bayley s Letters ; Rep. on 
 Fever of N. 0. in 1819, p. 50; Waring, 23; Chabert, pp. ix. and 26; McCabe, Ed. J. xv. ; 
 Boyle, 44, 75; Tendleton, Topogr. of Middle Georgia, Charleston J. vii. 450; Smith, 
 Rep. to Assembly, on Fever of 1847 in N. Y. 30, Cyclop, iii. 64 ; B. Perkins, of 
 Boston, Mem. of the Roy. Med. Soc. of Paris, i. 207; Monfalcon, 79; Rand, Med. 
 Repos. ii. 466-8; Fenner, Rep. ii. 442; Bryson, Stat. Rep. of II. of the Navy (Brit.), 
 11 ; Second Rep. on Quar. 14, 15; Thouvenelle, Climat de 1 Italie, i. 223; Vincent, 
 Dis. sur la F. J. 10; Mabit, Mai. de St. Dom. 5, 6.; Diet, de Med. Pratique, vii. 74; 
 Volney, Climat. des E. U. 316. 
 
 2 Malaria : an Essay, 93. 
 
 3 Edinb. R, xxxvi. 542 ; Boudin, Geographic Med. 70. 
 
 4 Med. Ch. Tr. iii. ; Ibid. Dissertation, i. 236. 
 
218 PNEUMONIA AND 
 
 this, we must allow, also, that the effect can only be due to the air 
 thus propelled being the vehicle of some deleterious agent, which 
 it receives from the infected surface, and not to the cold or heat, or 
 the vicissitudes of temperature, or humidity, which such winds 
 may occasion ; for these, as we have seen, do not alone produce 
 fevers, which often arise under circumstances rendering such an 
 explanation totally inadmissible. They appear under the influence 
 of the most opposite currents of air. In some cases, a north, at 
 other times a south, or a west, or an east wind, produces the effect 
 the result depending solely on the exposure of the suffering local 
 ity, relative to the position of the source of malarial elimination, 
 and not on any injurious quality appertaining to the wind itself, 
 and existing independently of the extraneous poisonous materials 
 the latter serves to convey ; for, as long ago remarked by Schner- 
 rer, 1 wind of itself, whatsoever may be its ther mo metrical or hygro- 
 metrical qualities, must be exonerated from the charge of producing 
 the peculiar morbid effects in question. Sometimes the wind is a 
 humid, sometimes a dry one ; and surely, heat and cold, humidity 
 and dryness, cannot all be fruitful sources of a disease which is 
 always fundamentally the same; while the same winds, equally 
 warm or cold, moist or dry, but lacking the extraneous poison 
 under consideration, have blown for months without occasioning 
 fever. 
 
 It has frequently been found in marshy countries and examples 
 of the kind have been noticed from early antiquity in Dalmatia, 
 Calabria, and Sicily that, by changing the position of towns, 
 houses, and encampments, so as to avoid the effects of winds which 
 blow over marshy or malarious localities, or by preventing access 
 to such winds, by closing carefully the doors and windows of houses 
 exposed to them, fevers have been arrested or guarded against. 
 
 Dr. Dundas having noticed that fever attacks were very common 
 among the inmates of the British Hospital, of which he had charge, 
 at Bahia (Brazil), sat about remedying the evil. In the first place, 
 he made several alterations in the hospital, and had those windows 
 nailed up, which admitted directly the current of wind suspected to 
 cause the mischief. At the same time, effectual measures were 
 taken to prevent convalescents from being exposed without cloth 
 ing. The results of these measures were immediate, and the evi- 
 
 1 DCS Epidemics et dcs Contagions, 92. 
 
AUTUMNAL FEVERS. 219 
 
 dence they offered was complete and apparently free from all fallacy. 
 From that time intermittent fever almost completely disappeared 
 from among the convalescents in the Bahia Hospital. 1 Of course 
 Dr. Dundas, who ignores malaria, attributes these results to a cause 
 very different from the mere shutting out of a malarial atmosphere; 
 but his fact is more useful than his explanation. 
 
 Yarro, in his Treatise upon Agriculture, relates that his name 
 sake Yarro, a Roman general, who was in great danger of suffering, 
 with a large fleet and army, from a malignant fever at Couyra, 
 having discovered the course of the miasmata which produced it to 
 be from the south, he fastened up all the southern windows and 
 doors of the houses in which his troops were quartered, and opened 
 new ones to the north, by which means he preserved them from the 
 fever, which prevailed in all the other houses of the town and 
 neighbourhood. 
 
 This practice, to which attention was specially called by Thouve- 
 nelle, in his clever, but eccentric work on the climate of Italy (iv. 13, 
 14), had not escaped the notice of Dr. Eush, who informs us that, in 
 1793, several families, who shut up their front and back doors and 
 windows, escaped the disease (iii. 83). It is probable, indeed, let it 
 be remarked en passant, that the benefit accruing from seclusion in 
 times of severe epidemics of yellow fever and plague may be ex 
 plained in this way, arid not, as is supposed by contagionists, by 
 the avoidance of individuals affected with the disease, or of objects 
 supposed to be contaminated with the poison. 
 
 Let not the distance to which the cause of fever is here said to 
 be occasionally wafted by the wind, deter the reader from lending 
 a willing ear to this mode of transmission. Many facts are recorded 
 to show that, through the same agency, other substances, diffused in 
 the same manner in the atmosphere, as well as some evident to the 
 sight, and of much heavier nature than the poison in question, have 
 been conveyed to a considerable distance. We are told, on reliable 
 authority, that on the 7th of May, 1842, soon after the outbreak of 
 the great fire at Hamburg, an unusual and strong empyreumatic 
 odour was experienced at Potsdam, at a distance of more than sixty 
 leagues, and evidently proceeding from the direction of the burning 
 city. The ashes of Yesuvius are sometimes wafted as far as Yenice 
 or even Greece, the distance of which from the volcano is not less 
 
 1 Sketches of Brazil, 233. 
 
220 PNEUMONIA AND 
 
 than 500 and 700 kilometres (375 and 525 miles). Instances are 
 mentioned of volcanic ashes having been conveyed much farther. 
 We learn that vessels at sea have, while sailing at the distance of 
 700 to 1,000 kilometres (675 and 750 miles), west of the African 
 coast, been covered with the red sand of that region. 1 In 1812, the 
 ashes of the volcano of St. Vincent were conveyed by the wind as 
 far as Barbadoes. On the same occasion those ashes fell to the 
 depth of several inches on the deck of a vessel at the distance of 
 181 leagues East of St. Vincent. In 1815, the ashes of the Tam- 
 boro, in the Island of Sumbawa, were conveyed as far as Java, 
 (108 leagues), in such large quantities as to obscure completely the 
 atmosphere. 2 The odour of burnt turf, which characterizes the ex 
 halations of the Westphalian marshes, has, we are told, been sensibly 
 felt as far as Brussels, Liege, and even Paris. 3 
 
 The effects of drying, overflowing and reclaiming marshy and sickly 
 localities, and vice versa, prove the existence and agency of malaria. 
 It may not be improper to bear in mind that the banks of water 
 courses, of marshy grounds, of ponds and lakes, as well as humid 
 alluvial surfaces, become, during the drying process, the seat of febrile 
 diseases of the periodic kind ; while other localities in the neighbour 
 hood, but where such a desiccation is not going on the centre of 
 lakes, or river streams, the open sea, beyond the influence of land 
 air remain healthy. Let those sickly surfaces be covered with 
 water, either artificially or otherwise ; cover masses of decom 
 posing materials with earth ; remove collections of putrid rubbish, 
 decayed timber, or decomposed grass, or other vegetable matter, 
 and fever, which before prevailed, will disappear, or greatly lessen. 
 Dry up marshy surfaces, improve and reclaim the land by artificial 
 means, and the same beneficial results will be obtained. On the 
 other hand, let a surface of country heretofore healthy whatever 
 be its dimensions be converted into a marsh, morass, or anything 
 of analogous kind ; as is yearly seen in various parts of Africa, 
 Asia, and America ; let a river bank be temporarily overflowed, 
 and then partially dried; let a portion of low land daily covered 
 by water at high tide, be imperfectly banked, in such a way that 
 the admission of the water is only partially prevented, while its 
 
 1 Bocqucrol, Sur les climats, 250. 2 Couclin, Geogr. M&l. 70. 
 
 3 Diet. Pratique, art. Emanation, vii. 74. 
 
AUTUMNAL FEVERS. 221 
 
 complete egress is impeded ; cut down a forest, and thereby expose 
 a virgin soil, rich in organic matter, or a heretofore harmless, humid 
 surface, to the sun s rajs ; upturn the earth, make deep excavations, 
 dig canals, cut down bluffs, partially remove the water from, and 
 thereby lay bare the bottom of, ponds ; let the alluvion of a river 
 encroach on the water and give rise to an extension of new-made 
 and imperfectly dried ground, and fevers, other circumstances aid 
 ing, will certainly occur or become more rife. All this is placed 
 beyond the reach of doubt. It is, of course, impossible, in the space 
 to which I am necessarily limited, to illustrate these statements by 
 more than a brief notice of the principal facts connected with the 
 subject, which present themselves to my memory. 
 
 The first effects of clearing land, &c. injurious. Dr. Rush remarks, 
 in reference to the epidemics of Pennsylvania, that intermittents 
 and mild remittents were converted, from clearing the country, 
 into bilious and malignant remittents, and destructive epidemics ; 
 and that it was not until after years of cultivation that general 
 salubrity followed. A like change has been found to occur in most 
 parts of New England as Avell as in our Western and Southern 
 States. 1 As the tide of emigration advances westward, remarks 
 an intelligent writer, these (lake fevers), the prevailing fevers 
 of Canada, retire before it. Kingston, situated at the eastern ex 
 tremity of Lake Ontario, is, in 1810, very much healthier than it 
 was in 1830 ; and Danville, two hundred miles, and Amherstburg, 
 four hundred and thirty miles farther west, where, now, there are 
 several cases of ague in every house in the course of the year, will, 
 probably, in either ten or twenty years, be as healthy as Kingston 
 is now. Besides there being less fever at Kingston than at the 
 other two places mentioned, its type is intermittent, while at Dan 
 ville and Amherstburg it is often remittent. 2 
 
 Again, we find this occurring in middle Georgia, particularly in 
 that portion of it lying west of the Oconee. 3 Here the country 
 boasted, at the origin of the settlement, of a salubrious climate. 
 Ten years after, when the forest trees had been levelled to the 
 
 1 Evei 3 where, the first clearing has been attended with an increase in the number 
 of cases, arid in the malignancy of fever; and, in all, healthiness has followed after 
 some years of settlement. 
 
 2 Stratton, Brief Notes on the Lake Fever of Canada, Edinb, J. 55, 348. 
 
 3 Tendleton, Charleston Med. J. vii. 451. 
 
222 PNEUMONIA AND 
 
 ground, the inhabitants began to suffer much from autumnal fevers, 
 and continued to do so for the next twenty years. "Since it has 
 become comparatively an old country, and few new grounds are 
 brought into cultivation, it is quite healthy, the fevers being con 
 fined to the more marshy districts." See, as an example, what has 
 been observed in the single town of Milledgeville. Dr. Fort, in a 
 communication on bilious remittent fever, published in the Southern 
 Medical and Surgical Journal* informs us that this fever appeared 
 there as suddenly as the face of Nature had been changed by the 
 hand of man, and that for eighteen years, during the summer and 
 fall, it was a formidable epidemic. " Forty years have elapsed since 
 the settlement of that tow r n, and the face of the surrounding country, 
 in that time, has been completely changed. The rich soil has been 
 washed away from the hills, and its deeply sanded bottoms have 
 become dry. The sources of malaria have been dried up, and the 
 mortality, which, in Milledgeville, at one time, from bilious fever, 
 might have been five per cent, per annum, has diminished until now 
 the deaths from this cause do not amount, annually, to more than 
 one in two thousand." 2 
 
 The late Dr. Williamson, of North Carolina, relates the following : 
 "A gentleman in Craven County, lived on his farm above forty 
 years Avithout suffering by intermittent fevers, though his family 
 consisted of fifty or sixty persons. There were about 100 acres of 
 clear ground in front of his house that had been cultivated many 
 years ; but there was a thick wood behind the house. In the be 
 ginning of the year 1785, he caused all the timber and shrubs that 
 were behind his house, within four or five hundred yards, to be cut 
 down. His object was pasture and a free circulation of air. One- 
 third of his family, on the next summer, was taken down by inter 
 mittent fevers. Such complaints were not more prevalent than 
 usual during that summer, in other parts of the flat country. 
 Those fevers were certainly caused by exposing to the sun a large 
 surface of fresh land, covered with putrescent vegetables." 3 
 
 Dr. Heustis, in his excellent work on the fevers of Alabama, 
 alludes to a similar fact in the following remarks. "For the first 
 three years after my arrival in this State, in 1821, 1822, and 1823, 
 the country was dreadfully sickly, and the mortality great and ap- 
 
 1 Nov. 1848, iv. No. 11. 
 
 2 The same statement is made by Dr. Fort, in Ids Medical Practice, 07. 
 
 3 Med. and Pldlos. Register, iii. 344. Hist, of North Carolina, ii. 103. 
 
AUTUMNAL FEVERS. 223 
 
 palling, more especially near the rivers. The whole country was 
 then new, and the warmth and humidity of the season caused a great 
 and rapid decomposition in the recently exposed and turned up 
 vegetable matters. Many flourishing towns upon the rivers, which 
 had risen up, as it were, by the hand of enchantment, received a 
 sudden check, and became suddenly, almost totally, abandoned, from 
 death and desertion. Strangers from, every part of the United 
 States, invited by the fertility of the soil, and the beauty of the 
 country, and the serenity of the climate, brought together by for 
 tuitous associations, with foreign and unseasoned constitutions, were 
 suddenly swept off by thousands. In many families there were not 
 well persons sufficient to attend upon the sick and dying. Never 
 have I known a time of such general calamity." 
 
 Similar results will be found recorded in the medical histories of 
 Pennsylvania, New York, and all our other States, as well as in 
 those of England, France, Switzerland, and other sections of Europe, 
 South America, and the West Indies. 1 In a word, everywhere we 
 find a confirmation of the remark long made by our sagacious 
 Franklin, "that all new countries are healthy for a certain period 
 after their first development. That they become inhospitable to 
 man, in a partial state of cultivation, and again healthful when the 
 whole soil shall be necessarily cultivated to supply the wants of a 
 population." 
 
 Partial draining injurious. Examples of the injurious effects of 
 partial draining and desiccation of wet localities, by artificial or 
 natural means, and conversely of the beneficial results attending 
 complete draining of marshy and insalubrious surfaces, or their 
 complete submersion, are numerous and conclusive. They establish, 
 beyond controversy, the fact that the insalubrity of marshy localities 
 increases in compound ratio to the degree of dryness they have 
 attained. They show that the greatest insalubrity and mortality 
 in such localities always coincide with the period of the greatest 
 desiccation, short of complete dryness; that this effect occurs earlier 
 
 1 Volncy, Climat des Etats Unis, 309; Forry, Climate of the U. S. 313 ; Drake, 249, 
 381, 8, 39(3, 404, 710, 717 ; U. Parsons, Dissert. 200 ; J. M. Smith on Epids. 73 ; Evans, 
 15-23 ; Williams, ii. 422; Macculloch, 126, 138, 172 ; Monfalcon, 180, 181 ; Cyclopedia, 
 iii. 61-2-4-82: Ludlow, N. Y. Mcd. and Phys. J. ii. 83; Leblond, 23; Lefoulon, 23; 
 Julia, 129; Boussingault, An. de Chimio, Ivii. 151 ; Copland, ii. 758; Fenner s Rep. 
 ii. 932 ; Transaction of Pemis. State Mod. Soc. ii. 42-65. 
 
224: PNEUMONIA AND 
 
 in hot than in cold latitudes, where the drying process is slo\ver; 
 earlier, when the season is precocious, and the reverse when it is 
 tardy. In illustration of the injurious effect of imperfect drainage, 
 by which a surface covered with water, and which before was com 
 paratively innocuous, is converted into a pestiferous spot, the oft- 
 mentioned case of the monastery of the Chartreuse, near Bordeaux, 
 in France, may be cited. " A succession of bad fevers, before un 
 known, commenced immediately upon the removal of the water 
 and the partial dryness of the land, showing themselves first in that 
 part of the town which lay nearest to the land reformed, and lasting 
 through several years." 1 In 1793 (4th Dec.), the revolutionary 
 government of France, with that questionable sagacity which charac 
 terized most of its measures, ordered the drying up of every pond 
 which was susceptible of the change the reason assigned being 
 the necessity of correcting the vitiated air supposed to be produced 
 by the water therein contained. Nineteen months after, on the 1st 
 of July, 1795, this law was repealed; because, in many localities, the 
 drying process having converted ponds into marshes, which were 
 partially desiccated after the rainy season, rendered the air much 
 more insalubrious than it had ever been before. The report made 
 on the subject to government by Creuse Latouche, judiciously recom 
 mended the reconversion of the marshes into ponds. 2 A similar 
 accession of fever from partial and imperfect drainage occurred at 
 Orville la Riviere, in France (Department of the lower Seine). 
 
 Injurious effects of the overflow of land. The extensive prevalence 
 of fever during hot weather, after the overflow of river, lake, or 
 pond banks, and especially at the receding of the water, is well 
 known to all medical readers, and has been noticed everywhere, 
 and at all times. 3 
 
 1 Macculloch, 114. 
 
 2 Villcrmc, Annales d llygiene, xi. 302 ; Parent du Chatclet, ib. xi. 808. 
 
 3 Drake, 130, 280, 372, 301 ; Bancroft, 294 ; Cycl. of Pract. Mod. iii. 01 : Evans, 
 25; Macculloch, 50-70-92; Williams, ii. 431 ; Mem. de 1 Ac. de Mod. xiii. 044; xiv. 
 1 17, 119 ; Humboldt, 702 ; Schiliz/i, cited by Melier, Mem. de 1 Ac. de Med. xiii. 044 ; 
 Am. Quart, llev. iv. 294 ; Copland, ii. 758; Garrison Tr. Am. Med. Association, ii. 191 ; 
 Leblond, 183; Nepple, 135; Jacquot, 11-22; Thevenot, 232; Second Kept, of 
 Lend. Commissioners, 1848, p. 40 ; U. Parsons, 205; Ludlow, X. Y. J. ii. 80-7 ; Perier, 
 Hyg. des Pays. Chaud. ii. 174; Fenner s llept. i. 357, ii. 448; Barton Kept. 34; 
 Warden, Nat. Hist, of Kinderhook, Med. Ilepos. ix. 019; White, Med. Ptepos. ix. 45, x. 
 30 ; Transactions of the Med. Soc. of the State of Pennsylv. ii. 71-133 : Buel Webster s 
 
AUTUMNAL FEVEKS. 225 
 
 At Massouah (Egypt), fever occurs every time the sea overflows. 1 
 Those of our readers who have examined the writings of Lancisi, 
 may recollect the epidemic of Balnesregium, a small town of Tus 
 cany, an interesting account of which was sent to Lancisi by the 
 Bishop of the place. The disease, on that occasion, was evidently due 
 to the fall or caving in of a hill-side damming up a river stream, and 
 thereby occasioning the inundation of the country around, and the 
 exposure of the subjacent soil to the action of the sun s rays. 2 The 
 epidemics of Pesaro, in 1708, and of Toronte and Trasilone, 3 cities 
 of the Compagna, in 1709, also referred to by the same writer, were 
 equally satisfactorily traced to a kindred cause. The inundations 
 occasioned by the overflowing of the Tiber, and the disease result 
 ing therefrom, are referred to by Livy, Dionysius of Halicarnassus, 
 Dio Cassius, Strabo, &c. Like effects were observed and noted in 
 the twelfth and thirteenth centuries, under the pontifical reign of 
 Innocent III., and, in the fourteenth, under that of Clement V., and 
 are particularly described by Lancisi, who accurately pointed out 
 some of the causes of the disease to which they gave rise. Lancisi 
 informs us that the river overflowed its bank in 1695. The water 
 spread over a large expanse of country, filling the ditches, the 
 sewers, and the canals. This, too, was followed in June, July, and 
 August, by extremely hot weather. Decomposition of the sub 
 merged soil ensued, and this was followed by a malignant periodic 
 fever, which spread far and wide, and occasioned a great mortality. 4 
 The epidemic of pestilential, or, as we presume, malignant autum 
 nal fever, which occurred along the Po at the commencement of the 
 sixteenth century, and is described by Fracastorius, was occasioned 
 by the overflow of that river, by which a large portion of the 
 country was covered with water, and several extensive marshes 
 were formed. 5 The epidemic of Ferrara in 1728, for an account of 
 which we are indebted to Lanzoni, was evidently produced by the 
 decomposition of organic matter arising from the large quantity of 
 rain of the preceding years, followed by intense heat. 6 
 
 collection, 54, 55 ; James Johnson, 43, 130, 360; Smelt, Med. Repos. ix. 125; Harri 
 son, ib. x. 0; Hiklreth, ib. xi. 346 ; Pitt, ib. xi. 337, Piltson, ib. v. 137; Worthington, 
 ib. viii. 372 ; Lipscombe, Trans. Am. Med. Assoc. vi. 322. 
 
 1 Auber Roche, An. d Hygiene, xxxiii. 22. 2 De Noxiis, &c. lib. ii. 210. 
 
 3 Ib. pp. 245 and 334. 4 Ib. 149, &c. 
 
 5 Opera Onmia Philosophica et Medica, 1555, 4to. 100. 
 
 6 Opera Omnia, iii. 4to. Lausanne. 
 
 15 
 
226 PNEUMONIA AND 
 
 The city of Strasburg, in France, is not often visited by mala 
 rial fevers. In 1824, the banks of the Ehine were overflowed, and 
 remained for some time under water. Soon after the water had 
 receded, fever began to prevail, and continued to do so during three 
 consecutive years; nor did it cease before the soil had become 
 perfectly dry. The occurrences which followed the great crevasses 
 of 1816 and 1849, in New Orleans, and the inundation, from the 
 Pontchar train Lake, of a large portion of that city, in 1830, are 
 fresh in our memories ; as also those recorded in Italy, Germany, 
 Egypt, India, Senegal, Algeria, and very many parts of our own 
 country. The irrigations at Oran, Karguantal, Sibi-bel- Abbas, and 
 other districts of Algeria, 1 where the practice is extensively applied 
 to agricultural purposes, and is carried to such an extent as to occa 
 sion a sort of daily inundation ; those of some of the departments 
 of France, as well as those resorted to in the rice plantations of this 
 country, have been found to give rise to the same morbific effects, 
 wherever and whenever the thermometrical condition of the atmo 
 sphere is such as to aid in the extrication of malarial effluvia. 
 
 Mr. Lee, one of the inspectors employed by the London General 
 Board of Health, in reporting on the irrigation by water-meadows 
 in AYiltshire, thus states his information in relation to them. It 
 not only shows, as an agricultural fact, the enormous quantity of 
 water requisite to produce a high state of fertility on the open gutter 
 and bed system of irrigation, but also that, for about half the whole 
 year, these meadows are under water. The first "turn" is during 
 winter, seven days on and seven days off. The second " turn" in 
 spring, four days on and four days off. The third in summer, three 
 days on and three days off ; then three days on and six days off. In 
 every " turn," except the last, the periods of irrigation are equal to 
 those during which the water is shut off; but, during the frost, the 
 water is kept on, if possible, altogether. These "turns" include night 
 and day. The whole of these meadows, therefore, during about half 
 the year, form one large evaporating surface, as much as would be 
 the case if the whole were constituted an immense lake. Even 
 when the water is off, the ground is so saturated that the evapora 
 tion must still be going on. No fen or morass in any low-lying, 
 ill-chained district of the country would, I apprehend, impart, area 
 lor area, an equal amount of moisture to the atmosphere. The 
 
 1 Jacquot, 23. Ficvres a Quinquina. 
 
AUTUMNAL FEVERS. 227 
 
 consequence is such as might be expected ague is extensively 
 prevalent in this valley, and is in some spots so general that scarcely 
 any of the inhabitants, rich or poor, young or old, escape it. 
 
 The difference between the people exposed to the influence of such 
 a surface and others living in neighbouring parishes of equal popu 
 lation, but not subject to malaria, may be seen, as Mr. Lee remarks, 
 in the dejected and haggard appearance of the former, and in the 
 greater amount dispensed among them for poor-rates. In the 
 course of his investigation into the sanitary condition of the parish 
 of Longbridge Deverill, near the town of Warminster, Mr. Lee 
 found that in one portion of that parish, the large village of Crocker- 
 ton, scarcely any of the inhabitants had escaped ague; and, on 
 comparing the poor-rates for seven years back with those of the 
 parishes of Corsley and ITorningsham, of about equal size, and in 
 the same union, it is seen that the charges for sickness in Long- 
 bridge Deverill are nearly double. 1 
 
 The conclusions as to the insalubrity of common irrigation, and 
 its unfitness for the proximity of towns, are fully corroborated by 
 the fact that, in the Lombardo-Yenitian provinces, where there is 
 some of the oldest, most extensive, and skilfully conducted irriga 
 tion in Europe, the government has long found it necessary to in 
 terfere for the protection of the health of towns. By law, as stated 
 in some information on the subject received by the English General 
 Board of Health from the authorities of Milan, " permanent" irriga 
 tions are prohibited within five miles distance of towns. These 
 permanent irrigations are there mostly applied to the cultivation of 
 rice. Cases are reported, from the irrigated districts, of the appear 
 ance and disappearance of fevers coincident with the operations of 
 flooding and drying particular tracts of land. It appears, indeed, 
 from extensive experience, that, wheresoever water is laid on the 
 land in greater quantities than it can immediately or very soon 
 absorb, or wheresoever there is alternate wetting (in such excess) 
 and drying, malaria is apt to arise. 2 
 
 In the Department of Marne and Loire, in France, the basin of 
 the Anthion is 32 kilometres in length, and 6 in its greatest breadth, 
 opposite to Corne, and contains 1,560 hectares, or 3,000 acres of 
 submersible land between the bridge of Bourgiernon and that of 
 
 o o o 
 
 1 Minutes of Information, &c. on Sewer-water and Town-manure, &c. London, 
 1852, pp. 7, 8. 
 
 2 Ibid. 9. 
 
228 PNEUMONIA AND 
 
 Forge, and 1,016 hectares, or 2,032 acres, equally submersible land, 
 in another direction. It constitutes an immense focus of decompo 
 sition, from which are evolved effluvia, and often paludal miasmata. 
 In the more depressed portions of this surface, the inundation is 
 as much as ten feet deep. It is difficult, however, to obtain a com 
 plete desiccation of it. In 1843, the whole of this basin was 
 flooded, and all the ditches completely rilled. The Anthion, that 
 year, remained higher than ordinarily. The water continued to 
 cover the greater portion of the soil, and it became impossible to mow 
 the grass in a dry state. This circumstance of an immense inunda 
 tion ought, it would seem, to have proved advantageous ; for the 
 whole basin was, by the overflow, converted into an immense lake, 
 by which an obstacle was put to the formation of a marsh. But no 
 sooner had the water somewhat subsided, and, by so doing, allowed 
 the exposure during the hot weather of July and August, of the 
 banks of the ditches, and of a few hillocks, than the effluvia, then 
 extricated from the mass of decomposing vegetable and animal sub 
 stances therein contained, were wafted by the S. S. W. wind to the 
 town, and infected the inhabitants, among whom it occasioned the 
 development of an extensive epidemic of intermittent fever. 1 
 
 The following statement is taken from a clever communication 
 contained in an English periodical: 
 
 " The summer in this country (Russia), is farther remarkable, 
 inasmuch as, from the end of May to the beginning of September, 
 no rain falls, and thunderstorms are extremely rare. The pheno 
 menon is doubtless owing to the flatness of the country. For five 
 hundred miles and more, around Perm and Kassan, there is not a 
 hill of any consequence, and the whole tract from Kiew to Ural, for 
 a breadth of five hundred miles, may be called a plain, only here 
 and there interrupted by ranges of gentle hills. The extraordinary 
 fertility, especially of the government of Kassan, is occasioned by 
 the inundation of the Wolga, which overflows annually at particu- 
 
 1 Gaultier de Claubry, Mem. de 1 Acad. de MeU xiv. 119, 120; sec also 117, for 
 another case of the same import. 
 
 The Canton of Amizy-le-Chateau is situate in a valley, on the south side of the 
 city of Laon. In the centre runs the small, sinuous, and shallow river of Elete, 
 which is supplied with water from a number of creeks. In the neighbourhood, there 
 lire a number of ponds, the whole subject to overflows, which, combined with the 
 peculiar nature of the soil, have given rise to extensive marshes, well known under 
 the name of the southern marshes of the Laonnais. The canton is very subject to 
 fevers (Bulletin, i. 154). 
 
AUTUMNAL FEVEKS. 229 
 
 lar seasons, as regularly as the Nile in Egypt, and converts the 
 whole country, to the distance of ten miles or more from its bed, 
 for five or six weeks, into an immense sea, These inundations of 
 the Wolga, and the other large rivers, the Witjalka, the Kama, the 
 Kinel, the Irgis, &c. which discharge themselves into the Wolga, 
 render the countries through which they flow at once lively and 
 fertile. At such seasons you may sail, either for pleasure or upon 
 business, in large two-masted vessels, carrying from six to ten guns, 
 over pastures and cornfields, to the neighbouring towns, which, 
 on this account, are all situated upon heights; and, when the waters 
 have withdrawn into their accustomed channels, the ground for 
 saken by them is covered often a yard deep with a fertilizing mud, 
 in which, during the hot season, all vegetables grow rapidty and 
 vigorously as in a hothouse. At the same time, pools are left 
 behind in the low grounds, where the water stagnates for several 
 months, becomes putrid, and generates putrid fevers in the months 
 of July and August in these otherwise healthy countries. The 
 government of Ufa, particularly, is visited about this time by an 
 intermittent fever, which attacks the patient every seventh day 
 only, but is so violent that it generally proves fatal." 1 "Near the 
 walls of a large city," says a celebrated writer, "stood a very exten 
 sive and deep pond of water, which, for forty years, had served as 
 a receptacle for all the filth from the houses and streets. As long- 
 as these putrid matters remained covered with water, they were 
 productive of no mischief; but, when they had so far accumulated 
 as to rise above the surface of the water, a most malignant fever 
 spread through the tract of country adjoining the city." 2 
 
 Dr. Cadwallader Golden, of New York, who wrote a full century 
 ago, makes the following remarks : 
 
 "It is well known that the Paltz Eiver or Wallkill, in Ulster 
 County, in this province, has been long taken notice of, as very 
 prejudicial to the health of those who live on the banks of it. The 
 waters of this river are of a dark colour, and come from a large 
 space of ground overflowed with stagnating water. The inhabitants 
 along this river, are yearly afflicted with intermittent fevers during 
 the summer season, and a constant fog or vapour is observed almost 
 all the summer (except in the time while the K. W. or northerly 
 
 1 Notices of Russia, United Service Journal, January, 1833, p. 49. 
 
 2 Seiific, De Nat. Febr. Recond. lib. i. cap. vii. fol. 34, 35. CaldwelPs Trans, 20. 
 
230 PNEUMONIA AND 
 
 winds blow) to arise over that river, and to remain there at a certain 
 height and distance every morning, till the heat of the sun disperses 
 it, and frequently, likewise, in the evening." 1 
 
 About the same time a distinguished physician, of this city, stated 
 the following fact : "A farm, within a few miles of this city, was re 
 markably healthy for fifty years, whilst the tide overflowed the low 
 lands, near the dwelling-house ; but after they were banked in by 
 ditches, so ill-contrived that they did not often discharge the water 
 that fell into them for a considerable time, it became putrid, and 
 thereby rendered the place as remarkably sickly as it had been 
 before healthy. I was told by a gentleman of veracity that he saw 
 the corpses of nine tenants, that had been carried from it in a few 
 years." 2 
 
 Between Winchester and Charlottesville, in the valley of Virginia, 
 is situate a remarkably large and deep spring, from which extends 
 a low, marshy piece of ground about a mile long, and perhaps one 
 hundred yards wide. All around this marsh the people have been 
 annually subject to fevers in an unusual degree. In the very wet 
 year of 1823, however, the marsh being inundated, they almost 
 entirely escaped. 3 The readers of Pringle will remember the occur 
 rences in Brabant during the campaign of 1748. "The country 
 bordering upon the lower part of the Maas is not only unhealthful 
 on this account (the humidity of the soil under the surface), but, 
 by reason of floods from the small rivers, lies all the winter under 
 water, and continues damp throughout the summer. The moisture 
 and corruption of the air were much increased by the inundations 
 (which had been made about the fortified towns since the com 
 mencement of the war), and sensibly became more noxious upon 
 letting off part of the water, in the beginning of the summer." 4 
 
 Dr. Eobert Hamilton, of Lynn Eegis, in a pamphlet quoted by 
 Bancroft, and referred to particularly in the Lond. Med. Gaz., de 
 scribes a remittent fever produced in that place, in 1779, by a freshet 
 which occasioned an inundation from the sea. "The inundations 
 from the sea are generally followed by severer consequences in re 
 spect to health, than those from the fresh water. If they extend far, 
 they cover much low ground under cultivation, and fill many ditches, 
 
 1 N. Y. Med. and Philos. Register, i. 323. 
 
 2 Bond, Tntrod. Lect. N. A. Med. and Surg. J. iv. 270. 
 
 3 Cooke on Eped. Fevers, Med. Recorder, vii. 457, 8. 
 
 4 Diseases of the Army, 01. 
 
AUTUMNAL FEVERS. 231 
 
 which, in many situations, cannot be drained by any other means 
 than evaporation by the heat of the sun." " The remittent fevers 
 which follow are of the worst kind; the effect being due to the 
 dead fish that remain, and the effluvia from the destruction of rep 
 tiles, insects, &c., and vegetables which are destroyed by the sea 
 water." The gale of 1779 was attended by such an inundation, the 
 effect of which, developed by the heat of five successive summers 
 and autumns, were seen in the fevers of those years, which were 
 more violent, universally epidemic, and more fatal than Dr. Ilarnil- 
 ton had seen them in the past forty years. These fevers have 
 ceased to show themselves. The country around, which was one 
 of the most unhealthy, has become one of the most salubrious, by 
 the complete draining of the Bedford level. 1 
 
 "Near Guerande and Pont Chateau, several localities on the coast 
 of Britanny partake more or less of the insalubrity of marshy sur 
 faces. Among these may particularly be cited the towns of Dinan, 
 Dol, Lamballe, and their environs, in consequence of the high tides 
 occurring on this part of the coast, and resulting from the obstacles 
 to the free flow of the sea from the western coast of the Cotentin. 
 The waters thrown back by that coast are carried to, and accumu 
 late in, the bays of St. Michel, St. Malo, and St. Brieux, where they 
 rise to the height of forty feet, and overflow the country far beyond 
 Dinan, spreading miasmata to the north and south." In the same 
 way, in the Bay of Isigny, the sea rises to a great height, and occa 
 sions the overflow of the rivers, especially in the vicinity of Carentan, 
 which is surrounded by stagnant water during several months of 
 the year. "Hence the city and its environs are seldom free from 
 fevers and other kindred diseases." 2 " In the province of Poitou, 
 the insalubrity of most of the towns and villages arises in like 
 manner from the exhalations generated in the morasses and ponds 
 by which they are surrounded, owing to the overflow of the rivers. 
 Thus the Sevre, in which the sea penetrates, overflows its stagnant 
 waters during several months of the year, to the depth of two, four, 
 and even six feet, and inundates the whole country around Lucon, 
 Maillezais, and Marans, as far as two leagues below Niort, thereby 
 forming a marsh of 65,085 arpents in extent. All this country is 
 subject to intermittent fevers and other diseases." 3 
 
 1 Lend. Med. Gaz. xxviii. 790. 
 
 2 Boncerf, Mem. de la Soc. Roy. de Med viii. 282, 3. 
 
 3 Ib. 282. 
 
232 PNEUMONIA AND 
 
 Mr. Ives, in the narrative of his travels from India to Europe by 
 land, relates the following interesting and apposite fact : 
 
 " After sailing up the Kiver Tigris, from Bassora, we arrived at 
 Bagdad. In this city, supposed to contain 500,000 souls, a purple 
 fever then raged; but though it was computed that an eighth part 
 of the inhabitants were ill, yet the distemper was far from being 
 mortal. Here we were informed that the Arabs had broken down 
 the banks of the river near Bassora, with a design to cover with 
 water the deserts in its neighbourhood. This, it seems, is the usual 
 method of revenge taken by the Arabs, for any injury done them 
 by the Turks in Bassora ; and it was represented to us as an act of 
 the most shocking barbarity, since a general consuming sickness 
 would undoubtedly be the consequence. This was the case fifteen 
 years before, when the Arabs, by demolishing the banks of this 
 river, laid the environs of Bassora under water. The stagnating 
 and putrid water in the adjacent country, and the great quantity 
 of dead and corrupted fish at that time lying upon the shore, pol 
 luted the whole atmosphere, and produced a putrid and mortal 
 fever. Of this fever, between 12,000 and 14,000 of the inhabitants 
 died ; at the same time, not above two or three of the Europeans 
 who were settled there escaped with life." 1 
 
 In the summer of 1780, a violent remittent prevailed in that 
 city, so general in its attacks, and so fatal in its effects, that it 
 destroyed 25,000 persons, and was called a plague. The disease 
 on this as on other occasions was manifestly owing to the cause 
 mentioned, which, after moistening to saturation a great extent of 
 the banks of the river, was speedily followed by intense solar desic 
 cation, during which the fever appeared. 2 Indeed, the same effects 
 are frequently produced at Bassora, and to a highly destructive 
 degree, after the ordinary overflowing of the Euphrates. Of the 
 consequences arising from simple inundation, Egypt affords, as we 
 have seen, a similar example; inasmuch as its season of fever com 
 mences with the subsidence of the Nile. Every one must know, 
 that equally disastrous results have often followed the overflowing 
 of the Adige, the Po, the Scheld, the Saave, the Theisse, the Don, 
 the Tigris, and other streams. 
 
 Hungary is as sickly a country as any other in Europe, and is 
 
 1 Lind, on Hot Climates, 118, 119. 
 
 2 Craigic s Practice, i. 172 ; Trans, of a Society for the Improvement of Med.-Chir. 
 Knowledge, ii. 55. 
 
AUTUMNAL FEVERS. 233 
 
 scarcely exceeded in that respect by any on this side of the Atlantic, 
 or in Africa. Its fevers, which in the short space of a few years 
 destroyed forty thousand Austrian soldiers, has, under the name of 
 morbus Hungarians, become familiar to all medical readers. Here, 
 the same causes which render other localities injurious to health, 
 and prolific of febrile complaints, subsist in an eminent degree. 
 " Hungary abounds in rivers, some of great magnitude the Danube 
 and the Drave, which, by often overflowing, leaves that low, flat 
 country overspread with lakes and ponds of stagnating water, and 
 with large unwholesome marshes." 1 
 
 The fevers of Senegal, described by Thevenot, and before him 
 by Schotte, are due to the annual inundation of the river of that 
 name. Containing but little water during eight months of the year, 
 it fills up rapidly during the wet season, and, soon rising to a height 
 of more than 38 or 40 feet beyond its proper level, spreads as do 
 also its many tributary streams and neighbouring lakes, which 
 before were dried up its waters over the whole country, which 
 now presents, like Egypt, during the inundation of the Nile, the 
 appearance of a vast expanse of water dotted over with villages. 
 On the subsidence of this, fever breaks out. 2 
 
 " The garrison of Fort Augusta, which stands very near some 
 marshes, to which it is to leeward when the land wind blows, w^as 
 yet remarkably healthy; but it became at one time extremely 
 sickly upon the breaking in of the sea in consequence of a high 
 tide, whereby the water, which was retained in the hollows of the 
 fort, produced a putrid moisture in the soil, exhaling a vapour of 
 fensive to the smell, and with all the noxious effects upon health 
 commonly arising from the effluvia of marshes." 3 
 
 The yellow fever epidemic of La Guayra, in 1797 the first 
 known to have occurred in that place has been referred, with 
 much plausibility, to the overflowing of the river of that name. 
 " This torrent, which in general is not ten inches deep, was swelled, 
 after sixty hours of rain in the mountains, in so extraordinary a 
 manner that it bore down trunks of trees and masses of rocks of 
 a considerable size. During this augmentation, the waters were 
 from thirty to forty feet in breadth, and from eight to ten feet in 
 depth. Many houses were carried away by the torrent, and the in- 
 
 1 Lind on Seamen, 59 ; Tringl. 189. 
 
 2 Thevenot, Maladies des Europeens, &c. 20, 21. 
 
 3 Bliine, Diseases of Seamen, 2d edit. 229, note. 
 
234 PNEUMONIA AND 
 
 undations became more dangerous for the stores, in consequence of 
 the gate of the town, which could alone have given an issue to the 
 waters, being accidentally shut. It was necessary to make a breach 
 in the wall in the sea-side ; more than thirty persons perished." 1 
 
 Bad effects of copious rains followed by great and desiccating heat. 
 A wet season, or heavy temporary rains, by converting dry and 
 heretofore healthy tracts of country into swamps or marshes, or by 
 merely thoroughly softening a soil previously hardened by a dry 
 spell of weather, and mostly destitute of vegetation, has, when fol 
 lowed by heat, given rise to a considerable extent of disease. 2 Hence, 
 in localities which are naturally dry, or which have been rendered 
 so by long-continued and intense heat, the rainy season is that of 
 the greatest insalubrity, and continues so until the soil becomes com 
 pletely submerged. Indeed, the fresh rains often become the signal 
 for the breaking out of the disease. Among the many facts that 
 might be cited in corroboration of the former statement, I shall select 
 the following: In Corsica, fevers break out in August and Septem 
 ber, not only along the marshes, but in the villages situate between 
 the mountains, on the occurrence of heavy showers. 3 Speaking of 
 1839, Mr. Gouraud says : " I was beginning to think that the extent 
 of the annual endemic had been greatly exaggerated. On the 20th of 
 August, during a very hot spell of weather, we had a shower. The 
 latter produced, instantaneously, a very offensive odour, and decided 
 the development of pernicious intermittents." 4 Similar effects of 
 the first rains are noticed in the Morea. On their landing there, in 
 1828, the French troops were exposed to intense heat by day and 
 cold by night. These vicissitudes, succeeding to a long period of 
 dry ness, invited the approach of the annual epidemic. Kain fell in 
 heavy showers on the 18th and 19th of September, and the disease 
 broke out on the 20th. 5 A gentleman, living on the ridge land 
 between the Opequon and the Shenandoah Eivers, in Virginia, in 
 formed Dr. Cookc, from whose essay on Epidemic Fevers I quote: 
 "That he had, for nineteen years before 1823, scarcely known what 
 sickness in his family was. A neighbour had been in the habit, 
 for many years, of watering his meadow by small rills, from his 
 mill-race. Before this wet year, the quantity he could spare was 
 
 1 Humboldt, Pers. Nar. iii. 202. 
 
 2 Villemic, An. d llyg. xi. 350; Leblond, 100, 184. 
 
 3 Gournud, Ktudes sur les F. Interm. Pemicieuses dans les contrdcs meridionales, 37. 
 
 4 lb. 40. 5 / t 218. 
 
AUTUMNAL FEVERS. 235 
 
 very small, and not enough to make the ground wet, the moisture 
 being absorbed immediately. This year, however, it was quite 
 marshy, and the road through it very bad. The consequence was, 
 that a great number of persons died in the houses just around the 
 meadows." 1 
 
 In 1830, the city of Macacu, in the Province of Eio Janeiro (Bra 
 zil), on the banks of the river of that name, suffered extensively from 
 periodic fever. The district around the city is rich in virgin forests 
 and in coffee, sugar, rice, and other plantations. Thence the disease 
 extended far and wide, occupying a surface of argillaceous soil, cut 
 up by numerous streams, torrents, and lakes bordered with man 
 groves, and subject to inundation at high tides. The epidemic was 
 evidently due to a great drought, which occurred in 1829-30, and 
 succeeded to heavy rains, which flooded the country. 2 
 
 It may be mentioned, in illustration of this, that sickly seasons are 
 generally those in which a wet spring is followed by a hot summer. 
 AYe have seen that in Africa, in the East Indies, in the Antilles, and 
 in South America, fevers make their appearance at the commence 
 ment and a short time after the close of the rainy season; when, 
 consequently, the soil is not yet deluged with water, or when it has 
 ceased to be so, and offers, by its exposure in a moist state to the 
 evaporating power of the sun, and by the greater luxuriance of 
 vegetation which ensues, ample food for the generation of the febrile 
 poison. This is equally true, both as regards common autumnal, 
 and malignant yellow fever. While they all often commence and 
 rage soon after the appearance of rain, and are sometimes put a 
 stop to by excessive and long-continued drought, they seldom break 
 out in an epidemic form during a very dry spell of weather, unless 
 the latter has been preceded by a wet spring, or a quick succession 
 of heavy showers, by which the earth is thoroughly saturated. 
 Facts illustrative of these effects have been observed everywhere, 
 both abroad and in this country. 3 It is on those observed by him- 
 
 1 Med. Recorder, vii. 457. 
 
 2 Sigaud, du Climat et dcs Mai. du Brazil, 170-2. 
 
 3 Town, 7-0; Warren, 8; Clialmers, i. 19-22; Macartney, quoted by Dickson, Ed- 
 inb. Journ. xiii. 47; Humboldt, 765; Desportes, i. 17, 121 ; Lind, 50; Bailly, Fievres 
 Interm. 180; Clark, Med. Notes on Climate of Italy, 80; Tommasini, ii. 488, 9; Da 
 vidson, quoted by Rush, iv. 155; Halphen (of N. 0.), 42, 43; Pallas, 209, 210 ; 
 Report of Sickness of British Army, 4-23 ; Savaresi, 256, 257, 292 ; Pugnet, 344, 345 ; 
 Mosely, 10, 11 ; Chisholm, i. 14G, 147; Belcher, Ed. Journ. xxiii. 248; Dariste, 33; 
 Davidson, Med. Repos. viii. 248. 249 ; Catel, 7 : Dazille, 10 ; Ed. Journ. Ixiii. 448 ; 
 Dupre, Am. Journ. N. S. iii. 205; E. II. Smith, Webster s Collection, 75; Bayley, 
 
236 PNEUMONIA AND 
 
 self and others in the West Indies, though especially in Holland, Spain, 
 and Portugal, that Dr. Ferguson built his theory of the exclusive 
 agency of the drying process, that grew with him into a hobby, which 
 he rode manfully and with much ability to the last day of his life, 
 and which a few of our countrymen would seem disposed to mount, 
 strangely unmindful of many other facts which strongly militate 
 against its exclusive adoption, and show, as we have seen, that, 
 under certain circumstances, malarial fevers not unfrequently ap 
 pear under the influence of the luetting process. 
 
 The establishment of mill-dams, and the subsequent partial de 
 siccation of the soil, have the same effect. Dr. 0. "W. Holmes, who, 
 besides writing amusing poetry, composes excellent medical essays, 
 adduces, in a work of marked ability, a large body of facts, showing 
 the injurious effects of these dams, and of ponds. 1 Dr. Rush, 
 in enumerating the causes of the increase of remittent bilious 
 fever in and about the year 1785, mentions, prominently, the esta 
 blishment of dams ; 2 and Yolney has expressed himself strongly in 
 their condemnation. 3 Harrisburg, in this State, situate between 
 the Eiver Susquehanna and a small creek, and extending nearly or 
 quite from one to the other, furnishes an acceptable illustration of 
 the above fact. In the year 1773, a dam was built across the creek, 
 in the rear of the town, and thereby produced a very extensive 
 and shallow pond. In the fall of the year succeeding, a mortal 
 fever prevailed in the town, which was satisfactorily traced to the 
 influence of that pond. The people insisted on having the dam 
 removed. The pond was completely drained, and the town was as 
 healthy afterwards as it had been before that time. 4 Mifflin County, 
 in this State, is generally free from sources of miasmal exhalations. 
 In 1823, intermittent fever prevailed extensively; but it was con 
 fined exclusively to the immediate vicinity of mill-clams. A few 
 cases, in the more healthy districts, could be traced, in every in 
 stance, to the same source, or to a visit to the river. 5 
 
 53,123; Ralph, Edinb. Mcd.-Cliir. Trans. 55-GO ; Doughty, 187,188; Lewis, N. 0. 
 Journ. for July, 1848, p. 38 ; Pinkard, ii. GO ; Lebloud, vii. 100, 100; Villerme, An. 
 cTIIyg. xi. 350. 
 
 1 Boylston Prize Dissertations (Interm. Fever) 47. 
 
 2 Rush, An Inquiry into the Causes of the Increase of Remittent ami Intermittent 
 Fevers in Pennsylvania. Philosoph. Trans, ii. 200. 
 
 3 Volney, Climat ties E. U. ii. 309, &c. 
 
 4 Cooke on Epid. Fev. Mod. Recorder, vii. 452. 
 
 * Traus. of State Mod. Society, ii. 44; see also p. 47. 
 
AUTUMNAL FEVERS. 237 
 
 Dr. Drake, in his imperishable volume, relates the following 
 strong fact : The village of Washington, in the State of Ohio, stands 
 on the north-east side of Paint Creek. About the year 1820, a mill- 
 dam was erected a short distance above the town, which caused the 
 inundation, to the depth of a few feet, of about sixty acres of bottom 
 land. As the stream generally fell too low, by the first of June, to 
 admit of grinding at the mill, it was the custom of the proprietors 
 to open the floodgates, and let the water escape, 1 after which the 
 copious showers of that month commonly washed aAvay the recent 
 deposits, and thus the health of the village did not appear to suffer. 
 In the year 1838, the owners did not let off the water until July, 
 and no rains followed to wash away the silt. In a short time an 
 offensive smell was wafted from this foul and drying surface into 
 the village, which was to its leeward, and, in the month of August, 
 the inhabitants began to sicken with remittent and intermittent 
 fevers. Those who lived on streets nearest to the pond, suffered 
 most. The people who resided in the vicinity, to the west, or 
 windward, did not suffer. No epidemic, so severe, had ever visited 
 the village before. In the succeeding years, up to the time of 
 Dr. D. s visit, in 1840, the waters had been drained off the first of 
 
 1 Speaking of the upper Cuyahoga Basin, Dr. Drake remarks that it is annually 
 more or less infested with autumnal fever, although elevated eleven hundred feet 
 above the sea, and in the mean latitude of 41 30 N. ; but the banks of the ponds 
 and marshes are much infested. " Thus, I was told by Mr. Coles, of Chardon, that 
 when a dam was built across the Cuyahoga, at Burton, the people were, in the two 
 next years, generally attacked by autumnal fever; and Dr. Hamilton, of the same 
 town, informed me that, in the neighbourhood of Burton, a dam was demolished in 
 summer or autumn, and nearly all the labourers engaged in the work sickened with 
 fever. From Dr. Bennett, of Sharlesville, I received the following facts : The Cuya 
 hoga flows near the western side of that village, from east to south-west. To obtain, 
 water for the Mahoning Canal, a dam was thrown across the river, which gave rise to 
 many cases of fever. Two years afterwards a higher dam was erected, lower down 
 the river, which raised the water to the level of the first, involved the ruin of an old 
 mill, produced stagnant water in the mouths of many small streams, inundated some 
 forest land, and so intercepted the volume of water flowing in the river, that when 
 it became reduced, in autumn, the whole was transmitted through the canal-feeder, 
 leaving but a series of pools in the partially dried up river bed below. During the 
 first autumn after this signal change in the condition of the river, no injury to health 
 was experienced ; but in the next, nearly all the inhabitants, on both sides of the 
 river, above and below the new dam, were attacked with autumnal fever. The num 
 ber of cases was estimated at one hundred and fifty. They who lived near the river 
 had intermittents ; those who resided farther off, and on higher ground, suffered more 
 from remittents." Pp. 372, 3. 
 
238 PNEUMONIA AND 
 
 June, and much of the drift-wood and filth cleared away ; in con 
 sequence of which, apparently, the epidemic had not occurred. 
 
 The same writer relates the following example : "On Cedar 
 Creek, a tributary of the Cumberland River, a mill-dam had been 
 erected, about sixteen feet high. After twenty-two }^ears, the basin 
 having become filled with silt and dross, the dam was torn down, 
 and the perpendicular face of the deposit exposed to the action of 
 the sun and air, in the month of August. The consequence of this 
 was, that nearly all the men who performed this labour were seized 
 with severe autumnal fever, and one died. 1 " 
 
 The following fact is related by another American writer, Dr. Lud- 
 low, of New York. A mill-pond in the vicinity of Lyons, Ontario 
 County, which overflowed ten or fifteen acres of land, was drained, 
 in the summer of 1822, for the first time, the mill having been built 
 about five years. In consequence, about thirty people in the im 
 mediate vicinity were taken suddenly ill, seven or eight of whom 
 died. Some of the intermittents Avere very malignant. 2 
 
 Macculloch refers to equally strong facts as observed in the iron 
 district of Glamorganshire, at Hirwren, and other parts of South- 
 end, near Lewisham, in Hertfordshire, and elsewhere in England. 3 
 
 Injurious effects of upturning the earth in hot iceather. It has 
 already been stated that the digging of canals, the opening of 
 ditches, the cutting down of bluffs, the levelling of lots, the filling 
 up or digging down of streets, the opening of roads, the establish 
 ment of brickyards, &c. have proved highly injurious, not only in 
 this country, but in parallel or hotter latitudes, as also during the 
 hot seasons of cold regions. The results of operations of the kind 
 in the East and West Indies are on record, and, like those in Alge 
 ria, an account of which has recently appeared, are of a nature not, 
 to be easily forgotten. Near Tlerncen, in Algeria, nearly all the 
 soldiers employed in digging a well were attacked with fever, while 
 all the others in the vicinity escaped. 4 The opening of roads, and 
 the upturning of the earth for various purposes, are recognized, by 
 the entire body of physicians attached to the French armv in that 
 
 1 Topogr. &c. of the Miss. Valley, 717. 
 
 2 A Stat. and Med. Account of the Genesee Country, N. Y. New York Med. and 
 rhys. J. ii. 89. 
 
 3 Op. cit. 101-103. * Jacquot, Fievres a Quinquina, 29. 
 
AUTUMNAL FEVERS. 239 
 
 country, as having given rise to the extensive development of fever. 1 
 The writings of Dr. Drake, 2 so often cited, those of Evans, 3 Blane, 4 
 Cassan, 5 Macculloch, 6 Usher Parsons, 7 Caldwell, 8 Bayley, 9 Tho 
 mas, 10 Anderbach, 11 Davy, 12 Graultier de Claubry, 13 and many others, 
 abound in similar cases. Dr. Merrill, in an essay on the yellow 
 fever of Natchez, has taken great pains to show, and with every 
 appearance of success, that the epidemic of 1823 arose from the 
 levelling of the streets, and the consequent exposure of the fresh 
 soil to the action of the hot sun. 14 
 
 The same able physician, in an excellent and interesting anniver 
 sary address read before the Medical Society of Memphis, Tennessee^ 
 on " the health and mortality" of that growing city, has traced the 
 great sickness and loss of life that recently occurred there, princi 
 pally to the work of grading and digging, which has been exten 
 sively carried on for several years past, and which produce an 
 obstruction to free drainage. " In this," says Dr. Merrill, " I am 
 sustained by the opinion of Dr. Grant, in his able address before 
 this Society at our last anniversary, by many of the members of 
 the Society, by the Board of Health, and by many persons of learn 
 ing and experience who are not members of the medical profession." 15 
 
 The injurious effects of these works is farther illustrated by 
 occurrences in Charleston, in 1842 and 1852: "In 1842, white 
 labourers, strongly predisposed to yellow fever, were employed in 
 opening drains and other works, and transferring the earth to dif 
 ferent portions of the city; and where the drains were opened and 
 the earth was deposited, there yellow fever occurred, and the unfor 
 tunate beings who performed that work were the greatest victims. 
 In 1852, the same thing occurred." 16 Dr. Simons remarks, in a note, 
 that, in reference to the last-mentioned year, at the new custom- 
 
 1 Ibid. 13-29. 2 Op. cit. 182, 229, 235-239, 372. 
 
 3 Op. cit. 75, 266. 4 Dissertations, i. 332. 
 
 5 Mem. de la Soc. Med. d Emulation, v. 142. 
 
 6 Op. cit. 83, &c. 7 Essay on Malaria, in vol. of Essays, 206. 
 8 Essay on Miasm, Boston J. ii. 504. 9 Yellow Fev. of New York in 1795. 
 
 10 Essai sur la Fievre J., 1st ed. 71. n N. Y. J. ii. 75, N. S. 
 
 12 Second Kept, on Quarantine (Lond.), 57. 
 
 13 Mem. de 1 Acad. de Med. xiv. 120. u Philad. Med. and Phys. J. ix. 340. 
 
 15 Memphis Med. Recorder, i. 85-94; see, also, Grant, "The Meteorology, Sani 
 tary Condition, Prevailing Diseases, and Mortuary Statistics of Memphis," Ameri 
 can J. July 1853, 74, 115 ; see, also, a paper by the same, in N. 0. J. for May, 1852. 
 
 16 Simons, Charleston J. viii. 364. 
 
240 PNEUMONIA AND 
 
 house, a great number of Irishmen were employed in excavating 
 the earth, and piling; that of these a great many were taken sick 
 and died ; and that the sale and distribution of the earth through 
 different portions of the city had a baneful effect. 1 The same correct 
 observer states, in addition, that " in 1849 an extensive drain was 
 opened in Ilasel Street, excavating the most filthy and offensive 
 materials ; and, likewise, an extensive drain in Market Street, from 
 Church Street to the wharf. Yellow fever occurred earliest in 
 those localities, and was more fatal. Again, the earth, so filthy and 
 offensive, was transferred to King s Street, from Horlbeck s Alley to 
 Ilasel Street, and, in this particular spot, there was sickness among 
 a class of persons who are generally exempt." 2 
 
 For the following account of an extensive diffusion of autumnal 
 fever from a kindred cause, which occurred in this country, we are 
 indebted to an English writer, who collected the information on 
 the spot. 
 
 The digging of that part of the Chesapeake and Ohio Canal 
 which runs from Seneka to Georgetown, commenced on the 17th 
 of October, 1828, and was nearly finished in November, 1830. The 
 distance is about twenty-three miles, and for the greater part the 
 canal runs nearly parallel, and very close to the Potomac Kiver. 
 The bank of the canal is elevated considerably higher, and, in some 
 places, as much as fifty-four feet above the banks of the stream, 
 which is there inclosed in a hilly country, and the water passes on to 
 the ocean, with all the rapidity of a mountain torrent. During the 
 summer of 1829, there were nearly four thousand labourers em 
 ployed in making this division of the canal. They continued 
 healthy until the end of June; but in July, August, and September, 
 they suffered severely. During these months, two out of three were 
 attacked with autumnal fever, most of them with its most aggra 
 vated form, and, as nearly as could be ascertained, of those that 
 were taken ill, about one-fifth fell victims to the disease. 3 
 
 All this is confirmed by what Lind pointed out, long ago that 
 " the effluvia from ground newly opened, whether from graves or 
 ditches, are far more dangerous than those from the same swampy soil, 
 where the surface is undisturbed ; nay, in some places, it has been 
 found to be almost certain death for an European to dig a grave in 
 
 1 Ibid. 365. 2 /k cjG4, 5. 
 
 3 Stevens on the Blood, 239. 
 
AUTUMNAL FEVERS. 241 
 
 swampy districts of tropical climates, unless long seasoned to the 
 country. In such a place, the attendance of friends at funerals 
 ought to be dispensed with." 1 
 
 The construction of the canal of the Ourcq, in France, in the 
 years 1810-13, will long be remembered for the extensive pre 
 valence of fever, of which it was evidently the cause, and the 
 large mortality which ensued at Pantin, and several other neigh 
 bouring villages. 2 We all have a recollection of the results attend 
 ing the digging of the Carondelet, and other canals in or near New 
 Orleans, and in other parts of the country. 3 A memorable instance 
 of this kind occurred in France in the latter part of the seventeenth 
 century, on the occasion of the construction of the aqueducts and 
 canals required for conveying water to Versailles from the River 
 Eure. The immense upturning of earth, which was effected during 
 very hot weather, was followed by a large amount of disease and 
 mortality all along the route, but more particularly about the Castle 
 of Maintenon, where the principal works were constructed. 4 
 
 Another instance of a more recent date, is worth recording. In 
 the small commune of Lutzenbourg, in the arrondissement of Sarre- 
 bourg, in France, the population of which did not exceed six hun 
 dred and twenty-five, remittent fever, preceded by a vast amount of 
 ague, prevailed during July, August, and September, 1852. The 
 spring had been cold and wet ; but about the first week of May, the 
 thermometer suddenly began to rise. The heat steadily increased, 
 and became intense in July. The disease, as Avell as the intermit- 
 tents which preceded, were satisfactorily traced to the influence of 
 the excavations and upturnings of earth required in the construction 
 of the Paris and Strasburg Railroad, which passes through the com 
 mune, and in cutting the canal connecting the Marne with the Rhine, 
 the bed, of which, from the stoppage of the work, had been con 
 verted into a boggy marsh. " In proportion," says the reporter, "as 
 the public works extended through (Sillonnaient) the valley, and by 
 upturning the earth, brought up to the surface the deeper layers of 
 the soil, so intermittent fevers arose and spread very extensively." 
 Prior to this, the population had been healthy, and strangers to 
 malarial fevers." " 
 
 1 Dis. of Hot Climates, 108. 2 Villerme, An. D Hyg. xi. 352. 
 
 3 Barton s Rep. to State Med. Soc. of Louisiana, 34. Thomas, 70, 1st ed. 
 
 4 La Beanmelle, Mem. de Mad. de Maintenon, iii. 239, 240. 
 
 5 Burchrmlt, Gaz. Med. de Strasburg, December 25, 1852, xii. 407. The esta- 
 
 16 
 
242 PNEUMONIA AND 
 
 I shall have occasion, as we proceed, to mention an event strik 
 ingly illustrative of the injurious effects of exhalation from open 
 ditches, which occurred at the General Lying-in Hospital in York 
 Road, Lambeth. 
 
 The following case, which is derived from Lancisi, 1 will be read 
 with interest: On the first of May, 1707, the hilly grounds to the 
 southward of the town of Bagnarea, after continued great rains, 
 began to fall into the river which was near that town, in such a 
 manner that whole vineyards were moved from their places, and 
 some houses entirely, without falling ; in one of them, a woman 
 was delivered of a child while the house was on its march. The 
 channel of the river was choked and filled up. Many cracks, gaps, 
 and holes were left in several parts of the ground, in which the 
 waters stagnated ; and they, being impregnated with sulphureous 
 minerals, with which the earth there abounded, became exceed 
 ingly offensive to the smell. During the summer heats, the colour 
 of the inhabitants became of a dead swarthy yellow, and grievous 
 pestilential fevers seized them. These were confined to the southern 
 and lower parts of the town ; while the other parts, which stood 
 high, and at a distance from the stagnating waters, out of reach 
 of the vapour which arose from thence, remained healthy, as 
 usual. By order of the magistrates, the channel of the river was 
 
 blishment of the railroad from Strasburg to Basle, has required the digging, to the 
 depth of 1 to 2 metres (from 3^ to 7 feet), of the adjacent fields, with the view of pro 
 curing earth with which to level the road. The results have been immense excava 
 tions in the vicinity of the communes of Bottwiler and of Feldkirch. After being 
 filled with water in the autumn and spring, these excavations become partially dried, 
 and deposit a large quantity of slime. They have thus been converted into true 
 marshes, in which M. A. Boumann has discovered the characteristic plants of stag 
 nant water. 
 
 Under the influence of this marshy surface the commune of Bottwiler, the popula 
 tion of which is 1446, has severely suffered from intermittent fever during the last 
 three years. In 1842, the number of fever cases amounted to 36; in 1844, to 166 ; in 
 1845, to 743 ; and in 1846, to 1166. The mortality has increased in the same propor 
 tion. The average in ten years (from 1836 to 1845) is 36. In 1846, it was not less than 
 54. The small commune of Feldkirch, with a population of 450, suffered with equal 
 severity. In 1843, the number of cases amounted to 2 ; in 1844, to 20 ; in 1845, to 135 ; 
 and in 1846, to 376. (Dollfus-Aussat. Comptes Rendus de 1 Acad. des Sciences, 1847, 
 xxiv. 779.) M. De Gasparin stated, at the meeting of the Academy of Sciences, when 
 this report was read, that similar effects were produced by analogous changes along 
 the railroad of Tarascon. He added that, when informed of these facts, the Minister 
 of the Interior ordered the marshes to be filled up. Archives, 4th series, xiv. 241. 
 
 1 Nox. Palud. Etfl. lib. 2, Epidem. iii. 210, 211. 
 
AUTUMNAL FEVERS. 243 
 
 cleared, drains were made for carrying off the water, the places 
 where it stagnated were cleared, and the cavities, which could not 
 be drained, were filled up, and the inhabitants were the next 
 summer freed from the fevers. 
 
 In the public thanksgiving ordered for this deliverance, the 
 Bishop declared the obligations they were under to Lancisi, by 
 whose advice they had been delivered from such poisonous diseases. 
 
 The injurious effects resulting from the receding of the sea, and 
 the consequent extension of the land by the deposition of alluvion, 
 have been noticed at the mouth of the Tiber, of the Po, of the 
 Ganges, of the Oronoco, of the Mississippi, &c. The partial revolution 
 which has taken place in the first of these localities, as is remarked 
 by Dr. Carriere, has not resulted merely in pushing back inland the 
 old city of Ostia, formerly the seaport of Rome, and separating from 
 the sea the original mouth of the Tiber ; it has placed the city in 
 the centre of an insalubrious territory, of which it formerly occupied 
 only the edge, and has been the cause of its progressive depopula 
 tion. We know that formerly Ostia was too small for the number 
 of its inhabitants, and figured among the magnificent cities of La- 
 tium. At present, it contains only a priest, a tavern-keeper, four or 
 five soldiers, and a few families, who do not venture even to reside 
 there all the year round. But this in salubrity is not limited to the 
 city; for, inasmuch as the miasmatic elaboration is effected on a 
 large scale, in consequence of the increased extent of surface, there 
 has arisen, since the time of the Romans, a new source of morbific 
 effluvia, which must be taken into account when we inquire into the 
 sanatory conditions of the country, though more especially when the 
 wind blows from the sea. 1 Another case in point is mentioned b} r 
 Sir W. Burnett. In former days, there existed a large marsh near 
 Malion. It has now been converted into productive gardens. Since 
 the draining of the greater part of this marsh has been completed, 
 the sea has been gradually receding from the head of the harbour, 
 leaving ( particularly during the prevalence of the easterly winds) 
 a large portion uncovered, from which, in the summer and autumn, 
 the most offensive exhalations proceed. 2 I have already alluded to 
 the effect of the annual receding of the Nile. The same effect re 
 sults from the diminished extent, noticed every year at particular 
 periods, in certain other streams and bodies of water, by which a 
 
 1 Amer. J. July, 1851. Carriere, le Climat de 1 Itulie, 20, 21. 
 
 2 Fevers of the Mediterranean, p. 14. 
 
244 PNEUMONIA AND 
 
 large portion of their banks is laid bare. The River Biviere, and 
 other watercourses in Sicily, lose, yearly, two-thirds or more of 
 their dimensions ; Lake Cagliari, in Sardinia, loses almost as much. 
 All are hotbeds of fever. 
 
 Beneficial effects of complete drainage. On the other hand, while 
 everywhere experience has demonstrated the injurious effects arising 
 from the ordinary mode of cultivating rice effects which have called 
 forth in several places the protective interference of governments 1 
 the physicians of Georgia are ready to tell us what has been the 
 result of the dry-culture system on the health of localities hereto 
 fore proverbial for their sickliness. 2 In New England, and other parts 
 of this country, the removal of mill-dams has, as in other instances 
 already mentioned, been found to produce the like salutary effects. 
 Several of the cities of England and France formerly contained 
 extensive portions of marshy ground, and other sources of miasrnal 
 exhalations, and were, in consequence, annually visited by remittent 
 and intermittent fevers. Many of these marshes have been com 
 pletely drained, and the surface built upon, or otherwise improved, 
 and the disease has disappeared. Thus, for example, in 1558, the 
 mortality from such fevers in London was so considerable, that the 
 living could hardly bury the dead. Less than a couple of centuries 
 ago, that city was subject to the same disease, in its worst forms. 
 Bishop Burnet s authority is cited for the fact, that, in the reign of 
 Mary, intermittent fevers raged like a plague. 3 The same may be 
 found in the writings of Sydenham and Morton. From 1661 to 
 1665, the annual loss from intermittents alone averaged more than 
 one thousand. Dr. Short informs us that among forty deaths from 
 fever, between 1628 and 1636, one was from ague. " There are 
 some diseases on the decline," he says. "Agues, whereof one of forty 
 of the whole that died of fevers, died ; now scarce one of 1,100 that 
 die of fevers, die of this. This distemper has at several times pre 
 vailed for a long series of years, and has sometimes raged like a 
 plague. In 1664 they disappeared, and scarce came on the stage 
 before 78 ; but from 1720 to 1729, they and remittents afflicted the 
 
 1 Monfalcon, 100; Bourely, Gaz. Med.de Montpellier, Oct. 1840, 99; ib. Annalcs 
 d FIyg. xliii. 328, 332; Cycl. of Tract. Mcd. iii. (50; Williams on Morbid Poisons, ii. 
 4:51 : Boileau Castclnau, Annalcs d Hyg. xliii. 331 ; Delongchamp, Diet, dcs So. Med. 
 xlix. 50, 7; Zimmerman, de 1 Experience, ii. 402; Fodere, Mcd. L6gale, v. 1-33. 
 
 2 Daniel, 29. 3 1Jlanc> j. 254, 255. 
 
AUTUMNAL FEVERS. 245 
 
 whole nation grievously ; and now, as to their severity, especially 
 mortality, they are extinct." 1 Eernittents and intermittents consti 
 tuted, as it would appear, no inconsiderable an item among the dis 
 eases which Fothergill noticed in London during certain seasons in 
 1751-4. 2 The immense marshes which were situate around the 
 city, at Lambeth and other places, were removed by under-drains 
 and sewers ; ditches were filled up ; the river, which, from Lambeth to 
 Woolwich, was swampy, was banked out, and the site rendered dry by 
 being covered with buildings, and the most satisfactory changes in 
 regard to salubrity were obtained. In 1728, the deaths from these 
 fevers amounted to forty-four ; in 1729, to forty-seven ; and in 1730, to 
 only sixteen. In 1752, the proportion was one in one thousand of 
 deaths. For some sixty years, the disease has not been known as 
 an endemic in that metropolis ; and of the few cases that occur, the 
 larger number, if not all, are traceable to fenny districts, situate at 
 a greater or less distance. 3 A similar improvement has taken place 
 at Portsmouth, which, in former days, was a hotbed of intermittent 
 fever; but has been freed of the disease, simply by paving the streets, 
 and removing various sources of miasrnal infection. 4 In England, 
 according to recent reports, of the fifty cities and towns in which 
 the mortality was highest, there was scarcely one in which drainage 
 or sewerage was complete. In seven, it was indifferent, and in forty- 
 two it was decidedly bad. Experience there has shown that no 
 population is healthy which live amid cesspools, or upon a soil per- 
 
 1 New Observ. Natural, Moral, Civil, Political,, and Medical, on City, Town, and 
 Country Bills of Mortality, &c. 208. Lond. 1750. 
 
 2 Weather and Diseases of London. Works i. 151, 210, 234. 
 
 3 Dr. Good, and his commentator, Mr. Cooper, have called attention to the fact that, 
 in 1822 and 1823, agues again made their appearance, and have prevailed ever since 
 more frequently than they had done for many years before, adducing this as a proof 
 of the disease arising often from other causes than malaria. These cases, however, 
 have prevailed principally on the outskirts and not the centre of the great metropolis. 
 Besides, as respects London and its vicinity, changes have taken place sufficient to ex 
 plain the circumstance without negativing the existence of malarial effluvia. Dr. 
 Copland, who is of that opinion, calls attention to the fact that "the streets have been 
 macadamized, constantly watered, and covered by a wet, clayey mud; the soil sur 
 rounding the metropolis has been turned up for the purpose of building, &c., to a much 
 greater extent since that period than formerly ; and the muddy and marshy banks of 
 the river have been unusually disturbed and inundated by the swell from the paddles 
 of the numerous steam vessels." Copland i. 1090, Am. ed. 
 
 4 See British & For. Med. R. i. 286. See, also, Baker on Intermittents, Med. Trans, 
 of College of Phy. of London, iii. 141, &c. ; Willan s Reports, 203. 
 
246 PNEUMONIA AND 
 
 meated by decomposing animal or vegetable refuse, giving off impu 
 rities to the air in their houses, and in the streets ; and experience 
 has proved, also, that in those places where such sources of impu 
 rity are removed, the salubrity improves. From this, we may infer 
 that a late writer is not far from the truth, when he avers that inter- 
 mittents have nowadays become, to the profession at large, mate 
 rials for medical history, rather than for medical observation ; since 
 it is a rare fact, in many places, to meet with a case. If they appear 
 at all, it is in marshy districts, some of which exist still, and must 
 long continue to do so, or in such places as along the Surrey bank 
 of the river from Battersea to Deptford, where a great part of 
 the surface is lower than high-water mark, and the ground conse 
 quently is never well drained. 1 
 
 In the Island of Ely (England), the mortality, as compared with 
 the births, was formerly as 70 to 61. The island has been drained; 
 and we learn from Sir John Sinclair, that the proportion is now as 
 54 to 61. Dr. Kirkland, who practised for thirty years at Chelm- 
 ford, situate in a marshy district of country, called the Hundred 
 of Essex, states that, in former days, the inhabitants were all pale, 
 jaundiced, emaciated, and bore in every way strong marks of the 
 effects of malaria. Fever prevailed extensively among them, and 
 hardly any stranger could venture to the place. Through the 
 instrumentality of philanthropic and enterprising individuals, the 
 country has been drained, improved, and cultivated; fevers have 
 disappeared or greatly lessened, and the inhabitants are as remark 
 able for their fine health and fine looks, as they were before for the 
 reverse. 2 
 
 Dr. Rigby, in his examination before the commissioners on the 
 
 1 London Medical Gazette, xxiii. 870. 
 
 2 Sinclair, The Code of Health and Longevity, 41, 42. London, 1820. 
 
 Mr. John Marshall, Jr., in a report, sa} r s: It has been shown that tlie Isle of 
 Ely was at one period in a desolate state, being frequently inundated bv the upland 
 waters, and destitute of adequate means of drainage ; the lower parts became a 
 wilderness of stagnant pools, the exhalations from which loaded the air with pestife 
 rous vapours and fogs ; now, by the improvements which have from time to time 
 been made, and particularly within the last fifty years, an alteration has been made 
 which may appear to be the effect of magic. By the labour, industry, and spirit of 
 the inhabitants, a forlorn waste has been converted into pleasant and fertile pastures, 
 and they themselves have been rewarded by bounteoiis harvests. Drainage, embank 
 ments, engines, and inclosures, have given stability to the soil (which in its nature is 
 as rich as the Delta of Egypt) as well as salubrity to the air. C/tadicick, 2d Re 
 port, Fol. 
 
AUTUMNAL FEVERS. 247 
 
 state of large towns, 1 says of the General Lying-in Hospital, in 
 York Eoad, Lambeth : " The hospital was seldom free for any 
 length of time from puerperal fever, occasionally producing fright 
 ful ravages, and requiring the building every now and then to be 
 closed. After the greatest attention had been paid to cleanliness in 
 every respect, the wards left open night and day for weeks, fumi 
 gated, the walls limed and painted, the beds thoroughly cleaned, 
 fumigated, repaired, and frequently renewed, and the most scrupu 
 lous attention paid to cleanliness, the fever reappeared, on some 
 occasions immediately, on the hospital being reopened. This cir 
 cumstance made us look to external causes, when we ascertained 
 that, in the immediate vicinity of the hospital, there were upwards 
 of 1,500 feet of open ditches, receiving the drainage of the poor 
 and dense population of the neighbourhood, one of the ditches 
 being not more than thirty feet from the wall of the building. It 
 was black and stagnant, and in constant ebullition from the dis 
 engagement of gas. After great difficulty and trouble, the hospital 
 having to bear a large proportion of the expense, the Commission 
 ers of Sewers were induced, although with much reluctance (in Oct. 
 1838), to have a portion of these ditches cleaned and properly 
 arched over ; an immense quantity of black pestilential mud was 
 excavated, but, instead of being removed, it was spread over the 
 adjoining ground. The effect was, that " at that time the hospital 
 was freed from disease, but ten cases of puerperal fever occurred 
 within twenty-four hours after this unjustifiable act." The drainage 
 of the hospital was then carefully attended to, and ventilation also 
 (the main drain had been entirely blocked up by two logs of wood), 
 and puerperal fever ceased. 
 
 It appears, from the statistical accounts of Scotland, that the 
 effects of drainage in various counties have been very beneficial to 
 the health of the population. 2 There is not much intermittent fever 
 in Edinburgh, but there was formerly a lock, called North Lock, 
 which was famous for it. Ague, remittents, and intermittents pre 
 vailed in that district till the spot was drained. 3 They now no 
 longer appear. The following facts are recorded in the Parliament 
 ary Reports. In Fordown County: "So much draining that now 
 no swamps; formerly, agues common; now quite unknown." Kin- 
 
 1 First Report, 412. 
 
 2 Second Kept, of the Lond. Coramis. for 1848, p. 43. 
 
 3 Elliotson s Lectures, Lond. Med. Gaz. ix. 890. 
 
248 PNEUMONIA AND 
 
 ross-Kinross : "Agues prevalent sixty years ago, in consequence of 
 marshes; now never met with." Oswell: "Ague prevalent for 
 merly, bat not since the land was drained." Redgorton; "Healthy; 
 no prevailing disease; ague was frequent formerly, but not since 
 the land has been drained and planted." Albernyte : " Since the 
 land was drained, scrofula rare, and ague unknown." Muckhart : 
 " Great improvement in agriculture ; ague formerly prevalent ; 
 not so now." 1 
 
 Mr. Smith states, in answer to questions put to him, at the re 
 quest of the Metropolitan Sanitary Commissioners, that in the 
 alluvial clay district of Stirlingshire, and west of Perthshire, where 
 the drainage was formerly effected by large open ditches, in the 
 Dutch fashion, ague was periodically prevalent, and rheumatism, 
 fevers, and scrofulous affections were much promoted, until the 
 introduction of thorough drainage, forty years ago; after which 
 period those diseases began to disappear, or to be greatly mitigated 
 in severity. " Few cases of ague now appear. Fevers are seldom 
 known, except in the usual course of fevers which prevail epidemi 
 cally over the whole country. In the undrained condition of those 
 districts, they were subject to dense fogs, especially in the autumnal 
 months, when much rain had fallen, communicating a chilly feeling 
 
 1 Dr. Southward Smith, before a committee of the House of Commons, declared: 
 " That in every district in which fever returns frequently, and prevails extensively, 
 there is, uniformly, bad sewerage ; a bad supply of water ; a bad supply of scaven 
 gers, and a consequent accumulation of filth. If you trace down the fever districts 
 on a map of the Commissioners of Sewers, you will find that, wherever they have not 
 been, the fever is prevalent; and, on the contrary, where they have been, lever is com 
 paratively absent." 
 
 In the Ifolywell and Long Alley district, with five hundred recorded cases of 
 diarrhoea and typhus, within the last six months, in one particular place, namely, 
 Long Alley which is a long, narrow, and close passage, crowded with inhabitants 
 the drainage, contrary to the general rule, has been put in good order, and this 
 place has remained exempt from disease. Two courts in Whitechapel, that were 
 iu an exceedingly damp arid filthy condition, and in which fever had prevailed for 
 some time in every house, ceased to be affected with disease on being drained. In 
 Dulwich, fever was arrested by clearing out drains. In Hammersmith, diarrhoea dis 
 appeared in one street after the emptying of a cesspool that had overflowed, a new- 
 drain having been built at the same time. In the Acton district, no fever is reported, 
 and only ten cases of diarrhoea, the external and internal cleansing having been well 
 attended to. Metropolitan Kanilar;/ Coininixxior), Id Report (1848), 22. 
 
 " It is reported to us that agues and remittent fevers, in Gravesend and the vici 
 nity, luivo been greatly reduced after the drainage, although very imperfect, which 
 has been accomplished in the town and neighbourhood. Id Report of London Com- 
 luixtsioncrs (1848), 42. 
 
AUTUMNAL FEVERS. 249 
 
 to the inhabitants ; but since the general introduction of thorough 
 draining, those fogs seldom prevail, unless in a general foggy tend 
 ency of the atmosphere of the country/ 
 
 On the farm of Deanston, in the west of Perthshire, consisting 
 of about 200 acres, and which was the first farm on which the entire 
 system of thorough drainage and subsoil ploughing was introduced, 
 there was a marked effect produced. The farm, after periods of 
 rain, used to be covered with chilly fogs, which entirely disappeared 
 after the thorough draining was effected. 
 
 Mr. Parker reports : "In respect of increased salubrity, induced 
 in towns and rural districts by drainage, I may instance the 
 acknowledged disappearance of ague and other periodical maladies 
 consequent on the great drainage effected in Cambridgeshire, as in 
 the Isle of Ely, &c., and in the Lincolnshire, and other great 
 marshes. As an example of the good effects arising from the 
 drainage of swamps, I may state that the Commissioners of Her 
 Majesty s Woods and Forests, of which your lordship is the chief, 
 have recently caused me to drain an extensive tract of country in 
 the new forest, called the Wear s Lawn and Bog, adjoining which is 
 a small hamlet, where inhabitants previously suffered much from 
 intermittent fevers. The hamlet is now healthy ; the offensive, 
 gaseous emanations from the soil have ceased ; and the inhabitants 
 are supplied with an abundance* of the purest spring water, dis 
 covered during the operations of drainage, and appropriated to 
 their use." 
 
 A Mr. Xeilson remarked: "I have also had several opportunities 
 of witnessing similar effects in the West Indies, and particularly in 
 British Guiana, where I resided several years. The surface is 
 almost a dead flat, lower than the sea at high water, and drained 
 only at considerable expense by large sluicegates for each estate, 
 which are opened each period of low water. When an estate is 
 abandoned, this is neglected, and its neighbourhood is invariably 
 the first to suffer on the approach of an epidemic; and I have 
 known instances of the course of a fever thus produced being 
 checked, and materially altered, by the neighbouring lands being 
 drained, an alteration considerably accelerated by a small quantity, 
 of lime, in a finely powdered state, being distributed on the lands 
 during a windy day." 1 
 
 1 Drainage of the Lruul Forming the Sites of Towns, 00-72. London, 1802. 
 
250 PNEUMONIA AND 
 
 According to Dr. Graves, whose premature loss to the profession 
 we must all greatly deplore, there can be no doubt that in Ireland, 
 as in other countries, the effects of cultivation and drainage on the 
 health of the inhabitants are very remarkable. He himself witnessed 
 several exemplifications of the improvements thus effected in respect 
 to the public health. Formerly, ague was of rather common occur 
 rence in some marshy districts in the immediate vicinity of Dublin, 
 and consequently, when he was a pupil, cases of intermittent fever 
 were constantly to be met with in the hospitals; now, the low 
 grounds have been drained, and thus the production of ague has 
 been entirely arrested. 1 
 
 The city of Cork, Ireland, lies in an irregular valley which is 
 open to the east and west, but is confined by hills on the north and 
 south sides. On the west it is connected with the fertile valley of 
 the Eiver Lee, which, rising from the mountain lake of Gongane 
 Barra, flows in a devious course until it reaches the city of Cork, 
 where it receives a large tidal accession. When the Lee is about 
 a mile west of the city, it divides into two channels, which gradually 
 diverge, but reunite again, thereby insulating a considerable tract, 
 upon which the main part of the city is built. This tract is low, 
 and being permeated by some small streams from the main 
 branches, inundations occur when the river is swollen by heavy 
 rains and high tides. From this* cause the city anciently derived 
 its not very flattering name, Corkagh, signifying a morass. This 
 unpromising locality, from its marshy nature, was, as might be 
 expected, very subject to intermittent fever, and " the fever and 
 ague" were as familiar words in Cork as they are in the swamps of 
 the Mississippi. Within the last century it has been drained, and 
 in part built upon. The smaller inosculating channels have been 
 arched over ; the river has been confined by handsome quays to its 
 two divisions, and the main branches have been deepened. The 
 effect has been, the almost disappearance of the fever, which now 
 shows itself but seldom, and for a number of years did not reign in 
 an epidemic form. 2 
 
 In fact, so far as Great Britain is concerned, the immense benefit 
 of drainage has been proved by all the researches of Mr. Chadwick, 
 who says: "In considering the circumstances external to the resi- 
 
 1 Cliiiiral Lectures, 51, Am. ed. 
 
 2 Poplmm, Notes on the (Miniate and Diseases of the City of Cork, Dublin .Journal 
 of Med. Sc. xv. 290, May, 1853. 
 
AUTUMNAL FEVERS. 251 
 
 dence, which affect the sanitary condition of the population, the 
 importance of a general land drainage is developed, by the inquiries 
 as to the causes of the prevalent diseases, to be of a magnitude 
 of which no conception had been formed at the commencement of 
 the investigation; its importance is manifested by the severe conse 
 quences of its neglect in every part of the country, as well as by its 
 advantages in the increasing salubrity and productiveness, wherever 
 the drainage has been skilful and effectual. 1 
 
 Lancisi gives a memorable instance of this in the town of Gon- 
 dolpho, already referred to, which, notwithstanding its elevation, 
 was rendered sickly by the exhalations from Lake Turnus, lying 
 below it to the south-west. The lake was dried up, by order of 
 Pope Paul V., and salubrity was the consequence. 2 The same 
 writer relates an interesting case of the beneficial effect of drainage, 
 which was communicated to him by Lentilius, physician to the 
 Duke of Wurtemberg, and which occurred at Stutgard. " What 
 you are preparing, on the noxious exhalations of marshes," says 
 Lentilius, " cannot but be entertaining and useful. No one can 
 doubt of the great importance of the subject. This I can illustrate 
 by a single statement : Stutgard, the residence of my most serene 
 Prince, is surrounded by mountains on every side except the east, 
 where there is a sort of plain, stretching about an hour s walk 
 towards the Elver Necker. Near the wall of the town, on the 
 eastern side, and near that plain, was formerly a fish-pond or pool 
 of several acres in extent. For many years, our metropolis has 
 been notorious for its obstinate quotidian intermittents, which, 
 being scarcely epidemic, but only endemic, have been commonly 
 known by the name of the Stutgard fevers. It happened, about 
 fifteen years ago, that this pool was drained, and converted into a 
 most beautiful meadow. From that time, intermittent fevers have 
 become so rare that they never once have deserved the name of 
 epidemic, but only appear in sporadic cases, here and there, and 
 are, moreover, much easier to cure. Hence, it appears that the 
 fevers arose from the filthy effluvia of the pool, wafted by the 
 eastern wind over the town, and confined there by the inability of 
 the wind to sweep them quite away, on account of the mountains 
 adjacent." 3 
 
 1 Second Kept, Fol. 
 
 2 De Xoxiis Palhulum Effluviis, 20. 3 Ibid. 10. 
 
252 PNEUMONIA AND 
 
 M. Huguenin, in a Prize Essay on Ponds, which was presented 
 to the Academy of Lyons in 1778, and is quoted in the Memoirs 
 of the Koyal Medical Society of Paris (vol. viii. p. 289), after dwell 
 ing on the injurious influences of marshes, says: "Lorraine long 
 experienced these baneful effects, before the cause of the periodic 
 return of the fatal febrile diseases, by which it was visited during 
 several successive centuries, could be ascertained. While its hu 
 mane and benevolent princes founded thousands of charitable insti 
 tutions to insure relief against these ever-renewed evils; while 
 natural philosophers and physicians laboured to discover the germ 
 of those disastrous epidemic diseases, agriculture came to the aid 
 of this desolated province, and, without suspecting the miracle it 
 was about performing, drained, in a short time, two hundred ponds, 
 in order to fecundate the precious soil which had so long been ab 
 sorbed by the water. The air being thereby relieved of the humid 
 ity and putrid vapours by which it had been heretofore saturated, a 
 stop, or at least an interruption, was put to this fatal circle of con 
 tagions, which, while endemic in localities surrounded by ponds, 
 appeared often epidemically in the rest of the province." 
 
 In Paris, malarial fevers, in the time of Ballon ius, were of daily 
 occurrence, and prevailed on a large scale. They have now become 
 so rare that when Alibert wrote his once popular treatise, it was 
 with difficulty he could find more than a few cases for examination. 
 Strasburg, already mentioned, has, in like manner, been cured of 
 such diseases, except in some parts of the suburbs; but here, 
 marshes have been allowed to remain unreclaimed. Like results, 
 though not invariably so entirely satisfactory, have been obtained 
 in other parts of France; as, for example, at Eochefort, Marenne, 1 
 Bresse, 2 Lome, 3 Bourg, 4 Monbrison, 5 Fours, 6 Lyons, 7 Bourgoin, 8 &c. 
 If the first of those cities which, in the days of Chirac, was pro 
 verbial for its unhealthiness, and was visited, in 1694, by a wide- 
 spreading and malignant epidemic, of which that most distinguished 
 physician has left us a vivid description still suffers from fevers in 
 autumn, the effect is due, not to the persistence of palludnl influ 
 ences within its walls, or in the immediate vicinity, but to other 
 circumstances already adverted to. 
 
 1 Melier, Mem. de 1 Acad. de Medccine xiii. 073. 
 
 2 Statistiquc du Depart, de 1 Ain, 184; Fodere, Med. Legale, v. 251. 
 
 3 faultier de Olaubry, Mem. de 1 Acad. de Med. xiv. 129. 
 
 4 Morifalcon, 32. 5 Ib. 42. 6 Ib. 184. ? Ib. 182. 8 Ib. 182. 
 
AUTUMNAL FEVERS. 253 
 
 The present beautiful city of Bordeaux was so sickly formerly 
 so frequently and fearfully visited by periodic fevers, arising from 
 the exhalation of extensive marshes, situate in the vicinity that 
 the Parliament of the Province, which held its meeting there, was 
 often compelled to seek shelter in other and more favoured locali 
 ties. Such was the case in 1473, 1495, 1501, 1515, 1525, 1546, 1653, 
 and 1654; on which occasions, the disease assumed a more malignant 
 form than common, and was, according to the custom of the times, 
 held in the light of a plague. Similar events would, probably, have 
 continued to occur, had not a venerable prelate, the Cardinal de 
 Sourdis, then bishop of the Province, formed, in 1604, the project 
 which he carried into effect at his own expense of draining and 
 reclaiming the larger portion of the marshes situate near the city. 
 This gigantic work was effected ; and fevers, since then, have seldom 
 if ever visited that city never, in that part of it which had been 
 more particularly under the influence of the culprit marshes. Other 
 similar works, in other parts of the city or the vicinity, have been 
 effected, and always with the same happy results. 1 
 
 1 Betbeder, Topogr. Med. de la villc de Bordeaux, Mem. de la Soc. Roy. de Med. 
 i. 187 ; see also same work, viii. 270 ; Yillerme, An. d Hyg. xi. 840. The ponds of the 
 Dombes, as already mentioned, have long been noted for the insalubrity they occasion. 
 In 1830, the sickness in the vicinity was so great that a commission was appointed 
 to suggest measures for remedying the evil. In his report on the subject, M. Purvis 
 says : " Almost every individual examined admitted the baneful effects of the ponds : 
 a large number viewed them as the principal cause ; a small number referred the 
 eft ect to the nature of the soil ; others, to the marshy condition of the fields, &c." 
 At the same time, a large amount of facts were adduced in the course of the inquiry, 
 tending to show that the salubrity of the place was restored whenever the ponds were 
 dried up. The commission, in view of the numerous facts obtained during the inquiry, 
 influenced by the advice of all the physicians who have turned their attention to 
 questions of public health, and of all the agriculturists and economists who have 
 written on the subject taking into consideration that the Dombes, before the increase 
 in the number of ponds, was much more extensively cultivated and more populous than 
 since they have been made to occupy a large portion of the soil ; that since then 
 more than one-half of the population seem to have disappeared ; that while the Bresse, 
 the formation of which is similar to that of the Dombes, with an inferior and unhealthier 
 soil, has, by drying up its ponds, enhanced its prosperity, and possesses now a popula 
 tion of 1,600 inhabitants to every square league ; the Dombes, on the contrary, by 
 multiplying hers, has lessened greatly the net value of her agricultural products, and 
 has now a population of less than 400 to the square league ; considering, finally, that 
 insalubrity and fevers reappear everywhere with the increase of ponds, and that com 
 monly salubrity is everywhere restored when these are dried up, the commissioners 
 are unanimous in the opinion that the ponds are, without the least doubt, the princi 
 pal cause of the insalubrity of the Dombes." They admit that marshy fields, bad 
 
254: PNEUMONIA AND 
 
 Surrounded as Copenhagen and all Denmark are by water, salt 
 and fresh, and situate, as the former is, in a low and flat country, 
 containing much stagnant water and many ditches, it is no wonder 
 that ague is of very common occurrence there. Yet the disease, as 
 we learn from Professor Otto, " is much less frequent now than 
 formerly, which must be attributed to the draining of several pools 
 and stagnant waters. The ague was, at one time, from the want of 
 proper drainage, extremely frequent, and in many cases fatal, on 
 the island of Langland." 1 
 
 Around Scanderoon, the seaport of Aleppo, are extensive marshes 
 and swamps, which produce their usual effects. " During the sway 
 of Ibrahim Pasha in the country, it was brought before his notice. 
 Attracting as it did so much attention, the whole was drained, and 
 canals formed to carry off the waste water continually from the 
 hills, &c. For two years subsequent to the completion of these 
 salutary exertions, an almost perfect immunity was enjoyed ; but 
 the soldiers, at the commencement of the operations in 1840, de 
 stroyed the embankments, &c., and soon reconverted what had 
 become cultivated land into their former state, and the disease, 
 which had almost been banished from the neighbourhood, again 
 resumed as severe a sway as formerly." 2 
 
 As cities enlarge and improve, malarial fevers decrease in them. In 
 our own cities the larger ones particularly- remittent and inter- 
 regimen, and, perhaps, the nature of the soil, have some agency in producing that 
 effect ; but they believe that all those causes combined are far from being capable of 
 occasioning a degree of evil equal to that occasioned by the ponds. (Statistique du De 
 partment de 1 Ain, quoted from Becquercl on Climate, 278.) The commune of Varenge- 
 ville, in the arrondissement of Dieppe (Seine Iriferieure), is situate on a surface which 
 formerly constituted part of a large marshy district noted for its unhealthiness, and was 
 the frequent seat, during the autumn, of epidemics of intermittent fever. On one 
 occasion, the almost entire population 177 out of 182 suffered simultaneously or 
 in succession. Their general health was bad ; they presented signs of a cachectic 
 state, and all the morbid conditions resulting from frequent attacks of intermittent 
 fever. The duration of life among them was short. Considerable ameliorations have 
 been effected in the condition of this locality during the last sixty years. A great 
 part of the marshy surface has been drained and converted into cultivated fields, and 
 periodic fevers have diminished or disappeared. In some parts, however, and espe 
 cially in the small commune of Varengcville, little or nothing has been done to reclaim 
 the land and marshy surfaces, and stagnant pools continue to exist ; and wherever 
 such is the case, fevers continue to prevail. (Mem. de 1 Ac. de Med. xiv. 118.) 
 
 1 Topogr. of Copenhagen. Trans, of the Provincial Mcd. and Surg. Assoc. vii. 205. 
 
 2 Robertson, Med. Notes on Syria, Ed. J. Ix. 38. 
 
AUTUMNAL FEVERS. 255 
 
 mittent fevers are limited to the suburbs. As the buildings extend 
 out, and the closely inhabited portions expand, and, by so doing, 
 lessen the area of humid and exposed soil, the disease recedes. 
 Charleston, Savannah, New York, Buffalo, Auburn, Geneva, Syra 
 cuse, Salina, and Louisville, &c. may be appealed to in illustration 
 of this. The statement of Professor Yandall, relatively to the latter 
 city, are apposite. The rock, of which the subsoil is composed, 
 " forms a surface remarkable for its evenness ; and the soil which it 
 produces, as it crumbles under the action of the air, frost, and water, 
 is peculiarly retentive of moisture. Ponds and slushes are abund 
 ant, wherever the black slate constitutes the surface-rock. The 
 first houses erected at the fall were built in the midst of ponds. 
 Entire squares of the city are now pointed out, which occupy the 
 ancient beds of ponds, large and deep enough to float a steamboat. 
 These have all been drained, and such collections of water are no 
 where to be seen within the city limits." Louisville, while it stood 
 amid its ponds, Dr. Yandall remarks, " was regarded as one of the 
 most sickly towns in the Valley of the Mississippi. It was com 
 monly called The Graveyard of the West? It is now esteemed one of 
 the most healthy. Intermittent fever was a regular annual visitant, 
 and occasionally a form of bilious fever prevailed, rivalling yellow 
 in malignity, and threatening to depopulate the town. The most 
 fatal of these endemics broke out in 1822, after a hot, rainy season. 
 The number of victims from it, out of a population of less than five 
 thousand, was two hundred and thirty-two. In a family consisting 
 of twenty persons, nineteen were sick at one time, and, in some 
 families, every individual died. At this time, only one street in 
 Louisville was paved, and within its limits were at least eight ponds 
 of greater or less dimensions, most of which, in the course of the 
 autumn, were dried up, exposing foul bottoms to the sun. " The 
 ponds have all disappeared. The streets have generally been 
 paved, and, though the grading is defective, and can never be as 
 effectual for drainage as it might be rendered on a less even sur 
 face, still, it is such as to carry off the rains into the river, and the 
 ditches south of the city. The only parts of Louisville obnoxious 
 to the charge of unhealthfulness, are its suburbs. Beargrass, a 
 small sluggish stream, with alluvial banks, which empties into the 
 river at the foot of Third Street, taints the air in its neighbourhood. 
 The ponds send up their effluvia from the south ; and the extended 
 rocks of the foils, laid bare by the retreating river in dry seasons, 
 
256 PNEUMONIA AND 
 
 exhales the poison of intermittent fever. The inhabitants along 
 the Beargrass, and of Water Street, and of the scattered dwellings 
 in the outskirts of the city, are sorely afflicted with the fever. The 
 infected circle is receding. In 1837, it was not deemed safe to re 
 side nearer the limits of the city than Walnut Street. Now, Chest 
 nut Street is considered healthy. As we go from the suburbs 
 towards the crowded parts, the chances for health increase, and, as 
 the new streets are built up, a barrier to the fever poison is thrown 
 around the older neighbourhoods." 1 
 
 If the reader desires to have another convincing proof of the 
 cessation of the production of autumnal fever from changes of the 
 kind mentioned, let him come and see what has been the result in 
 Philadelphia. In former days, when the city was of limited ex 
 tent with few improvements with buildings scattered about, and 
 leaving open and unimproved spaces between them with a marshy 
 stream running through the greater part of it with ponds, natural 
 and artificial, spotted over the plot in various directions, and with 
 unpaved streets fever was of common occurrence, and epidemics 
 were not unfrequent. At present, malarial fevers are unknown in 
 the city proper, as well as in the compactly built and well-drained 
 portions of the suburban districts. If we wish to meet with them, 
 we must go to the outskirts of these districts, or to some distance 
 from them, to the open meadow ground of the neck, or to other 
 unimproved surfaces of the vicinity ; but, more particularly, to the 
 marshes which still exist along the river banks. 
 
 Our townsman, Dr. Emerson, who has devoted considerable 
 attention to the subject of public hygiene, and furnished several 
 excellent essays on the vital statistics of Philadelphia, has conclu 
 sively shown that the influence of the sickly air is expended upon 
 the comparatively limited portion of the population living in the en 
 virons and outskirts of the city. During the periods embraced in his 
 calculations and the same holds good in all other times and places 
 the fever, in some of its forms, was almost universal ; whilst, in the 
 more dense and well-paved parts, the air seemed unusually healthy; 
 and where remittents and intermittents were met with, they could 
 almost invariably be traced to exposure to night air in the country 
 or suburbs. Never, he remarks, was a stronger demonstration 
 
 1 Sanitary Condition of Louisville; Trans, of Mcd. Assoc. ii. (ill. Oil : set- also 
 Drake, 249. 
 
AUTUMNAL FEVERS. 257 
 
 afforded of the resistance made by cities to the influence of country 
 malaria, than our late experience has furnished. Great as was the 
 amount of sickness during the epidemic of 1822 and 3, it was con 
 fined almost entirely to the comparatively small proportion of 
 population inhabiting the unpaved or ill-paved environs. "Our 
 .observation/ Dr. E. adds, " on this and other occasions, has led us 
 to ascribe this exemption, for the most part, to the pavements, 
 which, by effecting a perfect drainage, prevents exhalation, at the 
 same time that it admits of the total removal of vegetable and 
 animal matters, the sources of foul and unhealthy emanations. 
 The chief motive for paving the streets and sidewalks is usually 
 convenience ; but it has always appeared to us that by far the 
 most important object achieved by it was the preservation of 
 health." 1 Since the time to which this has reference, thirty years 
 have elapsed. In the interval, the compact, dense, and well-paved 
 parts have extended far beyond where they were then, and with 
 their expansion the disease has receded. 
 
 Hear what a physician of the middle of the last century says : 
 " When I first came into this city, the dock was the common-sewer 
 of filth, and was such a nuisance to the inhabitants about it, that 
 they were obliged to use more pounds of bark, than they have 
 ounces, since it has been raised and levelled." 2 
 
 Hear also what Dr. Bond s distinguished contemporary, Cadwal- 
 lader Golden, states : " I remember that several years since, when I 
 was at Bristol, Pa., opposite to Burlington, which is situated to the 
 northward of a large space of swamp ground, they told me that 
 they had been, from the first settling of Bristol, subject to inter 
 mittent fevers of a malignant kind; and, indeed, the aspect of the 
 inhabitants showed the ill effects of the air which they breathed. 
 While I saw them, they assured me, at the same time, that not 
 
 1 Amer. J. ix. 27. 
 
 2 Bond s Introductory Lecture, delivered at the Pennsylv. Hospital, Dec. 17, 1776; 
 N. A. Med. and Surg. J. iv. 270. 
 
 During the winter of 1849, 1850, the New Orleans city authorities ordered all the 
 timber standing between the city and the Metairie ridge an elevated space between 
 the city and lake, in the midst of a cypress swamp to be cut down. The greater 
 part of the ground was also well drained. By this means, an extensive swamp was 
 dried up by the rays of the sun, and the obstruction to free ventilation, by the breezes 
 of the lake, removed. Writing a year after, Dr. Fenner says: "I think it not at all 
 improbable, that this work has already exerted a beneficial influence upon the health 
 of the city." Southern Medical Reports, ii. 83. 
 
 17 
 
258 PNEUMONIA AND 
 
 above two or three children, born in that village since its first set 
 tling, had attained to the age of maturity; but since that time, 
 these swamps having been drained and converted into profitable 
 meadow grounds, I am informed that Bristol is, in a great measure, 
 freed from these annual epidemical fevers." 1 Speaking of Cahawba, 
 Ala., Dr. English states that the land in the immediate vicinity of 
 the town is low and flat, and was, until 1840, interspersed with 
 numerous small shallow ponds. These have been thoroughly 
 drained, and now hold water but a few hours after the heaviest 
 rains. It has become a subject of remark by the citizens of the 
 place, that since that time the town has become much more healthy, 
 particularly as regards endemic fevers. In truth, in the last four 
 or five years, the former dreaded scourge, bilious remittent fever, 
 has almost disappeared, and the few cases that do occur are of a 
 mild type. 2 
 
 Beneficial effects obtained from tlte draining of marshes prove the 
 existence and morlijic agency of malaria. Large portions of the Tuscan 
 and Luccan Marshes, the maremmes of Albagna, of Ombrone, Gros- 
 setto, Orbatello (between Sienna and the sea), Campilla, Piombino, 
 Castiglione, the val di Chiana, 3 have been reclaimed ; the soil has 
 been improved, and applied to useful purposes, and there sickness 
 has disappeared. The reader will find, in Tozetti s travels in Tus 
 cany, 4 an interesting account of the important changes effected by 
 the Grand Dukes Cosmo I. II. and III., and Ferdinand I. and II., 
 with a view to reclaim the marshes, and destroy the insalubrity of 
 the country around Pisa, and of the satisfactory results thereby 
 obtained. At a later period, under the direction of Gaetano Geor- 
 gini, and by order of Dukes Leopold I. and II., the principal basins 
 of the Tuscan Maremmes were drained, and otherwise improved, and 
 there, as was expected, fevers have disappeared, and the population 
 has sensibly increased. The town of Massa, which, for years, was 
 noted for its insalubrity, was completely restored to a healthful con 
 dition by the draining of a large and deep marsh, situate on the 
 north-east of it. By means of a canal, constructed through one 
 
 1 Med. Regist. i. O J J. 2 N. 0. J. vi. 108. 
 
 3 Fossombroni, Memoires historkjues ct hydrauliques sur le val dc Ohinna, 1780 : 
 T;irtini memorie .sul beneficiamento dolle Maremme To. x-uim, -13; Carricre, 32o. 
 
 * Voyage Mineralogique, Philosophiqtie, ct Historique en Toscane, par le Dr. J. T. 
 Tozotti, i. W.rl. 
 
AUTUMNAL FEVERS. 259 
 
 side of the liollow, the water escaped, the marsh was drained, and 
 the morbid effect was arrested. A few years after, the canal, which 
 was too small, being choked up, the surface once more became 
 marshy, and fevers reappeared; but, in 1829, the same canal was 
 cleansed and widened ; the soil \vas again dried ; fevers once more 
 ceased to prevail, and the city has, since then, remained healthy. 1 
 
 As regards the Luccan Marshes improvements had been effected 
 in them as early as 1741, when one of the three basins, into which 
 they are divided the Massaciuccoli the most unwholesome of all, 
 was drained. The success was so complete that fever entirely ceased. 
 In 1768, 9, the sea-water, owing to a derangement in the locks, 
 once more covered the reclaimed land. As a natural consequence, 
 marshes were reformed, and, with these, the disease reappeared. 
 The mortality at Viareggio, and the adjacent parishes, which the 
 year before had not exceeded one in forty of the population, 
 amounted now to one in fifteen (170 in 1830). The locks were 
 repaired, and health was re-established. In 1784, 5, a like accident 
 in the locks occurred, and the same results followed fever returned. 
 In the former of these years, out of a population of 1,898, 1,200 
 were attacked, while the number of deaths was 92, or 1 in 20 of 
 the whole amount of the inhabitants. In 1785, 103 died, out of a 
 population of 1,834, or 1 in about 18. Again, the locks were re 
 paired, the sea was excluded, the marshes were dried up, and health 
 was once more restored. Other portions of these pestiferous 
 localities were reclaimed in 1812, 1819, and 1821, and everywhere 
 the success has been equally satisfactory. 2 Need I add that, with 
 the diminution or cessation of fever, the population has increased? 
 At Grosseto alone, from 1814 to 1843, the augmentation has been 
 from 53,175 to 70,179. 3 In Yiareggio, the number of inhabitants 
 in 1733 was 1,509 ; in 1823 (90 years), it had increased to 9,408. 4 
 
 On the opposite effect, the following remarks of Lancisi deserve 
 attention : 
 
 " And we, taught by the calamities of the noble and crowded 
 cities of Italy, which have been desolated by the marshes alone, 
 behold with our o\vn eves the mischiefs occasioned by stagnating 
 waters, without looking abroad for the reasons or inquiring for the 
 
 1 Carrierc, Lc 01 mat ile 1 Italic, o 24, 5 : Salvagnoli, Saggio delle Statistica medica, 
 ck lle Marcmme Toseanc. 
 
 2 dicrdini. An. Jo Chemie, &o. xxix. 22-"). 234; Melier. op. cit. 086. 
 
 3 See Carrie re, ooo. 4 Giordiui, oj>. cit. 2o7. 
 
260 PNEUMONIA AND 
 
 evidence of other persons. Aquileia, for example, formerly in a, 
 most flourishing condition from the number of its inhabitants, even 
 so much as to merit its advancement, first to a metropolitan and then 
 to a patriarchal dignity, scarcely retains at this day the remains of 
 houses, or any traces of its former splendour ; and the sole cause of 
 its overthrow has been the contamination of the air from undrained 
 waters. The city of Brundusium, formerly so famous, is lament 
 ably mentioned by Antoninus Galatheus, in words which, by reason 
 of their aptness, we quote : Moreover, cities situated in a healthy 
 climate have been destroyed. Cities, indeed, like men, have their 
 vicissitudes. But the neglect of its inhabitants has been the ruin 
 of Brundusium ; for had outlets been made for its waters, it would 
 never have acquired such an unhappy distinction. " 
 
 The effects of covering sickly places luith water lead to the same belief. 
 But draining, improving, and cultivating the surface of infected 
 localities are not the only modes of putting a stop to, or greatly 
 diminishing, the prevalence of fever, and thereby proving the fact 
 that these must arise from a cause exhaled from the soil. We have 
 seen, on the authority of Pringle, that, during the campaign of 
 1748, in Brabant, the country bordering on the lower part of the 
 Maas, was rendered more unhealthy, upon letting off part of the 
 water by which the country around the fortified towns had been 
 submerged. It may now be proper to add, from the same author, 
 that the " States of Holland, being made sensible of the sickness 
 which raged at Breda, and in the neighbouring villages, gave orders 
 to let in the water again, and to keep it up till winter." 2 Indeed, 
 experience taught Pringle that, " as to cantonments in marshy 
 grounds, if the troops must remain there in the dangerous season, 
 it will be better to float the fields entirely, than to leave them half 
 dry." 3 The same process was resorted to some years ago, with 
 complete success, at Paris, Bordeaux, and other parts of France, 
 and is never neglected there, when marshy surfaces cannot be 
 otherwise reclaimed. 4 We have already seen the means adopted 
 to correct the blunders of the revolutionary government, in 1793. 
 Blanc informs us that, while the British troops were suffering from 
 
 1 Lancisi, op. cit. lib. i. cap. iii. 8; see also Dr. Mitchell s Tr., Med. Ilepos. xiii. 10. 
 
 2 Pp. 01, 02. 3 Ibid. 98. 
 
 4 *Turent du Chatelet, An. d Hyg. xi. 310; Fleuriau de Bellevue, Comptes Rendus 
 de 1 Acad. des Sc. xxv. 838, 9. 
 
AUTUMNAL FEVERS. 261 
 
 the Walcheren fever, " the native inhabitants affirmed they were 
 less sickly than usual at the same time, owing, as they said, to the 
 unusual quantity of rain that had fallen during the two or three 
 preceding months." 1 
 
 Indeed, the beneficial effects obtained from the flooding of marshes 
 or insalubrious surfaces, by artificial means, by freshets, or otherwise, 
 have been noticed from time immemorial, as well in foreign coun 
 tries, as in our own. 2 The practice is certainly not new, and may 
 be traced to an early period in the annals of hygiene, as the reader 
 will find by reverting to the history of Empedocles, who delivered 
 the inhabitants of Salimonte of the effluvia exhaled from the 
 marshy banks of the neighbouring rivers, by causing these to be 
 flooded by means of the pure water of other streams. In many 
 of the islands of South America, on the coast of Mexico, at Ba- 
 tavia, in Africa, in the East and West Indies, in Europe, and else 
 where, sickness, as we have seen, prevails at the commencement 
 and close of the rainy season, and ceases completely, or in great 
 measure, when the rivers are high, and the marshes, swamps, as 
 well as the country generally, are covered over with water. 
 
 More than a century ago, Desportes expressed himself in favour 
 of the opinion that yellow fever arises often from the foul condition 
 of ships, and attributed the escape of a vessel, the Jason, of seventy- 
 four guns, in 1746, at St. Domingo, to its extremely leaky condition, 
 by which the sources of exhalations in the hold were submerged. 3 
 
 The common saying of the sailors, that a leaky ship is ever a 
 healthy ship, is well known; and, in conformity with the result of 
 experience on that point, the submerging or sinking of infected 
 vessels has not unfrequently been resorted to as a means of puri 
 fication. 
 
 The practice is noticed, as extremely useful under peculiar cir 
 cumstances, by Lancisi, who was too clear an observer not to have 
 discovered that marshes are " harmless, when plentifully diluted and 
 cleansed throughout by pure and fresh supplies of water." Lancisi 
 reminds us, too, of a fact mentioned centuries ago, by Strabo, 4 and 
 which has been already briefly alluded to : " Alexandria, in Egypt, 
 
 1 Dissertations, i. 210. 
 
 2 Carriere, loc. cit. 526 ; Ludlow, N. Y. J. ii. 84 ; CalJwcll, Essay on Malaria, 75 ; 
 Villcrme, An. d Hyg. ii. 340. 
 
 3 Histoire des Maladies cle St. Domingue, i. 162. 
 
 4 Geographia, lib. xvii. 278. 
 
262 PNEUMONIA AND 
 
 stands near the marshes ; and although it ought to experience, 
 durin^ the scorching heat of summer, a close and suffocating air, 
 
 O O o i 
 
 yet, by the seasonable rise of the Nile, nothing filthy exists whence 
 vitiated exhalations can arise, especially when the Etesian winds 
 begin to blow from the north, and arrive after sweeping a wide 
 tract of sea." 
 
 The surface now covered by the city of Rome, as well as that over 
 which was spread the ancient mistress of the world, and the adjacent 
 campagna, could scarcely fail to be, to a certain extent, insalubrious 
 in olden times ; but, from all we can collect on the subject, it would 
 appear to have been less so formerly than it is at the present day. 
 When limited to a few hills, the Quirinal, the Palatine, and the 
 Capitoline, marshes of large size the great and little Yelabrum 
 existed in the close vicinity. At no great distance, were other 
 marshes, the Capuan, and those of Tarentum. Then there were 
 the Lakes of Castiglione and Giuturna, besides smaller lakes or 
 pools situate all about the Iloman territory. Most of those locali 
 ties, though now uninhabitable, were then populous, and, in all 
 probability, owed their greater salubrity to the fact that the larger 
 number of those receptacles of water, which were then complete! v 
 filled, have been partially drained by artificial means, or filled up 
 by the gradual increase of their subaqueous soil, and retains be 
 neath the surface the water by which it was once covered. 
 
 The following fact, already adverted to, illustrates more than one 
 of the results here mentioned : "It has been remarked by persons 
 who live in the vicinity of Morne Fortune (St. Lucia), that when the 
 military, who inhabit the Morne, suffer severely from sickness, the 
 inhabitants of the town of Castrie (in the close vicinity), are gene 
 rally in good health ; and, on the contrary, that when the inhabit 
 ants of the town are sickly, the garrison on the height is compara 
 tively healthy. The Morne is a bog in wet weather ; Castrie is 
 then an inundated swamp ; in continued dry weather, the Morne 
 has a hard and firm surface ; Castrie is then a swamp advancing to 
 exsiccation. The fact is obvious, and presents itself as a cause of 
 what takes place." 1 All these facts, as also the stoppage of febrile 
 epidemics by a profuse fall of rain, are, besides many referred to 
 under another head, attested by the most reliable authorities. 2 
 
 1 11. Jackson, Sketch, ii. 358, 9. 
 
 2 Bully, 309; James Johnson, 43, 320, 330; McWilliams, 184; Pritchctt, 108; 
 Boyle, 3, 123 ; Dazille, 10; Desportes, i. 52, 80, 87; Firmin, 3. 17; Gillespie, 137; 
 
AUTUMNAL FEVERS. 263 
 
 To the same effect may be cited the beneficial results obtained 
 in France and elsewhere, by the filling up of ditches and other 
 excavations remarkable examples of which are on record. 1 I 
 might dwell on the effects produced by the covering of the marshy 
 margins of river shores by sand inundations, as observed on the 
 borders of the Baltic, in Holland, Italy, France, Africa, 2 &c., and 
 particularly on the well-known case of the Goodwin Sands, in which, 
 while, from a similar cause, the usefulness of the land was destroyed, 
 the salubrity of the vicinity was firmly established. I might also 
 point out those instances, in which the infection of a locality has 
 been remedied, by covering the focus of exhalation with earth, as 
 was done to Galiopolis, in 179G. 3 
 
 H. McLean, 25; Rush, iv. 154; Ferguson, Recol. 199; Cliishohn, i. 294; Ferguson. 
 Med.-Ch. Tr. viii. 180, 1 ; Lempriere, i. 20; Rochoux, 11; Caillot, 121; Valentin, 
 89 ; Gouraud, Go ; Arnold, 31 ; Furlong, Med.-Cli. Rev. xxv. 289 ; Dickson, Edinb. 
 J. xiii. 47 ; Bancroft, 200; Berthc, 150 ; Macculloch, 204-0; Brown, in Cyc. of Pract, 
 Med. iii. 01 ; Cooke, Med. Rec. vii. 457 ; Pinckard, ii. 485, ; U. Parsons, 204; Irvine, 
 Dis. of Sicily, 6 ; R. Jackson, Sketch, ii. 259. 
 
 1 Monfalcon, 43 ; Macculloch. 120, 7; Cycl. of Pract. Med. iii. 61. 
 
 2 Macculloch, 207. 3 Potter on Contagion, 16. 
 
CHAPTER IV. 
 
 EXISTENCE AN MORBID AGENCY OF MALARIA, 
 CONTINUED. 
 
 The effect of the "washing" of sickly places lead to the same belief. 
 In the preceding chapter, attention was called to the salutary effects 
 of perfect drainage, as illustrative of the existence and morbid agency 
 of a malarial poison. With the same view I may, besides, appeal to 
 those instances in which places, heretofore insalubrious, have been 
 rendered otherwise, by being thoroughly washed, through the agency 
 of a freshet, or an inundation, which carried off all substances sus 
 ceptible of decomposition, and left in their stead a deposit of in 
 nocuous materials as occurred in New Orleans, after the crevasses 
 of May, 1816, and 1849, l and more recently in some parts of the 
 State of Pennsylvania. In the latter instance, prior to September, 
 1850, intermittent fever prevailed to a great extent along the 
 course of the Schuylkill, and was found, in many instances, to be 
 unmanageable, showing a tendency to a frequent recurrence. But, 
 since the flood which took place at the time mentioned, the same 
 localities have been remarkably free from it. 2 A flood, the highest 
 that ever occurred in the same river, took place on the night of 
 the 2d and 3d of September, 1850. " It completely inundated a 
 small village, of about thirty houses, in our neighbourhood, besides 
 some farm-houses. It filled, of course, all the cellars and wells, and 
 it left besides a great deal of filthy rubbish, forming a deposit of 
 mud, of several inches in thickness, of a most offensive character. 
 The greater part of two weeks must have elapsed before the cellars 
 could be cleansed, and the wells be fit for use. Meanwhile, the 
 people were living in filth, and without the usual supply of pure 
 
 1 Transactions of the Pennsylvania State Medical Society, ii. 34 ; see also i. 24. 
 
 2 Nicol, Obs. on the Nature of the Climate of Seringapatam, Edinb. J. xi, 290 ; J. 
 Johnson on Trop. Cl. 101. 
 
266 PNEUMONIA AND 
 
 water, and the surface of the ground everywhere about them 
 covered with the mud above alluded to. Yet, I am not aware that 
 this state of things had the least influence in aggravating the fevers 
 then prevailing. I asked the wife of a farmer, who had suffered 
 as much from the flood as any other person, and in whose family 
 intermittent fever prevailed, what effect the flood had had upon the 
 disease. Iler answer was: "I think we have had less of the ague 
 since the flood than before it." 1 In this case, the materials of 
 malaria were washed away in some parts, and new innocuous mud 
 was left in its place. 
 
 We learn, from Yitruvius, that, in the lagunes of Yenice, the air 
 was extremely pure, especially around Ravenna, Altino, and Aqui- 
 leia, the three principal, and doubtless the most populous points. 
 He himself affords us the explanation of this anomaly. At that 
 remote period, the marshes and ponds were situate to the north 
 and east of those districts, and their bottoms were higher than the 
 level of the sea ; owing to which the latter, at every ebbing of the 
 tide, carried away all the putrescent materials and filth, and thereby 
 cleansed the lagunes. 
 
 In Seringapatam, materials of putrefaction, for about eight 
 months of the year, lie all over the banks of water streams and 
 other repositories, "until the periodical rains of Malabar begin, 
 which, falling in the Ghauts, run down, and fill the Cauvery River. 
 The filling of this river is always very sudden, and it comes rushing 
 along with great impetuosity; sweeps out all the filth from the 
 ditches ; clears away all the impurities, so long stagnant on the 
 island ; and leaves the place, for a while, tolerably healthy, and 
 the air cool and refreshing." 2 
 
 The city of Avignon was inundated on the oOth of October, 
 and the 4th of November by a rise of the Rhone. Nine-tenths of 
 the city were under water. No fever, however, followed, owing to 
 the complete washing which the surface underwent, and the super 
 vention of the cool north winds, which wafted the morbid exhala 
 tions along the great valley of the Rhone out to sea. 3 
 
 With equal propriety, I may call attention to the results obtained 
 in some parts of the Pontine Marshes, as well as in and about the 
 
 1 Pennypacker, of Chester County, Tr. of Perm. St. Mod. Soc. i. 69. 
 
 2 J. Johnson on Trop. Cl. 101 ; Nicol, Obs. on the Climates, c. of Seringapatam, 
 Edinb. J. xi. 290. 
 
 3 Gouraud, Ficvres Interm. Pernicieuses, 133, 4. 
 
AUTUMNAL FEVERS. 267 
 
 Eternal City. 1 In former days, that part of Home on which the 
 immense population was crowded, and which is now almost deserted, 
 was healthy comparatively so, at least while the insalubrious 
 sections were the Campus Martins, the Velabrurn, and other parts 
 bordering on the river ; the site of the modern city. The reverse 
 is now the case; for, as we approach the inhabited parts of the pre 
 sent city, through the space separating St. John, of Lateran, from 
 the Forum and the Yelabrum, we pass over the principal focus of 
 the pestiferous exhalations. On the other hand, the surface of the 
 Campus Martins, or indeed the whole valley, is free from the tainted 
 atmosphere. The very section appropriated to the Jews, the Guetto, 
 where the principles of public hygiene are sadly neglected, is, to a 
 very great degree, healthy. How has this happened? The Campus 
 Martins was purified by Leo X., and the surface, after being divided 
 into streets, was soon covered with houses, churches, and other build 
 ings. The population, at the close of the reign of that pontiff, had 
 already reached 60,000. The narrow valley, between the Tiber and 
 the Pincian Hill, by which we now enter Kome, was transformed 
 from a vast marsh into the beautiful Piazza del Popolo ; and other 
 portions were, by successive pontiffs, greatly ameliorated. 2 The site 
 of the old city, which was not, originally, favourable to health 
 both on account of the peculiar condition of the soil, and its ex 
 posure to the influence of distant sources of miasmal infection, but 
 which had been rendered much less hurtful by drains, the erection 
 of numerous aqueducts, and other works of kindred character has 
 returned to its pristine state. It has gone to destruction, and is 
 now deserted. The houses and monuments by which it was 
 covered have disappeared ; the greater number of the aqueducts 
 have been destroyed, with the effect of allowing the free escape of 
 the water, and the formation of marshes and pools ; the drains have 
 been choked up, and the whole surface presents a mass of ruins and 
 rubbish. 3 
 
 Much more might be said on this important subject ; but the 
 instances mentioned must suffice. They furnish us with both 
 proof and counter- proof. With the existence of marshes, or 
 marshy and partially drained land, we have fever; with the re- 
 
 1 See Carriere, Climat de 1 Italie ; and Tournon, Etudes sur Rome. 
 
 2 Carriere, op. cit. 101. 
 
 3 See Review of Carriere, by the present -writer, Am. Journ. of Mod. Sci. July, 
 1851, p. 103. 
 
268 PNEUMONIA AND 
 
 claiming of that land, or its complete overflow, fever disappears. 
 Whenever, as in some cases cited, the surface returns to its pristine 
 marshy condition, the unhealthiness of the country returns also. 
 Once more the marshes are drained, and, with the improvement of 
 the land, we have a cessation of fever. In some instances, the disease 
 is found to break out in impure city localities ; the effect is remedied 
 by a judicious employment of drains, sewers, and other kindred 
 means. Nothing, it appears to me, can be more satisfactory ; be 
 cause no one who has looked at all into this matter, can have 
 failed to perceive that,, of all diseases which are susceptible of 
 assuming an epidemic character, few or none exhibit so clearly 
 the close relationship between the existence of certain local agents 
 and the effects produced by them, as periodic fevers ; none the 
 productive causes of which are more strikingly and undeniably 
 under the control of human agency. And when, bearing these cir 
 cumstances in mind, we revert to the fact that the mixture of salt 
 and fresh water has been found to increase 1 greatly the unhealthi 
 ness of marshy surfaces a result foreseen by Yitruvius, 2 pointed 
 out more satisfactorily by Lancisi, 3 dwelled upon by Gul. Piso, 4 Sir 
 J. Pringle, 5 and Sylvius; 6 noticed more than a century ago in this 
 country by Cadwallader Golden, 7 and subsequently by Ludlow, 8 
 and other American writers; and confirmed, beyond dispute, by the 
 effects observed at Bender- Abassi, on the banks of the Persian 
 Gulf ; 9 at the Valduc ; 10 at Martigues ; in the Luccan Marshes, near 
 Yiareggio, Motrone, and Montignoso; at Sebgha (Algeria); in South 
 America, &C.; 11 it will be difficult to resist the conclusion that some 
 
 1 " There dreadful is the air in low places, near the sea-shore, into which the waves 
 find entrance by a canal that has either been open during the memory of man, or made 
 by human artifice, or produced by a storm ; and into which receptacle also the rains 
 wash down the filth from the adjoining knolls and hills." " There are some ponds of 
 the kind in the territories of Ferrara and Ravenna as well as of Home, especially near 
 Ostea, where the salt-works have been erected." Lancisi, op cit. 18. 
 
 2 De Architectura, lib. i. cap. iv. 3 De Nox, Paludc Effluviis, 10, 18. 
 
 4 Hist. Nat, and Med. lib. i. 0. 5 Diseases of the Army, Appendix, 370. 
 
 6 Tract. Med. Append. Tract, x. 101. 
 
 7 Account of the Fever of New York in 1741, 42. Med. and Philos. Register, i. 323. 
 
 8 New York Med. and Phys. Journ. ii. 85. 
 
 9 Chardin, Voyage en Perse; Fodere, Med. Leg. v. 10 .). 
 
 10 Fodere, ib. 108. 
 
 " Giordini (Gnetario), Causes dc 1 Insalubrite de 1 Air dans le voisinage des niarais 
 en communication avec la mer. Ann. de Chimic. xxix. 220 ; Carrie-re, Climat de 
 ritalu-. 271 ; Bou.ssiiigault, Ann. de Chiuiic. Ivii. 150, 151 ; Salva (in Roehunx). 120; 
 
AUTUMNAL FEVERS. 269 
 
 poison exhales from surfaces where the mixture occurs, and that 
 the disease which ensues or prevails more widely there is the effect 
 of it, and not simply of heat, moisture, atmospheric vicissitudes, 
 or other agencies of the kind. 
 
 The conclusion will appear the more natural when we learn that, 
 while such is the effect of the mixture in question, it has been 
 found that, in the salinas of France, fevers are limited to the edges 
 and immediate vicinities of the rivulets, ditches, and canals sur 
 rounding or running through the salt basins, but containing fresh 
 water ; and do not affect the extensive surfaces on which unadulter 
 ated sea-water is introduced for the purpose of evaporation, and 
 which, at a certain period of the process, assume the outward cha 
 racters of ordinary marshes; 1 when, besides, we find that, so far 
 from these pure salt marshes proving injurious, the physicians of 
 Marseilles (Mercandier, Eobert, Peyron, Girard, &c.), to \Yhom the 
 subject was referred for examination, have pointed out, and expe 
 rience has demonstrated, the benefit resulting from the conversion 
 of common paludal localities into regular salinas, as may be found 
 by referring to the oft-quoted Eeport of Melier, contained in the 
 loth vol. of the Memoire of the Academy of Medicine of Paris, p. 655 ; 
 and that, conversely, the change of a salina into a common marsh, 
 has been folio \ved by the appearance and wide prevalence of fever, 
 which heretofore had not existed a change which has caused the 
 almost total depopulation and destruction of the once flourishing 
 cities of Marenne and Brouage, in France. 2 Dr. Ludlow, of New 
 York, remarks that the results of his observations, made at the 
 villages of Salina and Montezuma, New York, where this combi 
 nation takes place is, that it depends entirely on the proportions in 
 which the waters are mixed. If the waters of fresh marshes are 
 largely combined with salt water, or vice versa, the general healthi 
 ness of the situation will be improved. Dr. Hosack mentions, in 
 his lectures, that the marshes of Hoboken, in New Jersey, while 
 overflowed by the sea-water, were healthy, intermittent and remit- 
 
 Trail, Outlines of Medical Jurisprudence; Me Williams, 100; Daniel, Med. Gaz. ; Me 
 lier. Mem. do 1 Acad. xiii. 684 ; Monfalcon, 09, 70 ; Thouvenelle, Climat de 1 Italie, 
 i. 180, 183; iv. 34, 83, 218; Sigaud, du Climat et des Maladies du Bresil, 172; Mori- 
 cliini, 32. 
 
 1 Melier, op. cit, 035, 636, 684; Jacquot, loc. cit. 21, 25, 47 ; Maillot; Bourdier, in 
 same ; Maccullocli, 37, 8. 
 
 2 Melier, op. cit. 642, 645; ib. 651, 665. 
 
270 PNEUMOXIA AXD 
 
 tent fevers being unknown ; but since they have been drained, and 
 the ingress of the salt-water has been prevented, these diseases are 
 endemic. This was farther proved by the breaking of the dykes 
 during their prevalence, when they immediately ceased. 1 When, 
 again, we bear in mind that the morbific effects produced in the 
 localities mentioned are, sometimes at least, circumscribed, like 
 those noticed on shipboard, within very narrow bounds ; that while 
 in vessels the area of the infection, which necessarily can never 
 be large, is as already stated often limited to one side or one end 
 of the under-decks, or to the vicinity of the pumps, where, indeed, 
 it usually commences, the disease on land is frequently confined to 
 the immediate neighbourhood of a pond, of a mill-dam, of a slug 
 gish stream, of masses of decaying or green timber, or of other 
 vegetable or animal substances, separate or combined, in a state of 
 decomposition, or of a drain, or cesspool 2 not seldom to one side 
 only of these ; to an overflowed field or bank ; to a few streets of a 
 city, to one single street, or even to one side of this ; 3 to a few build 
 ings; to one solitary house, or side of a house, or room, or corner 
 of a room, 4 or the like ; we cannot well see how all these facts 
 the reality of which will not be contested can be explained on 
 the principles set forth by the opponents of malaria. The degree 
 of heat and humidity, the extent of the dew-point, the amount of 
 atmospheric vicissitudes and other morbid influences to which they 
 look for the causes of the disease, can scarcely be supposed to be 
 so much greater on one side of a street, in a few buildings, in a 
 solitary house, in one room, or corner of a room, than on the other 
 
 1 Op. cil. ii. 85; Hosack s Practice, 175. 
 
 2 Hush, iv. 90; Potter, 16; Caldwell, Dissert. 491, 2; ib. Essay, 09,; ib. Fever of 
 1805, p. 00 ; Picornel, in Thomas, 8, 22; Usher Parsons, Essays, 215 : ib. Hays s Journ. 
 vii. 80; ib. Boston Med. Journ. iii. 074, 088; Hand, Med. Reposit. ii. 407; Valentin, 
 Voy. Med. 55, 0; Vicq d Azyr, on City Interments ; see Review of this work in Chap 
 man s Journ. vii. 200-8; Audouard, Archives, xii. 312; Tr. of Med. Soc. of State of 
 Pennsyl. ii. 51 ; Harris, Charleston Med. Journ. ii. 015 ; Second Report on Quarantine 
 (Lond. 1852), 07, 08 ; Gaultier de Claubry, Mem. de 1 Acad. de Med. xiv. 118. 
 
 3 Lancisi, op. cil. 154; Bancroft, 105; Berthe, 74; Baglivi, 158; lligault do ITsle 
 (in Johnson), 315; Amer. Rev. iv. 290; Faust, Amer. Journ. vi. 53; Trans, of Med. 
 Soc. of State of Pennsyl. ii. 93; Macculloch ; Lefouion, p. 00. note; Pendleton, 
 Charleston Journ. vii. 450; Becquerol, sur les Climats, 10. 
 
 4 Lancisi, 154; Ferguson, Med.-Chirurg. Trans, viii. 14:!; Callow in Cycl. ii. 2SO : 
 Wilson. 158, 9 ; Vutable, 314 ; Rufz. 28 ; Imray, Ivlinb. Jouni. Ixiv. 355 ; Davy, 
 To[.og. of Medit. ii. 248; Harris, Charleston Journ. ii. 015: !><-<.iih, Life of Arm 
 strong, ii. 721; Second Report on Quarantine. 21. 22. 183. 
 
AUTUMNAL FEVERS. 271 
 
 side of the same street, in adjoining houses, in other rooms of the 
 same building, or other corners of the sickly room, to account for 
 the difference of results. Everything in this bespeaks the exist 
 ence of a separate morbific agent, penetrating, in combination with 
 the atmospheric air to, or generated in the infected spof, and sparing, 
 owing to reasons I need not stop to explain, neighbouring or adjoin 
 ing localities. 
 
 Some forms of malarial fevers resemble diseases produced by putrid 
 substances introduced into the circulation. The incorrectness of the 
 views of those who refuse to acknowledge the existence and agency 
 of a malarial poison, will the more forcibly strike us, when, reverting 
 to the preceding circumstances, we bear in mind the great analogy 
 existing between the phenomena of some forms of fevers and those 
 produced by the introduction of putrid substances in the torrent of 
 the circulation, or the forced inhalation of mephitic air, as shown 
 by the well-known and oft-mentioned experiments of Gaspard, 
 Magendie, 1 Leuret, Hamont, 2 and others ; by the ingestion of va 
 rious mineral and vegetable, and the absorption of some animal, 
 poisons 3 to say nothing of the discovery by Lassaigne, in his 
 analysis of putrid meat water, of a stinking volatile oil, the probable 
 poisonous agent in the effects obtained by those experimentalists, 
 and which can differ but little from the substance dissolved in the 
 air of malarious localities. 
 
 Take yellow fever as an example. The late Dr. Harrison, of 
 JSTew Orleans, who was perfectly competent to form a correct opinion 
 on the subject, speaking of the effects obtained from injecting pu 
 trid meat water into the veins of animals, as shown in the experi 
 ments of Gaspard, already alluded to, says : " Ko one can, I think, 
 fail to be struck with the extraordinary resemblance of those symp 
 toms and post-mortem lesions to those of yellow fever. The charac 
 teristics of the disease, its rapid course, its hemorrhagic tendency, 
 
 1 Journal dc Physiologic, ii. 1, and iii. 81-85. 
 
 2 Journal des Progres des Sc. Med. vi. 181. 
 
 3 Fontana, Traite de \\\ Vipere, i. 85; Celle, Hygiene des Pays Ckauds, 80; 
 iSauvages, Nosologie, iii. 112, 115; E. Miller, Works, 52, 53; Med. Repos. ii. 412; 
 Waring, Yel. Fey. of Savannah, 87, 38 ; John K. Mitchell, Cryptogamic Origin of 
 Fever, 78; Hunter, Dis. of the Army in Jamaica, 150; Dcwitt on Stramonium, Med. 
 Reposit. ii. 30: Ferguson, Recollections, 204, 5; Caillot, Fievre J. 29(5; Lcvacher, 
 78; Chaussicr, Consultations de Mod. Legale, 40; Rochoux, 79 ; Salva, Sogundo ano 
 del Real Estudio, &e. 142; Lafuente, Obeervaciones Sobre la Fiebre ainarilla, 201. 
 
272 PNEUMONIA AND 
 
 its peculiar lesions, are all to be met with in these experiments. We 
 have black vomit, bloody alvine discharges, redness of conjunctiva, 
 extreme tenderness over the abdomen, great and rapid prostration 
 of strength, burning thirst, anorexia, &c. all so characteristic of 
 yellow fever. In his other experiments, he speaks of other charac 
 teristic symptoms suppression of urine, intussusception of the 
 intestines, the existence of fetid fuliginous matter in the bowels, 
 ecchymosis of the mucous membranes, congestion of the lungs, &c. 
 In short, there is hardly any symptom mentioned by authors, as 
 occurring in yellow fever, which may not be found in these experi 
 ments ; and it is the same with regard to the post-mortem lesions." 1 
 Let it not be supposed that other substances, when injected into the 
 veins, will produce similar effects. Graspard, and after him Magen- 
 die, have found that many of them cause death, but none give rise 
 to the symptoms or anatomical lesions described above. Those pro 
 duced by ammonia come nearest to them. 
 
 Let us also bear in mind that dead animal matter is found to 
 run faster into putrefaction, in situations where, from the prevalence 
 of fever, marshy exhalations may be supposed to abound ; that 
 beer, wine, and other fermentable fluids, if kept there on the 
 ground, spoil sooner than in healthy localities; 2 that the active 
 operation of such exhalations on sores and wounds is often evinced 
 during life; that substances fabricated of silk, wool, cotton, and 
 flax, very rapidly undergo decay when exposed to. the atmosphere 
 of such situations silk and woollen becoming putrid, and cotton 
 and linen assuming a dingy or yellow hue, and afterwards losing 
 their cohesion ; and that these effects, which in Italy, France, and 
 other countries are generally recognized as indicative of the insalu 
 brity of particular places and seasons, though rapid and complete 
 in proportion to the moisture and warmth of the air, exhibit them 
 selves to the fullest extent when these conditions are combined 
 with sources of concentrated malarial exhalations. 
 
 When, besides, we recollect that the absorption of softened tu 
 bercular matter, in small proportion, and in the early stage of its 
 formation, produces an intermittent form of fever, of quotidian 
 type, and recurring in the evening; that, with the progress of the 
 softening of this matter and of its absorption, the type of the fever 
 
 1 Speculations on the Cause of the Yellow Fever, N. 0. J. iii. 570. 
 
 2 Barton, on Hong-Kong Fever, Dublin J. (N. S.) xii. 345. 
 
AUTUMNAL FEVERS. 273 
 
 changes, becoming first remittent, and, finally, continued; when we 
 recollect that the fever attendant on the absorption of pus formed 
 in the parenchyma of the liver often assumes the tertian type, and 
 that intermittent febrile paroxyms of great regularity have resulted 
 from such absorption j 1 when, finally, we bear in mind the changes 
 which take place in the system of those who recover from yellow 
 or other malarial fevers, through the unaided efforts of nature ; the 
 coincidence of the sudden and successive disappearance of the 
 symptoms with the appearance of phenomena of a critical character 
 dark discharges from the bowels, abundant sweats, and a copious 
 flow of flocculent and sediinentous urine so like what is known to 
 attend the expulsion or elimination of some poisonous substance, 
 it is impossible to avoid the conclusion that fevers, when they make 
 their appearance in the localities mentioned, are the offspring, not of 
 a cause of a general character or of physical influences, consisting of 
 some particular modification in the ordinary and sensible qualities 
 therinometrical, hygrometrical, electrical, &c., of the atmosphere; 
 since these operate in equal degree all around, without, however, 
 producing every where the morbific effects in question; but of some 
 thing exhaled from the soil, or from some of the various sources of 
 decomposition adverted to. In other words, we must infer that 
 fevers arise from the impress of a species of morbid material poison, 
 which finds admission in the blood, and occasions peculiar changes 
 iu certain of the constituents of that fluid conferring subsequent 
 immunity in many cases, like other causes of a kindred nature, 
 though in a less degree, and with less certainty ; possessing, to 
 some extent, other characteristic properties of true morbid poisons, 
 but differing from them in not being the product of operations 
 taking place in the living system; in its not being possessed of the 
 power of reproducing or multiplying itself in the body ; in its not 
 converting any of the elements of the blood into its own similitude, 
 and in its effect not being capable of propagation from one person 
 to another. 2 
 
 The geological formation of sickly localities, and the plants growing 
 therein, etc., lead to a belief in the malarial doctrine. The conclusion 
 will appear still more natural, when we take the following facts 
 
 1 P.oudin, 128, 120 ; Griffin, Lond. Med. Gaz. 
 
 2 See Simon s Lect. on General Pathology, 198, Am. ed. 
 
 18 
 
274 PNEUMONIA AND 
 
 into consideration : Malaria is more rife in localities characterized 
 by particular geological formations. In both the West and East 
 Indies, places where the mangrove and mancilina grow luxuriantly, 
 the most unhealthy are those in which the roots of those plants are 
 only occasionally under water. In general, in tropical latitudes, 
 the existence of a large quantity of astringent plants the bark of 
 which contains a large portion of animal matter, combined with 
 tannin is connected with the development of fever. 1 Mr. Boudin 
 informs us, in his Treatise on Periodic Fever, that, from some experi 
 ments made by himself, he is inclined to the opinion that certain 
 plants, more than others, have the power of giving rise, by their 
 decomposition, to the evolvement of febrific exhalations. Such are 
 some of the algce, as, for example, the chara vulgaris. lie attributes 
 the same febrific faculty to the rizophore and the calamus (p. 59). In 
 some parts of France (the Department of Ain- see the statistics of 
 that Department, p. 206), a similar agency is attributed to the An- 
 thoxentum odoratum. 
 
 Cause more effective near the surface of the^arth than at a distance. 
 The cause, though sometimes wafted to elevated spots, generally 
 manifests a tendency to remain near the surface of the soil, attacking 
 more generally, and with greater malignancy, individuals occupying 
 the lower floors of houses. 2 In Italy, and alono* the shores of the 
 
 J I O 
 
 Mediterranean, as well as in the West Indies, the ground floors are 
 never occupied by those who can avoid them ; and, in some parts 
 of the latter country, the houses are built upon pillars, by way of 
 avoiding the poison. When the Corsican peasants are obliged, in 
 the autumn, to leave their hill-towns, for the purpose of working 
 in the fields below, they never fail, if possible, to return home in 
 the evening. When, however, the distance is too great, they con 
 struct temporary cabins on the tops of the trees, to which they 
 carefully ascend for the night. 3 
 
 Much of this may arise from the refrigeration produced by up 
 ward radiation of heat, which, as is well known, exercises a marked 
 
 1 Humboldt, 7r3-771; &. Personal Nar. iii. 191, 872. 
 
 2 Smith, Fev. ot Gibraltar, Edinb. J. xxxv. 35; J. Hunter, 300; Cycl. Trnct. Mcd. 
 ii. 280; lUlpli. Trans, of Edinb. Med.-Chir. Soc. ii. 57, 59; ib. Eop. in Ferjruson, 
 Med.-Chir. Tr. viii. 170; Bancroft, Scq. 448; Blair (notes), 30; Cakhvell on Malaria, 
 130; S\- >\(\ Hep. on Quar. 60. 
 
 3 Jacq.u.c, 9. 
 
AUTUMNAL FEVERS. 275 
 
 influence as an exciting cause of disease. 1 But this radiation, how 
 ever powerful in the latter capacity, and however likely to arouse 
 into action the dormant efficient cause, cannot of itself give rise 
 to any of the various forms of autumnal fevers, seeing that it exer 
 cises the influence under consideration only in localities the infec 
 tious character of which is well ascertained, and where febrile 
 attacks take place without its agency. Add to this that diseases 
 justly referable to its sole agency belong to a different class. 
 
 Cause of fevers destroyed or mitigated by sanative measures. The 
 morbid effect of the cause is destroyed or mitigated, and its action 
 neutralized by disinfectants and antiseptics, which operate in the 
 same way on contagious poisons, and arrest the process of decompo 
 sition in animal and vegetable substances. The beneficial effects of 
 these agents, in all the cases in question, indicate a similarity of 
 nature in the morbid causes upon which they exercise their neutral 
 izing and destroying influence. Cold, a most powerful disinfectant 
 and antiseptic, which prevents decomposition for an indefinite, if not 
 infinite, period, arrests, as we have seen, the prevalence of fever. 
 Of the disinfecting or deodorizing power of fire or heat, much has 
 been said by philosophers and physicians in olden times ; indeed, if 
 the claims of any hygienic means to our respect could be enhanced 
 by its antiquity, few would be more entitled to it than the one in 
 question. It was recorded long before the days of Pliny, who 
 speaks of it as of a thing well known : " There exists in the very 
 fires a remedial power against pestilence occasioned by obscuration 
 of the sun by clouds, and by an excess of moisture. Fire, by its 
 fumigation, certainly assists in many ways. Empedocles and Hip 
 pocrates have demonstrated this amply." 2 Poets, too, recognized 
 the benefits derived from that agency. " Or all noxious principles," 
 Virgil says, " may be dried out of them by fire, and useless moist 
 ure driven out : 
 
 Sive illis omne per ignent, 
 Excoquitur vitium, atque excedat inutilis humor. " 
 
 The reader will doubtless recollect that it is reported of the father 
 of medicine, that he changed the morbific state of the atmosphere 
 
 1 See on this subject an excellent Report in the 6th vol. of Trans, of Am. Med. 
 Assoc. 
 
 2 Cap. 27, lib. 36. 
 
276 PNEUMONIA AND 
 
 at Athens, during the plague described by Thucydides, by kindling 
 large fires. 1 The same is related of Acron of Agrigentum. 2 At a 
 less remote period, the city of Rome furnishes a striking example 
 of the benefit which was supposed to arise from the same practice. 
 "Rome," as Lancisi remarks, "an unwholesome region may, thanks 
 to her furnaces, be inhabited with safety." Monfalcon informs us 
 that, when the French troops occupied the Mantuan, during the 
 early Italian campaigns of Bonaparte, they were forced to encamp 
 on the marshy surfaces which abound in that province, and in con 
 sequence exposed to malarial fevers. Bonaparte succeeded in pre 
 serving the health of his men, by ordering them to keep, day and 
 night, near large fires, kindled for that purpose. 3 
 
 Sir Gilbert Blane speaks in the highest terms of heat as a puri 
 fying agent on board of ships, and states that nothing served to 
 contribute so much to disinfect the filthy French ships captured by 
 Admiral Rodney in the famous battle of 1782, and sweeten the air 
 in them, as burning fires in the hold. 4 And we all know the ad 
 vantage resulting, in all malarious localities, from warming and 
 drying the houses, especially early in the morning, and at the 
 approach of night. 
 
 Chlorine, and other fumigations, destroy ammonia and organic 
 bodies with more or less facility ; and there are not wanting facts 
 to show that they exercise a salutary influence in mitigating or 
 arresting the progress of fever. 5 The same may be said of chloride 
 of lime, whose efficacy, though doubted by some observers, 6 is 
 highly thought of by reliable professional authorities in this and 
 other countries; 7 of chloride of zinc, which is highly extolled by 
 competent judges; 8 of smoke, which has been successfully employed 
 
 1 Galen, Thcrap. ad Pison ; Aetius, v. 94. 
 
 2 Plutarch, De Iside et Osiridc, see Adams s Trans, of Paulus JEgineta, i. 274 ; 
 ib. Tr. of Hippocrates, i. 12. 
 
 3 Traite des Marais, 201 . 
 
 4 Diseases of Seamen, 117, 287; see also Blane s Dissertation, i. 220; Folchi, N. 
 A. Med. and Surg. Journ. vii. 252 ; J. Clark, G7. 
 
 6 Savaresi, 451 ; Dariste, 227 ; Bally, 591 ; Valentin, 233 ; Arnold, 18; Robert, 574 ; 
 Townscnd, 223; Cullom, 3G5; Guyton Morveaux, Carmichael Smith, Playfair, Gra 
 ham, Hoffman, Cooper, in Sec. Ptcpt. of London Commissioners, 1848, p. 32, &c. 
 
 6 Bowie, in same work, 83. 
 
 7 Johnson, Some Account of the Origin and Prevalence of Yellow Fever in Charles 
 ton, Charleston Journ. iv. 164 ; Southern Agriculturist, iv. 250, 417, as quoted by Dr. 
 Johnson. 
 
 8 Bryson, 225. 
 
AUTUMXAL FEVERS. 277 
 
 in Germany, France, and elsewhere, on land and on shipboard; 1 
 as well as of the sprinkling of lime, 2 and of ozone, the most power 
 ful of disinfectants. 3 
 
 Dr. Stokes relates somewhere the instance of a district of Corn 
 wall, where paludal fevers prevailed extensively, and have disap 
 peared since the establishment of a copper foundry. It is known 
 that daring the fusion of copper, an escape of arsenical particles 
 takes place. In this respect malarial diseases approximate to those 
 produced by animal poisons. M. Bousquet has found that the 
 
 1 Zimmerman, de 1 Experience, notes by the translator. Bonnet, Essai sur la Puri 
 fication de 1 Air, 17; see also Hoffman and Van Swieten. Galeron, Mem. de la Soc. 
 Hoy. de Med. iii. 44 ; Lind on Seamen, 74. 
 
 2 Forbes s Review, July, 1844, p. 196. 
 
 8 This substance, which at one time was supposed to constitute the efficient cause 
 of epidemic diseases, because it is sometimes found in the atmosphere during the 
 prevalence of these, may now, if the experiments of Dr. Schoebein 1 are to be relied 
 upon and, so far, no doubts have been expressed on the subject be considered as 
 the most powerful disinfectant, and the great purifier of the atmosphere. It destroys, 
 quietly and effectually, the miasma disengaged from putrid flesh ; and there is every 
 reason to believe that it acts as efficiently in regard to the cause of fever, as to 
 atmospheric poisons, artificially produced ; whilst its effects in respect to these and 
 its virtues as a destroyer of the cause in question, lend a strong support to the opinion 
 which ascribes fever to the existence, in the air, of peculiar poisonous exhalations. 
 Ozone is abundantly found during thunderstorms, and we know that these purify the 
 atmosphere, mitigating or arresting the spread of epidemic fever. If it is diminished 
 in volume, by the presence of impurities artificially produced, and whose presence in 
 the atmosphere cannot be doubted, it is, in like manner, found in less quantity in hot 
 seasons and fever regions, where malaria may be supposed to exist in greater abund 
 ance ; and if, in the former case, the diminution in question is produced by the action 
 of the disinfectant, in neutralizing or destroying the existing impurity, we cannot 
 greatly err in referring the diminution, in the latter case, to a like action of that sub 
 stance on a kindred poison, and its consequent consumption. Ozone, on the other 
 hand, exists in greater abundance in winter ; and, as this is precisely the season at 
 which miasmal fevers do not prevail, and when the atmosphere is in the greatest state 
 of purity, we are justifiable in the conclusion that its accumulation, at that period, 
 arises from a less demand of it for the decomposition of oxiclable miasmatic matter or 
 poison. Again, it has been found that the higher stratas of the atmosphere are more 
 ozoniferous than the lower ones, an effect easily accounted for by the circumstance 
 that those strata contain a less quantity of that oxidable miasmatic matter than those 
 portions of the atmosphere which are nearer the surface of the earth, and that hence 
 a smaller quantity of the disinfectant substance is consumed. In a word, ozone acts 
 like chlorine, by destroying impurities existing in the atmosphere ; and, if it purifies 
 the air of infected localities, and destroys the cause of fever, it can only do so by 
 destroying or neutralizing a kindred impurity, or poisonous exhalation, floating in the 
 atmosphere of such localities. 
 
 Med.-Chir. Trans, xxxiv. 212. 
 
278 PNEUMONIA AND 
 
 chlorides produce an important change in the vaccine matter, and 7 
 indeed, annihilate its specific property, when the mixture is pro 
 perly made and somewhat prolonged. 1 The syphilitic virus, ac 
 cording to Ricord, unless not very much diluted, is not affected by 
 mixture with saliva, urine, vaginal mucus, muco-purulent matter of 
 the urethra or vagina, fecal matter, sweat, or sperm ; but is destroyed 
 by an alkali, or an acid, as the sulphuric, nitric, chlorhydric, acetic, 
 &c. ; by chlorides, potas.h, soda, ammonia, wine, alcohol, concentrated 
 decoction of tan. 2 Vaccine matter is destroyed by great heat, 3 and 
 by frost. 4 
 
 Cause arrested "by trees, &c. The extension or diffusion of the 
 cause is arrested by trees, walls, hills, rows of buildings, canvas, and 
 other such obstacles. 5 Lancisi cites a number of facts showing the 
 advantages of belts of trees in protecting against the effects of 
 malaria, and the danger resulting from their removal. He calls 
 attention to the fact that, in former days, there existed on the south 
 side of Home a thick forest. It extended from Frascati and Albano 
 to the Tiber, and protected the southern portion of the city, and the 
 neighbouring district, from the baneful influence of the effluvia of 
 the Pontine Marshes. This rampart has since been removed, and 
 the country has become proverbial for its unhealthiness. 
 
 Lancisi did not for a moment doubt the utility of these belts, 
 and expresses the opinion that the consecration by the ancients of 
 woods and groves had no other motive than guarding, through 
 their means, against the diffusion of the febriferous poison. 6 In this, 
 he was probably right. Among the Eomans, the advantage of 
 such barriers had long been recognized. Trees were planted in 
 rows and in masses, to guard against the diffusion of malaria. The 
 practice was enforced by law, and recorded on the Roman tablets. 
 This law, which was reported by Cicero "Lucos in agris htibinto"- 
 
 1 Nouvcaux Traite cle la Vaccine, 220. 
 
 2 Tr. Prat, des Malad. Vener, 178 ; Lcttrcs J. 86. 
 
 3 Anglada, i. 213. 4 Bulletin, ii. 10-51. 
 
 5 Rigault de 1 Isle, in Johnson, Trop. Cl. 807, 314, 310, 317; Mitchell (J. K.j, 20, 
 100; Macculloch, 110,252,3; Williams, Morbid Poisons, ii. 4-18, 453 ; Johnson, 
 Change of Air, 143; Evans, 15; Caldwcll on Malaria, 135; Tonrnon, foe. fit. \. 200; 
 Watson s Practice, 453; Bonnet, Fiev. Interni. 311 ; Drake, i. 727; Monfaleon, ( J3, 04, 
 160; Annesley on Diseases of India; Wilson Philip, on Fevers, i. 70; Tfosack, Prac 
 tice, 174; Dundas, Sketches of Brazil, 240; DC Ilerizi Miasmi Paludosi, 30. 
 
 6 Op. dt. 8 J, &c. 
 
AUTUMNAL FEVEKS. 279 
 
 bad reference evidently much more to the advantage in question, 
 than to the purposes for which trees are usually planted. In order 
 to insure their safety, such collections of trees were placed under 
 the protection of some divinity, or under the responsibility of the 
 Roman consuls. 
 
 " Sive sacro pavi, sedive sub arbori sacra," says Ovid. 
 
 " Si canirnus sylvas, sylvae sint consula dignas," according to 
 Suetonius. 
 
 Bapt. Donus, in his work on the means of insuring salubrity to 
 the soil of the Roman States, recommends the planting of pine and 
 other trees between Rome and the Pontine Marshes, to intercept 
 the miasmata wafted from these by the south-west winds. 1 At 
 Velletri, as also at Campo Salino, the destruction of belts of woods 
 was followed by the prevalence of fever. 
 
 The following fact, published by Dr. Lewis in his medical history 
 of Alabama, on the authority of Dr. "Wooten, at present, I think, 
 Professor in the Medical School of Memphis, is interesting and ap 
 posite : " Mr. P. E. had negro-quarters situated on the "first prairie 
 elevation above the low grounds of a small creek, the fourth of a 
 mile from the houses. The belt of low ground frequently over 
 flowed, causing water to remain in holes over its entire breadth, on 
 the subsidence of the stream, but it was well shaded by a dense 
 foliage, the plantation lying on the prairie in the rear of the cabins. 
 In the winters of 1842 and 1843, the trees between the houses and 
 creek were cleared away ; and up to that time, some eight or ten 
 years, the negroes living in this quarter had enjoyed uninter 
 rupted health, a case of fever scarcely ever occurring. During the 
 summer of 18-13, the first after the forest had been cleared away, 
 fever prevailed among the negroes with great violence, continuing 
 until frost. The negro-quarters were afterwards removed to the 
 opposite side of the creek, about the same distance from it, but 
 with an intervening growth of timber, and no fever has occurred 
 on the place since." 2 
 
 " Whole families," says Mr. Bartlett, " have resided near the Pon 
 tine Marshes, and, by the intervention of shrubs and trees, have 
 escaped for years the noxious effects of the mephitic vapours which 
 those putrid waters engender." 3 Dr. Ilosack states that a family in 
 
 1 De Rcstituencla Salnbritatc Agri Romani, 1GG7. 
 
 2 New Orleans Journal, iv. 4. 3 Thompson s Annals. 
 
280 PNEUMONIA AND 
 
 New Jersey was attacked with fever in consequence of cutting down 
 a wood that separated them from a morass in the neighbourhood. 
 Before that operation, they had been healthy. 1 " Army physicians, 
 therefore, recommend," says Dr. "Wilson Philip, " having a wood, if 
 possible, between marshy grounds and an encampment. 2 Rigault de 
 Lisle calls attention to the fact that, upon Mount Argental, above 
 the village of St. Stephano, there is a convent, which has lost all 
 the reputation for salubrity which it once enjoyed, since the lofty 
 trees, by which it was surrounded, have been cut down. I have 
 been informed, he adds, by persons worthy of credit, that, in con 
 sequence of the felling of the wood before Astcrna, near the Pontine 
 Marshes, Veletri was visited for three successive years by diseases 
 which made much greater havoc than usual throughout the whole 
 country, and penetrated to many places which they had not pre 
 viously been accustomed to reach. Rigault de Lisle cites other 
 cases, and refers to Yolney, who states that Beyroot, formerly very 
 unhealthy, has ceased to be so since the Emir Fakr-el-din planted 
 a wood of fir-trees, which still exists, a league below the town. 
 
 By Pliny and others, among the ancients, it was supposed that 
 trees absorb the. exhalations extricated from insalubrious places, 
 and that the beneficial effects obtained from woods are to be 
 accounted for in this way much more than by the obstacles they 
 offer to the diffusion of those exhalations. This opinion has, to 
 a certain extent, received the sanction of Thouvenelle, Copland, 
 and other modern writers; and its correctness is rendered probable 
 by the results of certain experiments made long ago, and repeated 
 more recently to ascertain the fact. " Plants," says Julia de Fon- 
 tenelle, "which Priestley had inclosed in glass jars filled with viti 
 ated air, continued to thrive, and, at the end of a few days, this air 
 had become as pure as that of the surrounding atmosphere." 3 A 
 more recent writer, Dr. Lewis, of Mobile, reverting to the subject, 
 remarks: " It is the generally received opinion that living vegetation 
 protects the human system from the deleterious effects of malaria; 
 and, reasoning by analogy, it would appear that experiments mado 
 by scientific men have satisfactorily explained the mutual depend 
 ence of the animal kingdoms on each other for support. It has 
 been ascertained that if air, rendered pernicious by respiration, be 
 
 1 rrnctico of Medicine, 174. 2 A Treatise on Feb. Di.s. i. 71). Am. ed. 
 
 3 Op. cit. 139. 
 
AUTUMNAL FEVERS. 281 
 
 confined in a bottle, into which some green plant has been intro 
 duced, and exposed to the action of the sun, the carbonic acid will 
 be absorbed, and the air restored to its original condition. The 
 putrefaction of animal matter, and the decomposition of vegetable 
 substances would cause a sufficiency of carbonic acid vapour, when 
 united with atmospheric air, to destroy every living being, were it 
 not for this wise provision of nature. This gas, which is poisonous 
 to the human as well as animal species, is a source of nutriment 
 to every variety of plant ; and thus, it would appear, exercises a 
 benign influence in protecting men from the deleterious effects 
 of poisonous vapours." 1 And if the effect is obtained so far as 
 regards one species of poisonous vapour, it may be equally so in 
 reference to that giving rise to fever. 
 
 Facts, indeed, are not wanting to show that aquatic plants, as 
 well as certain vegetable substances, growing in damp and swampy 
 or marshy soils, possess the property of disinfecting them a virtue 
 which, as is well known, Dr. Cartwright ascribes more particularly 
 to the Jussiena Grandifolia, an exclusively aquatic plant found in 
 great abundance in some parts of the Southern States, and espe 
 cially in some regions of Louisiana, which, though presenting many 
 of the usual characteristics of malarial surfaces, are exempt from 
 fever. 2 
 
 A distinguished natural philosopher, Changeux, inferred from 
 the results of his experiments, that the action of trees in the pro 
 duction of the effect under consideration is twofold. " Plants," he 
 says, " whether odoriferous or inodoriferous, give issue to emana 
 tions, which, when mixed with poisonous vapours exhaling from 
 marshy or damp soils, neutralize their pernicious influence. But 
 the former exercise a greater effect through means of the neutral 
 izing process than by the power of absorption just mentioned; 
 their emanations mixing with the air we breathe, and correcting 
 its deleterious properties by virtue of the particular qualities 
 with which they are endowed. The second class the inodorife 
 rous, on the other hand, act more evidently through means of their 
 power of absorption than of the neutralizing property of their ema 
 nation, and remove from the air the vapours by which it is con 
 taminated." 3 
 
 1 Med. Hist, of Alabama, New Orleans Jo urn. iv. 4, 5. 
 
 2 Western Journal of Medicine and Surgery, i. 428, &c. 
 
 3 Journal de Physique, vi. 211. 
 
282 PNEUMONIA AND 
 
 By not a few able observers and expert experimentalists, the dis 
 infection is ascribed, not to the absorption by trees and other vege 
 table substances of the gaseous poison floating in the atmosphere 
 of malarial localities, but to the purification of such an atmosphere 
 through means of the large supply of oxygen obtained from living 
 plants, and the neutralizing agency of that gas on the mephitic 
 particles it meets with in insalubrious places. 1 As to the manner 
 in which the oxygen thus produced destroys or prevents the elabo 
 ration of the malarial poison, some difference of opinion exists. 
 M. Carriere, in his excellent work on the climate of Italy, adopts 
 the views of Chevreul and Fontana, in relation to the formation of 
 the febrific poison through means of the action of organic matter on 
 the sulphates contained in the earth or in water with the aid of the 
 oxygen derived from the former. According to this writer, the 
 leaves of plants and of trees, as well as the green substances that 
 cover the soil, are all inexhaustible sources of oxygen, which 
 is so important to sustain life and preserve health. This fluid, 
 thus furnished, offers an obstacle to the action of organic mat 
 ter. If the latter acts chemically on the sulphates, the other, in its 
 turn, reacts on those compounds, and, from the double antagonistic 
 action thus produced, a state of equilibrium, advantageous to the 
 purity of the air and the salubrity of the country, is re-established. 
 " Hence, to cover the fields, the edges of marshes, and the whole 
 extent of the soil with an abundant vegetation, is equal to placing 
 on the surface of unhealthy regions a reparative apparatus of the 
 greatest power." " Trees, therefore, must have a large share in the 
 amelioration of the country, in consequence of the quantity of 
 leaves they furnish." 2 
 
 By others, again, it has been remarked, doubtless with much 
 truth, that malaria is collected by plants, particularly those of a 
 dense and entangling foliage, so as to be disengaged on cutting 
 them down or rooting them up, thus exciting fever in the labourers 
 who might otherwise have escaped, as proved by the circumstance 
 that in all those situations while the workmen are in the erect 
 posture, and engaged at their work, they escape the fever, but are 
 attacked if they sit, and, more particularly, if they lie down on the 
 ground and that whether they sleep or not. 3 Whether these views 
 
 1 Scncbicr, Physiologic Yegetalc, iii. 184, &c. 
 
 * Le Climat de 1 Italie, 328. 3 Edin. Rev. xxxvi. 540. 
 
AUTUMNAL FEVEKS. 283 
 
 be correct or otherwise; or whether the effect is generally due to 
 the mechanical obstruction trees afford to the transit of malaria 
 from its source, while the exemption of individuals who keep the 
 erect posture, and their liability when they sit or lie on the ground, 
 are to be explained by a difference in the amount of terrestrial radia 
 tion, or by the greater quantity of contaminated air they breathe, I 
 need not stop to inquire, and dismiss the subject with the simple 
 remark that, the same results being obtained from the interception 
 occasioned by walls, houses, hills, &c., we are justified in inferring 
 that trees, though they may perhaps act as absorbents, act also, and 
 principally, in the mechanical way mentioned. Be this as it may, 
 Dr. Ferguson, calling attention to the attraction of marsh poison for, 
 or rather its adherence to, lofty umbrageous trees, says that "this is 
 so much the case that it can with difficulty be separated from them ; 
 and that in the territory of Guiana, particularly, where these trees 
 abound, it is wonderful to see how near to leeward of the most pes 
 tiferous marshes the settlers, provided they have this security, will 
 venture and that with comparative impunity to place their habi 
 tations. The town of New Amsterdam, Berbice, situated within 
 musket-shot to leeward of a swamp extremely offensive at a certain 
 stage of dryness, owes, evidently, its ordinary exemption from fever 
 to this cause." "A still better instance of the same, and with the 
 same results, may be seen at Paramaribo, the capital of Surinam, 
 where the trade-wind, that regularly ventilates the town, and ren 
 ders it habitable, blows over a swamp within a rnile of the town, 
 which, fortunately for the inhabitants, is covered with the same 
 description of trees." 1 But whatever be the way in which these 
 operate in promoting the salubrity of malarial localities, the effect 
 tends to show that the benefit obtained is due to the destruction of 
 a poisonous agent floating in the air, or to the obstacle it encounters 
 in its passage with the atmosphere from one place to another. 
 
 Fever orrcstcdby removing sources of infection. The progress of fever 
 has been arrested by the clearing and washing of gutters, streets, 
 sinks, and sewers by the removal of other sources of effluvia ; 
 while in ships, as we have already seen, epidemic prevalences of 
 yellow fever have been arrested, and health restored, by kindred 
 means. 
 
 1 Marsh Poison, in vol. of Xotes and Rccol. 195, 6. See also Williams on Morbid 
 Poisons, ii. 448. 
 
284 PNEUMONIA AND 
 
 Fever sometimes connected with the existence of certain fogs or mists. 
 Instances are on record in which the surfaces of highly insalubrious 
 marshy localities have been found at particular hours of the day, 
 covered over with a heavy foggy cloud of a peculiar character, and 
 which carries infection 1 wherever it is propelled; while ordinary 
 fogs in the vicinity, or elsewhere, are perfectly innocuous, so far as 
 relates to the production of autumnal or periodic fevers. Such 
 was the case, for example, in Wilmington, in 1798. Such also has 
 been found over the town of Huaura, in South America, where 
 marshes are extensive. There malaria is stated to have been found 
 distinctly separate from the atmosphere, lying at an average of two 
 or two and a half feet above the marsh, and distinguished by a 
 peculiar kind of opalization, which, on certain changes of light, 
 exhibited a yellowish tint. 2 
 
 Allusion has already been made to the smokes of the African 
 coast. These very frequently, if not generally, carry with them 
 the seeds or cause of fever, and, while doing so, impress the system 
 in a different way from ordinary fogs. In a case mentioned by 
 Sir J. Pringle on the authority of Mr. Lauder, surgeon of a horse 
 regiment, the meadows and marshes on each side of the road which 
 the troops had to pass over on their way to forage, Avere covered, 
 at an early hour, with a thick fog of an offensive smell, which he 
 considered as the chief cause of the sickness which affected the 
 men, as few who were exposed to its impression escaped an attack. 3 
 Pringle also states that, in 1748, the nocturnal fogs near the inun 
 dations, were thick and fetid. 4 Dr. J. Johnson states that when, 
 at Batavia, the land-breeze came off from the low swampy grounds 
 about the place, early in the mornings, it brought with it a thick 
 mist, accompanied by a very fetid smell ; all of which would gra 
 dually go off as the sun rose, and the sea-breezes set in. During 
 the prevalence of this fetid mist,, many people complained of slight 
 indisposition in the head and stomach, which, likewise, w r ent off as 
 the sun rose. 5 We know, however, that all do not get well who 
 breathe that mist, for the great prevalence of fever about Batavia 
 is proverbial. 
 
 The following case occurred in St. Lucia: Two men, after fmish- 
 
 1 Vaughan s Med. Rep. iii. 30. 
 
 2 Von Tschudi s Travels in Peru. See Edinb. Journ. Ixix. 489. Watson, 451. 
 
 3 P. 178. 4 P. 03. 
 6 Trop. Climates, 127. 
 
AUTUMNAL FEVERS. 285 
 
 ing their day s work, before returning home, were occupied in haul 
 ing their canoe high upon the beach, close to the most dangerous 
 part of a large swamp, when they perceived, immediately to wind 
 ward, a small cloud of vapour gradually approaching them. In a 
 short time they were enveloped in it. One of them fell down, ap 
 parently in a state of asphyxia, and the other was so affected as to 
 be unable to render him any assistance. The latter soon recovered, 
 while the other, after coming to sufficiently to be led home, was seized 
 in the night with an intense ague, during which the surface of the 
 body was cold, the countenance expressed great anxiety, and the 
 pulse was small and scarcely perceptible. The patient was insensible 
 to surrounding objects, and in a state of coma, only interrupted by 
 severe convulsions. This cold stage continued about three hours, 
 and was followed by reaction attended with coma alternating with 
 delirium, vomiting of mucosities, and pain in the stomach aggravated 
 by pressure at the epigastrium. A remission followed, which, in its 
 turn, was succeeded by another paroxysm equal in violence to the 
 last, except that the cold stage was scarcely perceptible. Death 
 occurred about forty hours from the period of exposure. On dis 
 section, the blood was found fluid, and a small quantity of turbid 
 serum was effused between the arachnoid and pia mater; the lungs 
 were somewhat engorged, and the stomach was intensely inflamed, 
 containing two or three ounces of blood in its cavity. The other 
 man stated that the vapour had no perceptible smell ; that it was 
 warm and moist, like steam, stopped the respiration for a moment, 
 and produced a sense of faintness and trembling of the whole body. 1 
 
 The stagnant latter of marshes injurious to health. Stagnant water, 
 particularly that contained in marshes and swamps, cannot support 
 animal life, and furnishes no element for the sustenance of fish. 
 The discharge of such water into ponds or lakes has not unfrc- 
 quently given rise to the sudden destruction of those animals con 
 tained therein. 2 To produce such an effect, it must contain in solu 
 tion some poisonous matter ; and if so, it is not unreasonable to 
 suppose that this poison is taken up with the vapour absorbed in 
 the atmosphere, and that it affects those who are exposed to the 
 influence of the latter. 
 
 1 Evans, R., Clinical Treatise on the Epidemic Fevers of the West Indies, 21. 
 
 2 Monfulcon, 44. 
 
286 PNEUMONIA AND 
 
 Nor is it unreasonable to admit that the water of paludal sur 
 faces O f marshes, particularly may, when used as drink, give rise 
 to diseases similar to those resulting usually from the action of 
 the exhalations evolved from them. Centuries ago, Hippocrates, 
 in his masterly work on Airs, Waters, and Places, while treating in 
 a special and interesting section of the nature and morbid effects of 
 such water, attributes to its use the enlarged spleen so frequently 
 noticed among the inhabitants of marshy districts a pathological 
 condition which we now view as one of the effects of malarial poi- 
 sonin^; and though there can be no doubt that this deleterious effect 
 
 O " O 
 
 is usually the result of the absorption of the exhalation in a gaseous 
 form through the agency of the respiratory process, there are facts 
 to show that it may sometimes arise from the internal use of water 
 impregnated with the poison. M. Boudin, in support of this opi 
 nion relates the following case: A Sardinian vessel, the Argo, left 
 Bone (Algeria) in Juty, 1834, with 120 soldiers in good health. 
 During the passage to the lazaretto of Marseilles, thirteen of these 
 soldiers died, and at the arrival of the vessel ninety-eight had the 
 fevers, of all forms and types. "While such was the case among 
 the soldiers, the crew remained in health. On inquiry, it was found 
 that this result arose from the fact that the crew had made use of 
 pure water they had procured for that purpose, while the soldiers 
 had been obliged to content themselves with water derived from a 
 marshy locality situate near Bone. The few soldiers who escaped, 
 were those who had purchased water from the Sardinian sailors. 1 
 It must be added that two other vessels which sailed at the same 
 time from Bone, filled, like the Argo, with soldiers, but in which 
 pure water was used by these as well as by the crew, arrived at 
 Marseilles in good health. 2 
 
 The following fact, related by Dr. Drake, on the authority of Dr. 
 Trowbridge, deserves, on more accounts than one, to be recorded. 
 In the neighbourhood of Buffalo, for three (but not successive) 
 autumns, a local epidemic fever occurred among about twenty fami 
 lies, who drank, or otherwise used water, from the same spring. It 
 burst out beneath a ledge of limestone, about twenty-five feet below 
 the summit, beyond which, at the distance of a mile, there was a 
 piece of woodland with a pond, which Dr. Trowbridge supposed to 
 be the source of the spring; for, after rains, its waters became tur- 
 
 1 Boudin, Fevers Interm. GG, G7. * Ib. G6ograph. Mod. 55. 
 
AUTUMNAL FEVERS. 287 
 
 bid. The autumns in wliich the fever prevailed were unusually 
 dry. In its symptoms and violence, the disease might have passed 
 for yellow fever. Nine or ten persons died. The surrounding 
 neighbourhood remained healthy. The spring was at length aban 
 doned, and the fever did not return. Dr. Drake remarks that this 
 seems to show that the material cause of autumnal fever may be 
 absorbed by water, and thus produce its characteristic effects. 1 
 
 A paludal atmosphere enfeebles health. The feeble health entailed by 
 a long residence in fenny and fever regions, results often from a 
 frequent repetition of febrile attacks; as, frequently, it manifests 
 itself without the occurrence of open fever intermittent, remittent, 
 or continuous. It depends on pathological conditions of a special 
 kind, characterized by phenomena equally peculiar, and indicates 
 the agency of a morbific cause other than a mere modification in the 
 relative proportion of the natural constituents of the atmosphere, 
 or in the thermometrical or hygrometrical state of the latter. En 
 largement of the abdomen, and engorgement of its viscera, and 
 a morbid state of the blood, consisting in the simultaneous dimi 
 nution in the proportion of the globules, of the albumen of the 
 serum, and sometimes of the fibrin, attended with a bloated, pale, 
 and sallow countenance, a flabbiness of the flesh, an oedematous 
 condition of the cellular tissue, and, in some localties, a disposition 
 to ulcers and to gangrenous sores, are frequently, if not always 
 encountered in such regions, and have been noted by high profes 
 sional authorities. 2 The evil which this poison inflicts on man 
 is painful to tell, amounting in time to a total humiliating degene 
 racy of the race. The late Professor Caldwell remarks, in one of 
 his works, 3 that those who would witness that result, in its highest 
 degree, must visit some of the marshy and sickly districts of Eu 
 rope, more especially of France, Holland, Italy, Spain, and Portu 
 gal; for in some of them, where, by the operation of the poison, 
 
 1 Diseases of the Mississippi Vallej^, 382. 
 
 5 Fcclere, Mod. L<. -g. v. 165; Nepple, Fievrcs Intermit. 11; Boudin, Fievres Inter. 
 188; Diet, dcs Sc. Med., article Marais, 533; Monfalcon, viii. 114, 131; Blair, Y. 
 Fev. of Demerara, 23; Davy, Notes to Blair; Prony, Rapport sur les Mara is Pontines, 
 Becquerel, 170, 1; Edinb. Med. and Surg. Journ. Ixxx. 212; Tliouvenelle, Climat 
 de 1 Italie, 15, 16; Copland, art. Endemic Influences, i. 701, Am. ed. ; Carriorc, op. 
 cit. 87 ; De Renzi, Miasmi Paludosi, 83. 
 
 3 Essay on Malaria, 19. 
 
288 PNEUMONIA AND 
 
 through a long and unbroken line of generations, the effect has 
 reached its maximum, the issue is deplorable. The adage, which 
 attributed the dulness for which the Boeotians were proverbial to 
 the mists and paludal nature of their ill-favoured country, is as old 
 as the time of the ancient Athenians, and shows that, at an early 
 period, the cachectic effect of such localities was matter of ob 
 servation. Hippocrates may have had them in his mind, when, in 
 writing the famous treatise so often referred to, he remarked, that 
 such waters "as are marshy and stagnant, and belong to lakes, 
 are necessarily hot in summer, thick, and have a strong smell, since 
 they have no current ; but being constantly supplied by rain water, 
 and the sun heating them, they necessarily want their proper co 
 lour, are unwholesome, and form bile. Those who drink them 
 have large and obstructed spleens, their bellies are hard, emaciated, 
 and hot ; and their shoulders, collar-bones, and faces are emaciated ;^ 
 for their flesh is melted down and taken up by the spleen, and 
 hence they are slender; such persons, then, are voracious and 
 thirsty ; their bellies are very dry, both above and below. They are 
 very subject to dropsies of a most fatal character; and, in summer, 
 dysenteries, diarrhoea, and protracted quartan fevers frequently 
 seize them; and these diseases, when prolonged, dispose such con 
 stitutions to dropsies, and thus prove fatal. Women are subject to 
 oedema and leucophlegmasia. The children are particularly subject 
 to hernia, and adults to variccs and ulcers on their legs ; so that 
 persons with such constitutions cannot be long lived, but, before 
 the usual period, they fall into a state of premature old age." 1 
 
 Quod si 
 
 Judicium subtile videndis artibus illud 
 
 Ad libros et ad lieec musarum dona vocares 
 
 Bo3otum in crasso jxirares acre natum. HORACE, Episiol. lib. ii. Ep. 2. 
 
 Lancisi did not fail to notice the undermining effects on the mind 
 and body of an atmosphere thus vitiated, and closes a long and inter 
 esting chapter on the subject with remarking, "Adeo colore pallidi, 
 vitibus habetes, ingenio sunt tardo, muliebrique ;" 2 and that matters 
 have not changed in that respect in Italy, since his days, may be 
 easily found on consulting the works of Carriere, De Kenzi, Thou- 
 venelle, and others. 
 
 M. Bosse has furnished us with a graphic picture of the condi- 
 
 1 Airs, Waters, and Places, Adams s Transl. i. 195, 196. 2 Op. at. lib. i. 70, 
 
AUTUMXAL FEVERS. 289 
 
 tion of the inhabitants of the malarial districts of the Department 
 of Ain (formerly the province of Bresse), in France. "A pale 
 and livid complexion, a dull and heavy eye, swollen eyelids, a 
 wrinkled face, narrow shoulders, a contracted chest, a long neck, a 
 shrill voice, a skin always either dry or bedewed with debilitating 
 sweats, a slow and sluggish walk, &c., characterize such an individual, 
 who is old at thirty, broken and decrepit at forty or fifty." 1 
 
 Not different is it in the malarial districts of our Southern States, 
 for there the result adverted to is already visible. In those districts 
 the human frame is weakly constituted, the mortality of children 
 very great, and the mean duration of life short. "Along the fron 
 tier of Florida, and the southern borders of Georgia," says Dr. Forry, 
 " as well as in the low lands of our Southern States generally, may 
 be seen deplorable examples of the physical and perhaps mental 
 deterioration induced by endemic influences. In earliest infancy, 
 the complexion becomes sallow, and the eye assumes a bilious tint. 
 Advancing towards the years of maturity, the growth is arrested, 
 the limbs become attenuated, and the viscera engorged. Boys of 
 fifteen years may be seen bowed down with premature old age a 
 mere vegetating being, with an obstructed, bloated, and dropsical 
 system, subject to periodic fevers, passive hemorrhages, and those 
 other forms of disease which follow in the train of malaria." 2 
 
 These phenomena, which are indicative of that condition of the 
 system denominated very aptly the paludal cachexia, are certainly 
 not the usual results of the action of simple heat, cold, moisture, or 
 atmospheric vicissitudes, or of the introduction into the system of 
 any known gas; but point to the morbid influence of some spe 
 cial toxicological agent absorbed into the circulation along with the 
 air we breathe, and possessing a twofold action, one chronic another 
 acute; the former producing peculiar bad effects in the blood, in 
 the liver, in the spleen, and the whole alimentary canal and vascu 
 lar system ; the other giving rise to periodic fever. 
 
 Dr. Blair remarks that, in Demerara, " there seems to be both 
 an amemiatiny and a septic malaria. The former pervades the 
 colony, so that a rosy cheek is nowhere to be found after a year s 
 residence ; but it least affects the sea-shore. Its intensity increases 
 as we proceed into the interior, up the narrow creeks and muddy 
 
 1 Statistique Jn Department de FAin, 4. 
 
 2 F.Tiy, Climate of the U. S. 305, 3CG. 
 
 19 
 
290 PNEUMONIA AND 
 
 rivers. There, the complexion becomes perfectly etiolated, even 
 without an attack of intermittent ; the spleen gets enlarged, the 
 cellular tissue infiltrated, and dyspnoea and palpitations supervene 
 from mere whiteness (loss of the red particles) and thinness of 
 blood." (P. 23.) To this Dr. Blair s annotator, Dr. Davy, adds that 
 such an influence seems to be common in the West Indies. " It is 
 strongly marked by the pale, sallow, sickly hue of the white Creoles, 
 especially in Barbacloes. There, if they have any colour, it is most 
 frequently reddish ; whence the labourers of this class have been 
 called red legs. One rarely witnesses that bronzing of the ex 
 posed skin in the West, which is the almost constant effect of 
 exposure to the sun s rays in the East Indies, and in the south of 
 Europe," (Ib.) 
 
 In many southern regions, the West India Islands, for example, 
 malaria predisposes, as Hippocrates informs us was the case in 
 Greece, to ulcers. Of 6,395 admissions into the colonial hospital 
 of Georgetown, Demerara, 1,873 were cases of ulcers. Small wounds 
 produced by insects and serrated grasses, are sufficient to excite one 
 in subjects so predisposed. The ulcers chiefly affect the lower ex 
 tremities ; but the fingers are sometimes affected, and even the lips 
 and cheeks. In the negroes they are often large, with indurated 
 edges, and produce not the slightest inconvenience, except in the 
 trouble of dressing them. Among the emigrants, particularly the 
 Portuguese and the Coolies, the ulcer is generally sloughy, phage- 
 denic, bleeding, and sometimes a perfect sphacelus, without even 
 surrounding or previous erythema. This last form affects those 
 who have still a tolerably healthy appearance. In time, the soft 
 and solid parts are speedily destroyed, and if amputation be found 
 necessary, gangrene is apt to attack the stump within twenty-four 
 hours. In the ansemiated immigrant Portuguese, the granulations 
 are pale, and the progress of course is slow, but the sore will heal 
 kindly. 1 Dr. Blair is of opinion that this septic modification of the 
 malaria (which shows itself in the bleeding gangrenous ulcer) is 
 some imperfect development of the yellow fever poison. Dr. Davy 
 remarks, in support of this view: "In Barbadoes, among- the 
 white natives, who are almost always exempt from yellow fever, 
 the mucous membranes, especially of the prima? via?, and the skin, 
 are very prone to diseased action of a kind bearing some resem- 
 
 1 Blair, 23. 
 
AUTUMNAL FEVEKS. 291 
 
 bianco to what is witnessed in yellow fever; for instance, the chap 
 ping of the lips, with ulceration and bleeding ; an aphthous or 
 slightly ulcerated state of the fauces, and probably of the gullet and 
 stomach ; the yellowish sallowness of skin, with tendency to ulcera 
 tion. I may add that, during the absence of yellow fever amongst 
 the troops, a disposition to purpura hsemorrhagica is occasionally 
 witnessed." 1 
 
 Effect of a paludal atmosphere on the duration of life. Nor is it to 
 be forgotten that, for the above reason, a paludal atmosphere has 
 the effect of shortening the duration of life. Dr. E. Jackson states, 
 as the result of observations made during the period of our revolu 
 tionary Avar, that white females, born and constantly residing in the 
 lower districts of Georgia, were seldom observed to live beyond the 
 age of forty, and males of fifty. lie adds, that he was credibly 
 informed there was not on record an instance of a person born at 
 Petersburg, Va., and constantly residing there, who had lived to 
 the age of twenty-one. 2 Either the distinguished writer was misin 
 formed, or matters have greatly improved in that vicinity ; for the 
 average duration of life is infinitely greater now than he represents 
 it to be. But still, at present, the fenny districts of Virginia give 
 but a low average. Dr. James Johnson found that in the valleys of 
 Beveland and Walcheren, the peasants exhibited conspicuous marks 
 of premature old age, and seldom reached beyond fifty-five or sixty 
 years. 3 According to Sausset, the average duration in fenny 
 countries is not over twenty-six years. In many districts of 
 France, it does not exceed twenty-two. 
 
 Eozior, quoted by Monfalcon, fixes at fifty years the farthest 
 limit of human life of the inhabitants of Lower Brittany ; the old 
 age of whom, when they have attained this point, bears a great 
 resemblance to that of individuals who, in salubrious countries, 
 have reached to ninety. 4 It would be difficult to find a locality 
 where other than a lexicological cause could produce such disas 
 trous results on an entire population. From the researches of M. 
 Fleuriau dc Belle vue, we learn that the mortality of some com 
 munes around Marenne amounts to one in thirteen, and that that of 
 the Canton of Brouage, during a period of sixteen years 1817- 
 
 1 F. i 1 1. note. 2 Treatise on the Fevers of Jamaica, 77, 80. 
 
 3 Trop. Cl. 41. 4 Op. cit. 134. 
 
292 PNEUMONIA AND 
 
 1832, presents a proportion of one to twenty-one. 1 The same 
 writer remarks, in farther illustration of the deleterious effects of 
 paludal localities, in relation to the subject under consideration, 
 that inundated and well-shaded marshes were found to be as healthy 
 as dry and well-cultivated fields the mortality being one in from 
 42 to 46 ; that in districts possessing a purely compact argillaceous 
 soil, unsheltered from the rays of the sun, and on which rain-water 
 remains stagnant for some time, the mortality was one in 25, and even 
 one in 20 ; and that in five cantons containing several large regular 
 marshes, the mortality amounted to one in 18, and even reached as 
 high as one in 16. 2 In the Bresse and Dombes, the proportion is also 
 one to twenty-one ; while in the immediate vicinity, the proportion 
 is much less unfavourable, being from 1 to 25.6 to one to 26. 7. 3 In 
 the Department of Loiret (canton of La Ferte and Sully, but not 
 including the town of Sully), the average duration of life is 23.33 
 years. In the Department of Loir et Cher (cantons of La Motte, 
 Beuvron, Neung, Eomorantin, and Salbris), the average is 29.41. 
 In other less malarial cantons, it is 30.04, 30.64, and 34.34. 4 
 
 France, taken in its ensemble, exhibits a loss on one in about 
 forty ; from which it follows that the number of deaths in the 
 aforesaid malarial districts is twice as large as it is in the country 
 generally, and that the average of life is proportionably less. 
 Among children, the loss has been particularly large, amounting 
 during the first year to thirty-two per cent. ; and in some communes 
 to forty-two per cent., or four-tenths (near one-half), while in the 
 entire of France the proportion is only twenty-three or twenty-four 
 per cent. 5 
 
 To the same effect, I may call attention to a fact mentioned by 
 Dr. Price, in a work which has justly acquired a great reputation. 
 Referring to the District of Yaud, in the Canton of Berne (Switzer 
 land), the population of which amounted to one hundred and sixty- 
 nine families, representing a total of six hundred and ninety-six indi 
 viduals, he remarks that of these, one-half of all born in the mount 
 ains live to the age of forty-seven ; whereas, one-half of all born in 
 
 1 Statistique de la Cliarente Inferieur, quoted by Melier, Mem. de 1 Ac. do Med. 
 xiii. GG7. 
 
 2 Comptes de 1 Acad. des Sc. xxv. 338, 330. 
 
 3 Fodere, Medecinc Legale, v. 103; Nepple, Fiev. Intcrm. 11. 
 
 4 Becquerel, Des Climats, 2G5, 2G6. 
 
 5 Mem. de 1 Acad. de Medecine, xiii. GOT. 
 
AUTUMNAL FEVERS. 293 
 
 the marshy portion of the district, reach only to the age of twenty- 
 five. One in twenty, of all born on the hills, live to eighty ; only 
 one in fifty-two attain this age in the marshy portion. Hence, he 
 observes, the probabilities of living are highest in the most hilly 
 parts of the district, and lowest in the marshy. In the former, a 
 person aged forty has a chance of eighty to one for living a year. 
 In the marshy localities of the district, his chance is not thirty to 
 one for living a year. In the former, again, persons aged twenty, 
 thirty, and forty, have an even chance for living to forty-one, thirty- 
 three, and twenty-five years respectively ; in the latter, on the other 
 hand, persons at these ages, have an even chance of living only 
 thirty, twenty, and fifteen years. 1 
 
 The effects of malaria on population are well illustrated by the 
 results of observations made in the Pontine Marshes, where, not 
 withstanding the great ameliorations effected in their condition 
 from 1801 to 1811, the mortality has almost always exceeded the 
 births : - 
 
 Localities. 
 VELLETRI. SERRA. POPERIXO. SORINOI. Total. 
 
 Deaths . . 2,313 3,181 1,717 901 8,112 
 
 Births . . 1,786 3,338 1,601 885 7,610 
 
 Even in France, where malarial fevers are not as malignant as 
 they are in warmer latitudes, the difference is considerable. Take 
 the ten most malarial departments, and compare them with the ten 
 least so, and it will be found, in 18-16, that the former presented a 
 smaller proportion of births and a larger proportion of deaths than 
 the latter: 
 
 Ten least malarial departments. Ten most malarial departments. 
 
 Births .... 1 in 31.09 1 in 3-1.40 
 
 Deaths .... 1 in 46.61 1 in 41.08 
 
 Increase of population T J 5 T~9~4 2 
 
 Cause of fever produces an impress of greater or less strength on all 
 placed under its influence. The existence of a peculiar morbific agent 
 floating in the atmosphere of malarial localities, and differing from 
 the causes of ordinary diseases, may be inferred from the fact that 
 
 1 Annuities and Lives, ii. 29 ; ib. Letter to Dr. Horsier, on "Insalubrity of Marshy 
 Situations," Philos. Tr. of London, Ixiv. 06. See also Sir J. Sinclair, Principles of 
 Hygiene, 84. 
 
 2 Becmiercl, Tr. Elem. d Hyg. Privee et Publique, 103. 
 
294 PNEUMONIA AXD 
 
 in such localities all individuals are more or less, especially in times 
 of severe epidemics, under the influence of the cause, and, without 
 being necessarily ill, give evidence of that influence by presenting 
 in a minor form some of the symptoms of the prevailing disease. 
 By those who have noticed the progress of Asiatic Cholera, and of 
 the wide-spreading Pneumonia Typhoides which traversed this 
 country in 1812, 1813, and who have read of the sweating disease 
 of 1483-85, and of the Black Plague of the Middle Ages, it will be 
 remembered that besides the many who were attacked with those 
 complaints in full force, thousands suffered from some one or more 
 of their characteristic marks in a mitigated form. Phenomena of 
 an analogous kind result from the action of the causes giving rise to 
 remittent and intermittent fevers, yellow fever, and other affections 
 of similar nature; for, during the prevalence of epidemics of these, 
 a large number of individuals exposed suffer from slight indisposi 
 tions, and exhibit in a variety of ways the impress of the morbific 
 agent. On this subject, the facts recorded by Eush, 1 Mitchell, 2 
 Potter, 3 Archer, 4 Schnurrer, 5 Boudin, 6 Holmes, 7 Chervin, 8 Pariset, 9 
 Perlee, 10 and others, leave no doubt; and show the effect to have 
 borne on the eyes, on the secretions, on the alimentary canal, on 
 the brain and nerves, and on the blood. All this is explainable on 
 the supposition of a toxical agent floating in the atmosphere and 
 producing a morbid impress of greater or less force on all, but 
 cannot be accounted for if we refer the disease to the operation of 
 heat, cold, humidity, atmospheric vicissitudes; in a word, to any 
 known modification in the sensible qualities of the air. 
 
 Kindred phenomena, resulting from the gradual operation of 
 morbid agents, the true toxical nature of which is undeniable, are 
 matters of frequent observation, and serve to confirm the views here 
 suggested. M. Tanquerel des Planches, in his excellent work on 
 lead diseases, remarks: "Saturnine preparations, when introduced 
 into the system, indicate their presence there before the manifesta 
 tion of lead diseases by a specific action on most of the solids and 
 fluids." This action, which he denominates primitive introduc- 
 
 1 Vol. iii. 84, 85. 2 Med. and Pliilos. Register, iv. 188. 
 
 3 On Contagion, 55. 4 Med. Recorder, v. (58. 
 
 5 Matcriaux pour servir a une doctrine des epidemics, 40. 
 
 6 Fievres Interm. 188. 7 Am. J. of Med. Sci. X. S. xii. 80S. 
 8 Fievre J. d Espagne, 174. 9 Fievre J. de Barcelone, 27. 
 
 10 Philad. Med. and Physical J. iii. 12, 13. 
 
AUTUMNAL FEVERS. 295 
 
 tion, consists in, 1st, a peculiar discoloration of the teeth, and 
 lining membrane of the mouth; 2d, the saturnine smell, taste, and 
 breath ; od, the saturnine action, or yellow leaden hue of the coun 
 tenance ; -itli, the remarkable emaciation of the face. 1 
 
 The cause of autumnal fevers produce an impress on the lower order 
 of animals and on vegetables. The cause giving rise to the febrile 
 affections, which are usually referred to some one or other of the 
 modifications of malaria, extends its influence to the lower orders of 
 the animal creation, and even to vegetables. In this and other cities 
 of the United States epidemics of malignant fever have often been 
 ushered in and accompanied by sickness among cats, dogs, hogs, 
 &c. 2 Similar observations have been made elsewhere the symptoms 
 being often analogous to those of the reigning disease, 3 while epi 
 demic seasons have often been found marked by a great predomi 
 nance of insect life. The coincidence of blight with pestilence has 
 been recorded from ancient times. M. Dupuy has seen a number 
 of oxen perish with symptoms perfectly analogous to those of inter 
 mittent fever, after having pastured in a highly marshy locality. 
 In 1826, after the overflow of the Eiver Manse, an intermittent epi 
 demic broke out among horses, and occasioned a considerable mor 
 tality. Lancisi relates that, in 1713, during the prevalence of 
 intermittent fevers, an epizooty carried off thirty thousand oxen." 4 
 It should be added, also, that marshes occasion, among many ani 
 mals, " a chronic endemy, perfectly analogous to that produced in 
 the human species. The prolonged sojourn and pasturage of sheep 
 in marshy localities produce in them the hydroosmia, a disease cha 
 racterized by a diminution in the proportion of the blood-globules, 
 as also by a notable one in the quantity of the serum, and which, 
 
 1 Sec also Adams s R.ept. in Trans, of Am. Mod. Assoc. v. 171, 172. 
 
 2 Med. Repos. i. 250, 254,5, 351; Smith (E. H.) Fev. of N. Y. 76; Cakhvell, 133, 
 109 ; ib. fever of 1805, pp. 40, 61 ; Condie and Fohvell, 15 ; Rush, iv. 8; Shccut, 77 ; 
 Yanghan, 18 ; Cartwright, Recorder, ix. 7 ; Baxter s Med. Repos. xxi. 6, 7 ; Chap 
 man, Med. and Phy. J. ix. 395, ; Kilpatrick, N. 0. J. ii. 43; Seaman Webster s Col 
 lection, 3 ; Thouvenelie, iv. 200-202. 
 
 3 Smith, Edinb. J. xxxv. 36; Maclean on Epid. i. 289; Sir J. Fellows, 45, 236; 
 Cycl. of Tract. Med. ii. 74; Pariset, 67-69; Osborri, 70; Pinckard, i. 138; Des- 
 portes, i. 17; Arojula, 286, 331; Ralph, Ed. Med.-Chir. Tr. ii. 58; O Halloran, 26; 
 Melier, loc. cit. 669; Rep t on Quarantine, London, 13; Second Rep. 39, 865; Mo- 
 reaii do Jonnes, 112; King s Rep t on Fever of Boa Vista, 9; Blair, 63; Boudin, 
 Fiev. Int. 135; Monfalcon, 502. 
 
 4 Laucisi, De Boville Peste, 2, &c. 
 
296 PNEUMONIA AND 
 
 consequently, is analogous to the paludal cacliexia of men." M. 
 Gasparin reproduced this disease in sheep by causing them to drink 
 and to be rubbed with the condensed vapour obtained from marshy 
 surfaces. l 
 
 Mr. Chad wick informs us that in the course of the inquiries as to 
 what has been the effect of drainage upon health, one frequent 
 piece of information received has been, that the rural population 
 has not observed the effects on their own health, but they have 
 marked the effects of drainage on the health and improvement of 
 the stock. Thus, the less frequent losses of stock from epidemics 
 are beginning to be perceived as accompanying the benefits of 
 drainage, in addition to those of increased vegetable production. 2 
 
 The General Board of Health of London, in their Report on the 
 practical application of sewer-water and town manures, already re 
 ferred to, remark that the injurious effects upon health, of the pro 
 longed retention of excessive moisture on a surface of vegetable 
 mould, is established by the production of rot amongst sheep an 
 effect which sheep-feeders have produced by stocking closes just 
 after they had been flooded, and whilst they were saturated with 
 moisture. 3 
 
 In his examination before the Metropolitan Sanitary Commis 
 sioners, already referred to in a former chapter, Mr. Smith, after 
 speaking of the beneficial effects of draining on the healthiness of 
 malarious localities, remarks that it is generally observed by the 
 inhabitants, that their cattle or stock are now less subject to dis 
 eases. In a farm in the west of Perthshire, the cattle were very 
 subject to the disease called "red .water;" since the draining, there 
 has been no case of that disease. In other parts of Scotland and 
 England, similar results are stated to have followed the introduction 
 of thorough drainage. 
 
 Mr. Parker stated that the disease of foothalt in sheep and deer 
 has been perfectly removed in many gentlemen s parks, and in ex 
 tensive pasturage grounds, by deep under drainage. 
 
 " In the Highlands," Mr. Spooner remarked, " and more particu 
 larly on the west coast, there exists a well known and fatal disease 
 among slice}), incurable by any treatment, termed Braxey/ which 
 on undrained land, and in wet seasons, is a cause of very serious 
 
 1 Becquerel, Hydene, 18:1, 194, 105. 
 
 2 Second llep t of Commissioners of Inq. into the State of Large Towns. 
 
 3 P. 9, London, 1852. 
 
AUTUMNAL FEVERS. 297 
 
 losses. This is, in a great measure, prevented by drainage, and the 
 diminution of casualties alone is more than sufficient to cover its 
 cost, independently of the increased quantity and better quality of 
 the fodder produced. This system has been extensively practised 
 for several years, and invariably with the same beneficial results. 
 As to the health of cattle or stock," he added, " I have the strongest 
 evidence of the beneficial effects of drainage in many instances. On 
 the lands which I possess, and on several others in the district, a dis 
 ease called red water prevailed, in some years proving very fatal ; 
 but after drainage and cultivation of the marshy parts of the pas 
 turage the stock has been free of that disease. The surface drain 
 age of sheepwalks in every district is well known to promote the 
 healthiness of the stock, and I believe the thorough drainage of a 
 single swamp in any locality will be an important means of im 
 proving the health, both of the population and stock connected 
 with it." 1 
 
 In farther corroboration of this, it may be remarked that it has 
 been found in this country that those animals that feed in marshes 
 where periodic fevers prevail, have diseased viscera. We are told 
 by Dr. Ludlow, that in the town of Wolcott, Seneca County, N. Y., 
 where marshes and lowlands abound, the hogs, when killed, are 
 generally found to have eroded livers. 2 
 
 The history of the Oriental plague furnishes striking examples 
 of the influence of the morbid cause on the lower order of ani 
 mals. 3 It has been noticed from the earliest period ; is mentioned 
 by poets 4 and historians, 5 and recorded in holy writ. 6 
 
 It is certain, also, " that seasons which are unusually sickly to 
 large classes of human beings, are often alike unfriendly to the 
 health and fruitfulness of many classes of plants." 7 Fodere, in 
 speaking of the Marshes of Brcsse, in France, remarks that animals 
 
 1 Drainage of the Land forming the Sites of Towns, G9, 70. London, 1852. 
 
 2 New York Med. and Phys. Jo urn. ii. 88. 
 
 3 Hippocrates; Santi Romeo Ricerehe Sulla Peste Borbonica; Diego Picollo, de 
 scription de la Peste de Mission, chap. 2, 328; Aubert and Etienne, cited by Clot- 
 13ey, 2-57 ; Thos. Leslie Greyson, Rep. of Quarantine, 14 ; Schiller, 257 ; Short, 
 Chron. Hist, of the Weather and Dis. of Lond. 338; Hancock, 101. 
 
 4 Homer, Iliad, book i. G7, 70; Lucretius, lib. vi. 1117 ; Ovid, lib. vii. 523. 
 
 5 Thu; ydides, xi. 52 ; Livy, 3, 6, 571 ; Dionysius, lib. xx. 
 
 6 Exodus, vii. 7; xvii. 18; viii. 17: ix. 15. 
 
 7 11 iiiirt on Quarantine (London). 14; see also Chapman on Epid. Med. and Phys. 
 Jouru. vii. 250; Rush, 50; Cahhvell, 133; Coudic and Fohvell, 13; Thouvenel, 200. 
 
298 PNEUMONIA AND 
 
 and plants are there of a small and feeble complexion, stunted in 
 appearance, and endowed with a small degree of vital force; and 
 Boudin, who refers to this fact, states that he has seen plants which 
 were transplanted in marshy localities deteriorate rapidly, and re 
 turn to their normal state as soon as they were removed beyond 
 reach of the paludal influence. 1 
 
 The great diffusion and mortality of autumnal fevers is explained only 
 on the supposition of the cause being a gaseous poison. To no other than 
 a truly toxical agent, suspended in or mixed with the atmospheric 
 air, can we refer diseases which affect in a similar way, and such 
 rapid succession, so large a number of individuals, and occasion 
 often so extensive a mortality. No modification in the sensible 
 qualities of the air of a given locality ; no atmospheric vicissitude, 
 however frequent and extensive, has been known to produce such 
 effects. A single regiment, in Africa, with an effective force of 
 seventeen hundred men, sent, in the short space of six weeks, one 
 thousand and fifty to the hospital, and mostly for intermittent and 
 remittent fever. In 1830, the whole of another regiment was sent 
 to the hospital. In the same year (1830), the number of admissions 
 in the Hospital of Buff arick amounted to 2,386; and of these 1,491 
 were affected with intermittents. 2 According to Dr. Maillot, 22,330 
 cases were admitted in the Hospital of Bone, from the 16th of 
 April, 1832, to the 16th of March, 1835. Of these, 2,513 died. 3 
 So common is ague in many parts of Spain and Portugal, says Sir 
 James Macgrigor, 4 " that the inhabitants do not term it a disease." 
 Facts will bear Dr. Williams out in the remark, that the invasion 
 of the Burmese and of the African empires has, in each instance, 
 been so disastrous to the troops, that the whole force must have 
 perished from this class of diseases, in a few months, but for the 
 success of their arms in the one instance, or their being withdrawn 
 from the pestilent atmosphere in the other. 5 The British forces in 
 the Islands of Zealand, amounted, on the 25th of August, 1809, to 
 41,642 men, and 1,879 commissioned officers. Between the 21st of 
 August and 18th of November, the number of sick, almost exclu 
 sively from fever, amounted to 26,846, including relapses. 6 
 
 1 Fievres Interm. 108. 
 
 2 Gouraud. Fiev. Interm. 2 .0. 3 Fiev. Inform. 27<>. 
 
 4 Med.-Chir. Trans, vi. 41 o. 5 Morbid Poisons, ii. 4">7. 
 
 6 lil:ii)p. Dissert, i. 2 2ii, 227 : sec also Marshall, Edin. J. xlviii. 308, 30<. 
 
 The (]j. sense betrau to show itself between the loth and 20th ol August. OH the 
 
AUTUMNAL FEVERS. 299 
 
 Dr. Wind, who translated into Dutch Dr. Lind s essay on pre 
 serving the health of seamen, and who practised medicine in Wal- 
 cheren for many years, informs us that the Scotch regiment in the 
 Dutch service has been known to bury its whole numbers at 
 Sluys, in Dutch Flanders, in three years. We learn from the 
 reports of Dr. Borland and his coadjutors that, upon an examina 
 tion of the sick returns of the French army for a period of seven 
 years, it was found that at least one-third, or 33 per cent, of its 
 force was annually cut off by endemic diseases. I may add that, 
 when the English landed in Walcheren, there were only eighty-five 
 men alive in a Dutch regiment, which, at its arrival there, three years 
 before, was 800 strong. The annual ratio of mortality of this corps 
 must have been about 31 per cent., or rather more than double the 
 mean ratio of mortality which occurs among troops in Jamaica. 
 Napoleon seems to have known pretty well the real nature of the 
 climate of the Delta of the Scheldt, and of its influence upon 
 strangers; for, in a letter to the Minister of War, in regard to the 
 Walchereii expedition, he says : " We are rejoiced to see that the 
 English themselves are in the morasses of Zealand. Let them be 
 only kept in check, and the bad air and fevers peculiar to the cli 
 mate will soon destroy their army." The French, it is said, crowed 
 over the expedition with the force of reason, the bitterness of sar 
 casm, and the playfulness of ridicule. 1 
 
 Some fifty years before, Sir John Pringle, in tracing the influence 
 of paludal exhalations on the British troops in Flanders, during the 
 campaign of 1748, stated that they had scarcely been a month in 
 the cantonment, when the return of the sick amounted to 2,000. 
 One regiment, the Greys, cantoned in Yucht, a village surrounded 
 with meadows, either then under water or but lately drained, were 
 the most sickly. At the end of live weeks they returned about 
 150; after two months, 260, which was one-half of their number; 
 and, at the end of the campaign, they had in all but thirty men 
 who had never been ill. Another regiment, at Nieuland, where the 
 
 29th, the number of sick amounted to little less than 3,000 men. On the 30th, 200 
 of the artillery, 130 of the 3Gth, 300 of the 20th, 2-50 of the 71st, 200 of the 84th, and 
 the whole of the 23d, with the exception of about forty, were in the hospitals. Early 
 in September, there Avere upwards of 7,000 on the sick list. On the 14th, it was esti 
 mated that, of 15,000 in Walcheren, 10,000 were actually sick. Of one regiment 
 alone, the 38th, the sick return was 11 officers and 459 men. Davis, A Scientific and 
 Popular View of the Fever of Walcheren, 9, 12, 14, &c. 
 
 1 Marshall, Statistics of the Walcheren Expedition, Edin. J. xlviii. 313. 
 
300 PNEUMONIA AND 
 
 meadows had been floated all winter, and were but just drained, 
 returned sometimes above one-half of their number. Another, 
 again, the Scotch Fusiliers, at Dinther, had above three hundred ill 
 at one time. 1 The same distinguished writer informs us that when 
 four battalions of British troops, which had been employed in 
 Zealand during the year 1747, went into winter-cparters, their sick, 
 in proportion to the men fit for duty, were nearly as four to one, 
 which is equal to 800 per 1000. 2 
 
 At Fort Charlotte, in the rear of the town of Nassau, Bahamas, 
 nearly the whole of the 47th Eegiment, including women and chil 
 dren, were swept off within a short time. In 1802, 220 out of 300 
 perished. Of seventy men, sent there in 1818, forty died in six 
 months; besides thirteen women and children out of thirty-seven. 3 
 In relation to the sickness in Jamaica, Dr. Hunter states that four 
 regiments were sent from England in 1780. They arrived on the 
 first of August. Less than six months after, one-half of them 
 nearly were dead, and a considerable part of the remainder unfit 
 for service. 4 
 
 At the period of the English fleet anchoring in the Rangoon Eiver, 
 on the 10th of May, the troops mustered between 5,000 and 6,000 
 men. By the end of June, fever had so diminished the number, 
 that, even after reinforcements, scarcely 3,000 troops were left to 
 guard the lines. 5 Of the effects of exposure to the African coast, 
 the results of the Niger expedition w^ill testify. On that occasion 
 three vessels entered the river the Albert, the Wilberforce, and 
 the Soudam; the first with 62 white men aboard, including officers; 
 the second with 56, and the last with 27. The Albert remained 64 
 days in the river ; the Wilberforce 45 days, and the Soudam 40. 
 In that short space of time, the number of fever cases in the three 
 vessels, with a total force of 145 whites, amounted to 130, or one 
 in 1.12 ; and that of deaths to 40, or one in 3.6. 6 
 
 At Sierra Leone, an aggregate strength, in eighteen years, of 
 1,843 white soldiers furnished not less than 2,600 cases, being in 
 the annual ratio of 1.411 per 1,000 of mean strength; while the 
 mortality amounted during that time to 410.2 per 1,000. 7 In the 
 
 1 Dis. of the Army, 50, 59. 2 Pringle, Go, CO. 
 
 3 Second Report on Quarantine, 50. 4 P. 11. 5 Williams, ii. 457. 
 
 6 McWillhims, Mod. Ace. of the Expedition of the Ni<:er, 120-128. 
 
 7 Tuilock, Kept, of Sickness, Mortality, &c., among Troops on the West Coast of 
 Africa, 8. 
 
AUTUMNAL FEVERS. 301 
 
 Cape Coast command, the aggregate strength, in four years, being 
 630, the number of cases of remittent fever alone did not fall short 
 of 500, with an annual mortality, from the whole class, of 382.6 per 
 1,000 of mean strength. 1 In a preceding part of this volume, atten 
 tion was called to the fact that in the Jamaica command, with an 
 aggregate force, in twenty years (1817-1836), of 51,567 men, the 
 number of cases of malarial fevers amounted to 46,922, being in the 
 proportion of 910 per 1,000 of the mean strength. In the wind 
 ward and leeward commands, an aggregate strength of 86,661 gave, 
 during the same period, no less than 62,168 cases, or 717 per 1,000. 
 Honduras, where the aggregate strength of the white soldiers, in 
 fifteen years, did not exceed 320 men, there were 221 cases of fever, 
 or 690.6 per 1,000. 2 
 
 A detachment of the 98th Regiment, quartered on a height in 
 Happy Valley (Hong-Kong, China), experienced a mortality, within 
 six months, amounting to 25 per cent. In a locality called West 
 Point, at least one-half of the whole force is supposed to have been 
 lost by death or invaliding. In the summer of 18-13, the fever was 
 so fatal, in some parts of Hong-Kong, that it cut off 100 from a 
 total of 300 civilians residing upon the island. 3 
 
 In this city, during the memorable epidemic of 1793, when the 
 population fell short of 50,000, the number of cases may be esti 
 mated to have amounted to little less than 11,000, or 200 per 1,000; 
 with a mortality of about 3,500, or 70 per 1,000 of the population. 
 
 New Orleans, in 1847, contained a population estimated at 
 109,000. Of these, 20,000, or 184.31 per 1,000, suffered from the 
 yellow fever. Two thousand eight hundred and eleven cases were 
 reported, and of these 895 died. The population of "Woodville 
 (Miss.) amounted, in 1845, to 800. Of this number, 595 passed 
 through the disease in one or other of its various forms ; being in 
 the proportion of 74.4 per cent. It is to be borne in mind that 200 
 of the inhabitants left the village early, so that disease, in fact, bore 
 on a population of 600, and therefore attacked them in the propor 
 tion of 99.17 per cent. The population of Cadiz, in 1800, is stated 
 to have been 71,491. Of these, 48,520 were attacked with the 
 reigning epidemic; being in the proportion of 678.7 per 1,000. In 
 
 1 ibid. 20. 
 
 2 Ib. Sickness and Mortality of Troops in West Indies, 7, 44, 45, 77. 
 
 3 Bnrton, Fever of Hong-Kong, Dublin J. No. 24, p. 440, 441, N. S. 
 
302 PNEUMONIA AND 
 
 1819, the results were scarcely different. In Seville, in 1800, the 
 proportion was larger still; the population being 80,568, the 
 number of cases 76,488, or 919.4: per 1,000, and the deaths 11,685. 
 In Alicant, in 1801, out of a population of 13,000, 9,000, or 692.4 
 per 1,000 had the disease, and 2,172 died. 1 As I am writing these 
 lines (November 21), the melancholy accounts received from New 
 Orleans, exhibit a mortality there, this year, from yellow fever, of 
 40 in June, 1,406 in July, 5,189 in August, 1,070 in September, 
 and 139 from the 1st to the 22d of October, making a total, with 
 three in May, of 7,847. 
 
 During an epidemic of pernicious or malignant intermittent fever, 
 which occurred in Bordeaux in 1805, and is ably described by Dr. 
 Contanceaux, it is estimated that twelve thousand individuals 
 passed through the disease, and that one-fourth of these died. 2 
 The fever which swept over the Coromandel in 1809, 1810, and 
 1811, caused the loss of 106,789 out of a population of 1,828,610. 
 Coimbatore lost in sixteen months 22,451 out of 596,606; Madura, 
 in twelve months, lost 24,626 out of 245,654; Dendigul, in the 
 same space of time, had 21,510 deaths in 29,654 individuals: while 
 at Tinnivelly, the mortality, in the short space of five months, 
 exceeded 38,000 in a population of 690,696. 3 
 
 "It is remarkable," says Lind, "that, in the war which terminated 
 in. 1763, the English ships of war which touched at Batavia, suffered 
 more by the disease of that climate, than they did in any other part 
 of India, if we except a malignant scurvy which once raged in the 
 fleet at sea. Soon after the capture of Manilla, the Falmouth, a ship 
 of fifty guns, went to Batavia, where she remained from the latter 
 end of July to the latter end of January, during which time she buried 
 seventy-five of her crew and one hundred soldiers of the 70th Regi 
 ment, who were embarked on board of her, not one person in the 
 ship having escaped a fit of sickness, except her commander, Captain 
 Brereton. The Panther, a ship of sixty guns, was there in the years 
 1762 and 1764, both times, unhappily, during the rainy season. In 
 the year 1762, she buried seventy of her men, and had ninety-two 
 very ill Avhen she left the place. In the year 1764, during a short 
 
 1 Sec an Essay on the Mortality of Yellow Fever, by the present writer, Charleston 
 Mod. J. vii. 403. 
 
 2 Notice sur les Fievres Pernicieuses qui ont regn6 a Bordeaux, en 1 805. 
 
 3 Mod., Geog., and Agricult. Hep. on Fever of Coimbatore, c., by Ainslie, Smith, 
 and Christy, Lond. 1810, p. 98, &c. 
 
AUTUMNAL FEVERS. 303 
 
 stay, she buried twenty-five of her men. The Medway, which was 
 there in company with her, lost also a great number of her men." 
 The fever was of the remitting kind. 1 
 
 In addition to the facts already adduced, the attention of the 
 reader might be called to the wide diffusion and excessive mortality 
 noted during some epidemics of glandular plague. lie might be 
 reminded that, in London, in 1625, it carried off not less than 
 35,417 individuals, according to Grant, 2 and 46,000, according to 
 the calculation of Short ; 3 that, in the same city, the mortality, forty 
 years after (1665^, amounted to 97,000, 4 in a population of less than 
 500,000; that, in 1812, the loss at Constantinople amounted to 
 159, 534 ; 5 and that in Lyons, in 1628, 29, in a population of some 
 200,000 ; 6 fifty thousand persons were destroyed by the same disease. 
 They might also be told that, at Montpellier, the number of deaths 
 in 1629 fell but little short of one-half of the inhabitants who had 
 not left the city; 7 that, in Marseilles, the loss from the memorable 
 pestilence of 1720, amounted to forty thousand ; 8 that at 2s~oja, in 
 1815-16, the number of cases in a population of 5,300 reached 
 1,474, and the deaths 716 ; 9 that at Cyprus, in 1760, the disease de 
 stroyed 70,000, out of a population of 600,000 ; 10 again, that at 
 Aleppo, the population of which amounted to some 60,000, it car 
 ried off in two years (1761, 62)about 21,800, n and that, in 1835, the 
 loss in Cairo was little short of 26,000." 12 These and other instances 
 of like import, might be specially adduced for the object under 
 present consideration ; but as the question of the malarial origin 
 of the Oriental plague continues to this day to be a subject of 
 
 1 Hot Climates, 102, 103. Chisliolm states that, in the year 1795, the Majestic, 74. 
 Admiral Sir John Latbrey s ship, while shut up, during the hurricane months, within 
 a little landlocked bay, situate in the great bay of Fort Royal, Martinico, called Les 
 Irois ihts benits, and not inappropriately named, by the French, Goujfre de la Mort, lost 
 in seven weeks one hundred and eighty-nine men. During the same months of 1796, 
 Admiral Harvey s ship, the Prince of Wales, lay at the same place, and lost ninety- 
 seven men. (Manual of the Climate, &c. of Tropical Countries, 20.) 
 
 2 Natural and Political Observations, &c. made upon the Bills of Mortality, 8. 
 
 3 New Obs. on Bills of Mortality, 274. 
 
 4 Short, op. cit. 292 ; Marshall, Stat. and Mortality of the Metropolis, GO. 
 
 5 Braver, Neuf. Annees a Constantinople, ii. 248. 
 
 6 Papon, De la Peste, Ou les Epoques Memorables de ce Fleau, i. 184. 
 
 7 II. 195. s Ib. 343. 
 9 Moreo, Storia della Peste de Noja, 25 ; Tavola, 3. 
 
 w Russell on the Plague, 8. Ib. 
 
 12 Boudin (from Gaetani Bey), Geogr. Med. 14. 
 
304 PNEUMONIA AND 
 
 doubt amon " those most conversant with the disease, I shall not 
 
 o 
 
 insist upon them here. 
 
 Let this be, however, as it may, the facts already mentioned, no 
 less than the circumstance that, in times of violent epidemics, the 
 early cases, very generally, prove fatal, are with difficulty explained 
 on the supposition of those diseases resulting from the action of 
 any other cause than a morbid poison diffused in the atmosphere of 
 infected localities. Under no circumstances have diseases, undeni 
 ably produced by mere changes in the sensible qualities of the air, 
 been found to spread so widely, to occasion so extensive a mor 
 tality, and to assume so usually a more malignant and fatal charac 
 ter at the outset of their prevalence. 
 
 Autumnal fevers under the influence of various exciting causes. In 
 dividuals exposed to the atmosphere of paludal localities in sickly 
 seasons, or residing in cities visited by malignant and other fevers, 
 become affected with the disease therein prevailing from the opera 
 tion of a variety of exciting causes. Insolation, exposure to rain, 
 or to a current of cold air, a fit of intemperance, or the free use of 
 stimulating drinks, excessive fatigue, irregularity of diet, a blow, 
 a fall, a surgical operation, the loss of blood, a moral affection, an 
 inter current complaint, c. &c. will bring on an attack of the pre 
 vailing fever. It cannot be presumed that all these morbid influ 
 ences, differing as they do so materially from each other, are capa 
 ble of producing, unaided by some more efficient and special cause, 
 one and the same disease. Hence, their agency must be limited to 
 the placing suddenly the system, by the disturbance or shock they 
 therein occasion, in a condition required to enable it to be mor 
 bidly affected by a cause of a more general character, producing an 
 impression on all exposed to it, and occasioning, when it meets sub 
 jects suitably predisposed, a particular and specific set of morbid 
 phenomena similar in all that are attacked. We know of no dis 
 eases, except those owing their origin to the action of morbid poi 
 sons, that can thus be brought out by perturbating agencies of the 
 kind mentioned; and the fact of the circumstance being observed in 
 regard to intermittent and other fevers of like nature, lends a strong- 
 support to the opinion that the cause which gives rise to them 
 consists in a poison of the sort floating in the air of the sickly 
 locality. 
 
AUTUMNAL FEVEKS. 305 
 
 The malarial origin of such fevers confirmed by tJie violent manner 
 the cause often, acts. I might enlarge, in addition, on the circum 
 stance that the efficient cause of fever approximates in nature to all 
 morbid poisons by the suddenly violent and disorganizing effects it 
 produces in the system; for though, when applied in a lesser force 
 and in a gradual manner, it will give rise, as we have seen, to 
 derangements of the viscera, and consequent ill health, without, 
 however, exciting the usual symptoms of marked febrile affections; 
 though, in other instances, the application of the cause occasions 
 fevers of a comparatively mild character, running their course in 
 a few days, yet in some instances death rapidly or even suddenly 
 follows exposure to sources of infection ; so rapidly, indeed, that 
 dissection reveals no traces of structural lesion. In all epidemics 
 of yellow fever, while the duration of the disease extends generally 
 to the third, fifth, or seventh days, and in some few instances much 
 beyond, cases occur 1 in which it closes fatally in twenty -four, or 
 even in a very few hours, without leaving any posthumous sign of 
 local determination. Results not very different are observed in 
 that form of malarial disease which has received the name of con 
 gestive fever as well as in malignant or pernicious intermittents. 
 The system, in such cases, is at once prostrated, and the patient 
 sinks without having manifested the least sign of a healthful reac 
 tion. In no diseases, but those originating from the action of mor 
 bid poisons, do we meet with occurrences of the kind. 
 
 The cause of fever extends its action to the foetus in utero. I might 
 also refer as illustrative of the true toxical character of the efficient 
 cause of fevers of its analogy to other morbid poisons, and to 
 the fact of its producing, like these, its deleterious impression 
 through the blood, and consequently of its power of solution : that 
 it is known to affect the foetus in utero, and the infant at the breast. 
 Need I remark, that cases are on record to show that the smallpox 
 has been transmitted from the mother to her unborn offspring ; 
 children coining into the world with well-characterized pustules 
 
 1 Hush, iv. 13: Dcve /.c, 28; Cakhvell, 85-87; Lining, ii. 426; Manson. 181; 
 Baxter, llepos. xxi. 3; Grus. 13; Dickson, Chapman, J. iii. 256; Thomas, 8!) ; Ber- 
 thc, 70 ; Arejula, 10] ; Jackson, Fever of Spain, 45 ; Pym, 60 ; Palloni, G ; Kochoux, 
 510, 508; Warren, Fever of Barbadoes, 10; Gilbert, CO, 73; Bally, 272; Caillot, 
 22, 23; CliKsholm, i. 104; Aloseley, 440: Imray, Ed. J. liii. 82; Bancroft, 35; Wil 
 son. 7. 
 
 20 
 
306 PNEUMONIA AND 
 
 over the surface of the body? If the reader doubts it, let him open 
 the works of Jenner, Gregory, 1 Andry, 2 Gardien, 3 Desormeau, 4 
 Mauriceau, 5 Dimdale, and other writers of easy access, and he will 
 find instances of this transmission stated by high and reliable 
 authorities. He will find that Mauriceau, whose celebrity as an 
 obstetrician is known to all, was himself born bearing the charac 
 teristic marks of that disease. He will find, besides, that cases are 
 recorded in which those well-known marks were found on infants 
 whose mothers were not affected. 7 He will even find but for 
 the authenticity of the fact I will not hold myself responsible 
 that a Swedish woman having been vaccinated nine days before 
 her accouchement, the child, at its birth, bore on the arms, and on 
 the same spots as the mother, regular vaccine pustules. 8 Extending 
 his inquiries to other complaints, he will find that measles, scarla 
 tina, syphilis, 9 and pellagra 10 are reported to have been thus trans 
 mitted. While such is the case with these diseases, we have the 
 testimony of Kussell, and others, to the effect that a similar occur 
 rence has sometimes taken place in relation to tertian and other 
 malarial fevers. By more than one author cases are mentioned 
 and one of the kind fell under the notice of the present writer, 
 in which some of the symptoms of yellow fever were transmitted 
 in this way, from the mother to the unborn babe. 
 
 Dr. Ludlow, in his observations on the lake fevers in the Genesee 
 country, 11 relates the following case : 
 
 " Mrs. K. had fever and ague at two different times. During the 
 last stage of her last pregnancy intermittents were very prevalent. 
 Having for several days suffered some of the precursory symptoms, 
 she was, on Sunday afternoon, attacked with a severe paroxysm. 
 Every stage of it was regular and distinct, the paroxysm terminating 
 in diaphoresis. On Monday morning she was delivered of a boy, 
 apparently at the full time. On Monday afternoon, at about the 
 
 1 Cyclop, of Pract. Med. iii. 
 
 2 Maladies du Foetus, Journal des Progress des Sc. Med. N. S. i. 142. 
 
 3 Traite des Accouchemens, 352. 4 Diet, de Med. xv. 
 
 5 Obscrv. sur la Grossesse, &c. ii. 493; Obs. D. C. 
 
 6 Treatise on Smallpox, 279. 
 
 7 Bousquet, Traite de la Vaccine, 107; Fodere, Med. Legale, v. 397; Jenuer, Jour 
 nal des Progres, i. 142-6; Deneux, cited by Anglada, Traite de la Contagion, i. 81. 
 
 8 Journal des Progres, xv. 246. 9 Journal des Progres, i. X. 8. I 42, 170. 
 10 Roussel, Traite de la Pellagre. n New York Med. and Pliys. J. ii. 94, 95. 
 
AUTUMNAL FEVERS. 307 
 
 same time of day at which the Sunday s paroxysm had occurred, 
 the child was attacked; the cold stage was severe and long; the 
 skin being livid, and the child was thought to be dying. This was 
 followed by the hot stage, and, in due time, by diaphoresis. The 
 paroxysms continued to recur daily for about a fortnight, when 
 small doses of Peruvian bark were given. The disease soon ceased; 
 but, in about a week, the child had two fits more, when the bark 
 again arrested it. The child is now more than two years old, is fat 
 and healthy, arid has had no more attacks of the fever. The disease 
 did not recur in the mother after delivery. Both still reside in the 
 same house, which is on aguish ground." 
 
 Dr. Ludlow properly remarks, that this case -as others he re 
 lates very satisfactorily proves that the disease is sometimes con 
 genital. It is " remarkable for the regular transfer of the disease 
 from the mother (in whom the susceptibility had been worn out) 
 to the child, who, like others who had never had the disease, was 
 perfectly susceptible of it." The child was affected too soon after 
 birth to justify our believing he did not carry in him the seeds of 
 the disease. Dr. Stokes relates the case of a woman, pregnant and 
 labouring under tertian fever, who felt the child to have convulsive 
 fits on days of pyrexia. 
 
 Bond in, to whom reference has so often been made, states that 
 he has several times had occasion to notice the transmission of the 
 disease in question, from -nurses to infants at the breast, as manifested 
 by paroxysms of fever, and other limnhenic symptoms. " In proof," 
 he adds : " I will add that the infants in question were not under 
 the influence of a primitive intoxication, caught by them in a focus 
 of paludal exhalation, and that my observations were made at the 
 Lazaretto of Marseilles, where malarial fevers, unless imported, are 
 never encountered. Doubtless the most curious fact of transmis 
 sion I have met with, is the following: The wife of a soldier, 
 recently arrived from Africa, and enjoying good health, undertook 
 to nurse the child of an inhabitant of Toulon. On the third day, 
 the child was attacked with a malarial fever, which was only cured 
 by the sulphate of quinia." 1 In this respect, paludal fevers are on 
 a footing with syphilis, the mercurial disease, &c., all of which are 
 transmissible from a healthy nurse to the infant at the breast. 
 That typhoid fever has been found to be so conveyed, is proved 
 
 1 Fievre Interm. 103, 194. 
 
308 PNEUMONIA AND 
 
 by the ulcerations discovered in the intestines of the child. 1 The 
 same has been reported in reference to dysentery. 2 
 
 The cause of autumnal fever appears to lie neutralized by the poison 
 of some zymotic diseases which have no effect on common complaints. 
 Attention might be called also to and much said on the fact 
 observed in Sweden and other parts of Europe, 3 that intermittent 
 fevers disappeared for several years, after the great epidemic of 
 cholera, from their usual habitats ; that the observation was made 
 not only in places that had been visited by cholera, but likewise in 
 localities where that disease had never appeared ; and that, after the 
 decline of the former, fevers again made their appearance, but in a 
 less malignant form facts which cannot be readily explained, ex 
 cept on the supposition of the cause of fevers being of the nature 
 contended for, and of its being destroyed or neutralized by the one 
 giving rise to cholera. 
 
 It is also to be borne in mind, that mephitic exhalations would 
 appear to have the power of imparting protection to those accus 
 tomed to them against malarial diseases, as also against those arising 
 from peculiar meteorations. It was remarked at Paris, that indi 
 viduals employed or living in the immediate vicinity of the exten 
 sive knackery of Monfaucon, did not suffer, to any serious extent, 
 from the cholera, which almost decimated the other districts of that 
 city. In some parts of England, the men whose business it was 
 to attend to the drains were in like manner almost entirely exempt 
 from that disease. 4 Kaymond, nearly a century ago, had made 
 similar observations in regard to other zymotic complaints. " I no 
 tice," he says, "that workmen employed at inferior (sordides) trades, 
 and in factories filled with vapours, such as starch-makers, tanners, 
 buckskin-makers, &c., are less subject to popular diseases. This 
 observation reminds us of one recorded by Cole de Ballon a, that 
 during the fatal plague of the year 1348, individuals working at 
 filthy trades escaped the contagion." 5 The reader cannot have for 
 gotten that during the fatal epidemic of yellow fever which visited 
 the city of Philadelphia, in 1793, it was observed by Dr. Rush, 6 that 
 
 1 Boudin, 190; Roederer and Wagler, 163. 
 
 2 Zimmerman, Traite de la Dys. 28; ,T. Frank, Prax. Med. ; Watson, 440. 
 
 3 British and Foreign Med.-Chir. Rev. x. 375. 
 
 4 First Report of Commissioners on the State of Large Towns, 100, 104. 
 
 5 Mem. de la Soc. Roy. de Med. iv. 77. 6 Works, iii. 83. 
 
AUTUMNAL FEVERS. 309 
 
 the scavengers suffered much less than others differently employed. 
 Similar statements are made by Caillot. 1 Ambrose Pare remarks 
 that during the epidemic fever which prevailed at Paris in 1565, 
 tanners and curriers were in great measure exempt. It may be 
 remarked in addition that at Eome the section appropriated to the 
 Jews, the Ghetto where the precepts of public hygiene are sadly 
 neglected, and where of course filth abounds is not entirely but 
 comparatively free from the periodic fevers which afflict severely 
 other and cleaner parts of the city. 2 
 
 It is from a consideration of these facts, and from having observed 
 that in some localities in Mexico and other parts of America, indi 
 viduals inhabiting filthy districts suffer less from yellow fever than 
 those who live in cleanlier ones, that a physician of our country 
 maintained that what have heretofore been regarded as sources of 
 infection are, on the contrary, conducive to health. Without stop 
 ping to inquire whether the exemption alluded to is not the effect 
 of acclimatization or habit on the part of those who are supposed 
 to have reaped advantage from the nastiness in question; and, 
 without arguing the point, whether it would be beneficial or safe 
 to allow such filth to remain undisturbed with a view to counteract 
 the baneful effect of the febrile poison, I may remark that the 
 theory, and the practice founded upon it, are not new, as may be seen 
 in the following passage I transcribe from Lancisi : 3 " Some have 
 entertained a notion that the effluvia of corrupted substances and 
 marshy waters had no manner of noxious operation, because they 
 have read that these very agents were sometimes considered as 
 remedies in some pestilential seasons. Thus, Alexander Benedictus 
 relates that he had heard from a merchant of Candia, that all the 
 dogs were killed during the prevalence of a violent plague, and by 
 order of the physicians thrown about the streets. The air was soon 
 filled with their corrupting exhalations, and their remedial operation 
 immediately restored the place to health. The Sarmatians were ac 
 customed to employ the same means. Yery near akin to this story 
 is another, related by George Pictorius, who heard a man from 
 Utopia (!) affirm that, in an epidemic plague, nothing was more 
 wholesome and excellent than, three times a day, to snuff up the 
 
 1 Op. dt. 123. 
 
 2 Tournon, Etudes sur Rome, ii. ; Carriere, Le Cliinat de 1 Italie, 373; Valentin, 
 Voy. Med. en Italic, 100. 
 
 3 Do Xox Palud. Effl. lib. i. cap. iv. 11, 12. 
 
310 PNEUMONIA AND 
 
 fumes of a privy or of a sheepfold. So, also, Joseph. Quercetarms 
 adduces the case, so familiar to the people of Paris, to wit, that of 
 the nastiness of their streets being considered by many physicians 
 as checking the putrefactive taint of their atmosphere. Nor are 
 there wanting other authorities from very serious writers, collected 
 by Gaspar a Kejcs, by which it is shown that bad smells are some 
 times valuable auxiliaries of nature." 
 
 It is but justice to Lancisi to remark, that he attached no faith 
 to the theory thus set forth, or to the advantages of the practice 
 suggested, and seems disposed to unite in opinion with Kejes, who 
 rejects the practice, and says that the experiments and their authors 
 ought to be banished to those barbarous places where the former 
 were made. 
 
 Cause of autumnal fever antagonistic to that of some other diseases. 
 Xor is this the only instance of antagonism that may be referred to 
 in illustration of the toxicological nature of the cause of malarial 
 fevers. That of phthisis with, such fevers, in virtue of which one 
 of these diseases is stated to exclude the other, might, if founded 
 in fact, be usefully adduced ; for such an antagonism could not be 
 explained otherwise than on the supposition of the cause of fever 
 consisting of something different from a mere modification in the 
 sensible qualities of the air of something specifically different from 
 the ordinary causes of disease, and of the tubercular virus in par 
 ticular, and capable of neutralizing the latter, or of producing a 
 diseased condition of solids and fluids, which exercises- a counter 
 acting influence. Originally suggested in Italy, in the early part 
 of the last century, by Lancisi, wiio found, or thought he had found, 
 that " marshes are salutary to men of certain temperaments, such, 
 for example, as are full of acrid salts, prone to coughing, or slender 
 frames, and predisposed to consumption, " the belief in this patho 
 genic antagonism was subsequently advocated, in 1783, by Dr. 
 Bang, 2 of Copenhagen, and in 1784, by Dr. Marx, in a treatise on 
 consumption. Taken up anew in England, more than half a century 
 ago, by Dr. Harrison, of Ilorncastle, Lincolnshire, 3 and ton years 
 after him, by Dr. Wells, of London, 4 it has been revived recently 
 
 1 Op. cit. lib. i. cap. v. 10. 2 Scbata Diarii Xo.socomii Fredericiana, i. 1-3. 
 
 3 London Med. and 1 liys. J. viii. 221, Lond. 1802. 
 
 4 Trans, of a Soc. for the Improvement of Mcd. and Cbirurg. Knowledge, iii. -171, 
 Lond. 1812. 
 
AUTUMNAL FEVERS. 311 
 
 by Dr. Boudin, 1 and by him sustained with considerable ability and 
 much research, but with an evident pretension to originality well 
 calculated to elicit a smile from his English and American readers. 
 But although this antagonism has won the admiration of this able 
 writer, and is well thought of by some of his countrymen, and a 
 few physicians elsewhere ; 2 although it be true that phthisical 
 patients are frequently benefited by a residence in malarial locali 
 ties; that such localities are noted for the rarity or absence of 
 phthisis ; that those in which the latter disease prevails are free 
 from periodic fevers ; that these diseases have been found to replace 
 each other in the same locality; and that phthisis is becoming com 
 mon where the country, in consequence of the draining of marshes, 
 is freed from febrile paludal diseases ; and although, besides, the 
 power in question is in some measure explained and sustained 
 by the circumstance pointed out by Rokitansky, that an unusual 
 venosity of the blood a condition observed in malarial fever 
 proves an obstacle to the formation of tubercles ; still, the theory 
 has not yet been satisfactorily established. So far, indeed, from its 
 being true that one of these diseases excludes the other, facts may 
 easily be found to show that, in many regions of country where 
 intermittents and remittents are common, phthisis is as frequently 
 encountered as in non-malarial districts of neighbouring or distant 
 latitudes ; while there are many reasons to believe that the absence 
 of phthisis, and its mitigation in some paludal districts, is attributa 
 ble to the peculiarity of climate, growing out of the thermometrical 
 and hygrometrical conditions of the atmosphere, rather than to any 
 direct and antagonistic agency of the malarial poison there evolved. 3 
 
 1 De 1 Influence des localites Marecageuses sur le frequence et la march e de la Pht. 
 Pulm. et de la F. typhoide An. d llyg. xxxiii. 58, and republished under the title of 
 Etudes de Geologic Med. sur la Phthisis P., Paris, 1845; ibid. Tr. des F. Int. and 
 Remit, 1842, p. 72 ; ibid. Essai de Geogr. Med. 42, &c. 
 
 2 Tribe, De 1 heureux Influence des localites Marecageuses sur la tubei culisation 
 pulmonaire, Montpellier, 1843; Green, New York Journ. of Med. and Surg. 1840; 
 Henuen, Topography of the Mediterranean, 223; Carriere, Du Climat de Tltalie, 336; 
 Heulard, Mem. de 1 Acad. dc Med. xiv. 129 ; bulletin de 1 Acad. de Med. vii. 213, 305, 
 via. 931 ; llaspel, Maladies de 1 Algeria, ii. 423 ; Giannini, Delia Natura delle Febbri, 
 i. 115, and i. 237 of translation; King, Southern Journ. of Med. and Surg. Sci. i. 
 167; Pritchett, African Hem. Fever, 125 (note); Scheenlein, Klinische Vortraege, 
 Berlin, 1842; Wilson, Stat. Reports of the Health of the Navy (British) S. Am. 111. 
 
 3 Lefevrc, Bulletin de 1 Acad. x. 1041 ; Southey, Observations on Pulmonary Con 
 sumption, Loud. 1814; Forry, Climate of U. S. 205, 2GG ; Sir J. Clark on the Sanative 
 Influence of Climate, GO, 3d ed. ; An. d Hyg. xxxvi. 8, 12; Grant, Sanitary Condition 
 
312 PNEUMONIA AND 
 
 Dr. Lawson, in an instructive essay on the effects of climate in 
 the production of diseases of the lungs, 1 states, after a thorough 
 examination of the subject, that the mortality of tuberculous affec 
 tions of the lungs among the English troops, in the various mala 
 rious localities they occupy, completely accords with the opinion 
 of Sir James Clark and Dr. Forry; for, although the absolute num 
 ber of deaths from these diseases may, in the malarious situations, 
 be less than in a more healthy one, still, they will always be more 
 numerous, relatively to those from the purely inflammator} 7 - diseases 
 of the lungs, than in the more healthy locality. It is not sure, 
 indeed, that, instead of diminishing the tendency to consumption, 
 malaria will not increase it ; for it seems, as we all know, to destroy 
 the balance of the functions, and lessen the tone of the system, and, 
 by defibrinating the blood, deprives the body of the proper nutri 
 tion by which the organic functions are sustained circumstances 
 which all tend to produce or arouse the tubercular diathesis. 
 
 More plausible in many respects better sustained, indeed, by 
 facts, and explainable only by the neutralizing or antidotal effects 
 of different poisons is the theory of a pathogenic antagonism 
 existing between the cause of malarial diseases, properly so called, 
 and that of typhoid fever, by virtue of which the latter fever seldom 
 if ever prevails in paludal localities where periodic fever abounds, 
 and vice versa; and in the same locality, at different periods, and 
 under particular conditions of soil. Whether the history of these 
 two forms of febrile complaints, in all regions they visit, Avill bear 
 out the advocates of this antagonism to the full extent of their con 
 clusions, is more than can be now positively averred. Judging, 
 however, from the many facts collected by M. Boudin, 2 who de 
 serves more credit on the score of originality, in relation to this 
 point, than to that of the antagonism of phthisis with malarial 
 fevers, and from others gathered in this country and elsewhere, it 
 is impossible to withhold the expression of the opinion that the 
 theory he has suggested is entitled to a respectful consideration. 
 In the malarial districts of France, Germany, Spain, Algiers, Bone, 
 Senegal, India, and Greece; in the Morea, and the Walchcrcn, 
 typhoid fever is never or scarcely ever to be found. ]STor is it less 
 
 of Memphis (Term.), Am. J. July, 1853, p. 115; Ilelift, Zeitschrift, fiir Gcsfimmte 
 Meuiein, B. 3, s. 3<;0, see Kdin. J. Ixxi. 378; Michel Levy, Bulletin do TAc.-id. viii. 
 93 .), v S:o. ; Chargellny-Lagarde, Bulletin, xii. !257. 
 
 1 Ediub. Journ. Ixii. 57. 2 See the work cited above. 
 
AUTUMNAL FEVERS. 313 
 
 true, that it is little known in the West Indies. On the other hand, 
 in parts of Europe where typhoid fever is common, intermittent 
 and remittents are rare. At Constantino, in Africa, periodic fevers 
 are scarcely ever seen, while typhoid cases are numerous. In the 
 city of Strasburg, typhoid fevers are common, intermittents rare. 
 In the citadel, the reverse is the case. In Paris, Berlin, Dresden, 
 and St. Petersburg, we find typhoid fever in abundance; but little if 
 any of the other disease. In Denmark, periodic fever drove away 
 typhoid fever, which reappeared when the former had ceased to 
 prevail. In England, much the same thing has occurred ; for there, 
 as elsewhere, " it has been noticed that when intermittent fever 
 has yielded to improvements in cultivation, drainage, &c. typhus 
 very commonly succeeds." 1 Individuals arriving from marshy 
 localities, with their systems saturated with the cause of periodic 
 fever, in places where typhoid fever prevails, resist for a long while 
 the cause of the latter, and vice versa. (Boudin, 102.) 
 
 In this country, much the same results are obtained. Intermit 
 tents once were common in the New England States ; they have 
 made way, except in a few spots, for typhoid fever, which is the 
 prevailing febrile complaint of the country. In the south and west 
 the typhoid is gaining ground, and replacing the periodic forms in 
 districts where these once exercised an exclusive sway. Speaking 
 of typhoid fever, Dr. Bartlett says : " I have often met it in Ken 
 tucky, where it is sometimes called the red-tongue fever. It is, 
 probably, less common in those portions of the United States which 
 are vitiated by the various forms of intermittent fever, than in those 
 which are exempt from these diseases, although more extensive 
 and accurate observations, than have yet been made, are necessary 
 to settle this point." 2 Another distinguished writer of this country, 
 Dr. Cain, of Charleston, S. C., in a report on the diseases of his 
 State, remarks : " The intermittents and remittents were first ob 
 served to lapse into the continued type (typhoid), and finally gave 
 place to the latter altogether. The typhoid now holds, it may be 
 said, undisputed sway over Fairfield, Newbury, Chester, Union, 
 Laurens, Abbeville, and Edgefield Districts, composing a portion 
 of the clay -hill region of the State, but extending somewhat into 
 
 1 Cowan (C.), Report of the Reading Dispensary; Trans. Provincial Association 
 (X. S.), ii. 202. 
 
 2 Bartlett on Fevers, 2d ed. 84, 
 
314 PNEUMONIA AND 
 
 the middle or sand-Mil region, affecting Barn well, Sumter, Ker- 
 shaw, and Lancaster Districts." 1 
 
 Alluding to Bedford County (Term.), Dr. Lipscombe remarks : 
 " In this part of the county (the northern and western), in former 
 years, intermittents, remittents, and bilious fevers were more pre 
 valent than in the more broken parts of the county. But for the 
 last nine or ten years, these types of fever seem to have been gra 
 dually disappearing, and the enteric or typhoid fever to have taken 
 its place." 2 Another writer, Dr. McNally, reporting on the dis 
 eases of Lincoln County, in the same State, says : " L T ntil within the 
 last two or three years, bilious remittent, and intermittent and con 
 gestive fevers were the principal diseases which visited this county, 
 especially in the summer and fall. They were epidemic every 
 year, in every part of the county. Pea Kidge was more exempt than 
 any other part ; but occasionally they prevailed there as extensively 
 as elsewhere. But for two years past they have been only partially 
 so. During last summer and fall, they prevailed extensively in those 
 portions of the county not visited by dysentery and typhoid fever? At 
 Shelby ville. we are told that "the general type of disease, as 
 late as about 1846, was sthenic." " Since 1845 or 6, this charac 
 teristic of disease has yielded to the opposite or asthenic form. 
 Since that period, we have had more or less enteric or typhoid 
 fever to contend with; and less and less of the old-fashioned bilious, 
 remittent, and intermittent." 4 
 
 In Alabama, as we are told by Drs. English 5 and Anderson, 6 the 
 same observation has been made. By the former, it is remarked 
 that typhoid fever has pretty nearly superseded the remittent and 
 congestive fevers that once prevailed in that State ; and the latter 
 writer, speaking of the diseases of South Alabama, states that 
 autumnal fevers have totally declined there of late years, and that 
 typhoid a case of which was never heard of till within the last 
 five years has become a stranger among the inhabitants of this 
 country. Indeed, as observed by Professor Dickson, 7 in "all the 
 
 1 Trans. Am. Med. Assoc. v. 3-58. 2 Hid. vi. 3:21. 
 
 3 Ibid. 4 I Lid. 3:27, 328. 
 
 5 N. 0. Med. and Surg. Journ. vi. 1G8. 
 
 G Prize Essay on the Summer and Autumnal Fevers of South Alabama. Transl. of 
 Med. Soc. of the State of Alabama, for 1852. 
 
 7 Report on the lilendii!.^ of the Types of Fever; Trans, of the Am. Med. Associa 
 tion, v. lo.j; Charleston -Mod. Journ. vii. 843. 
 
AUTUMNAL FEVERS. 315 
 
 southern medical journals, of recent date, we find it stated that 
 throughout our malarial middle country and, indeed, though less 
 strikingly, in our lower alluvial districts also typhoid fevers are 
 becoming more and more frequent in places and settlements, and 
 under circumstances, where, hitherto, the ordinary autumnal remit 
 tents and intermittents prevailed exclusively. In certain localities, 
 the congestive forms of intermittents and remittents seemed for 
 years past to be gaining ground, but now appear to be giving way, 
 in their turn, to this newly observed type." It may be proper to 
 remark, that the probability of this conversion or substitution had 
 not escaped the prophetic eye of our great medical philosopher, the 
 late Dr. Drake, who thought it likely that autumnal fevers would 
 decrease, and typhus and typhoid fevers become more prevalent, 
 throughout the whole Valley of the Mississippi. 
 
 Doubtless, it is not to be denied that typhoid fever is found 
 occasionally to prevail in malarial districts conjointly with periodic 
 fevers. Ramcl 1 described the combination long ago, as having fallen 
 under his observation in some parts of the coast of Barbary and 
 Provence, where intermittents were and are still of common occur 
 rence. It is also found in La Vendee, in Brittany, in sundry valleys 
 near Paris, and other malarial parts of France, where periodic fevers 
 are matters of annual observation. In this country, too, it is on the 
 increase, or already prevails extensively in some aguish or fever 
 localities, as at Memphis, for example, where fevers attributable to 
 malaria have not yet, notwithstanding the appearance of the intruder, 
 lessened in frequency. 2 It may be true, also, that one of the main 
 reasons of typhoid fever being in general less common in rural dis 
 tricts than in cities, as also in the marshes of Corsica, Languedoc, 
 Italy, Algeria, and this country, is to be sought in the sparscness of 
 the population, and in the absence of other morbific agencies which 
 are found in denser communities, and are known to lend a powerful 
 aid to the production and propagation of the disease; while the 
 causes of periodic fevers, which are not found in the latter localities, 
 have not been removed in the former, and continue, therefore, to 
 exercise there their baneful influence. 3 But on the latter point 
 
 1 Memoire sur 1 Influence cles Marais, &c. sur le Sante de 1 liomme. Marseilles, 
 an. x. 
 
 2 Grant, Sanitary Condition of Memphis, Am. J. July, 1853, p. 103. 
 
 3 La Pileur, Quelques Objections a la Tlieorie de FAntagonisme, An. 
 xxxvi. G, 7. 
 
316 PNEUMONIA AND 
 
 we liave nothing but conjectures, which are met by the fact that 
 typhoid fever exists now paramount, and is becoming a source of 
 terror in many rural districts, where the population is nearly as 
 sparse now as it was previous to its appearance and the decline of 
 its antagonist, and where the other morbid agents above referred 
 to do not exist more abundantly now than they did during the 
 reign of the latter disease. Be this as it. may, examples of coexist 
 ence are not as frequent as those of reciprocal exclusion ; and if they 
 were, would not form a valid objection to the doctrine of antago 
 nism, as we can have no reason to deny the possibility of the occa 
 sional existence, at the same time, of the two poisons. 
 
 On these various topics much more, I am aware, might be said. 
 I might appeal also to the phenomenon of incubation, and show that 
 the seeds of autumnal fever, like those of other zymotic diseases, 
 occasionally remain concealed in the system during more or less 
 time until brought into activity through the operation of some 
 exciting agent often, under circumstances which prevent all idea 
 of attributing them solely to the action of the causes to which they 
 are ascribed by the opponents of malaria. Let individuals so 
 situated who have been exposed to the influence of the febrific 
 cause in some sickly place remove to a salubrious district, where 
 remittent, intermittent, and yellow fevers are not known, and they 
 will not urifrequently be attacked with one of these diseases weeks or 
 months after their arrival, in consequence of exposure to the action 
 of the sun, to sudden transition from heat to cold, to a shower of 
 rain, or to any other influence by which the surface is chilled after 
 being heated, and perspiration checked ; or after a fit of intempe 
 rance. Cases of this kind, as we shall see in a future chapter, are 
 not unfrequent. Can we admit that here we are furnished with an 
 illustration of the production of the fever by some sudden change 
 in the sensible qualities of the atmosphere, and independently of 
 the agency of a febrific poison? Had atmospheric vicissitudes, and 
 the other morbific agencies referred to, acted otherwise than as 
 mere exciting causes, we should have had as their product a disease 
 commonly occasioned by them in the locality where the attack has 
 taken place, and not a variety of fever unknown there, but similar 
 to that prevailing at the place whence those individuals came. 
 
 Let -us notice another occurrence. Two bodies of men arrive in 
 a salubrious locality, the one from a place where typhoid fever pre 
 vails, the other where periodic fevers reign. For months, the first 
 
AUTUMNAL FEVERS. 317 
 
 body remain subject to typhoid fever, and arc not troubled with 
 interrnittents. As regards the other set, intermittents continue to 
 prevail among them, while they are entirely free from typhoid. If 
 so attacked, weeks or months after exposure to sickly localities, by 
 fevers in every way similar to those they have left behind, but un 
 like the diseases existing in their new place of sojourn, it is evident 
 they must have carried within their system the seeds of such fevers; 
 those from typhoid districts the seeds of typhoid fever, those from 
 malarial districts the seeds of periodic fever. They are not indebted 
 for the disease by which they are there seized to any morbific agent 
 existing in the place of attack, for nothing of the kind is there to 
 be found. It is the result of exposure elsewhere. Such being the 
 case, the seeds they have thus carried with them, and which are at 
 last called into action, must be of a specific toxical character, for 
 none but morbid poisons can remain long latent in the system ; 
 and the atmospheric vicissitudes, through the instrumentality of 
 which the attack may probably have been brought about, cannot 
 have acted otherwise than as a merely exciting agent, seeing, par 
 ticularly, that other morbific influences, a fit of intemperance, a 
 burst of passion, &c,, produce at times the same effect. 
 
 I might dwell on the circumstance that as, in the above instances, 
 the cause of the febrile attacks under which the individuals alluded 
 to suffered were evidently of the kind mentioned, and not atmo 
 spheric vicissitudes or simple insolation, it would be unphilosophi- 
 cal to attribute the same disease to these latter agencies alone, and 
 ignore the aid of the malarial poison under consideration. I 
 might farther dwell on the process of acclimatization, and draw 
 from what we know on the subject an argument in favour of the 
 doctrine of the toxical nature of the febrile cause. Again, I might 
 point out, in support of the same doctrine, that in some forms 
 of autumnal or malarial fever, individuals who have once passed 
 through the disease, are like those who have suffered from some 
 other zymotic diseases, and, perfectly unlike anything that takes 
 place in complaints arising from heat, moisture, or atmospheric 
 vicissitudes, free from a second attack. But on some of those 
 circumstances, no additional illustration can be required ; and, as I 
 shall have occasion to revert somewhat in detail to the others in a 
 future chapter, I must here drop the subject. 
 
 As already remarked, enough has been said to show that au 
 tumnal fevers depend for their generation on something exhaled 
 
318 PNEUMONIA AND 
 
 under the influence of certain thermometrical and hygrometrical 
 conditions of the atmosphere, from the soil or the substances accu 
 mulated on its surface. Whatever may be our predilections, or 
 even our convictions, relative to the nature of the substance thus 
 produced and the reader cannot have failed to perceive that, on 
 that score, my opinions are already formed it matters not, strictly 
 speaking, to the question more particularly under consideration, 
 whether it consists of animalcules, of fungi, of a gaseous or vapor 
 ous poison, or whether it must be viewed as a vegetable, or animal, 
 or vegeto-animal product. Nor is it necessary, in order to sustain 
 the position assumed, that I should prove, any more than has been 
 done already, that the poison is the result of the decomposition, 
 fermentation, or putrefaction of organic matter, or of any other 
 known substance; or, that I should establish beyond controversy 
 that it is independent or not of those processes, and the result of 
 some unknown and mysterious agency operating in some equally 
 mysterious manner, or some unascertained materials floating in the 
 atmosphere, but having a predilection for particular localities. 
 
 On the animalcular doctrine, as applied to malarial fevers, and 
 other zymotic diseases, we may allow its modern advocates, both 
 those who regard it established beyond the reach of doubt, and 
 those who consider it as most plausible Bradley, 1 Pleniz, 2 Gattoni, 3 
 Crawford, 4 Mojon, 5 S. Brown, 6 Holland, 7 Drake, 8 Wood, 9 Grognier, 10 
 ]STott, u jGrassi, 12 Rasori, 13 and Milroy, 14 to repeat much that was said 
 in former days by Yarro, Lucretius, Columella, Yitruvius, Kircher, 
 Yalisnieri, Lancisi, Linnaeus, Nyander, Eicia, Ilartsrcker, Moufflet. 
 The same liberty may be extended to the defenders of the doctrine 
 
 1 The Plague of Marseilles considered, 1730. 
 
 2 Op. Mod. Phys. 1702. 3 Mem. do la Soc. de Med. x. 104. 
 
 4 Remarks on Quarantines in Baltimore, Observer. April and August, 1807. 
 
 5 Intcrno alia natura del Miasmo Cholcroso Asiatico, Lucca, 1832. A French 
 translation of this clever essay, by Julia de Fontanelle, was published at Paris in 
 1832. See Kev. of it in the N. A. Med. and Surg. J. 
 
 6 Dissertation on Bil. Malign. Fever, Boston, 1707, p. 9. 
 
 7 On the Hypothesis of Insect Life, in Med. Notes, chap, xxxiv. Am. Ed. 
 
 8 A Practical Treatise, &c. on Epid. Cholera, 34, 44 ; Topogr. and Dis. of the Val 
 ley of Mississippi, i. 723. 
 
 9 Practice of Medicine, i. 147, 30G. 
 
 10 Archive de Statistique du Dept. du Illume. 
 
 11 New Orleans Med. and Surg. J. iv. 503. 
 
 12 Rapport a FAcad. Roy de Med. sur la Peste (Pieces et Doc.) 418. 
 
 13 Hid. 14 Quarantine and the Plague, &c. 11. 
 
AUTUMNAL FEVERS. 819 
 
 which ascribes febrile epidemics, as well, indeed, as cholera and other 
 zymotic diseases, to the toxical effects of various fungi Pliny, 1 
 Varro, 2 Ovid, 3 Eeinesius, 4 Kamazzini, 5 Lange, 6 Paulet, 7 Ilecker, 8 
 Henle, 9 Cawdell, 10 Mitchell. 11 Either of these doctrines may, if they 
 suit the fancy of their advocates, be adopted. Either, separately con 
 sidered, or both conjoined, may, for what I know to the contrary, be 
 founded on fact and solid reasoning; though, judging from experi 
 ments recently adduced by a distinguished authority, Prof. Leidy, 12 
 I have strong misgivings on the subject. 13 We may leave the che- 
 
 1 Bk. xviii. chap. xxix. 2 De Re Rustica, lib. i. cap. 12. 
 
 3 Fast, lib. iv. v 907. 4 P. 218. 
 
 5 Const. Epid. Martinensis, anni 1690, i. 3, 4. 
 e Quoted by Dr. J. K. Mitchell, 38. 
 
 7 Rech. Hist, et Phy. sur les Maladies Epid. 443. 
 
 8 On Epid. of the Middle Ages, 200. 
 
 9 Pathologische Untersuchungen, 15; Brit, and For. Med. Rev. ix. 398. 
 
 10 A Disquisition on Pestil. Choi. Lond. 1848. 
 
 11 Oh the Cryptogamous Orig. of Malarious Dis., Philad. 1849. 
 
 12 Flora and Fauna within Living Animals, Introd. 14, 15. 
 
 13 "Many important diseases have been supposed to originate from parasitic ani 
 mals and vegetables. The former are not the true entozoa ; for these are too large, 
 and may be detected by the naked eye ; but they are to be considered to be animal- 
 cuke, so small that they cannot be discerned even with the highest powers of the micro 
 scope. But, independent of the fact that the existence of such entities is a mere 
 suspicion, none of the known ariimalculre are poisonous. At various times, I have 
 purposely swallowed large draughts of water containing myriads of Monas, Vibrio, 
 Euglenia, Volvox, Leucophrys, Paramecium, Vorticella, and without ever having per 
 ceived any subsequent effect. 
 
 "The production of certain diseases, however, through the agency of entophyta, is 
 no longer a subject of doubt, as in the case of the Muscardine in the silkworm, the 
 Mycoderm of Porrigo favosa in man, &c. But that malarial and epidemic fevers have 
 their origin in cryptogamic vegetables or spores, requires yet a single proof. If such 
 were the case, these minute vegetables and spores, conveyed through the air, and 
 introduced into the body in respiration, could be detected. The minutest of all 
 known living beings is the vibrio lineola of Muller, measuring only the 36,000th of an 
 inch; and the smallest known vegetable spore is very much larger than this, whilst 
 particles of inorganic matter can be distinguished the 200,000th of an inch in size. 
 
 " I have frequently examined the rains and dews of localities in which intermittents 
 were epidemic upon the Schuylkill and Susquehanna Pavers, but without being able 
 to detect animalcule, spores, or even any solid particles whatever. I have examined 
 the air itself for such bodies by passing a current through clear water. This was 
 done by means of a bottle with two tubes passing through a cork stopper ; one tube 
 dipping into the water, the other reaching not quite to its surface. By sucking upon 
 the latter tube, a current of air passed through the former, and was deprived in its 
 course of any solid particles. Ordinarily, when the atmosphere was still, early in the 
 morning, or in the evening, neither spores nor animalcules could be detected. When 
 
320 PNEUMONIA AND 
 
 mists to discuss the claims of the various gases to the distinction of 
 producing the morbid effects in question. We may grant, if per 
 chance any one insist upon it, that Sylvius de la Boe had good 
 reason for believing that the cause of fevers is of a saline and sul 
 phurous nature ; or that it is acid, as maintained by Kamazzini; or 
 that it consists in an oxide of azote, as believed by Textoris. We 
 may allow Dr. Balme to plead the cause of his septon of oxygenated 
 azote, a substance not very different from that which, under the 
 same name of septon, enjoyed some celebrity on this side of the 
 Atlantic under the fostering care of our distinguished countryman, 
 the late Dr. S. L. Mitchell, of ~N&w York. We may also allow Pro 
 fessor Dunglison to write and teach that vegetable matter has 
 nothing to do in the production of the morbific agent. We may, 
 besides, offer no objections to the opinion of Dr. Warren, and others, 
 who are no less zealous in absolving animal matter from all blame 
 in reference to the effects in question ; and we may go so far, for the 
 sake of argument, as to admit, if hard pressed by some fastidious 
 disputant, that the cause is not the production of the decomposition 
 of any kind of organic matter. All I insist upon at present is, that 
 be its nature, the materials from which it is derived, and the pro 
 cess by which it is generated, what they may, the febrile poison is 
 a stranger to, and must not be confounded with, the natural and 
 unchangeable constituent elements of the atmosphere; that it is 
 distingt from, and independent of, mere modifications in the sensi 
 ble qualities of the latter ; that it is suspended and floats in it, and 
 is wafted by the wind ; that it possesses an individuality of its own, 
 and serves, by its poisonous properties, to render the air of locali 
 ties where it is generated or conveyed insalubrious, and a fruitful 
 source of fever. 
 
 Other objections urged against the malarial origin of periodic or 
 autumnal fevers. It can scarcely be necessary to occupy our time 
 
 piles of decaying sticks, or dry leaves were stirred up, or the dust was blown about 
 by the wind, a host of most incongruous objects could be obtained from the air; none, 
 however, which could be supposed capable of producing disease. To assert, under the 
 circumstances, that there are spores and animalcule capable of giving rise to epidemics, 
 but not discernible by any means at our command, is absurd : as it is only saying, in 
 other words, that such spores and animalculae are liquid and dissolved in the air, or 
 in a condition of chemical solution." (Leidy, Flora and F<ui>ni trithin /.iri/iy Animals, 
 Introduction, 14, 15.) 
 
AUTUMNAL FEVERS. 321 
 
 in examining in detail the value of various other objections urged 
 against the existence and febrific power of malarial exhalations. 
 
 It is not likely that those who believe in the morbific agency 
 of these, and recognize in them the essential or efficient cause 
 of autumnal fevers, will be disquieted by the reasons assigned in 
 opposition by Giannini 1 and others, who remark that the exist 
 ence of malaria may be disproved on the following grounds : 1. 
 When a morbific matter is introduced into the human body, it 
 manifests its presence by the occurrence of cutaneous eruptions 
 and spots phenomena which are never observed in malarial or 
 periodic fevers. 2. The morbific matter, when introduced, is usu 
 ally expelled by means of critical discharges, more particularly by 
 sweats. This evacuation, in intermittent fever, is an effect of the 
 hot stage, and not an expulsive effort to get rid of the miasm. 
 Thus, when this last-mentioned stage is arrested by means of cold 
 immersions, the sweating process does not take place. 3. Morbific 
 matters, inimical to the organism, when introduced into the body, or 
 simply applied to the surface, usually manifest the power of repro 
 duction and multiplication. Through means of this power, a similar 
 disease is reproduced in those who come in contact with the sick. 
 Nothing of the kind takes place in intermittent fever, which pro 
 duces no morbific matter or excretion, and is not, therefore, con 
 tagious. 4. Periodic fevers, which are generally thought to be 
 produced by the paludal miasm, often terminate after the first 
 paroxysm. If the disease arose from the miasm, it is difficult to 
 comprehend how, in so short a time, that cause could be expelled, 
 considering that all morbific matters that produce fever in the 
 living system, remain in it some days before being expelled. 
 Peruvian bark and cold affusions cannot be supposed to act in 
 these cases by neutralizing the alleged poison, inasmuch as the 
 same means produce the same curative effects in periodic fevers 
 arising from other and totally different causes. 5. Diseases pro 
 duced by foreign matters introduced into the system are all com 
 municable by contact. So far from being the vehicle of contagious 
 diseases, the atmosphere decomposes all contagions. Reasoning 
 from analogy, therefore, we may conclude that the atmosphere 
 would do the same as regards the alleged miasm, did it exist. 6. If 
 there existed a paludal miasm, its effect would be specific and uni- 
 
 Vol. i. 230, 231. 
 
 21 
 
322 PNEUMONIA AND 
 
 form. So far from this, the effect of the pretended miasm is multi 
 form. It gives rise, not only to periodic fevers, but also to cachexia, 
 marasmus, abdominal obstructions, dyspepsia, chlorosis, dropsy, &c. 
 7. The cause often operates too suddenly to allow us to believe that 
 it consists in a miasm. If such were the case, we should be led to 
 admit that in a few hours the miasm has been introduced, that it 
 has circulated in the lymphatic vessels, and next in the arteries 
 and veins ; or that, after having penetrated the lungs, in opposition 
 to the known fact that these organs receive no other gases than 
 oxygen, it has been able to exercise an action on the nerves a 
 result which does not obtain in diseases produced by morbific 
 agents of a poisonous character. Besides, the same effect may be 
 produced by any other cause, since it is proved that an attack of 
 intermittent fever is often brought on by simply sleeping one night 
 in the open air in places free from marshes. Now, as in instances 
 of this kind, we cannot refer the disease to any other influence 
 than that of cold on the nervous system, we need not attribute the 
 other phenomena to a different cause. 
 
 To these objections it may be remarked : 1. That all morbific 
 poisons, introduced into the system, do not manifest their presence 
 therein by cutaneous eruptions and spots ; as proved by that pro 
 ducing hooping-cough. 2. Diseases caused by such poisons ter 
 minate often without the occurrence of critical discharges that by 
 sweat particularly while, on the other hand, autumnal fevers, of 
 the remittent or continued kind, which belong to the same class with 
 intermittents, are frequently judged by such discharges. 3. Nothing 
 has as. yet been said calculated to prove the contagious character of 
 cholera; the origin of which, from a morbific agent introduced into 
 the system, admits of no doubt. Many poisonous animal matters, 
 when introduced under the skin, cause dangerous and even deadly 
 diseases of a specific kind, without imparting to the system the power 
 of reproducing a similar matter endowed with poisonous qualities. 
 4. The cure of an intermittent fever by cinchona, after the first 
 paroxysm, is no proof of the non-existence of a malarial poison ; 
 as there is no reason for disbelieving the possibility of a disease 
 being produced by a small portion of miasmal poison, terminating 
 with or without a critical discharge, in a short space of time. 
 Some poisons require for their elimination a certain and fixed 
 number of days ; but it does not follow that in all the duration 
 must always be prolonged. Besides, in some fevers, due to the 
 
AUTUMNAL FEVERS. 323 
 
 same causes, or to influences closely allied to them, the disease runs 
 a long and definite course; and, when established, is not arrested 
 by the means mentioned. If arrested by cinchona, the effect is 
 due, as is also the cure of intermittent fever, to the control exer 
 cised by this remedy, and some other therapeutic agents, over all 
 affections that assume the periodic type, whether those affections 
 be produced by one set of causes or another. Giannini himself, 
 admits that typhus, petechial, pestilential, and other forms of fever, 
 which he regards as the effect of morbific poisons, may be, and 
 often are cut short, or greatly abridged in their duration, by cold 
 immersions. 5. It is not correct to say that the atmosphere is never 
 the vehicle of contagions ; since exposure to smallpox or like com 
 plaints, without contact, is generally followed, in unprotected indi 
 viduals, by an attack of the disease. The poison, in these cases, is 
 certainly conveyed from the sick to the well through the medium of 
 the atmosphere ; and if the latter does not always decompose it, 
 immediately on its escape from the diseased body, there is no reason 
 to deny that it may fail to do so in regard to the malaria producing 
 periodic fevers. 6. The diseases produced by malaria are specific 
 and uniform each variety of the poison producing a different form 
 of fever. The affections enumerated in proof of the multiform effect 
 of marsh poison are only sequelae of the specific disease, or the 
 result of the gradual and long-continued action of the cause. 7. 
 And lastly, even if it were true that no other gas than oxygen 
 found entrance into the lungs which is far from being the case 
 the occurrence of fever after slight and momentary exposure to 
 marsh air, is no proof of the non-existence of miasm ; for the small 
 pox and other diseases depending on morbific matters introduced 
 into the system, have often been occasioned by a few moments ex 
 posure to individuals labouring under them. 
 
 To only one more objection shall I devote a few remarks. It has 
 been said, as a proof of defective and erroneous reasoning on the part 
 of the advocates of the mode of origin of autumnal fevers under con 
 sideration, and as an evidence of a culpable violation of the rules of 
 induction, that such individuals insist that the same cause not "known 
 even to exist at all may and does produce different and distinct dis 
 eases in different individuals exposed under the same circumstances. 
 Now, to this I have only to say, that I cannot at this moment recall 
 to mind a single writer of sane intellect, or whose opinion is worth 
 notice, who has ventured and pertinaciously insisted on such an 
 
S24: PNEUMONIA AND 
 
 assertion. That some have believed, and continue to believe, that 
 the same cause miasmata produces what other pathologists regard 
 as different and distinct forms of fever, is perfectly well known. 
 But such writers, themselves, while believing in the identity of the 
 cause, believe also in the identity of all the fevers in question ; 
 holding these to differ from each other in nothing but the degree 
 of their violence, the organs that may be implicated, and other 
 circumstances of like import. Hence the remark cannot apply to 
 them. By others, nothing of the sort, so far as I can find, has been 
 advanced. By them, it has doubtless been said, very correctly, as 
 I think, that miasmata or exhalations, produce different forms of 
 fever ; but while doing soj they have not wished to be understood 
 as maintaining that those exhalations are always identically the 
 same in their nature. So far from this, they think themselves 
 justified in the belief that, considering the great diversity of effects 
 produced, as evinced by the phenomena and anatomical characters 
 noticed in those several forms of fever, poisons exhaled from 
 various sources of infection differ materially in composition and 
 nature. The exhalations from our wharves, from the timber of 
 ships, and some other sources, produce yellow fever, and never 
 intermittent fever. Those from swamps, marshes, &c., give rise to 
 periodic fevers of different grades never to yellow fever properly 
 so called. In Paris, and other parts of France and Europe, and in 
 various sections of our country, some effluvia appear to give rise 
 to typhoid fever. In several localities of Ireland, Scotland, and 
 England, certain exhalations have occasioned a peculiar form of 
 fever, which, from one of its noted characteristics, has been deno 
 minated the relapsing fever. The morbus Hungaricus, of some 
 centuries past, bore but a feeble resemblance to the Athenian 
 plague, described by Thucydides ; to the Oriental plague of the 
 present day ; to the sweating sickness, and to the black death of the 
 14th century .; or, again, to the typhoid fever of Paris, the typhus of 
 London, or the typhoid remittent of our negro alleys ; while none 
 of them resemble exactly the true yellow fever. Whatever view 
 we may take of the contagious character of typhus, it is not to be 
 denied that it arises often from miasmatic exhalations of some sort. 
 Even among fevers that are strictly speaking of malarial origin, 
 some difference occurs in their symptornatological. and other cha 
 racters. The jungle fever of India is not exactly the same in form 
 as the remittent of Africa: the fever of Batavia differs in some 
 
AUTUMNAL FEVERS. 825 
 
 respects from the bilious remittent of this country, or of the Gambia. 
 The febrile diseases of Koine are not precisely similar to those of 
 the West Indies or Batavia ; and the Walcheren fever differs in like 
 manner from both of these, or from that of Breskau. In France, 
 the fevers of Eochefort do not present the very same characters as 
 those of Bresse or of the plain of Forez. 
 
 The Mediterranean remittent, described by Sir William Burnett, 
 is somewhat unlike the periodic fevers of England and of northern 
 Europe. It differs in some particulars from that of Greece, an 
 account of which is found in the justly celebrated books of Epi 
 demics of Hippocrates, or .of Algeria, or the Morea. Our negro 
 fever of 1822, and the Bunker Street fever of New York, were too 
 unlike yellow fever on the one hand, and common periodic fever 
 on the other, to be supposed to have arisen from the agency of 
 precisely the same poison as these. 
 
 This probable diversity in the nature and composition of the 
 miasms in question, as exhibited by the diversity of the febrile 
 phenomena they produce, has called the attention, and met with the 
 assent of many writers of former and present times. It is referred 
 to by Lancisi -, 1 approved of by Eochoux, 2 Ferrus, 3 Desland, 4 Littre , 5 
 and many others of equal note ; and particularly insisted upon by 
 Twining, 6 J. M. Smith, 7 and Monfalcon. 8 
 
 Those fevers, though bearing a close family resemblance to each 
 other, are all more or less different in their phenomena, mode of 
 progression, and anatomical characters, but yet are all avowedly 
 the offspring of miasmal effluvia. Here, the cause giving rise to 
 each form, though included with others under the generic name of 
 miasma or malaria, is also regarded as different in its composition 
 or in the proportion of its component parts. This is what is 
 affirmed; and not the absurdity sometimes charged on the advocates 
 of the malarial origin of fevers, that a cause identically the same 
 may and does produce different and distinct diseases in individuals 
 exposed to it under the same circumstances. Individuals exposed 
 
 1 Op. cit. cap. xi. 34-3G. 
 
 2 Recherches sur les Differentes Maladies, &c. 135. 
 
 3 Diet, de Medecine, 1st ed. viii. G8. 4 Diet, de Med. Pratique, vii. 73. 
 5 (Euvres d Hippocrates, ii. 578. 6 Diseases of Bengal, ii. 288. 
 
 7 On Epidemics, 48, 67, &c. 
 
 8 Op. cit. 65, 69. See also Rev. of Deveze, Med. Repos. xxi. 187 ; Forry, op. cit. 
 285, 291 ; Desportes, Bulletin de 1 Acad. v. 380. 
 
326 PNEUMONIA AND 
 
 to the same cause, under the same circumstances, will have the 
 same disease. If the diseases produced differ, the cause must be 
 different too; because the same morbific agents cannot occasion 
 different effects, any more than different agents can occasion the 
 same effect. 1 
 
 If the causes of those diseases we^e precisely the same, and the 
 latter consequently of similar nature, they would be convertible 
 into each other, and show themselves in the same place ; yellow, 
 or typhoid, or relapsing fever would, under particular circum 
 stances, be converted into a remittent or intermittent fever, and 
 vice versa; and, where the one form of febrile complaints exists, the 
 other forms would appear too. But, notwithstanding all that may 
 be said to the contrary, experience shows that such is not the case ; 
 a true yellow fever has never been converted into a typhoid or an 
 intermittent fever. They may, and do often mix or combine 
 together ; their types may blend, but they remain independent of 
 each other, as will be dwelt upon on some other occasion. Where 
 intermittent fever prevails, yellow fever frequently never shows 
 itself; and in places most visited by yellow fever, the other is never 
 or very seldom seen. 
 
 In the Islands of Dominica, Demerara, and St. Lucia, common 
 miasmal fevers prevail annually, while the yellow fever appears at 
 irregular intervals. In Barbadoes, on the contrary, the latter dis 
 ease is of frequent occurrence, and the former scarcely known. 
 Bilious remittent fever, in its worst forms, is as prevalent in India, 
 in Eastern Europe, and in all parts of Africa, as in our Southern 
 States, the West Indies, and the western coast of Africa ; yet, not- 
 
 1 Cases are not wanting to show that the same locality will, under particular 
 hygienic and atmospheric conditions, produce different forms of fever. Witness the 
 following : At a short distance from Drieuze, in France, is situated a large pond called 
 Lindre Basse, which, for special purposes, is made to undergo certain changes. It is 
 two years full and one year empty. The first year it is only half-filled the second 
 year quite so; and the third, after the fish have been taken out, it is dried and cul 
 tivated. During the first year, intermittents prevail ; during the second, typhoid 
 fevers take the place of these, while during the third, malignant carbuncular diseases 
 succeed to both. 1 This order of succession has been regularly observed during the 
 last twenty years. 2 
 
 1 Ancelon, Memoires sur les Fievres Typhoidcs periotliquement devcloppees par le? emanations dc 
 1 Etang de Lindre Basse. Nancy, 1847 ; Melier, Mem. de 1 Academie de Med. xiii. 657. 
 
 2 A change in the rotation in 1848-49, has altered the order of succession of these diseases. Comptes 
 Ecndus, 1850. 
 
AUTUMNAL FEVERS. 327 
 
 withstanding, the yellow fever is seldom if ever seen there ; while 
 it is very common in the others. Bilious remittents and intermit- 
 tents prevail as extensively, and with as much violence, in the 
 interior of unhealthy countries as near the sea ; the yellow fever, 
 on the contrary, is confined within narrow limits, and is generally 
 observed on the sea-coast, and along navigable streams, and never 
 extends far into the interior. The yellow fever, as we have seen, 
 has often been known to arise from the foul exhalations of ships ; 
 no instance, so far as I have been able to ascertain, has as yet 
 occurred of epidemics of remittent or intermittent fevers having 
 broken out at sea, or been traced to the decayed timber, or dirty 
 bilge-water, or fermenting cargo of a ship. If they break out there, 
 they have invariably been brought from elsewhere. The yellow 
 fever is, strictly speaking, a disease of cities, or of places containing 
 a dense population. That it has sometimes attacked small towns, 
 villages, plantations, or rural districts, is true ; but such instances 
 are rare, and have always occurred along large watercourses. The 
 bilious remittents or inter mittents, though occasionally seen in city 
 localities, prevail more generally in the suburbs or adjacent coun 
 try, to which the other never extends. Although it often happens 
 that an epidemic of yellow fever is accompanied with a like preva 
 lence of remittents and intermittents in the surrounding country, 
 or, perchance, in the infected place itself, the occurrence is not 
 constant ; for instances are found when, daring severe visitations, 
 the country or suburbs have remained free from common malarial 
 fevers. On the other hand, in some very unhealthy seasons, both 
 in the West Indies and in our Southern and Middle States, when 
 the fevers have prevailed most extensively, the yellow fever has 
 not made its appearance. 
 
 To those who reject these views as unphilosophical and absurd, 
 it may be asked whether they are more so than others to which 
 "they are forced to give their assent, respecting phenomena wit 
 nessed every day. Take the process of putrefaction, as an example. 
 All animal substances give by this process the same products, but 
 they do not follow exactly the same laws, and present the same 
 phenomena. These are often dependent on a difference in the 
 proportion and nature of their constituent principles. Fourcroy, 
 a high authority on this subject, remarks: "Each substance has its 
 particular mode of comporting itself while undergoing the putrefy- 
 
328 PNEUMONIA AND 
 
 ing process." Each gives out a particular odour, and each pro 
 duces a somewhat, different effect by its action on living beings. 1 
 
 But we ask for proofs, not assertions, and unsupported denials; 
 and say, to all who condemn a doctrine which we regard as resting 
 on the most solid foundations, and which, as every one must ac 
 knowledge, has received the sanction of the highest professional 
 authorities, and enumerates among its advocates the larger number 
 of medical inquirers, that, to succeed in their efforts, something 
 more will be required at their hands, than the mere assertion that 
 those who advocate that doctrine labour under a most egregious and 
 unpardonable error, and are neither more nor less than open to 
 the charge of hazarding a sheer hypothesis at complete variance 
 with the results of daily observation and the commonest principles 
 of a sound philosophy, and worthy only of those unenlightened 
 minds who have lagged behind during the onward march of scien 
 tific knowledge. As for myself, whether it be from obtuseness of 
 intellect, ignorance of important facts, or other circumstances of like 
 import, matters not; but I cannot help thinking that, notwithstanding 
 all that may be affirmed to the contrary, the doctrine of malaria is, 
 to say the least, entitled to our most respectful consideration ; that 
 enough has been adduced to satisfy the minds of ordinary inquirers, 
 that those who admit the claims of that doctrine to be so viewed, 
 are not far from the truth; that nothing, at least, has so far been 
 done or said to prove the contrary ; and that the opponents of the 
 malarial origin of autumnal fevers would confer an inestimable 
 service on the profession, if, instead of contenting themselves, as 
 they have but too generally done, with summarily disposing of the 
 subject with a few words of contemptuous denial, or dwelling on 
 morbific influences, not one of which can, unaided by a more effi 
 cient cause, produce any form of that disease, they were at once to 
 refute all that has been said in support of that origin ; to show, 
 clearly and positively, how and in what manner their opponents 
 have erred and continue to err ; and to furnish us, in detail, with 
 facts and arguments as numerous and strong as thoss they seek 
 to overthrow. 
 
 In the meanwhile, at the risk of incurring the charge of repeti 
 tion, I must, before concluding the subject of malaria, lay down 
 a few propositions, which, it appears to me, we are warranted in 
 
 1 Julia de Fontenelle, op. ci(. 11G. 
 
AUTUMNAL FEVERS. 329 
 
 drawing from a survey of all the facts and statements which have 
 been passed in review. 
 
 1. The doctrine of malaria, though of ancient origin, and very 
 generally admitted, has encountered, and continues to encounter 
 opposition. 
 
 2. The appearance of autumnal or periodic fevers, where there 
 are no marshes, properly speaking, does not disprove the existence 
 or agency of malaria in the production of that class of disease, inas 
 much as there is nothing to hinder morbid exhalations from being 
 furnished by terrestrial surfaces of a different character, and no 
 writer of any reputation has denied the fact of such occurrences. 
 
 3. The constant association of these fevers with peculiar cha 
 racters and conditions of localities, and their absence or cessa 
 tion where these characters and conditions clo not exist, or, having 
 existed, have ceased to do so, through the operation of artificial or 
 other means, lead to the opinion of the evolvement from those 
 localities of some peculiar morbific poisonous substance from the 
 soil, or the materials by which it is covered ; and of the connection, 
 as cause and effect, between this exhaled substance and the diseases 
 in question. 
 
 4. The inability of the chemist to detect this malarial poison in 
 the atmosphere of sickly localities, and to point out its nature, does 
 not disprove its existence, inasmuch as other substances, the pre 
 sence of which cannot be doubted, equally escape detection. 
 
 5. Atmospheric heat alone will not serve to account for the pro 
 duction of periodic fevers, of various grades and types ; for these 
 fail to appear in seasons when, and in localities where, the ther 
 mometer ranges higher than at other seasons when, and in places 
 where, they prevail extensively. Besides, instances are not rare 
 when fevers have stopped, though the heat continued unchanged, 
 and apparently from the influence of a very high range of tempe 
 rature. 
 
 6. Nor can terrestrial or visible atmospheric humidity account 
 alone for the effect under consideration. Though fevers often break 
 out or prevail during wet weather, they usually cease when this 
 humidity is at its height, and reign most generally during the dry 
 ing process often during very dry spells of weather. 
 
 7. Fevers of the kind mentioned cannot be due simply to a high 
 dew-point, for they exist and are rife when the latter is not higher 
 than in healthy seasons. 
 
330 PNEUMONIA AND 
 
 8. For reasons assigned, the efficient cause of fever cannot be 
 sought in any peculiar modification in the electrical state of the 
 atmosphere. This fluid, by its excess or deficiency, may and does 
 no doubt exercise an agency in the matter ; but that agency is 
 evidently limited to placing the system in a proper condition to 
 receive the impress of a morbific cause; to furthering, when defi 
 cient, the formation of the latter, or, when in excess, to neutralizing 
 or destroying its effects. But, in all cases, the presence of such a 
 cause is required, before autumnal fevers can be produced. 
 
 9. The same may be said of atmospheric vicissitudes. These 
 may and do often occur, without periodic fevers being the conse 
 quence; and, conversely, those fevers frequently occur without ap 
 preciable vicissitudes. 
 
 10. The attack comes on too suddenly, and, not unfrequently, 
 after too transient an exposure to evident sources of infection, 
 without the possible concurrence of any other influencing agency ; 
 at other times, it occurs too long after a residence in, or visit to 
 places where the disease is known to prevail, to be the effect of any 
 other cause than a morbid poison introduced into the system. 
 
 11. The opinion of the existence and agency of such a poison 
 will appear the more natural, when we find that the danger of an 
 attack is generally proportionate to the proximity to localities 
 where these diseases prevail ; the other agencies being the same 
 beyond as within the sphere of their prevalence ; that vessels on a 
 sickly coast remain healthy so long as they do not approach the 
 land ; that they become again healthy by removing to a short dis 
 tance, or by merely shifting their position; and that individuals 
 from on board, who land, and those especially who sleep on shore, 
 are almost certain of being attacked. 
 
 12. The development and prevalence of fever on board of ships, 
 when other vessels in the vicinity remain healthy; its occurrence 
 only in limited parts of the under decks; and its being arrested 
 by a proper system of expurgation, lead to the opinion of the 
 generation and existence there of a morbific poison. 
 
 13. The innocuousness of some marshes, of ships in a foul state, 
 or of surfaces bearing a strong resemblance to others in which 
 periodic fevers prevail, is no proof that exhalations issuing from 
 sickly places or ships, are not the cause of the disease ; for, besides 
 that the latter is often traced to some source of decomposition in a 
 way to leave no doubt as to the agency of these, the exemption 
 
AUTUMNAL FEVERS. 331 
 
 may be justly attributed to the existence, in some instances, or to 
 the absence, in others, of a variety of necessary and concomitant 
 circumstances. Fevers do not prevail beyond a certain altitudinal 
 range; they require a certain amount of heat, and that this heat 
 should be continued during a certain length of time; they require, 
 besides, a certain amount of terrestrial humidity, no more nor less ; 
 or, at least, that the soil should have been well saturated before 
 being exposed to the prolonged operation of the solar heat ; also, a 
 close and still atmosphere, and other contingencies adverted to. 
 Without these they do not appear to show themselves, how favour 
 able soever to their generation may be the condition and nature of 
 the soil or the substances by which it is covered or permeated. 
 
 14. The malarial doctrine receives farther support from the well- 
 attested fact, that the cause of fever is carried by the wind from 
 paludal and sickly localities to places situate at considerable dis 
 tances; the latter places remaining healthy so long as they are to 
 windward of the others, and becoming sickly -when they are to lee 
 ward. In such cases, the wind cannot have carried an amount of 
 heat or humidity sufficiently different from that existing before to 
 account for the effect produced. Nor can it act by occasioning a 
 much greater amount than usual of atmospherical vicissitudes. 
 Hence the cause, to be thus wafted from one place to another, and 
 to give rise to a particular disease, similar to that of the locality 
 from whence it proceeds, must consist of a material poison, mixed 
 with, or suspended in the atmosphere. 
 
 15. Equally favourable to the correctness of the belief is the 
 effect resulting from the upturning of soil in hot weather. The 
 injury resulting from this operation, as illustrated by a wide dif 
 fusion of malarial fevers, and the great mortality often occurring on 
 the levelling of streets, digging ditches and canals, cutting down 
 bluffs, caving in of river banks, &c., cannot be accounted for on the 
 principles advocated by the opponents of the malarial doctrine, and 
 are more easily explained on the supposition of a poison exhaled 
 from the decomposed organic matter contained in freshly exposed 
 earth. 
 
 16. The effect of partial draining; of exposing a virgin soil to 
 the action of the sun ; of the imperfect desiccation of the soil after 
 an overflow, and other kindred occurrences, in producing or in 
 creasing fever; and the converse effect of complete draining, of 
 covering a marshy surface with water or sand ; or masses of decaying 
 
332 PNEUMONIA AND 
 
 organic materials, or any other unhealthy place, in the same way, 
 or with earth, in patting a stop to fever, lead to the same con 
 clusions. 
 
 17. Agreeably to no other doctrine than the malarial, can we 
 explain the greater sickliness of marshes formed by the mixture of 
 salt and fresh Vater ; for this mixture cannot increase any of those 
 influences to which others attribute diseases thus produced or 
 aggravated ; while we can understand that the mixture may act 
 injuriously, by furthering the decomposition of the organic matter 
 which it saturates, as well as by the reciprocal destructive action of 
 fresh water on the living beings contained in sea-water, and re 
 versely, the destruction by the latter of those contained in fresh 
 water. 
 
 18. The limitation of the disease to a restricted locality, to a few 
 streets or buildings, to one house, or side of a house, or one room, 
 &c., bespeaks, as do like occurrences on shipboard, the existence of 
 a local cause of infection, and consequently the exhalation from 
 this of a morbific agent. 
 
 19. The opinion of fever being due to the introduction into 
 the system of a morbid poison, floating in the atmosphere of 
 sickly places, receives a strong support from the analogy existing 
 between their symptoms and anatomical lesions, and those resulting 
 from the introduction of putrid organic matter into the circulation, 
 or the inspiration of putrid vapour. 
 
 20. The arresting or mitigation of fevers in sickly localities by a 
 resort to proper hygienic means, disinfectants, washing, excessive 
 heat, &c., lead to the same opinion ; for these means operate in the 
 same manner on other morbific causes the effluvial nature of which 
 is undoubted, while they have no efficiency in cases of diseases 
 arising from other agencies. 
 
 21. The effects of trees, walls, hills, buildings, curtains, &c., in 
 arresting the transit of the cause of fevers, are equally favourable 
 to the idea of that cause being a malarial poisonous substance 
 contained in the atmosphere. 
 
 22. Still more conclusive is the destruction of that cause by frost, 
 for the latter cannot produce its beneficial effects by an action on 
 any of the other agencies to which fevers are ascribed ; while it is 
 known to exercise the same destructive influence over other causes, 
 of a character similar to the one from which fever originates. 
 
 23. The wide prevalence of autumnal fevers in certain localities ; 
 
AUTUMNAL FEVERS. 333 
 
 the great mortality to which they sometimes give rise; and the 
 diffusion of some forms of them over a very large expanse of 
 country, at a time, too, when the sensible qualities of the atmo 
 sphere do not appear to have varied in any important point from 
 what they are in healthy seasons, afford an additional reason for 
 attributing them to a toxical agent floating in the atmosphere. 
 
 24. The transmission of the disease to the foetus in utero; its 
 production from the internal use of the waters of marshes ; the 
 inability of such waters to sustain life in fish and other animals 
 of the kind ; the undermining effect of a malarial atmosphere on 
 the system ; the production by it of a state of cachexia, and its 
 influence in shortening the duration of life, indicate the existence 
 and agency of a poisonous substance transmissible, in the one case, 
 like other morbid poisons, by the mother to the child she bears in 
 her womb ; in another case capable of solution in the water which 
 helps to its generation ; and in others, again, endowed, like well- 
 known poisons, with the power of gradually occasioning peculiar 
 and injurious changes in the blood and vital organs. 
 
 25. The neutralizing influence exercised by the poisons of some 
 zymotic diseases over the agent producing malarial fevers, would 
 seem to indicate the existence of a close analogy between the latter 
 and the former. The same remarks are applicable to the patho 
 genic antagonism existing between malarial and typhoid fevers. 
 
 26. Lastly, from all that we can gather respecting the origin, 
 mode of progression, and phenomena of autumnal fevers, the nature 
 of the localities they visit, the circumstances under which they 
 appear, the agencies which promote their development, or retard 
 or arrest their progress, we may conclude, without fear of error, 
 that everything tends to connect the morbific agent, of which 
 autumnal fever is the offspring, with the products of the decompo 
 sition of organic materials ; requiring as it does, for its generation, 
 the action of the very same agencies which are necessary for that 
 decomposition. Like the latter, it requires the presence of the 
 above materials; like the ordinary decomposition of these, the 
 febrile cause requires for its generation a more or less prolonged 
 continuance, and a certain degree of atmospheric heat ; it requires, 
 also, a certain amount of moisture. In the one as well as the other 
 process, an excess of this moisture prevents or arrests its progress ; 
 in the one as well as the other, a total absence of the same produces 
 a like preventive or destructive effect. The generation or diffusion 
 
334 PNEUMONIA AND 
 
 of the febrile cause is promoted by a calm and close state of the 
 atmosphere, and retarded, prevented, or modified, by free ventila 
 tion, elevated situations, and a pure quality of the atmosphere. Like 
 ordinary decomposition, the process by which the febrile cause is 
 produced, is retarded by cold, and arrested by frost, as well as by 
 intense heat. 
 
 Now, as has been said before, when we find the cause of fever 
 requiring for its development the action of the very agencies which 
 are necessary to insure the development of the gaseous products of 
 decomposition ; when we find that without these agencies, applied in 
 certain proportions, neither those gaseous products nor the efficient 
 cause of fever will manifest themselves ; that in all instances in 
 which the latter is produced, as shown by the occurrence of fever, 
 materials capable, when acted upon by the agencies in question, of 
 giving rise to the evolvement of the gaseous products of decompo 
 sition organic matter in various conditions and states of modifica 
 tion exists ; that the total absence of those materials, whatsoever 
 be the degree of heat, and of terrestrial and atmospheric moisture, 
 carries along with it an equal absence of fever ; and that, when 
 once formed, the gaseous products of decomposition, as well as the 
 febrific cause, are cut short by frost or intense heat, and the pro 
 cess by which they were generated arrested ; when, I repeat, all 
 these circumstances are borne in mind, we can have no reason to 
 doubt the propriety of admitting that the febrile cause presents 
 a close analogy to the above-mentioned gaseous products; and that 
 if r in regard to the latter, heat, humidity, and other agencies acting 
 in given proportions and in concert on dead organic matter, give 
 rise to certain products which assume the gaseous form ; and if the 
 process of the generation of these, and their existence in the atmo 
 sphere is destroyed by frost or intense heat ; the febrile poison which 
 requires for its generation the action of the same agencies, as also 
 the existence of a kindred matter, and is besides arrested in its 
 formation, and destroyed when formed in the way mentioned, must 
 necessarily consist also of some modification of a similar kind of 
 gaseous substance ; in other words, that autumnal fevers must be 
 the offspring of a malarial morbid poison, and not the effect of 
 modifications in the sensible qualities of the atmosphere. 
 
CHAPTER Y. 
 
 PNEUMONIA AND AUTUMNAL FEVEK COMPARED IN RE 
 FERENCE TO THEIR CAUSES, MODE OF PROGRESSION, 
 SYMPTOMS, ANATOMICAL CHARACTERS, AND THE CIR 
 CUMSTANCES BY WHICH THEY ARE INFLUENCED. 
 
 The causes of autumnal fevers and pneumonia are different. In 
 the preceding chapters, I have endeavoured to prove, by facts and 
 arguments, that autumnal fevers, in their several varieties and 
 forms, from the simple intermittent to the malignant yellow fever, 
 are produced by specific toxical agents, exhaled under the modi 
 fying action of certain contingent influences, heat, humidity, &c. 
 from organic substances during the process of decomposition ; 
 and those agents I have, in imitation of Dr. Irvine, who first 
 borrowed the term from the Italians, designated by the generic 
 name of malaria. Whether the attempt to establish, in a satisfac 
 tory manner, the correctness of this generally admitted but some 
 what contested belief has been successful or not, must be left to 
 the decision of the reader. Convinced, however, from all I have 
 seen or read, that the majority of those who have investigated the 
 subject with due accuracy, learning, and impartiality, will affirm 
 the conclusions to which I have arrived; unable to discern, in the 
 * writings of the opponents of the malarial origin of fevers, anything 
 calculated to weaken, in the least, the force of what has been 
 adduced in its support ; and fully satisfied that none of the other 
 agencies to which those diseases have been, at times, ascribed, can 
 give rise to their phenomena, I have no hesitation in regarding 
 that mode of origin as a fact placed beyond the possibility of doubt. 
 
 Now, if while entertaining these sentiments while holding au 
 tumnal fevers to be the morbid products of the poisons in ques 
 tion we lend a willing ear to the speculations of those, who, 
 reviving a long-exploded hypothesis, contend that the same dele- 
 
336 PNEUMONIA AND 
 
 terious agents which produce fevers will also produce pneumonic 
 inflammation ; and if, from this supposed similarity of origin, we 
 argue that pneumonia is really and substantially nothing more 
 than a peculiar form of remittent and intermittent fever, we shall 
 be inevitably led to the conclusion, that malarial exhalations may 
 and do give rise, in some localities, and under certain circumstances, 
 to inflammation of the lungs. Nor is this all. Experience, as I 
 have endeavoured to demonstrate in a former chapter, teaches that 
 pneumonia occurs, and even prevails extensively, under circum 
 stances when malaria cannot, in the most distant manner, be 
 suspected to have been an efficient and necessary agent in its pro 
 duction as, for example, in places where the poison is not evolved, 
 or, if so, is harmless ; or in seasons of the year when, supposing it 
 to have existed or produced its characteristic effects before it has 
 been destroyed through the influence of frost or other disinfecting 
 means. In all such localities and seasons (as the reader cannot fail 
 to perceive), it follows that the disease, when it occurs, must be due 
 to the operation of morbific agencies, different from those to which 
 autumnal fevers have been distinctly traced. The conclusion is 
 inevitable, and, if while taking it into consideration, we admit the 
 reality of the peculiar effects assigned to malarial exhalations if 
 we consent to regard these as prolific causes not only of autumnal 
 fevers but of pneumonic inflammation also we shall be compelled 
 to recognize the possibility of the latter disease being, not only in 
 different localities and in different seasons of the year, but every 
 where, and at all times, the offspring, indiscriminately, of two sets 
 of causes, which, on examination, will be found to possess very dis 
 similar characteristics and properties. Hence, we shall have the 
 rather anomalous phenomenon of one and the same disease some 
 times springing from the operation of a toxical agent the more 
 ordinary, or indeed legitimate effect of which is the production of 
 autumnal fevers and at other times resulting from morbific influ 
 ences, which, whatever be the variety of the diseases they really 
 produce a question we have nothing to do with at present have 
 never, so far as can be discovered, occasioned, alone and unaided 
 by the former agent, an attack of pure remittent, intermittent, 
 yellow, or kindred fevers. To conform ourselves to the language 
 of our opponents, we shall have an example of one form of 
 periodic fever, i. e. pneumonia, produced by a particular cause 
 malaria which gives rise also to other forms assumed by that 
 
AUTUMNAL FEVEKS. 337 
 
 Protean disease remittent, intermittent, and yellow fevers ; while 
 in other and more frequent instances, the aforementioned form, 
 pneumonia, springs from the action of other and very different 
 morbid influences, prolific in inflammations of that sort, but differ 
 ing widely from malaria in this, that they cannot give rise to the 
 fevers in question. In a word, admitting the views referred to to 
 be well founded, the so-called pneumonic form of autumnal fever 
 may be produced by either of two sets of causes; the one of which, 
 at the same time that it occasions that effect, is ^ the active agent in 
 the production of the more legitimate form of the disease ; while 
 the latter form of disease true autumnal fever results from the 
 operation of but one of these sets of causes malarial poison and 
 has never yet been satisfactorily traced to the baneful influence of 
 those other agents, which are acknowledged to produce the pneu 
 monic form. 
 
 Now, it is not presuming too much to say that there is not one 
 solitary case, authentically recorded, and adduced by an individual 
 competent to decide in matters of the kind, in which genuine pneu 
 monia can be truly said to have been produced solely by the well- 
 ascertained cause of autumnal fever, and which can thereby enable 
 any one to demonstrate, in a satisfactory manner, the connection, 
 as cause and effect, between malaria and that disease. That a con 
 gested state of the lining membrane of the bronchial tubes, allied 
 to inflammation, exists in many cases during the cold fit of an 
 ague, may be and is doubtless true. The strong, sonorous rale, 
 which totally disappears on the accession of perspiration, indicates 
 this condition, and has been noticed too often to be denied. There 
 may exist, also, during the cold stage, some congestion of the lungs, 
 which occasionally may approximate to the first stage of pneu 
 monia. But these conditions are the effects of the mere concentra 
 tion of blood in the internal organs, and occur in all complaints 
 attended with a chill. They do not amount to positive inflamma 
 tion; and, besides, do not present themselves in other forms of 
 malarial fevers in which the chill is feebly marked and not repeated. 
 None, indeed, of the circumstances connected with the evolvement 
 and dissemination of malaria, whose legitimate effect is the produc 
 tion of autumnal and periodic fevers of various grades and types, 
 in localities where the proper materials of decomposition exist, will 
 be found to prove instrumental in causing pneumonia or other 
 diseases of a kindred character. Nor can it be proper to look to 
 22 
 
338 PNEUMONIA AND 
 
 the products of such decomposition to account for the occurrence 
 of pulmonary inflammation in malarious localities and seasons, 
 unless we feel disposed, at the same time, to ignore, in such places 
 and at such periods, the morbific influence in the production of the 
 disease, of the causes which are acknowledged to produce that same 
 disease in situations where, and at times when, malaria does not 
 and cannot be admitted to float in the atmosphere. In other words, 
 before doing so, it will be necessary to prove that in localities or 
 seasons noted for the evolvement of malaria, the ordinary causes of 
 pneumonia do not prevail, or, if they do, remain perfectly harmless, 
 and allow their rival in mischief to produce alone effects, to which, 
 under other circumstances, they themselves give rise. It is scarcely 
 necessarv to remark, that there is nothing in the atmosphere of a 
 malarious locality capable of excluding the ordinary causes of 
 pneumonia; and i a maintaining that they there assert their sway 
 as freely as when the air is not tainted by morbid effluvia, we do 
 not sin against the canons of that system of philosophy on which 
 some of our opponents lay so much stress. Now, if such morbid 
 influences exist as well in malarious as in other localities ; if nothing 
 can be pointed out capable of preventing the morbid effects they 
 produce in the latter from being produced also in the former, it is 
 certainly needless to have recourse to such effluvia for the purpose 
 of accounting for the occurrence of that disease ; for when the latter 
 occurs under such circumstances, it may fairly be attributed, not to 
 malaria, but to the operation of its ordinary causes. The conclu 
 sion will appear still more natural when we bear in mind a fact 
 already adverted to, that none of the conditions of locality, which 
 are inimical to the formation of malaria, as well as none of the 
 hygienic means by which the evolvement of the poison is arrested 
 or diminished, have the effect of preventing or lessening the pre 
 valence of pneumonia. The disease continues to present itself as if 
 no changes had been made in the surrounding circumstances, and 
 we are justified in presuming that the same causes which give 
 rise to it after the extinction of malaria have produced it before that 
 extinction. 
 
 But let us admit, for the sake of argument, that in all I have 
 advanced on this subject, I err. Let us admit that sporadic pul 
 monary inflammation catarrhal or parenchymatous is produced 
 occasionally, or often, by the malarial poison, and that the epidemic 
 forms of the disease are due to the same cause ; I am not sure that 
 
AUTUMNAL FEVERS. 339 
 
 the admission will afford much help to those who feel disposed to 
 argue, from this circumstance, that pneumonia is only a peculiar 
 form of periodic fever. In the first place, the conclusion, if well 
 founded, would only apply to those particular cases which occur 
 where malaria is known to be evolved ; for, as we have seen, and 
 as is acknowledged, inflammation of the lungs presents itself under 
 circumstances when it must be due to the operation of other mor 
 bific influences, and cannot, therefore, be viewed as closely con 
 nected with the fevers in question. In the second place, whether 
 pneumonia be produced by one or the other of the causes, from 
 the action of which it is well-ascertained to originate, it is, to all 
 intents and purposes, the same disease; it is simply pneumonia, and 
 nothing else. If produced by malaria, the same thing would occur 
 the morbid effects produced on the lungs would be the same, as 
 if they w^ere the result of any of their ordinary causes. The dis 
 ease would not be, because thus produced, autumnal fever, but 
 simply pneumonia. If unmixed with unusual morbid elements, it 
 would be governed by the same laws as other cases; it would be 
 recognized by the same symptoms; would present the same ana 
 tomical characters, and would call for the same treatment ; while, 
 in cases presenting the unusual elements above alluded to, these 
 would constitute an addition to the original elements of the disease, 
 by which the latter would be complicated and more or less modi 
 fied, without, however, being altered in its essential characters. 
 
 2. We have seen, in a preceding chapter, that the prevalence of 
 malarial fevers, of various grades and types, is restricted within 
 certain localities ; that, in many instances, the area of these infected 
 places is very limited in extent; that while the disease prevails in 
 one spot, individuals who reside at a short distance, and abstain 
 from visiting that spot, escape ; that by removing from one part of 
 the same city to another not far distant, or from one end or side of 
 a house to another, or from a lower to a higher story, the disease 
 may be avoided; that ships, by shifting their position from one 
 part of a sickly port or shore to another close by, are often found 
 to lose the fever from which, before the change, they had suffered 
 severely. We have seen, on the other hand, that in certain locali 
 ties, the crexvs of vessels that had been exempt from fever so long- 
 as they remained at only a short distance from land, were attacked, 
 sometimes to a man, as soon as they ventured ashore ; and that 
 individuals who had enjoyed good health while avoiding infected 
 
340 PNEUMONIA AND 
 
 city or country localities, were attacked, with an almost unerring 
 certainty, in consequence of visiting or passing through them. 
 Now the physician who should undertake to collect facts to prove 
 that the sphere of prevalence of pneumonia is as narrowly circum 
 scribed as it is sometimes found to be in fever, would have an 
 ungrateful task to perform. "We nowhere hear of this disease 
 attacking a large number of the residents of a limited spot, of a 
 part of a street or house, and leaving every one in the close vicinitv 
 of that spot, in the next street, or in the adjoining houses, perfectly 
 unscathed. Nor need we fear to predict that the medical writer 
 who ventures on the assertion that pneumonia has frequently been 
 observed to attack the occupants of the lower rooms of houses, or 
 the basement wards of a hospital, and to scrupulouslv respect those 
 who dwell above ; that all the inmates of one end of an asylum, 
 hospital, prison, or house, have been struck down by inflammation 
 of the lungs, while those occupying the other parts of the same 
 building have remained untouched and that, too, not during one 
 season, but during a succession of seasons will run great risk of 
 giving but an unfavourable opinion of the authenticity of his facts, 
 or the soundness of his judgment. We do not hear of the crews of 
 ships ridding themselves of the disease in question, by shifting their 
 position, and anchoring at the distance of a few dozen yards ; or of 
 vessels, which before had been healthy, becoming, by a reverse 
 change or the removal of an intervening ship or other object, sud 
 denly visited with the disease. Neither do we find a large number 
 of instances on record of vessels which were free so long as they 
 remained under sail, or at anchor at a short distance from an in 
 fected shore, being filled with pneumonic cases the moment they 
 approached close to the land, or sent their boats to explore the 
 mouths of rivers, &c.; or, again, of scores of individuals, who had 
 remained healthy while residing at a short distance, being attacked 
 with pleurisy or pneumonia in consequence of jumping over the 
 barricades, and promenading about the streets of an infected spot. 
 
 3. It has been seen that the cause of autumnal fever is wafted 
 by the wind ; that the disease prevails in localities situate in such 
 a way as to receive, through that means, the malarial exhalations 
 evolved from local sources of infection ; while other localities placed 
 in a contrary direction, though at a very short distance, escape 
 more or less completely. It has been seen, also, that the effect does 
 not depend upon the particular point of the compass, abstractly 
 
AUTUMNAL FEVERS. 341 
 
 considered, whence the wind happens to blow, but upon the posi 
 tion the suffering locality occupies relatively to marshes or other 
 sources of morbid effluvia. Again, we have seen that the disease, 
 thus produced, will be arrested in, or diverted from, its course by 
 a hill, a row of trees, a wall, a curtain, or other such causes of ob 
 struction; and, on the contrary, that places heretofore healthy have 
 become infested with fever, by simply removing such obstructions 
 and allowing a free access to some particular wind. The history of 
 pneumonia furnishes us with nothing of the kind. It presents no 
 example of the disease being produced or prevented in this way ; 
 of its causes being wafted by a particular wind passing over an in 
 fected locality ; of its course being impeded by hills, trees, walls, 
 and curtains ; or of cases of it being multiplied by the removal of 
 these. That cold winds will, as we shall see, produce, under par 
 ticular circumstances, cases of pneumonia, is doubtless true; but it 
 should be borne in mind that it matters not whether such winds, 
 in order that they may occasion that effect, pass over sickly or 
 healthy localities, while their real agency in the matter is without 
 difficulty accounted for by the sudden production of one or more 
 of the ordinary causes of the disease. 
 
 4. We have seen that the overflow of the sea, of lakes, of 
 rivers, or other sheets or streams of water ; the establishment of 
 mill-dams ; the digging of canals ; the levelling of streets ; the partial 
 draining of marshy surfaces ; the clearing of new land, and the like, 
 are fruitful sources of fevers. We have seen that these are produced 
 by exhalations from masses of decaying or green timber, or of 
 other vegetable as well as of animal substances, separate or com 
 bined, in a state of decomposition. Where, may it not be asked, 
 shall we find well-authenticated instances of pneumonia produced 
 by such occurrences, unless they bring along with them some of 
 the ordinary and well-known causes of the disease? Apart from 
 these causes those occurrences are harmless, so far as thoracic in 
 flammations are concerned. 
 
 5. Facts in large numbers have been adduced to show the salu 
 tary effects of complete drainage in putting a stop to, or in dimi 
 nishing, the prevalence of fevers. While such is the constant result 
 of this measure in regard to those diseases, no change is effected so 
 far as concerns pneumonia, which generally continues to show itself 
 as if nothing had occurred. We have seen that the same salutary 
 effects, as regards fevers, have followed the complete flooding, by 
 
342 PNEUMONIA AND 
 
 artificial or natural means, or the washing of insalubrious localities. 
 So far, nothing has been pointed out calculated to show that from 
 such occurrences have resulted like salutary effects in respect to 
 pneumonia, the number of cases of which does not seem to be 
 smaller when the country at large is deluged with water, than 
 when it is but partially covered ; or after a heretofore sickly locality 
 has been rid, through the effect of rain or otherwise, of all sources 
 of malarial exhalations. 
 
 6. We have seen that autumnal fevers, the offspring of malarial 
 exhalations, prevail sometimes to an extraordinary extent in certain 
 localities, and that, on particular occasions, they spread over a wide 
 expanse of country, striking down at once, or in rapid succession, a 
 large portion of the population, and causing among them a consider 
 able mortality. We have seen, also, that while in certain localities 
 such fevers prevail extensively, and occasion a great loss of life, in 
 other places, situate close by, and differing little from the former 
 in climate, altitudinal range, and other particulars, they attack but 
 few, and give rise to a small proportional mortality ; that in some 
 of the West India Islands, for example, the deaths among the troops 
 have amounted to 104.1 per 1,000 (Tobago), while in others (St. 
 Vincent s and Barbadoes) they have not reached 12 per 1,000. No 
 thing of the kind will be found to hold good as regards pneumonia, 
 which in ordinary times is, comparatively at least, a disease of 
 unfrequent occurrence ; prevails in the same place to very much 
 the same extent at each return of its appropriate season; or, if it 
 varies in that respect, does so on account of corresponding changes 
 in the sensible qualities of the atmosphere; prevails to an equal 
 extent in each of the several places where fevers are so unequally 
 distributed ; occasions everywhere much the same rate of mortality ; 
 and, at periods of its widest epidemic diffusion, neither attacks by 
 far so large a number of individuals, nor causes so immense a loss 
 of life, as we find to be the case with regard to the other disease. 
 
 7. It is a fact placed beyond doubt, that malarial fevers, what 
 ever be the form they assume, are more likely to be the result of 
 exposure, in infected localities, to night air, by which the poison 
 may very naturally be understood to be condensed and rendered 
 more prolific of disease. During the various epidemics of yellow 
 fever in this city, the baneful influence of night air was manifested 
 in such innumerable instances as to leave no doubts on the subject 
 in the minds of physicians conversant with the disease, by some of 
 
AUTUMNAL FEVERS. 343 
 
 whom it has been recorded in emphatic terms. 1 Dr. Merrill, already 
 cited, in a private communication to the present writer says, in 
 reference to the yellow fever of Natchez : "I know of no instance in 
 which the disease was ever taken from exposure in the daytime, and 
 then returning home to the country." This only confirms an observa 
 tion very generally made at every epidemic return of this form of 
 fever in tropical and temperate climates. The same holds good in 
 regard to remittents and intermittents everywhere, abroad or at home; 
 even under circumstances when the greatest attention is paid to guard 
 against the action of ordinary morbific influences. 2 I am not aware 
 that pneumonia, in regard to the peculiarities attending its produc 
 tion, is governed by any law of the kind. Its causes are operative 
 by day as they are by night. When proper precaution is taken, 
 during the latter period, to shield the body from their effects, the 
 disease will be easily avoided. But when the same precautions are 
 not attended to during the day, the disease is as apt to follow then 
 as at any other period. Even admitting this not to be true, expe 
 rience teaches that night exposure is not more dangerous, so far as 
 regards this disease, in a malarial than in a non-malarial locality ; 
 the condition of soil, temperature, and other contingencies being 
 the same in all ; whereas, the contrary is the case in reference to 
 autumnal fevers, which follow on such exposure only in certain 
 localities. 
 
 8. Nor are we to lose sight of the fact pointed out by very 
 reliable authorities, and which experience everywhere confirms, 
 that the production of fevers is favoured by the state of sleep. 
 Dr. Eush, in his account of the epidemic of 1793, says: "A great 
 proportion of all who were affected by this fever, were attacked in 
 the night. Sleep induced direct debility (which he afterwards 
 called debility by abstraction), and thereby disposed the contagion 
 (malaria), which floated in. the blood, to act with such force upon 
 the system as to destroy its equilibrium, and thus produce a fever. 
 The influence of sleep, as a predisposing and exciting cause, was 
 
 1 Hush, Fever of 1703, p. 50; Works, iv. 18. 85 ; Deveze, 113, 114; J. K. Mitchell, 
 53, 54; Chapman, Phil. Med. and Thy*. J. via. 319 ; Emlen, N. A. J. v. 327; Cald- 
 woll on Miasm, 507; do. on Malaria, 128, 144; Wood, i. 314. 
 
 2 Grant, 58; Monltric, 62; Valentin, 228; Lempriere, ii. 113; Dariste, 218; Hollo. 
 144: Arnold, GO; Celle, 202 ; Cnillot, 200 ; Bally, 500 ; Bryson, 217; Brocchi, 260 ; 
 J. Johnson on Trop. Cl. 73 ; Higaiul do L Isle, in do. 312; Gilbert, 81 ; Barton, Fev. 
 of Hong-Kong, Dublin J. (X. S.) xii. 344-347. 
 
344: PNEUMONIA AND 
 
 often assisted by the want of bedclothes suited to the midnight or 
 morning coolness of the air." That such an agency has been called 
 in question by Dr. Deveze (114, llo), and others, is doubtless true. 
 But by reference to some of the older and many later and contem 
 porary writers, from Lancisi to the present day, we shall find state 
 ments of facts observed in Europe, Asia, Africa, and America, 
 which confirm the views of our eminent countryman. 1 Speaking 
 of the remittent and intermittent fevers of Peru, Ulloa long ago 
 remarked : " Quand ces fi^vres regnent dans les Quebradas (or deep 
 valleys) il suffit d*y syourner pour en etre pris ; qu on y dorme de nuit ou 
 dejour, on ne les evite pas" 2 Nor can the effect be matter of astonish 
 ment. Every one knows that certain functions are modified in a 
 more or less marked degree by the state of sleep. Dr. Edwards 
 has shown, 3 and the same observation was made before by Sancto- 
 rius and Keill, that the state in question has a tendency to increase 
 the perspirable process. At the same time, the nervous energy is 
 diminished, the circulation is less rapid, calorification is lessened, 
 other functions are performed with less energy, and the whole 
 system is in a state of relaxation. In a word, the body is in a 
 condition calculated to impair greatly the elimination of the malarial 
 poison, and thereby favour its morbific impression on the system. 
 That the state of sleep may, for the same reason, render the body 
 more susceptible to the action of other morbid agencies even of 
 those which give rise to pneumonia and that hence the attack, in 
 some instances, may have been due to exposure to cold during that 
 state, no one is justified in denying. But such cases are compara 
 tively seldom encountered; and in fenny districts or infected 
 localities, persons who fall asleep in the open air at night, during 
 the sickly season, are not more than ordinarily liable to attacks of 
 pneumonia, or at any rate not more so than if no cause of infection 
 existed; while in other localities, during corresponding seasons, 
 but where such causes do not exist, sleeping in the night air may not 
 
 1 Lancisi, op. cit. 77; Bancroft, 86, 87, 100, 172; Lind on Seamen, 75 ; II. on Hot 
 Cl. 192, 233; Wood, i. 144; Simons, 18; Bryson, 218; Wallace, Edinb. J. xlvi. 273; 
 Monfalcon, 196; Alibcrt. 235; Folchi, N. A. J. vii. 258; Clark s Notes on Italy, 10; 
 Blanc on Seamen, 230; Edinb. Rev. xxxvi. 546; Cclle, prat, des Pays Chauds, 298; 
 Watson, Tract. 450 ; Brocchi, Stato Fisico de Roma. 
 
 2 Ulloa, Mcmoires Philosopbiques Hist Physiques concernent la Decouverte de 
 1 Amcrique, i. 245. 
 
 3 On Physical Agents, 102, Am. ed. 
 
AUTUMNAL FEVERS. 345 
 
 be indulged in with impunity unless the same precautions are used 
 as would be necessary in the daytime. 
 
 9. We have seen that the development of fever may be pre 
 vented, and its progress arrested, by the judicious use of disin 
 fectants by smoke, the sprinkling of lime, the lighting of fires; 
 by the clearing and washing of gutters, sinks, and sewers ; by the 
 removal or covering over of sources of infection. No such means 
 have ever, to my knowledge, prevented the development or arrested 
 the progress of pneumonic inflammation, among the inhabitants of 
 any locality, large or small. To this, let me add that in malarial 
 localities, where fevers are rife, and exposure early in the morning 
 is almost sure to be followed by an attack, it has been found useful 
 to avoid going out on an empty stomach or without taking a small 
 quantity of ardent spirits, or a cup of hot coffee. From this has 
 doubtless arisen the custom, so prevalent in some parts of tropical 
 countries in Martinique, Guadalonpe, Guiana, Cayenne, &c. of 
 taking a cup of strong infusion of the latter on rising in the morn 
 ing. Ity means of this substance, the bitter principle of which 
 bears some analogy to that of cinchona, intermittent fevers, as we 
 learn from Moreau de Jonnes, are frequently prevented. The same 
 effect is obtained by bark itself, or some of its salts taken in the 
 same way. When the French army encamped in the morasses of 
 Mantua, the soldiers were all made to take, at the dawn of day, a 
 portion of tincture of bark, and from this precautionary measure, 
 which was long ago recommended by Lind and other writers, the 
 most beneficial results were obtained. 1 These precautions will serve 
 very little purpose against pneumonia. 
 
 10. We have seen that fevers are in very many instances the 
 result of a solitary and transient exposure to an infected locality ; 
 indeed, that the large majority of those who thus expose them 
 selves, run an imminent risk of an attack. In regard to pneumonia, 
 not one probably in thousands would be in danger from such ex 
 posure in any locality ; and in those so attacked, after a visit to an 
 infected spot, the disease would easily be traced to a disregard of 
 precautionary measures absolutely necessary everywhere to guard 
 against the disease, and which have no connection whatsoever with 
 
 1 Blane, Dissertations, i. 221 ; Bryson, 227; Aubert Roche, Mem. sur I Acclimate- 
 ment, An. d Hyg. xxxiii. 23 ; Monfalcon, op. cit. 232 ; Celle, Hygiene des Pays Chaucls, 
 347, 367 ; Moreau de Jonnes, Hygiene Militaire des Antilles, 07 ; Lind on Hot Climates, 
 317, 318; Thevenot, 05; Cuillot, 264; Hollo, 147. 
 
346 PNEUMONIA AND 
 
 the special causes of autumnal fevers, while the danger would not 
 be greater in sickly localities than elsewhere. 
 
 11. It has been stated, on respectable authority, that in both the 
 West and East Indies, places where the mangrove and mancinellas 
 grow luxuriantly, the most unhealthy spots are those in which the 
 roots of those plants are only occasionally and partially under 
 water ; and that in tropical climates the existence of a large quan 
 tity of astringent plants, the bark of which is rich in animal matter 
 combined with tannin, is generally connected with the development 
 of fever. What reason have we for believing that these circum 
 stances exercise an influence on the development of pneumonia ? 
 
 12. Epidemics of fever are on very many occasions attended 
 with a wide-spread disturbance in the health of the population at 
 large a considerable number of individuals, though not labouring 
 under the fully-formed disease, exhibiting one or more of its symp 
 toms in a mitigated form, and bearing the marks of the cause hav 
 ing produced an impress on the system, as shown by the condition 
 of the eyes, the secretions, the alimentary canal, the brain and 
 nerves, the blood, &c. AVe do not find such a result to obtain 
 during seasons when pneumonia is most prevalent. 
 
 13. Neither do we find that in those seasons the lower orders of 
 animals or plants suffer in a way corresponding to that they are 
 often found to suffer in times of fever epidemics. 
 
 In fine, the more we examine the question at present before us, 
 the more inclined we must be to adopt the opinion, that pneumonia 
 is never produced simply by the introduction into the system of a 
 malarial poison by which the atmosphere of an infected locality is 
 polluted; for, when the disease attacks individuals exposed to the 
 influence of such places, it may be traced to the operation of other 
 agencies, which prevail contemporaneously with the poison in ques 
 tion, and cannot fail to exercise their baneful effects in an impure, 
 as they do in a pure locality. Nor can we greatly err, when we 
 affirm that if those agents produce pneumonia in places where the, 
 malarial influence does not extend, where malaria is never evolved, 
 or where its evolution, if it has taken place, has been completely 
 arrested, as proved by the constant absence or cessation of its legi 
 timate effects fevers it is to them we must look for the true 
 cause of the development of the disease when it shows itself in 
 infected localities, and not to the exhalations by which the atmo 
 sphere of those localities may be contaminated. So long as care is 
 
AUTUMNAL FEVERS. 347 
 
 taken to avoid the action of those agencies, exposure to malaria 
 may produce fevers ; but no quantity of it received into the system 
 will occasion pneumonia, which, in fever localities as elsewhere, 
 owes its origin to the operation of the same causes. 
 
 Causes of Pneumonia. As regards the nature of the morbific 
 influences in question, it will not be necessary to say much in this 
 place. Every one conversant with the subject, whether in or out 
 of the profession, knows full well, that pneumonia and all other 
 kindred affections of the thoracic organs, are very usually due, not 
 in one place and in one season only, bat in all places and at all 
 times, to atmospheric vicissitudes, to exposure to cold, especially 
 when the body is hot and perspiring, to currents of cold air, and the 
 like. 1 Dr. Barton, of New Orleans, who has paid much attention 
 to meteorological subjects, informs me, in a private communication, 
 that "Pneumonia is most apt to occur at variable temperatures 
 from 20 to 50 with a low dew-point, and great drying power, 
 producing rapid evaporation from the surface of the lungs and 
 skin." Add to these sundry physical and local causes violent 
 exercises of the voice, irritating vapours, and asphyxiating gases, 
 blows on the chest, wounds of the lungs ; the translation by meta 
 stasis of gout, rheumatism, cutaneous diseases ; the transfer of 
 inflammation or purulent deposits after extensive wounds in vari 
 ous parts of the body, or important surgical operations. 2 Expe 
 rience teaches all this; and teaches, besides, that the prevalence of 
 pneumonic inflammation in each system of climate increases and 
 decreases in proportion, not as the evolution of malaria increases or 
 decreases, but as the seasons are contrasted ; thus maintaining, as 
 Dr. Forry has correctly pointed out, an unvarying relation with the 
 extreme range of the thermometer as connected with the seasons. 
 In other words, we find that the ratio of those diseases is highest in 
 proportion as the difference between the temperature of summer 
 
 1 Plildebrand, Inst. Pract. Med. iii. 194; Bouillaucl, Diet, de Med. Pract. xiii. 359; 
 Ib. Med. din. ii. 151 ; Grisolle, 147 ; Swett. 80, 81 ; Williams, Cycl. of Pract, Med. iii. 
 407; Chomel, Diet, de Mod. xxv. 1G4; Andral, Med. Clin. i. 512; Barthez et Rilliet, i. 
 115; Pinel & Brichetau, Diet, des Sc. M&l. xliii. 396; Laennee, i. 546; Forbes s 
 Transl. 225 ; Daniel Monro, ii. 247 : W. Phillip, 204 ; Wood s Pract. ii. 42. 
 
 2 See Sir C. Bell s Surg. Operations; Guthrie on Gunshot Wounds; Forbes s Laen 
 nee ; Williams, Cyclopedia; Grisolle, 142: Rouppe, 44; J. Frank, 810 : Lieutaud, i. ; 
 Portal, Auat. Med. v. 72: Andral, Clinical Med, i, 512; Erichsen, Mcd.-Ch, Trans, 
 xxvi. 2!l 
 
348 PNEUMONIA AND 
 
 and winter increases, and lowest in proportion as it grows less; 
 that the stronger the impression on the system by the high tempe 
 rature of the former season, the more susceptible the lungs are ren 
 dered, so far as regards inflammatory complaints, to the morbific 
 agency of the opposite seasons ; that those diseases are invariably 
 less prevalent in the moist and changeable climate peculiar to the 
 sea-coast and large lakes of this country, where malaria is abund 
 antly evolved, than in the dry atmosphere of the opposite locality, 
 where the febrile poison is not largely produced. Hence, if pneu 
 monia and pleurisy are more frequently encountered in the Middle 
 and Southwest regions of the United States than in the cold and 
 variable climates of our Northern and Eastern States, the explana 
 tion is not to be sought in the fact, that the cause of periodical or 
 autumnal fevers exist in many sections of those regions, but in the 
 circumstance that individuals are placed under the control of the 
 law above alluded to ; i. e. the greater impressibility of the thoracic 
 organs to cold occasioned by the previous influence exercised by 
 long-continued summer heat; and that the effect is equally well 
 marked, whether the locality where these diseases are found, be or 
 be not the seat of febrile affections, or characterized by the kind of 
 soil prone to the production of the latter ; and are likewise noticed 
 in climates where, from the peculiarities of the soil, the nature and 
 proportionate duration of the seasons, and the range of the thermo 
 meter and hygrometer, they never have originated, and in all 
 probability never can originate. 
 
 Another writer, who has investigated the subject on even a 
 larger scale than Dr. Forry Dr. Lawson, of the English army, and 
 whose conclusions are drawn from the results obtained among the 
 British troops in the different stations scattered over the greater 
 part of the earth, remarks, that the frequency of inflammatory dis 
 eases of the lungs, and the amount of the resulting mortality, are 
 proportional to the prevalence and activity of the (not malarial 
 poison, but) refrigerating causes relatively to the powers of resist 
 ance of the constitution. 1 
 
 Not very different is it in relation to catarrhal complaints, which, 
 as we have seen, Dr. Copland and others have classed among the 
 products of malaria. Except, perhaps, when it presents itself in the 
 garb of what lias been denominated influenza and then it is appa- 
 
 1 Ediub. Med. and Surg J. Ixii. 50. 
 
AUTUMNAL FEVERS. 349 
 
 rently due to some wide-spread and travelling meteorological change, 
 of the essence of which we know nothing, but certainly bearing no 
 analogy to miasmal exhalation catarrh is evidently the offspring 
 of those atmospheric influences to which other thoracic irritations 
 are due; while the idea of its dependence on the specific cause of 
 periodic fevers will be found destitute of solid foundation. On this 
 subject let the following remarks of Dr. Forry suffice : 
 
 " That catarrhal fever has not the remotest connection with ma 
 larial causes, is demonstrated by the statistics of our troops. As 
 the ratio of intermittent and remittent fever is about five times 
 higher in our southern than northern latitudes, and as that of 
 catarrhal affections is twice as high in the latter, it follows that, as 
 the results are in an inverse proportion, no relation of cause and 
 effect is discoverable. As the classification of Dr. Copland, how 
 ever, limits the production of catarrhal fever to temperate ranges 
 of atmospheric heat, aided by moisture, it may be said that it ap 
 plies only to our northern regions. In diametrical opposition, then, 
 to this view, it is found that in the winter, when no miasm from 
 decayed vegetable matter arises, the ratio is twice as high as in 
 summer, and that the annual ratio in the moist climate of the lakes, 
 and the coast of New England, is not more than half as high as that 
 of the dry climate of the region remote from large bodies of 
 water. " 1 
 
 All this, let it be said en passant, differs somewhat from the re 
 sults obtained in regard to autumnal fevers, which, in temperate 
 regions, where the temperature of the several seasons are generally 
 strongly contrasted, often prevail most when a very long hot sum 
 mer succeeds to a very cold winter; and which, on the other hand, 
 spread more extensively in tropical regions and in the southern 
 regions of this country and Europe, where the seasons are not con 
 trasted, or are so to a limited extent, and which require for their 
 development and dissemination meteorological conditions, for the 
 most part the reverse of those mentioned in regard to pneumonia. 
 
 But be this as it may, the experience of the world shows that 
 although it is not always possible, in all individual cases of pneu 
 monia, and under all circumstances, to arrive at a precise knowledge 
 of the cause of the disease, owing to the difficulty of obtaining defi 
 nite and correct information from those attacked, or from the indis- 
 
 1 Climate of the U. S. 305. 
 
350 PNEUMONIA AND 
 
 tinct manner in which the morbid agent has impressed the s} r stem; 
 yet, in the larger number of instances, the disease is due to well- 
 ascertained injurious influences, not one of which can produce, or 
 has ever produced, intermittent, remittent, bilious, or yellow fevers, 
 or bears the least analogy to the morbid poisons which give rise to 
 these maladies. And it is not a very great stretch of assumption 
 to suggest, that in those instances in which the cause cannot be 
 satisfactorily ascertained, it would, if discovered, be found to be 
 allied to the former influences, and to have nothing in common with 
 the latter. True it is that writers have speculated on the possibility 
 of inflammatory affections of the lungs being, under particular cir 
 cumstances, produced by the introduction of certain morbid poisons 
 into the circulation, through the agency of respiration or otherwise ; 
 and it may be argued that, if we admit this to be the case in some 
 instances, the advocates of the malarial origin of pneumonia will 
 think themselves justified in maintaining, that what is true of one 
 or more poisons, may be supposed to hold equally good in regard to 
 the cause of autumnal fevers. Such, for example, has been said to 
 be the effect of the poison of the rattlesnake, which, it is affirmed, 
 gives rise to pneumonia; and we know that epidemic catarrh or 
 influenza, in which the disease extends sometimes to the substance 
 of the lungs, as well as epidemic pneumonia, are supposed by 
 respectable authorities among whom, in reference to the latter 
 complaint, we find no less a name than that of Laennec 1 to be due 
 to a peculiar miasm floating in the atmosphere ; the reason assigned 
 being the universality of the prevalence of those affections, and the 
 difficulty of tracing them to any of their ordinary causes. In all 
 this, however, we can discover nothing more than conjecture. In 
 the first place, the statement respecting the agency of the poison -of 
 the rattlesnake in producing pneumonia, to say the least, needs 
 confirmation. By those most experienced in the matter, it is statod 
 that when a rabbit or small animal is poisoned by this snake, it 
 gives no evidence of feeling pain, and generally for some minutes 
 appears to be well his ears then begin to droop, giddiness and 
 uneasiness follow, and the animal falls; the pupil becomes dilated, 
 slight convulsions ensue, and death closes the scene in about fifteen 
 minutes from the accident. On examination, it is found that tin* 
 red colour of the blood in the part affected has been d-jstrnyo-l. 
 
 1 Traite de 1 Auscultation, i. 547. 
 
AUTUMNAL FEVERS. 351 
 
 The muscular fibres and cellular substance for two inches around 
 the puncture are black, and so is the blood in the veins leading 
 from the wound ; that in the heart is darker than natural, and does 
 not coagulate so firmly as when the animal has been killed by a 
 blow on the head ; the supply of blood to the brain is deficient; but 
 neither this organ nor any other solid parts show signs of injury, 
 except near the wound, which swells sometimes very considerably. 1 
 In man, the symptoms are longer in developing themselves, and 
 the disease runs a more protracted course ; but the phenomena are 
 similar in kind, and in no instance evince anything indicating the 
 existence of pneumonic inflammation. If pulmonary symptoms 
 occur, and the lungs are found to present, after death, marks of 
 morbid change, the effects are due, in this and other kindred cases, 
 to simple congestion, a condition very generally encountered in 
 affections characterized by, or combined with a defibrinated state 
 of the blood. 2 
 
 Again ; of the morbific agent which gives rise to influenza we 
 know little. Indeed, if we knew more, it is not certain that our 
 information would lead to anything of much importance relative to 
 the present inquiry ; inasmuch as that agent, whatsoever be its na 
 ture, affects primarily the mucous tissue of the lungs ; and pneu 
 monia, when it occurs, is only consecutive, and not the direct effect 
 of the cause producing the primary disease. Moreover, in regard 
 to epidemic pneumonia, nothing as yet adduced proves its malarial 
 origin. If sporadic cases of pulmonic inflammation can and do arise 
 from the operation of causes totally unconnected with the existence 
 and evolution of miasmal exhalations, there is no reason why the 
 epidemic form of the disease should not be assigned to the same or 
 similar agencies acting more extensively, in consequence of a uni 
 versal state of predisposition brought about by a peculiar, insensible, 
 and unfathomable condition of the atmosphere. The diffusion of the 
 disease over large tracts of country ; its prevalence at diversified sea 
 sons of the year, under diversified conditions of the sensible qualities 
 of the atmosphere; its visiting with equal force localities of different 
 or even opposite characters and conditions ; its appearing, even at 
 sea, far beyond the reach of any possible source of exhalation ; are 
 inimical to the theory of its miasmal origin; while the argument 
 
 1 Stevens on the Blood, 138. 
 
 2 See a communication on " The Bites of Venomous Serpents," by Dr. E. Hallo- 
 well, in Trans, of Thilad. Col. of Phys. i. N. S. 394. 
 
352 PNEUMONIA AND 
 
 derived from the circumstance of the impossibility of discovering 
 an evident cause to account for epidemic pneumonia is met by the 
 fact already referred to, that sporadic cases, which it would be next 
 to an absurdity to attribute to malaria, spring up without its being 
 possible to trace them to any evident cause. At any rate, if the 
 morbid agent giving rise to this and the preceding form of disease 
 must really be viewed as nothing more than a species of malaria, 
 that malaria can bear no analogy to the one producing autumnal 
 fever. More likely is it that the cause of diffusion of the disease is 
 meteorological, and assimilable to the terrestrial fluids of electricity 
 and magnetism, and that its operation is limited to predisposing the 
 system to be acted upon by other agencies. 
 
 Dr. Merrill, to whose Essay attention has been, especially called, 
 disclaims, as we have seen, the disposition to deny that pneumonia 
 sometimes appears as an idiopathic affection a form of the disease 
 which he seems never to have encountered in his practice, and only 
 admits, because, to use his own language, such is the result of ob 
 servations made by others, who are certainly not less qualified to 
 form a correct judgment in the premises. Even while upholding 
 his favourite theory respecting the supposed connection between 
 that disease and periodic fever, he regards the former, wheresoever it 
 may appear, and whatsoever form it may assume, as being excited 
 into action, or, in other words, as requiring for its development, the 
 agency of the sudden transitions of temperature which occur on the 
 approach of winter. Entertaining such views on these subjects; 
 recognizing as a well-established fact the existence of an idiopathic 
 form of the disease, distinct from that which he supposes prevails 
 most generally sometimes sporadically and frequently as an epi 
 demic he will not refuse to acknowledge what, indeed, as we have 
 seen, experience establishes beyond the possibility of doubt, that in 
 northern latitudes and in elevated situations, where malarial fevers 
 do not occur at all, or, if they do, show themselves only during a 
 limited portion of the year, and are cut short by the intervention of 
 frost ; where, therefore, the cause producing them is never evolved, 
 or, being so, is destroyed on the approach of winter ; and where, as 
 a consequence, pneumonia cannot be regarded as the offspring of 
 that cause; this disease, which prevails in such localities at all sea 
 sons of the year, and is more particularly rile under circumstances 
 perfectly incompatible with the development of febrile diseases, 
 must necessarily be referred to the atmospheric influences above 
 
AUTUMNAL FEVERS. 353 
 
 enumerated. We must presume, also, that lie will not refuse to 
 regard the idiopathic form of pneumonia, when it occurs in truly 
 miasmatic regions, whether in the south, the north, the east, or the 
 west, as the offspring of a cause differing from that giving rise to 
 periodic fevers, and with these to that form of the disease which he 
 views as closely connected or identical with the latter ; which cause 
 cannot be other than the atmospheric influences which, as we have 
 seen, produce inflammation of the lungs elsewhere, and, according 
 to his own saying, is necessary to excite into being the sympto 
 matic form. The inference is inevitable ; for, were the cause not 
 acknowledged to be of a different character, there would be no 
 ground upon which to establish the distinction between an idiopa 
 thic and a symptomatic form of pneumonia. 
 
 Now, if the disease is thus viewed as arising from the agency of a 
 distinct cause often in these and in northern latitudes, and some 
 times in the south and malarial districts generally; if, at the same 
 time, it is acknowledged (if not in actual words, at least by implica 
 tion) that, were it not for this cause i. e. the sudden transitions of 
 temperature which occur at the approach of winter the thoracic 
 viscera would not, even in the symptomatic form of the disease, 
 be called upon to bear the burden of local disease, and would escape 
 risk of inflammation; and if, besides, while such views are expressed, 
 we are told that " the pneumonias which prevail in this country 
 generally sometimes sporadically and frequently as an epidemic 
 are really and substantially nothing more than a peculiar form 
 6f remittent and intermittent fevers," it must follow that such 
 pneumonias are the result of the cause which produces these 
 fevers, and which we may presume Dr. Merrill regards as different 
 from that giving rise to what he holds to be the idiopathic form 
 of the disease. Here, then, we find the same causes atmospheric 
 influences officiating in some cases as the efficient and sine qua 
 non agents in the production of the disease, and in others acting 
 simply by promoting the development of the disease, the founda 
 tion of which had been laid by another and very different patho 
 genic influence. But, more than this ; we find the same disease 
 for we are not informed of the existence of any symptomatological 
 or pathological difference between the two supposed forms of 
 pneumonia ascribed, as already mentioned, to two distinct classes 
 of causes ; atmospheric vicissitudes on the one hand, and the pecu 
 liar agent, whatever this may be, which gives rise to periodic fever, 
 23 
 
354 PNEUMONIA AND 
 
 on the other. The reader can scarcely fail to see that this mode 
 of proceeding does not accord with the canon laws of that system 
 of philosophy of which we hear so much, and by which it is to 
 be hoped all medical inquirers are guided; for that philosophy 
 teaches the impropriety of referring a specific effect to more than 
 one cause. In the present instance, it would lead us to conclude 
 that, since the idiopathic pneumonia of the south is admitted to 
 arise from causes distinct from those that produce periodic or 
 autumnal fever; since the same disease undoubtedly arises very 
 frequently, not to say universally, from such causes in the north 
 and elsewhere; and since, in the south, the agency of the former is 
 essential to its manifestation, even when the causes of fevers are 
 supposed to be instrumental in its production, there can be no rea 
 son for attributing pulmonary inflammation, when it appears in the 
 southern section of this country, any more than when it shows 
 itself in northern latitudes and in elevated positions, where autumnal 
 fevers do not extend their sway, to a different morbific agent. 
 Everywhere the same cause must produce the same effect, and a 
 different effect must be produced by a different cause. Everywhere, 
 therefore, the disease must arise from the same modifying agencies; 
 and hence, if in some places it is due to atmospheric influences, 
 there can be no propriety in lending our support to the idea that 
 it arises elsewhere from the operation of agencies of a different 
 kind. In other words, we must discard the theory which teaches 
 that in the same place the disease occurs sometimes from the influ 
 ence of one cause, at other times from that of another ; and that the" 
 same influences sudden transitions of temperature, and the like 
 act in some instances as an efficient cause, and in others lower 
 themselves to the secondary office of exciting into action an inflam 
 mation produced by another agency. 
 
 Autumnal fevers, if not produced like other zymotic diseases, are localized 
 in certain places; not so pneumonia. Let us examine the subject in an 
 other point of view, and acknowledge, for a moment, that remittent, 
 intermittent, and yellow fevers, and other zymotic diseases more or 
 less allied to them, are not the offspring of peculiar morbid poisons 
 exhaled from the localities where they prevail; and are, so far as that 
 goes, on a par with pneumonic inflammations ; I am not sure that the 
 admission would afford much help to those whose opinions are under 
 examination ; for it is impossible to shut our eyes to the fact, that 
 
AUTUMNAL FEVERS. 355 
 
 the localization of those diseases takes place only where certain 
 peculiar combinations of materials appertaining to the soil, or 
 which have found their way there accidentally or otherwise, exist. 
 Bearing this in mind, we arrive at once at the conclusion, that 
 the real cause, whatsoever it may be, meets there certain agencies 
 which so modify the system as to render it liable to their morbid 
 impress. In a word, what many regard as the active and effi 
 cient cause of those diseases, may, after all, be only a predisposing 
 agent. If this be correct, autumnal and periodic fevers are, in that 
 respect, on an equal footing with other zymotic diseases arising 
 from specific ferments or poisons. Every one knows that while 
 Asiatic cholera and the febrile exanthemata are never produced by 
 the malarial exhalations evolved from foul localities or marshy 
 surfaces ; while typhus and typhoid fevers are, as it is said, seldom 
 the offspring of the former, and certainly never of the latter ; while 
 none of these diseases are occasioned by the ingestion of putrescent 
 food, by the use of foul water, by imperfect ventilation, by starva 
 tion, by excessive muscular exertions, by the intemperate use of 
 alcoholic liquors, and the like ; and while, with the exception, per 
 haps, of typhus, they do not arise from the effluvia proceeding from 
 the human body particularly the lungs and skin and consisting 
 of the effete and highly putrescent matter mingled with the air or 
 perspiration it is a notorious fact, that they are principally rife in 
 situations where such influences operate, and strike with greater 
 violence, malignancy, and fatality among individuals exposed to 
 their baneful effects. This is true, whether the disease be the pro 
 duct of a zymotic poison floating in the atmosphere, and independ 
 ent for its development of any organic process, as Asiatic cholera; 
 or whether it arises from a poison formed in the system and trans 
 missible from one individual to another through means of contact, 
 or the medium of the atmosphere ; or whether, again, it is due to 
 a particular poison proceeding from external sources of animal or 
 vegetable decomposition, or from the result of a morbific condition 
 of the sj^stem, as is the case, perhaps, with puerperal complaints, 
 erysipelas, and surgical fever. 
 
 It will only be necessary to open the records of cholera in all the 
 countries it has visited, and especially in England, where the sub 
 ject has been investigated with greater attention than elsewhere, or 
 of typhus or typhoid fevers, to be perfectly satisfied that, where the 
 predisposing influences in question exist, there these diseases rage 
 
356 PNEUMONIA AND 
 
 with, the greatest violence. Indeed, as Dr. Grainger well remarks, 
 before the outbreak of any epidemic, knowing where the predis 
 posing causes are rife, physicians can foretell the precise localities 
 where it will occur ; nay, even name the alley, or point to the exact 
 house that will suffer. 1 
 
 Now admitting, as already remarked, that autumnal fevers, of all 
 possible grades, are to be placed in the same category with the 
 diseases mentioned; admitting that the same relationship exists 
 between them and the morbid influences above specified, as between 
 these and the other forms of zymotic complaints ; in other words, 
 admitting, that not only intemperance, starvation, imperfect ventila 
 tion, putrescent food, foul water, but marsh miasmata and malaria 
 generally, are restricted in their agency to the predisposing of the 
 system to receive the morbid impressions of the efficient cause, it 
 would not, be the less true, that there exists a wide difference in 
 that respect between those fevers and pneumonia. 
 
 We have already seen that the latter disease, so far from being 
 necessarily more frequent in malarious countries, has often, if not 
 generally, been noticed to prevail less extensively there than in 
 places differently circumstanced. Malaria, therefore, cannot be re 
 garded as its predisposing cause. If we turn to our wharves, courts, 
 alleys, and the habitations of the poor, where sources of foul exha 
 lations, of every kind imaginable, are abundant, we do not find that 
 pneumonia is more generally noted there than in other localities. 
 Nor do we find that putrescent food, foul water, imperfect ventila 
 tion, starvation, intemperance, or concentrated human effluvia, exer 
 cise an important influence in localizing the disease and increasing 
 its prevalence. These morbid agencies, and a few others which 
 predispose to fevers, may have an injurious effect as regards pneu 
 monia; they may, by lowering the tone of the system, and diminish 
 ing the power of the latter to resist the force of the morbid impres 
 sion, increase, to a certain extent, the danger of the attack ; in the 
 same way as do advanced age and other causes of constitutional 
 prostration. But the injurious effect, so far as regards predisposi 
 tion, is comparatively restricted in reference to pneumonia; while in 
 regard to fevers and other zymotic diseases, it is strikingly great. 
 Pneumonia attacks, and, the force of the constitution being the 
 
 1 Influence of Noxious Effluvia on the Origin and Propagation of Epidemic Diseases. 
 Quoted by Med. Exam. April, 1853, p. 253. 
 
AUTUMNAL FEVERS. 357 
 
 same, is equally fatal among all classes of society, the rich and the 
 poor. We possess no authentic statements calculated to show that 
 the latter are more prone to the disease than the former ; for, if 
 among the rich thoracic inflammations have occasionally been 
 found to prevail less extensively, the explanation may be readily 
 found in the fact that they are less exposed, not to the modi 
 fying influences above mentioned, which, as we have seen, predis 
 pose to fevers and zymotic complaints generally, but to the injuri 
 ous impression of the ordinary exciting causes of the disease. In a 
 word, autumnal and periodic fevers of all grades supposing them 
 not to be produced by malarial exhalations are like other zymotic 
 diseases, principally rife among individuals whose systems have 
 been for a greater or less period of time under the depressing 
 influence of such exhalations. These, like the rest of the recog 
 nized morbific influences mentioned, must, at the very least, be 
 admitted, in accordance with that view of the matter, to act inju 
 riously by predisposing the system to the action of the disease; and 
 when examined attentively, the effect will be found to be evidently 
 accomplished, as Dr. Carpenter well remarks, by producing in the 
 blood of the individual exposed to them an excess of those decom 
 posing organic compounds, which, as physiology teaches us, are 
 always present in the circulating current, in minute proportion ; 
 being conveyed by it from the spots in which they are introduced, 
 or in which they are generated, to the organs through which they 
 are to be eliminated ; and an excess of which is manifestly produ 
 cible, either by the direct introduction of those matters from with 
 out, in the food or drink consumed, or in the air respired ; or by 
 the production of them within the body, at a rate beyond that at 
 which they are normally eliminated ; or by some obstacle to their 
 elimination, which prevents the amount ordinarily originated from 
 escaping at its normal rate through the usual outlets. 1 It would 
 puzzle the most clairvoyant among the advocates of the hypothesis 
 under examination, to discover and point out the existence of the 
 most distant analogy in regard to the subject just mentioned, be 
 tween pneumonia and autumnal fevers; for while the predisposing 
 if not efficient causes of the latter are of the nature stated, and 
 exercise their baneful influence in the way mentioned; while for 
 this reason those fevers establish their claims to take rank among 
 
 1 Brit, and For. Med.-Chir. Rev. Jan. 1853, p. 102. 
 
358 PNEUMONIA AND 
 
 zymotic diseases ; pneumonia recognizes for its predisposing causes 
 agencies of a very different character ; such as, instead of lowering 
 the purity of the blood, tend to increase its vitality, and would, in 
 the absence of a thousand other reasons, suffice to put a bar to the 
 idea of placing the disease among the zymotics, and establishing a 
 parallel between it and fevers. 
 
 The opinion is incorrect, for it leads to the inference that the same 
 cause produces diseases differing widely in symptoms and anatomical 
 characters. Nor does it appear less certain that the theory, or more 
 properly the hypothesis, under examination, is faulty in another 
 point of view ; for while, as has been seen, it admits that the pneu 
 monia of the south, if not pneumonia generally, is in some instances 
 an idiopathic affection, and hence arises from causes distinct from 
 those to which, it is thought, the disease should, in the majority of 
 cases, be referred ; in other words, while in accordance with that 
 belief, inflammation of the lungs may be the offspring of two dif 
 ferent sets of causes, we are given to understand that from the same 
 cause malaria, according to some, and atmospheric influences, 
 agreeably to others there may and do arise various series of mor 
 bid phenomena, which, when examined, are found to bear no 
 resemblance to each other, and which, consequently, medical ob 
 servers, from the days of Galen, if not of Hippocrates, to our own, 
 have, with scarcely an exception, regarded as essentially dissimilar. 
 "What diseases, indeed, in the long list of those flesh is heir to, differ 
 more widely from each other than pneumonia and malarial fever ? 
 Of the former, the seat is necessarily the substance of the lungs, 
 with or without an implication of their covering and lining mem 
 brane, in which morbid changes are effected that need not to be 
 specified here. AVhile this is the case with these organs and tis 
 sues, the contents of the abdominal and other cavities may, and do 
 often remain unaffected to the last ; or if they become implicated at 
 the outset, or during the course of the attack, the effect is generally 
 due to causes independent of that which gave rise to the thoracic 
 affection. When, in such cases, the inflammation of the lungs has 
 been removed by proper means, or when, as not unfrequently hap 
 pens witness the effects of homoeopathy it subsides through the 
 influence of the recuperative powers of the system, the fever by 
 which it was accompanied disappears also, unless some other organ 
 or tissue has taken on inflammation, and the latter keeps up febrile 
 
AUTUMNAL FEVERS. 359 
 
 excitement ; or unless the case be complicated from the onset with 
 some other complaint. This result could scarcely be looked for 
 were the disease a constitutional one, caused by some general agency, 
 and the local affection only a secondary effect superadded to the pri 
 mary complaint. So far from this, the fever in pneumonia is depend 
 ent on and inseparable from the pulmonary inflammation, the removal 
 of which is necessarily followed by the cessation of the former. 
 
 On the other hand, the febrile poison manifests an affinity for the 
 abdominal viscera, which are affected to a greater or less extent in 
 the large majority of cases. While doing this, it sometimes spreads 
 its effects to the brain or its membranes ; which, however, are more 
 frequently involved in a secondary than in a primary way. But 
 whatsoever be the morbid impression produced on these organs, the 
 poison does not injure the pulmonary tissues, for which it has no 
 affinity so far at least as to excite in them the inflammatory change. 
 Even on the abdominal organs, it does not always excite true 
 inflammation; or when it does, the effect is felt by the mucous sur 
 faces and secretory organs, and not by the serous and parenchyma- 
 tous structures. If these at any time, and in any case, become the 
 seat of inflammation, the result is due to fortuitous circumstances, 
 and does not constitute an essential part of the disease, which may 
 and does generally exist and run its course, to recovery or death, 
 clothed in all its legitimate and characteristic colours, without ex 
 hibiting evidence of such an implication. Contrary to what occurs 
 in pneumonia, when, in pure and uncomplicated cases of autumnal 
 or periodic fevers, the physician succeeds in removing all the local 
 inflammations which may exist, he must not be too sanguine about 
 putting a stop to the fever itself; for the chances are a hundred to 
 one that it will continue to run its course, uninfluenced in that 
 respect by the cure of the local disease ; in the same way that the 
 alligator s head, in the experiments of a distinguished physiologist 
 of our country, continued to live saw, winked, snapped, and even 
 jumped though deprived of its usual appendage, the body. 
 
 Affinity of morbific and therapeutic agents for special organs not to 
 be denied. The fact of the affinity of deleterious agents for a par 
 ticular part, is not one of which a well-read and observant physician 
 can be ignorant; it has been observed and admitted from time 
 immemorial. More than a century ago, Borden, whose authority in 
 matters of the sort will not be impugned, remarked : " All morbific 
 
360 PNEUMONIA AND 
 
 miasms have their organs marked and predisposed for their germina 
 tion. It is in these organs that each miasm penetrates ; it is for them 
 it has a special tendency; the herpetic attacks the skin, the scrofulous 
 the glands, the venereal the organs of generation. The poison of 
 gout affects the whole nervous system, and is only developed in the 
 articular membranes. Each imparts to the individual in whom it 
 germinates peculiar modifications, often of a diseased kind, often also 
 consisting of a particular manner of being, or a well-characterized 
 temperament." 1 At a later period, Mr. Hunter stated, in language no 
 less explicit, that " poisons take their different seats in the body as 
 if they were allotted to them." In a word, such agents, when intro 
 duced into or applied to the system, do not produce their effects 
 on all the organs or tissues indiscriminately. So far from this, 
 each morbid or common poison, each article producing some phe 
 nomenon which links it, as to its effects, with other articles, gives 
 rise to phenomena of a special character, and is often found to 
 occasion lesions of specific organs. While putrid substances, 
 when inhaled into the lungs, or thrown into the circulation, affect 
 the gastro-intestinal surface, the subcarbonate of soda applied in 
 the latter way disorganizes the thoracic viscera. The lungs be 
 come gorged with blood, which gushes out when incisions are made 
 into their substance, and bloody fluid is effused into the pleura, 
 while the tissues and organs of the abdominal cavity are found in 
 their normal state. 2 The lungs are specially affected by the bichlo- 
 rate of mercury; the bronchia attract and eliminate phosphorus; 
 the heart is affected by the upas antiar and digitalis ; the kidneys by 
 cantharides, oil of turpentine, indigo, saffron, and nitrate of potash ; 
 the liver by verdigris; the same or some other secretory organs are 
 affected b} r mercury ; the stomach by ipecacuanha, colchicum, and tar 
 tar emetic; the bowels and not the stomach by purgatives; the brain 
 by opium ; the spinal marrow and nervous system by nux vornica 
 and prussic acid ; the uterus by ergot ; the capillary system by eu- 
 phorbium, &c. 3 
 
 The advocates of the malarial origin of pneumonia, some of whom 
 seem to have forgotten this power of affinity, would do well to bear 
 these facts in mind: as also the pustules of smallpox; the cynanche 
 and erythema, and kidney affections of scarlatina ; the intestinal 
 
 1 Borden, Analyse Med. du Sang, in Collected Works, 1011, 1012. 
 
 2 Magendie on the Blood, 178, 188, 101, &c. 
 
 3 See Blake, Sir Everard Home, Haller, Magendie, Lcgallois, Gaspard, Simon, &c. 
 
AUTUMXAL FEVERS. 361 
 
 ulcers of typhoid fever; the catarrh and eruption of measles; the 
 rupia and periostitis of syphilis ; the swollen parotid of mumps ; the 
 suppurating tumours of glanders ; and other similar local affections 
 which present themselves daily to our observation. Let them do 
 so ; and remember, at the same time, that " syphilis never produces 
 ulcers in the ileum, scarlatina never causes iritis," and that "the 
 causative poison of the one disease differs from the causative poison 
 of the other, for on the selfsame subject it produces different 
 effects," 1 and they will, perhaps, feel less reluctance in admitting 
 that the malarial poison exercises its specific effects on the mucous 
 tissue of the gastro-intestinal apparatus, and on the spleen, and 
 leaves the pulmonary organs uninjured. 2 
 
 Distinctive symptoms and pathological conditions different in pneu 
 monia and malarial fevers. In all that precedes, I am borne out by 
 the symptoms observed during life in the two diseases. In the 
 former (pneumonia), the phenomena indicate the existence of acute 
 inflammation, and greater or less congestion of the organ affected ; 
 while the blood exhibits changes, as well in regard to the propor 
 tion of its fibrin and other elements, as to its physical characters, 
 which not only prove it to differ considerably from the healthy 
 fluid, but assimilate the disease to a class very unlike the pyrexise. 
 It need scarcely be remarked, that in all inflammations the blood is 
 in what has been denominated a state of hyperinosis. It contains 
 more fibrin than in the normal state 5 or 6 parts in 1,000, instead 
 of 2 or 3 while the corpuscles decrease in proportion to the excess 
 of the fibrin, from about 141.1 in 1,000 to about 128.0. The fatty 
 matter also is increased ; and, as a consequence of all these changes, 
 the whole solid residue is diminished. The blood coagulates more 
 slowly than in the normal state ; the clot is not usually small, but 
 very firm and consistent, and does not break up for a considerable 
 
 1 Simon s Lectures on Gen. Path. 191. 
 
 2 "If we were to attempt to explain how it happens that particular organs are 
 affected rather than others, we must do so upon the most crude hypothesis. We must, 
 therefore, as well observed by Mr. 1 iorry, accept the facts, without being able to 
 account for them. Chemists cannot tell you why carbon has more affinity for oxygen 
 than for azote ; nor can physicians tell why cantharides, taken into the blood, act 
 rather upon the kidneys than upon the brain. Whether we regard medicines or 
 poisons, morbid secretions, excretions, contagions, or miasmata, absorbed into the 
 blood, these observations are equally applicable," AncclVs Lectures on the 
 Lancet, 1840, p. 781, 
 
362 PNEUMONIA AND 
 
 time. It is almost invariably covered with a buffy coat, which, is 
 firm, tough, and intimately connected with the clot ; its edge is often 
 turned upwards and its surface uneven. If the clot be small, the 
 buffy coat and the surface of the clot arc more or less cupped, and 
 the serum is of a pure lemon colour, not tinged red. When whip 
 ped, the fibrin separates in thicker and more solid masses than in 
 ordinary blood. After the removal of the fibrin the corpuscles 
 quickly sink, and frequently occupy only one-fourth of the whole 
 fluid, while in healthy blood they sink very imperfectly, or not at all. 
 The blood has always an alkaline reaction, and is of a higher tem 
 perature than in the ordinary state. All these changes are propor 
 tionate to the degree of the inflammation. 1 Such is the condition 
 of the blood in the phlegmasiaB generally. In pneumonia, the state 
 of hyper inosis is even more decided than in other diseases of that 
 class, as the blood retains its heat longer ; the clot is below the 
 ordinary size, and very consistent, and does not break down for a 
 considerable time. It admits of being sliced, and the sections retain 
 their consistency for some time. Its surface is covered with the 
 buffy coat, and is more or less cupped. The serum is of a pure 
 yellow colour. The quantity of solid constituents is usually less 
 than in healthy blood. The proportion of fibrin increases and 
 varies, according to Andral and Gavarret, from 4 to 10.5 in 1,000 
 parts, with a mean (in 58 experiments) of 7.5 ; from 5.919 to 12.726, 
 according to Kinclskopf, and 3.4 to 9.15, with a mean of 6, accord 
 ing to Simon ; while the blood-corpuscles, according to the first 
 experimenters, amount to from 83.2 to 137, with a mean of 114.1 ; 
 and, according to Simon, to as little as from 36 to 78. 2 If other 
 symptoms present themselves, or if the blood assumes a different- 
 appearance, these results are due to complications; they do not 
 constitute a necessary link in the chain of phenomena imparting an 
 individuality to the disease, and are not, therefore, pathognomic. 
 
 Examine we now the distinctive symptoms of periodic and 
 autumnal fevers (applying to those terms their most enlarged 
 sense) those symptoms which alone enable us to diagnose those 
 fevers which impart to them their individuality, and assign them 
 an independent position in every nosological arrangement, and we 
 shall not discover one calculated to lead us, for a moment, to the 
 
 ! Geo. Polli, Richerche ct Esperienze, sul san<rue umano Annali Universal], cxiii. 
 333; Simon, Animal Chem. i. l>r0; T. W. Jones, Ediub. Journ. Ixxvi. 108. 
 2 Simon, op. cit. I 258, 259, i!i;2. 
 
AUTUMXAL FEVERS. 363 
 
 supposition tliat the lungs are the seat of inflammation or acute 
 congestion. So far from it, indeed, respiration is less impaired in 
 the early stage of those diseases than most of the other great 
 functions. When it becomes deranged, the effect is of a nervous 
 character, or the result of the inability of the blood-corpuscles to 
 carry oxygen ; and physical exploration usually indicates no 
 important morbid change in the pulmonary tissue, and when it 
 does as more frequently occurs during the latter stage of malig 
 nant cases the signs are those of passive congestion. Bronchitis, 
 except in a very few cases, is not developed, and when so, is usually 
 traced to its legitimate causes, and need not be laid to the score of 
 the malarial poison. At the same time, all the symptoms observed 
 all, I repeat, that are pathognomonic point most usually to the 
 stomach, bowels, liver, and spleen, sometimes to the brain, as being 
 the organs principally implicated. Sometimes they indicate the exist 
 ence of acute inflammation in one or more of these more gene 
 rally of simple congestion, and more frequently still of functional 
 disorder of the former, with or without congestion of the latter 
 of the spleen particularly which in some of the pyrexice bears a 
 large share of the brunt of the disease. The blood at the same 
 time either exhibits, as in some of the milder forms of the disease 
 simple intermittents, for example or in the early stages of other 
 forms of a more severe character, little or no change from its nor 
 mal state ; or manifests in the more advanced stage of these, and 
 even in some cases of intermittents, as well as in the early stages of 
 the other, and particularly in the malignant grades, alterations in 
 its chemical composition and plrysical characters the very reverse 
 of those observed in pneumonia and the phlegmasiaB generally. 
 The fluid is in that state which has received the denomination of 
 hypinosis. The fibrin is frequently less than in healthy blood, or 
 if it amounts to the normal quantity, its proportion to the blood- 
 corpuscles is less than is found in a state of health (2.1 : 110, Simon, 
 or 3 : 110, Lecanu) ; the quantity of corpuscles is either absolutely 
 increased, or their proportion to the fibrin is larger than in the 
 healthy state ; and, in addition, the quantity of solid constituents is 
 also frequently larger than in the normal fluid. 
 
 The clot, though sometimes small, is more commonly the reverse. 
 It is soft, diffluent, and of a dark, almost red colour. Occasionally, 
 indeed, no clot is formed. The buffy coat is seldom seen, and when. 
 this is the case, is thin and soft, and forms a gelatinous parti-coloured 
 
364 PNEUMONIA AND 
 
 deposit on the clot. The serum is sometimes of a deep yellow 
 tinge from the colouring matter of the bile ; or red, from blood- 
 red corpuscles in suspension. The blood has always an alkaline 
 reaction. 1 In some forms of the disease, it even approaches that 
 state denominated spanoemia ; it is watery, very poor in fibrin, and 
 of a dark colour. If any clot be formed, it is diffluent and very 
 soft, the serum is frequently of a dark yellow or brown-red colour ; 
 partly from the colouring matter of the bile, and partly from dis 
 solved haematoglobulm. It possesses a very peculiar smell, which 
 not improbably depends on a volatile salt of ammonia. 2 These 
 changes, which can be artificially produced by the introduction of 
 putrid substances into the circulation, are observed in a more or 
 less marked manner, not only in malarial remittents, sometimes in 
 intermittents, but also in typhoid, typhus, relapsing, yellow, and 
 pestilential fevers, as well as in a variety of other diseases arising 
 from the action of morbid poisons. 
 
 The fevers of this country, from the simple intermittent to the 
 malignant yellow, have exhibited them to a greater or less extent. 
 As regards the latter form of the disease, the altered condition of 
 the blood has been noticed by Lining and Moultrie, and, since 
 them, by Hush, Deveze, Nassy, Physick, Cathrall, Brown, Currie, 
 Caldwell, Miller, Drysdale, E. II. Smith, Potter, Gros, Cartwright, 
 Kelly, Nott, S. Jackson, Stone, and by almost every other writer 
 on the subject. It is, indeed, a fact of so notorious a character, as 
 not to call for any special illustration in this place. Kot less evi 
 dent, though perhaps not so distinctly marked, are the changes in 
 question on the milder forms of the disease. They were noticed by 
 Dr. John Mitchell, in the fever he observed in Virginia in 1737, 
 1741, 42, and which was improperly denominated yellow fever. 3 
 Since then, attention has been called to them in a more or less 
 pointed manner by Drs. Daniels, Dickson, Drake, Stewardson, and 
 other American writers, as also by Dr. Stevens, who had an oppor- 
 
 1 Simon, Animal Chemistry, i. 287, 301, 302. 
 
 2 Ibid. i. 319 ; ibid. Appendix, ii. 510. 
 
 Salvagnoli examined the blood of four persons actually labouring under, or who 
 had just recovered from intermittent fever, and were living in a malarious district. 
 He found that it exhibited a notable diminution of albumen and fatty matter, and that 
 the phosphates had almost entirely disappeared. It contained, however, a large 
 quantity of cholesterin. It is remarked that the biliary secretion of those living in 
 such districts has been previously noticed to be rich in cholcsteriu. Saggio illustra 
 tive dclla Statistica Medico, dclla Maremme Toscane, 00. 
 
 3 Med. and Philos. Register, iv. 188. 
 
AUTUMNAL FEVEES. 365 
 
 tunity, during his visit to this country, to observe our lake and 
 marsh fevers. It would be useless to enter at large on the sub 
 ject ; and I shall content myself with making room only for a brief 
 summary of observations made on the subject by Dr. Frick of Balti 
 more. This writer examined twelve cases of autumnal fever. Of 
 these, five were of the remittent, and the balance of the intermittent 
 type. In two of those cases one of the intermittents, and one of the 
 remittents, the disease assumed the congestive form. In four classed 
 as remittents, the proportion of the fibrin was above the usual 
 standard. In the fifth case of that class, the disease was of three 
 weeks duration, and all the elements of the blood, except the chlo 
 rides and the phosphates, were below their natural standard. In 
 five of the cases of intermittent fever out of seven, the fibrin was 
 below the average quantity. Of the two exceptional cases, one was 
 complicated with ascites, and oedema of the lower extremities, coming 
 on as an acute affection, and being preceded by a chill; and the 
 other was complicated with pneumonia at the summit of the lung. 
 The increase of fibrine in the four cases of remittents, as above 
 mentioned, was due to the superaddition of gastro-duodenitis to the 
 original disease. The blood-globules in the remittent form were, 
 as is the case in the pyrexia generally, in all the instances except 
 the one above alluded to, increased. 1 
 
 The same changes have been noticed not only as regards typhus, 
 typhoid, and relapsing fevers, but common malarial diseases, in 
 England, France, Ireland, Scotland, Italy, and Germany, as well as 
 in the West Indies, Algeria, Western Africa, &c., as the reader may 
 readily find by referring to the writings of Huxham, Cleghorn, 
 Sarcone, E. Armstrong, Evans, Tweedie, Cormack, Stevens, Boyle, 
 J. Davy, Andral and Gavarret, Leonard and Foley, Clanny, Burne, 
 Stokes, Keid, Stoker, Haspel, Boudin, Me Williams, Jennings, J. 
 Armstrong, Lecanu, Cozzi, Salvagnoli, F. Home, and Clot-Bey, to 
 say nothing of the very large majority of authors who have treated 
 of the yellow fever of Spain and tropical regions. 
 
 In the same way that in pneumonia we find that a condition of 
 blood, more or less approximating to the one mentioned above, 
 indicates the complication of a typhoid diathesis, or of a strong mala 
 rial taint, so in fevers arising from the latter cause, or in the pyrexise 
 
 1 Of the Relative Proportions of the different Organic and Inorganic Elements of 
 the Blood in different Diseases, Am. J. xv. (N. S.) 29. 
 
366 PNEUMONIA AND 
 
 generally, the excess of fibrin, and its greater proportion relatively 
 to the blood-corpuscles, indicates the existence of a phlegmasia in 
 addition to, but forming no essential part of, the disease. 
 
 These changes in the appearance of the blood are noticed not 
 only during the attack of malarial fever; they have been observed 
 even in individuals in apparent health residing in malarial regions, 
 and especially during the prevalence of an epidemic of remittent, 
 intermittent, or yellow fever; and, indeed, of many other forms 
 of zymotic diseases. The late Dr. John Mitchell, of Virginia, in 
 the account he left us of the so-called yellow fever which prevailed 
 in some parts of that State about the middle of the last century, 
 remarks : " Even those who are bled after a received contagion 
 before the fever is formed, have a thin, dissolved, florid blood, even 
 in winter. This was the constant state of the blood in about thirty 
 or forty whom I have known to have been bled at all seasons of 
 the year." 1 Alluding to the fever of Baltimore in 1800, Dr. Potter 
 says: "To ascertain the appearance of the blood in subjects appa 
 rently in good health, I drew it from five persons who had lived, 
 during the whole season, in the most infected parts of the city, who 
 were, in every external appearance and inward feeling, in perfect 
 health. The appearance of the blood could not be distinguished 
 from that of those who laboured under the most inveterate grades 
 of the disease. A young gentleman having returned from the 
 western part of Pennsylvania, on the 10th of September, in good 
 health, I drew a few ounces of blood from a vein on that day; it 
 discovered no deviation from that of other healthy persons. He 
 remained in my family till the 26th of the month, and, on that day, 
 I repeated the bloodletting. The serum had assumed a deep yellow 
 hue, and a copious precipitate of red globules had fallen to the bot 
 tom of the receiving vessel." 2 Dr. Archer, of Norfolk, has also 
 noticed the same fact, stating, as an evidence of the extent to which 
 the predisposing causes of this fever operated, that the blood taken 
 from healthy persons generally exhibited changes which were easily 
 discernible as it trickled down the sides of the basin. These were 
 pretty regularly increased as you approached the infected district. 3 
 
 The same fact is confirmed in regard to malarial fevers of lower 
 grades by the results of observations made in the Tuscan Maremma 
 
 1 Mcd. and Philos. lleg. iv. 188. 2 A Memoir 011 Contagion, 54. 
 
 3 lli.<t. oi the Ye!. Fcv. of Norfolk in 1821, Mod. lice. v. G8. 
 
AUTUMNAL FEVERS. 367 
 
 and in the miasmatic districts of this country. " So great and so con 
 stant is the difference," says a high authority in reference to the for 
 mer, "that, from the physical examination of the blood only, almost 
 without error, the physician may judge if the patient resides con 
 stantly in an unhealthy atmosphere, and if the liver and spleen have 
 been altered." 1 During his visit to the United States, Dr. Stevens saw 
 much of our lake fever, especially in the Genesee country. In the 
 months of September and October, 1830 the sickly period he bled 
 several individuals who resided in some of the infected localities, but 
 had not yet been attacked with the fever. In every one of these, the 
 blood invariably presented the same diseased appearance which he 
 had often observed in those who resided near to swampy situations 
 in the West Indies. It was very dark in colour, and evidently 
 deranged in its physical appearance, while the serum which sepa 
 rated, in place of being clear, had a muddy or brown colour, and, 
 in some cases, an oily appearance. In fact, Dr. Stevens did not 
 meet with even one intelligent practitioner in that country, who 
 was not aware of the fact that the blood of the inhabitants, during 
 the sickly months, is very different from that of those individuals 
 who arrive from healthy situations ; whilst even in those who re 
 side in the most unhealthy situations, and who have not yet had the 
 fever, it is not only dark in colour, but evidently so much diseased 
 in its properties as to be very unlike the blood in health. 2 
 
 To this it may be added that, in pneumonia, the blood preserves 
 its ordinary and specific odorous exhalation; while in diseases 
 arising from the action of the malarial poison in some forms of 
 them at least the fluid acquires a peculiar odour not encountered 
 in other complaints. In some forms of fever typhus, plague, and 
 yellow fever the blood possesses a very peculiar smell, which pro 
 bably differs in each disease, and is produced by a volatile salt of 
 ammonia. 3 Dr. Stevens, in speaking of the condition of the blood 
 in what he calls the African typhus, remarks that, "when first 
 drawn, it has a peculiar smell." 4 And Dr. Eush, in his account of 
 the epidemic of 1794, mentions that a similar statement was made 
 to him by a German bleeder, whose experience in 1793 was very 
 ample, and affirmed he could distinguish a yellow fever from all 
 other forms of fever. " From the certainty of his decision in one 
 
 1 Saggio illustrative le Tavolc della Statistica Medica. della Maremme Toscane, 211. 
 
 2 On the Blood, 216. 3 Simon, op. tit. i. 319, 320. 
 4 On the Blood, 210. 
 
368 PNEUMONIA AND 
 
 case which came under my notice," adds Dr. Eush, " before a sus 
 picion had taken place of the fever being in the city, I am disposed 
 to believe that there is a foundation for his remark." 1 I may add, 
 that Mr. Ripperger, a highly respectable bleeder of this city, who 
 has gone through all our epidemics from 1793 to the present day, 
 and, during that time thanks to the sj^stem long in vogue shed 
 more blood than any ten men living or dead, has confirmed to me 
 the above statement of Dr. Rush s authority. And why should it 
 not be so? It is known, particularly since the experiments of 
 Barruel, that the blood of every vertebrate animal has in it an 
 odoriferous principle, identical in all the individuals of the same 
 species, and similar to the odour of the cutaneous transpiration, or 
 to that part of it which gives to each animal its characteristic smell. 
 We know, also, that according to the principle laid down by Bar 
 ruel, and more or less acknowledged by other chemists, that the 
 blood of each individual exhales an odour closely resembling that 
 of the cutaneous perspiration, and so peculiar that the species, and 
 even the sex of any animal from whom a given quantity of blood 
 has been drawn, may be determined by it. 2 It is known, also, that 
 certain poisonous and other substances ether, hydrocyanic acid, 
 camphor, and alcohol, which, when taken into the system, find their 
 way into the circulation, impart peculiar odours to the blood; and 
 when we combine these various circumstances together, we cannot 
 help perceiving that the malarial poison, when absorbed, may so 
 modify that fluid as to produce analogous effects. 
 
 Are we not justified in explaining, by the changes which occur 
 in the blood of individuals affected with autumnal and other fevers, 
 many of the phenomena which present themselves in the course of 
 those diseases? On the subject of anemia and scorbutic attacks, 
 there can be but little difficulty. In reference to intermittcnts, a 
 writer in the Dublin Journal (vii. 219) says, and his remarks apply 
 equally well to other fevers : " The diminution of the globules 
 (probably also a diminution of their power of absorbing oxygen) 
 explains the prostration of the entire constitution and the occasional 
 disturbances of the circulation. The diminution of the fibrin ex 
 plains the ecchymosis on the skin and in the cellular tissues, the 
 bleeding from the nose and gums, the gangrene of the mouth which 
 sometimes occurs, and the pain in the limbs. The diminution of 
 
 1 Works, iii. 2 2 ,j. 2 Crit. and For. Rev. xi. i!Jf). 
 
AUT-UMNAL FEVERS. 369 
 
 the albumen explains the hyclropsical swellings, anasarca, ascites, 
 and probably also the watery diarrhoea, which always closes the 
 last scenes of persons weakened by fever." 
 
 Another writer remarks: "The first action of the poison is appa 
 rently upon the functions of the blood; those are impaired, or, in 
 peracute cases, cease altogether. The functions of the blood are, 
 first, to maintain the activity of the nervous and muscular systems ; 
 and, secondly, to supply the materials for the molecular changes 
 constantly going on in the tissues. It is essential to this being 
 properly performed that the blood-corpuscles be in a fit condition 
 to carry oxygen, and it would appear from the symptoms which 
 mark every stage of fever, that this function of the corpuscles is 
 impaired from the first. This is indicated by the besom de respirer 
 developed in the premonitory stage; the sensation and condition of 
 the respiratory organs are precisely the same as if their capacity 
 had been diminished, and due aeration of the blood thus prevented. 
 The patient takes many forced inspirations, sighs, or gasps, and the 
 breathing is quickened on the least exertion. The hasmato-globuline 
 is changed also, for the skin assumes a peculiarly pale, sallow, and 
 unhealthy look. The function of the nervous system is impaired 
 in consequence of these changes in the blood, namely, the changes 
 effected by the poison and the defective oxygenation hence lassi 
 tude and weariness, disturbed functions, or congestion of some or 
 all of the viscera, and a lower temperature." 1 
 
 From all that precedes, it follows that in uncomplicated pneu 
 monia, we have febrile reaction attended necessarily with, and 
 depending on, local inflammation of the lungs which fever is ac 
 companied with an increase of fibrin in the blood. In the autumnal 
 (as also in other) pyrexias we have likewise fever; but unlike what 
 occurs in the former, this fever is not necessarily attended with 
 symptoms of local inflammation, and is characterized by a defibrin- 
 ated condition of the blood. This defibrinated condition of the 
 blood, and the symptoms accompanying it, many of which it serves 
 to explain, are analogous to, or resemble, those produced by the 
 introduction of putrid or poisonous matters into the circulation ; 
 whilst the opposite condition of the same fluid in pneumonia serves 
 to explain the symptoms by which this disease is attended, and would 
 be totally incapable of accounting for those that are characteristic 
 
 1 Brit, and For. Med.-Chir. Rev. iii. 95, 96. 
 24 
 
370 PNEUMONIA AND 
 
 of idiopathic fever ; at the same time that it could not in any con 
 tingency be the result of a poisonous agent thrown into the circula 
 tion. Can any one, with such facts before him, seeing an increase 
 of fibrin on the one hand, and a diminution of the same element 
 on the other, unite in sentiment with those who regard the two 
 diseases as pathologically identical, and maintain with them that 
 pneumonia is really and substantially nothing more than a peculiar 
 form of remittent and intermittent fever? In other words, can he 
 be persuaded that a peculiar disease, characterized by a particular 
 condition of the blood, and depending for its existence on the local 
 inflammation of a special organ, is only a different form of another 
 disease, marked by a diametrically opposite condition of that fluid, 
 and not necessarily connected with the inflammation of that, or any 
 other organ ? 
 
 Odour of the surface peculiar in some malarial diseases ; not so in 
 pneumonia. Nor do we find that the two diseases approximate 
 much more closely in respect to the odour emitted by the sick. 
 In pneumonia, as in other kindred inflammations, the odour, apart 
 from that which accompanies ordinary perspiration consequent on, 
 or occurring during or at the close of the stage of febrile excite 
 ment more frequently at the period of crisis or from that which 
 depends on the peculiar complexion of the patient, or the particular 
 idiosyncrasy he may possess, presents nothing unusual, and apper 
 taining in a special manner to the disease ; nothing which is not seen 
 every day in other and dissimilar febrile complaints nothing which 
 may serve to impart to the case a particular pathogenic character. 
 If this does not hold good in all cases, the exceptions occur principally 
 in the typhoid form of the disease, or when the case, though not ori 
 ginally of that kind, fulls into a low malignant condition ; or they 
 occur when the pneumonia is complicated db initio with some dis 
 ease in which the phenomenon commonly shows itself; but, in such 
 instances, the fetid odour emitted belongs to that typhoid condition, 
 or to the other complaint superadded to the thoracic inflamma 
 tion, and not to the latter itself. If, now, we pass from this disease 
 to the malarial pyrexios, we shall find that in these, particularly in 
 the advanced stages, and in the malignant forms, the odour of the 
 surface constitutes frequently a prominent, and, as it were, a cha 
 racteristic symptom, which, considering the connection between the 
 odour of the blood and that of the skin in the state of health, may 
 
AUTUMNAL FEVERS. 371 
 
 be presumed to arise from that imparted to the circulating fluid 
 by the malarial poison. We may even go so far as to aver, that 
 each variety of malarial fevers presents something peculiar in that 
 respect, which, while enabling the pathologist to distinguish it 
 from pneumonia and other true phlegmasias, affords him the means 
 of pointing out, to a certain extent, at least, the particular nature of 
 the case under examination, or the class to which it belongs. Speak 
 ing of the second period of the Niger fever, Dr. Me Williams says : 
 " The principal complaint at this period was from the odour of the 
 perspiration, particularly in those cases that subsequently proved 
 fatal. I was not sensible of this peculiarity in the smell of the per 
 spiration in my own case, but I perceived it very distinctly in 
 several others." 1 In the bilious remittent fevers of Ceylon and the 
 West Indies, a peculiar smell emitted by the sick is alluded to by 
 Dr. Millingen, and other writers. 2 
 
 In the yellow fever, a peculiar odour is described as being of still 
 more common occurrence. I am aware that many writers on the dis 
 ease as it shows itself in tropical and temperate regions, have taken no 
 notice of this symptom; and that there are not wanting those who 
 have expressed doubts as to its occurrence, or even denied it alto 
 gether. Dr. Townsend, for example, in his account of the epidemic 
 of New York in 1822, says that there was not, at any time, as far 
 as his experience goes, a foul cadaverous effluvium from the body, 
 " a symptom so peculiarly characteristic of typhus, with which yel 
 low fever, however, ought not to be confounded. On the contrary, 
 in a majority of cases, everything about the patient seemed perfectly 
 inodorous, and for hours after death." 3 Dr. Tally also, in speaking of 
 the fever of Middletown, Conn., in 1820, informs us that, in general, 
 there was but little fetor before death, and even the usual febrile 
 smell was not, in many instances, perceptible. 4 
 
 But whatever may have been the case in New York and Middle- 
 town, at the periods in question, and in other instances that might, 
 if necessary, be mentioned, and however true it may be that from 
 these facts and the silence of several writers on the subject, we may 
 infer that the surface of the body in the yellow fever does not 
 
 1 Op. tit. loo. 
 
 2 Second Report of London Board of Health. 364; James Clark, Fever of. Domi 
 nica, 20. 
 
 3 Op. tit. 105. 
 
 4 Essays on Fevers and other Medical Subjects, &c. 30. 
 
372 PNEUMONIA AND 
 
 invariably emit an odour of a peculiar kind; jet facts sufficient may 
 be gathered from the writings on this disease, in both temperate and 
 tropical regions, to bear me out in what is here stated, and to show, 
 not only that the symptom in question occurs often, but does so 
 under circumstances calculated to induce us to view it as pathog- 
 nomonic of the fever generally. I cannot doubt having recognized 
 a peculiar and offensive odour about the persons of individuals 
 affected with this disease; and I think it has enabled me, in some 
 instances, to establish a correct diagnosis. In one or two cases 
 the smell was highly offensive. It has been noticed in all our 
 epidemics. Dr. Deveze 1 speaks of it as of frequent occurrence 
 in the latter stages of the disease, and designates it as fetid um 
 odeur infecte. Dr. Bush 2 states that, in 1793, the sweats in some 
 persons had an offensive smell resembling that of the washings of a 
 gun. This odour was emitted by those who, though not ill of the 
 fever, were exposed to the prevailing cause. It was perceived even 
 in those cases in which the disease went off on the first day of the 
 attack. 3 In his history of the epidemic of 1794, the same eminent 
 physician says: "I recollect having more than once perceived a 
 smell which had been familiar to me during the prevalence of the 
 yellow fever in 1793. It resembled the smell of liver of sulphur. 
 I suspected for awhile that it arose from the exhalations of the gut 
 ters of the city. But an accident taught me that it was produced 
 by the perspiration of my body. Upon rubbing my hands, this 
 odour was increased so as to become not only more sensible to 
 myself, but in the most sensible degree to my pupil, Mr. Otto. 
 From this fact, I was convinced that I was strongly impregnated 
 with miasmata." 4 Dr. S. Jackson mentions that in one case a most 
 intolerable fetor proceeded from the patients body for twenty-four 
 hours before his entire and complete dissolution. 5 Drysdale, 6 in 
 Baltimore ; Hill, 7 in Wilmington, .North Carolina ; Gros, 8 in New 
 Orleans; Stone, 9 in Woodville and Natchez; Dr. A. Hosack, in New 
 York; 10 Dr. Manson, 11 in New Haven, have made similar observa 
 tions during the epidemics they describe. 
 
 I Traite de la F. J. 26. 2 Op. tit. iii. 85. 
 3 Ibid. iii. 03. Ibid. iii. 217. 
 
 5 Fever of 1820, p. 54. 6 Med. Mus. i. 137. 
 
 7 Med. Recorder, v. 90. 8 Rep. on Fever of 1817, N. 0. 12. 
 
 9 Y. F, of New York in 1795, p. 1C. 10 Webster s Collection, 182. 
 
 II N. 0. J. ii. 180; ibid. v. 453. 
 
AUTUMNAL FEVERS. 373 
 
 Speaking of the fever of Woodville (1844), Dr. Stone remarks : 
 " Sometimes before, and always after an attack, and not dependent 
 upon the perspiration, a peculiar odour was perceptible, which it is 
 not easy to describe ; but which to have observed once is to remem 
 ber always ; I think I could detect the disease by this alone. One 
 of my children, aged eight years, gave off this odour twelve days 
 before the development of fever." Besides this, the perspiration 
 was of an offensive odour. Of the symptom under present consider 
 ation, as it presented itself four years after in Natchez, the same 
 writer says: "An odour which I cannot describe, but which was 
 the odour that had been indelibly impressed on me in 1844, was 
 strongly perceptible in many of the simplest cases towards the latter 
 part of the epidemic, but which I did not notice for a month after 
 its commencement." On this, as on the former occasion, the "per 
 spiration was always offensive, often fetid." 
 
 In the yellow fever epidemics of Leghorn, and of various parts 
 of the South of Spain, the same symptom was frequently observed, 
 and is specially noticed in the numerous accounts of them which 
 we possess. In the first-named city, the fetor was compared to that 
 of fetid bile. 1 Arejula, 2 at Malaga, in 1803, likened it to the smell 
 of putrid fish. It is mentioned by the same writer, Berthe, 3 and 
 others, as of common occurrence during the epidemics of Anda 
 lusia, from 1800, and 1810. Martel, 4 in describing the disease as 
 it occurred among the French soldiers in 1811, at Eotana, Lev- 
 r illa, and Alcantarilla, lays great stress on that symptom. Dr. 
 E. Jackson 5 informs us that, at Cadiz and Xeres, in 1820, the 
 fetor emitted by the body of the sick, in some forms of the dis 
 ease, was singular sickly and faint, and not unlike the smell 
 of a fish-market. The next year, at Barcelona, Pariset 6 and his 
 colleagues noticed a cadaverous odour in some, though not gene 
 rally. Audouard 7 mentions it as of frequent occurrence ; so does 
 Lafuente, 8 and other Spanish writers. Rochoux 9 states that some 
 of the sick emit a very offensive odour, analogous to that of gan 
 grene ; and adds that it is a usual attendant on the cutaneous exhala- 
 
 1 Eilinb. Journ. ii. 84. 2 Ibid. i. 448. 
 
 3 Op. fit. 55, 50. 4 Quoted by Bally, 250. 
 
 5 Epid. Y. F. of the South Coast of Spain, 105. 6 Op. cit. 435. 
 
 7 Op. cit. 211, 393. 
 
 8 Observnciones sobre la Fiebre Amarilla, &c. Pcriodico de la Soc. Med. Cir. i. 1G5. 
 (See Mochoux, 472.) 
 
 9 Rochoux, op. cit. 461, 472, 473. 
 
374 lNEf MOtflA AtfD 
 
 tion, whether the latter assumes the character of sweat or of insensi* 
 ble perspiration. "It is not," he adds, "so strong as to be perceived 
 from the street, as some physicians have asserted ; but we never fail to 
 be struck with it when we uncover a patient and approach very near 
 him. It is of an insipid nature (fade), somewhat nauseous, and 
 adheres strongly to clothes." The same writer remarks, in ad 
 dition, that, on this point, the yellow fever approximates closely to 
 hospital typhus, and the plague, both of which are characterized by 
 a peculiar odour. 
 
 Nor is this all; Desportes, 1 more than a century ago, noticed the 
 same phenomenon in the fever of St. Domingo, where it was sub 
 sequently observed by Bally 2 and Gilbert, 3 the former designating 
 it as fetid, the latter as cadaverous. Dr. E. Jackson 4 found in the 
 West Indies, as he did in the fever of Europe, cases in which the 
 perspiration had a peculiar smell, resembling that of a fish-market. 
 In the fever of Dominica, as we learn from Dr. Imray, 5 the odour 
 of the cutaneous exhalation was often extremely disagreeable as 
 well to the patient himself as his attendants. Additional testimony 
 on this subject might be gathered from the writings of Gillespie 
 (34), Savaresi (273, 4), Madrid (25), Yatable (346), Frost (Med. Re- 
 pos. xiii. 33), Comrie (Ed. J. xiii. 177), Ealph (Ed. Med.-Chir. Tr. ii. 
 75), Arnold (10). 
 
 The condition of the urine different in the two diseases. It may not 
 be improper to call attention, in this place, to the condition of 
 the urine in the two diseases. As is known, this fluid in its normal 
 state, contains, on an average, 11.88 of urea, 0.395 of uric acid, 
 6.80 of inorganic salts, and 8.60 of organic matter. Of the salts, 
 the chloride of sodium may be estimated at from ^ gJJ parts to 
 f jfjf in 1,000. Now when, with this before us, we inquire how 
 matters stand in respect to malarial fevers and pneumonia, we find 
 that these diseases differ in no inconsiderable degree from each other 
 and from the state of health, so far as the proportionate quantity 
 of those ingredients is concerned. In the former the urea is in 
 less quantity than in health, presenting a proportion of only 9.01. 
 At the same time, the quantity of uric acid attains an amount of 
 9.80, or eight times larger than in health. As regards the inorganic 
 
 1 Maladies de St. Domingues, i. 221. 2 Typhus d Amerique, 247, 248. 
 
 3 Hist. Med. de 1 Armee Frar^aise a St. Domingue, 6(5. 
 
 4 Sketch, i. 04. 5 Edinb. Med. and Surg. Journ. liii. 80. 
 
AUTUMNAL FEVERS. 375 
 
 salts, we find them to rise as high as about 16.72, or much more 
 than twice as high as in healthy urine, while the organic matter 
 varies but slightly, if at all, from the normal state. As a matter 
 of course, amid this increase in the salts, the chloride of sodium 
 can suffer no diminution, and in all probability has increased in 
 the same ratio as the other salts. 1 During the stage of apyrexia 
 in intermittent fever, the urine is often found, so far as the above 
 ingredients are concerned, in its natural state : a condition propor 
 tioned in great measure to the extended duration of that stage and 
 the shortness of the febrile paroxysm. In some cases the fluid is 
 healthy throughout. But in most instances the changes under con 
 sideration exist as well in the intermissions as during the parox 
 ysms, and are greater in proportion to the length of the disease. 
 In no instance can we discover that the proportion of uric acid 
 remains at the normal point, and that the quantity of the fixed salts 
 falls considerably below. 
 
 In reference to the phlegmasiae, and pneumonia in particular, the 
 proportions are nearly reversed ; for Simon and other high che 
 mical authorities have shown that the urine therein exhibits a 
 marked diminution of the inorganic salts, and a greater relative 
 amount of organic constituents ; the proportion of the ingredients 
 mentioned being urea, 7.3 ; uric acid, 0.4 ; fixed salts, 2.7 ; and or 
 ganic matter, 8.8. 2 In an examination by Becquerel (op. cit. 329), 
 the following proportions, which differ but little from the preceding, 
 were obtained : urea, 7.761 ; uric acid, 0.464 ; inorganic salts, 2.871 ; 
 organic matter, 9.332. Of the salts, the chloride of sodium was 
 early found to suffer a greater diminution than the others in all the 
 phlegmasiae. Subsequent observations, made some three years ago 
 by Dr. Redteiibacher, leave no doubt that, in pneumonia, the result 
 in question is still more marked and constant than in inflammation 
 of other organs ; for while in these the chloride is usually only greatly 
 diminished, and sometimes, indeed, preserves its normal proportions, 
 in pneumonia the quantity of the salt never fails to diminish gra 
 dually until the period of hepatization has occurred, when no. traces 
 of it can be detected in the urine, and only makes its appearance 
 again as the resolution of the inflammation proceeds. It may be 
 remarked that this effect cannot be due solely to the altered diet 
 
 1 Becquerel, Semeiotique cles Urines, 256-291 ; Heretier, Cbiuiie Med. 528 ; Simon, 
 op. cit. ii. 255-257. 
 
 2 Simon, op. cit. ii. 216. 
 
376 PNEUMONIA AND 
 
 taken by patients labouring under the disease, for other inflamma 
 tions require the same diet, and we have just seen that in them the 
 phenomenon often fails to present itself. 1 
 
 By Mr. Beale, of London, the subject has been recently taken up 
 and apparently examined with considerable care; and from his 
 researches in the matter, he arrives at the following conclusions : 
 
 1. That in pneumonia, there is a total absence of chloride of 
 sodium from the urine, at or about the period of hepatization of 
 the lung. 
 
 2. That soon after the resolution of the inflammation, the chloride 
 becomes restored to the urine, and often in considerable quantity. 
 
 3. That at this period the serum of the blood is found to contain 
 a greater amount of chloride than in health. 
 
 4. That the presence of chloride of sodium in the urine may be 
 taken as evidence of the existence of a greater quantity of the salt 
 in the blood, than is required for the wants of the system gene 
 rally, or at least of an amount sufficient for that purpose ; and that 
 the absence of the salt from the urine indicates that the circulating 
 fluid contains less than the normal quantity. 
 
 5. That the sputa in pneumonia contain a greater quantity of 
 fixed chloride than healthy pulmonary mucus, if there be not much 
 less than a normal amount in the blood, although there be a com 
 plete absence of the salt from the urine. In all cases, however, 
 there is found in the sputa a quantity many times greater than 
 exists in an equal amount of blood at the same period of the dis 
 ease. The absolute amount present is subject to variation at dif 
 ferent periods of the disease, and in different cases. 
 
 6. That there is reason to believe that the absence of the chloride 
 of sodium from the urine during the stage of hepatization, depends 
 upon a determination of this salt to the inflamed lung, and that, 
 when resolution occurs, this force of attraction ceases, and what 
 ever salt has been retained in the lung is reabsorbed, and appears 
 in the urine in the usual way. 2 
 
 Here, then, we perceive a strong contrast existing between 
 pneumonia and malarial fevers increase of urea in the one, and 
 diminution of the same in the other disease ; diminution of uric 
 acid in the former, and great increase in the latter; diminution of 
 the salts in the one, great increase of them in the other ; consider 
 able diminution, and finally total absence of the chloride of sodium 
 
 1 Edinb. J. Ixxx. 246. 2 Med.-Chir. Trans, xxxv. 355, &c. 
 
AUTUMNAL FEVERS. 377 
 
 in the one, increased or normal quantity of the same in the other 
 disease ; finally, vast increase of organic matter in the former, 
 ordinary quantity of it in the latter. To this, let it be added that 
 when in malarial fevers results of an opposite nature are obtained? 
 they will be found due to an inflammatory complication. 
 
 But I have sufficiently enlarged upon these topics. Nor shall I do 
 more than refer to the peculiar acid alliaceous odour of the breath, 
 which has been regarded, justly no doubt, as among the character 
 istics of yellow fever; 1 the pearly appearance of the gums in the 
 same disease, to which attention was first called by Dr. Yaletti, of 
 New Orleans ; to the peculiar indentation at the roots of the nails, 
 " indicating the point at which their growth was suspended by the 
 disease ;" observed, it is said, in 1847, by Dr. Walkly, of Mobile, 
 in all the forty -one cases he examined ; 2 or to the bluish discolora 
 tion of the gums said to be peculiar to all malarial diseases. These 
 subjects have not yet been examined to a sufficient extent to be 
 used in this place for purposes of comparison. 
 
 Anatomical characters different in the two diseases. Nor is the dis 
 crepancy less marked in regard to the anatomical characters of the 
 two diseases. In the one, there is often no traces of inflammation, 
 properly so called. When these do present themselves, they are 
 seated in the gastro-intestinal surface ; sometimes, though not 
 always, in the cerebral organs and membranes, and occasionally in 
 the liver. As frequently, these organs are only congested. Usu 
 ally, the liver is neither inflamed nor greatly congested, being in 
 some forms of fever (the bilious remittent) of a bronze hue, depend 
 ing on the deposit of a dark mela3nic pigment, not unlike the dark 
 solid substance of black vomit. It does not contain a larger quan 
 tity than natural of fatty matter, but is filled with bile. 3 In another 
 form of malarial fever the yellow the organ is of a pale yellow 
 colour, and dry anemic texture. It bears the marks of having se 
 creted little or no bile during the course of the attack, 4 and has been 
 shown by Dr. A. Clark, of New York, whose discovery was fully 
 
 1 Kelly, Am. J. xiv. (N. S.) 374. 2 N. 0. J. v. 481. 
 
 3 Brit, and For. Med.-Cli. Rev. Jan. 1849, pp. 95. 96. Stewardson, Am. J. (N. 
 S.), i. 313; Swctt, ib. iii. 83, 35; Anderson and Frick, ib. xi. 332; Anderson (of 
 Alabama), Prize Essay, Proceedings of Alabama Medical Association, 1852, p. 117. 
 
 4 See Louis on Yellow Fever, and mai^ other works on the same disease. 
 
378 PNEUMONIA AND 
 
 confirmed during the last autumn in Philadelphia, to contain, and 
 to owe its peculiar hue, to the deposit in the hepatic cells of a large 
 quantity of oily or fatty matter, which, in some cases, imparts to 
 the organ much of the characteristic appearances of a common 
 fatty liver. The spleen is usually found congested, softened, or 
 enlarged, or even hypertrophied. This condition of the organ 
 appertains more specially to the intermittent and remittent forms 
 of malarial fevers, and has been noted universally in this country, 
 in France, England, Holland, Algeria, India, and, indeed, in every 
 country where these diseases prevail, and where dissections have 
 been performed. It is noted also in typhoid, and in the relapsing 
 fever of the British islands so frequently, indeed, as to be viewed 
 in the light of a characteristic phenomenon. 1 Finally, the blood 
 in general is found altered in colour, often more or less fluid, and 
 exhibiting, in malignant cases, signs of decomposition. But amid 
 all these changes, the lungs remain unimplicated ; or, if otherwise, 
 the occurrence is rare, and differs in nothing from what is seen in 
 other acute diseases not especially seated in those organs. 
 
 Here, then, we perceive that neither this affection, nor any local 
 inflammation, nor a buffy or cupped blood form part and parcel of 
 autumnal fevers during life, or leave traces after death. In the 
 other disease, on the contrary pneumonia the lungs never fail to 
 present marks of inflammation, varying in character according to 
 the stage at which the disease had arrived; and while such changes 
 are necessarily and invariably detected in those organs, the stomach, 
 bowels, liver, and spleen are very usually found in their normal 
 state. In fact, no sign observed during life, no anatomical character 
 discovered after death, can be adduced in evidence of the pathologi 
 cal identity of those diseases, or induce us, for a moment, to think 
 they arise from the same cause. In the one case, the latter consists 
 
 1 Cleghorn, 84 (5th eel.); Monfalcon, 208,532; Addison, Lond. Med. Gaz. xxiii. 
 796 ; Forbes s Rev. xviii. 189 ; Tweedy, 33, Am. ed. ; Copland, ii. 1089 ; Henderson, 
 Edinb. J. lix. ; Dickson, Charleston J. i. 20; Am. J. July, 1852 ; Drake, i. 830, 842; 
 Swett, Am. J. (N. S.) iii. 33, 35; Stewardson, Am. J. (X. S.) i. 314 ; Bartlett, 332 ; 
 Anderson and Frick, Am. J. (N. S.) xi. 332; Haspcl, Mai. de 1 Algerie, ii. 201, 317; 
 J. Davy, ii. 230; Williams, ii. 470; II. Jackson, i. 80; Boudin, Gdographia Med. 40; 
 Cycl. of Pract. Med. ii. 223 ; Twining, Fevers of Bengal ; Boyle, Dis. of West C. of 
 Africa, 89, 141, 140; Durand, Mem. &c., sur les rates engorgees pendant les f. Interm. 
 0; Bryson, 73; Evans, 221 ; Marshall, Top. and Dis. of Ceylon, 142; Watson, 455; 
 Anderson, loc. cit. 117; Ncpple, F. I. 61, 270; Audouard, Bulletin, xii. 151; C. 
 Broussais, ib. 293; Corney, ib. 624; Maillot, 285; Bonnet, 214; Bailly, 102, &c. 
 
AUTUMNAL FEVERS. 379 
 
 chiefly in some irregular mode of application of common atmospheric 
 influences, which operate by occasioning, after a comparatively 
 short, or even without any visible sedation, an inflammatory reac 
 tion in the organ affected, as also secondarily in the system at large. 
 In the other case, the cause consists evidently of a peculiar poisonous 
 matter floating in the atmosphere; the primary and prominent 
 effects of which are subduction of the vital or nervous power, dimi 
 nution of vascular action, prostration, to a greater or less extent, of 
 all the energies of life, and, as a consequence, of the vital affinity 
 and cohesion of the soft solids and contamination of the circulatory 
 and secretory fluids. These are doubtless attended, in the early stage 
 of the milder cases and less violent forms, with symptoms of reac 
 tion, as well as with a functional derangement of important organs ; 
 but often this reaction is broken or imperfect; and frequently the dis 
 ease is characterized, throughout its whole progress by symptoms of 
 prostration. In a word, we perceive effects which bear, in the more 
 severe and malignant forms of the disease especially, a close analogy 
 to those occasioned by other and more tangible toxical agents. Like 
 some of these, as oxalic acid or nicotine the malarial and several 
 other zymotic poisons, sometimes suddenly prostrate the system to 
 the verge of the grave, or even destroy life in a few hours and during 
 the first access, or, as Dr. Simon says, in the tremendous shock and 
 depression thereby occasioned in the system. So rapidly destruc 
 tive, indeed, is the effect, that were it not for concomitant circum 
 stances it would often be difficult to form an idea of the real nature 
 of the case. The narcotico-irritating quality of the poison is fully 
 indicated by the phenomena of the opening stage of fever, for this 
 is marked by a reduction of vital energy, obtuseness of sensibility, 
 suspended or perverted secretion, and diminished calorification. As 
 Dr. Drake remarks : " We may assure ourselves that its first effects 
 will not be increase, but depression of excitement, by referring to 
 the constitutional influence of foreign matters, liquid or gaseous, 
 when introduced into one of the serous membranes (as the peri 
 toneum, for example) which are always those of depression as well 
 as irritation." 1 
 
 It may not be amiss to remark, while on this subject, that parox 
 ysms of febrile excitement, assuming a periodic type, and which, 
 though not identical with, bear some analogy to, various forms of 
 
 1 Op. dt. 733. 
 
380 PNEUMONIA AND 
 
 malarial fevers, are not unfrequently produced by agencies of a 
 debilitating character, even though the localities where they occur 
 are free from periodic fever; and we know that in paludal or fever 
 districts, attacks of the disease are sure to be brought on by the 
 application of such agencies, and that experience has taught the 
 necessity of avoiding, in such districts, a mode of living calculated 
 to place the system below par. Of the first of these causes, one 
 example will suffice. M. Eenouard communicated to the Academy 
 of Medicine of Paris, in 1847, an account of several cases in which 
 periodic paroxysms of fever were produced in a non-malarial locality 
 by copious losses of blood. In one of these instances the disease 
 produced assumed a regular tertian type ; in two others the fever 
 was remittent. All were cured by a tonic and quinine treatment. 1 
 
 The two diseases differ widely as regards the duration of the %)rocess 
 of incubation. Other reasons may be adduced in support of the 
 opinion here advocated. In one of these diseases periodic or 
 autumnal fevers the period of incubation or latency, i. e. the period 
 during which the system tolerates the poison, and the latter remains 
 apparently innocuous until reaction is brought about by some in 
 trinsic circumstance of the depressing kind or otherwise though 
 considered as very short by Macculloch, 2 Nepple, 3 and a few others, 
 is often found to be very greatly prolonged; while in every case of 
 pneumonia the morbid effect soon follows the application of the 
 cause. The yellow fever poison, though occasionally rapid in its 
 effects, and attacking but a few hours or days after exposure, re 
 mains at times dormant in the system as long as fifteen, thirty, or 
 fifty days. In one case mentioned by Blair (69, 70), the period 
 seemed extended to four months. In a private communication to 
 the author, Dr. Merrill states that during the epidemics of Natchez, 
 which he witnessed, the period of incubation occasionally extended 
 to fifteen days. M. Bertulus, who saw the disease in the West 
 Indies, limits the period to from three to eight days, and affirms 
 that it never extends beyond three weeks. 4 Dr. Stevens, also, who is 
 well acquainted with the true yellow fever, which, in accordance with 
 his views, respecting its origin and nature, he denominates African 
 typhus, states that it never produces its effects previous to the fourth 
 
 1 Bulletin, xii. 040. 2 An Essay on Marsh Fcv. i. 20. 
 
 3 Traite do la F. Int. 140. 
 
 4 Mem. sur 1 Intoxication Miasmatique, 39 
 
AUTUMNAL FEVERS. 381 
 
 day, and that ho has known some well-marked cases in which, the 
 poison being applied in a less concentrated form, the individuals 
 were not attacked until twelve days had elapsed after exposure. 1 
 From all the facts I have myself been enabled to collect, I am of 
 opinion that, though sometimes very short, and at others very long, 
 the period of incubation in yellow fever usually varies from five to 
 ten days. 
 
 In other forms of malarial fevers, the period of latency is seldom 
 shorter than three or four days. In general it extends beyond this, 
 and has not unfrequently been known to reach a limit far exceeding 
 that noticed in the yellow fever. Our lake fever, according to Dr. Ste 
 vens, has an incubative period of about a week ; but, when the poison 
 is concentrated, an attack often comes on as early as the third day 
 never sooner. 2 In the epidemic of Naples, in 1764, the disease some 
 times, though rarely, broke out immediately after exposure. In the 
 greater number of instances, the poison remained latent to the end 
 of the first week. 3 Dr. John Hunter states that, on the Watering ser 
 vice in the West Indies, some fell sick on the first and second day ; 
 others embarked and were seized on the tenth or fourteenth day, or 
 even three weeks after exposure. 4 He informs us that the Suffolk 
 militia were called, in 1793, from their healthy country to Hilson 
 Barracks, the low, marshy, unhealthy situation of which is pro 
 verbial. Twenty-two died before they left at the end of June. In 
 July the regiment, with eleven other battalions, encamped at Water- 
 town, near Tunbridge Wells. One hundred sickened soon, out of 
 five hundred, with fever. Some were taken ill in October, or four 
 months after leaving the Ililson Barracks. The 18th regiment, in 
 1783, after being at the same barracks from June 22 to October 9, 
 were sent to Gibraltar. There were then sixteen of the men labour 
 ing under ague. While at Gibraltar, though the regiment was only 
 four hundred strong, the disease spread so rapidly among them, 
 that by May the cases amounted to two hundred and eighty (in 
 cluding women and children), of whom a part were then recently 
 attacked for the first time. Whilst such was the course of events 
 in this ill-fated regiment, the disease did not exist in any other part 
 of the garrison. 5 Dr. Hunter adds that, "ships returning from a 
 warm climate, particularly if they have been in harbour during the 
 
 1 Stevens on the Blood, 235. 2 Op. cit. 243. 
 
 3 Sarcone, Maladie de Naples, ii. 73, 74. * Op. cit. 153. 
 
 5 Ibid. 327-334. 
 
382 PNEUMONIA AND 
 
 unhealthy season, have many of their men taken ill of the remittent 
 fever, even two or three months after being at sea. 1 
 
 Some of the British soldiers who inhaled the pestiferous atmo 
 sphere of the Walcheren Marshes, were attacked for the first time 
 in healthy situations in England Colchester, Woodbridge, &c. 
 as late as nioe months after they were brought back. 2 The follow 
 ing facts, communicated to Dr. Bancroft by Mr. Nixon, surgeon to 
 a battalion of the 1st Eegiment of Foot Guards, will be read with 
 interest. The battalion landed on South Beveland on the 2d of 
 August, 872 strong. On the 19th, the endemic appeared among 
 the men, and between that day and the 4th of September, when the 
 men embarked for England, i. e. sixteen days, 359 of them were 
 attacked. The battalion was landed at Chatham about the 7th or 8th 
 of September. Many of the men continued to be attacked with 
 endemic fever, so that by the 8th of March, 1810, only 117 of the 
 original strength had escaped the disease in question. Some of the 
 117 men were attacked with intermittent fever as late as the middle 
 of the month of June. 3 Dr. Ferrus, a distinguished physician of 
 Paris, relates a striking instance of the kind. Three hundred men, 
 of the old Imperial Guard, to which he was surgeon at the time, 
 were exposed to the cause of autumnal fevers in Breslau. Many 
 of them took the disease ten days after leaving the place ; other 
 cases followed, and the fever became general. Dr. Ferrus himself 
 was attacked six months after, while stationed on the Niemen, 
 where no disease of the kind prevailed, and at a period when the 
 country all around was perfectly healthy. 4 Of forty cases of inter 
 mittent fever which occurred on board the II. C. ship Barrosa, in 
 1832, 1833, three took place seventy to eighty days after leaving 
 England: thirty-one while lying at Whampoa; and seven from two 
 to three months after leaving Canton, and ninety-three days after the 
 disease had ceased in the ship. 5 Labourers, especially the Irish 
 will go down, for harvest work, into Lincolnshire, and bring back 
 the seeds of ague within them, and yet may not be attacked for 
 weeks or months. 5 M. Boudin calls attention to a fact which he him- 
 
 1 Op. cit. 335. 
 
 * Bancroft on Yellow Fever, 241, 304; Elane Diss. i. 244; Williams, Morbid Poi 
 sons, ii. 4G5. 
 
 3 Bancroft, 307, 308, note. 
 
 4 Diction, de Mod. xii. G; ibid. 2d ed. xviii. GO. 
 
 5 Peterson, Med. Gaz. xv. 2GO. 6 Med. Gaz. xxviii. 3G5. 
 
AUTUMNAL FEVEKS. 383 
 
 self noticed ; that regiments that had returned to Marseilles, where 
 periodic fevers are but little known, from the malarial districts of 
 Algeria and Corsica, as well as those that had formed part of the 
 expeditionary army of the Morea, continued during several years 
 (des anntes entires) to suffer from diseases bearing unequivocal 
 marks of the fevers of the localities they had left. 1 Towards the 
 close of the year 1843, two regiments of infantry arrived at Cour- 
 bevoie ; the one (23d Light Infantry) coining from a northern gar 
 rison, the other from the citadel of Strasburg, where malarial fevers 
 prevail extensively. The two regiments occupied the same bar 
 racks, performed the same duties, partook of the same fare, and 
 were in every other respect on the same footing. Yet, while the 
 first of these regiments suffered from typhoid fever and pneumonic 
 inflammations, the other furnished, for more than a year, a large 
 number of intermittent fever cases. The disease spread to several 
 hundred of the men, and spared few not even those who had not 
 had it during their stay in the malarious locality whence they 
 came. 2 A similar occurrence was observed in another regiment 
 (the 75th) transferred from Strasburg to Versailles, in the autumn 
 of 1843. In December of the year following, the fever was still 
 prevailing, but only among the men who had arrived from Stras 
 burg; the new recruits remaining free from the disease. 3 In an 
 other essay, M. Boudin remarks : " So far as regards myself, after 
 a survey of the numerous observations we have collected in France, 
 at periods and in localities exempt from periodic fevers among 
 men arriving from the paludal districts of Corsica, Morea, and 
 Africa, we have no hesitation in declaring that the period of 
 latency of the malarial intoxication may extend to eighteen 
 months." 4 
 
 One of our countrymen, Dr. L. II. Anderson, of Alabama, in his 
 Prize Essay, already referred to, states that he was himself attacked 
 in the city of Paris, six months after leaving a mountainous dis 
 trict, with an intermittent of a very different character from the 
 fever usually observed in that city. The remote cause, as he 
 remarks, had no doubt been harboured in the system all the time, 
 his general health appearing, notwithstanding, for three months 
 before the attack, better than it had been for years. The exciting 
 
 1 Annales d Hygiene, xxxiii. Go. 2 Loc. cit. 64. 
 
 3 Ibid. 65. 4 Boudin, Geographic Med. 64, 
 
384 PNEUMONIA AND 
 
 t 
 
 cause, Dr. Anderson thinks : was doubtless the bad air of the hos 
 pitals, dissecting-rooms, &C. 1 
 
 Dr. Lee relates the case of an officer of our navy, who was ex 
 posed several years before to the highly concentrated miasm which 
 produced the fatal endemic among the residents of Thompson s 
 Island, on the Florida coast. Although he escaped the bilious 
 remittent, which proved so fatal to many others, he yet had occa 
 sional attacks of genuine intermittent, for several years afterward, 
 on exposure to cold, moisture, or great fatigue, although residing 
 in a part of New England where intermittents were never known 
 to prevail. 2 
 
 In all fenny countries, individuals exposed to the miasmata of 
 autumn are often affected for the first time the following winter or 
 spring; while exposure, at the latter seasons, in the same locality, 
 is in no way attended with danger to those who have not imbibed 
 the malaria. So frequently is this result obtained, that it is very 
 generally admitted by the most accurate and cautious observers, 
 that vernal or winter periodic fevers are the offspring of autumnal 
 exposures. For the occurrence of such cases in this country, we 
 may, as Dr. Drake has done, refer to the experience of every phy 
 sician who resides in regions infested with autumnal fever. 3 
 
 This power of prolonged latency is an attribute of diseases arising 
 from the agency of morbid and specific, and of many common poi 
 sons whether they are endowed or not with contagious pro 
 perties and its manifestation by autumnal fevers, establishes the 
 fact of a close connection between malaria and the other class of 
 morbid agencies alluded to, and indicates the propriety of referring 
 that fever to a cause of kindred nature. According to Ilildenbrand, 
 the incubative period in typhus varies from three to seven days 
 (p. 30). Haygarth 4 says, that of 72 persons exposed to the poison, 
 5 were attacked within ten days ; 13 between the tenth and seven 
 teenth day ; 41 between the seventeenth and thirty-second ; and 1 
 on the seventy-second. Of typhoid fever, we find that the period 
 of latency, though usually short, is sometimes as long as it is in 
 typhus, if not longer. Boudin states that at Algiers and Bone, 
 
 1 Proceedings of the Ala. Mecl. Assoc. for 1852, p. 115. 
 
 2 Copland s Diet. ii. 1000, note. 
 
 3 Topog. &c. of the Miss. Valley, i. 813; Cooke, Med. Recorder, vii. 459; Edinb. 
 J. Ixxi. 355; Stevenson the Blood, 241. 
 
 4 Letter to Dr. Percival, 68. 
 
AUTUMNAL FEVERS. 385 
 
 
 where this form of fever does not prevail or originate, troops 
 
 arriving from Marseilles suffered from it for a few months, while 
 others that arrived from elsewhere, or had been in the country 
 some time, were exempt. 1 Dr. Williams states that the period may 
 extend to five or six months. 2 
 
 None of our readers need be told that some mineral poisons as 
 arsenic, mercury, and lead, for example occasionally do not manifest 
 their baneful or remedial effects until a long while after being ab 
 sorbed; and may give, during a still longer period, proofs of their 
 existence in the system, without, however, producing actual disease, 
 or even indisposition. Orfila found, on the 3d and 7th of February, 
 arsenic in the blood drawn from the arm of an individual who had 
 swallowed a quantity of the metal on January 28th. In another 
 case, he found the same substance in the blood twenty- two days 
 after it had been taken. 3 The pestilential pustule (bouton cFAlep) 
 does not break out, in some cases, until months after exposure. 
 Boudin mentions a case in which it made its appearance in France 
 ten months after the return of the individual from the East. 4 Au- 
 bert Eoche states that, during a period of one hundred and twenty- 
 two years (1717-1841), the incubation in plague was not found to 
 be prolonged beyond eight days. 5 
 
 The researches of the commission appointed by the Academy of 
 Medicine of Paris, to investigate the subject of quarantine, lead to 
 the conclusion that the incubation of the plague varies according 
 to the period of the epidemic and other less influential circum 
 stances. In the early period of an epidemic, the incubation is short. 
 In the second period, and subsequently, its duration varies from 
 three to five days. The larger number of the authorities consulted 
 were of opinion that the incubative process did not exceed eight 
 days ; some thought it might run to the tenth day, or even beyond. 
 Such cases, however, appear to have been rare. Nevertheless, 6 
 Pariset mentions a case in which the period extended to the thir 
 tieth day. 7 
 
 The usual length of the period of latency in hydrophobia is esti 
 mated at between thirty and forty days. Mr. Demeunynk, in a 
 
 1 An. d Hyg. xxxiii. 63; Geog. Med. 50. 2 Morbid Poisons, i. 40. 
 
 3 Bulletin de 1 Acad. de Med. iii. 598, G76. 4 Geog. MeU 65. 
 
 5 De la Peste ou Typhus D Orient, 85. 
 
 6 Rapport a 1 Academic, &c. 190, 197; Clot-Bey, 19. 
 
 7 Revue Medicale, Sept. 1844. 
 
 25 
 
386 PNEUMONIA AND 
 
 memoir presented to the Academy of Medicine, in May, 1839, 
 relates three cases. In one, the period of incubation extended to 
 thirty -two days ; in the second, it reached to fifty -four days ; and in 
 the third, the disease did not break out before three months. 1 
 Fothergill 2 mentions the case of a Mr. Bellamy, who was bitten by 
 a rabid cat, and was attacked with that disease four months after. 
 Similar cases are mentioned by Mosely and Dr. Matthei of Geneva ; 
 Yaughan extends the period to seven months; Fracastorius to 
 eight; 3 Mead to eleven; 4 Bauhin to twenty-two; Dr. John Hunter, 5 
 R. Hamilton, and Nurse, to from seventeen to nineteen ; Grant to 
 twenty; 8 while Lentilius speaks of three years; M. Bouillod of 
 seven years ; 7 Dr. Bardsley of twelve years ; and Morgagni of twenty, 
 and even forty. Leaving out the latter very extraordinary cases, 
 for the correctness of which I am not prepared to vouch, and which 
 may have been, and probably were, the effect of the imagination, or 
 symptomatic of some other complaint, there is enough left to show 
 that the period of latency in hydrophobia is occasionally very long. 
 The length of the period in cowpox varies from three days to three 
 weeks. In a case observed by M. De Lens, the disease did not 
 show itself before a full month. 8 In another, mentioned by Dr. 
 Stevens, the pustule did not make its appearance until six weeks 
 after vaccination. 9 
 
 The usual period in chancre is from four to eight days, unless 
 the surface is abraded. Hunter has known the disease to be re 
 tarded as late as seven weeks. Secondary syphilis breaks out 
 ordinarily between six weeks and six months after the cure of the 
 primary symptoms ; sometimes, however, not before several years. 
 In one case, mentioned by Williams, the disease did not show itself 
 in fifteen years. The average incubative period in smallpox is 
 estimated at fourteen days, from exposure to the contagion, to the 
 appearance of the eruption the extremes being one and three 
 weeks five to twenty-three days, according to Williams. In the 
 greater number of cases, no uneasiness is experienced before the 
 eleventh or twelfth day after exposure. The period in scarlatina 
 
 1 lleport by M. Dubois, Bulletin dc 1 Acad. iii. 929. 2 Works, ii. 222. 
 
 3 DC Contng. 123. < The Med. Works, 57. 
 
 5 Cyclop, ii. 492. 
 
 e Med. and-Phy. Tr. of Calcutta, ii. 51. 
 
 7 Anglada, Traite de la Contagion, i. 209. 
 
 8 Bousquet, Traite" de la Vaccine, 525. 9 On the Blood, 237. 
 
AUTUMNAL FEVERS. 387 
 
 
 
 is from a few hours to ten days. In measles, from ten to sixteen 
 days. 1 
 
 Process of latency governed by definite laics. The results of observa 
 tions made during a period of a third of a century, have inclined 
 me to the opinion, which others had adopted long before, that the 
 process of latency in autumnal fevers is ordinarily governed, as 
 regards duration, by certain definite laws, analogous to those which 
 preside over the progress, fluctuations, and return of the same arid 
 some other diseases. The late Dr. R. Jackson was of opinion that 
 the aptitude to receive the morbific impression of the cause of fever, 
 takes place more at particular periods than others ; that it manifests 
 itself more frequently about the fourteenth day after communication 
 with an infected source, and that it is observed chiefly at septenary 
 periods, the seventh, fourteenth, twenty-first, &c. from the time of 
 exposure. This opinion was based upon the results of his own ob 
 servations, " made upon numerous bodies of men ; upon healthy men 
 placed as attendants in infected hospitals, and upon healthy soldiers 
 sent to concentrated sources of endemic fevers." Among such, fever 
 scarcely ever appeared before the seventh day, commonly not be 
 fore the fourteenth, and in numerous instances not till the expira 
 tion of six weeks, or even two months ; though the cause of disease 
 during the time was ordinarily in great activity. 2 Nor has it failed 
 to be noticed that intermittent fevers exhibit, during their course, 
 a tendency to a septenary revolution ; that at those periods, either 
 after the seventh, fourteenth, or twenty-first paroxysm, the disease 
 has a disposition to terminate spontaneously. This was frequently 
 verified in Florida, under Dr. Forry s observations, 3 and has been 
 noticed sufficiently often elsewhere to justify its being viewed in 
 the light of a well-established fact. In remittent fever, the same 
 tendency is noticed, the disease having a particular disposition to a 
 favourable critical change on the seventh, fourteenth, twenty-first, 
 and twenty-eighth day. 4 Nay, more, there are not wanting facts to 
 show that the tendency to relapse in autumnal fevers is governed 
 by analogous laws. We know that in the form of fever, which, 
 from its constant return at stated times, after apparent convales 
 cence, has received the name of the relapsing fever, the symptoms,. 
 
 1 Williams on Morbid Poisons, i. 40, 120, 172, 214. 
 
 2 Outlines, 247, 248. 3 Climate of the United States, 283. 
 4 Jackson, Sketch, i. 107; Copland, ii. 1101. 
 
388 PNEUMONIA AND 
 
 after the critical sweat of the fifth or seventh day, generally return 
 on the fourteenth; and those relapses recur not only once, but 
 several times. Other fevers, in like manner, show a disposition to 
 recur at stated periods. In the government of Ufa (Russia), 
 autumnal fever, which in that section of country is very common, 
 attacks the patient every seventh day only, and is so severe that it 
 generally proves fatal. 1 Similarly to what occurs in relation to the 
 decline of the disease, or to its attack after exposure to the cause, 
 the periods most remarkable, according to the ample experience of 
 Dr. E. Jackson, for the recurrence of the symptoms are the sep 
 tenary; the seventh, fourteenth, twenty-first, and twenty-eighth, 
 with, as that high authority adds, new and full moon. 2 Whether 
 the doctrine will bear the test of observation, particularly in its 
 application to the period of latency, time must determine. Suf 
 ficient is it for our present purpose to call attention to the fact, 
 that, should the statement of Dr. Jackson and others, relative to the 
 period of attack after exposure, be well founded, it furnishes an 
 illustration of the connection between the period of latency and the 
 septenary revolutions of the system, so far, at least, as the number 
 of those revolutions have been counted. To this I must add, that 
 individuals who relapse with fevers, do so, in all probability, in 
 consequence of the cause not being completely eliminated from 
 their system, and remaining in a latent state during the period of 
 exemption. If this be admitted, and we find that these relapses 
 take place at regular septenary periods, we derive from that fact a 
 proof that the process of latency is under the influence of the law 
 of septenary revolution. 
 
 Much may be said concerning the above law relative to the period 
 of seven days in fevers ; for it is one which, as Dr. Laycock has 
 forcibly shown, is of very general application in the explanation of 
 vital phenomena in health and disease. Everything, indeed, leads 
 to the conclusion that a period of seven days, and definite fractions 
 or multiples of that period, are very prominent in the series of 
 phenomena called critical days, and the operations of the system 
 generally. It forms part of the great fact of vital periodicity, to 
 which attention was called by some of the most ancient writers who 
 have left records of their observations. The doctrine of septenaries 
 
 1 Notices of Russia, United Service Journal, Jan. 1833, p. 49. 
 
 2 Sketch, ii. 212; Outline, 304. 
 
AUTUMNAL FEVERS. 389 
 
 is literally as old as the hills. Originating probably with the Chal 
 deans or Egyptians, it formed part of the system of Pythagoras ; 
 and its application, to the phenomena of disease particularly, is dis 
 cussed by Hippocrates, Diocles, Galen, Celsus, and others. In his 
 ingenious speculations on the periodicity of the phenomena of life, 
 Dr. Laycock has shown that the critical days of health and the 
 critical days of fevers produced by the entrance of a poison into 
 the system whether that poison consist in malaria, or in a conta 
 gious matter are identical ; that the depression of the system will, 
 in consequence, take place at those critical days, and that a fever 
 depending on a poison is more likely to appear on those days than 
 on any other. In confirmation of this, he states that the latent 
 period in most diseases is regulated by weeks, as are also the latent 
 period of animal poisons. He remarks that, in accordance with 
 this law, the latent period of fever rarely extends beyond twenty- 
 eight days. " If we take menstruation as a type of the critical days, 
 and suppose that a movement takes place every seven days, gra 
 dually becoming more intense at each up to the fourth week, we 
 have fever days, at least in every month in which the peculiar 
 symptoms of the poison, whether malarious, exanthematous, or con 
 tagious, may exhibit themselves; probably the number may be 
 greater ; but if one or two of these days be passed over without an 
 outburst of febrile action, it is scarcely possible that the third or 
 fourth will. 1 1 
 
 In the fevers of hot climates, which are all or for the most part 
 malarial, the doctrine of critical days, such as it has been transmit 
 ted down to us from the days of Hippocrates, has been amply veri 
 fied. On this subject, we have the testimony of high professional 
 authorities. 2 In the fevers of Europe, it has been found equally 
 applicable; 3 and in this country, when the efforts of nature are 
 not too much interfered with by an heroic perturbative treatment, 
 the Hippocratic doctrine often shines out in all its purity. To this 
 fact, which some twenty or thirty years ago it would have been 
 considered heresy to allude to approvingly, the eyes of our more 
 
 1 London Lancet, Oct. 1842, p. 161. 
 
 2 Poisonriier Fievre de St. Domingo, 119; Desportes, Mai. de St. Domingue, i. 198, 
 232; Dazille, Maladies des Negres, 36, 65; Bajon, Mem. sur Cayenne, i. 2d Mem. ; 
 Leblond, Fievre Jaune, 43 ; Levacber, Guide Med. 50. 
 
 3 Hildenbrandt, Med. Pract. pt. i. chap. v. ; De Haen, Pract. Med. pt. i. cap. iv. ; 
 Baglivi, Opera, 80. 
 
390 PNEUMONIA AND 
 
 enlightened physicians are opening. Even in sections of country 
 where formerly the idea of critical days met with most opposition, 
 a very different sentiment is now found to prevail in the minds of 
 correct, careful, and enlightened observers. Let one example suf 
 fice. Dr. Anderson of Alabama, in a prize essay, already cited, 
 after remarking that a second exacerbation takes place the next 
 day after an attack of fever, generally after meridian, adds : " This, 
 in turn, gives way during the night, or towards morning, and an 
 other remission, more or less decided, is observed. If the fever 
 take the double tertian type, the next exacerbation will come on 
 during the morning, and will be followed by another the succeeding 
 evening. The fever thus continues, sometimes rising during the 
 same hour every day, and sometimes later on alternate days, until 
 the sixth, when, if the observations of the writer of this essay are 
 worth anything, the fever (if it terminate favourably) has a decided 
 spontaneous tendency to decline, and leaves the patient free .from 
 disease on the seventh day." Again : " The fever (malarial) is gene 
 rally at its height on the fifth day; and, in bad cases, this is the 
 day of danger. In malignant tertian intermittents, the fifth is the 
 day for the third, paroxysm, universally known to be the most 
 hazardous; and, when death occurs in the disease, it commonly 
 takes place either on that day or during the next." " Commencing 
 practice," continues Dr. Anderson whose fate, in that respect, has 
 been similar to that of hundreds of physicians of this country 
 "with an utter disbelief in the doctrine of critical days, the contrary 
 opinion has been forced upon me by actual observation. I am 
 aware that the idea is discarded by a majority of physicians of the 
 day; but I think that if any practitioner in the southwest will 
 carefully note down the days in which malarious fever makes its 
 appearance, and record accurately its subsequent course, he will 
 find that the doctrine has a foundation in fact, and is worthy of 
 some consideration. It is true, that the fever may often be made 
 much lighter, or apparently arrested by the administration of qui- 
 nia during the remissions ; but it will generally be observed that 
 the patient does not frankly recover, and that it is not until the 
 seventh day that he seems actually well, and clear of all symptoms 
 of the disease." 1 
 
 But it is not necessary to enlarge farther on these topics. Enough 
 
 1 Proceedings of the Med. Assoc. of Alabama for 1852, p. 107. 
 
AUTUMNAL FEVERS. 391 
 
 has been said to prove to the most fastidious inquirer that, in 
 periodic fevers, the period of latency is occasionally remarkably 
 long ; that in these diseases, as in others appertaining to the class 
 of zymotics, the incubative process, the occurrence of relapses, the 
 duration of the attack, and the period of critical changes are under 
 the control of certain definite laws. May it not be asked whether 
 anything of the kind has been observed in regard to pneumonia 
 and kindred inflammations ? A prolonged incubation in such dis 
 eases may, for what I know, have been noticed elsewhere ; but so 
 far as the experience of the physicians of this section of the country 
 extends, it may be safely averred that nothing of the sort has 
 occurred, and I tax my memory in vain for a reference, bearing on 
 this point, to some one of the many publications, foreign and native, 
 that have passed through my hands. Never and nowhere have I 
 seen, or heard, or read of a case in which the attack has come on, 
 whether abruptly or preceded by premonitory symptoms, more 
 than a few days after exposure to the cause. An incubation of 
 eighteen months or a year, of a month, or of a fortnight, has never 
 been, and probably never will, nor can be seen or heard of in such 
 complaints. Neither can we find that the process of incubation or 
 latency is under the controlling influence of any fixed law, and has 
 a fixed and regular duration. The same may be said of relapses 
 which may occur at any period during convalescence, whether on 
 an odd or even day. Such, at least, may be presumed to be the 
 case, for so far nothing satisfactory has been adduced to prove that 
 the phlegmasise are, in regard to relapses, governed by the law of 
 septenaries. How far the action of the same law extends relatively to 
 the duration and periods of critical changes in those diseases, remains 
 yet a mooted point. That the influence is exercised to a certain 
 extent, may possibly be one day conclusively shown ; for in some 
 diseases other than those produced by malarial or contagious poi 
 sons hemorrhages and nervous complaints the intervals are often 
 regulated by weeks ; and in sundry acute and even chronic diseases, 
 we not ^infrequently observe especially in the first, as Dr. Laycock 
 well remarks a movement of a tertian or quartan type, or in clini 
 cal phraseology, a good and a bad day. 
 
 In pneumonia, as in other affections attended with febrile reac 
 tion, the same tendency to a movement of the kind is often mani 
 fested, and the disease is found in many cases to end on particular 
 days. But, so far as observations go, the exhibition of a tertian or 
 
392 PNEUMONIA AND 
 
 quartan movement, is not as generally noticed in such complaints 
 as in the pyrexiae, while the disease is far less under the control, 
 in regard to the period of critical changes and to duration, of the 
 law so often referred to. If exceptions are encountered ; if cases 
 of this and other kindred diseases are found, in which the critical 
 movements referred to are as marked and regular as they are in 
 autumnal fevers generally, it is principally among those on which 
 the malarial poison has produced its impress, or which are com 
 bined with a malarial complaint. For this poison, while engrafting 
 the periodic type on the diseases with which it combines, imparts 
 to them many of the other peculiarities which characterize its legi 
 timate offspring. True it is, that Dr. Traube has, in his experi 
 ments, found that in many cases of pneumonia the period of 
 termination was marked by some critical discharge; and that in 
 many the change began to take place when the disease ended 
 within the first fortnight either on the third, the fifth, seventh, 
 ninth, or eleventh day. Out of fifty-two cases of disease analyzed, 
 the change suddenly took place in thirty. Out of twenty-seven of 
 these, four ended on the third ; nine on the fifth ; eleven on the 
 seventh ; two on the ninth ; and one on the eleventh day. In two 
 of the remaining cases, the beginning of the disease could not be 
 accurately fixed, and in one the change took place on the seven 
 teenth day. Dr. Traube s reviewer, Dr. Herman Weber, remarks : 
 " Amongst sixty-two acute cases, into which we lately accurately 
 inquired with this purpose, in eighteen only could we ascertain the 
 commencement of the disease; in five of these cases the notes on the 
 temperature are not sufficient to be analyzed for the present sub 
 ject ; of the remaining twelve, the change took place rapidly in 
 eight cases, and of these, on the fifth day, in two cases ; between 
 the fifth and sixth day, in one case ; on the seventh day, in two 
 cases ; between the seventh and eighth, in one case ; on the ninth 
 day, in one case ; between the ninth and the tenth, in one case." 1 
 But the number of cases in which the observation held good is, 
 after all, but small ; and of those in which it was verified, we are 
 not positively informed how many were of pneumonia, and whe 
 ther the disease was pure or complicated ; and as we find that 
 many of the individuals experimented upon were affected with 
 typhoid fever, and as this, like other zymotic diseases, may reason- 
 
 1 See Brit, and For. Med.-Chir. Rev. xi. 44, 45. 
 
AUTUMNAL FEVERS. 393 
 
 ably be supposed to be governed by different laws from common 
 inflammation, we can derive no accurate information relative to the 
 subject before us, so far as it applies to pneumonia, from the state 
 ments, interesting as they -doubtless are, of those writers. Besides, 
 if, in some cases of this disease, the influence of the law is found to 
 be felt ; in a greater number of others, not less accurately observed, 
 it has failed to be so. 
 
 Andral remarks that pneumonia is one of those diseases in which 
 the question seems the most easy to decide ; because, on the one 
 hand, the precise period of its onset is often very well marked ; 
 while, on the other, the period of its termination is often just as 
 easily ascertained. One hundred cases gave the following results 
 in the hands of this accurate observer : 
 
 3 ended on the 4th day. 
 
 2 " 5th " 
 
 6 " " 6th " 
 
 23 " 7th " 
 
 2 " 8th " 
 
 4 " " 9th " 
 
 11 " " 10th " 
 
 13 "" llth " 
 
 1 12th " 
 
 2 " 13th " 
 
 11 " " 14th 
 
 2 " " ... .. loth " 
 
 2 " " 16th " 
 
 9 " " 20th " 
 
 1 " " ..... 27th " 
 
 1 " 42d " 
 
 Of the remainder, the period of termination could not be ascer 
 tained precisely. 
 
 3 lasted from . . . 5 to 7 days. 
 
 12 " " . . . . 7 to 14 " 
 
 7 " " . . . . 14 to 20 " 
 
 4 " .... 20 to 30 " 
 
 From this it follows that the days on which the larger number 
 terminated, were the seventh, eleventh, fourteenth, and twentieth. 1 
 
 1 Clinique Medicale, i. 558, 559. 
 
394: PNEUMONIA AND 
 
 To a certain extent the result is favourable to the Hippocratic doc 
 trine, though it must be borne in mind that the number of cases 
 which ended on those days did not amount to more than one-half 
 of the whole. On the other hand, the results obtained by Grisolle, 
 are far from corroborating any conclusion favourable to the afore 
 said doctrine that might be drawn from the facts heretofore 
 adduced. This author studied all the phenomena of the disease, 
 from the beginning to the end, in one hundred and thirty cases. 
 In thirty -four of these, or about one-third, the period of the resolu 
 tion coincided with some of the phenomena usually regarded as 
 critical. In twenty-two, there was sweat, with or without deposit 
 in the urine, either spontaneous or artificially obtained by nitric 
 acid. In six, the disease ended by eruptions on the lips ; in four, 
 by urine ; in two, by hemorrhage. To a certain extent the absence 
 of critical movements in those cases may have been due to the kind 
 of treatment pursued ; and to the same circumstance may be ascribed 
 the fact that these movements are less trenchant, or easily made 
 out at present, than they probably were in Greece at the time of 
 Hippocrates, whose treatment, as Baglivi 1 remarked long ago, was 
 purely expectant, and did not disturb or oppose the efforts of nature. 
 But to this cause alone we shall not feel disposed to ascribe the 
 whole of the difference, if we bear in mind that, though more active 
 now than it was in ancient times, the treatment, in the hands of 
 judicious and skilful physicians, has for its main object the aiding 
 nature, and that, if those critical movements were in pneumonia, as 
 in fevers, the governing power, they would be promoted instead of 
 impeded by the means employed. To this, let it be added that, in 
 regions of country similar to Greece in respect to climate, cases of 
 pneumonia in which the phenomena in question are well marked, 
 the effect has usually been found to be the result of a complication 
 with a malarial disease. 
 
 As to the period at which those critical phenomena manifested 
 themselves, one of the cases observed by Grisolle ended on the 
 fourth day; seven on the fifth; four on the sixth; three on the 
 seventh ; two on the eighth ; eleven on the ninth ; one on the tenth ; 
 and three on the thirtieth. Few, as will be perceived, presented 
 salutary discharges on what Hippocrates regarded as the essentially 
 critical days, the seventh, fourteenth, and twentieth. So far from 
 
 1 Opera Omnia, 80. 
 
AUTUMNAL FEVERS. 395 
 
 it, the greater number of critical discharges (twenty) presented 
 themselves on those days when the crises were considered by him 
 as occurring less frequently, and as being less effectual. In eight, 
 the change took place on empty days, i. e. those which were not con 
 sidered as periods of crisis ; and four presented critical movements 
 on the sixth day, which, by the Hippocratic school, was viewed as 
 the most pernicious, and hence was denominated, by Galen, the 
 tyrant. From all this, Dr. Grisolle very justly infers that the doc 
 trine of critical days is very unsettled, " and that it cannot be re 
 garded as founded, so far as relates to pneumonia." 1 If, in addition 
 to all this, we inquire as to the results observed in ten cases in 
 which the disease was left to the powers of nature, we find that, in 
 more than one-half of that number, the crisis took place on empty 
 days ; convalescence commenced in six on those days, and in four 
 only on genuine critical days ; a circumstance militating still more 
 strongly against the doctrine in its application to the disease in 
 question. 
 
 In some forms of autumnal fever the susceptibility of the system ex 
 hausted by one attack not so in pneumonia. It is a fact very generally 
 conceded, that one attack of some forms of malarial fever exhausts 
 the susceptibility of the system to the subsequent action of the 
 poison giving rise to them. This is more particularly the case with 
 respect to the yellow fever, which, according to the highest profes 
 sional authorities in various parts of tropical climates, as well as in 
 Europe and this country, seldom, if ever, attacks the same indi 
 vidual more than once. I am aware that exceptions on this point 
 are to be met with ; that by some they are represented as being 
 quite numerous, and that by a different set of authorities they are 
 maintained to be so frequently encountered as to invalidate or 
 annul any rule attempted to be established on the subject. 2 But, 
 notwithstanding all that has been said in favour of this opinion, the 
 experience of those competent to decide in the matter, will justify 
 the conclusion that instances of the repetition of the disease are 
 comparatively rare ; that one attack of true yellow fever serves, if 
 
 1 Trnitc tie la Pneumonic, 324, 325. 
 
 2 R. Jackson, Yellow Fever of Spain, 50; Edinb. Journ. Ixviii. 497; Bancroft s 
 Sequel, 42 ; Rush, iii. 87, 88 ; Maclean on Epid. i. 233 ; Pinkard s Notes on W. I. ii. 
 257 ; Tullock s Stat, of Brit. Army, 4 ; Labat, ii. 74, iv. 307 ; Arnold, 62 ; Former, N. 
 0. Journ. v. 200. 
 
396 PNEUMONIA AND 
 
 not always, at least in the large majority of cases, as a protection 
 against reinfection; that when in the "West Indies, and other sec 
 tions of hot latitudes, second attacks present themselves, they most 
 usually do so in individuals whose systems, after having passed 
 through the disease, have been modified or renovated by a long 
 residence in some cold region or by spending much time at sea 
 or in whom the original attack was mild; or again among those 
 who, after having experienced an attack of the fever in its sporadic 
 form, or during the course of a mild epidemic, become exposed to 
 an extensive and malignant visitation of the same. Cases of the 
 kind, whatever be the circumstances under which they may occur, 
 are, I repeat, few in number, and scarcely more frequently encoun 
 tered than are second attacks of smallpox, scarlet fever, and kin 
 dred diseases, the protective power of which is fully recognized. 1 
 
 It is more than probable that those who contend for the frequent 
 repetition of the yellow fever in the same individual, will be found 
 principally among the advocates of the identity of that and other 
 forms of autumnal fevers. If this be correct, the instances of 
 second attacks recorded or referred to, may reasonably be supposed 
 to have been cases not of true yellow fever, but of ordinary bilious 
 remittent fever, and we shall read with less astonishment of the 
 individual mentioned by Dr. Potter, of Baltimore, who had the 
 disease as many as eight times. Dr. Potter, as also Dr. Eush, Dr. 
 McLean, Dr. Pinkard, Dr. R. Jackson, Dr. Bancroft, and others in 
 this country and abroad, who speak so confidently of such frequent 
 repetitions of the disease as an every-day occurrence in yellow 
 
 1 Lining, ii. 490 ; Dickson, Phil. Med. and Phys. Journ. iii. 273 ; ib. Essays, 352 ; 
 Irving, 31; Simons, 21 ; Francis, N. Y. Journ. i. 299; Currie, 15; Hosack, i. 385; 
 Townsencl, 217; Archer, Med. Ilec. v. 61; Kelly, Am. Journ. Oct. 1847; Barton, 
 Hep. 21; Cartwright, Rcc. vii. 15; Wood, i. 304; Arejula, 191; Fellowes, xxiii. 67; 
 Berthe, 336; Gilpin, Med.-Chir. Tr. v. 318; Amiel, in Johnson, on Tr. Cl. 269; Parisct, 
 97 ; Wilson, 73, 74 ; Pym, 29 ; Appendix, 302 ; Rochoux, 38 ; Pugnet, 348, 349 ; Chis- 
 holm, ii. 233; Savaresi, 256; II. McLean, 8, 187; Caillot, 249; Gilbert, 76; Pariste, 
 38, 112; J. Clark, 19; Blanc, ii. 147, 148; Forry, 205; Williamson, i. 311; Strobell, 
 202; Dickinson, 40, 47, 68; Doughty, 183; Copland, Diet. ii. 951 ; Mitchell, 128 ; 
 Chapman, Phil. Med. and Phys. Journ. ix. 130; Seamen, Med. Repos. i. 319; ib. 
 Fever of 1795, in Webster s Coll. 40; Blair, 85, 86; Hume, 241 ; Klapp, Med. Rep. vi. 
 472; Veitch, 110; Monges, N. A. Journ. ii. 58; Ashbel Smith, Trans, of N. Y. Acad. 
 of Med. i. 59; Treat, on Yellow Fever of Galvcston, 60; Davy, Notes on Blair, 85; 
 Lewis, Fever of Mobile, N. 0. Journ. i. 418, ii. 43, iv. 162; McCrnven, Top. and Dis. 
 of Houston, Texas, Trans, of Am. Mod. Assoc. v. 669 ; Jameson, Dublin Journ. of 
 Med. Sci. (N. S.) xvi. 358. 
 
AUTUMNAL FEVERS. 397 
 
 fever regions, are all firm believers in the identity in question ; 
 while we shall look in vain, in the writings of those who entertain 
 different pathological views, for the admission that such cases 
 should be regarded otherwise than as exceptional. But even were 
 we to admit that the disease, in all the instances of repeated attacks 
 mentioned, whether the second or the eighth, was really the true 
 genuine yellow fever, we should not be justified, from that circum 
 stance, in denying the protective power of the disease ; not only 
 because such instances are, after all, comparatively rare, but because 
 occurrences of. an analogous kind are encountered in diseases which 
 possess that power in a marked degree. As already mentioned, 
 second attacks of smallpox, scarlet fever, and other kindred dis 
 eases, are not unfrequently encountered nay, it is doubtful whether 
 yellow fever repeats itself more frequently than either ; and cases 
 are on record in which they have outdone in point of repetition, 
 anything that can be related of the yellow fever. Dr. Davy informs 
 us, on the authority of a general officer (whose mother was the 
 subject), of a case in which the smallpox was repeated eleven times 
 in the same person. 1 
 
 Other forms of malarial fever afford, if we may credit the state 
 ments of respectable authorities, protection against reinfection. In 
 the West Indies, there are several forms of fever distinct from the 
 true typhus icterodes, and which Dr. Copland has denominated 
 bilio-inflammatory or ardent fever, and adynamic marsh fever, 
 which act as seasoning fevers to Europeans who arrive in hot cli 
 mates ; the former appearing in robust plethoric persons, who have 
 emigrated to the West Indies, intertropical Africa, &c., the other 
 in those less robust, or who have not been attacked by ardent fever. 2 
 Dr. Stevens also recognizes the existence of two fevers independent 
 of the true yellow fever, which he denominates African typhus, 
 and, like Chisholm, Pym, and some others, regards as a native of 
 Africa, One of the other two aforesaid fevers, he designates the 
 climate fever. It corresponds to the bilio-inflammatory of Copland, 
 and is a seasoning fever, and, as a general rule, is not taken twice, 
 unless the individual so attacked has left the West Indies and 
 returned again, 3 The Batavian and Edam fever, which, notwith 
 standing some points of similitude with the yellow fever of the 
 West Indies, and the occasional occurrence in it of a few of the 
 
 1 Notes on Blair, 86. 2 Diet. ii. 1104. 3 On the Blood, 194. 
 
398 PNEUMONIA AND 
 
 symptoms appertaining to the latter, cannot be considered as iden 
 tical with it, is also evidently a seasoning fever. 1 
 
 The pernicious fevers of Algeria, France, and other localities 
 the periodic and malarial nature of which cannot be disputed, have 
 never, in the experience of Dr. Boudin, attacked the same individual 
 a second time. 2 After observing that, with one exception, the exan 
 themata, which occur only once, have a quartan type, Dr. Lacock 3 
 says that " it is at least a carious coincidence, that a person who has 
 had a quartan ague is not liable to a second attack." Sydenham 
 many years ago made the remark, and stated as a fact worthy of 
 observation, that if any person be seized with a quartan who has 
 had it, though long since, it terminates spontaneously after a few 
 fits, of whatever age or constitution he be. 4 After him, Van 
 Swieten, as Dr. Lacock reminds us, expressly stated and insisted 
 upon the same feet; and Dr. Wallis, in his note upon the above 
 passage in Sydenham, confirms the statement, and remarks that "it 
 is known from observation, in the marshes of Essex, the fens of 
 Cambridgeshire, and other places where intermittents are ende- 
 mial, that those who have laboured once for a scries of time under 
 this complaint, which will sometimes continue two or three years 
 with short intervals, and escape the fatal consequences, will after 
 wards live totally free, or subject only to very slight attacks, which 
 spontaneously disappear; though this is not ahvays the case." 5 Sir 
 Gilbert Blane states of the fever of Walcheren, that it is well ascer 
 tained that strangers, if they survive the first attack, become there 
 after much less liable to the endemic intermittents. 6 
 
 Some of the physicians whose views are now under examination. 
 will not find fault with me for calling their attention to the fact 
 that second attacks of typhoid fever, 7 a disease which doubtless 
 arises, in some instances at least, from peculiar malarial sources, or 
 at any rate is most certainly localized where these exist, and which 
 not a few of them regard as nothing more than a peculiar form of 
 autumnal or periodic fever, are seldom encountered. By some of 
 them, too, Asiatic cholera is held in much the same light. Let 
 them say how many cases of second attacks they have observed in 
 that disease. 
 
 1 Johnson, op. eif. lol. 2 Geographic MeMicule, 40. 
 
 3 Lancet, 18-12, i. 102. 4 Sydenham, Wallis s edit. 5. 82. 
 
 5 Ibid. 82. c Dissertations, i. 221. 
 " IJartlett on Fevers, 08. 
 
AUTUMNAL FEVERS. 399 
 
 Dr. Barker, in liis report of the Cork Street Hospital, Dublin, 
 states that he has for some time entertained the opinion, that sufferers 
 from fever, attended with petechial eruption, if they are not alto 
 gether secured by it from a second attack* are not, at least, so liable 
 to it as those who have had no fever of the ordinary kind. And, 
 in continuation, he says : " Though I have frequently made the 
 inquiry, I have not found a patient in whom this symptom was dis 
 tinct, who had suffered from the same fever on any former occasion. 
 The analogy which this bears to other fevers, more especially to 
 that which appeared at Gibraltar, and also to some exanthematous 
 diseases, lend support to the opinion of its rarely occurriog more 
 than once in life." 1 
 
 But while the power of exhausting the susceptibility of the sys 
 tem to future attacks appertains to some forms of autumnal fevers, 
 as also to several other diseases, which many of the advocates of the 
 views under examination have no hesitation in regarding as mere 
 modified forms of periodic fevers, it would be wrong to attribute 
 the same privilege to all the other forms of these. Experience, in 
 deed, teaches, that however true it may be that the severe and 
 malignant bilious remittent of the West Indies assumes, at times, 
 the character of a seasoning disease, and guards against the return 
 of the same so long, particularly, as the individual remains in the 
 country the rule is far from being general, and does not apply to 
 the common forms of the disease; for it is a well-established fact, 
 that in temperate climates an attack of remittent or intermittent 
 fever not only fails to impart perfect immunity to the sufferer, but 
 is regarded by accurate and experienced observers as affording no 
 protection at all, and even as increasing the liability of the system 
 to fresh invasions of the complaint. 2 
 
 If now we inquire how matters stand, so far as concerns pneumo 
 nia, in reference to the exhausting power in question, we shall find, 
 that while that disease, and indeed all those of the same class, 
 approximate to some forms only of malarial fevers, it differs widely 
 from several of the more important ones ; for, like bilious remittents 
 and intermittentSj but unlike yellow and other fevers mentioned, 
 one attack of pneumonia, nowhere and under no circumstances, 
 
 1 Bracken s Kept, in Barker and Cheyne s Acc t of Fey. of Ireland, i. 241. 
 
 2 Asbbel Smith, loc. cit. 58; Dickson s Essays, &c. 344, 345; do. Charleston J. vii. 
 840; Simons, 21; Wood, i. 304; Tullock, Statist. 4G ; Strobcl, 203; Parry. Am. J., 
 Jan. 1843. 
 
400 PNEUMONIA AND 
 
 whether in the north or the south, the east or the west ; whether 
 the case be mild or severe, simple or complicated, affords the most 
 remote shadow of protection against the recurrence of the disease. 
 So far from its doing so, everywhere we find that persons who have 
 laboured under pneumonia, are by that very fact rendered more 
 liable to the complaint than they were prior to the attack. Hence, 
 second and third repetitions are very frequently observed, especially 
 in the same lung. The disease has been noticed ten times in the 
 same individual by Chomel; eleven times by Frank ; sixteen times in 
 eleven years by Andral; twenty-eight times by Eush; three, four, 
 five, seven, and eight times by Grisolle ;* and there is scarcely a 
 practitioner in this or any other country, who has not witnessed 
 instances of the kind. 
 
 It is not to be denied that, on this particular point, pneumonia, 
 while differing greatly from some of the forms of autumnal fevers, 
 allies itself to others which do not possess the power of exhausting 
 the susceptibility of the system to future attacks; and the advocates 
 of the close alliance and identity of the two diseases may appeal to 
 this circumstance in proof of the correctness of their views. But 
 on reflection, the reader will, unless I am greatly mistaken, join in 
 the opinion that the similarity in question can afford but little if 
 any support to the idea of pneumonia being only a peculiar form 
 of autumnal fevers. For, if an argument is built upon the circum 
 stance that neither pneumonia nor the forms of malarial fever in 
 question afford protection against future attacks of the same, what 
 shall we do with the fact that other forms of those fevers possess 
 the privilege in question ? The latter fact is not to be ignored ; and 
 if the advocates of the identity of pneumonia with periodic fever 
 are permitted to adduce in support of their views the absence of the 
 exhausting power in both the former, and some of the varieties of 
 the latter, no reason can be assigned for refusing to the opponents 
 of that hypothesis the liberty of pointing out, in proof of the sound 
 ness of their theory, the existence of that very power in yellow and 
 some other fevers, the malarial origin of which is as evident as that 
 of common bilious remittents and intermittents. In this way, we 
 should have both parties in the controversy appealing to opposite 
 peculiarities in different forms of the same class of diseases, to prove 
 
 1 Cyclopedia of Pract. Med. iii. 406; Chomel, Diet, de Medecine, xvii. 214; Frank, 
 Intern. Cl. Obs. Select. 96; Andral, Med. Cl. 192; Desoteux, Diet, des Sc. Med. xliii. 
 376; Grisolle Tr. de la Pncumome, 111. 
 
AUTUMNAL FEVERS. 401 
 
 or disprove the identity of these with pneumonia. So far from con 
 ceding to the advocates of the unity in question, the propriety of 
 deriving an argument from the similarity or absence of the power 
 of exhaustion alluded to in pneumonia, and in common periodic 
 fevers, there can be no difficulty in perceiving that the fact of the 
 poisons of yellow, and of some other kindred fevers, exhausting the 
 susceptibility of the system, must lead to very contrary conclusions, 
 and fortify us in the belief of the propriety of establishing a line of 
 separation between pneumonia and malarial fevers generally. These 
 fevers, as we have seen, are, like other zymotic diseases, the off 
 springs of particular poisonous agents introduced into the system, 
 and therein producing special effects ; and the only difference be 
 tween them, so far as regards the exhausting power in question, 
 depends on this, that in some forms the morbid poison in its action 
 on the system destroys certain materials or principles, the existence 
 of which is necessary to enable the latter to be morbidly affected 
 by the impress of that poison ; while, in the other case, the poison 
 possesses no such destructive effects, and leaves the system suscep 
 tible of being again affected by it. 
 
 While bearing this in mind, the reader must not lose sight of the 
 circumstance that this power of exhaustion, though possessed by 
 many of the morbid poisons, is- not a necessary and indispensable 
 attribute of them all ; for among them not a few are found, which, 
 while affecting the system in a specific manner, and occasioning 
 diseases of a highly and often fatal character, do not impart to 
 those who recover the power of resisting their future morbid im 
 press. In this category, we may place a number of the animal 
 poisons and venoms. The absence of the same power of exhausting 
 the susceptibility of the system to reinfection, cannot, therefore, be 
 adduced in denial of the toxical nature of the cause of the particular 
 forms of autumnal fever in which it is noticed, and as lending sup 
 port to the belief in the close connection referred to between such 
 fevers and pneumonic inflammations. If we refuse to admit the 
 toxical nature of those fevers on the score of the absence in them 
 of the power in question, and acquiesce for the same reason in the 
 propriety of severing them from zymotic diseases with the view to 
 class them with pneumonia, we cannot object to rejecting from the 
 list of morbid poisons the animal venoms and poison above alluded 
 to, and classing the diseases they produce among the phlegmasias 
 of the chest. The conclusion in the one case, would be just as 
 26 
 
402 PNEUMONIA AND AUTUMNAL FEVERS. 
 
 reasonable as in the other ; and I close the subject with the remark 
 that, in all malarial or autumnal fevers, the introduction of a poi 
 son, whether endowed with that destructive agency or otherwise 
 matters not, is necessary to occasion the disease a circumstance 
 very different from what occurs in pneumonia, the production of 
 which is in no way connected with the existence of a poisonous 
 agent ; and if the latter disease assimilates itself with some forms 
 of malarial fevers in this, that, like them, it leaves the system sus 
 ceptible to farther attacks, it differs from them in not being the 
 result of a morbid poison, as well as in its phenomena, anatomical 
 characters, and other circumstances already dwelled upon ; while 
 those fevers, though not exhausting the susceptibility of the system, 
 present a close analogy to those that possess the privilege of doing 
 so, in regard to their toxical origin, their phenomena, their anatomi 
 cal characters, and the laws by which they are governed. Viewed, 
 therefore, as a class, malarial fevers like many other zymotic dis 
 eases may be considered, so far as concerns second attacks, as 
 differing from pneumonia. 
 
CHAPTER VI. 
 
 PNEUMONIA AND AUTUMNAL FEVERS COMPARED IN REFER- 
 ENCE TO THE POWER OF ACCLIMATIZATION AGES, SEXES, 
 AND RACES OF THOSE AFFECTED: PREVALENCE OF THE 
 TWO DISEASES AT THE SAME TIME, AND IN RAPID SUC 
 CESSION, NO PROOF OF IDENTITY. 
 
 The power of acclimatization does not extend to pneumonia Still 
 more strikingly do autumnal fevers of various forms and grades 
 differ from pneumonia, on the score of the protection afforded 
 against attacks of those diseases, by the peculiar organic changes, 
 resulting from long habituation to the sensible or insensible quali 
 ties of the atmosphere of particular regions or localities, or to the 
 poisonous materials by which that atmosphere may be contaminated. 
 That such a protection is thus obtained, to a greater or less extent, 
 in regard to all malarial and some other forms of fever, no one who 
 has examined the subject with attention will feel disposed to deny. 
 By long habituation to infectious localities, and to the high temper 
 ature of hot regions, the system becomes acclimatized, and thereby 
 acquires the power of tolerating perfectly and permanently the 
 poison, or of eliminating it as soon as received, without succeeding 
 reaction. The observation is of old standing. Pliny, nearly twenty 
 centuries ago, called attention to the fact, " that they who are sea 
 soned can live amid pestilential diseases," and the statement has 
 been confirmed by all subsequent observations. 
 
 Equally well ascertained is it, that the danger of infection among 
 strangers increases in proportion to the coldness of their native 
 land, or of their accustomed place of residence j 1 that protection in 
 its entire perfection is only enjoyed by the residents of towns or 
 cities subject to the disease; and that the inhabitants of neighbour- 
 
 i Savaresi, 260; Bally, 268, 334; Dariste, 210; Fontana, 170; Arnold, 26; N. 
 Dickinson, 13 ; Blair, 59. 
 
40-i PNEUMONIA AND 
 
 ing, but more elevated and salubrious portions of the country, 
 though less prone to the disease than strangers from cold climates, 
 are, nevertheless, liable to suffer when they venture in an infected 
 place. 1 Not less certain is it, that the protective influence of accli 
 matization is lost by a prolonged residence in cold climates ; 2 that 
 the children of the natives of, and acclimatized to, tropical regions, 
 do not enjoy the same advantages in regard to protection as their 
 parents, 3 but acquire them rapidly as they advance in age ; that the 
 residents of some portions of tropical regions suffer to a certain 
 extent from the disease, on removing to another and more insalu 
 brious part of the same regions, 4 or even to one differing but little 
 in point of salubrity. We find also that individuals acclimatized 
 to a yellow fever locality sometimes lose, to some extent, the pro 
 tection they had enjoyed, by a long exemption of that locality from 
 local sources of infection, or its being favoured, during several suc 
 cessive summers, with a cooler and purer atmosphere than before ; 5 
 and that the same results obtain when individuals change their 
 residence to places where the effluvia evolved, though not more 
 detrimental to health, are of a different nature from those to which 
 they were accustomed. 
 
 So far as regards the yellow fever, every medical writer, from 
 the days of Towne, Warren, and Pouppe Desportes, whose works 
 contain the earliest professional records we possess relative to the 
 fevers of tropical climates, has dwelled upon the protective effects 
 enjoyed in hot regions by those who are acclimatized to sickly local 
 ities. 6 The decided advantages resulting therefrom is adverted to 
 
 1 Dariste, 37, 38 ; J. Clarke, 22 ; Humboldt, 772, 773 ; Keraudren, 24 ; Imray, Edin. 
 Journ. liii. 94 ; Ferguson, Med.-Chir. Trans, viii. 144 ; Bancroft, 268. 
 
 2 Rochoux, 40, 41 ; Maher, 884; Bally, 332, 340; Arnold, 2G ; Me Arthur, in John 
 son, 350 ; R. Jackson, Fevers of Jamaica, 250 ; H. McLean, 187 ; Fugnet, 345, 346 ; 
 Frost, Med. Repos. xii. 224 ; Dariste, 37 ; Savaresi, 256 ; Bancroft, 268 ; Frazer, Med.- 
 Chir. Rev. xiii. 347; Rufz, Med. Exam. iii. 109; N. Dickinson, 12; Veicht, 111, 112; 
 Hume, 267. 
 
 3 Musgrave, Med.-Chir. Trans, ix. 106, 107 ; Rufz, Med. Exam. iii. 106. 
 
 4 Humboldt, 761, 771, 772; J. Clark, 1, 2; Fugnet, 346. 
 
 5 Chervin, Report on Rufz s Mem. 44. 
 
 6 Williams. 51; N. Dickinson, 11, 66; Edin. Journ. xxxvii. 154; Henderson, 5; 
 Hume, 237; Wright, Med. Facts, c. viii. 8; Jackson, Fevers of Jamaica, 250; H. 
 McLean, 187; Madrid, pt. I. 32; Savaresi, 260 ; Bally, 268,332; Dancer, Med. Assist. 
 82; Lefoulon, 20; Leblond, 18, 227, 245; Manson, 5; Rochoux, 31 ; Caillot, 13; Che- 
 vallier, 3; Finkard, ii. 472, 1st ed. ; Gilbert, 75, 76; John Hunter, 19; Arnold, 20: 
 Bancroft, Seq. 41 ; McArthur, Dis. of Barbadoes, Med. Obs. vii. 326 ; Feixotto, N. Y. 
 
AUTUMNAL FEVEES. 405 
 
 by Labat, 1 Ulloa, 2 Griffith Hughes, 3 Moreau de St. Mery, 4 Ilerrera, 5 
 Oviedo, 6 and other early, and by all modern, travellers and histo 
 rians ; and among the public at large the reality of the privilege 
 was early, and continues to this day to be, viewed as placed beyond 
 the possibility of doubt. 
 
 The whole history of yellow fever, as we are told by one who 
 has thoroughly investigated the subject, shows that its most sus 
 ceptible subjects in tropical climates are those who have recently 
 arrived within its sphere, particularly the inhabitants of northern 
 climates, and that the predisposition to an attack increases with the 
 degree of the northern latitude from which the stranger has arrived, 
 and the shortness of the interval that has passed since he left the 
 European for the equatorial region. In illustration of the com 
 parative security of native inhabitants over new-comers, this author 
 Dr. Ferguson adverts to the experience of the troops at Cape 
 St. Nicholas Mole, St. Domingo, among whom, soon after disem 
 barking, yellow fever broke out " at every station and in every 
 place." During the earlier part of the residence of the British 
 troops there, while all were deeply interested to stop the mortality, 
 a census was taken of the inhabitants of the town, exclusive of the 
 negro slaves and the white soldiers, when they were found to be 
 very nearly equal in numbers. But by the time they had buried 
 the original complement of 1,500 men, the inhabitants had not lost 
 more than one in thirty of all ages. 7 
 
 Dr. Burrell states, that " of thirty regiments that arrived in the 
 Windward and Leeward Islands, between 1816 and 1848, ten were 
 attacked with black vomit fever a very short time after landing ; 
 two within three months ; eleven within twelve months ; five within 
 two years ; and two within three years of their arrival. Of thir 
 teen regiments, which landed in Jamaica between the years 1816 
 and 1834, four were attacked within six months; seven within 
 twelve months ; and two within eighteen months. From 1838 to 
 
 Journ. i. 417; J. Clark, 22; Dariste, 21; Evans, 276 ; Gillkrest, Cycl. ii. 270; Boyle, 
 150; Blair, 59; Doughty, 65; Trans. Am. Med. Assoc. v. 589. 
 
 1 Nouveau Voyage en Amerique, ii. 264. 
 
 2 Voy. Hist, de 1 Amerique Meridionale, i. 42. 3 Hist, of Barbadoes, 37. 
 
 4 Loix et Constitutions de Saint Domingue, i. 375. 
 
 5 Historia General de los echos de los Castellanos in las Islas, &c. de Mar Oceano, 
 lib. iii. cap. 15, lib. x. cap. 4. 
 
 6 La Historia General de las Indias, lib. v. cap. 11. 
 
 7 Ferguson s Notes and Recollections, 150. 
 
4b6 PNEUMONIA AND 
 
 1848, seven regiments arrived in that island, but the emancipation 
 of the negroes permitting the troops to be quartered in the mount 
 ains, a few cases only of black vomit fever appeared within that 
 period, in two of them soon after landing." 1 
 
 It is, however, proper to remark that, general as the rule un 
 doubtedly is, it is not universal, but subject to occasional, and, 
 according to some writers, more or less frequent exceptions. 2 Phe 
 nomena of like nature are observed in our southern cities New 
 Orleans, Charleston, Savannah, Mobile where the fever is, as it 
 were, endemic, and the heat considerable and of long continuance, 
 and where the causes of insalubrity assume a character of perma 
 nency. There, as in tropical regions, the natives and long residents 
 who have gone through the process of acclimatization remain, with 
 few exceptions principally in times of severe epidemics, when the 
 cause is very powerful free from the disease, which exercises its 
 effects among strangers ; so exclusively, indeed, as to have acquired 
 in Charleston, and some other places, the name of the stranger s 
 fever. There, as within the tropics, true and effective acclimatiza 
 tion is enjoyed only by the residents of localities liable to the dis 
 ease, and not by those who reside in country districts, or even in 
 the suburbs of infected cities. Like "West Indians, the acclimatized 
 inhabitants of our southern cities lose the protection they possessed 
 by a prolonged residence in some northern place, or in a rural dis 
 trict of the same region; while their children, and those of the 
 natives, are as prone to the disease as strangers themselves. 3 
 
 1 Second Report on Quarantine, 9, Lond. 1852. 
 
 2 Griffith Hughes, 37; Chevalier, 6; Gillkrest, 279; Pugnet, 331, 346; Caillot, 
 142; Bally, 332; Savaresi, 134; Rufz, Examiner, iii. 109; Chervin, Kept, on do. 32, 
 44; Musgrave, Med. Ch.-Tr. is. 106 ; Ib. Med. Ch. R. and J. iv. 981 ; Imray, Ed. J. 
 liii. 79 ; Stevens, 195, 201 ; Chisholm, ii. 234 ; Bancroft, Seq. Ferguson Med. Ch. Tr. 
 viii. 139-150; Jackson, 11, 35; Ib. Outlines, 63; Lempriere, ii. 29; Hunter, 19; 
 Hillary, 120; Catel, 6; Desportcs, i. 192; Humboldt, 771,772; Dancer, 82 ; Guyon, 
 28 ; Warren, 4 ; Furlong, 290 ; Barry in Boyle, 270. 
 
 a Gros. Rept. 7; Girardin, 49, 51; Thomas, 1st ed. 77; 2d ed. 22; Michaud, Voy. 
 a 1 ouest des monts Alleganys, 5 ; Townsend (for fever of St. Augustin), 361 ; Ticknor, 
 N. A. J. iii. 218 ; Barton, Lecture on Acclimatement, 3; Essay, 21 ; Strobell, 139, 160 ; 
 Bancroft, 188, 192 ; Dickson, Phil. Med. and Phys. J. iii. 257 ; Ramsay, Rev. of Improv. 
 39; Ib. Med. Repos. iv. 218; Ib. viii. 366-395; Ib. Hist, of S. Car. ii. 88; Drayton, 
 Rev. of S. Car. 27, 28; Dickson, Bell s J. iv. 112; Simons, 13; Rept. on Fever of 
 N. 0. of 1819, pp. 35 and 43 ; Ib. on Fever of 1839, p. 324 ; Ib. Fever of 1820, p. 6 ; 
 Monette, Western J. iv. 339 ; Seagrave, Med. and Phil. Reg. iii. 442 ; Waring, 59 ; 
 Daniel, 63; Dupr6, Hays s J. ii. 382 (N. S.); Harrison, N. 0. J. 130; Dickson, Es 
 says, 343 ; Lewis, Fev. of Mobile, N. 0. J. i. 417; v. 43. 
 
AUTUMNAL FEVERS. 407 
 
 The same, though to a more limited extent, is found to be the 
 case in various of our less southern cities as Natchez, Yicksburg, 
 Grand Gulf, and Norfolk, where the protection afforded by acclimati 
 zation is not sufficiently effective to limit the inroads of the fever to 
 strangers. For there the natives and long resident, while less liable 
 than the latter, are, nevertheless, far from being entirely exempt. 1 
 There also, as well as in the cities of our Middle States and in Eu 
 rope, where nativity or long residence affords no protection, the in 
 habitant of more southern or tropical localities, in which the yellow 
 fever prevails endemically, and assumes often the epidemic charac 
 ter, exposes himself with impunity to the causes of the disease ; 2 
 and there also, as in tropical regions, among the unacclimatized, 
 the disease is less apt to attack natives of southern than those of 
 northern climates less Spaniards, Portuguese, and French, than 
 Eussians, Germans, Swedes, &c. 
 
 ISTor is it less true that acclimatization extends its influence, 
 though less effectually and less generally, to some other forms of 
 malarial fevers. In England, says Dr. Pinkard (ii. 480), " the har 
 vest-men and strangers who go into the fens of Kent and Lincolnshire 
 in the autumn, are more readily attacked with the endemical fever 
 of those provinces than the inhabitants who constantly reside in 
 the atmosphere which causes it." The protection afforded by accli 
 matization against endemic remittent is found to be enjoyed in this 
 country, often giving entire immunity, and generally lessening the 
 violence of the disease. Dr. Coventry mentions it in reference to 
 our lake fever. 3 It is also recognized as regards the fever of our 
 Southern States Georgia and South Carolina. 4 
 
 The term acclimatization, as we are told by Dr. Fenner, is just as 
 familiar to the inhabitants of all the southern portion of the Missis 
 sippi Valley as it is to the citizens of New Orleans, " and is used to 
 
 1 Merrill Chapman s J. ix. 246 ; Cartwright, Recorder, ix. 15 ; Taylor and Hans- 
 ford, Mod. Rep. iv. 206 ; Seldcn and Whitekead, ib. iv. 334; Archer, Recorder, v. 61. 
 
 2 Bancroft, 206; Berthe, 167-169; Fellowes, 59; Gilpin, Med.-Ch. T. v. 317; 
 Pym, 25; Arejula, 183, 330, 446; Pariset, 14, 15; Caisergues, 200, 201; Rochonx, 
 123 ; Sliecut, 108 ; Seamen, Fev. of 1795 in N. Y. 7 ; A. Hosack, 10 ; Warren, in Tyt- 
 ler, 501 ; Potter, 1G2; Drysdale, Med. Mus. i. 39, 40; Dalmas, 100; Ramsay, Edin. 
 J. viii. 429; Deveze, 55; Rush, iii. 80; Currie, 12; Ib. Barton s J. ii. 38; Cathrall, 
 6 ; Nassy, 38 ; Carey, 67 ; Condie and Folwell, v. vi. ; Caldwell, Fever of 1805, 79 ; 
 Facts and Obs. by College of Phys. 19 ; O Halloran, 119; Bartlett, 461. 
 
 3 Address, 42. 
 
 4 Pendleton, Charleston J. vii. 451 ; Lewis, N. 0. J. i. 323. 
 
408 PNEUMONIA AND 
 
 ( 
 
 express the same idea, viz. that persons coming from a northern 
 climate and settling there, are very liable to have attacks of fever 
 during the first two or three years, but afterwards become quite 
 exempt. 1 The same power of resistance to the action of disease 
 by the acclimatized has long been recognized in other countries 
 in South America, in Italy, &c. 2 Lancisi says that they who are 
 born and reared in the neighbourhood of marshes enjoy good 
 health in an unhealthy atmosphere. And children can, by degrees, 
 be accustomed to take considerable doses of the poison, beginning 
 with small ones at first. " By this power of habit does it happen 
 that man can live upon the small islands in those ponds and lakes ; 
 and that even the floating islands which the winds drive about 
 from place to place, have their human inhabitants. For Secundus, 
 in his description of the Lake of Yadimon, declares he has seen 
 them. P. Cabasus has observed them in the marshes of Ferrara, 
 and I myself have seen them in the Alban Lake." 3 
 
 Dr. A. Brown, whose observations have reference evidently as 
 much to the common remittent as to the yellow fever of tropical 
 climates, after stating that a soldier, or stranger, cannot be con 
 sidered inured to such climates by a residence of less duration than 
 from three to five years, remarks that if the latter period be adopt 
 ed, as affording a greater probability that a regiment has passed 
 through at least one epidemic season, on turning to table 76, p. 92, 
 of the Statistical Eeport, we find that the average mortality, during 
 the five years of service, was in the ratio of 147.7 per 1,000, whereas, 
 in the second five years, it was 104.7 per 1,000 of the strength. If 
 we now examine table 77, p. 93, from which the great epidemic 
 years are excluded, we find that the mortality in the first five years 
 of service was 102 per 1,000, and in the second five years 82 per 
 1,000 of the strength. From this we perceive that the immunity, or 
 advantage enjoyed by the acclimatized, is not confined to epidemic 
 years/ though in such it appears to be about twice as great as in 
 ordinary years ; the diminution of the mortality, amounting in the 
 former to four, and in the latter to two per cent, of the force 
 respectively. 4 
 
 1 Southern Mod. Rep. i. 32. 
 
 2 Weatherham, Celle Hyg. cles Pays Cliauds, 70 ; Macculloch on Remittent Fever, i. 
 10, 11 ; Johnson on Trop. Climates, 151. 
 
 3 De Xox Pal. Effl. lib. i. cap. v. 21. 
 
 4 Second Report on Quarantine, 294, 295. 
 
AUTUMNAL FEVERS. 409 
 
 The following remarks of Sir Gilbert Blane on this subject, 
 though, applying only to the "Walcheren fever, may be appropriately 
 introduced here: "One of the most important circumstances in 
 the operations of marsh miasmata on the human body, is the power 
 of habit in mitigating its influence. The natives are a robust 
 people ; they are of a very wan and sickly hue, with flaccid flesh, 
 and have all suffered more or less from the bad air which they 
 breathe. The children of both sexes are very subject to glandular 
 and abdominal complaints; and the adults, particularly those of 
 the lower orders, have all of them, sometime or other in the course 
 of their lives, laboured under the endemic intermittent. They are, 
 however, infinitely less subject to intermittent fevers than strangers." 
 " These strangers are also variously affected, according to the dis 
 trict from which they come. It was found, that of the British 
 troops, the natives of mountainous countries and dry soils, such as 
 the Highlands of Scotland, were more frequently affected than the 
 natives of flat and moist districts, such as Lincolnshire." Sir Gil 
 bert mentions the case of a French regiment, " which suffered in 
 the second year of its being there only one-half of the sickness and 
 mortality which it suffered the first year, and hardly suffered at all 
 the third." 1 Monfalcon informs us that the same fate attends the 
 inhabitants of the high and healthy localities in the vicinity of the 
 fenny districts of the Bresse, who visit the plains in quest of work 
 during harvest ; 2 and similar statements are made by Fodere in 
 regard to the peasantry of Romagna, Moclena, and Ferrara. 3 
 
 From all the accounts that have been transmitted to us of the 
 sickness and mortality of French troops in Algeria, as well as of 
 the results in a sanitary point of view of the colonisation of 
 that country, we learn, that the Europeans, from the north 
 particularly, experience great difficulty in becoming acclimatized 
 there, and that their chances of success in that respect are, to say 
 the least, extremely precarious. 4 Diseases miasmal fevers par 
 ticularly carry off a large number of the troops ; a larger number 
 are soon invalided, and the rest must, sooner or later, be sent back 
 to France to renovate their constitutions. While such is the result 
 among the European troops, the natives of the country, and the 
 
 1 Kept, on Mission to Walcheren, Dissertations, i. 223, 224, 225. 
 
 2 Tvftite clcs Marais, 196. 3 Med. Led. v. 167. 
 
 4 Pcrier, An. d Hygiene, xxxiii. 307 ; Boudin, ib. xsxvi. 381 ; Maillot, Fierres Int. 
 205 ; Haspel Mai. clc PAlgerie, i. 78. 
 
410 PNEUMONIA AND 
 
 Arabs enrolled in the army, and doing duties similar to those 
 assigned to the former, remain free from fever, or take it in its 
 mildest forms. Similar results are obtained along the shores of 
 the Keel Sea ; for while the natives are exempt from the fevers of 
 the country, and individuals of the Indo-Ethiopian race easily be 
 come inured to the climate, the Europeans are with extreme diffi 
 culty acclimatized. 1 
 
 Chomel and other writers state that typhoid fever attacks more 
 readily those who have been only a short time in Paris, while it 
 in a great measure spares the natives of that city. It appears from 
 a table published by Dr. Davidson, 2 that among 568 eruptive cases 
 of typhus, in whom this point was ascertained at Glasgow Fever 
 Hospital from November 1, 1838, to November 1, 1839, 176 were 
 natives of that city, and 392 were strangers ; 206 of these stran 
 gers had resided in Glasgow only from one day to two years, and 
 186 from two to twenty years and upwards. Dr. D. draws the 
 following deductions : 1. That strangers are more liable to become 
 infected with typhoid fever than native residents. 2. That the 
 majority of strangers are infected within a comparatively short 
 period of their residence in Glasgow. 3. That a minor portion of 
 strangers, like the natives of Glasgow, may escape infection for 
 many years, and yet be afterwards attacked. 3 
 
 In 1851, typhoid fever prevailed epidemically at Montpellier, 
 especially among the troops of the garrison. It was principally 
 rife among those who had not been long in the place. So far as 
 civilians were concerned, it more generally attacked workmen 
 going the rounds of France (faisant leur tour de France), and 
 recently arrived, as also people from the country who had come to 
 work at the crops and the vintage ; in a word, the disease selected 
 its victims among individuals unacclimatized to the place. 4 
 
 Having established the fact of the immunity complete or par 
 tial obtained from the action of the causes of autumnal, yellow, 
 and other fevers, by long residence in malarial and infected locali 
 ties, I am prepared to ask what analogy there exists in that respect 
 between those fevers and pneumonia. In regard to the latter, it is 
 undoubtedly true, as we have seen, that it prevails more frequently 
 
 1 A. Roche, An. d Hyg. xxxiii. 30. 
 
 2 Thackeray, Prize Essay on the Causes of Fever, G8. 
 
 3 See also Bartlett, 102. 
 
 4 Anglada, Traite" de la Contagion, i. 121. 
 
AUTUMNAL FEVERS. 411 
 
 in some orders of climates than in others ; but whatever be the extent 
 of its prevalence, it is not less certain that, wheresoever it does show 
 itself, no class of the population is exempt from its attacks. Accli 
 matization exercises no influence in that respect ; natives and long 
 residents are as subject to it individual constitutions, tempera 
 ments, idiosyncrasies, habits of exposure to atmospheric vicissi 
 tudes, and other circumstances being the same as strangers and 
 new residents. 
 
 Pneumonia and autumnal fevers affect different races. The two dis 
 eases do not differ less essentially in regard to the force with which 
 they affect the several races. It can scarcely be necessary to re 
 mark, that in all countries subject to malarial fevers generally 
 whether the true and genuine yellow fever, or ordinary autumnal 
 or periodic fever the black race is to a greater or less extent ex 
 empt from the disease. So far as regards the former fever, the 
 immunity enjoyed by negroes born and raised, or acclimated, in 
 countries where the disease is endemic the West India Islands 
 and the coasts of Mexico, and Southern America and especially 
 by the natives of Africa, has been noticed and recorded by almost 
 every writer. This immunity they possess in much greater perfec 
 tion than the whites born, bred, or acclimatized in the same locali 
 ties; and hence may be supposed to owe a large share of it to the 
 peculiarity of their organization. Few among them take the fever ; 
 and those that do so, have it generally, though not universally, in 
 the mildest form. 1 If, like the whites, they occasionally lose this 
 protection by a prolonged residence in cold climates, and take the 
 disease on their return within the tropics, the occurrence is less 
 frequently noticed among them, and the attack is of a milder cha- 
 
 1 Custin, in Duncan s Com. v. 149 (Am. eel.); Moseley, 146; Lempriere, ii. 29; 
 Bancroft, 51, 270-272; Jackson, Fevers of Jamaica, 250; Hunter, 20, 308; Puguet, 
 346, 347 ; Savarcsi, 256-258 ; Frost, Med. Repos. xii. 223 ; Rufz, Med. Examiner, 
 iii. 129 ; Ib. Chervin s Rep. 30 ; Ferguson s Med.-Ch. Trans, viii. 121 ; Ib. Med.-Ch. 
 Rev. Jan. 1840, p. 300 ; Ib. Recol. 142 ; H. McLean, 187 ; Humboldt, 772 ; Hume, 
 237, 238 ; Chisholm, i. 142, 225; Bourgeois, Maladies de St. Domingue in Voy. Inte- 
 ressants, &c. 417 ; J. Clarke, 3 ; Caillot, 14 ; Manson, 5 ; Bally, 269, 303-305 ; Ar 
 nold, 34; Dickinson, 12, 48; Evans, 276; Me William s Niger Exped. 128; Ib. Fev. 
 of Boa Vista, 93, 94; Doughty, 50 ; Warren, 14; Wright, Med. Facts, &c. vii. 8; 
 Henderson, 7; Bryson, 54; Pinkard, ii. 484; Copland, iii. 151; Leblond, 18, 245; 
 McCabe s Rep. on Dis. of Warm Climates, 43 ; Diction de Med. xix. 151. 
 
412 PNEUMONIA AND 
 
 racter f and if blacks removing there from northern climates suffer 
 from the disease, sometimes even in its most aggravated forms, 2 the 
 effect is far less frequently observed among them than among the 
 whites. 
 
 In our Southern States, the blacks have always exhibited the 
 same superiority in regard to immunity over the whites subject, 
 however, to the same modifications not only in those sections of 
 country or in cities where the protection afforded to the latter by 
 acclimatization is very general, if not entire, 3 but in those places, 
 as Natchez, Washington (Miss.), Norfolk, &c., where that protection 
 is comparatively limited. 4 In our Middle States, the blacks have 
 usually though not always escaped entirely, and among the few 
 affected, the disease has almost invariably assumed a mild and 
 tractable character. For proof of this, I confidently appeal to the 
 records of the epidemics by which this city has been visited; 5 while, 
 if we cross the Atlantic, and inquire how matters stand in that 
 respect in the cities of Spain and in Leghorn, we shall find that 
 there also the blacks have almost universally escaped. 6 
 
 Nor is it less a fact placed beyond dispute, that blacks are much 
 less liable than whites to other forms of miasmal fevers, and that, 
 when attacked, they have the disease in a milder form. This com 
 parative unsusceptibility was noticed in the West Indies from the 
 period of the earliest introduction there of negroes. It did not 
 escape the attention of Herrera (lib. 3 and 10), and other of the 
 early historians, whose observations on the subject have been con 
 firmed by every subsequent writer on the climate and diseases, not 
 only of those Islands, but also of every other portion of tropical 
 regions. " The negro," says Dr. Ferguson, " may also be said to 
 
 1 Jackson, Dis. of Jamaica, 250; H. McLean, 187 ; Lempriere, ii. 29; Bancroft, 
 176 ; Savaresi, op. cit. ; Gillkrest, Cyclop, ii. 279. 
 
 2 Frost, op. cit. 224, note ; Ferguson, Bell s J. iii. 14. 
 
 3 Lining, Essays and Obs. Fhys. and Literary, ii. 409; Ramsay s Hist. S. C. ii. 85 ; 
 Simons, 14; Ib. Address, 12; Daniel, 65; Thomas, 77; Chalmers, i. 39; Sengrave, 
 Med. and Phil. Reg. iii. 420; Fever of N. 0. in 1839, in Rev. Mcd. for 1840, 325; 
 Ticknor, N. A. J. iii. 218; Dickson, 345 ; Lewis, N. 0. J. i. 410; Burtlctt, 345. 
 
 4 Cartwright, Rec. 9; Seldcn and Whitelicad, Med. Repos. iv. 335; Merrill, Chap 
 man s J. ix. 246; Archer, Recorder, v. 61 ; Monette, Am. J. i. 245 ; Hogg, Western 
 J. i. 413-416; Valentin, 90. 
 
 5 Rush, iii. 81; Caldwell, Memoirs, 210; Cathrall, 6; Currie, 13, 14; Wood, i. 
 307 ; Deveze, 108, 109 ; Folwell, 57 ; Carey, 85. 
 
 6 Berthe, 1G7; Caisergue, 191-200; Burnet, 242; Rept. of the Mod. Acad. of 
 Barcelona, 23 ; Pariset, Fievre de Barceloue, 542. 
 
AUTUMNAL FEVERS. 
 
 413 
 
 be fever proof; and the marshy savannas, which lie low and 
 scattered and unventilated, prove to him the most healthful abode. 
 From peculiarity of idiosyncrasy, he appears to be proof against 
 endemic fevers. To him marsh miasmata, which so infallibly de 
 stroy our white soldiers, are in fact no poison. The warm, moist, 
 low, and leeward situations, where these pernicious exhalations are 
 generated, prove to him congenial in every respect. lie delights 
 in them; for he there finds life and health, as much as his feelings 
 are abhorrent to the currents of wind that sweep the mountain tops, 
 where alone the whites find security against tropical diseases; but 
 the black, when placed there, is almost infallibly struck with the 
 bowel and heart complaints which prove so fatal to him." 1 
 
 The comparative average prevalence of fever among the European 
 and black troops of the British army in the West Indian and 
 African commands, and the like mortality from the same disease, 
 afford a striking illustration of the difference of susceptibility in 
 question. Thus, we find that, during a period of twenty years, 
 from 1817 to 1836, inclusive, the result was as follows: 
 
 Strength. Fevers. Deaths. 
 
 Jamaica Command. 
 
 Whites .... 51,567 46,922 5,253 
 
 Blacks .... 5,729 634 47 
 
 Bahamas. 
 
 Whites .... 535 506 85 
 
 Blacks .... 7,102 2,260 40 
 
 Honduras. 
 
 Whites .... 320 221 27 
 
 Blacks .... 4,356 1,100 19 
 Windward and Leeward. 
 
 Whites .... 86,661 62,163 3,195 
 
 Blacks .... 40,934 6,856 190 
 
 Mauritius. 
 
 Whites .... 30,515 4,707 53 
 
 Blacks .... 1,395 121 
 
 Sierra Leone. 
 
 Whites .... 1,843 2,600 756 
 
 Blacks .... 7,581 405 18 
 
 1 Ferguson s Recollections, Black Troops in the W. I. 207, 209. See also McCabe, 
 op. cit. 43. 
 
414 PNEUMONIA AND 
 
 The following table will show the comparative ratio of mortality 
 from the disease, per 1,000 of mean strength, in the various West 
 India Islands, and other commands : 
 
 Windward and Leeward Islands. Whites. Blacks. 
 
 English Guiana .... 52.2 8.5 
 
 Trinidad 61.6 3.2 
 
 Tobago 104.1 8.6 
 
 Grenada 26.3 4.8 
 
 St. Yincent 11.2 .9 
 
 Barbadoes 11.8 3.8 
 
 St. Lucia f 63.1 5.2 
 
 Dominica 19.3 7.7 
 
 Antigua 14.9 1.7 
 
 St. Christopher .... 12.1 10.5 
 
 Average of whole command 36.9 4.6 
 
 Jamaica 101.9 8.2 
 
 Bahamas 159.1 5.6 
 
 Honduras 81.0 4.4 
 
 Sierra Leone .... 410.2 2.4 
 
 Mauritius 1.7 0.0 
 
 Ceylon 25.7 1.1 
 
 In all those localities, we find the average number of fever cases 
 among white troops far exceeding that among the blacks, while the 
 mildness of the disease among these is evinced by the smallness of 
 the mortality . they suffered, compared to that among their Cau 
 casian comrades. In speaking of the sickness of the British troops 
 in the Sierra Leone command, Major Tullock says : " Fatal as the 
 fevers of this colony have proved to the whole troops, the blacks 
 have been but little affected by them ; indeed, the attacks have been 
 fewer, and the deaths have not materially exceeded the proportion 
 among an equal number of white troops in the United Kingdom or 
 other temperate climates. Though fevers are much more frequent 
 and fatal among the whites than in the West Indies, the reverse is 
 the case with the blacks." 1 By another writer, Dr. Bryson, we are 
 told (p. 22), that the natives of Fernando Po are a healthy, athletic 
 race of people, yet this island is more detrimental to health than 
 
 1 Dis. and Mort. of the British Army (Western Africa), 1G. 
 
AUTUMNAL FEVERS. 415 
 
 any spot in the known world; even the Africans from the continent 
 are always sickly here. Of thirty white mechanics who arrived 
 in November, 1827, all had the fever in a very short time; the 
 number that died cannot be ascertained. A few were invalided, 
 and five only remained in June, 1828 (pp. 22, 69, 70). 1 The reader 
 is doubtless already conversant with the universal exemption of the 
 Kroomen, not only from the common remittent of the coast, but 
 from every deadly fever, as a circumstance rendering them of ex 
 treme utility to the coast squadrons, and to all traders. 
 
 The negroes of our Southern States are but little subject to ma 
 larial fevers; and, while on the rice plantations of Georgia and 
 South Carolina, the white cannot reside for fear of the country fever, 
 the negro works with impunity, exposed to the rays of the broiling 
 sun, and to the humidity of the flooded fields. 2 Dr. Ketchum, in a 
 report on the topography, sanitary condition, and vital statistics of 
 Mobile, says of the slaves owned by the Creole population : " They 
 seem to be entirely exempt from the attacks of yellow and bilious 
 fevers." 3 Another writer, Dr. Pendleton, of Georgia, remarks: 
 " That the African is less susceptible to malarious influences than 
 the white, I have believed from general observation heretofore. 
 Although more exposed to the cold dews and hot sun of autumn, 
 as well as having more filth about their habitations, they seem to 
 be less liable to periodic fevers, and more readily recover than the 
 white." In illustration of this, Dr. P. shows that, in the county he 
 resides in, the number of idiopathic fevers among the whites greatly 
 predominates over that among the blacks ; being in the proportion 
 of 14.5 to 10.4 4 After remarking that congestive fever prevailed 
 epidemically in his neighbourhood, Dr. Lewis, of Mobile, says: 
 " There were, in my professional circle, two blacks to one white ; 
 yet I did not see a single case of congestive fever in a negro, nor 
 did I hear that any died of the disease in that section of country. 
 I have made inquiries of several medical gentlemen who have long 
 been practising in the country; their experience does not materially 
 differ from mine ; the fact is, that the remarkable exemption from 
 yellow fever, which this race enjoys, extends in a great measure to 
 
 1 See also Darnell s Topography of the Coast of Guinea, 134. 
 
 2 Daniel, 64, 65 ; Wood, i. 240-267. 
 
 3 Former s Southern Med. llept. ii. 307. 
 
 * General Report on the Topography of Middle Georgia, Charleston Journ. vii. 455. 
 
416 PNEUMONIA AND 
 
 all the malarious fevers of hot climates ; they may all have inter 
 mittent and light bilious fevers, as well as the milder grade of yel 
 low fever ; but it is only under extraordinary circumstances that 
 these diseases affect them so seriously as to cause death." 1 Dr. 
 Lewis remarks, that any one who weighs calmly all the influencing 
 circumstances by which plantation negroes are beset, the vicissi 
 tudes of heat and cold to which they are hourly exposed, such as 
 running from the fields during a shower of rain, sleeping in wet 
 clothes, on a cold bluff, or earthen floor, from which they arise with 
 a pain in the head, or cold stiffened limbs; their inattention as to 
 the preparation of their food, which they eat in a crude, half-cooked 
 state, it will be found that these, and not malaria, are the chief 
 causes of the mixed undefinable fevers, dysenteries, and diarrhoeas 
 that annoy them. 2 
 
 Now, if with all these facts before us as to the insusceptibility 
 of the African race to malarial fevers, we inquire into the preva 
 lence of pneumonic inflammation among them, we shall find but 
 little calculated to justify the idea of the close alliance of the two 
 diseases ; for experience teaches, that the bracks are as subject as 
 the whites to pneumonia, if, indeed, they are not more so. 
 
 Dr. Kobert Jackson, whose authority no one will attempt to 
 impugn, says of pneumonia : " It is the most common form of dis 
 ease that occurs among the transplanted natives of Africa, whether 
 such as are enrolled in the lists of the army, or such as are reserved 
 for field labour ; particularly in islands of a dry air and broken 
 surface." 3 
 
 In illustration of this, let the reader examine the results ob 
 tained among the African portion of the British army, in tropical 
 climates, and compare them with those referred to relatively to 
 fevers, and he will at once convince himself of the correctness of 
 the statement. 
 
 1 Lewis on the Yellow Fever of Mobile, N. 0. Journ. i. 417; Duperier, ib. vii. 575 : 
 Grier, N. 0. Journ. ix. 430. 
 
 2 In a relcve of 1,03G cases of malarial fever occurring from 1843 to 1848, and fur 
 nished by Dr. Eoling, in a report on the epidemics of Alabama, there were G71 whites 
 and 365 blacks and mulattoes. Trans. Am. Med. Asaoc. v. 4^5. 
 
 3 Sketch, ii. 83, 84. 
 
AUTUMNAL FEVERS. 417 
 
 Aggregate Cases pneu. Deaths. Ratio of cases 
 strength. and pleu y. in 1,000. 
 
 Jamaica command, 1817-36. 
 
 Whites . . . 51,567 736 15 13.4 
 
 Blacks . . . 5,729 75 17 13.1 
 
 Bahamas. 
 
 Whites ... 535 3 2 5.6 
 
 Blacks . . . 7,102 176 15 24.6 
 
 Honduras. 
 
 Whites ... 320 2 6.24 
 
 Blacks . . . 4,356 43 3 9.7 
 
 Windward and Leeward. 
 
 Whites . . . 86,661 1,975 113 20.5 
 
 Blacks . . . 40,934 1,823 160 44,5 
 
 Mauritius. 
 
 Whites . . . 30,515 726 39 23 8 
 
 Blacks . . . 1,395 30 2 216 
 
 Sierra Leone. 
 
 Whites . . . 1,843 15 1 8.14 
 
 Blacks . . . 7,581 81 12 10.69 
 
 The frequency of pneumonia and kindred complaints among the 
 blacks of tropical climates, has, indeed, been noticed time after time, 
 and recorded by the best authorities; 1 and has not less attracted 
 attention in this country, whether the disease appear in its ordinary 
 inflammatory form, or in that denominated pneumonia typhoides. 2 
 In middle Georgia, as shown by Dr. Pendleton, while the diseases of 
 the respiratory organs prevail among the whites in the proportion 
 of 13.8 per cent., the same diseases extend among blacks at the 
 rate of 28.0 per cent. 3 Dr. Lewis, in like manner, represents the 
 various forms of pneumonia as being particularly prevalent among 
 the negroes of the South, especially in Middle and South Alabama. 4 
 " Pneumonia without subjective symptoms," says Dr. Cartwright, 
 " is very common among them (the blacks). Intercurrent pneu 
 monia is more common among them than any other class of people. 
 
 1 Desportes, i. 5, 33, 92, ii. 273; Dazille, 113; Leblond on Fever, 77; Levacher, 
 39; Campct, 210, 211 ; Daniell, Topog. of Gulf of Guinea, 53, 94; Bajon, Mala-d. &c. 
 de Cayenne, i. 73. 
 
 2 Fenner s Southern Med. Repts. ii. 432 ; Charleston Med. Journ. vi. 838. 
 
 3 Fenner s Repts. i. 335. 4 Med. Hist, of Alabama, N. 0. Journ. iv. 33. 
 
 27 
 
418 PNEUMONIA AND 
 
 It is met with in typhoid fevers, rheumatism, and hepatic derange 
 ments, to which they are very liable in the cold season." 1 Accord 
 ing to Dr. Harris, of Alabama, negroes were attacked, during an 
 epidemic of pneumonia which prevailed in Wetumpka, in 1851, in 
 "somewhat greater proportion than the whites, and among the 
 former the mortality was decidedly greater than among the latter." 2 
 Dr. Grier has also called attention to the same circumstance, and 
 remarks, " that the negro is more liable to pneumonic attacks than 
 the white race, and the complaint proves more fatal to them." 3 
 
 Difference of susceptibility of the two sexes. We are scarcely less 
 justified in seeking for proof of dissimilarity between the two dis 
 eases in the difference of liability of each of the two sexes. As 
 regards pneumonia, males may furnish generally a larger number 
 of cases than females, and the disease in them may assume fre 
 quently its most severe character. But there are facts sufficient on 
 record to warrant the conclusion, that this greater prevalence of the 
 disease in the first-mentioned sex is not the result of an inherent 
 susceptibility; but is due, when it occurs, to a series of fortuitous 
 and modifying causes; more particularly to the circumstance that 
 males owing to the nature of their avocations and mode of life 
 are usually more exposed than females to the causes of pulmonary 
 inflammation ; and that in places where exposure is equal in both 
 sexes, the disease manifests itself as frequently in the one as in the 
 other. On this subject, statements, for which we are indebted to 
 Grisolle, 4 Chomel, 5 Williams, 6 Yalleix, 7 and others, can leave no 
 doubt on the rnind of the unbiased inquirer, so far as regards 
 Europe. For, besides that in rural districts, where women are as 
 much exposed as men, the disease does not manifest itself more fre 
 quently in one sex than in the other; in prisons, for example, 
 where the material conditions of life are similar for all the inmates, 
 the number of females attacked equals that of males. Nor should 
 it be forgotten that among children, who are exposed to the same 
 
 1 On the Philos. of the Negro Constitution, N. 0. Journ. ix. 205. 
 
 2 Rept. on the Epid. of Alabama, Trans, of Am. Med. Assoc. v. 373 ; see also Drake, 
 N. 0. Journ. i. 584. 
 
 3 N. 0. Journ. ix. 430. 4 Op. tit. 114. 
 5 Diet, de Med. xxv. 161. 6 P. 289. 
 
 7 Guide du Med. Prat. ii. 259. 
 
AUTUMNAL FEVERS. 419 
 
 influences, the disease has usually been found to bear with equal 
 severity on the two sexes. Similar observations have been made 
 in this country and elsewhere. 
 
 In regard to malarial fevers of various grades or varieties, from 
 the simple intermittent to the deadly and malignant yellow fever, 
 we arrive at different conclusions. In these, males, excepting in 
 some epidemics mentioned by Musgrave (106), Catel (10), Rufz 
 (32), and under circumstances of a special kind, are more frequently 
 affected than females ; and, as a general rule, it may be stated that 
 when these are attacked, they have the disease in a milder form. 
 That this comparative immunity on the part of females may, in 
 some mensure, be due to their more temperate habits, and to their 
 being usually less exposed to the deleterious influence of night air, 
 or, perhaps, as is presumed by Copland, to the state of the female 
 constitution during the period of uterine activity, is doubtless true ; 
 but it is equally certain, that, after making every possible allowance 
 for the efficiency of these causes of resistance, we still find enough 
 to convince us that females are far less obnoxious to the impression 
 of the febrile poison than individuals of the other sex. Speaking 
 of paludal fevers generally, Dr. Williams remarks that in the West 
 Indies, in civil life, a woman is esteemed twice as good a life as a 
 man, and he adds that " in barracks the same difference of liability 
 is observed between the sexes." 1 The same fact is pointed out by 
 other writers in reference to all those fevers conjointly, 2 as well as 
 by those who have described the ordinary forms of the disease 
 intermittents and remittents in France, Africa, Germany, and Italy. 3 
 In 1,036 cases reported by Dr. Boling, of Alabama, there were 585 
 males and 451 females. 4 
 
 In yellow fever, the difference of liability and intensity has been 
 noticed both in intra and extra tropical climates. In the West 
 
 1 Morbid Poisons, ii. 456. 
 
 2 Pinkard, ii. 470; Hume, 237; Arnold, 34; Williams, 51 ; Henderson. 4; Madrid, 
 pt. i. 32; Copland, iii. 139. 
 
 3 Ramel de 1 irifluence des marais sur la Sante de 1 homme, Marseilles ; Foder^, on 
 Epidemics; Hufeland, Journal der prakt, June, 1811; Eisenrnann, Der Vegetation 
 and Exlanger, 1835. 
 
 Ramel remarks: " Women are much less subject to the disorders of marshy 
 localities. We have noticed this fact on the coasts of Africa, and several of our 
 friends who resided at Cayenne, have assured us that in that colony more than one 
 female has had six husbands." 
 
 4 Tr. Am. Med. Assoc. v. 425. 
 
420 PNEUMONIA AND 
 
 Indies it was observed and is dwelled upon by Desportes, 1 Moseley, 3 
 Le blond, 3 Blane, 4 Pugnet, 5 Poissoniere, 6 Bally, 7 Savaresi, 8 Jackson, 9 
 Hunter, 10 Trotter, 11 Ilumboldt, 12 Caillot, 13 Dariste, 14 Dickinson. 15 
 
 In this country, the same circumstances have been recorded by 
 Deveze, 16 Kush, 17 Carey, 18 Bamwell, 19 Condie and Folwell, 20 Cald- 
 well, 21 Valentin, 22 Drysdale, 23 A. Hosack, 24 Thomas, 25 Townsend, 26 
 Simons, 27 Waring, 28 Hogg, 29 Cartwright, 30 Perlee, 31 Merrill, 32 Archer, 33 
 Gros, 34 Kept, of 1ST. 0. Fever of 1 819, 35 ib. of 1839, 36 Bartlett. 37 
 
 In Europe, also, similar observations have been made by Arejula, 38 
 Berthe, 39 Fellowes, 40 Louis, 41 Bally, 42 Gillkrest, 43 Caisergue, 44 Pal- 
 loni. 45 
 
 I am not aware that the facts hitherto published, regarding the 
 susceptibility of the sexes to typhoid fever, are as yet sufficiently 
 numerous to warrant us in drawing any certain conclusions from 
 them. In some of the hospitals and cities of Europe and this 
 country, more females than males affected with this disease have 
 doubtless been treated ; but, neither from this circumstance, nor from 
 anything as yet adduced, can we derive satisfactory evidence of 
 the male sex being less liable than the female; for the reverse of 
 
 I Mai. do St. Domingue, i. 4, 195. 2 Trop. Climates, 433. 
 3 Fievre Jaune, 95. 4 Dis. of Seamen, 405. 
 
 5 F. cle Mauvais Caractere, 347. 6 Mai. des Pays Chauds, 55. 
 
 7 Typhus d Amerique, 209, 299. 8 Tr. de la F. J. 264. 
 
 9 Fev. of Jamaica, 250. I0 Dis. of Army in Jamaica, 201. 
 
 II Medica Nautica, i. 347. 12 Nouvelle Espagnc, 775. 
 
 18 Ficvre Jaune, 15, 135. H Fievre Jaune, 218. 
 15 Inflam. Endem. of W. I. 13, 82. 16 Tr. de la F. J. 105. 
 17 Works, iii. 80. I8 Fev. of 1793, p. 74. 
 
 19 Physical Investigations and Deductions from Med. and Surg. Facts, 374. 
 
 20 Fev. of 1798, p. 5. 21 Fev. of 1805, p. 78. 
 
 22 Tr. de ia F. J. 70. 23 Med. Mus. i. 33. 
 
 21 Diss. on Y. F. of N. York in 1795, p. 2. B Tr. de la F. J. p. 73. 
 
 25 Fev. of N. Y. in 1822, p. 253. * Kept, to B. of H. of Charleston, 7, 14. 
 
 23 Fever of Savannah, GO. Western J. i. 413. 
 
 30 Med. Recorder, ix. 1G. 31 Philad. J. of Med. and Phys. Sc. i. 10. 
 
 * 2 Phila. J. of Med. andPhy. Sc. ix. 24G. Med. Recorder, v. Cl. 
 
 34 Rap. sur la F. J. de la N. 0. in 1817, p. 7. 
 
 *> Hid. in 1819, p. 7. 36 Ibid, in 1839, p. 324. 
 
 37 On Fevers, 457. 
 
 38 Breva Dcscripcion de la Fiebre Amarilla, 182, 438. 
 
 *9 Fievre J. d Andalousie, 354. On Pestilential Fever, 120. 
 
 41 On Yellow Fever, 291. 42 Typhus d Amerique, 301. 
 
 Cycl. of Pract, Med. ii. 279. 4t Contagion de la F. J. 190. 
 45 Osservazioni sulla Malattia, &c. 90. 
 
AUTUMNAL FEVERS. 421 
 
 the above result sometimes occurs. When it does not, the greater 
 amount of females affected finds a ready explanation in the excess of 
 female population in some of the cities where the observation was 
 made, and the greater exposure of women to the infection in the 
 capacity of nurses and attendants. But, however this may be, it 
 has been proved satisfactorily by the statistics of every large hospi 
 tal, and by the bills of mortality of some cities where a proper 
 registration is kept, that as large a percentage of male as of female 
 patients die of the disease. 1 
 
 The following are the proportions which occurred in the epidemic 
 at Gibraltar in 1828, among the civilians: 
 
 Men 684 
 
 Women . . . .286 
 
 Children .... 200 
 
 Difference of susceptibility of the two diseases at different periods of 
 life. Experience has shown that, with the exception of a few epi 
 demics in which children appear to have suffered severely from 
 autumnal and periodic fevers, these diseases are the attendants of 
 adult age the young and very old being comparatively little ame 
 nable to the influence of the poison, and, when attacked, having the 
 disease in a milder form. Exceptions to this rule are to be found 
 in those seasons when the infectious effluvia are concentrated, and 
 unusually powerful; or when exposure to their influence is un 
 usually great. As was mentioned in speaking of the comparative 
 liability of the sexes, this ordinary exemption of the young and old 
 may, in some measure, be accounted for by their less exposure to 
 the action of the efficient cause. t Nevertheless, a review of all the 
 facts we possess on the subject, can leave no doubt on the mind as 
 to a greater liability to infection in adults and individuals in the 
 prime of life, than at any other period, as well as to the fact, that if 
 during the course of some epidemics, or at the close of others, a 
 larger proportion of children suffer, the result, on the one hand, 
 must be ascribed to the fact that the adult portion of those exposed 
 are acclimatized 2 an advantage which children do not enjoy; and, 
 on the other hand (as illustrated at Barcelona in 1821), to the cir- 
 
 1 See Davidson on the Cause of Fever, 60, 61 : Bartlett, 101. 
 
 2 Catel, 10: Byam in Chisholm, i. 143; Arnold, 147; Statistics of British Army, 
 52; Ramsay, Hist, of S. C. ii. 85; Dickson, Phil. J. iii. 257; Ib. Eclectic J. iv. 112; 
 Simons, 11. 
 
422 PNEUMONIA AND 
 
 cumstance, that the proportion of this class remaining unattacked 
 or liable to be infected 1 was, owing to peculiar causes, greatly en 
 larged. Be this as it may, if we lay aside these apparently excep 
 tional cases, and examine the accounts of those fevers as they 
 prevail in tropical and extra-tropical regions generally, we shall 
 find, that though children and old people are often attacked every 
 where, they enjoy, to a very great extent, the exemption to which 
 I have alluded. So it has ever proved in the West Indies, in 
 Europe, and in this country, as we learn from numerous and re 
 liable authorities. 2 
 
 In a memoir on the influence of marshes on the duration of 
 human life, Yillerme, in drawing his conclusions from a very large 
 number of observations collected in the paludal departments of 
 France, states that the injurious influence is principally felt by 
 young children. He adds: 1st. Infants under one year of age ap 
 pear, relatively to their number, to suffer less than children from 
 one to four. 2d. After the age of ten, the influence of marshes is 
 less injuriously felt than before. 3d. It is, or appears to be, still 
 less felt from fifteen and eighteen, to twenty-five; but, from thirty- 
 five or forty to fifty or fifty-five, this injurious influence is more 
 striking, though not as great as among young children. 4th. Fi 
 nally, old people appear more able to resist the effects of the mor 
 bific influence in question, than individuals at any other periods of 
 life. 3 
 
 This, so far as concerns children, is somewhat at variance with 
 what was said above; but it should be borne in mind that the 
 amount of mortality among these is not to be understood as result 
 ing from marsh fevers alone ; but evidently includes that of children 
 
 1 Copland, iii. 168. 
 
 2 Chisholm, i. 141; Pugnet, 348; Savaresi, 264, 265; Caillot, 15, 136; Moscley, 
 438; Bally, 269-296 ; II. McLean, 36 ; Manson, 6; Madrid, 32; Dariste, 218; Ar 
 nold, 34; Rochoux, 120; Pinkard, ii. 476; Hume, 238; Williams, 51; Dickinson, 
 13; Blair, 50; J. Clarke, 2; Arejula, 182; Sir James Fellowes, 58, 420; Ch. 
 Maclean, 15; Berthe, 170; Mem. of Acad. of Barcelona, 23, 44; Caisergue, 191; 
 Louis, 260; Burnett, 493; Pariset, 454; Palloni, 9, 10; Cleghorn, 106, Rush s ed. : 
 Deveze, 106 ; Caldwell, 78 ; Carey, 74 ; Condie and Fohvell, 5 ; Monges, Matthieu, 
 Rousseau (see Rept. of French Acad. 28); Valentin, 90; Thomas, 73-77; Harrison, 
 136; Barton, 20; Gros, 71; Cartwright, ix. 16; Merrill, 9, 246; Simons, 7, 8, 10; 
 Townsend, 253 ; Shecut, 109; A. Hosack, 9 ; Waring, 60; Dickson, Eccl. J. iv. 112; 
 N. 0. Fever of 1820, p. 7 ; ib. 1839, p. 325 ; Archer, v. Rec. 61 ; Brown, 88 ; Bartlett, 
 344 ; Perry, N. 0. J. April, 1844; Wharton, Am. J. July, 1843. 
 
 3 Annales d Hygiene, xi. 345, 346. 
 
AUTUMNAL FEVERS. 423 
 
 who die from all diseases. 2d. That in all situations, whether marshy 
 or otherwise, the mortality between one and five, is much greater 
 than at all other periods of life. If these circumstances are taken 
 into consideration, it will be perceived that the conclusions arrived 
 at by Villerme may be correct, without invalidating the statement 
 made as to the greater susceptibility of adults to malarial fevers. 
 It is to be remarked, also, that Villerm refers to the epidemic of 
 Groningen in 1826. On this occasion, however, the mortality 
 among children from one to five, though considerable, and large in 
 Droportion to that at some other periods of life, was smaller than 
 among adults from forty to fifty, and from sixty to sixty-five. At 
 Pautin, and other villages situate along the course of the canal of 
 Ourcq, malarial fevers prevailed extensively in 1810, 1811, 1812, 
 and 1813 at the period of the construction of that canal; but 
 children do not appear to have suffered more severely than others 
 (352). 
 
 Typhoid fever may also be said to be a disease of adult age ; for 
 though children, and young ones too, as well as old people, are 
 sometimes attacked, they are so comparatively seldom; the fever 
 bearing with greater force on individuals from eighteen to thirty. 1 
 
 When, with these facts before us, we inquire how matters stand 
 in relation to pneumonia, we discover, contrary to the stated opin 
 ions of Hippocrates, and, long after him, of Morgagni, Cullen, and 
 others, that, so far from sparing children, the disease is of very 
 common occurrence among them. 2 The researches of our country 
 man, Dr. Gerhard, 3 of Dr. Eufz, 4 and other modern pathologists, have, 
 it is true, led to the conclusion that primitive pneumonia seldom or 
 never attacks children between the ages of two to five ; but grant 
 ing this to be confirmed by subsequent and equally accurate ob 
 servation, which, seeing the result obtained by Barthez and Rilliet, 5 
 we cannot for the present be inclined to do, it is admitted that they 
 are very liable to the secondary form of the disease. At every 
 
 1 Chomel; Bartlett, 100; Cowan, Vital Statistics of Glasgow, 20; Geary, Dublin 
 Journ. of Med. Sci. xii. 98, 99. 
 
 2 Laennec, i. 547; Billnrd, Mai. des Nouv. nes, 1833; Valleix, ii. 256; Barthez and 
 Rilliet, Essai, 77; Guersent, Diet, de Med. viii. 76; Chomel, same work, XXY. 160; 
 Williams s Cyclopedia, iii. 406 ; Grissolle, 97, 98 ; Swett, 79. 
 
 3 Am. Journ. Aug. and Nov. 1834. 
 
 4 Journal dcs Connaissances Med. Ch. 1834, p. 101, &c. 
 
 5 Maladies des Enfants, i. 108; Ib. Essai, 76, 77. 
 
424 PNEUMONIA AND 
 
 other period of infancy, the two forms, whether lobulated or dif 
 fused, are frequently observed ; while, at all subsequent epochs of 
 life, individuals are, in an almost equal degree, liable to both forms. 
 I am aware, that by many the disease is supposed to bear with greater 
 force on individuals between the ages of twenty and thirty, a result 
 apparently confirmed by comparative tables draAvn up in the hos 
 pitals of Paris, and more particularly by the following one of 630 
 cases collected by Grisolle : 
 
 11 to 20 years 84 
 
 20 " 30 " 190 
 
 30 " 40 " . . . . . . 117 
 
 40 " 50 " 107 
 
 50 " 60 " 84 
 
 60 " 70 " 37 
 
 70 and above 11 
 
 But when it is borne in mind that the proportion of individuals 
 between twenty and thirty is considerably larger than that of any 
 other portion of the population of the place where the above results 
 were obtained, and that persons of that age are usually more ex 
 posed than others to the exciting causes of the disease, we shall 
 cease to be influenced in our conclusions respecting the periods of 
 life most obnoxious to pneumonia, by the large number of cases 
 there reported. Indeed, if we take this into account, we shall find 
 that the excess of frequency at that age does not reach beyond one- 
 tenth, and that the same may be said of the proportion between 
 thirty and fifty. The number in old age, compared with the 
 number of persons who have reached that period, is very large, 
 and justifies the remark of Chomel, that pneumonia, far from being 
 rare in old people, is the most frequent disease to which they are 
 liable, and withal the most fatal. 2 Dr. Williams remarks that, 
 from his own observations, he is inclined to consider young chil 
 dren as more frequently the subject of pneumonia than adults. Of 
 fifty -five cases attended by Dr. By am and himself at a dispensary 
 
 1 Chomel, Diet, de Med. xxv. 100 ; Grisolle, 101 ; Pclletan, Mem. de 1 Acad. de 
 He d. viii. 335. 
 
 a Op. cit. 101 ; see also Grisolle, 101 ; Yalleix, ii. 257; Trus, Mem. de 1 Acad. viii. 
 13; Horn-man and Dechambre, Archives, August, 1835. 
 
AUTUMNAL FEVEES. 425 
 
 in the parish of St. Marylebone, thirty-two cases were of the age of 
 six years and under. 1 A still higher authority, Laennec, 2 is of 
 opinion that the two extremes of life are the most exposed to the 
 influence of the disease. Dr. Swett, a distinguished physician of 
 this country, recognizes the greater frequency and fatality of pneu 
 monia in infancy and old age ; 3 and epidemic pneumonia has been 
 found from the days of Sydenham to our own, to be rife and highly 
 fatal among persons advanced in life. 
 
 Effects of the passions and emotions in the two diseases. Nicholas 
 Massa, very many years ago, said: "Multi ex solo timore et irnagi- 
 natione inciderunt in febrem pestilentialem ;" Pigray denominates 
 panic " pabuluni et nutrimentum pestis." Similar views have been 
 entertained respecting the injurious effects of that and other de 
 pressing passions and emotions anxiety, grief, and sorrow, as well 
 of anger, and other exciting ones as productive causes of Oriental 
 plague, by Diemerbroeck, Chicoyneau, Rivirius, Hodges, Desgenettes, 
 Larrey, Clot-Bey, and almost every writer on that disease. Equally 
 explicit on the subject are Hoffman, Aretius, Coelius Aurelianus, 
 Fazio, Chirac, Senac, Falconer, Crogan, Home, Cullen, and Huxham, 
 so far as regards pestilential, typhus, nervous, or petechial fevers. In 
 our own days, Dr. E. Hamilton, of Edinburgh, has shown the influ 
 ence of panic in propagating contagious fever, as exhibited in the 
 Magdalen Asylum of that city, in the spring of 1821. 4 
 
 Lind, who, like Yandermeer and others, had pointed out the 
 baneful effects of mental depressions in the production of scurvy 
 and other camp and ship diseases, and the benefit arising from 
 cheerful and buoyant spirits, remarks, in respect to their influence 
 in the production of autumnal fever, that it is quicker and more 
 violent in hot and insalubrious situations, than in purer and cooler 
 air. A fit of passion, he affirms, often brings on an instantaneous 
 attack of fever ; a violent fit of anger or grief will immediately pro 
 duce a jaundice or the yellow fever ; the sight of a corpse, or any 
 object of horror, and even a shocking story told to a person, have 
 been often known, through an impression of fear upon the mind, to 
 bring on a delirium, sometimes a violent vomiting and purging, 
 which vomit carried off the patient in twenty -four hours. In an- 
 
 1 Cyclop, of Pract, Med. iii. 400. 2 Traite de 1 Auscultation, i. 547, 548. 
 
 3 Lect, on Dis. of the Lungs, 79. 4 Med.-Chirur. Trans, of Edinb. i. 296. 
 
426 PNEUMONIA AND 
 
 other work the same author reiterates the sentiment, remarking 
 that it is a received opinion that fear is a cause of itself sufficient 
 to produce, in certain dispositions, a bad or malignant fever ; there 
 being many instances in besieged towns, where no other reason 
 could well be assigned for the rise of malignant disorders, than the 
 dejection of spirits, grief, and panic of the inhabitants, occasioned 
 by the bombardment, and the apprehensions of a violent death 
 from some sudden assault of the enemy. 1 
 
 I am not prepared to say from personal observation, nor have I 
 now the leisure to examine, how far the opinion of Lind as to the 
 great injury arising from the action of the passions, under the cir 
 cumstances mentioned, exclusive of some other agency, may be 
 founded. Especially am I not prepared to admit on so equivocal 
 an authority as Lassis 2 who, not content with discarding all idea 
 of contagion, disbelieves the existence of infection also that nine- 
 tenths of the mortality attributed to yellow and other fevers, should 
 be ascribed to the effects of the fear and panic under which every 
 one labours to a greater or less extent in times of epidemics. But 
 there can be no doubt that such affections of the mind, as also most 
 others to which we are liable, will be found to play an important 
 part in the production and aggravation of the diseases of hot cli 
 mates, and of the summer season of temperate ones, whether in 
 Hindostan, in Africa, in the West Indies, in this country, in Europe, 
 or anywhere else. Upon this subject there can be no mistake. 
 Facts and statements in relation to it will be found recorded in 
 almost every publication extant on those diseases. In his account 
 of the fever of Barbadoes, in 1817, Dr. Ealph mentions, in illustra 
 tion of the influence of anxiety of mind in the development of the 
 fever, the tendency it showed to affect different classes of persons. 
 " First among the people of the huts it prevailed ; then in the bar 
 racks. After we had lost one officer by fever, several others soon 
 became affected ; and, in like manner, when one of the hospital 
 attendants had died, others soon fell sick, grew alarmed, and died." 
 " Un caractere ferme," is, he remarks, the best preservative from 
 fevers on all occasions. To this cause we may attribute, in some 
 measure, the terrible mortality of the fever in Spain, " when fear, 
 
 Op. cit. 149. 
 
 2 Causes des Maladies Epidemiques, 88 ; ib. Calamites resultant du Systeme de la 
 Contagion, 9, &c. 
 
AUTUMNAL FEVEKS. 427 
 
 the handmaid of ignorance, reigns triumphant over the minds of 
 the people." 1 
 
 Similar statements are contained in the works of Warren, 20, 
 25; Desportes, i. 24, 96, ii. 264; Clarke, Dis. of Long Voy. i. 165; 
 Hillary, 146; Hunter, 18; Lempriere, ii. 10, 11 ; Chisholm, ii. 53 ; 
 Pugnet, 335 ; Amiel, Johnson on Trap. Cl 270, 271 ; Chirac, Mai Pest. 
 i. 186 ; Berthe, 147 ; Pariset, 586 ; Rush, iii. 49 ; Currie, 10 ; Gros, 7, 
 8 ; Moultrie, 26 ; Deveze, 113 ; Johnson, Trop. Cl 74; Maillot, 265 ; 
 and of others, reference to some of whom will be found at the bottom 
 of the page. 2 The same remarks are applicable to excess in eating, 
 drinking, indulgence in the venereal act, exposure to the sun, &c., 
 all of which are known, in times of epidemics, to be fruitful sources 
 of sickness, and to bring on an attack in individuals who have been 
 exposed to the action of malarial or other zymotic poisons. "Were 
 I, says Dr. Rush, to enter a city, and meet its inhabitants, under 
 the first impressions of terror and distress from its appearance, my 
 advice to them would be BEWARE, not of contagion, for the yellow 
 fever of our country is not contagious, nor of putrid exhalations, 
 where the duties of humanity and consanguinity require your 
 attendance, but beware of exciting causes? 
 
 While such is the case with malarial fevers of various grades 
 and forms, it may be doubted whether anything of the kind can be 
 pointed out in regard to pneumonia. There are no cases on record, 
 so far as I have been able to ascertain, calculated to show that the 
 disease has been brought on effectually by the depressing or ex 
 citing passions, as we have just seen in regard to fevers ; and it 
 may be presumed that the medical writer who should, nowadays, 
 venture on the assertion, that a large number of patients had been 
 seized with the disease in consequence of their fearing to be so, of 
 their labouring under the depressing effect of panic, or of their 
 experiencing a fit of anger; and that others, endowed with a greater 
 
 1 Med.-Chir. Trans, of Edinburgh, ii. 23, 24. 
 
 2 Caillot, 188; Savaresi, 228; Gillespie, 132; Rochoux, 24, 114; Rouppe, 293, 296; 
 Bally, 360; Catel, 17, 18; Rufz, 34; Osgood, 22; Dariste, iv. 23, 39, 63, 64; Lefort, 
 30, 31 ; R, Jackson, Outlines, 249; Gilbert, 71; Bancroft, 185; Ralph, ii. 63, 64, 77; 
 Mouille, 16; Repey, 16; Lorrein, 9; Mabit, 15; Hume, 236; Copland, ii. 10, 53; 
 Blin, 21 ; Audouard, 435; McWilliams, 105; Archer, Med. Recorder, v. 66; Drysdale, 
 Med. Mus. i. 34; Tooley, 16; Barton, 20; Perlee, Chapman s Journ. i. ii. 10; Barn- 
 well, 373; Fever of Mobile in 1819, in Jenning s collection relative to the fever of 
 Baltimore. 
 
 3 On the means of preventing, &c. autumnal diseases, Works, iv. 126. 
 
428 PNEUMONIA AND 
 
 share of moral courage, equanimity of temper, or a fine flow of 
 spirits, had escaped, would be likely to excite the surprise of his 
 professional readers. Nor is it less evident, that, common as pneu 
 monia is in certain regions and seasons, of all countries, our own 
 included, the number of cases would be vastly increased, were 
 indulgences in good eating and hard drinking, and especially in 
 what good old Floyer quaintly denominated " womanizing," as cer 
 tain to bring on an attack of that disease, as they are to occasion 
 the development of fevers in persons exposed to a malarial atmo 
 sphere. 
 
 It is possible that as regards the importance attached by me to 
 the preceding points, as also to many of those noticed on former 
 occasions, I may err; and that for advocating them so earnestly, I 
 may, in the opinion of some learned writers, exhibit nryself in the 
 light of one who has remained sadly behind the times. But, if I am 
 really found amenable to so grave a charge, I have the consolation 
 to know, that those who entertain contrary views, and may accuse 
 me of ignorance, have not as yet produced anything on the subject 
 calculated to establish the correctness of their own position, and 
 likely to change the current of opinion on the question at issue 
 among t the enlightened and reflective portion of medical inquirers. 
 Let the reader examine what has been written on the subject ; let 
 him inquire what are the sentiments entertained on these various 
 points, in this country and Europe, and he will find in what I have 
 said little more than the reassertion of opinions more than once 
 advocated ; and of facts and statements adduced by the very highest 
 professional authorities. If I err, therefore, I do so in good com 
 pany. And surely, under these circumstances, I can have no objec 
 tion to being accused of upholding antiquated notions, of hazarding 
 nothing but bare assumptions, and amusing myself with starting 
 conjectures at variance with what is fancied to be the present state 
 of knowledge ; provided, not that my opponents should prove that 
 they are right and I am wrong, for this might give them some 
 trouble ; but that the aforesaid authorities, to whom the medical 
 world has heretofore found good reason to look up to as safe 
 guides, should be regarded as open to the same sort of censure. 
 
 TJie prevalence of the two diseases at the same time and in rapid succes 
 sion no proof of identity. We have seen that those who advocate the 
 idea of the unity of pneumonia with periodic fever, derive an argu- 
 
AUTUMNAL FEVERS. 429 
 
 ment in favour of their views from the circumstance that these 
 diseases sometimes, or indeed, often prevail at the same time in the 
 same place, or in neighbouring localities, or that they succeed to one 
 another in the same situation, merging into each other as time pro 
 gresses. If, as it is argued, intermittent, remittent, and other fevers, 
 arising indubitably from the action of malarial exhalations, and if, as 
 every pathologist acknowledges, these fevers are identical in nature 
 different forms of one and the same complaint if they prevail 
 together, or replace each other as the season advances ; and, if from 
 this circumstance of coexistence and succession we are justified in 
 inferring the existence of a similarity of origin and of nature, so 
 the coexistence of pneumonia with those fevers, and the succession 
 of the former to the latter, must equally warrant the conclusion 
 that they arise from the same cause, and constitute different forms 
 of the same disease; " the difference in their characters phenomenal 
 and anatomical arising in part from the season of the year in 
 which they appear, the peculiar localities in which they occur, but 
 mainly from the nature of the organs which become involved in 
 the diseased action, the predominance of inflammation or conges 
 tion, and the character of their periodicity." Dr. Merrill, who seems 
 to attach much importance to the circumstance of succession, and 
 doubtless will not refuse to join in sentiment with those who appeal 
 to that of coexistence, sums up, in a passage already cited, but 
 which I must once more call attention to, the gradual changes 
 which this supposed one and identical disease experiences as time 
 advances. " In the spring, we are apt to find those diseases assum 
 ing names which have reference more particularly to this periodi 
 city and general pathology. As summer comes on, the greater 
 implication of the hepatic organs changes the name, or adds an 
 epithet to designate a prominent symptom. In autumn, the chylo- 
 poietic viscera become more strikingly involved in the diseased 
 action ; and this, again, is indicated by an ever-changing nomen 
 clature. But when winter approaches, and the subjects are exposed 
 to sudden transitions of temperature, the thoracic viscera are called 
 upon to bear the burden of local disease ; and then it is that the 
 names pleurisy, pneumonia, pneumonia typhoides, pneumonia bi- 
 liosa, pleuro-pneumonia, bilious pleurisy, lung fever, &c. become 
 familiar sounds." 
 
 The attempt made to prove the identity of the diseases in ques 
 tion on the ground of their coexistence and succession, differs in 
 
430 PNEUMONIA AND 
 
 nothing from that made to assimilate together, both as regards 
 causation and nature, certain forms of febrile diseases, which, by 
 other -observers, are viewed as totally distinct from each other, and 
 also by that which has not unfrequently been attempted, to deprive 
 them all of an independent nosological position, and pathological in 
 dividuality, and prove them to be nothing more than so many grades 
 or forms of common autumnal malarial fever. But the argument 
 founded on such occurrences is not more satisfactory in the one case 
 than in the other. Were it valid, we should on the same ground be 
 led to the conclusion that scarlatina, measles, hooping-cough, influ 
 enza, and the like, which sometimes coexist with or succeed to each 
 other, are one and all offsprings of the same parent, and necessarily 
 one and the same disease. We should be compelled to admit 
 also that, inasmuch as measles or influenza are followed occa 
 sionally by angina, in some of its various forms, and often coexist 
 with, and more frequently though not universally, as maintained 
 by Webster precede autumnal or periodic fever, whether these 
 present themselves in the endemic or epidemic garb, it necessa 
 rily follows that they must all be viewed as resulting from the same 
 cause as such fevers, and as being mere modified forms of them 
 the difference depending, as in the case of pneumonia, upon the 
 season of the year at which they make their appearance, the locali 
 ties in which they may occur, or the organs and tissues which 
 become involved, &c. We every day see other coexistences and 
 successions of djseases which have nothing in common with each 
 other in respect to pathology and etiology ; and which are equally 
 independent, on those points, of the ordinary autumnal or periodic 
 fevers of the localities where they show themselves. Asiatic 
 cholera, for example, must have preceded, succeeded to, and coex 
 isted with, many a prevalence of such fevers, and in 1832 it existed 
 simultaneously, in New Orleans, with the yellow fever ; and yet no 
 writer of note, save Dr. Merrill, Dr. Searle, and a few others, have 
 ever seriously thought of holding up cholera as a mere form of 
 autumnal fever a disease which it no more resembles in respect to 
 phenomenal and anatomical characters, mode of progression, and 
 laws by which it is governed, than smallpox does scarlet fever. If 
 it approximates it on any point, it is in appearing with greater 
 force in localities noted for containing sources of malarial infection; 
 a circumstance for which it has been supposed by some physicians 
 of reputation in Europe, as Boudin, Marechal, Moucbet, and others, 
 
AUTUMNAL FEVERS. 431 
 
 and a few but very few of equal stamp in this country, to belong 
 to the category of malarial diseases. But on closer and more care 
 ful examination, we shall find reason to discard such notions, and 
 to conclude that, in the case of cholera, as in that of other zymotic 
 diseases which have nothing in common with autumnal fevers 
 except their toxical origin, the effluvia arising from these foul 
 localities, as well as putrescent food, impure water, &c., produce 
 their deleterious effects, not by furnishing the efficient cause of the 
 disease, but by predisposing the system of those exposed to their 
 influence, to receive the morbid impress of that cause. Typhoid 
 pneumonia, which some have, with equal impropriety, converted 
 into a peculiar form of periodic fever, but which, from its symp 
 toms, the season of the year at which it usually shows itself, and 
 the places where it has at times reigned paramount, is evidently 
 unconnected with this disease, has necessarily been found in some 
 localities to succeed the latter, and may, so far as I now recollect, 
 have prevailed simultaneoiisly with it. Nevertheless, few patholo- 
 gists will feel disposed, from this circumstance alone, to coincide 
 with them in the views they have set forth as regards the nature 
 of that complaint. All who have seen much of it, recognize it to 
 proceed from a special epidemic cause, similar everywhere, and 
 giving rise to phenomena which impart to it a character distinct 
 from that of autumnal fevers. It requires no great stretch of 
 diagnostic knowledge to perceive that it is nothing but a combi 
 nation of pneumonia and typhus or typhoid fever. It reigned in 
 this country from 1807 to 1820 principally from 1812 to 1814. 
 During this period, typhus or typhoid fevers occurred extensively, 
 while the pneumonia was superadded in some cases only. 
 
 Typhus, typhoid, and relapsing fevers have been found to pre 
 vail together in several cities and localities of Great Britain. In 
 this country, typhus, and especially typhoid the more common 
 disease of the two on this side of the Atlantic have not unfre- 
 quently coexisted, to a certain extent at least. More often they 
 have succeeded to, or supplanted the common autumnal or periodic 
 fever ; and yet the soundest pathologists and most experienced and 
 careful observers of the day men whom the stiffest contemner of 
 book authorities may not be ashamed to look up to with respect 
 have found ample cause to regard these two fevers, however true it 
 may be they both belong to the class of zymotics, as distinct diseases; 
 while the physician who, in this nineteenth century, should argue 
 
432 PNEUMONIA AND 
 
 from the fact of typhoid fever prevailing at the same time with, or 
 succeeding to, or supplanting ordinary autumnal fevers ; that it is 
 merely a modified form of the latter disease, thus ignoring the fact 
 that the former presents distinct phenomena, and gives rise to dis 
 tinct anatomical characters; that it runs a different course; that it 
 has a different duration, and appears often in places where malarial 
 fevers have never shown themselves, or have ceased to appear, or 
 at seasons of the year when malaria is not and cannot be evolved; 
 that it is in all probability antagonistic of the other, and is propa 
 gated in a different way would give no enviable measure of his 
 professional sagacity and knowledge. 
 
 Admit, then, for a moment, the validity of an argument in sup 
 port of the identity of pneumonia with autumnal fevers founded on 
 the coexistence of the two diseases in the same locality, or the suc 
 cession of the former to the latter, and the reverse, and we shall be 
 forced, for the sake of consistency, to make other and kindred 
 admissions, which, in the present state of knowledge, would appear 
 rather awkward. That typhoid fever is not a mere form of common 
 periodic fever, is a pathological fact, which, from what precedes, I 
 take for granted every intelligent and well-informed physician 
 knows full well. The typhoid is the predominant fever of a great 
 portion of our Eastern States, and of many districts of France, and 
 other localities where periodic fevers are not at all known or sel 
 dom encountered. Paris, London, and other cities, as we have seen, 
 are not visited by intermittent and remittent fevers while typhoid 
 fever prevails there extensively. Now, if we regard the pneumonia, 
 which in malarial districts occurs at the same time with or follows 
 on the heels of, intermittent and remittent fever, as identical with 
 them, on the ground of that coexistence or succession, there is no 
 reason why we should not admit that cases of pneumonia, which 
 are very common in New England, in Paris, London, and other 
 places subject to typhoid fever, and which coexist with or follow 
 that complaint, are due to the same cause that gave rise to the 
 latter, and are mere modifications of it. The conclusion would not 
 be more extraordinary in the latter than in the former case. 
 
 But there can be no necessity to enlarge on this matter. Already, 
 in the opening chapter, attention was partially called to it, and 
 enough was perhaps then said to justify the inference, that nothing 
 favourable to the idea of the identity of pneumonia with periodic 
 fevers could be made out of the fact that the two diseases coexist, 
 
AUTUMNAL FEVERS. 433 
 
 or that the former succeeds to the latter. It was there remarked 
 that inflammation of the lungs prevails very extensively in places 
 where remittent, intermittent, and other fevers of kindred nature 
 are not observed ; that it shows itself usually at seasons of the year 
 when, if the ordinary causes of fever had at any time exercised 
 their influence, they have been effectually or temporarily removed ; 
 that in places where periodic fevers prevail daring a certain period 
 of the year, they are put a stop to, in all their varieties, by frost. 
 It was shown that while fevers are thus arrested, pneumonia, which 
 had coexisted with them, instead of disappearing also, continues to 
 prevail as it did before the accession of frost, or even is observed to 
 spread more extensively; and that as the cause of the fever had thus 
 been destroyed as proved by the entire absence of its legitimate 
 effects the cases of pneumonia which continue to show themselves 
 after the accession of frost, cannot be referred to the morbid agency 
 of the cause in question, but are due to the operation of some other 
 morbific influence, over which frost exercises no control, and differ 
 ing consequently from the former. It was stated that the same 
 causes which give rise to pneumonia after a stop has been put to 
 periodic fevers by frost, must be similar to those that produce the 
 disease during the prevalence of those fevers and anteriorly to the 
 occurrence of frost. It was moreover argued that, if the cause 
 which produces pneumonia after that event must, for reasons 
 stated, differ essentially from that occasioning the fevers thus 
 arrested in their course, the cause giving rise to the cases that ap 
 pear during the fever season, must also be different from the febrile 
 poison; that hence, when the two diseases show themselves to 
 gether, two sets of causes are at work; that from this difference of 
 cause we have reason to infer the existence of a difference in the 
 nature of the diseases produced ; and that when pneumonia, in the 
 regular succession of the seasons follows on periodic fevers, after the 
 accession of cold or frost, or at the period of atmospheric vicissi 
 tudes, it is not influenced in its production by the cause of those 
 fevers. It appears, therefore, as the effect not of a gradual change 
 from one form to another of the same complaint, but as the result 
 of the creation of a different, or the continuance of an independent 
 disease. 
 
 Pneumonia and autumnal fevers are not convertible diseases. In 
 order that coexistence and succession may furnish material towards 
 28 
 
434 PNEUMOXIA AND 
 
 building an argument in favour of the identity of the two diseases, 
 it is necessary that they should be combined with other concomi 
 tant circumstances. Separately considered, they can serve but little 
 purpose, and lend but feeble aid in the settlement of the question. 
 The connection of intermittents with remittents, which has been 
 appealed to, in illustration of the supposed identity under examina 
 tion , affords but little support to the argument, because it is founded 
 to a much greater extent on other and more weighty facts than 
 mere coincidence and succession. Under much variety of aspect, 
 as is remarked by a most eminent writer of this country, these 
 fevers "possess many deep-seated analogies and identities; they fre 
 quently change from one type to the other. Thus, an intermittent 
 turns into a remittent, and the latter, assuming the type of the for 
 mer, is often seen to become, first a quotidian, then a tertian, and 
 finally, a quartan. A simple intermittent may, in the third or 
 fourth paroxysm, take on the character of a fatal congestion; and 
 that which began with an aspect of malignity, sometimes emerges 
 into simplicity and mildness; vernal agues attack those who, in 
 autumn, had suffered under remittent fever, not less than those who 
 had experienced the intermittent form ; the sequelas of all the varie 
 ties are almost identical; the same treatment, with certain modifica 
 tions, is applicable to the whole." Surely, nothing of this kind is 
 observed to occur in reference to many diseases, the identity of 
 which is insisted upon on the ground that they coexist together, 
 or follow each other in the same locality. The yellow and common 
 autumnal fevers, though kindred zymotic diseases, and arising from 
 malarial exhalations, are not, strictly speaking, convertible, though 
 cases occur which exhibit symptoms characteristic of both, and the 
 diseases may either blend together, or appear in rapid succession 
 in the same subject. Kemittents or intermittents never change 
 into yellow fever, and vice versa ; their anatomical characters and 
 sequels are not the same; those attacked with yellow fever in the 
 autumn, are not affected with ague the following spring, and the as 
 pect of the two diseases are not the same. In a word, they do not 
 possess deep-seated analogies and identities similar to those existing 
 between the various forms of ordinary paludal fevers. Still less 
 allied to autumnal fevers in those respects, are typhoid or typhus 
 fevers, and true oriental plague, which, under the fostering hands of 
 some Unitarian pathologists, have been admitted into the family of 
 
 1 Drake, 704. 
 
AUTUMNAL FEVERS. 435 
 
 periodic marsh miasmatic fevers, there to keep company with yellow 
 fever, Asiatic cholera, typhoid pneumonia, to say nothing of phre- 
 nitis, gastritis, gastro-enteritis, hepatitis, and, for what I know, peri 
 tonitis, cystitis, tonsillitis, nephritis, gout, rheumatism, and the rest 
 of the forty or fifty different varieties of diseases into which, as we 
 are told, the nosology of southern fevers might be arranged, and 
 which constitute so many links in the chain of morbid action, ex 
 tending from a septenary ague up to the most violent and fatal form 
 of yellow fever. At a still greater distance, in these same respects, 
 from autumnal fevers, do we find pneumonia. So far as I am aware, 
 the physician is yet to be found who has discovered that pneumonia 
 and periodic fevers are convertible diseases in the way that the seve 
 ral forms of these have been shown to be. A case of intermittent or 
 remittent is not converted into pneumonia by injudicious treatment, 
 or a case of pneumonia transformed into a mild intermittent by 
 proper, or into malignant remittent by improper remedies; their 
 sequelae are not identical. Those who have pneumonia in the autumn 
 or winter, do not run as much risk of suffering from vernal agues 
 or summer remittents, as those who have passed through these com 
 plaints; they do not possess many deep-seated analogies and iden 
 tities, and the same treatment would require more than trifling modi 
 fications to make it applicable to both. 
 
 In saying this much on the subject, I am far from denying the 
 change from one disease to another. Such changes are of daily 
 occurrence, and are observed in regard to almost every complaint 
 to which the human system is subject. A case commences with 
 symptoms of common remittent or intermittent fever, and at its 
 close exhibits phenomena appertaining to yellow fever. In other 
 instances the reverse occurs, cases of yellow fever ending with 
 symptoms of periodic fever. Typhus, typhoid, or pestilential fevers 
 terminate sometimes in the same way ; while, at other times, cases 
 which at their outset presented the characteristics of common inter 
 mittent or remittent fever, assume, as the disease progresses, those 
 of the fevers mentioned. So also with regard to pneumonia and 
 fever. Cases of the former not UD frequently, under peculiar ende 
 mic or epidemic influences, end with symptoms of autumnal, as also 
 of yellow, or typhus, or typhoid fever. On the other hand, cases 
 of periodic or other fevers sometimes terminate with symptoms of 
 pneumonia. 
 
 Doubtless changes of the kind may, strictly speaking, be re- 
 
436 PNEUMONIA AND AUTUMNAL FEVERS. 
 
 garded as the effect of conversion; but the conversion herein 
 noticed is not that of one form of a disease into another form of the 
 same. It cannot be occasioned by an increased force in the cause 
 of the disease first existing, by a difference in the state of predispo 
 sition of the person attacked, or by the peculiar mode of treatment 
 pursued. It is not the result of a mere modification of one and the 
 same thing ; but a change of one thing to another of a more or less 
 different kind; in a word, it is the substitution, partial or complete, 
 of one disease for another. Such conversions of diseases are not of 
 rare occurrence. They are, indeed, familiar to all practitioners. 
 They often lead to evil or fatal consequences, or simply to the 
 removal of disease without restoration to health ; and, without feel 
 ing disposed to believe, with Sir George Gibbes, that one disease is 
 always necessary to the cure of another, that just as many functions 
 undergo a secondary derangement as are necessary for the cure of 
 the primary one, and that no diseases occur but such as are curative 
 in their effects or in their tendency, 1 we cannot doubt, taught as 
 we are by daily experience, that the cure of one disease is often 
 effected by the occurrence of another; but whether leading to 
 baneful or salutary consequences, while many conversions are due 
 to the transfer from one part to another of a specific cause, floating, 
 as it were, in the system, as the gouty, rheumatic, &c., a large num 
 ber are the effects, not of the operation of such a cause acting in 
 this latter way, but, as already stated, of the slow or abrupt substi 
 tution of one disease for another ; sometimes, though not necessarily, 
 allied to it in a pathological or etiological point of view. 
 
 The late Dr. Hillier Parry, 2 of Bath ; Dr. Mackenzie, 3 and others, 
 relate interesting cases of the kind, and several have fallen under 
 my own observation, embracing a variety of dissimilar complaints; 
 and if such occurrences are admitted to take place in the cases men 
 tioned, we can have no reason to doubt that the same will hold good 
 in reference to those instances in which symptoms of one fever re 
 place those of another ; as also in those in which the phenomena of 
 autumnal fever succeed to those of pneumonia, and vice versa. 
 
 1 Brit, and For. Med. Rev. xxiii. 591. 
 
 2 Elements of Pathology and Therapeutics, i. 48, 306-320. 
 
 3 Sketch of the Natural Cure of Diseases, Brit, and For. Med. Rev. xxiii. 590. 
 
CHAPTER VII. 
 
 PNEUMONIA AND AUTUMNAL FEVEKS, ALTHOUGH INDE 
 PENDENT OF EACH OTHER, AS REGARDS NATURE AND 
 CAUSE, COMBINE TOGETHER, AND FORM, LIKE OTHER 
 COMPLAINTS, HYBRID DISEASES, WHICH MUST NOT BE 
 CONSIDERED AS PECULIAR FORMS OF EITHER. 
 
 Cases of pneumonia marked by symptoms appertaining to autumnal 
 fever, are the results of complications. I am prepared to be told that, 
 so far, my remarks can have had reference only to pure and idiopa- 
 thic pneumonia, such as the disease is said to show itself in high and 
 healthy localities and northern latitudes, and that they do not apply 
 to that form of it which physicians in the south or southwest are 
 in the habit of observing. I may be told, that cases there present 
 themselves, in which the ordinary symptoms of pneumonia are more 
 or less modified, and are associated, to a greater or less extent, 
 with other phenomena which approximate the disease to autumnal 
 fevers ; and that while in other regions thoracic inflammation may 
 be, for what we know for on that matter doubts are occasionally 
 expressed independent of periodic fevers both in regard to causa 
 tion and nature, the cases which prevail in malarial countries, and 
 exhibit the phenomena in question, may be admitted to give coun 
 tenance to the hypothesis under examination. Of the occurrence 
 of such cases, no experienced or well-read physician can be igno 
 rant. He must be fully aware, that in miasmatic regions they are 
 frequently encountered, and that there pneumonia like, indeed, 
 very many other diseases often, if not generally assumes, to a 
 greater or less extent, the periodic type. So frequently are such 
 cases observed in those regions, and so decided often is the tendency 
 to this type, that it cannot be a matter of astonishment that some 
 physicians, noticing a succession of instances of the kind, and yield 
 ing too readily to a spirit of exaggeration and hasty generalization, 
 
438 PNEUMONIA AND 
 
 pardonable in individuals of limited professional acquirements, but 
 which ought not to be encountered in other quarters, should have 
 been deceived, and arrived at the conclusion that, with few ex 
 ceptional instances, in which they admit, on the authority of others, 
 the disease to be idiopathic, "the pneumonia which prevails in this 
 country, sometimes sporadically, and frequently as an epidemic, is 
 really and substantially nothing more than a peculiar form of 
 remittent and intermittent fever." 
 
 But when we view these facts more attentively, without being 
 swayed by a favourite hypothesis, and with a full knowledge of 
 the occurrence of kindred modifications in a number of other dis 
 eases, and of the diversified effects produced in many complaints 
 by the various modifying influences that surround us, we shall not 
 be long in perceiving, that the facts in question admit of an easy 
 explanation, on principles very different from those contended for 
 by the advocates of the identity in question, and in a way which 
 renders unnecessary the disunion of the beforementioned class of 
 pneumonias from the ordinary form of that disease. It is a fact 
 well ascertained, and perfectly familiar to those who have investi 
 gated the subject of the progress and succession of epidemic or 
 endemic diseases, that the type of the fever which prevails immedi 
 ately before the outbreak of pneumonia in other words, before the 
 period of the year at which the usual causes of the latter are mostly 
 encountered and operate with more force and effect on constitutions 
 predisposed to their action arrives impresses its own character on 
 pulmonary inflammations. Hence at that season, low surfaces, the 
 vicinity of mill-ponds, of the banks of streams, and of other locali 
 ties, which before were the abodes of pure remittent and intermit 
 tent fevers, become the seat of pneumonias, which often assume a 
 marked remittent, and not unfrequently an intermittent 1 character 
 the result of anterior influences ; while the same disease in other situ 
 ations where malaria is not evolved, or at a more advanced period of 
 the year, when it has been completely destroyed, presents nothing of 
 the kind for a longer period. 1 The same combination of phenomena 
 is necessarily observed for a longer period whenever pneumonia shows 
 itself in localities where malaria continues to be evolved all the year 
 round, or where, from the absence of frost, it is only moderated, and 
 not completely destroyed. In many such cases the inflammation of 
 
 1 Lewis, Med. Topog. of Alabama, N. 0. J. iv. 28. 
 
AUTUMNAL FEVERS. 439 
 
 the lungs presents itself in combination with symptoms appertaining 
 to ordinary bilious remittent fever, or hepatic or bilious derange 
 ment, giving rise to what is denominated bilious pleurisy, a form 
 of disease accurately described by many American and European 
 writers. 1 In other instances, the bilious symptoms are not so pro 
 minent, and the affection of the lungs is associated with those of 
 simple remittent or intermittent fevers. 2 Indeed, instances of re 
 mittent and even intermittent pneumonia, pleurisy and pulmonary 
 catarrh, in which the inflammation is complicated with symptoms 
 indicating the existence in greater or less purity of the element of 
 periodicity, are to be found described in the writings of the most 
 reliable authors. Morton, who early called attention to them, and 
 indicated the treatment they required, had seen a hundred such 
 cases ; and since his day they have continued to be adduced as ob 
 jects of familiar professional observation, not only in Europe, but 
 in this country also. 3 
 
 The pleurisies which prevailed in Minorca, in 1745-46, and of 
 which Cleghorn has left us so graphic a description, commonly 
 began like an ague fit, with shivering and shaking, flying pains all 
 over the body, bilious vomiting and purging, which were soon 
 
 1 Bianchi, Hist. Hepat. i. 236; Stoll, Med. Constitution of years 1770-77, i. 50; 
 Frank, pt, 2, ii. 350 ; Forsyth, Med. Rep. xii. 353 ; Williams, Med. Reg. iii. 454 ; 
 Potter, Med. Recorder, iv. 404 ; Drake, i. 749, 765 ; Wood, ii. 38 ; Pelletan, Mem. 
 Statist, sur la Pleuro-pn. Mem. de 1 Acad. de Med. viii. 443 ; see Bulletin do 1 Acad. 
 i. 835; iv. 447; Eberle, Pract. of Med. i. 284. 
 
 2 Matheson, Charleston J. iii. 152; Oliver, N. 0. J. vii. 387-89; Day, ibid. ii. 578-587. 
 
 3 Morton, Opera Omnia Hist. &c. 21 ; Brera, Journal de Sedillot, xxxiii. ; Bailly, 
 Fievrcs Intermittcntes, 253 ; Gouzee (of Antwerp), Archives, 2d series, iv. 71 ; Da 
 niel (of Cctte), Ephemerides de Montpellier, iv. 339, 357, 454; Gouraud, Etudes 
 sur les Fievres Interm. 103 ; Sarcone, Mai. de Naples, i. 202 ; Frank, ii. 352 ; Mou- 
 ton, An. Clin. de Montpellier, xxvii. 133 ; Laennec, i. 391, 4th ed. ; Alibert, 57 ; 
 Bonnet, F. Interm. 76, 118; Detournel, Arch. Gen. April 1829, p. 255 ; Nepple, F. Int. 
 99, 124, 260; Roche etBerquin, Nouv. Elem.i. 440; Leonard and Foley, Researches sur 
 1 Etat du Sang, &c. en Algerie, Mem. de Med. and de Chir. Militaire, Ix. 135, 209 ; De 
 Renzi, Miasmi Paludosi, 121 ; Lauter, Hist. Medica Bienn. Marb. Rural, 5th and 7th 
 cases; Strack, Obs. de Feb. Intermit., obs. 32, 58, p. 74; Sauvages, Nosol. Med. ii. ; 
 Abloing, Journal General de Medicine, Iviii. ; Matthei, Journal do la Societe Med.- 
 Cliir. de Parme. ii. ; Bonakli, ib. ; Archier, Journal de Med. 1784, Ixi. ; Evans, 54, 17, 
 71, 78; Chauffard, Traite des Fievres, 254, 257; Macculloch, 385; Mongellaz, 221, &c. ; 
 Bibliothique Med. Jan. 1819, from Tr. of Med. Soc. of Lyons, N. A. Med. and Surg. J. 
 viii. 193; Du Pro, Charleston J. v. 607, 608; Maillot, 17, 41, 127; Raymond, Mem. 
 de la Soc. Roy. de Med. iv. 72 ; Foster, Stethoscope, iii. 91-93 ; Blake, N. 0. J. vii. 
 510, 511; Rochoux, Bulletin de 1 Acad. i. 926; Cooke, Recorder, vii. 459 : Meli, Sulle 
 Febbrc Biliosi, 54, 55. 
 
440 PNEUMONIA AND 
 
 succeeded by quick breathing, immoderate thirst, inward heat, 
 headache, and other feverish symptoms. In a few hours, the respi 
 ration became more difficult and laborious ; the most part of the 
 sick being seized with stitches in their sides. In a few instances 
 these complaints preceded the fever ; in others they did not come 
 on till the day after. Many were drowsy, and inclinable to sleep, 
 but they raved at intervals, or were much disturbed with extrava 
 gant dreams. In the mean time, the internal heat was in several 
 very moderate ; in some less than natural ; but, for the most part, 
 it was so intense as to raise the thermometer to the 102d degree; 
 and often in the afternoon to the 104th. The pulse was likewise 
 very variable, not only in different persons, but in the same at dif 
 ferent times. In some cases it was like that of a man in health, or 
 even slower than natural, while the patient was in the greatest 
 danger ; so that it could neither be depended upon as a prognostic 
 sign, nor as an indication of cure. Nor was the colour or con 
 sistence of the blood more to be trusted ; in many it had a white 
 or pale yellow crust, the serum being of the same complexion ; but 
 for the most part it was red and florid. Besides some abatement 
 of the fever, which commonly happened every morning, it was 
 remarkable that upon the third day, or beginning of the fourth, 
 there was frequently a great remission, sometimes a total cessation 
 of every violent symptom, so that the sick were thought to be out 
 of danger ; but on the fourth or fifth, a delirium suddenly came on, 
 or the breathing became more difficult than ever, and one or both of 
 these symptoms increasing hourly, the patient expired in a day or 
 two, either suffocated or raving mad, unless, nature or art assisting, 
 he had the good fortune to escape by some critical evacuation. 1 
 
 In the bilious pleurisy or pneumonia of many regions of our 
 country, the reader will recognize a disease much resembling the pre 
 ceding, and which, unless biased by strong theoretical prepossession, 
 he cannot fail to regard as the result of the combined agency of 
 miasmata and atmospheric vicissitudes. The following description 
 of the disease, by Dr. Eberle, embodies all that need be said on the 
 subject. The initial symptoms differ very little from those which 
 usually usher in an attack of ordinary remittent bilious fever. In 
 some instances, a sense of fulness and tension is experienced in the 
 right hypochondrium, a few days previous to the supervention of 
 
 1 Dis. of Minorca, 2G1-2GG. 
 
AUTUMNAL FEVERS. 441 
 
 the disease, and occasionally dysenteric symptoms occur before the 
 fever commences. In almost all the cases considerable pain is felt 
 in the back and extremities during the premonitory period. The 
 skin, from the beginning, is more or less tinged with bile, and the 
 conjunctiva especially is conspicuously icterode. The face is flushed, 
 and a sickly mixture of red and yellow, upon close examination, 
 betrays the existence of a disturbed state of the liver. Acute pain 
 in the forehead is almost constantly present. The pain in the chest 
 is sometimes extremely severe and pungent ; but more commonly 
 it is obtuse, and attended with a sense of weight or oppression in 
 the breast. In some cases the fever continues for several days 
 before the pectoral pain supervenes. The expectoration is not very 
 copious, the sputa being of a frothy, yellowish appearance, marked 
 frequently with streaks of blood. The fever is generally attended 
 with manifest evening exacerbations, and morning remissions. 
 When vomiting takes place, an occurrence very common in this 
 affection, more or less of bilious matter is generally thrown up, 
 although in some instances the secretion of bile appears to be en 
 tirely suspended ; the ejections consisting of nothing else than 
 gastric mucus and the ingesta. The tongue is at first white, with 
 a yellowish streak along the middle, which, as the disease advances, 
 becomes dark brown and dry. The urine is always of a deep yel 
 low or bilious colour ; and the pulse is generally small, frequent, 
 and quick, with a slight degree of preternatural tension. 1 
 
 In the following statement we certainly do not recognize the 
 phenomena of the ordinary and legitimate form of pneumonia, or 
 pleuro-pneumonia, and must, as in the preceding, admit the admix 
 ture of some of the characteristics of malarial fevers. The vicinity of 
 marshes within the tropics, and in countries, during the summer and 
 autumn, subject to tropical heat, says Chisholm, is always influential 
 in the formation of the type and character of the disease. This is re 
 markably exemplified in dysentery and pneumonia. In the latter it 
 " gives the disease, originating in suspension or interruption of the 
 functions of the cutaneous organization, a remittent or intermittent 
 form. In fevers of an infectious nature, whether symptomatic or 
 idiopathic, the same type is communicated by the reception of the 
 marsh miasmata into the system, without suspending or changing 
 the original diathesis. Thus smallpox, measles, and scarlatina have, 
 
 1 Treatise on the Practice of Medicine, i. 284. 
 
44:2 PNEUMONIA AND 
 
 in such situations, a remittent, or even an intermittent form of 
 symptomatic fever ; and thus, from the same cause, idiopathic in 
 fectious fever has often superadded the type. All these, therefore, 
 under such circumstances of locality, are truly hybrid diseases; 
 although, in their treatment, the original disease is alone to be re 
 garded. In hybrid pneumonia, the pneumonic symptoms and fever 
 are concomitant, and affect the patient according to the type of the 
 latter; in paroxysms, if it is intermittent; in remissions and exacer 
 bations, if it is remittent; that is, the pneumonic symptoms are 
 always exasperated during the presence of the fever, and mitigated 
 during its intermission or remission." 1 
 
 As we have seen in the opening chapter of this volume, Dr. 
 Yaughan, of Delaware, founded his opinion regarding the identity- 
 pathological and etiological of pneumonia and fever, partly on the 
 occurrence of cases of the former in which the pulse presented 
 peculiar characters, the fever had a tendency to assume a tertian 
 type, and the countenance became early hippocratic. 2 We have 
 seen also that Dr. Forry inclined to the same opinion, because 
 sundry cases reported by Drs. Pitcher and Wharton, of the army, 
 partook of the intermittent character, and were successfully treated 
 by the same remedies which are found to arrest intermittent fevers. 3 
 A farther proof of the existence of such cases will be obtained by 
 referring to the great work of Dr. Drake, as well as to an essay by 
 Dr. Boling, of Montgomery, Ala., in which the blending of the peri 
 odic type with pulmonary and other inflammations, is ably treated 
 and amply illustrated by interesting cases. 4 
 
 Within the last few years, as we learn from the Charleston Hfedical 
 Journal, even thoracic diseases bronchitis, pneumonitis, pleuritis, 
 &c. (while retaining their distinctive characters), have taken on a 
 strongly-marked periodical intermittent or remittent character. 
 Two years ago, in Charleston, almost all the cases of the above- 
 mentioned diseases were of this nature, and were promptly checked 
 by quinia. 5 Nor is it in the south alone that such a tendency has 
 been noticed. Dr. Rush, in his account of the bilious fever which 
 prevailed in Philadelphia in 1780, states that in the spring of that 
 year, a catarrh appeared among children, from one to seven years 
 of age. " It was accompanied by a defluxion from the eyes and 
 
 1 Manual of the Climate and Diseases of Tropical Countries, 10G. 
 
 2 Med. Repos. iv. 130. 3 Climate of the U. S. 18G. 
 4 Am. J. of Med. Sc. viii. 87, and X. S. 5 Vol. v. 824. 
 
AUTUMNAL FEVERS. 443 
 
 nose, and by a cough and dyspnoea, resembling in some instances 
 the cynanche trachealis, and in others a peripneumony. In some 
 cases it was complicated with the symptoms of a bilious remittent 
 and intermittent fever. The exacerbations of this fever were always 
 attended with dyspnoea and cough." 1 Among the sick labouring 
 under the fever they had brought to England from "Walcheren, or 
 who were attacked after their return from the latter place, pneu 
 monia was of common occurrence, especially about the month of 
 November, when they were exposed to the combined influence of 
 cold and humidity. In such cases the pulmonary influence was 
 modified in its type and other peculiarities by the paludal fever 
 with which it was associated. 2 
 
 Sir George Baker, in his description of the- influenza of 1762, 
 states that the disease exhibited the intermittent character. " Some 
 times it proved periodical, and of the tertian type." 3 Dr. Holland 
 made the same observation in London, during the epidemics of 
 that disease which prevailed there, from 1831 to 1838, remarking 
 that the tendency to intermittent symptoms, both tertian and quo 
 tidian in type, and often very regular in period, seemed to be more 
 common when the disorder was abating. 4 A similar fact was no 
 ticed by Dr. Rush, who, in his history of the influenza of 1807, 
 observes : " The bilious fever which prevailed in August imparted 
 to it several of its symptoms. There were obvious remissions and 
 intermissions, great pain in the back, and apparent cessation of the 
 symptoms of the disease on the third, and a return of them on the 
 fourth day, &c. The disease appeared in one respect to be a mon 
 ster ; its head and breast wore the character of influenza, while its 
 trunk and limbs indicated it to be a bilious fever." 5 
 
 Pneumonia and other inflammations presented the periodic ele 
 ment, and other phenomena appertaining to malarial fevers, during an 
 epidemic of the latter which prevailed at Auch (France) a few years 
 ago, a description of which was given by an able physician of the 
 place, M. Campardon. 6 Dr. Constant, who practises in one of the 
 marshy districts of the Department of the Lot in France, has seen 
 
 1 Works, ii. 231. 
 
 2 Davis, Scientific and Popular View of the Fever of Walcheren, 10-42. 
 
 3 Treatise, &c. in Collection of the Sydenham Soc. 73. 
 
 4 Medical Notes Connection of Certain Diseases, 64. Am. Ed. 
 
 5 Vol. iv. 101. 
 
 6 Bulletin de 1 Acad. de Med. viii. 634. 
 
444 PNEUMONIA AND 
 
 much of that form of disease, and draws attention to the signs which 
 distinguish it. The initial shivering is more intense and prolonged 
 than in ordinary pneumonia ; the local pain is felt early, and always 
 in front of the chest, although the congestion is localized posteriorly ; 
 it is more amenable to blisters than to leeches ; violent headache 
 comes on early, and is either frontal or sincipital ; there is often severe 
 lumbar pain, which observes the same stages of increase and de 
 crease as the headache ; the shivering is followed by intense heat, 
 which, after several hours, gives place to abundant sweating ; the 
 pulse, during the paroxysm, in place of being full, strong, and 
 vibrating, as in ordinary pneumonia, is rapid, soft, undulating, and 
 compressible; there is never any purulent expectoration, these 
 pneumonias never proceeding beyond the second stage, i. e. red 
 hepatization, the pulmonary engorgement being rather a sangui 
 neous congestion than inflammation; auscultation shows the rapid 
 passage from the first to the second stage ; for eight or twelve hours 
 will be sufficient for the passage from a circumscribed rale to the 
 hepatization of a whole side. The disease especially appears in 
 summer and autumn, while ordinary pneumonia prevails in spring 
 and winter. The blood from a vein is often below the normal tem 
 perature, very black, and deficient in plasticity. After rest, its 
 surface acquires a bluish colour, especially if the patient is taking 
 quinia. The clot is slow in forming, and soft. The buffy coat is 
 absent, or very thin, and inclines to a bluish colour. In the dis 
 trict where the form of pneumonia here described is seen, purely 
 inflammatory pneumonia is observed during winter ; but, in propor 
 tion to the high temperature and the production of malarial emana 
 tion, this inflammatory element is replaced by the paludal one. 1 
 
 In the foregoing instances we certainly have pulmonary inflam 
 mation ; but the form which the disease assumes differs somewhat 
 from that we see elsewhere. It is peculiar in its type, in the greater 
 length and distinctness of its remissions, and in the gastric and bilious 
 symptoms by which it is accompanied; as well as in the condition 
 of the blood, pulse, skin, and expectoration. Everything, indeed, 
 affords proof of the existence of a periodic or malarial element. 
 
 1 British and For. Med.-Chir. Rev. xii. 552, from the Bulletin de Therapeutique, 
 xliii. 481-491. 
 
 The same complication is noticed on a large scale, both as regards pneumonia and 
 pleurisy, in Rio Janeiro and other parts of Brazil, where, as we learn from Sigaud, who 
 mentions the fact, the periodic or malarial element associates itself to all diseases. 
 See his excellent work on the climate and diseases of that country, pp. 301-304. 
 
AUTUMNAL FEVERS. 445 
 
 Though sometimes encountered in ordinary fever seasons, and in 
 most places subject to malarial fevers, and though more particu 
 larly rife in times of violent and wide-spreading epidemics, and in 
 very sickly localities ; this complication of inflammation of the lungs 
 with miasmatic fever is not unfrequently found to occur under 
 circumstances of a different kind ; for, by virtue of the power of 
 latency possessed by these, the system remains predisposed to 
 them ; and the same exciting cause which occasions an attack of 
 pneumonia, long after or in a healthy season, calls into activity 
 the malarial poison, and the result is the compound disease under 
 consideration. This condition of things has been observed in all 
 miasmatic countries, and nowhere more strikingly than in our own. 
 By more than one of our southern physicians who have not adopted 
 the views at present under examination, we shall be told, that, as 
 many carry the predisposition to miasmatic diseases throughout the 
 autumn without having fever excited, so some continue to retain 
 it in the winter, and on some sudden exposure to cold, which often 
 produces it in the autumn, fever is excited in those who continue 
 in that state; or if the approach of cold weather be sudden and ex 
 cessive, before the predisposition is done away, and proper provi 
 sion made against the weather, the number affected is greater. In 
 the winter following those seasons in which miasmata abound, the 
 number of persons remaining predisposed, and the predisposition 
 itself, are greater. Sudden cold, then, produces many cases of com 
 bined symptoms of summer and winter disease. 1 
 
 But neither in these instances, numerous and interesting as they 
 doubtless are, nor in those cases of remittent or intermittent perito 
 nitis, rheumatism, ophthalmia, apoplexy, hemiplegia, convulsions, 
 meningitis, lunacy, of which we read in the writings of Torti, 
 Morton, Morgagni, Elliotson, Macculloch, Mongellaz, Gouraud, 
 Lay cock, Boling, 2 and examples of some of which I have myself 
 not seldom observed in this country and Europe, can we dis 
 cover any good reason for creating a new class of diseases, distinct 
 from the ordinary inflammation, congestion, or irritation of the 
 parts affected, both as regard cause and nature. Still less are 
 we justified in admitting the identity of the two diseases repre 
 sented in the compound of phenomena noticed, or that the one 
 
 1 Cooke, Med. Recorder, vii. 460. 
 
 2 See also Med.-Chir. Trans, iii. 348; Med. Gaz. iv. 116; Med.-CMr. Rev. xiv. 514; 
 London Lancet, i. 425. 
 
446 PNEUMONIA AND 
 
 is a modification, or really and substantially nothing more than a 
 peculiar form of the other. To me, as also to some of the writers 
 just referred to, and to many more I might cite, all these cases fur 
 nish illustrations of the complication or coexistence of two distinct 
 complaints, produced by distinct causes, having distinct seats and 
 characters, and being governed by different laws, but which often 
 modify each other to a greater or less extent. 
 
 Similar views were long entertained by high professional authori 
 ties. In an excellent essay on the " relation existing between epi 
 demic and other diseases prevailing at the same time and place, 
 and denominated intercurrent," 1 Kaymond, among others, in refer 
 ence to facts he had observed during a long series of years, dwelled 
 at some length on the complication of pneumonia with the epidemic 
 or stationary constitution of the atmosphere existing at the time the 
 disease happens to show itself, and remarked : " Those kinds of 
 thoracic inflammations have constantly assumed the types of the 
 epidemic constitution during the existence of which they appeared. 
 They have engrafted themselves on the epidemic or constitution of 
 the year, and presented the same symptoms and the same functional 
 lesions, in addition to the affection of the respiratory organs which 
 characterizes them in a special manner. Apart from the expectora 
 tion, which appertains to them, their march, their critical movements, 
 and their mode of termination, were the same. Inflammation of 
 the lungs is, therefore, composed of, or complicated with, the sta 
 tionary modes or symptoms of the constitution or epidemic of the 
 year, and of the transient and intercurrent constitutions of the period 
 and of the seasons from which they arise." If, he continues, inter 
 current diseases are founded on constitutional fevers, in their turn 
 intermittent fevers are often complicated with the elements by which 
 the former are characterized. 
 
 "While the Walcheren fever which pursued the British troops to 
 England, or attacked them after their return home, was the off 
 spring of a morbid agent which had impressed the system in a 
 distant land; the pneumonia with which, as we have seen it was 
 often combined, was the effect of a cause appertaining to the place 
 where the complaint showed itself. The combination thus pro 
 duced must consequently be regarded as the result of the action of 
 two seperate sets of causes, and hence as a compound of two inde- 
 
 1 Mem. de la Soc. Roy. de Med. iv. 72, 73. 
 
AUTUMNAL FEVERS. 447 
 
 pendent diseases. Dr. Davis, who calls attention to the occurrence 
 in question, evidently takes this view of the subject. After remark 
 ing, that all the important consequences entailed by protracted 
 intermittent, comprehended enlargement of the liver and spleen, 
 wasting of the omentum, inflammation of the peritoneal cavity of 
 viscera, extensive adhesions of the abdominal viscera to each other, 
 scirrhosity of the pancreas, enlargement of the mesenteric glands, 
 chronic inflammation of the intestines, dropsy, jaundice, &c. he 
 adds : " The chief disorders combined with intermittent were pneu 
 monia and angina. I have known pneumonia to be repeatedly 
 combined with simple and double tertian paroxysms; and in Chap 
 man s Medical Commentaries, there is a corroboration of pulmonary 
 complaints assuming an intermittent type. Though it is a fact that 
 autumnal intermittents are apt to run into dysentery, and vernal 
 intermittents to attack the lungs, yet one of the most frequent com 
 binations of the protracted fever of "Walcheren was inflammation 
 of the lungs, an affection that became very frequent in November, 
 and that generally ended fatally." Section 8 of Dr. Davis s work 
 is headed, " Pneumonia as a combination with the primary disease." 
 He therein describes a peculiar form of the complaint, to which the 
 fever patients were particularly subject, and adds: "Pneumonia 
 never was symptomatic of the Walcheren remittent, as it sometimes 
 is of measles, catarrh, and phthisis pulmonalis ; but was combined 
 and interwoven in a particular manner with it, so as apparently to 
 constitute a part of the same disease." 1 
 
 The true nature of these cases did not escape the sagacity of our 
 great medical philosopher, Dr. Drake. " The lungs, it is well 
 known," as he remarks, " are liable to inflammation in this fever ; 
 and, instead of occurring late in the disease, like cerebritis, it gene 
 rally arises at an early period. Such inflammation may prove 
 fatal ; and then a post-mortem inspection will show the lesions result 
 ing from bronchitis or pleurisy, but more frequently still those of 
 pneumonia, such as sanguineous engorgements and hepatization. 
 But they cannot be regarded as constant, essential, or characteristic 
 of autumnal fever; for, first, a vast majority of cases, even those 
 which prove fatal, do not present a single symptom of pulmonary 
 inflammation; and, second, this inflammation, in most instances, is 
 the undoubted effect of sudden changes of weather in the latter part 
 
 1 Op. cit. 42, 149, 153. 
 
448 PNEUMONIA AND 
 
 of autumn, and must, therefore, be taken as the offspring of an 
 incidental cause, acting subsequently to that which produced the 
 fever." (824.) In another place, Dr. Drake states that the most 
 frequent of the complications occasioned by the influence of malarial 
 fevers is that presented by the pneumonias of the south, and also 
 of the lakes in the north (765). 
 
 Again, in speaking of the complications of intermittent with other 
 diseases, the same eminent writer farther says : " But the more fre 
 quent and formidable of these complications is that presented by the 
 pneumonias of the south, as also on the shores of the lakes in the 
 north, where numerous cases occur, which the profession too often 
 find unmanageable by any method of treatment they have been 
 able to devise." (i. 765.) In another place, he calls attention to the 
 fact that the subdiaphragmatic viscera, except the pancreas, are 
 subject to inflammation in remittent fever, and says : " Sometimes, 
 however, from idiosyncrasy, or the co-operating action of other 
 causes, inflammation in other parts occurs," " and, when the fever 
 makes its attack late in autumn, the combined action of vicissi 
 tudes of temperature, and that of the specific cause, developed at 
 an earlier period, may determine inflammation upon the lungs or 
 pleura." (740.) " The pneumonia biliosa," says Dr. Potter, " is a 
 compound affection, originating from a double remote cause." " It 
 is the immediate offspring of a low temperature, engendered upon 
 a miasmatic predisposition." (Op. cit.) 
 
 Dr. Eberle is decided in the opinion that this variety of pneu 
 monia, which occurs during cold and variable seasons, abounding 
 in sources of miasmatic exhalations, is the result of the combined 
 agency of koino-miasmata, and atmospheric vicissitudes. ( Op. cit. i. 
 284.) Other references to the same object, might be made, for there 
 is scarcely a writer of note among us, or elsewhere, who has viewed 
 suca cases in a different light ; but the above will suffice to show 
 the opinion entertained on the subject by high authorities. 
 
 The lungs become implicated in a number of diseases; in typhoid 
 and typhus fevers, the complication is of great frequency, and has 
 been long recognized as such, as the writings of Huxham 1 and others 
 will fully attest. This eminent physician informs us, that at Ply 
 mouth, in 1740 and 1745, abundance of people were seized with 
 shivering, then great heats, fever, and difficulty of breathing; impor- 
 
 1 Essay on Fever, 59-61 ; Obs. on Air and Epid. Dis. ii. 59. 
 
AUTUMNAL FEVERS. 449 
 
 tunate, laborious cough ; very acute darting pains of the breasts, sides, 
 and back ; frequent also in the head and temples. They had often 
 times a very quick, hard pulse, but concentrated, as it were. The 
 breath was very hot and offensive, and the matter they expectorated 
 was sometimes thin and crude; sometimes as yellow as saffron, but 
 more commonly a thin, gleety, bloody matter ; frequently very fetid, 
 and sometimes so acrid as to cause a great hoarseness and soreness 
 of the windpipe and throat, and sometimes excoriations of these 
 parts. The blood drawn from them was either of a darkish-livid 
 colour, covered over with a lead-coloured or greenish thin film, or 
 sometimes quite florid (particularly on the first bleeding), but of a 
 loose, soft consistence when cold. In others, the blood drawn was 
 covered over with a pretty thick tough coat, " not of a whitish-yel 
 low colour, as usual in common pleuritic or pleuro-peripneumonic 
 blood, but of a colour approaching to that of cornelian stone, or a 
 little more dilute than that of the common jelly of red currants." 
 The urine was commonly very high, and sometimes dark-coloured, 
 with a kind of lead-coloured sediment; it was generally rendered 
 in small quantities. Faint, uncertain, partial sweats often attended, 
 particularly about the face and head ; although many times, towards 
 the fatal period, they were very profuse and colliquative. Livid or 
 black spots frequently appeared about the state, and seldom or 
 never failed of being the certain harbingers of death. 
 
 Huxham remarks that, at the same time when this malignant 
 peripneumonia reigned at Plymouth and its neighbourhood, pleuri 
 sies, peripneumonias, and pleuro-peripneumonias were everywhere 
 epidemic, and generally of the true inflammatory kind, arising 
 from the cold, dry, northerly and easterly winds, which had for a 
 long time prevailed. " Now I must farther take notice," he con 
 tinues, " that contemporary with both these disorders, a contagious, 
 putrid, petechial fever was very rife in and about this town, espe 
 cially among the sailors and prisoners, and those that were very 
 conversant with them ; and it was chiefly among those sorts of per 
 sons that the malignant pulmonic fever raged, so that this seemed 
 to be a complication of the common inflammatory peripneumonia 
 with the contagious petechial fever ; the contagious effluvia acting 
 on the blood in the manner of acrimonious salts, and destroying its 
 crasis." Montault 1 found inflammation of the lungs in twelve cases 
 
 1 Mem. de 1 Acad de M6d. vii. 209. 
 
 29 
 
450 PNEUMONIA AND 
 
 out of forty-eight of typhus. Louis found it in somewhat more than 
 one-third of his cases. 1 Attention was called to the complication by 
 Sauvages, 2 by Fodere, 3 Choinel, 4 Bartlett, 5 Parr, 6 Low, 7 Hosack, 8 
 Wood, 9 and a hundred others. 
 
 In these cases, pneumonic symptoms are undoubtedly modified 
 to a greater or less extent by the febrile poison, and the disease is 
 not unfrequently wanting in the pathognomonic characters which 
 serve to distinguish it when it exists alone. But in most cases the 
 thoracic inflammation is easily distinguished, and is to all intents 
 and purposes a pneumonia like every other pneumonia, bat often, 
 though not always, partaking largely of the congestive rather than 
 of the purely inflammatory character; but whatsoever be its cha 
 racter, it is something superadded to the typhoid fever, and form 
 ing no essential part of it. In the disease which, since the days of 
 Sauvages, has very generally been denominated pneumonia ty- 
 phoides, we have sometimes a primitive or pure pneumonia, which, 
 as it progresses, assumes a low or typhoid character. It is then 
 constituted of common pneumonia and a typhoid or malignant state 
 of the system. But in other instances, the disease presents from 
 the outset distinct symptoms of both pneumonia and typhoid or 
 typhus fever. It is therefore a mere complication. Such was found 
 to be the case during the prevalence of the disease in various 
 parts of this country from 1807 to 1820. As remarked before, 
 typhoid or typhus fever extended widely and fatally. It was 
 attended occasionally, though not necessarily, with pneumonia; 
 sometimes with inflammation of other organs, and not of the lungs. 
 The latter, consequently, formed no essential part of the disease; 
 and when it occurred, was a mere complication. Our countryman, 
 Dr. Wood, has pointed this out in a most satisfactory manner. 10 
 Dr. Hosack also well understood the nature of the disease. " You 
 have," he says, " two opposite conditions of body to contend with 
 local inflammation on the one hand, and a typhus state of the whole 
 system on the other. The causes of the disease are no less compounded 
 than the disease itself. The local inflammatory affections are pro 
 bably occasioned by the sensible changes of the atmosphere, while 
 
 1 DC la Fievre Typhoide, i. 300. 2 Nosologia, i. 
 
 3 Med. L6g. v. 351. 4 Lee. dc Mcd. Clin. 
 
 5 On Fever, 111. 6 Die. Art. Pneumonia. 
 
 7 Med. Register, iv. 25. s Med. Register, iii. 449. 
 
 9 Practice, ii. 39. 10 Op. cit. ii. 37. 
 
AUTUMNAL FEVERS. 451 
 
 the typhoid character of the disease is derived from an epidemic 
 constitution of the air, the same which has given rise to the typhus 
 petechialis, or spotted fever, which prevailed for some time past in 
 our northern and eastern States, and which is doubtless the same 
 disease as that now prevailing in Albany, with the exception that 
 the present epidemic is complicated with the symptoms of local 
 inflammation of the chest, brain, throat, &c., the effect of the pre 
 sent cold season of the year." 1 
 
 The complication with relapsing fever was very common in Ire 
 land in 1847. 2 Like symptoms indicative of pneumonic inflammation 
 have often been observed in the plague, and pointed out by many 
 writers from the days of Biverius. 3 They occur in several eruptive 
 complaints, in dysentery, and even in anaemia. Why should it not 
 be so? Assuredly, if the lungs are susceptible of taking on morbid 
 action through the effect of certain causes, in persons previously 
 healthy, they cannot help being more likely to be so when the sys 
 tem is labouring under disease; and when all the organs and tis 
 sues, as well as the circulating fluids are, consequently, more alive 
 to the influence of morbific agents. Nor is it difficult to under 
 stand how the inflammation, by which they are attacked, can 
 awaken into activity a fever, the cause of which had lain dormant 
 in the system, and which, when developed, continues to prevail at 
 the same time with the disease already in existence, and modifies it 
 to a greater or less degree. 
 
 But these secondary attacks are mere complications; and it would 
 be just as reasonable to regard, in Ireland and France, for example, 
 where typhus and typhoid fevers are, as it were, endemic, all pneu 
 monias which, occur in individuals affected with those diseases, as 
 due to the causes of the latter, and as being in consequence really 
 and substantially nothing more than a peculiar form of them, as to 
 hold all pneumonias observed in paludal districts and during fever 
 seasons, and presenting some or many of the essential characters of 
 autumnal fevers, as the offspring of the paludal poison, or as a mere 
 form of that class of complaints. Inflammation of the lungs, there 
 fore, when it presents itself in cases characterized by symptoms of 
 periodic or autumnal fevers, is to be viewed in no other light than as 
 a complication, and not as part and parcel of the fever-in question. 
 
 1 Obs. on Peripn. Typhoides, now prevailing in several districts of the U. S. 1813, 
 Med. Regist. iii. 450. 
 
 2 Dublin J. viii. 334. 3 De Feb. Pestil. ii. 05. 
 
452 PNEUMONIA AND 
 
 Each disease may, and often does exist independently of the 
 other; but both may, and sometimes do coexist in the same 
 subject ; and while in such cases the febrile disease is due to its 
 specific poison, the pneumonia arises from the same cause that 
 would under any other circumstances have produced it. In 
 such instances of complication, each of the two diseases may be 
 simply modified by, or as it were tinged with, the other, i. e. 
 a violent pneumonia may present feeble symptoms of an en 
 demic fever; or, vice versa, to a severe attack of fever may be asso 
 ciated symptoms of slight pneumonic inflammation. In some cases 
 they start together. At other times the one precedes the other ; 
 the former acting by enhancing the susceptibility of the system to 
 the action of the cause producing the second; or calling into play 
 morbid conditions which before had lain dormant or latent in the 
 system. To this it may be added, that while in some instances the 
 pulmonary inflammation is subordinate to the fever, and, so long 
 as it has not reached beyond the first stage, disappears during the 
 apyrexia of the intermittent form, to recur again with the accession 
 of the fever ; and while it very greatly abates with the subsidence 
 of the hot stage or exacerbation in the remittent, as proved by the 
 general symptoms and physical signs, and follows, as it were, the 
 phases of its associate; in other and probably the larger number of 
 cases, the disease only abates to a greater or less extent, but does 
 not cease in the first-mentioned form, and does so but slightly in 
 the latter, thus showing its independent existence. Finally, in such 
 complications, it has not unfrequently happened, that the periodic 
 fever has been arrested, while the local inflammation has continued 
 to run its course, in the usual way, to recovery or death. 1 
 
 The complication of diseases more or less distinct in their nature, and 
 the modifying influence of epidemic over other complaints, are well known 
 to etiologists and patholo gists. The fact of malarial fevers engrafting 
 themselves on other complaints, and imparting to them the charac 
 ter of periodicity, is perfectly well known and generally admitted. 
 It is one of such frequent occurrence as to surprise no experienced 
 and observant physician, and illustrates while it confirms what has 
 just been said relative to the complication of pneumonia with 
 some or more of the phenomena of autumnal fevers. The latter, 
 
 1 Torti, 371, 476, 490, 405, 496; Hippocrates on Popular Med. Hist. vii. : Mcr- 
 gagui, Letters, 31-33. See also Bailly, Mongellaz, &c. 
 
AUTUMNAL FEVERS. 453 
 
 as well indeed as otlier epidemic and wide-spreading diseases, have 
 a tendency to impress their livery on every intercurrent complaint, 
 however dissimilar in character ; while they all, in their turn, 
 not unfrequently become modified by other diseases that assume the 
 epidemic garb and prevail in greater force. And I need scarcely 
 remark, that such an effect can only be explained on the principle 
 that such epidemic diseases, arising as they do from extensively 
 diffused and powerful causes, complicate to a greater or less extent, 
 and add a few or more symptoms to those appertaining to other 
 diseases, by which individuals exposed to their morbid influences 
 may be attacked. 
 
 The effect has been noticed from the earliest times, even from the 
 days of Thucydides, who remarks that the epidemic fever of Athens 
 obliged all other diseases to change their nature by assuming some 
 of its symptoms. " And none of the usual endemic maladies made 
 their attacks during its continuance ; or, if they did, soon terminated 
 in this." 1 It was pointed out in a particular manner by Sydenham, 
 Hodges, Huxham, Storck, Lepecque de la Cloture, by our own 
 Kush, and after him by other writers. See what takes place in 
 regard to smallpox. If, in certain seasons, according to Sydenham 
 and others, this disease prevails extensively, the fevers which ap 
 pear at the time assume an inflammatory character, come on like 
 the variola, have kindred phenomena less, however, the eruption 
 the same disposition to sweat, salivation, &c. Thus, in the epidemic 
 smallpox of 1667, 1668, 1669, the continued fever which prevailed 
 at the same time assumed the characters of that disease, and was 
 " not much unlike it, except in the eruption of the pustules, and 
 the symptoms thereon depending." There was pain over the pit 
 of the stomach ; chills, headache, heat, absence of thirst ; the same 
 appearance of the tongue and urine ; the same disposition to symp 
 tomatic and profuse sweat ; to petechi&3, when the antiphlogistic 
 treatment was not pursued ; the same tendency to salivation which 
 occurred in the fever when the inflammation was violent and ac 
 companied the other disease when of the confluent kind. So alike, 
 indeed, were the two diseases, in many of their phenomena, that 
 " with the exception only of those symptoms which were the neces 
 sary effects and consequences of the eruptions, it was, if not identi 
 cal, at least closely akin to the smallpox." " Finally," says S., " as 
 
 1 Bk. ii. chap. 51. Bloomfield s Tr. i. 413. 
 
454 PNEUMONIA AND 
 
 the fever was most rife at that particular time when the ravages of 
 the smallpox were greater in these parts than at any other time 
 within the limits of my own observation, there can be but little 
 doubt as to the identity of character between the two diseases." 
 " For this reason," says Sydenham, after recapitulating the whole, 
 " although no man dislikes the coining of new names more than 
 myself, I may, perhaps, be allowed to designate the present fever 
 as the variolous fever, from its likeness to the smallpox or variola." 
 The practical indications were manifestly the same in both diseases, 
 those excepted which the eruption of the smallpox and the symp 
 toms thence arising afforded, and which could not be expected in 
 this fever, because it was not attended with an eruption. The disease, 
 though it affected fewer persons by far than the smallpox, never 
 theless lasted as long; but in the winter, when that abated, this pre 
 vailed ; and when the smallpox returned again in the spring, the 
 fever went off, so as thus to leave the smallpox the predominant 
 epidemic of the constitution of that period. The fever, notwith 
 standing, never manifestly ceased during this space, till at length 
 it totally disappeared, together with the smallpox, in August, 1669. 
 Notwithstanding these points of similarity, the fever could not be 
 regarded as cases of smallpox without eruption ; for, as Sydenham 
 remarks, they occurred indiscriminately in all classes, though 
 principally among adults, the greater number of whom had, in all 
 probability, passed through the disease. 
 
 It may be useful to mention that, while this fever still survived, 
 a diarrhoea, unaccompanied by any manifest febrile symptoms, was 
 prevalent. It was worse in 1668. Sydenham says that at that 
 time the constitution was tending towards the dysenteric, which 
 was the character of the next coming years. He considered this to 
 be the same fever with the variolous fever then rife, although it 
 took another form, arid exhibited itself with a fresh symptom. It 
 was observed by him that chills and rigors preceded the diarrhoea. 
 He also thought it evident that the diarrhoea itself depended on 
 the same origin with the fever. Hence, he maintained that this 
 fever arose from the inflammatory rays turned inwards towards 
 the intestines, and so provoking them to repulsion. The blood in 
 the meanwhile was freed by this division from those disorders 
 which otherwise would have been caused by such rays. Besides 
 this, the patient could not bear the pit of the stomach to be touched 
 by the hand a symptom common to both the fever and the small- 
 
AUTUMNAL FEVERS. 455 
 
 pox of tliis constitution. All this made it as clear to him as the 
 light of day, that .the diarrhoea was of the same nature and essence 
 with the dominant fever; and this opinion was, he thought, con 
 firmed by the effect of venesection, and the cooling medicine, regi 
 men, and diet, which he found so advantageous in the fever. They 
 cured the diarrhoea as well ; whilst, if treated upon a different prin 
 ciple, it changed its character from a mild disease to a deadly one. 1 
 
 The writings of Iluxham contain accounts of several instances 
 of similar complications. In 1729, in the month of July, the small 
 pox prevailed much at Plymouth; and, during this month, a slow 
 putrid fever, which remitted towards the end, and at length inter 
 mitted, became very epidemic there. It chiefly affected the head, 
 stomach, and loins, as if the smallpox was coming on, and was at 
 tended with an oppression at the breast, sighing, and great languor. 
 Perhaps it was such a kind of disorder that Sydenham called febris 
 variolosa. Children, young people, women, and the more infirm, 
 were more especially attacked with it. The blood drawn from them 
 was seldom viscid; the urine commonly thin, crude, with an ash- 
 coloured, mucous, and imperfect sediment, as if made up of wheaten 
 bran. The more perfect the sediment, the more hope. The tongue 
 was not very dry, but daubed over with a glutinous brown mucus. 
 Near the end of the disease a diarrhoea, and sometimes a bloody 
 dysentery, was greatly urgent. These were fatal to some. But a 
 kind of red petechias, red miliary, itching pustules, or large sweats, 
 breaking forth, most commonly quite carried off the fever. 2 Some 
 thing of the same kind occurred in 1740 ; the fever was modified 
 by the smallpox. In 1745 arid 1746 the contrary took place. The 
 smallpox was modified by the typhus with which it was complicated. 3 
 
 Diemerbroeck informs us that, during the prevalence of the plague 
 in Nimeguen in 1635 and 1636, all the intercurrent diseases which 
 showed themselves, assumed, before the close of twenty -four hours, 
 the characters of the reigning epidemic; and during a whole year, 
 he continues, vix ullus morbus peste incomitatus visus fuerit. 4 Senner- 
 tus observed, during the great plagues of 1616 and 1626, that nearly 
 all other diseases disappeared ; and whenever any of them appeared 
 and lasted a few days, it was sure to become complicated with the 
 
 1 Vol. 5. 151, 152, 157, 158, and edit, of Sydenham Society. 
 
 2 Observations on the Air, and Epidemic Diseases, i. 39, 40. 
 
 3 Id. ii. 60, &c. 190, &c. Huxham on Fever, 3d edit. 131, &c. 
 
 4 Tractatus, De Peste, 13. 
 
456 PNEUMONIA AND 
 
 prevailing fever. " The plague," says Pugnet, " reigns alone. In 
 saying this, I do not wish to convey the idea that, when in all its 
 vigour, it puts a bar to the development of all other diseases, but 
 that it stamps its characteristic features on those that show them 
 selves ; assuming, itself, the forms imparted to it by the tempera 
 ment of the individual attacked." 1 
 
 A more recent and an excellent authority, who has often seen and 
 studied the disease in Constantinople, remarks, that when the sickly 
 season arrives, and the plague breaks out, it encounters, besides chro 
 nic diseases, those appertaining to the season, as well the sporadic as 
 the endemic and epidemic. " If the plague is mild, the intercurrent 
 complaints, and also those existing at the time, are uninfluenced in 
 their progress. Sometimes, however, the regularity of their symp 
 toms is disturbed, and we notice a concealed plague, or a painless 
 exanthema. If the plague is malignant, its deleterious influence 
 complicates a large number of the reigning or intercurrent diseases, 
 arrests the course or changes the character of their symptoms, in 
 order to substitute its own. It dries up blistered surfaces, issues, 
 and setons ; alters the character of the pus issuing therefrom, 
 causes abortion, &c. If the epidemic is violent, acute and chronic 
 intercurrent diseases almost invariably experience its influence, and 
 the mortality among those affected is very large. In seeing the 
 plague ingraft its symptoms on those of the larger number of pre 
 vailing diseases, the public fancy that, before showing itself with 
 its legitimate characters, the former was concealed under the form 
 of those various diseases, and was the sole cause of them. The 
 complaint is pronounced to be proteiform, and people are no longer 
 astonished at the errors of the physicians ; while, in truth, the effect 
 is only due to a deleterious influence added to the pre-existing dis 
 eases, and affecting the systems or apparatus of the economy with 
 a force proportioned to the amount of their irritability. 2 
 
 In speaking of the plague of London, Dr. Hodges remarks, that 
 " at the rise of the plague all other distempers went into it ; but 
 that at its declension, it degenerated into others ; as inflammations, 
 headache, quinsies, dysenteries, smallpox, measles, fevers, and hec 
 tics, wherein the plague yet predominated." 3 Sydenham, whose 
 observations extended over a period of sixteen years, including the 
 
 1 Fievres de mauvais caractere, 185. See also Rapport de 1 Acad. 52, 53, G2. 
 
 2 Braver, Neuf Annees a Constantinople, ii. 289, 290. 
 
 3 Loimologia, 26. 
 
AUTUMNAL FEVERS. 457 
 
 time immediately preceding and following the great plague of Lon 
 don, calls attention to the fact that a remarkable change took place 
 in the character of fevers and other complaints, approximating the 
 general type of disease, in several striking features, to the distin 
 guishing characteristics of the pestilence at hand, some months 
 before that dreadful malady assumed its distinct and proper shape, 
 which it did at last quite suddenly. He remarks that the disease 
 which precedes the plague changes its character, and is accompanied 
 with a multitude of anomalous accidents. " It is like a monarch 
 with a body-guard of foreigners." Such deaths from plague as 
 sporadically occur during the few years following those of the 
 great plague, and which gradually decrease and finally vanish alto 
 gether, are to be attributed to a partial persistence of the pestiferous 
 disposition of the atmosphere, which has not yet undergone its full 
 change from foul to healthy. Deaths, in years like these, are only 
 the gleanings of the harvest that has gone before ; and it is from 
 traces of former infection that the fevers of the first year or two 
 after great plagues take a pestilential character ; of true plague, 
 indeed, they want some of the characteristics. Notwithstanding 
 this, they resemble it exceedingly in character and disposition, and, 
 as shown below, demand a similar line of treatment." (i. 99.) Again, 
 in speaking of the epidemic coughs of the year 1675, he says: 
 "And here I must again remark that, in the treatment of fevers, 
 the physician who does not keep continually before his eyes the 
 constitution of the year, the extent to which it favours the epidemic 
 production of this or that disease, and the power it has of twisting 
 to its own proper shape and likeness all the other concurrent dis 
 orders of the time, wanders widely in a maze without a clew." (i. 230.) 
 Dr. Rush, in his account of the Scarlatina Anginosa, which pre 
 vailed in Philadelphia in 1783 and 1784, says: "Intermittent fever, 
 which made its appearance in August, was not lost during the 
 month of September. It continued to prevail, but with several 
 peculiar symptoms. In many persons it was accompanied by an 
 eruption on the skin, and swelling of the hands and feet. In some, 
 it was attended with sore throat, and pains behind the ears. Indeed, 
 such was the predominance of the scarlatina anginosa, that many 
 hundred people complained of sore throats, without any other 
 symptom of indisposition. The slightest occasional or exciting 
 cause, particularly cold, seldom failed of producing the disease," 1 
 
 1 Vol. ii. 245. 
 
458 PNEUMONIA AND 
 
 Dr. Southgood Smith has remarked that, during the six months 
 immediately preceding the appearance of cholera in England, the 
 character of fever in London so entirely changed, that typhus, 
 which for a long series of years had been essentially an inflam 
 matory disease, became a disease of debility, so closely resembling 
 cholera, that the fever into which cholera patients commonly fell, 
 could not be distinguished from the primary fever found in the 
 wards of the fever hospital when cholera was at its height, which 
 had appeared there for the first time six months previously, but 
 which has never disappeared since. 1 So also in all our yellow 
 fever epidemics, every intercurrent disease assumed to a greater or 
 less extent the character, and presented some of the phenomena, of 
 the reigning complaint. 2 
 
 The same absorbing power the same influencing agency, is as 
 cribed by Desportes to the yellow fever of St. Domingo. Speaking 
 of the epidemic which prevailed in the City of the Cape, in 1733, 
 he informs us that the violence of the disease was such that it 
 lulled all other diseases, and reigned alone. " This is the character 
 of all contagious and pestilential diseases. Sydenham, and before 
 him Diemerbroeck, had remarked it of the plague." 3 
 
 Dr. Chisholm makes a similar remark in relation to the epidemic 
 fever which prevailed so extensively at St. George, Grenada, in the 
 year 1793. Most other diseases, he says, degenerated into or par 
 took very much of the nature of this. Dysenteries suddenly stop 
 ped, and were immediately succeeded by the symptoms of the pes 
 tilential fever. Catarrhal complaints, simple at first, soon changed 
 their nature ; convalescents from other diseases were very subject 
 to this, but it generally proved mild. Those labouring at the time 
 under chronic complaints, particularly rheumatism and hepatitis, 
 were also very subject to it. The puerperal fever became malig 
 nant, and of course fatal ; and even among pregnant negro women, 
 who otherwise might have had it in the usual mild degree peculiar 
 to that description of people, were reduced to a very dangerous 
 situation by it. In short, every disease, in which the patient was 
 exposed to infection, sooner or later assumed the appearance, and 
 acquired the danger, of the pestilential fever. 4 
 
 Dr. James Clark states that, in 1793, children, adults, and old 
 
 1 General Board of Health s Report on Quarantine, 13. 
 
 2 Rush, iii. 76, 79. 3 Maladies tie St. Domingue, 40, 41. 
 4 Op. cii. i. 180-182. 
 
AUTUMNAL FEVERS. 459 
 
 people labouring under smallpox, were attacked with the yellow 
 fever about the time the secondary fever generally came on, whether 
 the disease assumed the confluent or simple form. 1 Dr. Eush re 
 marks that the bilious remittent, or break-bone fever, which pre 
 vailed in Philadelphia in 1780, chased away every other febrile 
 disease, or blended itself with the intercurrent diseases. 2 In his 
 account of the measles of 1801, the same eminent physician states 
 that the disease wore the livery of the autumnal fever in the fol 
 lowing particulars : " It was strongly marked by remissions and 
 intermissions; the exacerbations came chiefly at night; there 
 was in many cases a constant nausea and discharge of bile by 
 puking." 3 
 
 Dr. Balfour tells us that the intestinal remitting fever of Bengal, 
 of which he has left us a graphic account, often appeared with 
 symptoms of dysentery, rheumatism, and pleurisy. 4 In 1777, Clos- 
 sot observed yellow fever associated with putrid typhus, and the 
 union of two poisons in this way was noticed by Pringle and others 
 in Europe, in the case of typhus and marsh fevers. The fever of 
 Banker Street, New York, in 1820, was evidently a complication 
 of bilious remittent and typhus the idio koino miasmal fever of 
 Dr. J. M. Smith. 5 
 
 In the epidemic of Naples, in 1764, it was rare, as we learn from 
 Sarcone, for other diseases, originating from causes different from 
 those of the epidemic which scourged the city, not to pass finally 
 into the latter. 6 Loew remarks that, during the petechial fever 
 which prevailed in Presburg, in 1683, gout, colic, and sporadic dis 
 eases generally were often confounded or blended with the popular 
 or epidemic fever. 7 
 
 Dr. Blake, in his account of the climate and diseases of California, 
 remarks that, although the influence of malaria does not show itself 
 in the Sacramento Valley, " by producing any of the more marked 
 forms of disease by which its presence is usually manifested, yet 
 we have constant indications of its existence, by the character it 
 impresses on almost every form of disease occurring in this lo 
 cality." 8 The yellow fever which prevailed epidemically at Tam- 
 
 1 Fever of Dominica, 19. a Vol. ii. 235, iii. 77. 
 
 3 Vol. iii. 73. 
 
 4 A Collection of Treatises on the Effects of Sol-lunar Influence in Fevers, 124, 125. 
 
 5 On Epidemics, 57. 6 Maladies cle Naples, ii. 59. 
 7 Epid. de Morbo Petechiali, 5. 8 N. 0. Journ. is. 510, 511. 
 
460 PNEUMONIA AND 
 
 pico, in 1836, exercised a marked influence on all the intercurrent 
 diseases which, in consequence, presented themselves, clothed with 
 some of the symptoms of the reigning fever. 1 Experience, indeed, 
 everywhere shows that remittent, intermittent, and yellow fevers 
 are sometimes engrafted upon or blended with smallpox, scarla 
 tina, measles, dysentery, erysipelas, syphilis, scabies, hooping-cough, 
 oriental plague, cholera, gonorrhoea, &c. 
 
 Dr. ISTepple, in his description of an epidemic of periodic fever 
 which prevailed in the Canton of Dombes, in France, in 1823, states 
 that almost every febrile disease was then attended with periodical 
 paroxysms, which subsequently degenerated into true intermittent 
 attacks. Bronchitis, which was very common, and of a highly 
 acute character during the winter, became complicated with nervous 
 irritations, spasmodic dyspncea of a more or less intermittent type, 
 and with remittent paroxysms. Intermittent neuralgias were more 
 than usually common. In a word, every disease appeared to have 
 assumed a nervous and periodic character. 2 
 
 The same phenomenon was observed at Auch some years later, 
 where, independently of intermittent pernicious fevers which pre 
 vailed extensively, periodicity entered as an element in, or as a 
 complication of the greater number of the intercurrent diseases, 
 even in those which presented the inflammatory character, and in 
 which physicians were more than once obliged to employ at the 
 same time the lancet and the sulphate of quinia. 3 
 
 The sweating fever prevailed epidemically in the Department of 
 Dordogne, in France, during the greater part of the year 1841, 
 affecting 10,803 individuals in a population of 83,342, and causing 
 a mortality of 797, or 1 in about 5.5 of the sick. For two years 
 previous, the Department (especially that part of it embracing the 
 Cantons of Nantron, Kiberac, and Perigueux), was overrun with 
 eruptive fevers measles, scarlatina, smallpox, and varioloid. Gene 
 rally, one or two of these occupied the ground three or four weeks, 
 and then made way for the others. In several instances, measles 
 and scarlatina, or smallpox and varioloid, marched together ; while 
 in some, all four existed at the same time. Under these circum 
 stances, the sweating fever made its appearance. In the course of 
 
 1 Goupilleau, Kept, by Chervin, Bulletin de 1 Acad. in. 308. 
 
 2 Tr. des Fievres Interm. 137. 
 
 3 Campnrdon, Apei^u sur les Maladies qui out regne epidemiquement a Auch, Bul 
 letin de 1 Acad. viii. Go4. 
 
AUTUMNAL FEVERS. 461 
 
 the year from the 7th of May to November the disease broke 
 out five times in as many different places, and disappeared; so that 
 the epidemic, considered in its ensemble, appeared, as it were, in five 
 instalments. On four of these occasions it assumed suddenly its 
 legitimate garb, and immediately drove away all other diseases. 
 
 On the fifth, however, things took a different turn. All at once, 
 after a thunderstorm, on the 7th of May, and the days following, a 
 disease heretofore unknown broke out. It was very different in its 
 nature and results from the measles, which then prevailed; but yet 
 difficult at first to recognize, owing to its being under the depend 
 ence of the complaint it so singularly and suddenly came to replace. 
 The disease no longer presented exactly the same train of pheno 
 mena, the same kind of pulse, or eruption. Nevertheless, there was 
 in that new physiognomy of symptoms a family air which greatly 
 puzzled the physicians. The measles were modified. To the pre 
 cursory febrile symptoms were added others which are strangers to 
 the disease : while others which belong to it disappeared unexpect 
 edly. Some days before, the patients had been seized with a chill, 
 cough, coryza, and all the opening symptoms of measles. In some 
 cases, one of these symptoms now gave way ; in others, a different 
 one disappeared; in all, the attack henceforward came on without 
 the chill. Some, however, had a marked and well-defined rubeolic 
 eruption ; while in others the skin became covered with a miliary 
 eruption. 1 To this interesting fact may be added another, somewhat 
 akin to it, derived from high authority; that Storck and Lepecque 
 de la Cloture mention epidemics of miliary fever, during which the 
 pneumonias which prevailed terminated, not by expectoration, but 
 by miliary eruptions, more or less abundant, or by fetid sweats. 
 
 Diseases arising from various species of malaria mix together and 
 form compounds. Furthermore, diseases arising from the opera 
 tion of malarial effluvia, but having a separate and independ 
 ent existence, marked by distinct characters, and governed by 
 different laws, combine with each other and present groups of 
 phenomena which, though they have given rise to considerable 
 discussion and been subjects of angry controversy, must be viewed 
 as the effect of such complications, and not as mere modifications 
 of one and the same disease. The amalgamation of typhus with 
 
 1 Parrot, Histoire de la Suette Miliaire. Mem. de FAcad. de Med. x. 395, 396. 
 
462 PNEUMONIA AND 
 
 intermittent fevers, diseases which, differ materially on many points, 
 "but approximate on others, has been noticed in some of our 
 Southern States, the cases exhibiting clearly the symptoms of 
 the former disease; while, at the same time, the type was periodic. 1 
 Dr. Stoker, speaking of a number of cases of ague he treated in 
 Dublin, some years ago, says that, "though the periodical revolu 
 tions which characterize agues were observable in these cases, still } 
 they were more or less under the debilitating influence of the 
 same epidemic constitution, and also of the same moral and phy 
 sical causes which hitherto prevailed, and even at the same time 
 impressed some cases of fever with the characteristics of typhus in 
 an exquisite degree." 2 A like combination of true malignant yel 
 low fever with simple or double tertians, or other varieties of peri 
 odic or autumnal fevers of various types, the. existence of which 
 was recognized and pointed out upwards of a century ago by Pouppe 
 Desportes, 3 has been dwelled upon with more or less emphasis by 
 scores of our contemporaries, and of writers of the preceding 
 generation. 4 Its occurrence, the assertion of a few physicians to 
 the contrary notwithstanding, is indisputable, and may be cited as 
 a satisfactory illustration of the compounds in question ; while the 
 circumstance of its being overlooked or undiscovered may be viewed 
 as one of the principal causes of the error committed by those pa- 
 thologists who regard the former disease merely as a higher grade 
 of the latter. 
 
 During the epidemic of yellow fever at Tampico in 1836, already 
 referred to, intermittents, in particular, assumed this complicated 
 form ; for, during the continuance of the epidemic, they almost in 
 variably presented, in addition to their legitimate symptoms, one 
 or more of those appertaining to the yellow fever. 
 
 The yellow fever which closed its epidemic career in Charleston, 
 a year ago, was accompanied by and blended with the breakbone 
 
 1 Du Pre, on the Antagonism of Disease. Charleston Journ. v. COT, 608. 
 
 2 Pathological Observations, pt. ii. 103. 
 
 3 Maladies de St. Domingue, i. 230. 
 
 4 Lempriere, ii. 70; Osgood, 27, 28; Imra} T , Edinb. Journ. Ixiv. 337; Rochoux, 
 197; Nott, New Orleans Journ. iv. 580; J. M. Smith, on Epidemics, 310; Kelly, 
 Amer. Journ. N. S. xiv. 376 ; Wood, Practice, i. 304 ; Chisholm, Letter to Dr. David 
 son, Med. Repos. v. 231, 232; Lewis, New Orleans Journ. ii. 202, 413; Id. iv. 154; 
 Id. v. 40; Charleston Journ. ii. 696; Dickson, Essays, 152, 153; Id. Trans, of Med. 
 Assoc. v. 252; Barton s Rep. 30; Bryson, 70, 84, 1%, &c. : Blair, 70; Heberden, 
 385; Williams, i. 303, 302, 464, 625; Dcsruelle on Hooping-cough. 12: Ilalphen, 1, &c. 
 
AUTUMNAL FEVERS. 463 
 
 fever, or dengue, and well-marked eruptions of several varieties 
 pustular, papular, and exanthematic. The complication of dengue 
 with remittent and intermittent fevers has been noticed by Dr. 
 Arnold, of Savannah, 1 and by Professor Dickson, of Charleston. 2 
 The like blending of remittent with typhoid fever is pointed out 
 by Dr. Cain of the same city. 3 In a clever article on the Medical 
 Topography of the Parish of De Soto, La., Dr. Gibbs speaks of 
 cases of a mixed nature, which, u although affording all the usual 
 indications of typhoid fever, displayed likewise the so-called mala 
 rial characters ; as evinced by the distinct intermissions which at 
 tended for several days, the icterode appearance of the skin and 
 eyes, and the yellow coating of the tongue, with other symptoms 
 of bilious derangement." 4 
 
 In Blair County, of this State, typhoid fever prevailed exten 
 sively from the middle of January, 1852, to September. Sporadic 
 cases occurred in other months, but the disease only assumed an 
 epidemic character during the above-mentioned period. Dr. Coffey, 
 of Hollidaysburg, remarks, that the cases that happened in the 
 summer and fall, resembled strongly in their commencement remit 
 tent fever, and for which the inexperienced readily mistake them. 
 " Indeed," says the reporter, " the manifestations of this disease are 
 protean. It occasionally simulates intermittent fever." 5 Typhoid 
 fever is on the increase at Eio Janeiro, where, as we have seen, 
 malaria abounds; and we are told by Dr. Sigaud, that cases in 
 which the symptoms of the disease are combined with those of 
 periodic fever, are very commonly encountered. To such an extent, 
 indeed, does the complication prevail, that it at one time occasioned 
 the greatest confusion in the minds of many as regards the diagnosis 
 of the cases, and led to much hesitation respecting the proper treat 
 ment to be pursued. 6 Similar complications of typhoid with inter 
 mittent have been noticed in France. 
 
 M. Gauthier cle Claubry, in his Eeport on the Epidemics of France 
 during the year 1847, makes particular mention of the wide preva 
 lence of typhoid fever that year ; and states, as the result of observa 
 tions made in various parts of the country, that sometimes the disease 
 
 1 Charleston Journ. vi. 332. 2 Trans, of Med. Association, v. 145. 
 
 3 Ibid. 358. 
 
 4 Fenner s Southern Reports, ii. 196, 197 ; see also Charleston Journ. v. 824. 
 
 5 Trans, of Med. Soc. of State of Pennsylvania, iii. 75. 
 
 6 Sigaud, Climat et Maladies du Bresil, 252. 
 
PNEUMONIA AND 
 
 presented the phenomena of intermittence or rather of remittance. 
 This was often attributed to the influence of accidental causes, as 
 marshes, stagnant waters, with the more reason, indeed, because 
 this modification in the symptomatology of the typhoid affection 
 occurred only in individuals placed directly under the influence of 
 some of the above-mentioned causes, while the inhabitants of places 
 situate far from marshes and stagnant waters, presented only the 
 symptoms of ordinary adynamic or ataxic typhoid fever. 1 
 
 Euecker long ago recognized the complications of intermittent 
 with malignant or typhus (probably typhoid) fever. 2 Pringle, on 
 his side, regarded the morbus Hungaricus as a compound of bilious 
 with hospital fever; and those who attentively examine the accounts 
 we have of that disease, can scarcely refuse to admit that the 
 opinion has the appearance of being well founded. 3 Indeed, it may 
 be laid down as a fact of general occurrence, that when typhoid 
 fever breaks out in paludal localities, after intermittents have there 
 prevailed, the cases are frequently of a modified character, and 
 assume a periodic type. And surely he would scarcely be listened 
 to who maintained that all the diseases here enumerated, simply 
 because they present themselves clothed with some or many of the 
 symptoms of malarial fever, or impart some of their characteristics 
 to these, must, therefore, be due to the cause giving rise to the 
 latter, and are really and substantially nothing more than peculiar 
 forms of one and the same complaint. An intelligent writer of one 
 of our Southern States, after describing the several forms of fever 
 of his neighbourhood, remarks, very pertinently : " Here are four 
 varieties of acute disease, peculiar somewhat to certain terrestrial 
 formations. Can any one possessed of candour and ordinary rea 
 soning powers, examine into their history, and fail to see the strik 
 ing characteristic differences. The enslaved and overtasked mind 
 may reason, that, inasmuch as they are all fevers of the same season, 
 appearing, blending, and mingling together, and often running into 
 each other, specific distinctions cannot be made. To this kind of 
 argumentation, we may properly reply, that red, white, black, 
 green, are all colours. They may be so mingled and blended, run 
 ning into each other by imperceptible degrees, as to produce 
 various shades, and associate in the mind a most intimate and 
 
 1 Mem. de 1 Acad. de Med. XT. 12. Sec also vol. xviii. 107. 
 
 2 De Feb. Interm. Complicatione cum Maligna Casa, &c. 
 
 3 Diseases of the Army, 188. 
 
AUTUMNAL FEVERS. 465 
 
 inseparable connection ; yet, when they are displayed in their pri 
 mitive natural character, how boldly and prominently do they con 
 trast." 1 Each of the diseases mentioned exists at times, and, indeed, 
 generally, independently of the others; some are the offspring of 
 specific contagious poisons, and can in no way possible arise from 
 the operation of other causes producing different complaints ; others 
 are the offspring of non-contagious poisons; others, again, arise 
 from changes in the sensible qualities of the atmosphere. They 
 blend together in very many ways, in their types and characters, 
 under the conjoint influence of several concurrent causes ; and if, 
 in their simple and uncomplicated garb, they must be held as 
 idiopathic and independent disorders, they cannot cease to be so, 
 when, to their own characteristic phenomena, are added some or 
 more of those that appertain to malarial fevers. Now all this 
 applies equally well to those cases which form more particularly 
 the subject of our present inquiries ; for in the same way that mala 
 rious fevers are sometimes engrafted on typhus, plague, &c., so they 
 may be, and often are, engrafted on serous, mucous, and paren- 
 chymatous inflammations, and on that of the substance of the lungs 
 among the rest. To say that such an occurrence is not possible, 
 would be equivalent to maintaining, that a complication which 
 undeniably occurs in regard to many diseases, even to some pro 
 duced by specific and contagious poisons, cannot do so in reference 
 to thoracic inflammations. I leave to those who feel disposed to 
 hazard the assertion, the task of explaining the reason of this ex 
 ception. If they succeed, we shall be forced to doubt the possibility 
 of the coexistence of other morbid poisons in the same individual ; 
 for the evidence on which such coexistences rest is not a whit 
 stronger than that adduced in favour of the complication of pneu 
 monia with malarial fevers. 
 
 Diseases due to specific contagious poisons amalgamate together, or with 
 other complaints, and form hybrid complaints, or exist together in the 
 same subject. Disprove satisfactorily the complication under con 
 sideration, and it will follow, that when writers, whatever be the re 
 spect usually accorded to their opinions and statements, tell us of the 
 variolous poison being capable of coexisting with several other poi 
 sons of its influencing their actions and being reciprocally influ- 
 
 1 Lewis s Med. Hist, of Alabama, N. 0. Journ. iv. 165. 
 30 
 
466 PNEUMONIA AND 
 
 enced by them ; when they talk of smallpox existing in the same 
 subject with scarlatina, hooping-cough, measles, miliary fever, psora, 
 or syphilis; when they affirm that hooping-cough and measles, the 
 vaccine poison and syphilis, scarlatina and measles, or scarlatina and 
 hooping-cough occasionally combine together ; when they cite cases 
 in which typhus existed with erysipelas, scarlatina, vaccinia, psora, 
 syphilis, or gonorrhoea ; when they describe the plague as sometimes 
 existing in combination with smallpox, vaccinia, syphilis, or cholera 
 Asiaticus; or of dengue uniting with scarlatina influenza with the 
 latter disease or measles or syphilis with herpes or psora; when, 
 in addition, they inform us of three distinct diseases, as smallpox, 
 measles, and hooping-cough; or measles, scarlatina, and chicken- 
 pox, running their course simultaneously ; when we are told that 
 inoculation with a mixture of variolous and vaccine matters will 
 produce, not, as Woodville stated, one or other of the two dis 
 eases, but loth; when a case is cited on the authority of Leroux, 
 in which the vaccine pustule was, as it were, imbedded in the 
 variolous, and the matter of each, when used for inoculation, pro 
 duced its specific disease; when, I say, they talk of such occurrences, 
 we shall be justified in doubting the accuracy of their observations, 
 and in maintaining that, instead of assemblages of distinct diseases, 
 we have in all such instances really and substantially but one com 
 plaint, modified somewhat by peculiarities of season and weather, 
 or other causes, but still to all intents and purposes the same. 1 
 
 All these complications all this livery wearing all this amal 
 gamation of things distinct from each other, is now perhaps too 
 well known, and generally acknowledged, by those whose attention 
 has been drawn to the subject, and who are, in consequence, best 
 qualified to form an opinion upon it, to have required any length 
 ened remarks in this place, were it not that some writers among us 
 and elsewhere, who are not backward in severely criticizing and cast 
 ing ridicule on the views of physicians of high authority, and who 
 charitably undertake to set the whole professional world right on 
 
 1 See, on these various combinations, Nott, N. 0. Journ. March, 1848, p. 586; Dick- 
 son, Trans, of Mod. Assoc. v. 142, 143; Williams on Morbid Poisons, i. 40, 120, 211, 
 212, 204, 301, ii. 38, 65, 191, 206, 623; Holland, Connection of Diseases, 58, Am. ed. 
 64; Blair, 70; Heberden, 385; Fodere", Med. Legale, v. 352-357* Lafont-Gouzi, Mate- 
 riaux pour servir a 1 Hist. de la Medecine Militaire, &c. 47-83 ; Sarcone, Mai. de Naples, 
 ii. 225; Anglada, Traite de la Contagion, i. 331, 332, 334, 336; Adams on Morbid 
 Poisons, 11, 13; Bousquet, Traite de la Vaccine, 300; Bxtbertson, a General View of 
 the Nut. Hist, of the Atmosphere, ii. 370. 
 
AUTUMNAL FEVERS. 467 
 
 knotty points of pathology and etiology, appear to have lost sight, 
 or to be ignorant of the true explanations of the occurrences 
 alluded to. If they have forgotten, they must be reminded, and if 
 they do not know, they cannot fail to be benefited by the informa 
 tion, that the Hunterian maxim, which teaches that no two different 
 fevers can exist in the same constitution 1 a maxim from which Bar- 
 thez started, in establishing his doctrine of the distraction of forces, 2 
 and about which so much has been said is unfounded ; that though, 
 in most cases, one of those diseases acquires the supremacy over 
 the other, and either expels it or keeps it in check, in other in 
 stances, they progress simultaneously; that this takes place even 
 in relation to eruptive fevers, a fact denied by Hunter ; and that 
 the whole of what has been remarked in the preceding pages is 
 conformable to certain laws which should not be overlooked by 
 those who undertake to describe the true and fundamental cha 
 racters of diseases, and to assign to these their nosological position. 
 When they come to investigate the subject as it deserves to be in 
 vestigated, they will find that intercurrent, endemic, or even epi 
 demic diseases, are influenced not only by the meteoric constitution 
 of the period at which they appear, but that their characters, pheno 
 menal and anatomical, are constituted at the outset of those apper 
 taining to them, and also, to a greater or less extent, of those 
 transmitted by complaints arising from anterior medical constitu- 
 tutions or reigning causes ; and toward the close of their preva 
 lence, of those characterizing succeeding complaints. They will 
 find that such diseases seldom manifest themselves in their pure 
 and unmodified garb except towards the middle of their career of 
 prevalence, when the influence of anterior and succeeding constitu 
 tions or morbid causes is not felt ; that what takes place in the 
 same locality during different periods occurs at the same epochs in 
 different localities diseases which retain their purity of character 
 in particular places, losing it as they reach other places where dif 
 ferent morbid influences prevail ; and that much the same results 
 obtain in regard to diseases which attack individuals exposed to 
 other morbid influences elsewhere, or in the same place at other 
 seasons. 3 
 
 1 On the Blood, introd. 13. Am. ed. 
 
 2 Nouv. Elem. de la Sc. de I homme, ii. 181. 
 
 3 See on these subjects Boudin s Geographic Medicale, 22, and Fuster s very excel 
 lent work, Des maladies de la France dans leurs rapports avec les saisons, 193-199. 
 
468 PNEUMONIA AND 
 
 " This fact," as Dr. J. M. Smith observes, " was specially remarked, 
 by Sydenham and Hodges, of the disorders which preceded the 
 plague of London in 1665. Similar instances are recorded by Bel- 
 linus, 1 Yan Swieten, Bayley, 2 and, indeed, by most writers on 
 pestilential epidemics. Dr. Mead sums up these facts in the general 
 observation, that fevers of extraordinary malignity are the usual 
 forerunners of plagues, and the natural consequence of that state of 
 air which attends all plagues. Part 1, ch. I." 3 
 
 Pneumonia, like other inflammations, sometimes assumes a periodic 
 type, independently of a malarial influence. Most of the instances 
 mentioned are doubtless the effects of the complication or blending 
 of distinct diseases. But while admitting this to be the most proper 
 explanation of the amalgamation of the phenomena they present, we 
 must not lose sight of the circumstance that the inflammation of the 
 lungs, like other acute affections, has a tendency in some cases to 
 assume a remittent or intermittent type. That such a tendency may 
 be noticed in that disease is a fact which we might a priori con 
 clude ; for there are but few cases in which symptoms of febrile 
 reaction do not exhibit a diurnal abatement and aggravation more 
 or less marked, or do not present every second or third day a more 
 decided change of the same kind. As stated on a former occa 
 sion, the existence of a good and bad day is evidently recognizable 
 in most cases of pneumonia ; and I presume it may safely be averred 
 that a decided remission is only a considerable diminution, and an 
 intermission only a temporary cessation of the morbid condition 
 existing during the abatement referred to. These remarks are 
 equally applicable to other inflammations and irritations, where 
 soever they may be seated, and by whatsoever cause they may be 
 produced. This tendency to decided remissions and intermissions, 
 occurs more frequently during the prevalence of the cause of pe 
 riodical fevers, which modifies the morbid process, and imparts to 
 it the element of periodicity, without, however, being sufficiently 
 energetic in its impression, or meeting in the system with a suffi 
 cient degree of susceptibility, to produce a decided attack of fever, 
 or even to give rise to the development of some of the more marked 
 symptoms of the latter. But cases of the kind have occurred when, 
 
 Webster, ii. 44. 2 F ever O f jf ew Y ork, 1795. 
 
 Smith on Epidemic, 170, 171. 
 
AUTUMNAL FEVEES. 469 
 
 from the non-existence of periodic fevers in the vicinity, it was 
 impossible satisfactorily to refer the effect to the agency of the 
 admitted cause of such diseases, and under circumstances which 
 precluded the supposition of its arising from the development of a 
 morbid agent lying dormant in the system. 
 
 The manifestation of this tendency in pneumonia cannot, there 
 fore, lend support to the idea of identity, as regards causation and 
 nature, of that disease with malarial fevers, of which periodicity, 
 partial or complete, constitutes a characteristic element ; unless we 
 are prepared to assert that all diseases in which we notice perfect 
 or imperfect remissions whether observed in districts of country 
 subject to malarial complaints, or in places totally free from these 
 are the products of the same cause as remittent and intermittent 
 fevers, and consequently really and substantially nothing more 
 than peculiar forms of these. From this the strictest medical unit- 
 arian will doubtless shrink ; for he must have seen or if he has 
 not, others have cases afar from any malarial influence, in which 
 irritation produced by mechanical or kindred causes, has been 
 attended with, or followed by, febrile symptoms characterized by 
 decided remissions, or, indeed, intermissions. Every one knows 
 that the introduction of a bougie into the urethra has sometimes 
 produced that effect. Bartholin, Forestus, Pollini, Eoederer, Mon- 
 gellaz, and others, relate cases of intermittent diseases occasioned 
 by the irritation of intestinal worms. Frank relates, from Schmac, 
 a case of the same kind, resulting from swallowing a piece of lard. 
 Frank himself saw the same effect produced by mushrooms. A 
 case fell under my own observation, some years ago, in which six 
 febrile paroxysms were produced by the ingestion of a peach-stone. 
 In this instance there could have been no malarial taint. Dr. Evan- 
 son, in his work on the Diseases of Children, 1 mentions a case in 
 which febrile paroxysms of a remittent type, which lasted several 
 days, occurred in a child, from swallowing a marble. The symp 
 toms made their appearance soon after the occurrence, and were 
 suddenly cured by the expulsion of the irritating cause. The same 
 effect has resulted from the formation in the stomach of a cheesy 
 coagulum, and was cured by its expulsion. 2 Dr. Pascalis describes 
 intermittent paroxysms resulting from the irritation of decayed 
 teeth ; the elder Frank from a gumboil, &c. Other examples of 
 
 1 P. 243, Am. ed. 
 
 2 See Copland s Diet ii. 1120; Stewart, Dis. of Children, 127. 
 
470 PNEUMONIA AND 
 
 the same import might easily be adduced ; but the task is unneces 
 sary ; experience daily showing, that morbid irritations, by whatso 
 ever causes produced, and in whatsoever organic apparatus or system 
 of the economy situate, may, and often do assume the remittent and 
 intermittent types. These are observed in irritation , of the red 
 capillaries, inflammatory and hemorrhagic; in sub-inflammatory 
 and nervous irritations. Of all these, examples may be found in 
 works of easy access. In a word, there are facts enough afloat, to 
 prove that the element of periodicity does not belong exclusively 
 to febrile diseases of a malarial origin. 
 
 So far from it, the periodical is as much a natural type as the con 
 tinued. It characterizes many of the phenomena of health, and ex 
 hibits itself in the physiological play both as regards progress and 
 intensity of many of the functions ; in the processes of secretion, 
 elimination, and calorification ; in the operations of the nervous 
 system ; in muscular contraction ; in the action of the heart, &c. 
 Intermittence, indeed, may well be viewed as an element essential 
 to the existence of the normal actions of the economy. What is 
 more, it adheres to these actions in their passage from the state of 
 health to that of disease, and may, therefore, be recognized as an 
 element of this state also. It stands as an illustration of the great 
 law of periodicity which regulates all the vital movements. This 
 law has elicited, as we have seen, the attention of medical and phy 
 siological observers from an early period of our science, and has 
 not been neglected in modern times. An American writer, the late 
 Dr. Carpenter, of New Orleans, has, among others, pointed this 
 manifestation of intermittence in the functions, and after showing, 
 as Dr. Lay cock had done already, that the periodicity of these is 
 governed by a power or agency inherent in the system, and only in a 
 secondary manner dependent upon the physical influences which sur 
 round us, properly remarks: This principle once established, it be 
 comes an easy matter to account for the intermittence of disease, by 
 referring it to the persistent and controlling influence of these phy 
 siological oscillations, whose periods and intervals continue to mark 
 and measure its stages and paroxysms. The matter of surprise and 
 inquiry will then become, not why some diseases are intermittent 
 in their course, but rather, why it is, that all of them are not so ? u 
 
 1 New Orleans Med. Journ. iii. 423. See, on this subject, Bich.it, Anatomic Gene- 
 rale, Lois d lutermittence, i. ; Holland on Morbid Actions of Intermittent Kind, 
 Medical Notes, 193, Am. ed. ; Mongellaz, Essai sur les Irritations Intermittents, vol. 
 i. 3-5 ; X. A. Med. and Sura;. Journ. i. 327. 
 
AUTUMNAL FEVERS. 471 
 
 Surely, when we take all these facts and circumstances into consi 
 deration, we cannot but perceive the impropriety of concluding, 
 from the occurrence of remissions and even full intermissions in 
 pneumonia, that the disease must necessarily be the offspring of the 
 cause whkih gives rise to periodic fevers, and nothing more than a 
 peculiar form of the latter. 
 
 The success of the anti-periodic treatment in pneumonia supposing it 
 true no proof of the identity in question. For these reasons, I am not 
 prepared to admit that, in managing a case of pneumonic inflamma 
 tion, "we must not lose sight of the fact that we are dealing with 
 a constitutional disease with a periodic fever which is to be re 
 lieved by quinia, or to adduce, from the supposed beneficial effects 
 of that remedy in the disease in question, an argument in favour of 
 the identity contended for. This argument may be traced far back 
 in the history of our science, when every disease that was cured 
 by bark was supposed to partake of the nature of an intermittent 
 fever to be, in fact, only a periodic fever in disguise. The prac 
 tical advice above referred to can, at most, apply to some cases only, 
 and certainly not to all. In the large majority of instances of pneu 
 monia, as observed everywhere even in very many of those seen 
 in the South the physician will have no reason to bear in mind 
 what Dr. Merrill lays so much stress upon. The disease is in no 
 way connected with periodic fever. It is a constitutional affection 
 in this sense only, that the system at large becomes implicated in 
 the morbid disturbance by nervous and arterial reaction. In that 
 respect it is closely allied to all other complaints in which import 
 ant organs or tissues become, from some cause or other, the seat of 
 inflammation, and in which, unless the powers of life are crushed, 
 from the outset, and placed beyond the possibility of reaction, febrile 
 phenomena set in. Hence, the principal object in the treatment 
 will be, not to cure the constitutional disease, but the local inflam 
 mation and its various complications ; because, on the disappear 
 ance of these, the case will come to an end. Supposing, now, that 
 some cases get well under the use of quinia, the result could not 
 prove the connection suggested. Before adducing that success for 
 the purpose in question, it would be necessary, first, to demonstrate 
 beyond doubt the reality of the benefit to be derived from the 
 remedy, or rather of the superiority of the method proposed, if not 
 .the indispensable necessity of resorting to it ; and secondly, to show 
 
472 PNEUMONIA AND 
 
 how, admitting the results to be as advantageous and marvellous 
 as the warmest advocates of the method represent them to be, they 
 can in any way serve to prove the dependence of thoracic inflam 
 mation upon ordinary periodic fever. 
 
 Now, as to the former of these points the great benefit or supe 
 riority claimed for the quinia practice, when resorted to during 
 the abatement of febrile excitement in pneumonia I cannot greatly 
 err, when expressing the opinion that many, very many practitioners, 
 in all parts of the world, who have seen much of the disease, and 
 acquired the needful skill in its management, will feel no disposi 
 tion to join in singing the praise of that method, or to adopt it to 
 the exclusion of the one they have heretofore employed. They 
 will say, and I suspect that statistical returns will bear them out in 
 the assertion, that while autumnal fevers, especially when they 
 assume the truly periodic type, call, in some of their stages, for the 
 use of anti-periodics, and more particularly of quinia, it is very 
 far from being proved that the same will hold good with regard 
 to pneumonia and kindred thoracic inflammations, which are, to say 
 the least, cured just as well without as with the aid of the salts of 
 bark; that in their usual form they yield to antiphlogistics, gene 
 ral and topical, and to revulsives, or even, in some instances, to the 
 powers of nature; that, in the majority of cases, the quinia prac 
 tice would be not only useless but hazardous, and should on this 
 account be avoided ; that, as a general rule, the remedy, if used at 
 all, can only be so after other means of a different or opposite kind 
 have been resorted to ; and that, when these have been properly 
 timed and judiciously employed, the disease seldom requires the 
 aid of tonics, still less of those possessing an anti-periodic power. 
 They will say, besides, that when tonics are called for, it is not in 
 virtue of their anti-periodic effects; that as much advantage, if not 
 more, is derived from other articles of the materia medica; and 
 that, when the disease assumes the typhoid form, it may be more 
 successfully treated by local depletions and revulsives, or by the 
 latter without the former, together with stimulating diaphoretics and 
 expectorants, and sometimes with stimulants and tonics. Finally, 
 they will say that, when the latter are required or admissible, quinia 
 will often answer a good purpose ; but that it is doubtful whether 
 it will bo more serviceable than other articles of the materia 
 medica. In all this, the majority of professional men throughout 
 this country and in Europe will, I have little doubt, acquiesce. 
 
AUTUMNAL FEVERS. 473 
 
 In these parts, where, I should presume, the treatment of pneu 
 monic inflammation is as well understood, and as successful, as it 
 is in any other section of the world, I feel confident that few physi 
 cians of note would be disposed, from experience, to resort to quinia 
 or other kindred remedies at any but the last period of the disease, 
 or when signs of prostration or relaxation of the powers of life 
 manifest themselves. But in such instances they would prescribe 
 it on very different principles from those advocated by Dr. Merrill ; 
 and I think it might be shown that the same sentiment is enter 
 tained elsewhere, even in the very section of country where he has 
 acquired the larger share of his experience. 
 
 To this it may be added, that the claim set up in latter times for 
 quinia, of being a powerful and pure counter-stimulant or sedative 
 especially when administered in large doses an opinion which, 
 originating in Italy some thirty years ago, has received the support 
 of several French, English, and American physicians, 1 is not, after 
 all, sufficiently authenticated, so far, particularly, as relates to dis 
 eases produced by causes different from ordinary malarial exhala 
 tions, to justify a resort to the remedy in the treatment of pneu 
 monia so long as signs of inflammatory irritation exist. Admitting, 
 therefore, that all we have heard, and continue to hear, concerning 
 the manifestation of that property, and of the wonderful effect result 
 ing from it in periodic fevers, of all possible grades, types, and 
 forms to say nothing of dozens of other complaints, the number of 
 which seems to enlarge with every succeeding writer, in some sec 
 tions of our country were placed beyond the possibility of doubt, 
 the fact would not help those who, from a supposed similarity of 
 effect of certain remedies in certain diseases, venture the conclusion 
 that those diseases are similar; for it is yet to be proved, by correct 
 clinical observations, that quinia exhibits that property, and is re 
 markably successful in pneumonia. Nay, more, supposing these 
 wonderful effects, both as regards the latter disease and malarial 
 
 1 Bailly, Traite des Fievres In term. 1825, p. 424 ; Guersant, Diet, de Mdd. xxvi. 564 ; 
 Geromini, Annali Univ. de Med., March. 1841; Blair, 107; Drake, 746 ; Bell s Lec 
 tures, ii. 782 ; Boling, Am. Journ. N. S. viii. 89 ; Fenner, New Orleans Journ. v. 208 ; 
 Id. 9, 318, &c. ; Id. Southern Reports, ii. 849 ; McCormick, New Orleans Journ. ii. 175 ; 
 Holmes, A. J., N. S., xii. 304; Merrill, New Orleans Journ. viii. 161, 163; Upshur, 
 Stethoscope, ii. 437 ; McCaw, Stethoscope, ii. 666, &c. ; Desiderio, Comptcs Rendus 
 de 1 Acad. des Sciences, ix. 509; Bally, J. Gen. do Med. Oct. 18, 1829, p. 7; Me>at 
 et Delens, Diet, de Mat. Med. v. 607 ; Jacquot, Arch. Gen, 1845, vi. 76 ; Briquet, 
 Traite Therapeutique du Quinquina, 21, 42, 107, 123. 
 
474 PNEUMONIA AND 
 
 complaints, to be such as they are represented in certain quarters; 
 supposing that quinia is a decided sedative; that it is a perfectly 
 harmless remedy ; that by its means fevers may be cut short at the 
 outset; supposing that it may be safely, and, indeed, beneficially 
 employed in large and repeated doses throughout the attack of 
 these diseases, or before the complete cessation of febrile reaction, 
 and that analogous effects may be expected to result, and are ob 
 tained, in pneumonia, it is difficult to perceive how, from these 
 circumstances, a proof of the identity of this disease with fever can 
 be derived. 
 
 Not only does the success of quinia in the latter fail to indicate 
 that the same result must necessarily attend the employment of the 
 remedy in pneumonia, but success in both complaints would lend 
 no help to the advocates of the identity in question. In the first 
 place, no fault can be found with those who in the present state of 
 the question at issue, are skeptical as to the wonders related of 
 quinia, and feel disposed to question the propriety of administering 
 very large doses of it at the commencement of a febrile attack, 
 without waiting for a marked remission, and especially during the 
 continuance of high arterial action and symptoms of local inflam 
 mation or irritation ; for, after all, this practice, for which Dr. Dun- 
 das 1 claims credit, but for which the profession in this country was 
 long before his time indebted, some say (for this important point, 
 if important it really be, has not yet been satisfactorily settled, there 
 being several claimants in the field) to Dr. Thomas Fearn, 2 of Ala 
 bama ; others to Dr. Metcalf, 3 of Miss. ; and some, again, to Dr. Per- 
 rine, 4 of the same State ; this practice, I say, though it enumerates 
 warm and respectable advocates both on this and the other side of 
 the Atlantic, 5 cannot be said with certainty to have proved, in the 
 
 1 Sketches of Brazil, 287, 291, &c. 2 Fenner s Southern Reports, ii. 346. 
 
 3 Id. i. 352. 4 Amer. Journ. xi. 250. 
 
 5 Drake, Western J. xi. ; Ib. Dis. c. of the Valley, &c. 775, 789 ; May, Transyl. 
 J. x.; Van Buren, Examiner, 1846; Upsher, ib. ; Maillot, Fievres Interm. 11, 140, 
 362; Broqua, M6m. sur le Sulf. de Quinine, Bulletin, vi. 619,749; viii. 624 ; Fletcher, 
 Med. Times and Gaz. April 23, 1853, p. 422; Ib. Braithwaite, pt. xxvii. 264, Am ed. ; 
 11. Gee and W. Eddowcs, Lancet, Sept. 1853, p. 210, Am. cd. ; Cummins, ib. 218; 
 Sigaud, Climat et Maladies du Bre"sil, 245; Briquet, Trnite Therapeutique, 339, 358, 
 366; Tuck, N. 0. J. ii. 303; Mitchell, ib. iii. 16; Merrill, ib. viii. 161; Fenner, ib. v. 
 209; Ib. ix. 318; Ib. Southern Med. Rep. i. 118; Ib. ii. 98; McCraven, N. 0. J. v. 
 234; McCormick, N. 0* J. ii. 173; Coolidge, South. Med. Rep. ii. 449; Haspel, Mai. 
 tie 1 AlgeYie, ii. 332, &c. ; Manson, Stethoscope, iii. 135. 
 
AUTUMNAL FEVERS. 475 
 
 hands of every good and safe practitioner, as advantageous, except 
 perhaps under exceptional circumstances, as its originators and 
 partisans so confidently assert. 
 
 To whomsoever the bright idea may have suggested itself among 
 us, the practice is evidently but a revival of the one suggested and 
 resorted to as early as the close of the seventeenth century, by 
 Morton adopted not long after by Torti, Burserius, Werlhof, 
 Trnka, and other physicians of the times, and highly eulogized, 
 so far at least as regards its applicability to yellow fever, by 
 Arejula, Sarravia, Lafuente, Bobadilla, and the majority of Spanish 
 physicians, as well as by Valentin, Cassan, Lefoulon, Guyon, Sava- 
 resi, Stevens, Kuhn, &c. of administering the Peruvian bark in the 
 largest* possible doses, in all stages of the disease, after little prepa 
 ration, or without any preparation at all ; and we all know that the 
 success obtained from it, though satisfactory in a few cases, has not 
 been such as to encourage its general adoption. The theoretical 
 views upon which the practice was predicated were, doubtless, some 
 what different from those by which the advocates of the quinia 
 treatment, above referred to, are guided ; but the effects claimed are 
 similar. Forget for a moment that the writers cited are speaking 
 of cinchona, and not of quinia, and you may fancy that the latter 
 remedy is the subject of their remarks. Upon the administration 
 of a large dose, it was said, the pulse is reduced ; the skin cools 
 and moistens; thirst, if it existed, disappears; the tongue becomes 
 clean and moist; in a word, fever disappears as by enchantment; 
 arid if the patient experience a little uneasiness about the head, a 
 little dizziness, perhaps a slight buzzing in the ears, the whole soon 
 subsides, and convalescence follows. Such were the effects claimed 
 for bark, in the class of disease in which the quinia, used in the 
 way mentioned, is said to act as by magic. Is not the fate of the 
 former practice calculated to raise some doubts as to the perma 
 nence of reputation of the latter? 
 
 Let it be said, en passant, that experience will doubtless one day 
 demonstrate, to all whose eyes are not blinded by theory, that more 
 noise has recently been made about the abortive plan of treating 
 febrile diseases by means of scruple or even larger doses of quinia, 
 given, with or without preparation, at the outset of the attack, with 
 the intention of arresting their progress, than is warranted by the 
 nature of the results obtained. Entitled as the authority of many 
 
476 PNEUMONIA AND 
 
 of the advocates of the plan may be to our respect, it may be 
 fairly suspected that, in singing its praise so loudly, and pro 
 claiming its superiority over every other heretofore pursued, they 
 have allowed their imagination to get somewhat the better of 
 their judgment. To this conclusion I am the more inclined, be 
 cause it is yet to be proved that remittent and yellow fevers, when 
 once established, can be arrested in their course ; and the practice 
 has failed, and even proved detrimental, in the hands of other 
 observers, so far especially as regards the yellow fever. 1 Besides 
 this, several of its more zealous advocates would extend the prac 
 tice to every other form of fever named in the books typhus, 
 typhoid, &c. in which, when resorted to by other equally skilful 
 physicians, in this country and elsewhere, quinia, as an abortive, 
 sedative, or specific, has failed to produce the anticipated effect, 2 
 unless perhaps the disease had assumed a decidedly remittent or 
 intermittent type, when it required no prophet to tell us it would 
 be useful. It is true that, by the warm supporters of the plan in 
 question, no heed is taken of the opposition it has encountered ; 
 but on inquiry we cannot find that any stronger reason has been 
 assigned (and, taking all things into consideration, it cannot but 
 appear extraordinary that something better could not have been 
 offered) for the failure experienced, even with what might well be 
 regarded as classical doses of the panacea, than that physicians who 
 recount their ill success would have obtained opposite results had 
 they only given the quinia a fair trial ; in other words, adminis 
 tered it earlier and in larger quantities. To those who have no 
 hobbies to ride, the fact of these repeated failures, to say nothing of 
 certain analogies they may bear in mind, and sundry theoretical 
 views they may entertain respecting the pathology of the disease, 
 and the mode of operation of the remedy, will be sufficient to 
 deter them from joining in the hosannas sung in some quarters; 
 while the allegation that southern and western physicians, who, we 
 should think, cannot be accused of over-timidity in the use of remc- 
 
 1 Stone, N. 0. J. ii. 184, &c. ; Dickson, Charleston J. i. 14; Lewis, N. 0. J. i. 425, 
 427; Ib. iv. 174; N. 0. J. x. 279; Furlonge, Lancet, Dec. 1853, p. 441, Am. ed. In 
 this city, last .autumn, the quinia practice failed completely. 
 
 2 Gibbs, Former, ii. ; Bolirig, N. 0. J. ix. 2, c. ; Maggibbon, N._ 0. J. x. 25, 36; 
 Scruggs, N. 0. J. x. 206; Gordon, ib. 146, 210; Fletcher, Braithwaite s Abstract, 
 July, 1853, p. 204 ; Grant, Am. J. sxvi. (N. S.) 104 ; Barclay, Mcd. Times, Jan. 8, 53. 
 
AUTUMNAL FEVERS. 477 
 
 dial agents witness the history of calomel, tartar emetic, and the 
 lancet, among them have not been struck with the success of the 
 abortive method, simply because they had not been heroic enough 
 with quinia, which the most cautious among them daily use in 
 doses which cause astonishment in excellent and skilful practitioners 
 elsewhere, will appear passing ludicrous, and may recall to their 
 minds, as it has done to mine, a certain passage in Gil Bias, in 
 which the great Sangrado the worthy prototype of more than one 
 physician of an era not very remote from our own accounts for 
 the loss of the Canon Sedillot, whom he had, as a matter of course, 
 bled profusely and deluged with warm water. I quote the original : 
 " Comme il rendaitles derniers soupirs le medecin parut, et demeura 
 un peu sot, malgre 1 habitude qu il avait de depecher ses malades. 
 Cependant loin d imputer la mort du chanoine a la boisson et aux 
 saignees, il sortit en disant d un air froid qu on ne lui avait pas fait 
 tirer assez de sang ni fait boire assez d eau chaude." 1 
 
 I am aware that the experiments of Bricquet and others show, 
 that the sulphate of quinia, when given in doses of fifteen grains or 
 upwards, has a tendency to reduce very considerably the frequency 
 and force of the circulation ; and that a similar effect is also obtained 
 in lower animals, whether the remedy be administered by injection 
 into the vessels, by the stomach, or by insertion into the cellular 
 tissue. 2 I am aware, also, that this depressing action of quinia 
 has been very frequently observed in this country and in Europe. 3 
 But while we admit all this, and feel convinced, besides, that many 
 physicians, among us especially, have heretofore been too timid in 
 the administration of the article, have used it in too small doses, 
 and postponed it too long ; that it is better to give it in a few smart 
 doses, than in small and repeated quantities ; and that, in some 
 cases, it is tolerated, and has produced excellent effects in very large 
 doses ; nevertheless, it is impossible to shut our eyes to the fact 
 
 1 Liv. ii. chap. ii. 
 
 2 Comptes Rendus des Seances de 1 Acad. des Sci. xxvii. 549 : Ib. Reflexions sur 
 1 emploi du S. de Q. a hautes doses, Bulletin, viii. 898 ; Ib. Traite Therapeutique, &c. 
 21, 42. 
 
 3 Briquet. Traite Therapeutique du Quinquina, 21, 42, &c. ; Bally and Banquier, 
 J. Gen. de Med. Oct. 1829, p. 7 ; Jacquot, Arch. Gen. 1845, vi. 76 ; Lambert, 
 Essai sur la Methode Endermique, 97 ; Guersant, Repertoire des Sc. Med. art. Quin 
 quina ; Legroux, Journ. de Med. et de Chir. Pratiques, April, 1845: Boucher, Sur 
 1 emploi du S. de Q. dans la Fievre Typhoide. These, 1846. See others, mentioned 
 above, at p. 173. 
 
478 PNEUMONIA AND 
 
 that this sedative action does not always manifest itself; that 
 quinia not unfrequently increases the force and activity of the cir 
 culation ; that when the sedation is produced, it is for the most part 
 secondary, and akin, as Guersant, McCaw, and others remark, to 
 that occasioned by overpowering portions of alcoholic or other 
 stimulants, or to the after effect of lesser doses of these ; that it is 
 preceded by a stage of reaction in short, it may be, but too evident 
 to be denied that when produced, the depression of the circulation 
 is obtained at the expense of the brain and nervous system (of 
 which it is far from being a true sedative), and of the gastric and 
 sometimes the entire mucous membrane, on which it operates as an 
 irritant ; that in ordinary, if not in all diseases, the existence of 
 inflammation is generally found by physicians entitled to the fullest 
 credit, to prove a bar to its production, and that this morbid condi 
 tion is apt to be aggravated by the free use of the remedy. All 
 this is so evident, that we may venture the remark that experience 
 will, before a very long while, prove, to the satisfaction of all candid 
 observers, that those who carry the vaunted abortive plan to the 
 extent recommended ; those who use quinia in very large doses, 
 without regard to the existence of inflammation, and prescribe it 
 as well during the exacerbation of febrile complaints as during the 
 apyrexia, run the risk of doing much mischief; that they are re 
 commending a method of treatment very far from being calculated 
 to lessen the ratio of mortality ; that of the cases which appear 
 to have been greatly benefited, or cured by the use of quinia given 
 in the heroic way mentioned, not a few have got well in spite of 
 the treatment; that others are seriously injured by it, or receive 
 the seed of much subsequent mischief; and that, of those who suc 
 cumb under the plan in question, many might have had a better 
 chance of recovery if treated in a different way. 
 
 The supposition must appear the more natural, when we reflect 
 that more than enough may be gathered from experiments insti 
 tuted in England, France, Italy, and this country, as well as from 
 clinical observations made by most reliable authorities in all parts 
 of the world, to demonstrate, beyond the possibility of doubt, that the 
 sulphate of quinia possesses toxical properties of no inconsiderable 
 power, and sufficiently glaring to prevent all prudent physicians from 
 trifling with it, and from using it, without absolute necessity, in the 
 enormous doses resorted to by a few French and Italian practi 
 tioners, but more particularly in certain parts of this country; often 
 
AUTUMNAL FEVERS. 479 
 
 without the most remote regard to the idiosyncrasy of the patient, 
 to the condition of the stomach or bowels, and to other circum 
 stances of like importance. Let the reader turn to the results of 
 experiments on dogs and other animals, and he will find that, when 
 given in large doses, quinia has occasionally produced stupor, dilated 
 pupils, coma, convulsions, and death ; and that dissection in such 
 cases has revealed congestion of the brain and its membranes, and 
 a fluid state of the blood. What is more to our present purpose, 
 the experiments of Magendie, Melier, and others exhibited, besides 
 the phenomena mentioned, signs of congestion of the lungs during 
 life, and complete hepatization of these organs after death. 1 Turn 
 ing to the human species, we find that much mischief has sometimes 
 resulted from the same remedy. Cases could here be referred to, 
 in which an active quinia treatment, pursued with the view to cure 
 what was supposed to be obscure remittent fever, gave rise to sun 
 dry and very distressing nervous symptoms, which it required much 
 time to eradicate. I have now in my mind a case of that kind of 
 fever, treated in strict accordance with the rules of the method in 
 question, by one of its most zealous and experienced advocates, and 
 with which I became conversant in the South ; in which the patient, 
 although she recovered from the disease, had a tedious conva 
 lescence, and remained for years a martyr to the effects of extra 
 quiniaism. The remedy, when administered in large, sometimes in 
 moderate, doses, has given rise, besides tinnitus aurium its usual 
 attendant to agitation, headache, vertigo, subsultus tendinum, deli 
 rium, coma, hasmaturia, frequent micturition, dysuria, amaurosis, 
 deafness, gastralgia, gastro-enteritic inflammation, diarrhoea, epileptic 
 symptoms, extreme prostration, paralysis, loss of speech, uterine 
 hemorrhage, numbness and coldness of the surface, echymosis, pe- 
 techias, &c. 
 
 In all this, I am fully borne out by the results of the experi 
 ments of Briquet, 2 already referred to, of Bennet, 3 Melier, 4 Deside- 
 rio, 5 Greromiiii, 6 Baldwin, 7 and others. Thus, the experiments of 
 Desiderio show that quinia, when given in large doses, produces 
 drowsiness, a difficulty of keeping the erect posture, a tendency to 
 
 1 Melier, op. tit. 720, 729. 2 Op. cit. xxvii. 549. 
 
 3 Edinb. Monthly J. Jan. 1852; Am. J. Oct. 18o2, p. 491. 
 
 4 Mem. de 1 Acad. de Med. x. 722. * 
 
 5 Comptes rcndus de 1 Acad. dcs Sciences, xx. 370. 6 Op. cit. 
 
 7 Am. J. (X. S.) xiii. 292. See also Pereira, Mat. Med. ii. ; Laiicet, xxxix. 
 
480 PNEUMONIA AND 
 
 immobility, dimness of vision, and a dropping of the eyelids. 
 Acetate of morphia and alcohol, when given in suitable doses (the 
 size of these differing according to the kind of animals experimented 
 upon), produce effects analogous to those resulting from quinia, and 
 when administered in cases in which the latter has been freely 
 given, add their effects to those occasioned by the other. On the 
 other hand, distilled laurel-water produces effects of a contrary kind, 
 and may, to a certain extent, be considered as an antidote to qui 
 nia. Bleeding is still more efficacious in that respect. Powdered 
 digitalis appeared to produce analogous effects. The experiments 
 of Briquet himself, upon which stress has been laid by the advocates 
 of the heroic quinia practice, prove that, when thrown into the 
 bloodvessels, the remedy produces cerebral excitement, and gene 
 rally convulsions. When it penetrates the brain in an indirect 
 manner, there is, first, a certain amount of general agitation; then 
 follow debility, headache, vertigo, tinnitus aurium, and paralysis of 
 the acoustic nerves, intolerance of vision, burning sensation in the 
 orbits, weakness of sight, dilatation of the pupils, and blindness, 
 numbness of the skin of the face, subsultus tendinum, trembling of 
 
 O 
 
 the limbs, an appearance of intoxication; then a general collapse 
 and loss of muscular power, diminution or cessation of pain in cases 
 of neuralgia. Autopsy reveals injection of the large vessels of 
 the pia mater, slight sandy injection of the substance of the brain, 
 and sometimes meningitis. 
 
 The same experiments establish the fact that quinia produces an 
 hypera3mic or engorged state of the lungs. In small doses it ex 
 cites the lining membrane and secretory organs of the mouth, pro 
 duces salivation, and increases the appetite and digestive powers. 
 When given in large quantities, and persevered in for some time, 
 it sometimes produces inflammation of the mucous membranes; 
 and gives rise to vomiting, colic, diarrhoea, and all the phenomena 
 of gastritis and enteritis in a mild degree. The urinary organs suffer 
 irritation, as manifested by pain, frequent desire to make water, 
 hsematuria, dysuria, and even retention of urine. In women, the 
 free use of the article not unfrequently gives rise to uterine hemor 
 rhage. In men, small doses excite the sexual organs, while large 
 and frequently repeated doses produce reverse effects. The skin 
 is benumbed and cpoled, and spotted over with ecchymoses and 
 petechia3. While doing all this while producing these various 
 morbid changes in the tissues and organs, quinia affects the compo- 
 
AUTUMNAL FEVERS. 481 
 
 sition of the blood, which, according to many, 1 it notably defibrinates, 
 and renders fluid, dark, and incoagulable; or, as would appear to 
 result from the numerous experiments and observations of Briquet, 2 
 it renders, on the contrary, richer in fibrin; and it would not 
 be difficult to point out instances in which, when pushed to what 
 certain physicians in our country would regard as safe and even 
 moderate closes, it has caused death, 3 not only in animals experi 
 mented upon, but in the human species. 
 
 With these facts before us, it cannot be deemed improper to 
 suggest the necessity of abstaining from administering the remedy 
 in larger doses than are strictly necessary to insure its specific 
 effect which effect, in fevers, especially, is due not so much to the 
 sedative as to the purely antiperiodic property it possesses. , That 
 this property, which the advocates of sedation have often con 
 founded in theory with the latter is real, will not be denied by 
 those who have seen quinia stop intermittent fever without pro 
 ducing any apparent effect on the system, save a little buzzing of 
 the ears. In the next place, it is not improper to suggest the pro- 
 prietv, as a general rule, of desisting, except in cases of extreme 
 emergency, from the use of it during the continuance of high febrile 
 excitement, and especially during the existence of well-marked local 
 inflammation, and of reserving it for the period when by other 
 means an abatement or removal of these have been obtained; or 
 for those instances in which the disease assumes a congestive or 
 pernicious character, and must be put a stop to at all hazard. Let 
 it not be forgotten that some of the most decided believers in the 
 sedative property of quinia, who are friendly to its use in large 
 doses in fevers intermittent and remittent and have tried it on a 
 large scale, are decidedly opposed to its employment in those dis 
 eases whenever the surfaces with which it comes in contact the 
 mucous membranes of the stomach and bowels are in a state of 
 
 1 Magoudie, Lecons sur les Phenomenes Physiques cle la Vie ; Melier, Mdm. de 
 1 Acad. de Med. x. 725, Sic. ; Giacomini, Annali Universal! de Medicina, March, 1841 : 
 Baldwin, Am. J. xiii. (N. S.) 290; Guersant, Diet, de Med. xxvi. 5G7 ; Bulletin de 
 1 Acad. de Med. viii. 905; Bonora and Arvedi, Ann. Univ. de Medieina, March, 1843, 
 .juoted by Melier; Monneret. Mem. sur le S. de Q. a haute dose, June 27, 1843; Le- 
 groux, op. tit. 
 
 2 Traite Therapeutique, &c. 82, c. 
 
 3 Depuisaye, Examinateur Med. 15th Feb. 1843, quoted by Melier, 733; Briquet, 
 Journal de Med. de M. Bean, quoted by Melier : Piedagnel, communicated to Melier, 
 Baldwin, op. cit. 293. 299; Guersant, op. tit. 508. 
 
 81 
 
482 PNEUMONIA AND 
 
 inflammation. Among these may be mentioned Briquet himself, 
 who not only found, in his experiments, that this substance occa 
 sionally produces an inflammatory irritation of those tissues, but 
 noticed that it invariably occasions injurious effects whenever the 
 above-mentioned parts are already inflamed. Hence, he advises the 
 discontinuance or omission of the quinia in all diseases in which 
 those membranes are so affected. And as this condition, or at least 
 a morbid state of irritation approximating to it, obtains very com 
 monly at some period of remittent, and is not unfrequently encoun 
 tered during the exacerbation of intermittent fevers, we may under 
 stand that, in the opinion of the great apostle of sedation himself, 
 the use of quinia is very frequently contra-indicated in those dis 
 eases, and certainly should not be resorted to indiscriminately, and 
 without due regard to the condition of gastro-intestinal surfaces. 1 
 
 Be this, however, as it may, as regards autumnal fevers gene 
 rally; considering what every one knows that, more than any 
 other remedy, quinia finds a useful application in such fevers ; 
 admitting, for the sake of argument, that it really exercises a seda 
 tive action in them; that it may be both safely and advantage 
 ously administered in large doses during the exacerbation; and 
 that the inflammation which accompanies malarial diseases is so 
 modified by the poison that the system is enabled to tolerate, with 
 comparative impunity, large doses of the medicine, nothing of the 
 kind can be affirmed in regard to ordinary inflammations that of 
 the lungs among them ; if not in a special manner. In these, qui 
 nia, in the hands of skilful observers, has not usually been found to 
 exercise the pure sedative effect in question ; and so far from gene 
 rally proving beneficial, it has often, when administered during the 
 force of the febrile excitement, exasperated the disease. Such is the 
 case when quinia is given in the usual quantities; and surely, we 
 have no reason to believe that the system, in such cases, is under 
 the influence of a modifying agency capable of placing it in a con 
 dition to tolerate the medicine in the large and indeed immense 
 doses we occasionally hear of. 
 
 It would be the height of impropriety, therefore, to argue, from 
 the real or supposed benefit of quinia in autumnal fevers, that the 
 remedy will be equally useful in pneumonia; and to conclude, from 
 this similarity of effects, that the two diseases are identical in nature 
 
 1 Trait^ Therapeutiquc, &c. 205. 
 
AUTUMNAL FEVERS. 483 
 
 and causation, and that pneumonia is only a particular form of 
 periodic fever. The impropriety of the conclusion will appear the 
 more evident; because, while quinia is of immense benefit in 
 periodic fevers, and may, as some aver, be "used safely in them 
 during the existence of fever, or even inflammation, it is found 
 that it not only acts injuriously in pneumonia, but, when given in 
 large doses, has at times exhibited a tendency to produce the 
 evil we wish to remove. On this subject, the facts mentioned 
 by Melier (733, 734), and Baldwin (xiii. 299), can leave no doubt ; 
 while the reality of the tendency might, in the absence of those 
 facts, have been foreseen from the results obtained on dogs and 
 other animals, and to which reference has already been made. 
 Nor is it less certain that the use of quinia in pneumonia has been 
 discarded or its benefit doubted, even by some of the strongest 
 advocates of its sedative action, and of its employment in the 
 exacerbation of autumnal fever. Dr. Boling says: "As an anti 
 phlogistic remedy in elevated and healthy localities (i. e. in which 
 the disease is not complicated with or modified by malarial fever), 
 it will probably never supersede the lancet, &c., though it may, in 
 many cases, be brought to their aid." 1 " It may be administered," 
 says Dr. Upshur, "during the intensity of the febrile paroxysm, but 
 not if the fever is the result of pneumonia and arachnitis ; and the 
 physician who should give quinia in these diseases, to reduce the 
 pulse, because he had seen it produce such an effect in remittent 
 fever or rheumatism, would commit a great blunder." 2 Not differ 
 ent is the opinion of Dr. Lewis, of Mobile, 3 and other physicians of 
 the South, who use quinia only in cases requiring tonics and stimu 
 lants, and shun it in truly inflammatory pneumonia. 
 
 A still later, and very intelligent Southern medical writer a 
 strong advocate of its use in the active stage of remittent, inter 
 mittent, and continued fevers Dr. McCaw, of Eichmond, Va., re 
 marks : " Quinia does not apply itself to the cure of inflammation 
 of a local character. It is not, in my opinion, an antiphlogistic at 
 all." "I know that some of the quininists do say that it is of great 
 use as a sedative, even in this class of diseases. I do not think so 
 myself. I have not found it so, certainly. I have given it many 
 times during the progress of pneumonia and pleurisy ; complicated 
 
 1 American J. viii. 110. 2 Stethoscope, ii. 437. 
 
 3 N. 0. J. iv. 174; ii. 629. 
 
484 PNEUMONIA AND 
 
 witli intermittent and remittent fever, I have always seen it cure 
 the complication, but never the inflammation. In truth, the short 
 stimulating stage of the remedy would possibly add to the inflam 
 mation, but that its special influence over the accompanying fever, 
 stopping the daily paroxysms of congestion which must be so per 
 nicious to the favourable termination of the disease, amply repays 
 you for this slight mischief." 1 " Notwithstanding the opinion of 
 contra-stimulists," says a high authority, " it is admitted by unpre 
 possessed physicians, that Peruvian bark (and its salts) aggravates 
 pare acute inflammation, and it is hurtful in almost every paren- 
 chymatous and membranous inflammation. It aggravates pneu 
 monia and gastro-enteritis with regular fever. It is not less injuri 
 ous in inflammatory diseases farther removed from the centre of 
 the circulation," 2 &c. 
 
 Briquet himself, who as much as any one has insisted upon, and 
 endeavoured to prove by experiment on animals, and the results of 
 clinical observation, the sedative action of the quinia, and the neces 
 sity of using it in all febrile diseases, to moderate the action of the 
 heart and arteries, acknowledges, in his very recent volume on the 
 therapeutic employment of the remedy: 1st, that the coexistence 
 of a large proportion of fibrin in the blood, or that of a severe 
 inflammation of the membranes, and especially of the parenchyma, 
 exercise on the heart an influence which the sedative property in 
 question, administered in safe doses, cannot neutralize ; 2d, that the 
 administration of quinia, given in doses sufficiently large to insure 
 its sedative effects on the circulation, produces in the economy a 
 sufficiently serious perturbation to induce us to avoid the risk of 
 it, in cases in which, from the severity of the disease, it becomes 
 urgent to put a stop to it. 3 
 
 The only instances of pneumonia in which quinia has been found 
 undeniably and decidedly useful for the purposes contended for, are 
 those in which the periodic element is marked by well-defined remis 
 sions, or complete intermissions, and the malarial complication is 
 clearly exhibited. It matters not whether these intervals be of long- 
 duration, and exhibit the quotidian or tertian types, or whether 
 the exacerbation or paroxysm return after a few hours, or even a 
 single hour of repose a phenomenon which we know to occur in 
 
 1 Stethoscope, ii. 070. f,71. * Cuersant, Diet, de Mod. xxvi. -384. 
 
 3 On. cit. 110. 
 
AUTUMNAL FEVERS. 485 
 
 other forms of diseases. 1 In these, and in every other case in 
 which this periodic element is manifest, quinia should, undoubtedly, 
 be resorted to, more especially when the disease displays a per 
 nicious or malignant tendency a circumstance which renders the 
 recurrence of a paroxysm of the utmost danger. These cases, in 
 which the inflammation is in all probability modified by the 
 malarial taint, in such a way as to tolerate the use of remedies, 
 which, under other circumstances, could not be borne with impu 
 nity, resist every other mode of treatment. They cannot be cured 
 by antiphlogistics alone ; for although by these the inflammatory 
 affection of the lungs may, if uncombined, be removed, the malarial 
 fever or taint is not to be so destroyed ; and the recurrence of every 
 paroxysm or exacerbation, has the effect of aggravating the local 
 disease; which cannot, therefore, be eradicated, unless a stop be put, 
 by anti-periodic remedies, to the complicating complaint. With 
 the cessation of the latter, the pneumonic inflammation, if it has 
 not reached beyond the first stage, generally disappears also. In 
 other cases, it abates considerably, as indicated by an improvement 
 in the general symptoms and physical signs. In others, again, it 
 continues. When this occurs, it must be treated by the usual 
 means. But these cases, which, as already said, are generally, if 
 not universally, the product of a malarial influence superadded to 
 the ordinary cause of the disease, afford us examples, not of simple 
 pneumonia, but of positive complications of this disease with 
 periodic fever, or of its modification through the agency of the 
 febrile poison. As a natural consequence, they are rarely, if ever, 
 encountered in our large cities, or in very many places where, 
 though pneumonia prevails extensively, the malarial poison is not 
 evolved, or exercises its baneful influence with little force, and 
 during a short period of time only. On the other hand, they are 
 of frequent occurrence in miasmatic regions generally, and nowhere 
 more so than in our Southern and Southwestern States, where the 
 quinia has consequently been used successfully. It cannot be 
 surprising, therefore, that Dr. Farrar should remark, in his medical 
 topography of Jackson (Miss.): "In this climate, a stage will 
 usually be seen in pneumonia, when quinia may be used with 
 freedom and efficiency, which for some years past has been my 
 experience." 2 Others have written or spoken to the same effect. 
 
 1 Melier. Mom. de 1 Acad. de Mod. x. 551. 
 
 2 Fenner s Southern Reports, i. 357. 
 
4:86 PNEUMONIA AND 
 
 But in such cases, I repeat, we are not to recognize pure, but com 
 plicated and modified pneumonias. 
 
 In them, the disease receives, by virtue of its association -with 
 malarial fever, the periodic type by which the latter is character 
 ized, and is benefited by quinia, not in consequence of the sedative 
 or contra-stimulant action of this remedy on the local disease and 
 the system at large, but of the anti-periodic power it possesses, and 
 by which it is enabled to arrest the progress of the malarial, or 
 periodic and complicating fever. The older physicians used bark 
 freely in such cases, a point upon which the reader may refresh his 
 memory by referring to the writings of Torti, Morton, Lauter, Ali- 
 bert, Mongellaz, Gouraud, as well as to an essay on intermittent 
 irritations, published in form of a review in an early volume of the 
 North American Medical and Surgical Journal, by the author of the 
 present volume. "There is no one among us," says Sarcone, "who 
 is not in a condition to present numerous observations respecting 
 the happy results obtained by cinchona in affections of the lungSj 
 combined with periodic fever. Messrs. Serao, Yentapane, Rubertis, 
 Cinque, Visoni, and others, have effected memorable cures with 
 bark in diseases of the same nature, not only this year (17 64), but 
 also in the preceding ones. I myself, though confessedly young 
 in the profession, and of little importance in comparison with men 
 of eminent talents, such as those I have had the honour to name, 
 am able to adduce numerous examples of the useful employment 
 of that remedy in the diseases in question." 1 The use of quinia in 
 the same disease is universally resorted to. I have myself em 
 ployed it largely by the mouth or rectum, and have seen it em 
 ployed by others both at home, in the south of this country, and in 
 Italy, where instances of the kind are not uncommon. Of course, it 
 is a matter of indifference whether the inflammation be in the lungs 
 or elsewhere. Whenever it assumes a decidedly remittent or an 
 intermittent type, and is blended with a malarial fever, or modified 
 by a malarial taint, and more particularly whenever signs of malig 
 nancy or congestion manifest themselves, quinia should be resorted 
 to, and that promptly. We must, as is well remarked by Dr. Mer 
 rill, take advantage of the first remission, otherwise we may expect 
 the second exacerbation to become more violent than the first; an 
 effect due, in part, to the fact that every violent paroxysm of fever 
 
 1 Maladies de Naples, i. 212. 
 
AUTUMNAL FEVERS. 487 
 
 more particularly when preceded by a chill tends to aggravate 
 the local inflammation or congestion, and prostrate the nervous 
 power. Be this, however, as it may, cases such as have just been 
 alluded to, are in a great measure exceptional, and their occurrence, 
 as well as the treatment they call for, proves nothing, so far as re 
 gards ordinary and uncomplicated pneumonia, in which the quinia 
 practice would stand but little chance of proving useful. Now this 
 practice being found inapplicable to the greater number of cases of 
 pneumonic and other inflammations, of doubtful necessity in other?, 
 and only decidedly important in a comparatively few instances of the 
 disease and those, too, in which the periodic type evidently arises 
 from the complication or modification mentioned the argument 
 founded on the success or superiority of the mode of treatment in 
 question in pneumonia cannot be sustained; for that usefulness or 
 superiority, as regards the disease generally, is very far from being, 
 as yet, proved. The first postulate must, therefore, be abandoned. 
 As to the second that the success of quinia in pneumonia must 
 be viewed as a sure proof that this disease is identical with, and 
 constitutes only a particular form of periodic or autumnal fever, in 
 the treatment of which that remedy is, if not a specific, at least a 
 most efficacious remedy ; it need only be remarked that, even Avere 
 we disposed to recognize the validity of the claims set up in favour 
 of quinia in all instances of pneumonia, it would be illogical to 
 deduce from that superiority a proof of the identity in question. 
 As every one knows, quinia is daily used advantageously in dis 
 eases which owe their origin to causes very different from the legiti 
 mate poison of autumnal fevers, and which, nevertheless, it is not 
 probable any one would be disposed to regard as constituting really 
 and substantially anything more than particular forms of those 
 fevers. In articular rheumatism, arising without malarial taint, 
 and having nothing in the world in common with autumnal fevers, 
 it has been and is employed by Briquet and others, with, as it is 
 said, great utility. No one but Dr. Macculloch will be inclined to 
 maintain the intimate and constant dependence of neuralgia upon 
 intermittent fever, and to regard it as being produced exclusively by 
 malaria, That it is often, as remarked by Dr. Drake (863), the con 
 sequence of autumnal fevers, especially when it assumes the periodic 
 type, no one will deny. But it is also found to be the consequence 
 of other complaints in no way allied to such fevers ; cases occur 
 ring and assuming the intermittent character under circumstances 
 
488 PXEUMOXIA AXD 
 
 which forbid the idea of any malarial agency. Nevertheless, quinia 
 is often beneficially employed in the various forms of that painful 
 disease. 
 
 Whatever be the cause of periodicity in a disease, or rather what 
 ever be the nature and cause of a disease, which presents a well- 
 marked remittent or intermittent character, quinia will be found 
 a useful remedy in its treatment. It is useful also in certain 
 nervous disorders in which the periodic element does not manifest 
 itself, and which have no more to do with periodic fever than with 
 smallpox or syphilis ; and if we conclude that pneumonia, generally, 
 is really and substantially nothing more than a peculiar form of 
 remittent and intermittent fever, and should take its appropriate 
 place (in company with pleurisy, &c.) under the plain designation 
 periodic/ever, on the ground that certain cases of it are, under par 
 ticular circumstances, and at a particular period of their course, 
 greatly benefited or arrested by quinia; if with Dr. Forry, and 
 others, we admit that the subjection of these diseases to the same 
 remedies which are found to arrest the course of the one, also 
 arrests the course of the other, " implies a close alliance, if not a 
 common origin;" 1 we shall be led to conclude, also, that all the 
 other disorders in which it may be useful wheresoever the locality, 
 and at whatsoever season they may show themselves are of ma 
 larial origin ; and must, in like manner, take their appropriate 
 place under the same plain designation. Such a mode of reasoning 
 would lead us, if we wish to be consistent, to pathological deduc 
 tions, at which our good sense must revolt, and which would ill 
 accord with the principles of the inductive philosophy so dear to 
 some of our opponents. ISTo one will deny that mercury is the 
 remedy for syphilis; for although, in the days of our infatuation for 
 the Broussaian doctrine, many practitioners denied the necessity or 
 propriety of that remedy, and attributed to it a thousand evils, 
 experience has shown, and no less an authority than Ricord main 
 tains, that it is superior to every other means, especially in the first 
 stage of the disease, and that in many cases it cannot be superseded 
 by any other. But mercury is found very useful, and even indis 
 pensable in various complaints: in hepatic and other glandular 
 derangements; in inflammation of the serous membranes of the 
 abdomen, chest, and head ; in sundry diseases of the eye ; iritis, for 
 
 1 Op. dt. 185, 180. 
 
AUTUMNAL FEVERS. 489 
 
 example. It is useful also in various other inflammations and en 
 gorgements, and even in some forms of periodic and malignant 
 fevers. Surely, we shall look in vain for a pathologist disposed to 
 conclude that the benefit derived in these latter diseases from mer 
 cury indicates their identity with, or dependence on syphilis, of 
 which mercury must be viewed as the specific. If such an admis 
 sion cannot be entertained if we acknowledge that the advantages 
 derived from mercury, in the diseases mentioned, in no way justify 
 a belief in the identity of these with syphilis, it is difficult to per 
 ceive the propriety of viewing pneumonia as nothing more than a 
 particular form of periodic fever, on the plea that quinia may prove 
 useful when resorted to at the period of remission. The second 
 limb of the argument, founded on treatment, must, therefore, like 
 the first, be set aside. 
 
 The hypothesis of the identity of pneumonia, with autumnal fever 
 not supported by facts and solid arguments. But it is scarcely 
 necessary to pursue the subject any farther. If what has been 
 said is correct, neither the symptoms observed during life; the 
 anatomical characters revealed after death in pneumonia and 
 autumnal fevers ; the treatment found useful ; the mode of pro 
 gression of those diseases; the localities in which they prevail; 
 the external agencies by which they are influenced, nor any other 
 point to which I have adverted, afford any support to the belief 
 of their being pathologically identical, or of their arising from 
 the same cause. The theory under examination must, therefore, 
 fall to the ground, and those who uphold it stand chargeable with 
 having ventured on a hasty and illogical conclusion. Indeed, they 
 have built up, not a theory, but simply an hypothesis, resting on 
 mere assumptions and conjectures. I say assumptions; for we look 
 in vain in the writings of those who, discarding generally received 
 opinions, have revived the hypothesis in question, for any facts or 
 arguments calculated to sustain the position therein assumed. Thus, 
 we are told by Dr. Merrill, in a passage already quoted, that, ac- 
 according to his observations, " the pneumonias which prevail in 
 this country generally sometimes sporadically, and frequently as 
 an epidemic are really and substantially nothing more than a 
 peculiar form of remittent and intermittent fever." In another 
 page the writer says : " Let us talk as learnedly, and refine, dis 
 criminate, and vary our nomenclature as we may, to suit the fash- 
 
490 PNEUMONIA AND 
 
 ion of the times ; when we come to deal witli plain facts, as they are 
 presented to us in practice, this whole class of diseases, to which I 
 have here alluded (pleurisy, pneumonia, &c.), will be found to take 
 its appropriate place under the plain designation, periodic fever." 
 This fever, it is maintained, is a general disease, affecting the whole 
 system; but this general disease probably never exists without 
 evincing a strong determination of diseased action to some par 
 ticular organs. If the brain be particularly implicated, the disease 
 assumes the shape of phrenitis ; if the stomach, we have gastritis ; if 
 the liver, hepatitis ; if the lungs, pneumonia, &c. All this, and 
 much more of the same tenor, is affirmed as matter of fact. The 
 decision, as it would seem, is without appeal ; and all who refuse to 
 acquiesce in it, run great risk of being stigmatized as having re 
 mained behind the times. But no pains is taken no attempt 
 made to substantiate the particular opinions thus thrown out. 
 Nothing is offered in their support ; nothing calculated to show that 
 the writer, who has hazarded them, is right, and all who have enter 
 tained, or continue to entertain different sentiments, are wrong. 
 So far from it, we discover nothing but the bare statement; nothing 
 having the most distant appearance of proof; nothing, certainly, so 
 far at least as I have been able to discover, which may be viewed 
 in the light of solid or plausible argument, based on correct and 
 accurately observed facts, and calculated to satisfy sound patho- 
 logists and etiologists. For it cannot be supposed, after all that 
 precedes, and in the present state of professional opinion relative to 
 the reality and frequency of complications, arising from the co- 
 agency of two or more distinct and independent causes, and of the 
 successive evolution of separate diseases, that we shall admit, as a 
 sufficient proof of the identity contended for, the circumstance that 
 in some cases the symptoms of pneumonia are combined with a 
 greater or less number of those of periodic or malignant fever, and 
 vice versa; that pneumonia coexists with, or succeeds to, these 
 fevers ; and that when the affection of the lungs, owing to such a 
 complication, or to some other morbid agency, assumes the remit 
 tent or intermittent type, quinia will be found an appropriate 
 remedy. 
 
 Let it not be said, in proof of the unity of all febrile diseases 
 the thoracic and other inflammations included and of the identity 
 of their efficient cause, that writers draw a line of distinction be 
 tween two cases of disease, in which no one can detect the slightest 
 
AUTUMNAL FEVEES. 491 
 
 difference while they are in progress. Let us not be told, by our 
 opponents, that "it may be a good employment for students in medi 
 cine to learn the distinctive character of each variety so invented 
 and described, but when we approach the bedside of the sick, we 
 find it difficult enough, and useless enough, to designate the precise 
 nosological position to which each particular case belongs." As 
 suredly, the thrust here made at medical writers cannot have refer 
 ence to the distinction they may point out between pneumonia and 
 periodic fever; for it is scarcely possible to suppose that any one 
 who has attended one month to clinical studies could confound them 
 together so far as regards their phenomenal and anatomical characters. 
 Allusion must be made to the line of distinction drawn between the 
 various forms of fevers themselves. Now, I take upon myself to 
 answer, that though some writers, as Copland, may have been 
 guilty of too much refinement in their subdivisions of fevers, the 
 fault is not universal; that in writings of deserved reputation, no 
 greater number of varieties of that class of disease is admitted than 
 can be proved to have an independent existence; and that, so far 
 from there being any reason to conclude that there is not the 
 slightest difference discoverable during the progress of cases be 
 tween which writers draw the line in question, it is ten, nay, a 
 hundred to one, that, when an identity between such cases is affirmed 
 to exist, by the ordinary run of physicians, in opposition to the 
 opinion of professional writers of admitted experience, and who, 
 while having at their command the means of investigating the sub 
 ject on a sufficiently ample scale, and in all its branches, are well 
 trained in the art of conducting such an investigation, the cause of 
 the opposition is to be found, not in the fact that the latter are 
 really at fault, but in the inattention, carelessness, theoretical pre 
 possessions or limited knowledge of the individual who undertakes 
 to pronounce an opinion on the nature and proper nosological posi 
 tion of the cases placed before him. 
 
 The science of diagnosis is far from being one of the easiest to 
 master. Indeed, the more we proceed in the study of it the more 
 we investigate, analyze, and compare the distinctive features of 
 diseases, their pathognomonic phenomena, their points of analogy 
 and dissimilarity the more satisfied must we become, that it is not 
 every physician who can safely be entrusted with the task of dis 
 criminating between the various forms of febrile complaints, pro 
 perly so called ; especially if these present, as they sometimes do, 
 
492 PNEUMONIA AND 
 
 phenomena of a somewhat approximative character, or blend with 
 each other in the way already mentioned. Errors are often com 
 mitted, especially at the outbreak of an epidemic, even by those 
 who have made a particular study of this branch of medical know 
 ledge, and enjoyed the advantages afforded by an extensive field of 
 observation in public and private practice. They must, necessarily, 
 be more frequently so by the less informed, expert, experienced, or 
 careful members of the profession, or by those who do not enjoy 
 the opportunity, or whose time is too much engrossed to prosecute 
 the study of pathological anatomy and other branches of medical 
 knowledge, without which it is in vain to pretend to accuracy in 
 diagnosis. Individuals of this kind necessarily abound in every 
 community, though nowhere perhaps more than in this country. 
 Many, hence, may be very apt to see identity, where more experi 
 enced, accurate, and trustworthy diagnosticians and pathologists 
 will detect diversity. The physicians of Charleston find no diffi 
 culty in distinguishing the yellow or stranger s fever from the 
 ordinary endemic remittent of the adjacent county, which by some 
 has been, without due attention to distinctive phenomena and other 
 important circumstances, confounded with the former. The same 
 may be said of other diagnosticians and experienced observers in 
 various parts of this country, in the West Indies, on the coasts of 
 South America and Africa, and in Europe, who draw the line of 
 demarcation between those fevers with undeniable precision. 
 
 The best French and English pathologists, as well as many accu 
 rate and sound observers in this country, have learned to draw a 
 proper distinction between typhus and typhoid fevers, and so on 
 of other febrile complaints ; and they would probably demur to the 
 opinion of those who venture to maintain that typhus and typhoid 
 fevers are identical with bilious, remittent, and yellow fevers. In 
 fact, the farther knowledge has advanced the more closely the 
 phenomena of the diseases mentioned have been analyzed and 
 compared the more their mode of progression has been scruti 
 nized and their anatomical characters minutely and accurately 
 studied, the greater has been the tendency among medical men to 
 draw a precise line of distinction between their several forms. So 
 great, indeed, has been the change in that respect such the in 
 crease in the number of its advocates in quarters where minute 
 and correct observations are alone to be looked for, that we cannot 
 err greatly, when we express the opinion that the day is not far 
 
AUTUMNAL FEVERS. 493 
 
 distant when physicians generally, regardless of the clamour of a 
 few opponents, will feel no more disposed to jumble up together 
 the different varieties of fevers, as is still but too often done by a 
 certain class of physicians, than they do now to regard, as did our 
 ancestors, smallpox, measles, and scarlet fever as one and the same 
 disease, really and substantially. 
 
 That difficulty is experienced in making out the diagnosis of 
 fevers, especially in the commencement of an attack, no doubt can 
 exist. The difficulty is often felt, even by experienced physicians, 
 in the case of diseases, the nature and causes of which differ essen 
 tially, and which approximate only in being attended by symptoms 
 of constitutional excitement. On this subject I need hardly insist. 
 It is, or certainly ought to be, admitted by all who have the least 
 smattering of practical medicine. If this be true in reference to 
 such diseases, the embarrassment may well be admitted to occur 
 much more frequently when the complaints to be diagnosed are of 
 the same family, though of different species ; for all know that in 
 such diseases the full development of the phenomena which serve to 
 characterize the case, is usually preceded by febrile symptoms veiy 
 similar in all ; and well calculated, on that account, to create diffi 
 culty in respect to the diagnosis. If we take, for example, the 
 incubative symptoms in continued fever, we shall find that the 
 description of them may apply to many of the acute blood or 
 zymotic diseases. 
 
 The following catalogue of symptoms I borrow, like Dr. Simons, 
 from Dr. Watson s matchless book on the practice of medicine. 
 "The expression of the patient s countenance alters; he becomes 
 pale, languid, and abstracted : those about him observe that he is 
 looking very ill. lie is feeble, and easily tired ; reluctant to make 
 any exertion of mind or body ; listless, and often apprehensive of 
 some impending evil ; he loses his appetite ; his tongue becomes 
 white, and inclined to tremble; the bowels are irregular, often con 
 fined, sometimes affected with diarrhoea; his senses lose their 
 natural delicac}^ lie has uneasiness or wandering pains in various 
 parts of the body, and occasionally there is some giddiness ; drow 
 siness, perhaps, during the day, and unsound, unrefreshing sleep at 
 night. In a word, the patient droops. The regular onset of the 
 fever is very frequently, indeed, marked by a shivering lit ; another 
 common phenomenon at the period of the invasion is severe head 
 ache. But you will also perceive, even when there have been no 
 
494 PNEUMONIA AND 
 
 premonitory circumstances, that symptoms arise, even thus early, 
 which belong to the nervous system, and denote some disturbance 
 and alteration in the functions of sensation, thought, and voluntary 
 motion. They are comprised under the general phrase, febrile 
 oppression, and they are different from what we notice when 
 pyrexia or feverishness supervenes upon inflammation. The mus 
 cular power is sensibly enfeebled. Sometimes the patient will 
 struggle against this, but in a few hours, or in a day or two at far 
 thest, he takes to his bed." 
 
 To these symptoms, which, as Dr. Simons remarks, constitute 
 equally a picture of most of the diseases of the class, there succeed 
 a stage of reaction in which fever runs more or less high. The 
 skin is hot and dry, sometimes moist ; the pulse is excited, thirst is 
 developed, and so on of other symptoms familiar to all physicians ; 
 and it is only after these have continued more or less time that the 
 characteristic phenomena manifest themselves, and the true nature 
 of the case is satisfactorily made out. Exceptional cases, doubtless, 
 are found, in which from peculiar signs, aided by various concomi 
 tant circumstances, the diagnosis may be established earlier. But 
 in general it is not so; and every prudent physician finds it better 
 to avoid precipitancy in the expression of his opinion. With Dr. 
 Nott, therefore, we must all concur, when he remarks : " If a phy 
 sician were called in the forming stage of a number of cases of the 
 plague, smallpox, yellow fever, some forms of typhus, and other 
 diseases arising from morbid poisons, as well as certain vegetable 
 poisons, he would be much at a loss how to distinguish them for 
 two or three days ; and in some of those in which the characteristic 
 signs are never developed, as smallpox without eruption, &c., a 
 diagnosis never could be made. It should not be wondered at, 
 then, that difficulty of diagnosis should sometimes occur between 
 bilious and yellow fever, which belong to the same family, the same 
 season, and (often) the same locality." 1 Another cause of difficulty 
 in the diagnosis depends on the occurrence of the complications 
 already adverted to ; for it is a circumstance well understood by 
 observant and experienced pathologists, and which has not escaped 
 the notice of some of our distinguished Southern physicians, that 
 when two or more epidemic or atmospheric diseases prevail to 
 gether, they become blended. Under circumstances of the kind, 
 
 1 N. 0. J. iv. 584. 
 
AUTUMNAL FEVERS. 495 
 
 yellow fever, especially if it prevails in a mild form, and does not, 
 by the wide diffusion and great energy of the poison giving rise to 
 it, take exclusive possession of the field, becomes more or less 
 blended with remittents and intermittents of all grades, and forms 
 with these compounds, which may sometimes embarrass the most 
 correct diagnostician, and are sure to puzzle and confuse those less 
 expert in matters of the sort, and to lead them to doubt the pro 
 priety of establishing a line of demarcation between those fevers. 
 
 The physician who would be astonished at the appearance of 
 black vomit, in a case of what he fancies to be ordinary fever, and 
 who would always wait till the occurrence of that formidable symp 
 tom before establishing his diagnosis and pronouncing the disease 
 to be yellow fever who could not know the latter to be such till 
 the patient was in articulo mortis should be advised (supposing the 
 case to have been really of the kind mentioned for every one 
 knows that black vomit alone is not sufficient to characterize yellow 
 fever) to go back to school, or to keep his eyes wider open the next 
 time. If the appearance of black vomit were indispensable to enable 
 the physician to establish his diagnosis, it would follow that, in a 
 large proportion of cases of what there can be no doubt is yellow 
 fever, the true nature of the disease could not be positively ascer 
 tained. As a general rule, it may be stated that, in cases that reco 
 ver, black vomit does not make its appearance. In this city, the 
 mortality among the reported cases has averaged one in 2.12, the 
 proportion varying from one in 1.2 to one in 3.86. In other places, 
 the loss has occasionally been less. The number of those who 
 escape that symptom must hence be everywhere larger than that 
 of those who suffer from it. The amount of the former will be 
 found to be even greater than here stated; for those who die do not 
 all eject the fluid, and it then requires an autopsy to ascertain that 
 it has been effused. And yet no difficulty is experienced, in those 
 who recover, or die without throwing up the black matter, in dis 
 tinguishing the disease from other forms of febrile complaints. 
 Such errors are generally the result of want of skill or want of at 
 tention on the part of the observer ; for the yellow fever, as also 
 the remittent, present, together with phenomena approximating 
 them to each other and to different complaints, characteristic fea 
 tures of their own, which, when duly and carefully examined and 
 analyzed, prevent the one from being mistaken for the other, 
 except in cases of an anomalous or complicated nature, or at the 
 
496 PNEUMONIA AXD 
 
 very outset of the attack of mild cases especially or which, at 
 any rate, enable the physician to establish his diagnosis, in the ordi 
 nary forms of the disease, long before the accession of that formida 
 ble symptom. The blunders of the unskilful or careless, or the 
 fancies of the Unitarian must not be urged in denial of the possi 
 bility of tracing a line of distinction between the different forms of 
 autumnal fevers. Let them, by way of encouragement, peruse the 
 following statement made by a clever physician of Mobile : Two 
 clergymen of this city, Mr. Balzan and Mr. Dorman, whose active 
 benevolence has won for them much correct information in relation 
 to fevers, have frequently, in my private and hospital practice, de 
 signated each variety and grade of fever with the greatest ease and 
 correctness, separating the grave from the ephemeral cases of yellow 
 fever, and distinguishing these again from periodic fever. In their 
 diagnosis they were governed by the character of fever, pain, rest 
 lessness, colour of skin, physiognomy, paroxysms, and nature of the 
 secretions. 1 
 
 I have not ^infrequently heard it affirmed by physicians of the 
 South, who favour the opinion under examination, that the identity 
 contended for is shown by the fact that men digging down a bluff 
 will often become sickly, and have fever with periodicity. Physi 
 cians who attend them report some to be affected with hepatitis 
 with complication of pneumonia, and the reverse ; others to have 
 gastritis complicated with phrenitis, and the reverse; enteritis, ne 
 phritis, &c., with their complications; remittent bilious fever, inter 
 mittent fever, yellow fever, &c. &c. Now, it is argued, all these men 
 derive their sickliness from the same cause the digging down 
 of a bluff, &c. If one and the same cause can produce so many 
 groups of morbid phenomena, docs it not seem almost certain that 
 the disease thus engendered, though designated by as many as forty 
 different names, is essentially the same in all cases ? 
 
 For my part I must, with due deference, demur to this conclu 
 sion, and express the belief that I shall be fully sustained by many 
 well-informed and experienced physicians on this and the other side 
 of the Atlantic, Avhen I deny the possibility of so great a variety 
 and diversity of well-marked effects resulting from the agency of 
 one and the same cause; or of the same disease assuming such a 
 diversity of forms as to simulate as many as forty separate diseases, 
 
 1 Lewis, Fever of Mobile in 1847, N. 0. J. v. 40. 
 
AUTUMXAL FEVEKS. -i97 
 
 each entitled to a separate name, and occupying a separate place in 
 our nosological arrangements. If it be found that . a number of 
 men, employed in cutting clown a bluff, are seized with a diversity 
 of what we are accustomed to regard as distinct diseases, and that 
 these are all referred to the same cause; or if we are told that the 
 disease in all these cases is the same, but has assumed a diversity 
 of aspects, and merely presented itself in a variety of groups of 
 symptoms, which, though having in many instances little or no 
 resemblance to each other, are nevertheless the offspring of one 
 and the same parent, pathologists will, in all probability, be dis 
 posed to accuse the reporters with, betraying a great deficiency of 
 knowledge, both as regards the nature and causation of the morbid 
 phenomena described ; or with an unpardonable degree of hastiness 
 and carelessness in the manner of making their observations and 
 drawing their conclusions; or perhaps with being under the spell 
 of some preconceived notion or favourite hobb}^. The digging 
 of no ditch or can^ the cutting down of no bluff, the levelling 
 of no streets, has ever produced, such diversified complaints; and 
 when we hear of physicians giving many names no matter whe 
 ther ten or forty to the morbid phenomena resulting from the 
 agency of exhalations issuing from the upturned earth, we may 
 safely set them down as erring; and as having, owing to their in 
 ability to establish a correct diagnosis, regarded in the light of dis 
 tinct diseases what other and more careful observers would have 
 found to be otherwise. On the other hand, when several diseases 
 are really found to occur among men thus similarly employed a 
 circumstance not unlikely to occur it is much more natural to 
 conclude that different causes have been simultaneously at work, 
 and that each has produced its legitimate effects, than to attribute 
 those diseases to the same agent, which, from our experience else 
 where, and under different circumstances, we have reason to think 
 are incapable of giving rise to such multitudinous and diversified 
 phenomena. Such diggings and cuttings produce no catarrh, no 
 pleurisy, no pneumonia, &c. ; and if .those diseases occur among the 
 diggers and cutters, there is no reason why they should not be 
 occasioned by the causes that produce them elsewhere ; as well 
 where fevers prevail, as where they are not observed ; as well where 
 the fresh, earth has been recently exposed, as where it has not been 
 disturbed. From such operations, when undertaken in particular 
 seasons of the year, in certain localities, and within certain degrees 
 32 
 
498 PNEUMONIA AND 
 
 of terrestrial altitude, diseases, sometimes of a formidable character^ 
 undoubtedly result. This was exemplified in New Orleans at the 
 time of the opening of the Carondelet Canal, in 1794-1797; in the 
 same city, during the extensive paving executed in 1817, 1824, 
 1832 ; and at the opening of the Bank Canal, in 1832-1835. It was 
 also exemplified in Natchez, at the period of the levelling of the 
 streets, in 1816, 1825; at Memphis, Tenn., within the last few years; 
 and, indeed, as already seen, in every place where canals, ditches, 
 and other excavations have been made, and the earth extensively 
 upturned. But in all such instances the disease produced has been 
 fever; often of a malignant, at other times of a remittent form; 
 according to the season of the year, the peculiarities of the weather, 
 the nature of the soil, and other influencing circumstances, which 
 it is needless to enumerate. 
 
 I am not ignorant of the fact that, by many physicians who en 
 tertain sentiments different from those expressed in the preceding 
 pages, little or no respect is paid to the opinions of professional 
 writers or teachers, however eminent these may be. Few of my 
 readers can have failed to hear such authorities unceremoniously 
 stigmatized, by those who throw out some new or revive some 
 antiquated and forgotten notion, as being a long way behind the 
 times, and as having not yet renounced the Aristotelian, and fully 
 adopted the Baconian philosophy. It is not uncommon, to hear it 
 affirmed that the whole system of pathology and practice, etiology 
 and physiology of fever and febrile affections, is founded upon pre 
 conceived notions, and not upon facts and inductions, and that it 
 requires to be remodelled on more correct principles. All this, 
 and much more of similar import, we are not unfrequently told in 
 ephemeral publications, and even in works of higher pretensions. 
 I have neither room nor inclination to examine here how far such 
 assertions are warranted, and to enlarge on the degree of improve 
 ment to which medical inquirers and teachers among them have 
 attained in the several departments of medical knowledge, or to 
 inquire Avherc the desired revolution in professional opinion con 
 cerning those important subjects is more likely to originate. It 
 will be sufficient to remark that, in regard to the matter more par 
 ticularly before us, professional investigators the enlightened por 
 tion of them, I mean so far from being sadly behind the times, 
 are, as every unprejudiced reader must know, far ahead of their 
 predecessors ; and that nothing has been said or done bv contem- 
 
AUTU.MXAL FEVERS. 499 
 
 porary writers, in this country or elsewhere, to disprove the cor 
 rectness of their conclusions. It is, indeed, precisely in reference 
 to the very subjects specified, that the science seems to me to have 
 mostly improved. An examination of professional records will 
 show that, in every place where the opportunity of carrying on 
 the investigation on a sufficiently enlarged scale, and with proper 
 minutiae and thoroughness, has presented itself, and where men 
 possessing the talents and knowledge requisite to study and extend 
 the stock of information, and to lay the result of their inquiries 
 effectively before the public, have set to work, the pathology, 
 etiology, and therapeutics of fevers and febrile diseases (including 
 parenchymatous and membranous inflammations) have been dili 
 gently and successfully studied, and our knowledge respecting 
 them has been very greatly enlarged. 
 
 The knowledge thus accumulated has been very freely laid before 
 the medical public, and through means of the writings of those 
 pioneers in the cause of science and of their followers, every read 
 ing physician or teacher has the opportunity, if he thinks fit to 
 embrace it, of becoming fully informed as to the matter in question. 
 If many, therefore, among us and elsewhere, are found to be 
 truly amenable to the charge of being sadly behind the times, the 
 fault necessarily lies with them and no one else. They constitute, 
 at best, only a portion I hope a minority of our professional 
 brethren. Hence, there can scarcely be any more truth or justice 
 in the assertion that medical men, and professional teachers gene 
 rally, must find a place in this category of ignoramuses; that they 
 have all lagged a good way behind the times; that, therefore, their 
 opinions should be discarded on the score of their being antiquated, 
 and no longer on a level with the state of knowledge on the sub 
 ject, than there would be foundation for the idea that the medical 
 inquirer must turn, for truly correct notions regarding the patho 
 logy, causation, or treatment of fevers, to the lucubrations of the 
 above few. The assertion, I say, is not founded in justice, nor on 
 solid ground; for the opinions thus impeached are the result of a 
 considerable amount of correctly observed facts, and are based on 
 philosophical deductions of the strictest kind; and should, as such, be 
 respected till disproved by others founded on equally well observed 
 and equally numerous data. It is certain, indeed, that, so far from 
 the whole system of pathology, &c. of fevers and febrile diseases 
 being founded on preconceived notions, and not upon facts and 
 
000 PNEUMONIA AND 
 
 inductions, a careful survey of what has been done on the subject 
 in France, England, Germany, and the large cities of this country, 
 will show that the views at present entertained are based upon 
 nothing but facts and legitimate deductions, to the exclusion of pre 
 conceived notions; that there never was a period when the en 
 lightened portion of medical men were less disposed to be biased 
 by such notions, and when they have less allowed themselves to be 
 led astray by fanciful speculation in their conclusions on pathological 
 and etiological questions than at present; and that, in fact, such a 
 cutting loose from the shackles of preconceived notions constitutes 
 the distinctive characteristic of the present mode of investigation as 
 regards the nature, the cause, the mode of progression, and the treat 
 ment of fevers and febrile diseases, and, indeed, of every other morbid 
 ailment. The doctrine of Broussais, erroneous as it may appear to 
 many at the present day, was based on important facts, often well 
 explained, and leading to correct or plausible deductions. The at 
 tentive readers of his Pldegmasies Chromques, of his first Examen, and 
 of his Commentaries, will not gainsay me in this. The doctrine was 
 faulty, not in the deficiency of the facts upon which it was based, but 
 in the nature of many conclusions drawn from them. But how was 
 it overthrown ? Certainly, not through the operation of a greater 
 power of reasoning possessed by Broussais s antagonists, for some of 
 the most successful among them are not particularly gifted on 
 that score, but by facts more numerous, more carefully observed 
 and analyzed, and more accurately compared with each other. 
 How have we acquired our present knowledge of the pathology of 
 typhoid fever ? Open the works of Louis, Andral, Chomel, Jenner, 
 Gerhard, Flint, and see whether facts are wanting. How have 
 physicians attained their present views of the pathologv and ana 
 tomical characters of pulmonary or cardiac diseases? How have they 
 learned to ascertain, by means of auscultation and percussion, the 
 condition of internal organs? Is it by abstract reasoning, or by 
 following out and cherishing some exclusive and dominant idea, and 
 forcing everything to bend to it; some preconceived notions; or 
 is it not rather through the instrumentality of facts accumulated 
 in France, England, Germany, and a small portion of this country? 
 It can scarcely be necessary to answer the question. 
 
 Those who raise such an outcry about the necessity of facts, and 
 reprove the most authoritative writers and teachers for a supposed 
 adherence to preconceived notions, and a neglect of the true prin- 
 
AUTUMNAL FEVERS. 501 
 
 ciplcs of the inductive philosophy, should first satisfy the profession, 
 not only that they are less liable to error than their opponents, in 
 drawing deductions from the facts they may happen to collect, but 
 that these facts have been examined in a way calculated to insure 
 advantageous results. They should remember that, great as the 
 number of useless theories may be, it sinks into insignificance 
 when compared with the amount of incomplete facts which float 
 around us. To observe accurately to seize the important and 
 useful points in the case examined to discover its true bearing 
 to other cases, its exact analogy to or dissimilarity from them 
 to ascertain its dependence on, or independence of, surrounding 
 influences to point out accurately the morbid agencies which have 
 produced it, and to ascend by an analysis of its symptoms and 
 anatomical characters, to its pathological nature and therapeu 
 tical indications, require a degree of skill, a tact, a habit of close 
 observation that are not easily acquired, as well as opportunities for 
 investigation that do not fall to the lot of every one. And yet a 
 writer must give proof of possessing them before he can expect to 
 command the attention of the cautious inquirer, and change the 
 current of professional belief. " A vast mass of facts," says a recent 
 writer, "may be collected and tabulated the numerical method 
 may be applied in every conceivable mode and yet, so long as no 
 connecting idea is discovered among them, they remain utterly 
 incapable of serving for the establishment of those general prin 
 ciples which enable true science to predict with certainty what will 
 not occur in any given contingency; and which, therefore, furnish 
 the only satisfactory basis for the use of art as to what should or 
 should not be done." A great master, Montesquieu, has said: "Un 
 fait qui n emporte pas une idee, duquel on ne pent pas s elever 
 pour voire plus loin, est un caillou qui ne vaut pas la peine d etre 
 ramasse, et qu il faut au contraire repousser du pied pour en de- 
 barasser la route." 
 
 What the result of the mode of proceeding adopted at this day 
 by standard pathologists has been as regards the distinctive pathog- 
 nomonic marks, and the separate nosological positions of the 
 several forms of fevers, properly so called, has already been stated. 
 Much the same may be found in reference to other febrile com 
 plaints dependent on local inflammation, as well as to other dis 
 eases ; to the symptoms and anatomical characters by which they 
 are recognized, and which distinguish them from each other and 
 
502 PNEUMONIA AND AUTUMNAL FEVERS. 
 
 from the pyrexiae, as well as to the causes by which they are pro 
 duced. Now if in the course of this revolutionizing movement, 
 and at the present period of progressive improvement, some medical 
 writers or teachers are really found to be a long way behind the 
 times, it can scarcely be those who have taken an active part in the 
 race of investigation, who have helped to overthrow old and 
 erroneous views, and, by appealing to facts, to place matters in a 
 proper light, or who have diligently and carefully studied the works 
 of modern standard writers. They must be sought elsewhere. 
 
 Here I must close the remarks I wished to offer in opposition to 
 the supposed connection between pneumonia and periodic fevers. 
 They have extended far beyond what was originally intended. For 
 this the reader is entitled to many apologies. The greater part of 
 the volume thus inflicted on him was penned somewhat in haste, 
 and under the pressure of a variety of circumstances unfavourable 
 to minute investigation, systematic arrangement, and correct com 
 position. With more tranquillity around me, with a larger share 
 of health than I have recently enjoyed, with a freer and more con 
 stant access to publications relating to the questions at issue, and 
 especially with more leisure at my command, it might have been 
 presented in a shape more acceptable to those who will do me the 
 honour to peruse it. But I must plead as an excuse, the same reason 
 which Voltaire assigned for having written a very long letter to 
 one of his princely correspondents I had not time sufficient to 
 write more briefly. Such as it is, with all its many imperfections 
 and gross defects of commission and omission, these remarks are 
 placed before the medical public in the hope that they may do some 
 service, and contribute in some measure to the settlement of the 
 question ; or at any rate that they may excite in others, better 
 qualified for the task, a desire to point out, in an ampler, clearer, 
 more logical, and more forcible manner, the groundless nature and 
 dangerous tendencies of the pathological and etiological heresies to 
 which I have called attention. 
 
 THE END 
 
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 collateral sciences, we beg to remark that no exertions are spared to render the issues 
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 both as regards the high character of the works themselves, and in respect to every 
 point of typographical accuracy, and mechanical and artistical execution. Gentlemen 
 desirous of adding to their libraries from our list, can in almost all cases procure the 
 works they wish from the nearest bookseller, who can readily order any which 
 may not be on hand; and who, as well as ourselves, will be happy to answer any 
 inquiries as to price, &c. 
 
 BLANCHARD & LEA. 
 
 PHILADELPHIA. February. 1853. 
 
 TWO MEDICAL PERIODICALS, FREE OF POSTAGE, 
 
 FOR FIVE DOLLARS PER 
 
 THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, subject to 
 postage, when not paid for in advance, ....... $5 00 
 
 THE MEDICAL NEWS AND LIBRARY, invariably in advance, - - 1 00 
 or, BOTH PERIODICALS furnished, FREE OF POSTAGE, for Five Dollars remitted 
 in advance. 
 
 THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
 EDITED BY ISAAC HAYS, M. D., 
 
 is published Quarterly, on the first of January, April, July, and October. Each number contains 
 at least two hundred and eighty large octavo pages, appropriately illustrated, wherever necessary, 
 by engravings. It has now been issued regularly for a period of THIRTY-FIVE years, during a quarter 
 of a century of which it has been under the control of the present editor. Throughout this long 
 space of time, it has maintained its position in the highest rank of medical periodicals both at home 
 and abroad, and has received the cordial support of the entire profession in this country. Its list of 
 Collaborators will be found to contain a large number of the most distinguished names of the pro 
 fession in every section of the United States, rendering the department devoted to 
 
 ORIGINAL COMMUNICATIONS 
 
 full of varied and important matter, of great interest to all practitioners. 
 
 As the aim of the Journal, however, is to combine the advantages presented by all the different 
 varieties of periodicals, in its 
 
 REVIEW DEPARTMENT 
 
 will be found extended and impartial reviews of all important new works, presenting subjects of 
 novelty and interest, together with very numerous 
 
 BIBLIOGRAPHICAL NOTICES, 
 
 including nearly all the medical publications of the day, both in this country and Great Britain, with 
 a choice selection of the more important continental works. This is followed by the 
 
BLANCHARD & LEA S MEDICAL 
 
 QUARTERLY SUMMARY, 
 
 being a very full and complete abstract, methodically arranged, of the 
 
 IMPROVEMENTS AM DISCOVERIES IN THE MEDICAL SCIENCES, 
 
 This department of the Journal, so important to the practising physician, is the object of especial 
 care on the part of the editor, it is classified and arranged under different heads, thus facilitating 
 the researches of the reader in pursuit of particular subjects, and will be found to present a very 
 lull and accurate digest of all observations, discoveries, and inventions recorded in every branch of 
 medical science. The very extensive arrangements of the publishers are such as to afford to th 
 editor complete materials for this purpose, as he not only regularly receives 
 
 ALL THE AMERICAN MEDICAL AND SCIENTIFIC PERIODICALS, 
 
 but also twenty or thirty of the more important Journals issued in Great Britain and on the Conti 
 nent, thus enabling him to present, in a convenient compass a thorough and complete abstract of 
 everything interesting or important to the physician occurring in any part of the civilized world. 
 
 An evidence of the success which has attended these efforts may be found in the constant and 
 >teady increase in the subscription li>t, which renders it advisable for gentlemen desiring the 
 Journal, to make known their wishes at an early day, in order to secure a year s set with certainty, 
 the publishers having frequently been unable to supply copies when ordered late in the year. To 
 their old subscribers, many of whom have been on their list for twenty or thirty years, the publish 
 ers ieel that no promises are necessary; but those who may desire for the first time to subscribe, 
 can rest assured that no exertion will be spared to maintain the Journal in the high position which 
 it has occupied for so long a period. 
 
 By reference to the terms it will be seen that, in addition to this large amount of valuable and 
 practical information on every branch of medical science, the subscriber, by paying in advance, 
 Incomes entitled, without further charge, to 
 
 THE MEDICAL NEWS AND LIBRARY, 
 
 a monthly periodical of thirty-two large octavo pages. Its "NEWS DEPARTMENT" presents the 
 current information of the day, while the " LIBRARY DEPARTMENT" is devoted to presenting stand 
 ard works on various branches of medicine. Within a few years, subscribers have thus received, 
 without expense, the following works which have passed through its columns : 
 
 WATSON S LECTURES ON THE PRACTICE OF PHYSIC. 
 
 BRODIE S CLINICAL LECTURES ON SURGERY. 
 
 TODD AND BOWMAN S PHYSIOLOGICAL ANATOMY AND PHYSIOLOGY OF MAN. 
 
 724 pages, with numerous wood-cuts, being all that has vet appeared in England. 
 WEST S LECTURES ON THE DISEASES OF INFANCY AND CHILDHOOD. 
 MALGAIGNE S OPERATIVE SURGERY, with wood-cuts. 
 SIMON S LECTURES ON GENERAL PATHOLOGY. 
 BENNETT ON PULMONARY TUBERCULOSIS, with wood-cuts, and 
 WEST ON ULCERATION OF THE OS UTERI. 
 
 While the year 1855, presents 
 BROWN ON THE SURGICAL DISEASES OF FEMALES. 
 
 HANDSOMELY ILLUSTRATED ON WOOD. 
 
 The diseases treated in this volume have hitherto not received from writers of systematic 
 works the attention to which their importance entitles them. In treatises on female diseases they 
 have been but little noticed, as belonging more properly to the surgeon, while our surgical text-books 
 have in like manner referred them to the writer on midwifery and female affections. In supplying 
 this palpable vacancy in medical literature, Mr. Brown has brought to his subject the result of 
 many years of observation and experience, and his labors will prove of much value to all practi 
 tioners. The publishers therefore flatter themselves that in securing this volume for the " LIBRARY 
 DEPARTMENT" of the " MEDICAL NEWS" they will meet the wishes of their numerous subscri 
 bers, who will thus receive this highly important work free of all expense. 
 
 It will thus be seen that for the small sum of FIVE DOLLARS, paid in advance, the subscriber 
 will obtain a Quarterly and a Monthly periodical, 
 
 EMBRACING ABOUT FIFTEEN HUNDRED LARGE OCTAVO PAGES, 
 
 mailed to any part of the United States, free of postage. 
 
 These very favorable terms are now presented by the publishers with the view of removing all 
 difficulties and objections to a full and extended circulation of the Medical Journal to the office of 
 every member of the profession throughout the United Slates. The rapid extension of mail facili 
 ties, will now place the numbers before subscribers with a certainty and dispatch not heretofore 
 attainable; while by the system now proposed, every subscriber throughout the Union is placed 
 upon an equal footing, at the very reasonable price of Five Dollars for two periodicals, without 
 further expense. 
 
 Those subscribers who do not pay in advance will bear in mind that their subscription of Five 
 Dollars will entitle them to the Journal only, without the News, and that they will be at the expense 
 of their own postage on the receipt of each number. The advantage of a remittance when order 
 ing the Journal will thus be apparent. 
 
 As the Medical News and Library is in no case sent without advance payment, its subscribers 
 will alwnys receive it free of postage. 
 
 It should also be borne in mind that the publishers will now take the risk of remittances by mail, 
 only requiring, in cases of loss, a certificate from the subscriber s Postmaster, that the money was 
 duly mailed and forwarded. 
 
 Address, BLANCHARD & LEA, PHILADELPHIA. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 ANALYTICAL COMPENDIUM 
 OF MEDICAL SCIENCE, containing Anatomy, Physiology, Surgery, Midwifery, 
 
 Chemistry, Materia Medica, Therapeutics, and Practice of Medicine. By JOHN NEILL, M. D., 
 and F. G. SMITH, M. D. Second and enlarged edition, one thick volume royal 12mo. of over 
 1000 pages, with 350 illustrations. E2T See NEILL. 
 
 ABEL (F. A.), F. C. S. 
 
 Professor of Chemistry in the Royal Military Academy, Woolwich. 
 
 AND 
 
 C. L. BLOXAM, 
 
 Formerly First Assistant at the Royal College of Chemistry. 
 
 HANDBOOK OF CHEMISTRY, Theoretical, Practical, and Technical, with a 
 Recommendatory Preface by Dr. HOFMANN. In one large octavo volume of 602 pages, with 
 illustrations. (Now 
 
 The present volume is a synopsis of their (the lent guide, since he will find in it, not merely the 
 
 authors ) experience in laboratory teaching ; it gives 
 the necessary instruction in chemical manipulation, 
 
 approved modes of analytical investigation, but most 
 descriptions of the apparatus necessary- with such 
 
 a concise account of general chemistry as far as it is manipulatory details as rendered Faraday s Che- 
 involved in the operations of the laboratory, and last- mical Manipulations so valuable at the time of its 
 ly, qualitative and quantitative analysis. Itmustbe publication. Beyond this, the importance of the 
 understood that this is a work fitted for the earnest work is increased by the introduction of much of 
 student, who resolves to pursue for himself a steady 
 search into the chemical mysteries of creation. Fo r 
 such a student the Handbook will prove an excel- 
 
 the technical chemistry of the manufactory." Dr 
 Hofmann s Preface. 
 
 ASHVVELL (SAMUEL), 
 
 Obstetric Physician and Lecturer to Guy s Hospital, London. 
 
 A PRACTICAL TREATISE ON THE DISEASES PECULIAR TO WOMEN. 
 
 Illustrated by Cases derived from Hospital and Private Practice. Third American, from the Third 
 and revised London edition. In one octavo volume, of over 500 pages. (Now Ready.) 
 The most able, and certainly the most standard | practical skijl, and sound sense. British and Fo- 
 and practical, work on female diseases that we have 
 
 yet seen. Medico-Chirurgical Review. 
 
 We commend it to our readers as the best practi- 
 tical treatise on the subject which has yet appeared 
 London Lancet. 
 
 The young practitioner will find it invaluable, 
 while those who have had most experience will yet 
 find something to learn, and much to commend, in a 
 book which shows so much patient observation, 
 
 reign Med. Revieio. 
 
 With no work are we acquainted, in which the 
 pleasant and the useful are more happily blended. It 
 combines the greatest elegance of style with the 
 most sound and valuable practical information. 
 We feel justified in recommending it, in unqualified 
 terms, to our readers, as a book from which they 
 can scarcely fail to derive both pleasure and im 
 provement. It is truly a model for medical compo 
 sitions. Southern Med. and Surg. Journal. 
 
 ARNOTT (NEILL), M. D. 
 
 ELEMENTS OF PHYSICS; or Natural Philosophy, General and Medical. 
 Written for universal use, in plain or non-technical language. A new edition, by ISAAC HAYS. 
 M. D. Complete in one octavo volume, of 484 pages, with about two hundred illustrations. 
 
 BENNETT (HENRY), M. D. 
 A PRACTICAL TREATISE ON INFLAMMATION OF THE UTERUS 
 
 ITS CERVIX AND APPENDAGES, and on its connection with Uterine Disease. Fourth 
 
 American, from the third and revised London edition. In one neat octavo volume, of 430 pages. 
 
 with wood-cuts. Just Issued.) 
 
 This edition will be found materially improved over its predecessors, the author having carefully 
 revised it, and made considerable additions, amounting to about seventy-h ve pages. 
 
 This edition has been carefully revised and altered, , When, a few years back, the first edition of the 
 and various additions have been made, which render | present \york was published, the subject was oneal- 
 it more complete, and, if possible, more worthy of ] most entirely unknown to the obstetrical celebrities 
 the high appreciation in which it is held by the ; of the day ; and even now \ve have reason to know 
 medical profession throughout the world. A copy j that the bulk of the profession are not fully alive to 
 should be in the possession of every physician. the importance and frequency of the disease of which 
 Charleston Med. Journal and Review. it takes cognizance. The present edition is so much 
 
 We are firmly of opinion that in proportion as a . enlarged, altered, and improved, that it can scarcely 
 knowledge of uterine diseases becomes more appre- \ be considered the same work. Dr. Ranking s Ab- 
 ciated, this work will be proportionably established , stra ct. 
 as a text-book in the profession. The Lancet. 
 
 BROWN (ISAAC BAKER)., 
 
 Surgeon- Accoucheur to St. Mary s Hospital, &c. 
 
 ON SOME DISEASES OF WOMEN ADMITTING OF SURGICAL TREAT 
 MENT. With handsome illustrations. One vol. 8vo. (At Press.) 
 
 Publishing in the "Medical News and Library" for 1855. See preceding pa^e. 
 Mr. Brown has earned for himself a high reputa- : and merit the careful attention of every surgeon- 
 tion in the operative treatment of sundry diseases accoucheur. Association Journal 
 and injuries to which females are peculiarly subject j We have m) hegitation jn re(;O mmendin- this book 
 We can truly say 01 his work that it is an important to the careful attention of all sur , e ons who make 
 addition to obstetrical literature The operative female complaints a part of their /K and practfc" 
 suggestions and contrivances which Mr. Brown de- _ Dublin (j uarterly J OW rna 
 scribes, exhibit much practical sagacity and skill, | 
 
BLANCHARD & LEA S MEDICAL 
 
 BENNETT (J. HUGHES), M.D., F. R. S. E., 
 
 Professor of Clinical Medicine in the University of Edinburgh, &c. 
 
 THE PATHOLOGY AND TREATMENT OF PULMONARY TUBBRCU- 
 
 LOSIS, and on the Local Medication of Pharyngeal and Laryngeal Diseases frequently mistaken 
 lor or associated with. Phthisis. Jn one handsome octavo volume, with beautiful wood-cuts. 
 
 (Noiv Ready.} 
 
 BILLING (ARCHIBALD), M. D. 
 THE PRINCIPLES OF MEDICINE. Second American, from the Fifth and 
 
 Improved London edition. In one handsome octavo volume, extra cloth, 250 pages. 
 
 BLAKISTON (PEYTON), M. D., F. R. S., &c. 
 PRACTICAL OBSERVATIONS ON CERTAIN DISEASES OF THE 
 
 CHEST, and on the Principles of Auscultation. In one volume. 8vo., pp. 384. 
 
 BURROWS (GEORGE), M.D. 
 
 ON DISORDERS OF THE CEREBRAL CIRCULATION, and on the Con 
 nection between the Affections of the Brain and Diseases of the Heart. In one 8vo. vol., with 
 colored plates, pp. 21b . 
 
 BUDD (GEORGE), M. D., F. R. S., 
 
 Professor of Medicine in King s College, London. 
 
 ON DISEASES OF THE LIVER. Second American, from the second and 
 
 enlarged London edition. In one very handsome octavo volume, with four beautifully colored 
 plates, and numerous wood-cuts, pp." 468. New edition. (Just Issued.) 
 
 The reputation which this work has obtained as a full and practical treatise on an important class 
 of diseases will not be diminished by this improved and enlarged edition. It has been carefully and 
 thoroughly revised by the author ; the number of plates has been increased, and the style of its me 
 chanical execution will be found materially improved. 
 
 The full digest we have given of the new matter 
 introduced into the present volume, is evidence of 
 the value we place on it. The fact that the profes 
 sion has required a second edition of a monograph 
 such as that before us, bears honorable testimony 
 to its usefulness. For many years, Dr. Budd s 
 
 work must be the authority of the great mass of 
 British practitioners on the hepatic diseases ; and it 
 is satisfactory that the subject has been taken up by 
 so able and experienced a physician. British and 
 Foreign Medico-Chirurgical Jieview. 
 
 BUSHNAN (J. S.), M. D. 
 THE PHYSIOLOGY OF ANIMAL AND VEGETABLE LIFE; a Popular 
 
 Treatise on the Functions nnd Phenomena of Organic Life. To which is prefixed a Brief Expo 
 sition of the great departments of Human Knowledge. In one handsome royal 12mo. volume, 
 with over one hundred illustrations. 
 
 Though cast in a popular form and manner, this work is the production of a man of science, and 
 presents its subject in its latest development, based on truly scientific and accurate principles. 
 It may therefore be consulted with interest by those who wish to oUlain in a concise form, and at 
 a very low price, a resume of the present staie of animal and vegetable physiology. 
 
 BLOOD AND URINE (MANUALS ON). 
 BY JOHN WILLIAM GRIFFITH, G. OWEN REESE, AND ALFRED 
 
 MARKWICK. One thick volume, royal 12mo., extra cloth, with plates, pp. 460. 
 
 BRODIE (SIR BENJAMIN C.), M. D., &c. 
 CLINICAL LECTURES ON SURGERY. 1 vol. 8vo. ; cloth. 350pp. 
 
 BIRD (GOLDING), A. M., M. D., &c. 
 URINARY DEPOSITS: THEIR DIAGNOSIS, PATHOLOGY, AND 
 
 THERAPEUTICAL INDICATIONS. A new and enlarged American, from the last improved 
 London edition. With over sixty illustrations. In one royal 12mo. volume, extra cloth. 
 
 The new edition of Dr. Bird s work, though not 
 increased in size, has been greatly modified, and 
 much of it rewritten. It now presents, in a com- 
 
 Sendious form, the gist of all that is known and re- 
 lable in this department. From its terse style and 
 convenient size, it is particularly applicable to the 
 student, to whom we cordially commend it. The 
 Medical Examiner. 
 
 It can scarcely be necessary for us to say anything 
 of the merits of this well-known Treatise, which so 
 admirably brings into practical application the re 
 
 sults of those microscopical and chemical researches 
 regarding the physiology and pathology of the uri 
 nary secretion, which have contributed so much to 
 the increase of our diagnostic powers, and to th 
 extension and satisfactory employment of our thera 
 peutic resources. In the preparation of this new 
 edition of his work, it is obvious that Dr. Goldirig 
 Bird has spared no pains to render it a faithful repre 
 sentation of the present state of scientific knowledge 
 on the subject it embraces. The British and Foreign 
 J\Iftlico-C/iirurgical Review. 
 
 BY THE SAME AUTHOR. 
 
 ELEMENTS OF NATURAL PHILOSOPHY; being an Experimental Intro 
 duction to the Physical Sciences. Illustrated with nearly four hundred wood-cuts. From the 
 third London edition. In one neat volume, royal 12rao. pp. 402. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 BARTLETT (ELISHA), M . D., 
 
 Professor of Materia Medica and Medical Jurisprudence in the College of Physicians and 
 Surgeons, New York. 
 
 THE HISTORY, DIAGNOSIS, AND TREATMENT OF THE FEVERS 
 
 OF THE UNITED STATES. Third edition, revised and improved. In one octavo volume, 
 
 of six hundred pages, beautifully printed, and strongly bound. 
 
 In preparing a new edition of this standard work, the author has availed himself of such obser 
 vations and investigations as have appeared since the publication of his last revision, and he has 
 endeavored in every way to render it worthy of a continuance of the very marked favor with which 
 it has been hitherto received. 
 
 The masterly and elegant treatise, by Dr. Bartlett 
 is invaluable to the American student and practi 
 tioner. Dr. Holmes s Report to the Nat. Med. Asso 
 ciation. 
 
 We regard it, from the examination we have made 
 of it, the best work on fevers extant in our language, 
 and as such cordially recommend it to the medical 
 public. St. Louis Medical and Surgical Journal. 
 
 Take it altogether, it is the most complete history 
 
 Of the value and importance of such a work, it is 
 needless here to speak ; the profession of the United 
 States owe much to the author for the very able 
 volume which he has presented to them, and for the 
 careful and judicious manner in which he has exe 
 cuted his task. No one volume with which we are 
 acquainted contains so complete a history of our 
 fevers as this. To Dr. Bartlett we owe our best 
 thanks for the very able volume he has given us, as 
 embodying certainly the most complete, methodical, 
 
 of our fevers which has yet been published, and and satisfactory account of our fevers anywhere to 
 every practitioner should avail himself of its con- be met with. The Charleston Med. Journal and 
 tents . The Western Lancet. I Review. 
 
 BUCKLER (T. H.), M . D., 
 
 Formerly Physician to the Baltimore Almshouse Infirmary, &c. 
 
 ON THE ETIOLOGY, PATHOLOGY, AND TREATMENT OF FIBRO- 
 
 BRONCHITIS AND RHEUMATIC PNEUMONIA. In one handsome octavo volume, extra 
 cloth. (Just Isszied.) 
 
 BOWMAN (JOHN E.), M.D. 
 PRACTICAL HANDBOOK OF MEDICAL CHEMISTRY. In one neat 
 
 volume, royal 12mo., with numerous illustrations, pp. 288. 
 
 BY THE SAME AUTHOR. 
 
 INTRODUCTION TO PRACTICAL CHEMISTRY, INCLUDING ANA- 
 
 LYSIS. With numerous illustrations. In one neat volume, royal 12mo. pp.350. 
 
 BARLOW (GEORGE H.), M . D. 
 A MANUAL OF THE PRINCIPLES AND PRACTICE OF MEDICINE. 
 
 In one octavo volume. (Preparing.) 
 
 BEALE (LIONEL JOHN), M. R. C. S., &c. 
 THE LAWS OF HEALTH IN RELATION TO MIND AND BODY. 
 
 A Series of Letters from an W Practitioner to a Patient. In one handsome volume, royal 12mo., 
 extra cloth. 
 
 COLOMBAT DE L ISERE. 
 A TREATISE ON THE DISEASES OF FEMALES, and on the Special 
 
 Hygiene of their Sex. Translated, with many Notes and Additions, by C. D. MEIGS, M. D. 
 
 Second edition, revised and improved. In one large volume, octavo, with numerous wood-cuts. 
 
 pp. 720. 
 
 The treatise of M. Colombat is a learned and la- i M. Colombat De LTsere has not consecrated ten 
 borious commentary on these diseases, indicating years of studious toil and research to the frailer sex 
 very considerable research, great accuracy of judg- in vain; and although we regret to hear it is at the 
 ment, and no inconsiderable personal experience, expense of health, he has imposed a debt of gratitude 
 With the copious notes and additions of its experi- as well upon the profession, as upon the mothers and 
 eiiced and very erudite translator and editor, Dr. daughters of beautiful France, which that gallant 
 Meigs, it presents, probably, one of the most com- nation knows best how to acknowledge. New Or- 
 plete and comprehensive works on the subject we leans Medical Journal. 
 possess. American Med. Journal. \ 
 
 COPLAND (JAMES), M . D., F. R. S., c. 
 OF THE CAUSES, NATURE, AND TREATMENT OF PALSY AND 
 
 APOPLEXY, and of the Forms, Seats, Complications, and Morbid Relations oi Paralytic and 
 Apoplectic Diseases. In one volume, royal 12mo., extra cloth, pp. 326. 
 
 CLYMER (MEREDITH), M. D., &c. 
 FEVERS; THEIR DIAGNOSIS, PATHOLOGY, AND TREATMENT. 
 
 Prepared and Edited, with large Additions, from the Essays on Fever in Tweedie s Library of 
 Practical Medicine. In one octavo volume, of 600 pages. 
 
 CARSON (JOSEPH), M. D., 
 
 Professor of Materia Medica and Pharmacy in the University of Pennsylvania. 
 
 SYNOPSIS OF THE COURSE OF LECTURES ON MATERIA MEDICA 
 
 AND PHARMACY, delivered in the University of Pennsylvania. In one very neat octavo 
 volume, of 208 pages. 
 
BLANCHARD & LEA S MEDICAL 
 
 CARPENTER (WILLIAM B.), M.D., F. R. S., &c., 
 
 Examiner in Physiology and Comparative Anatomy in the University of London. 
 
 PRINCIPLES OF HUMAN PHYSIOLOGY; with their chief applications to 
 
 Psychology, Pathology, Therapeutics, Hygiene, and Forensic Medicine. Fifth American, from 
 the fourth and enlarged London edition. With three hundred and fourteen illustrations. Edited, 
 with additions, by FRANCIS GURNEY SMITH, M. D., Professor of the Institutes of Medicine in the 
 Pennsylvania Medical College, &c. In one very large and beautiful octavo volume, of about 1100 
 large pages, handsomely printed and strongly bound in leather, with raised bands. New edition. 
 (Lately Issued.) 
 
 The most complete work on the science in our i The best text-book in the language on this ex- 
 language. Am. Med. Journal. tensive subject. London Med. Times. 
 
 A complete cyclopaedia of this branch of science. 
 N. Y. Med. Times. 
 
 The most complete exposition of physiology which 
 any language can at present give. Brit, and For. 
 
 Med.-C/iirurg. Review. 
 
 We have thus adverted to some of the leading 
 "additions and alterations," which have been in 
 troduced by the author into this edition of his phy 
 siology. These will be found, however, very far to 
 exceed the ordinary limits of a new edition, "the 
 old materials having been incorporated with the 
 new, rather than the new with the old." It now 
 certainly presents the most complete treatise on the 
 subject within the reach of the American reader; 
 and while, for availability as a text-book, we may 
 perhaps regret its growth in bulk, we are sure that 
 the student of physiology will feel the impossibility 
 of presenting a thorough digest of the facts of the 
 science within a more limited compass. Medical 
 Examiner. 
 
 The greatest, the most reliable, and the best book 
 on the subject which we know of in the English 
 
 The standard of authority on physiological sub- 
 
 ! jects. * * * In the present edition, to particularize 
 
 the alterations and additions which have been made, 
 
 would require a review of the whole work, since 
 
 scarcely a subject has not been revised and altered, 
 
 added to, or entirely remodelled to adapt it to the 
 
 present state of the science. Charleston Med. Journ. 
 
 Any reader who desires a treatise on physiology 
 
 may feel himself entirely safe in ordering this. 
 
 Western Med. and Surg. Journal. 
 
 From this hasty and imperfect allusion it will be 
 seen by our readers that the alterations and addi 
 tions to this edition render it almost a new work 
 and we can assure our readers that it is one of the 
 best summaries of the existing facts of physiological 
 science within the reach of the English student and 
 physician. N. Y. Journal of Medicine. 
 j The profession of this country, and perhaps also 
 , have anxiously and for some time awaited 
 
 language. Stethoscope. . the announcem ent of this new edition of Carpenter s 
 
 The most complete work now extant in our Ian- Human Physiology. His former editions have for 
 
 guage. N. O. Med. Register. 
 
 The changes are too numerous to admit of an ex 
 tended notice in this place. At every point where 
 the recent diligent labors of organic chemists and 
 micrographers have furnished interesting and valu 
 able facts, they have been appropriated , and no pains 
 have been spared, in so incorporating and arranging 
 
 many years been almost the only text-book on Phy 
 siology in all our medical schools, and its circula 
 tion among the profession has been unsurpassed by 
 any work in any department of medical science. 
 
 It is quite unnecessary for us to speak of thig 
 work as its merits would justify. The mere an 
 nouncement of its appearance will afford the highest 
 pleasure to every student of Physiology, while its 
 
 them that the work may constitute one harmonious ! perusal will be of infinite service in advancing 
 system. Southern Med. and Surg. Journal. I physiological science. Ohio Med. and Surg. Journ. 
 
 BY THE SAME AUTHOR. (Now Ready.) 
 
 PRINCIPLES OF COMPARATIVE PHYSIOLOGY. New American, from 
 
 the Fourth and Revised London edition. In one large and handsome octavo volume, with over 
 
 three hundred beautiful illustrations. 
 
 The delay which has existed in the appearance of this work has been caused by the very thorough 
 revision and remodelling which it has undergone at the hands of the author, and the large number 
 of new illustrations which have been prepared for it. It will, therefore, be found almost a new 
 work, and fully up to the day in every department of the subject, rendering it a reliable text-book 
 for all students engaged in this branch of science. Every effort has been made to render its typo 
 graphical finish and mechanical execution worthy of its exalted reputation, and creditable to" the 
 mechanical arts of this country. A few notices of the last edition are appended. 
 
 Without pretending to it, it is an Encyclopedia of 
 the subject, accurate and complete in all respects 
 a truthful reflection of the advanced state at which 
 
 the science has now arrived. Dublin Quarterly 
 Journal of Medical Science. 
 
 A truly magnificent work in itself a perfect phy 
 siological study. Ranking s Abstract. 
 
 This work stands without its fellow. It is one 
 few men in Europe could have undertaken ; it is one 
 no man, we believe, could have brought to so suc 
 cessful an issue as Dr. Carpenter. It required for 
 its production a physiologist at once deeply read in 
 ithe labors of others, capable of taking a general, 
 
 critical, and unprejudiced view of those labors, and 
 of combining the varied, heterogeneous materials at 
 his disposal, so as to form an harmonious whole. 
 We feel that this abstract can give the reader a very 
 imperfect idea of the fulness of this work, and no 
 idea of its unity, of the admirable manner in which 
 material has been brought, from the most various 
 sources, to conduce to its completeness, of the lucid 
 ity of the reasoning it contains, or of the clearness 
 of language in which the whole is clothed. Not the 
 profession only, but the scientific world at large, 
 must feel deeply indebted to Dr. Carpenter for this 
 great work. It must, indeed, add largely even to 
 his high reputation. Medical Times. 
 
 BY THE SAME AUTHOR. (Preparing.) 
 
 THE MICROSCOPE AND ITS REVELATIONS. In one handsome volume, 
 
 beautifully illustrated with plates and wood-cuts. 
 
 BY THE SAME AUTHOR. (Preparing.) 
 
 GENERAL PHYSIOLOGY. In one large and very handsome octavo volume ; 
 with several hundred illustrations. 
 
 The subject of general physiology having been omitted in the last edition of the author s Com 
 parative Physiology," he has undertaken to prepare a volume which shall present it more tho 
 roughly and fully than has yet been attempted, and which may be regarded as an introduction to 
 his other works. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 CARPENTER (WILLIAM B-), M. D., F. R. S., 
 
 Examiner in Physiology and Comparative Anatomy in the University of London. 
 
 ELEMENTS (OR MANUAL) OF PHYSIOLOGY, INCLUDING PHYSIO 
 
 LOGICAL ANATOMY. Second American, from a new and revised London edition. With 
 one hundred and ninety illustrations. In one very handsome octavo volume. 
 
 In publishing the first edition of this work, its title was altered from that of the London volume, 
 by the substitution of the word " Elements 1 for that of " Manual," and with the author s sanction 
 the title of "Elements" is still retained as being more expressive of the scope of the treatise. A 
 comparison of the present edition with the former one will show a material improvement, the 
 author having revised it thoroughly, with a view of rendering it completely on a level with the 
 most advanced state of the science. By condensing the less important portions, these numerous 
 additions have been introduced without materially increasing the bulk of the volume, and while 
 numerous illustrations have been added, and the general execution of the work improved, it has 
 been kept at its former very moderate price. 
 
 To say that it is the best manual of Physiology | 
 now before, the public, would not do sufficient justice 
 to the author. Buffalo Medical Journal. 
 
 In his former works it would seem that he had 
 exhausted the subject of Physiology. In the present, 
 he gives the essence, as it were, of the whole. N. Y. 
 Journal of Medicine. 
 
 Those who have occasion for an elementary trea 
 tise on Physiology, cannot do better than to possess 
 themselves of the manual of Dr. Carpenter. Medical 
 Examiner. 
 
 The best and most complete expose" of modern 
 Physiology, in one volume, extant in the English 
 language. St. Louis Medical Journal. 
 
 With such an aid in his hand, there is no excuse 
 for the ignorance often displayed respecting the sub 
 jects of which it treats. From its unpretending di 
 mensions, it may not be so esteemed by those anxioug 
 to make a parade of their erudition; but whoever 
 masters its contents will have reason to be proud of 
 his physiological acquirements. The illustrations 
 are well selected and finely executed. Dublin Med. 
 Press. 
 
 BY THE SAME AUTHOR. 
 
 A PRIZE ESSAY ON THE USE OF ALCOHOLIC LIQUORS IN HEALTH 
 
 AND DISEASE. New edition, with a Preface by D. F. CONDIE, M. D., and explanations of 
 scientific words. In one neat 12mo. Tolume. (Now Ready.) 
 
 This new edition has been prepared with a view to an extended circulation of this important little 
 work, which is universally recognized as the best exponent of the laws of physiology and pathology 
 applied to the subject of intoxicating liquors, in a form suited both for the profession and the public. 
 To secure a wider dissemination of its doctrines the publishers have done up copies in flexible 
 cloth, suitable for mailing, which will be forwarded through the post-office, free, on receipt of fifty 
 cents. Societies and others supplied in quantities for distribution at a liberal deduction. 
 
 CHELIUS (J. M.), M. D., 
 
 Professor of Surgery in the University of Heidelberg, &c. 
 
 A SYSTEM OF SURGERY. Translated from the German, and accompanied 
 with additional Notes and References, by JOHN F. SOUTH. Complete in three very large octavo 
 volumes, of nearly 2200 pages, strongly bound, with raised bands and double titles. 
 
 We do not hesitate to pronounce it the best and 
 most comprehensive system of modern surgery with 
 which we are acquainted. Medico-Chirurgical Re 
 view . 
 
 The fullest and ablest digest extant of all that re 
 lates to the present advanced state of surgical pa 
 thology. American Medical Journal. 
 
 As complete as any system of Surgery can well 
 be. Southern Medical and SurgicalJournal. 
 
 The most learned and complete systematic treatise 
 now extant. Edinburgh Medical Journal. 
 
 A complete encyclopaedia of surgical science a 
 very complete surgical library by far the most 
 complete and scientific system of surgery in the 
 English language. N. Y. Journal of Medicine. 
 
 The most extensive and comprehensive account of 
 the art and science of Surgery in our language. 
 Lancet. 
 
 CHRISTISON (ROBERT), M. D., V. P. R. S. E., &c. 
 A DISPENSATORY; or. Commentary on the Pharmacopoeias of Great Britain 
 
 and tho United States; comprising the Natural History, Description, Chemistry, Pharmacy, Ac 
 tions, Uses, and Doses of the Articles of the Materia Medica. Second edition, revised and im 
 proved, with a Supplement containing the most important New Remedies. With copious Addi 
 tions, and two hundred and thirteen large wood-engravings. By 11. EGLESFELD GRIFFITH, M. D. 
 In one very large and handsome octavo volume, of over 1000 pages. 
 
 It is not needful that w, should compare it with 
 the other pharmacopoeias extant, which enjoy and 
 merit the confidence of the profession : it is enough 
 to say that it appears to us as perfect as a Dispensa 
 tory, in the present state of pharmaceutical science, 
 could be made. If it omits any details pertaining to 
 this branch of knowledge which the student has a 
 right to expect in such a work, we confess the omis 
 sion has escaped our scrutiny. We cordially recom 
 mend this work to such of our readers as are in need 
 of a Dispensatory. They cannot make choice of a 
 better. Western Journ. of Medicine and Surgery. 
 
 There is not in any language a more complete and 
 perfect Treatise. N. Y. Annalist. 
 
 In conclusion, we need scarcely say that we 
 strongly recommend this work to all classes of our 
 readers. Asa Dispensatory and commentary on the 
 Pharmacopoeias, it is unrivalled in the English or 
 any other language. The Dublin Quarterly Journal. 
 
 We earnestly recommend Dr. Christison s Dis 
 pensatory to all our readers, as an indispensable 
 companion, not in the Study only, but in the Surgery 
 also. British and Foreign Medical Review. 
 
8 BLANCHARD & LEA S MEDICAL 
 
 CONDIE (D. F.), M. D., fitc. 
 A PRACTICAL TREATISE ON THE DISEASES OF CHILDREN. Fourth 
 
 edition, revised and augmented. In one large volume, Svo., of nearly 750 pages. (Just Issued.) 
 FROM THE AUTHOR S PREFACE. 
 
 The demand for another edition lias afforded the author an opportunity of again subjecting the 
 entire treatise to a careful revision, and of incorporating in it every important observation recorded 
 since the appearance of the last edition, in reference to the pathology and therapeutics of the several 
 diseases of which it treats. 
 
 In the preparation of the present edition, as in those which have preceded, while the author has 
 appropriated to his use every important fact that he has found recorded in the works of others, 
 having a direct bearing upon either of the subjects of which he treats, and the numerous valuable 
 observations pathological as well as practical dispersed throughout the pages of the medical 
 journals of Europe and America, he has, nevertheless, relied chiefly upon his own observations and 
 experience, acquired during a long and somewhat extensive practice, and under circumstances pe 
 culiarly well adapted for the clinical study of the diseases of early life. 
 
 Every species of hypothetical reasoning has, as much as possible, been avoided. The author has 
 endeavored throughout the work to confine himself to a simple statement of well-ascertained patho 
 logical facts, and plain therapeutical directions his chief desire being to render it what its title 
 imports it to be, A PRACTICAL TREATISE ON THE DISEASES OF CHILDREN. 
 
 Dr. Condie r s scholarship, acumen ? industry, and 
 practical sense are manifested in this, as in all his 
 numerous contributions to science. Dr. Hoi 
 
 mes s 
 
 "We feel assured from actual experience that no 
 physician s library can be complete without a copy 
 of this work. N. Y. Journal of Medicine. 
 Report to the American Medical Association. 
 
 _. _ ,. . A veritable pacdiatnc encA clopoedia, and an honor 
 
 Taken as a whole, in our judgment, Dr. Condies _.. __-..- 
 
 Treatise is the one from the perusal of which the 
 
 practitioner in this country will rise with the great 
 est satisfaction Western Journal of Medicine and 
 Surgery. 
 
 One of the best works upon the Diseases of Chil 
 dren in the English language. Western Lancet. 
 
 Perhaps the most full and complete \york now be 
 
 to American medical literature. Ohio Medical and 
 Surgical Journal. 
 
 We feel persuaded that the American medical pro 
 fession will soon regard it not only as a very good, 
 but as the VERY BEST "Practical Treatise on the 
 Diseases of Children." American Medical Journal. 
 
 We pronounced the first edition to be the best 
 
 fore the profession of the United States; indeed, we 
 
 may say in the English language. It is vastly supe- language, and, notwithstanding all that has been 
 
 rior to most of its predecessors. Transylvania Mud. j published, we still regard it in that light. Medical 
 
 COOPER (BRANSBY B.), F. R. S., 
 
 Senior Surgeon to Guy s Hospital, &c. 
 
 LECTURES ON THE PRINCIPLES AND PRACTICE OF SURGERY. 
 
 In one very large octavo volume, of 750 pages. (Lately Issued.) 
 
 For twenty-five years Mr. Bransby Cooper has I Cooper s Lectures as a most valuable addition to 
 been surgeon to Guy s Hospital; and the volume | our surgical literature, and one which cannot fail 
 
 before us may be said to consist of an account of 
 the results of his surgical experience during that 
 long period. We cordially recommend Mr. Bransby 
 
 to be of service both to students and to those who 
 are actively engaged in the practice of their profes 
 sion. The Lancet. 
 
 COOPER (SIR ASTLEY P.), F. R. S., &c. 
 A TREATISE ON DISLOCATIONS AND FRACTURES OF THE JOINTS. 
 
 Edited by BRANSBY B. COOPER, F. R. S., &c. With additional Observations by Prof. J. C. 
 WARREN. A new American edition. In one handsome octavo volume, with numerous illustra 
 tions on wood. 
 
 BY THE SAME AUTHOR. 
 
 ON THE ANATOMY AND TREATMENT OF ABDOMINAL HERNIA. 
 
 One large volume, imperial Svo., with over 130 lithographic figures. 
 
 BY THE SAME AUTHOR. 
 
 ON THE STRUCTURE AND DISEASES OF THE TESTIS, AND OX 
 
 THE THYMUS GLAND. One vol. imperial Svo., with 177 figures, on 29 plates. 
 
 BY THE SAME AUTHOR. 
 
 ON THE ANATOMY AND DISEASES OF THE BREAST, with twenty- 
 five Miscellaneous and Surgical Papers. One large volume, imperial 8vo., with 252 figures, on 
 GO 
 
 These last three volumes complete the surgical writings of Sir Astley Cooper. They are very 
 handsomely printed, with a large number oi lithographic plates, executed in the best style, and are 
 presented at exceedingly low prices. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 CHURCHILL (FLEETWOOD), M . D., M. R. I. A. 
 ON THE THEORY AND PRACTICE OF MIDWIFERY. A new American, 
 
 from the last and improved English edition. Edited, with Notes and Additions, by D. FKAJJCIS 
 CONDIE, M. D., author of a "Practical Treatise on the Diseases of Children," &c. With 139 
 illustrations. In one very handsome octavo volume, pp. 510. (Lately Issued.) 
 
 To bestow praise on a book that has received sucli No work holds a higher position, or is more de- 
 marked approbation would be superfluous. AVe need serving of being placed in the hands of tho tyro, 
 only sav, therefore, that if the first edition was | the advanced student, or the practitioner. Medical 
 
 "-- Examiner. 
 
 Previous editions, under the editorial supervision 
 of Prof R. M. Huston, have been received with. 
 ;rved it ; but this, re- 
 blin edition, carefully 
 
 revised and brought up by the author to the present 
 time, does present an unusually accurate and able 
 exposition of every important particular embraced 
 in the department of midwifery. * %? The clearness, 
 directness, and precision of its teachings, together 
 with the great amount of statistical research which 
 its text exhibits, have served to place it already in 
 the foremost rank of works in this department of re 
 medial science. N. O. Med. and Surg. Journal. 
 
 thought" worthy of a favorable reception by the 
 
 medical public, we can confidently affirm that this 
 
 will be found much more so. The lecturer, the 
 
 practitioner, and the student, may all have recourse of Prof R. M. Huston, have 
 
 to its pages, and derive from their perusal much in- I marked favor, and they deser 
 
 terest and instruction in everything relating to theo- printed from a very late Dub: 
 
 retical and practical midwifery. Dublin Quarterly 
 
 Journal of Medical Science. 
 
 A work of very great merit, and such as we can 
 confidently recommend to the study of every obste 
 tric practitioner. London Medical Gazette. 
 
 This is certainly the most perfect system extant. 
 It is the best adapted for the purposes of a text 
 book, and that which he whose necessities confine 
 him to one book, should select in preference to all 
 others. Southern Medical and Surgical Journal. 
 
 The most popular -work on midwifery ever issue 
 from the American press. Charleston Med. Journal. \ guage. Monthly Journal of Medical Science. 
 
 In our opinion, it forms one of the best if not the 
 very best text-book and epitome of obstetric science 
 d which we at present possess in the English Ian- 
 
 Were we reduced to the necessity of having but 
 one work on midwifery, and permitted to choose, i 
 we would unhesitatingly take Churchill. Western 
 Med. and Surg. Journal. 
 
 It is impossible to conceive a more useful and 
 elegant manual than Dr. Churchill s Practice of 
 Midwifery. Provincial Medical Journal. 
 
 Certainly, in our opinion, the very best work on 
 the subject which exists. N. Y. Annalist. 
 
 The clearness and precision of style in which it is 
 written, and the great amount of statistical research 
 which it contains, have served to place it in the first 
 rank of works in this department of medical science. 
 N. Y. Journal of Medicine. 
 
 Few treatises will be found better adapted as a 
 text-book for the student, or as a manual for the 
 frequent consultation of the young practitioner. 
 American Medical Journal. 
 
 BY THE SAME AUTHOR. 
 
 ON THE DISEASES OF INFANTS AND CHILDREN. 
 
 handsome volume of over 600 pages. 
 
 In one large and 
 
 eg 
 
 to completeness than any other of the kind with 
 which we are acquainted. Most cordially and earn 
 estly, therefore, do we commend it to our profession 
 al brethren, and we feel assured that the stamp of 
 their approbation will in due time be impressed upon 
 it. After an attentive perusal of its contents, we 
 hesitate not to say, that it is one of the most com 
 prehensive ever written upon the diseases of chil 
 dren, and that, for copiousness of reference, extent of 
 research, and perspicuity of detail, it is scarcely to 
 be equalled, and not to be excelled, in any lan 
 guage. Dublin Quarterly Journal. 
 
 After this meagre, and we know, very imperfect 
 notice of Dr. Churchill s work, we shall conclude 
 by saying, that it is one that cannot fail from its co 
 piousness, extensive research, and general accuracy, 
 to exalt still higher the reputation of the author in 
 this country. The American reader will be particu 
 larly pleased to find that Dr. Churchill has done full 
 justice throughout his work to the various American 
 authors on this subject. The names of Dewees, 
 Eberle, Condie, and Stewart, occur on nearly every 
 page, and these authors are constantly referred to by 
 tiie author in terms of the highest praise, and with 
 the most liberal courtesy. The Medical Examiner. 
 
 The present volume will sustain the reputation 
 acquired by the author from his previous works. 
 The reader will find in it full and judicious direc 
 tions for the management of infants at birth, and a 
 compendious, but clear account of the diseases to 
 which children are liable, and the most successful 
 mode of treating them. We must not close this no 
 tice without calling attention to the authors style, 
 which is perspicuous and polished to a degree, we 
 regret to say, not generally characteristic of medical 
 works. We recommend the work of Dr. Churchill 
 most cordially, both to students and practitioners, 
 as a valuable and reliable guide in the treatment of 
 the diseases of children. Am. Journ. of the Med. 
 Sciences. 
 
 We know of no work on this department of Prac 
 tical Medicine which presents so candid and unpre 
 judiced a statement or posting up of our actual 
 knowledge as this. N. Y. Journal of Medicine. 
 
 Its claims to merit both as a scientific and practi 
 cal work, are of the highest order. Whilst we 
 would not elevate it above every other treatise on 
 the same subject, we certainly believe that very few 
 are equal to it, and none superior. Southern Med. 
 and Surgical journal. 
 
 BY THE SAME AUTHOR. 
 
 ESSAYS ON THE PUERPERAL FEVER, AND OTHER DISEASES PE 
 CULIAR TO WOMEN. Selected from the writings of British Authors previous to the close of 
 the Eighteenth Century. In one neat octavo volume, of about four hundred and fifty pages. 
 
 To these papers Dr. Churchill has appended notes, ! demies of that disease. The whole forms a very 
 embodying whatever information has been laid be- | valuable collection of papers, by professional writers 
 fore the profession since their authors time. He has | of eminence, on some of the most importantaecidents 
 also prefixed to the Essays on Puerperal Fever, to which the puerperal female is liable. American 
 which occupy the larger portion of the volume, an 
 
 interesting historical "sketch of the principal epi- 
 
 Journal of Medical Sciences. 
 
10 
 
 BLANCHARD & LEA S MEDICAL 
 
 CHURCHILL (FLEETWOOD), M . D., M . R. I . A., &c. 
 
 ON THE DISEASES OF WOMEN; including those of Pregnancy and Child 
 bed. A new American edition, revised by the Author. With Notes and Additions, by D FRAN 
 CIS CONDIE, M. D., author of "A Practical Treatise on the Diseases of Children." In one large 
 and handsome octavo volume, with wood-cuts, pp. 684. (Just Issued.) 
 
 From the Author s Preface. 
 
 In reviewing this edition, at the request of my American publishers, I have inserted several new 
 sections and chapters, and I have added, I believe, all the information we have derived from recent 
 researches; in addition to which the publishers have been fortunate enough to secure the services 
 of an able and highly esteemed editor in Dr. Condie. 
 
 "We now regretfully take leave of Dr. Churchill s 
 book. Had our typographical limits permitted, we 
 should gladly have borrowed more from its richly 
 stored pages. In conclusion, we heartily recom 
 mend it to the profession, and would at the same 
 time express our firm conviction that it will not only 
 add to the reputation of its author, but will prove a 
 work of great and extensive utility to obstetric 
 practitioners. Dublin Medical Press. 
 
 Former editions of this work have been noticed in 
 previous numbers of the Journal. The sentiments of 
 high commendation expressed in those notices, have 
 only to be repeated in this; not from the fact that 
 the profession at large are not aware of the high 
 merits which this work really possesses, but from a 
 desire to see the principles and doctrines therein 
 contained more generally recognized, and more uni 
 
 versally carried out in practice. 
 Medicine. 
 
 -N. Y. Journal of 
 
 AVe know of no author who deserves that appro 
 bation, on "the diseases of females," to the same 
 extent that Dr. Churchill does. His, indeed, is the 
 only thorough treatise we know of on the subject; 
 and it may be commended to practitioners and stu 
 dents as a masterpiece in its particular department. 
 The former editions of this work have been com 
 mended strongly in this journal, and they have won 
 their way to an extended, and a well-deserved popu 
 
 larity. This fifth edition, before us. is well calcu 
 lated to maintain Dr. Churchill s high reputation. 
 It was revised and enlarged by the author, for his 
 American publishers, and it seems to us that there is 
 scarcely any species of desirable information on its 
 subjects that may not be found in this work. The 
 Western Journal of Medicine and Surgery. 
 
 We are gratified to announce a new and revised 
 edition of Dr. Churchill s valuable work on the dis 
 eases of females We have ever regarded it as one 
 of the very best works on the subjects embraced 
 within its scope, in the English language; and the 
 present edition, enlarged and revised by the author, 
 renders it still more entitled to the confidence of the 
 profession. The valuable notes of Prof. Huston 
 have been retained, and contribute, in no small de 
 gree, to enhance the value of the work. It is a 
 source of congratulation that the publishers have 
 permitted the author to be, in this instance, his 
 own editor, thus securing all the revision which 
 an author alone is capable of making. The Western 
 Lancet. 
 
 Asa comprehensive manual for students, or a 
 work of reference for practitioners, we only speak 
 with common justice when we say that it surpasses 
 any other that has ever issued on the same sub 
 ject from the British press. The Dublin Quarterly 
 Journal. 
 
 DEWEES (W. P.), M.D., &c. 
 A COMPREHENSIVE SYSTEM OF MIDWIFERY. Illustrated by occa- 
 
 sional Cases and many Engravings. Twelfth edition, with the Author s last Improvements and 
 Corrections. In one octavo volume, of 600 pages. (Just Issued.) 
 
 BY THE SAME AUTHOR. 
 
 A TREATISE ON THE PHYSICAL AND MEDICAL TREATMENT OF 
 
 CHILDREN. Tenth edition. In one volume, octavo, 548 pages. (Just Issued.) 
 
 BY THE SAME AUTHOR. 
 
 A TREATISE ON THE DISEASES OF FEMALES. Tenth edition. 
 
 one volume, octavo, 532 pages, with plates. (Just Issued.) 
 
 In 
 
 DICKSON (S. H.), M. D., 
 
 Professor of Institutes and Practice of Medicine in the Medical College of South Carolina; late Professor 
 
 of the Institutes and Practice of Medicine in the Medical Department of the 
 
 University of New York, &c. &c. 
 
 ELEMENTS OF MEDICINE; A Treatise on Pathology and Therapeutics. 
 
 one large and handsome octavo volume. (Preparing.) 
 
 In 
 
 DANA (JAMES D). 
 ZOOPHYTES AND CORALS. In one volume, imperial quarto, extra cloth, 
 
 with wood-cuts. 
 
 ALSO, 
 
 AN ATLAS TO THE ABOVE, one volume, imperial folio, with sixty-one mag 
 nificent plates, colored after nature. Bound in half morocco. 
 
 ALSO, 
 
 ON THE STRUCTURE AND CLASSIFICATION OF ZOOPHYTES. 
 
 Sold separate, one vol., cloth. 
 
 DE LA BECHE (SIR HENRY T.), F. R. S., &c. 
 THE GEOLOGICAL OBSERVER. In one very large and handsome octavo 
 
 volume, of 700 pages. With over three hundred wood-cuts. (Lately Issued.) 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 11 
 
 DRUITT (ROBERT), M.R. C.S., &c. 
 THE PRINCIPLES AND PRACTICE OF MODERN SURGERY. A new 
 
 American, from the improved London edition. Edited by F. W. SARGENT, M. D., author of 
 
 Minor Surgery. 
 
 Illustrated with one hundred and ninety-three wood-engravings. In 
 
 one very handsomely printed octavo volume, of 576 large pages. 
 
 Dr. Druitt s researches into the literature of his 
 subject have been not only extensive, but well di 
 rected ; the most discordant authors are fairly and 
 impartially quoted, and, while due credit is given 
 to each, their respective merits are weighed with 
 an unprejudiced hand. The grain of wheat is pre 
 served, and the chaff is unmercifully stripped otf. 
 The arrangement is simple and philosophical, and 
 the style, though clear and interesting, is so precise, 
 that the book contains more information condensed 
 into a few words than any other surgical work with 
 which we are acquainted. London Medical Times 
 and Gazette, February 18, 1654. 
 
 No work, in our opinion, equals it in presenting 
 so much valuable surgical matter in so small a 
 compass. St. Louis Med. and Surgical Journal. 
 
 Druitt s Surgery is too well known to the Ameri 
 can medical profession to require its announcement 
 anywhere. Probably no work of the kind has ever 
 been more cordially received and extensively circu 
 lated than this. The fact that it comprehends in a 
 comparatively small compass, all the essential ele 
 ments of theoretical and practical Surgery that it 
 is found to contain reliable and authentic informa 
 tion on the nature and treatment of nearly all surgi 
 cal affections is a sufficient reason for the liberal 
 patronage it has obtained. The editor, Dr. F. W. 
 Sargent, has contributed much to enhance the value 
 of the work, by such American improvements as are 
 calculated more perfectly to adapt it to our own 
 views and practice in this country. It abounds 
 everywhere with spirited and life-like illustrations, 
 which to the young surgeon, especially, are of no 
 minor consideration. Every medical man frequently 
 needs just such a work as this, for immediate refe 
 rence in moments of sudden emergency, when he has 
 not time to consult more elaborate treatises. The 
 Ohio Medical and Surgical Journal. 
 
 The author has evidently ransacked every stand 
 ard treatise of ancient and modern times, and all that 
 
 is really practically useful at the bedside will be 
 found in a form at once clear, distinct, and interest 
 ing. Edinburgh Monthly Medical Journal. 
 
 Druitt s work, condensed, systematic, lucid, and 
 practical as it is, beyond most works on Surgery 
 accessible to the American student, has had much 
 currency in this country, and under its present au 
 spices promises to rise to yet higher favor. The 
 Western Journal of Medicine and Surgery. 
 
 The most accurate and ample resum& of the pre 
 sent state of Surgery that we are acquainted with. 
 Dublin Medical Journal. 
 
 A better book on the principles and practice of 
 Surgery as now understood in England and America, 
 has not been given to the profession. Boston Medi 
 cal and Surgical Journal. 
 
 An unsurpassable compendium, not only of Sur 
 gical, but of Medical Practice. London Medical 
 Gazette. 
 
 This work merits our warmest commendations, 
 and we strongly recommend it to young surgeons as 
 an admirable digest of the principles and practice of 
 modern Surgery. Medical Gazette. 
 
 It maybe said with truth that the work of Mr. 
 Druitt affords a complete, though brief and con 
 densed view, of the entire field of modern surgery. 
 We know of no work on the same subject having the 
 appearance of a manual, which includes so many 
 topics of interest to the surgeon ; and the terse man 
 ner in which each has been treated evinces a most 
 enviable quality of mind on the part of the author, 
 who seems to have an innate power of searching 
 out and grasping the leading facts and features of 
 the most elaborate productions of the pen. It is a 
 useful handbook for the practitioner, and we should 
 deem a teacher of surgery unpardonable who did not 
 recommend it to his pupils. In our own opinion, it 
 is admirably adapted to the wants of the student. 
 Provincial Medical and Surgical Journal. 
 
 DUNGLISON, FORBES, TWEEDIE, AND CONOLLY. 
 THE CYCLOPAEDIA OF PRACTICAL MEDICINE: comprising Treatises on 
 
 the Nature and Treatment of Diseases, Materia Medica, and Therapeutics, Diseases of Women 
 and Children, Medical Jurisprudence, &c. &c. In four large super royal octavo volumes, of 
 3254 double-columned pages, strongly and handsomely bound. 
 
 *^* This work contains no less than four hundred and eighteen distinct treatises, contributed by 
 sixty-eight distinguished physicians. 
 
 j unquestionably one of very great value to the prac 
 titioner. This estimate of it has not been formed 
 from a hasty examination, but after an intimate ac 
 quaintance derived from frequent consultation of it 
 during the past nine or ten years. The editors are 
 practitioners of established reputation, and the list 
 of contributors embraces many of the most eminent 
 professorsand teachers of London, Edinburgh, Dub 
 lin, and Glasgow. It is, indeed, the great merit of 
 this work that the principal articles have been fur 
 nished by practitioners who have not only devoted 
 especial attention to the diseases about which they 
 have written, but have also enjoyed opportunities 
 for an extensive practical acquaintance with them, 
 and whose reputation carries the assurance of their 
 competency justly to appreciate the opinions of 
 others, while it stamps their own doctrines with 
 high and just authority. American Medical Journ. 
 
 The most complete work on Practical Medicine 
 extant; or, at least, in our language. Buffalo 
 Medical and Surgical Journal. 
 
 For reference, it is above all price to every prac 
 titioner. Western Lancet. 
 
 One of the most valuable medical publications of 
 the da}- as a work of reference it is invaluable. 
 Western Journal of Medicine and Surgery. 
 
 It has been to us, both as learner and teacher, a 
 work for ready and frequent reference, one in which 
 modern English medicine is exhibited in the most 
 advantageous light. Medical Examiner. 
 
 We rejoice that this work is to be placed within 
 the reach of the profession in this country, it being 
 
 DUNGLISON (ROBLEY), M.D., 
 
 Professor of the Institutes of Medicine in the Jefferson Medical College, Philadelphia. 
 
 HUMAN HEALTH; or, the Influence of Atmosphere and Locality, Change of 
 
 Air and Climate, Seasons, Food, Clothing, Bathing, Exercise, Sleep, fcc. &c., on Healthy Man ; 
 constituting Elements of Hygiene. Second edition, with many modifications and additions. In 
 one octavo volume, of 464 pages. 
 
12 
 
 BLANC HARD & LEA S MEDICAL 
 
 DUNGLISON (ROBLEY), M.D., 
 
 Professor of Institutes of Medicine in the Jefferson Medical College, Philadelphia. 
 
 MEDICAL LEXICON; a Dictionary of Medical Science, containing a concise 
 
 Explanation of the various Subjects and Terms of Physiology, Pathology, Hygiene, Therapeutics, 
 Pharmacology, Obstetrics, Medical Jurisprudence, &rc. With the French and other Synonymes ; 
 Notices of Climate and of celebrated Mineral Waters; Formulae for various Officinal, Emp irical, 
 and Dietetic Preparations, etc. Eleventh edition, revised. In one very thick octavo volume, of 
 over nine hundred large double-columned pages, strongly bound in leather, with raised bands. 
 (Just Issued.) 
 
 Every successive edition of this work bears the marks of the industry of the author, and of his 
 detenni nation to keep it fully on a level with the most advanced state of medical science. Thus 
 nearly FIFTEEN THOUSAND WORDS have been added to it within the last few years. As a complete 
 Medical Dictionary, therefore, embracing over FIFTY THOUSAND DEFINITIONS, in all the 
 branches of the science, it is presented as meriting a continuance of the great favor and popularity 
 which have carried it, within no very long space of time, to an eleventh edition. 
 
 Every precaution has been taken in the preparation of the present volume, to render its mecha 
 nical execution and typographical accuracy worthy of its extended reputation and universal use. 
 The very extensive additions have been accommodated, without materially increasing the bulk of 
 the volume by the employment of a small but exceedingly clear type, cast for this purpose. The 
 press has been watched with great care, and every effort used to insure the verbal accuracy so ne 
 cessary to a work of this nature. The whole is printed on fine white paper ; and, while thus exhi 
 biting in every respect so great an improvement over former issues, it is presented at the original 
 exceedingly low price. 
 
 AVe welcome it cordially ; it is an admirable work, valuable work, we directed the attention of our 
 and indispensable to all literary medical men. The 
 labor which has been bestowed upon it is something 
 prodigious. The work, however, has now been 
 done, and we are happy in the thought that no hu 
 man being will have again to undertake the same 
 gigantic task. Revised and corrected from time to 
 time, Dr. Dunglison s " Medical Lexicon" will last 
 for centuries. British and Foreign Med. Chirurg. 
 Revieiv, July, 1S53. 
 
 The fact that this excellent and learned work has 
 
 readers to its peculiar merits; and we need do 
 little more than state, in reference to the present 
 reissue, that, notwithstanding the large additions 
 previously made to it, no fewer than four thou 
 sand terms, not to be found in the preceding edi 
 tion, are contained in the volume before us. 
 Whilst it is a wonderful monument of its author s 
 erudition and industry, it is also a work of great 
 practical utility, as we can testify from our own 
 experience; for we keep it constantly within our 
 
 LueiHOGiuBEtnunceiiez r* m s reach and make very frequent reference to it, 
 
 ^^^A^^?^ h ;?J^ I "early always finding in it tl?e information we seok! 
 
 rendered necessary by the demands of the public, 
 affords a sufficient evidence of the general apprecia 
 tion of Dr. Dnnglison s labors by the medical pro 
 fession in England and America. It is a book which 
 will he of great service to the student, in teaching 
 him the meaning of all the technical terms used in 
 medicine, and will he of no less use to the practi 
 tioner who desires to keep himself on a level with 
 the advance of medical science. London Medical 
 Times and Gazette. 
 
 In taking leave of our author, we feel compelled 
 to confess that his work b> 
 
 incredible labor havin,, ... ^^^^, .. v . v . ,, lls> ,>,.- 
 position. Edinburgh Journal of Med. Sciences. 
 Sept. Ib53. 
 
 A miracle of labor and industry in one who has 
 written able and voluminous works on nearly every 
 branch of medical science. There could be no more 
 useful book to the student or practitioner, in the 
 present advancing age, than one in which would be 
 found, in addition to the ordinary meaning and deri 
 vation of medical terms so many of which are of 
 modern introduction concise descriptions of their 
 
 and all this and much Harit wjth j he writins?s o f the ancient and modern 
 Lime before us It is I masters ()f our art) >> reu ders him skilful to note 
 
 British and Foreign Med.-Chirurg. Review. 
 
 It has the rare merit that it certainly has no rival 
 in the English language for accuracy and extent 
 of references. The terms generally include short 
 physiological and pathological descriptions, so that, 
 as the author justly observes, the reader does not 
 possess in this work a mere dictionary, but a book. 
 which, while it instructs him in medical etymo 
 logy, furnishes him with a large amount of useful 
 information. The author s labors have been pro 
 perly appreciated by his own countrvmen ; and we 
 ,vork bears evidence of almost c;m onlv confirm the i r judgment, by recommending 
 "r b T e . Cn beS , t0 ^ et L U C 0n ^ lt ? C0m " this most useful volume to the notice of our cisat 
 lantic readers. No medical library will be complete 
 without it. London Med. Gazette. 
 
 It is certainly more complete and comprehensive 
 than any with which we are acquainted in the 
 English language. Few, in fact, could be found 
 better qualified than Dr. Dunglison for the produc 
 tion of such a work. Learned, industrious, per 
 severing, and accurate, he brings to the task all 
 the peculiar talents necessary for its successful 
 performance; while, at the same time, his fami- 
 
 3V, and tor its being brought i 
 quite up to the date of publication ; the author states : One ( tlie most complete and copious known to 
 in his preface that he has added to it about four thou- I I 16 cultivators of medical science. Boston Med. 
 
 sand terms, which are not to he found in the prece 
 ding one. Dublin Quarterly Journal of Medical 
 Sciences. 
 
 Journal. 
 
 The most comprehensive and best English Dic- 
 ..onary of medical terms extant. Buffalo Medical 
 On the appearance of the last edition of this | Journal. 
 
 BY THE SAME AUTHOR. 
 
 THE PRACTICE OF MEDICINE. A Treatise on Special Pathology and The 
 rapeutics. Third Edition. In two largo octavo volumes, of fifteen hundred pages. 
 Upon every topic embraced in the work the latest ferings of the race. Boston Medical and Surgical 
 
 information will he found carefully posted up. Journal. 
 
 Medical Examiner. 
 , r < t , . f .. . It is certainly the most complete treatiseof which 
 
 nZnnt vnlnm me(1i . cine f w find m ^ e tw we have any knowledge.- Western Journal of Med i- 
 
 elegant volumes, a mine of facts, a gathering of: ,.,,,,,,/ 
 
 precepts and advice from the world of experience, ! g J 
 
 that will nerve him with courage, and faithfully I One of the most elaborate treatises of the kind 
 
 direct him m las efforts to relieve the physical suf- we have. Southern Med. and Surg. Journal. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 I 
 
 DUNGUSON (ROBLEY), M.D., 
 
 Professor of Institutes of Medicine in the Jefferson Medical College, Philadelphia. 
 
 HUMAN PHYSIOLOGY. Seventh edition. Thoroughly revised arid exterj- 
 
 sively modified and enlarged, with nearly five hundred illustrations. In two large and hand 
 somely printed octavo volumes, containing nearly 1450 pages. 
 It has long since taken rank as one of the medi 
 cal classics of our language. To say that it is by 
 far the best text-book of physiology ever published 
 in this country, is but echoing the general testi 
 mony of the profession. N. Y. Journal of Medicine. 
 
 There is no single book we would recommend to 
 the student or physician, with greater confidence 
 than the present, because in it will be found a mir 
 ror of almost every standard physiological work of 
 the day. We most cordially recommend the work 
 to every member of the profession, and no student 
 should be without it. It is the completes! work on 
 
 Physiology in the English language, and is highly 
 creditable to the author and publishers. Canadian 
 Medical Journal. 
 
 The most complete and satisfactory system of 
 Physiology in the English language. Amer. Mud. 
 Journal. 
 
 The best work of the kind in the English lan 
 guage. Silliman s Journal. 
 
 The most full and complete system of Physiology 
 in our language. Western Lancet. 
 
 BY THE SAME AUTHOR. (JllSt Issued.) 
 
 GENERAL THERAPEUTICS AND MATERIA MEDIC A; adapted for a 
 
 Medical Text-book. Fifth edition, much improved. With one hundred and eighty-seven illus 
 
 trations. Iu two large and handsomely printed octavo vols., of about 1100 pages. 
 
 The new editions of the United States Pharmacopoeia and those of London and Dublin, have ren 
 
 dered necessary a thorough revision of this work. In accomplishing this the author has spared no 
 
 pains in rendering it a complete exponent of all that is new and reliable, both in the departments 
 
 of Therapeutics and Materia Medica. The book has thus been somewhat enlarged, and a like im 
 
 provement will be found in every department of its mechanical execution. As a convenient text 
 
 book for the student, therefore, containing within a moderate compass a satisfactory resume of ite 
 
 important subject, it is again presented as even more worthy than heretofore of the very great favor 
 
 which it has received. 
 
 In this work of Dr. Dunglison, we recognize the 
 same untiring industry in the collection and em 
 bodying of facts on the several subjects of which he 
 treats, that has heretofore distinguished him, and 
 we cheerfully point to these volumes, as two of the 
 most interesting that we know of. In noticing the 
 additions to this, the fourth edition, there is very 
 little in the periodical or annual literature of the 
 profession, published in the interval which has 
 elapsed since the issue of the first, that has escaped 
 
 As a text-book for students, for whom it is par 
 ticularly designed, we know of none superior to 
 it. St. Louis Medical and Surgical Journal. 
 
 It purports to be a new edition, but it is rather 
 a new book, so greatly has it been improved, both 
 in the amount and quality of the matter which k 
 contains. N. O. Medical and Surgical Journal. 
 
 We bespeak for this edition, from the profession, 
 
 the careful search of the author. As 
 
 reference, it is invaluable. Charleston Med. Jour 
 
 nal and Review. 
 
 It may be said to be the work now upon the sub 
 jects upon which it treats. Western Lancet. 
 
 its increased merit. IV. Y. 
 
 book for an i ncrease of patronage over any of its former 
 ones, on account of 
 Journal of Medicine. 
 
 We consider this work unequalled. Boston Med . 
 and Surg. Journal. 
 
 BY THE SAME AUTHOR. 
 
 NEW REMEDIES, WITH FORMULAE FOR THEIR ADMINISTRATION. 
 
 Sixth edition, with extensive Additions. In one very large octavo volume, of over 750 pages. 
 One of the most useful of the author s works. diseases and for remedies, will be found greatly to 
 Southern Medical and Surgical Journal. enhance its value. New York Med. Gazette. 
 
 This well-known and standard book has now 
 reached its sixth edition, and has been enlarged and 
 improved by the introduction of all the recent gifts 
 to therapeutics which the last few years have so 
 richly produced, including the anaesthetic agents, 
 &c. This elaborate and useful volume should be 
 found in every medical library, for as a book of re 
 ference, for physicians, it is unsurpassed by any 
 other work in existence, and the double index for 
 
 The great learning of the author, and his remark 
 able industry in pushing his researches into every 
 snurce whence information is derivable, has enabled 
 him to throw together an extensive mass of facts 
 and statements, accompanied by full reference to 
 authorities; which last feature renders the work 
 practically valuable to investigators who desire to 
 examine the original papers. The American Journal 
 of Pharmacy. 
 
 DURLACHER (LEWIS). 
 A TREATISE ON CORNS, BUNIONS, THE DISEASES OF NAILS, 
 
 AND THE GENERAL MANAGEMENT OF THE FEET. In one 12mo. volume, cloth, 
 pp. 134. 
 
 DE JONGH (L. J.), M. D., &c. 
 THE THREE KINDS OF COD-LIVER OIL, comparatively considered, with 
 
 their Chemical and Therapeutic Properties. Translated, with an Appendix and Cases, by 
 EDWARD CAREY, M. D. To which is added an article on the subject from "Dunglison on New 
 Remedies." In one small 12mo. volume, extra cloth. 
 
 DAY (GEORGE E.), M. D. 
 A PRACTICAL TREATISE ON THE DOMESTIC MANAGEMENT AND 
 
 MORE IMPORTANT DISEASES OF ADVANCED LIFE. With an Appendix on a new 
 and successful mode of treating Lumbago and other forms of Chronic Rheumatism. One volume , 
 octavo, 220 pages. 
 
14 
 
 BLANCHARD <fe LEA S MEDICAL 
 
 ELLIS (BENJAMIN), M.D. 
 THE MEDICAL FORMULARY : being a Collection of Prescriptions, derived 
 
 from the writings and practice of many of the most eminent physicians of America and Europe. 
 Together with the usual Dietetic Preparations and Antidotes for Poisons. To which is added 
 an Appendix, on the Endermic use of Medicines, and on the use of Ether and Chloroform. The 
 whole accompanied with a few brief Pharmaceutic and Medical Observations. Tenth edition, 
 revised and much extended by ROBERT P. THOMAS, M. D., Professor of Materia Medica in the 
 Philadelphia College of Pharmacy. In one neat octavo volume, of two hundred and ninety-six 
 pages. (Now Ready. Revised and enlarged to 1854.) 
 
 After an examination of the new matter and the It will prove particularly useful to students and 
 alterations, we believe the reputation of the work young practitioners, as the most important prescrip- 
 built up by the author, and the late distinguished tions employed in modern practice, which He scat- 
 editor, will continue to flourish under the auspices tered through our medical literature, are here col- 
 of the present editor, who has the industry nnd accu- lected and conveniently arranged for reference. 
 racy, and, we would say, conscientiousness requi- Charleston Med. Journal and Review. 
 site for the responsible task. American Journal of 
 Pharmacy, March, 185L 
 
 ERFCHSEN (JOHN), 
 Professor of Surgery in University College, London, <kc. 
 
 THE SCIENCE AND ART OF SURGERY; BEING A TREATISE ON SURGICAL 
 
 INJURIES, DISEASES, AND OPKRATIONS. Edited by JOHN H. BRINTON, M. D. Illustrated with 
 three hundred and eleven engravings on wood. In one large and handsome octavo volume, oJ 
 over nine hundred closely printed pages. (Now Ready.} 
 
 This is a new work, brought up to May, 1854. 
 
 It is, in our humble judgment, decidedly the best 
 hook of the kind in the English language. Strange 
 thai just such books are noioftener produced by pub 
 lic teachers of surgery in this country and Great 
 Britain Indeed, it is a matter of great astonishment, 
 but no less true than astonishing, that of the many 
 works on surgery repuhlished in ihis country within 
 the last fifteen or twenty years as text-books for 
 medical student.*, this is the only one, that even ap 
 proximates to the fulfilment of the peculiar wants of 
 young men just entering upon the study of this branch 
 of the profession. Western Jour, of Med. and Surgery. 
 
 Embracing, 33 will be perceived, the whole 
 
 ,,v.. t,v,i .. .., ... u ... "*! rroi. I jricnseirs wor, for ns si 
 
 cal domain, and each division of itself almost com- ,, ur p assei | ; his nine hundred and , 
 plete and perfect, each chapter full ami explicit, each f use)y j]| Uflra , e d, are rich in physii 
 
 -subject faithfully exhibited, we can only express our 
 exumate of it in the aggregate. We consider it an 
 excellent contribution to surgery, as probably the 
 best single volume now extant on the subject and 
 with grrjit pleasure we add it to our textbooks 
 Nashville Journal of Medicine and Surgery. 
 
 Its value is greatly enhanced by a very copious 
 well-arranged index. We regard this as one of the 
 most valuable contributions to mortem surgery. To 
 one entering his novitiate of practice, we regard it 
 the most serviceable guide which he can consult. He 
 will find a fulness of detail leading him through every 
 step of the operation, and not deserting him until the 
 final issue of the case is decided. For the same rea 
 son we recommend it to those whose routine of prac 
 tice lies in such parts of the country that they must 
 rarely encounter cases requiring" surgical manage 
 ment. Stethoscope. 
 
 Prof. Erichsen s work, for its size, has not been 
 eight pages, pro- 
 
 )y illustrated, are rich in physiological, patholo 
 gical. a?)d operative suggestions, doctrines, details, 
 and processes; and will prove a reliable resource 
 for information, both to physician and surgeon, in ttie 
 hour of peril. N. 0. Med. and Surg. Journal. 
 
 FOWNES (GEORGE), PH. D., &c. 
 ELEMENTARY CHEMISTRY; Theoretical and Practical. With numerous 
 
 illustrations. A new American, from the last and revised London edition. Edited, with Addi 
 tions, by ROBERT BRIDGES, M. D. In one large royal 12mo. volume, of over 550 pages, with 181 
 wood-cuts, sheep, or extra cloth. (Now Ready.) 
 
 The lamented death of the author has caused the revision of this edition to pass into the hands oi 
 ihose distinguished chemists, H. Bence Jones and A. W. Hofmann, who have fully sustained its 
 reputation by the additions which they have made, more especially in the portion devoted to Organic 
 Chemistry, considerably increasing the size of the volume. This labor has been so thoroughly 
 performed, that the American Editor has found but little to add, his notes consisting chiefly of such 
 matters as the rapid advance of the science has rendered necessary, or of investigations which had 
 apparently been overlooked by the author s friends. 
 
 The volume is therefore again presented as an exponent of the most advanced state of chemical 
 science, and as not unworthy a continuation of the marked favor which it has received as an ele 
 mentary text-book. 
 
 We know of no better text-book, especially in the \ The work of Dr. Fowues has long been before 
 
 the public, and its merits have been fully appreci 
 ated as the best text-book on chemistry now in 
 existence. We do not, of course, place it in a rank 
 superior to the works of Brande, Graham, Turner, 
 Gregory, or Gmelin, but we say that, as a work 
 for students, it is preferable to any of them. Lon 
 don Journal of Medicine. 
 
 A work well adapted to the wants of the student. 
 It is an excellent exposition of the chief doctrines 
 and facts of modern chemistry. The size of the work, 
 and still more the condensed yet perspicuous style 
 in which it is written, absolve it from the charges 
 very properly urged against most manuals termed 
 popular. Edinburgh Monthly Journal of Medical 
 Science. 
 
 difficult department of organic chemistry, upon 
 which it is particularly full and satisfactory. We 
 would recommend it to preceptors as a capital 
 " office book" for their students who are beginners 
 in Chemistry. It is copiously illustrated with ex 
 cellent wood-cuts, and altogether admirably "got 
 up." A r . J. Medical Reporter, March, 1854. 
 
 A standard manual, which has long enjoyed the 
 reputation of embodying much knowledge in a small 
 space. The author hasachieved the difficult task of 
 condensation \vith masterly tact. His book is con 
 cise without being dry, and brief without being too 
 dogmatical or general. Virginia Med. and Surgical 
 Journal . 
 
 FRICK (CHARLES), M. D. 
 RENAL AFFECTIONS; their Diagnosis and Pathology. 
 
 One volume, royal 12mo., extra cloth. 
 
 With illustrations. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 15 
 
 FERGUSSON (WILLIAM), F. R. S., 
 
 Professor of Surgery in King s College, London, &c. 
 
 A SYSTEM OF PRACTICAL SURGERY. Fourth American, from the third 
 
 and enlarged London edition. In one large and beautifully printed octavo volume, of about seven 
 hundred pages, with three hundred and ninety-three handsome illustrations. (Just Issued.) 
 
 The most important subjects in connection with 
 practical surgery which have been more recently 
 brought under the notice of, and discussed by, the 
 surgeons of Great Britain, are fully and dispassion 
 ately considered by Mr. Fergusson, and that which 
 was before wanting has now been supplied, so that 
 we can now look upon it as a work on practical sur 
 gery instead of one on operative surgery alone. 
 There was some ground formerly for the complaint 
 before alluded to, that it dwelt too exclusively on 
 operative surgery ; but this defect is now removed, 
 and the book is more than ever adapted for the pur 
 poses of the practitioner, whether he confines him 
 self more strictly to the operative department, or 
 follows surgery on a more comprehensive scale. 
 Medical Times and Gazette. 
 
 No work was ever written which more nearly 
 comprehended the necessities of the student and 
 practitioner, and was more carefully arranged to 
 that single purpose than this. 2V. Y. Med. and Surg. 
 Journal. 
 
 The addition of many new pages makes this work 
 more than ever indispensable to the student and prac 
 titioner. Ranking s Abstract. 
 
 Among the numerous works upon surgery pub 
 lished of late years, we know of none we value 
 more highly than the one before us. It is perhaps 
 the very best we have for a text-book and for ordi 
 nary reference, being concise and eminently practi 
 cal. Southern Med. and Surg. Journal. 
 
 GRAHAM (THOMAS), F. R. S., 
 
 Professor of Chemistry in University College, London, &c. 
 
 THE ELEMENTS OF CHEMISTRY. Including the application of the Science 
 
 to the Arts. With numerous illustrations. With Notes and Additions, by ROBERT BRIDGES, 
 M. D., &c. &c. Second American, from the second and enlarged London edition 
 PART I. (Lately Issued) large 8vo., 430 pages, 185 illustrations. 
 PART II. (Preparing) to match. 
 
 The great changes which the science of chemistry has undergone within the last few years, ren 
 der a new edition of a treatise like the present, almost a new work. The author has devoted 
 several years to the revision of his treatise, and has endeavored to embody in it every fact and 
 inference of importance which has been observed and recorded by the great body of chemics^ 
 investigators who are so rapidly changing the face of the science. In this manner the work has 
 been greatly increased in size, and the number of illustrations doubled ; while the labors of the editor 
 have been directed towards the introduction of such matters as have escaped the attention of the 
 author, or as have arisen since the publication of the first portion of this edition in London, in lS- r >0. 
 Printed in handsome style, and at a very low price, it is therefore confidently presented to the pro 
 fession and the student as a very complete and thorough text-book of this important subject. 
 
 GROSS (SAMUEL D.), M. D., 
 
 Professor of Surgery in the Louisville Medical Institute, &c. 
 
 A PRACTICAL TREATISE ON THE DISEASES AND INJURIES OF 
 
 THE URINARY ORGANS. In one large and beautifully printed octavo volume, of over seven 
 hundred pages. With numerous illustrations. 
 
 A volume replete with truths and principles of the 
 utmost value in the investigation of these diseases. 
 American Medical Journal. 
 
 Dr. Gross has brought all his learning, experi 
 ence, tact, and judgment to the task, and has pro 
 duced a work worthy of his high reputation. We 
 feel perfectly safe in recommending it to our read 
 ers as a monograph unequalled in interest and 
 
 this department of art. We have, indeed, unfeigned 
 pleasure in congratulating all concerned in this pub 
 lication, on the result of their labours; and expe 
 rience a feeling something like what animates a long- 
 expectant husband man, who, often times disappointed 
 by the produce of a favorite field, is at last agree 
 ably surprised by a stately crop which may bear 
 comparison with any of its former rivals. The 
 
 practical value bv anv other on the subject in our ! grounds of our high appreciation of the work will 
 language. Western Journal of Med. and Surg. be obvious as we proceed ; and we doubt not that. 
 
 the present facilities for obtaining American books 
 will induce many of our readers to verify our re- 
 
 It has remained for an American writer to wipe 
 
 commendation by their own perusal of it. British 
 id Foreign Medico-Ckirurgical Revieiv. 
 
 Whoever will peruse the vast amount of valuable 
 
 away this reproach ; and so completely has the task 
 
 been fulfilled, that we venture to .predict for Dr. j and Forei gn Medieo-Ckirurgical Review. 
 
 Gross s treatise a permanent place in the literature 
 
 (vf surgery, worthy to rank with the best works of 
 
 the present age. Not merely is the matter good, ! practical information it contains, and which we 
 
 but the getting up of the volume is most creditable ] have been unable even to notice, will, we think, 
 
 to transatlantic enterprise; the paper and print I agree with us, that there is no work in the English 
 
 would do credit to a first-rate London establishment; language which can make any just pretensions to 
 
 and the numerous wood-cuts which illustrate it, de- be its equal. N. Y. Journal of Medicine. 
 
 monstrate that America is making rapid advances in i 
 
 BY THE SAME AUTHOR. (Now Ready.) 
 
 A PRACTICAL TREATISE ON FOREIGN BODIES IN THE AIR-PAS- 
 
 SAGES. In one handsome octavo volume, with illustrations. 
 
 No complete monograph on this interesting and difficult subject has hitherto appeared in any lan 
 guage. The profession will therefore find a want supplied by the present volume, containing an 
 elaborate investigation of the nature, symptoms, and treatment of this class of accidents, founded 
 on the details of more than two hundred cases, carefully analyzed and compared. .Besides the ex 
 perience gathered from the author s practice, and that of numerous friends and correspondents, he 
 has laboriously collected all the scattered information embodied in medical periodicals, reports of 
 learned societies, and other sources; and, examining the whole by the aid of the most recent patho 
 logical and anatomical investigations, he has presented a complete and systematic view of the sub 
 ject in all its bearings. 
 
 BY THE SAME AUTHOR. (Preparing.) 
 
 A SYSTEM OF SURGERY ; Diagnostic, Pathological, Therapeutic, and Opera- 
 
 live. With very numerous engravings on wood. 
 
16 BLAN CHARD & LEA S MEDICAL 
 
 GRIFFITH (ROBERT E.), M . D., &c. 
 
 A UNIVERSAL FORMULARY, containing the methods of Preparing and Ad 
 ministering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceu 
 tists. SECOND EDITION, thoroughly revised, with numerous additions, by ROBERT P. THOMAS, 
 M. D., Professor of Materia Mcdica in the Philadelphia College of Pharmacy. In one large and 
 handsome octavo volume, of over six hundred pages, double columns. (Just Issued.) 
 It was a work requiring much perseverance, and It is one of the most sef il books a country practi- 
 
 when published was looked upon as by far the best | tioner can possibly have in his possession. Mtdicnl 
 
 work of its kind that had issued from the American Chronicle. 
 
 press being free of much of the trashy, and embrac- , The amount of useful, every-day matter, for a prac- 
 most of the non-officinal formula used or known \ licinjr physician, is really immense. Boston Mtd. 
 
 cm: 
 
 in American, English, or French practice, arranged 
 under the heads of the several constituent drugs, plac 
 ing the receipt under its more important constituent. 
 Prof Thomas has certainly "improved." as well as 
 added o this Formulary, and has rendered it addition 
 ally deserving of the confidence of pharmaceutists 
 and physicians. American Journal of Pharmacy. 
 
 We are happy to announce a new and improved 
 edition of this, one of the most valuable and useful 
 works that have emanated from an American pen. 
 It would do credit to any country, and will be found 
 of daily usefulness to practitioners of medicine; it is 
 better adapted to their purposes than the dispensato 
 ries. Southern Med. and Surg. Journal. 
 
 A new edition of this well-known work, edited by 
 R. P. Thomas, M. D., affords occasion for renewing 
 our commendation of so useful a handbook, which 
 ought to be universally studied by medical men of 
 
 every class, ami made use of by way of reference by j effort has been spared to include in them all tht 
 office pupils, as a standard authority. It has been j rent improvements which have been published in 
 much enlarged, and now condenses a vast amount j medical journals, and systematic treatises. A work 
 of needful and necessary knowledge in small com- j of this kind appears to us indispensable to the physi- 
 pass. The more of such books the better for the pro- cian, and there is none we can more cordially recom- 
 ftssion and the public. N. Y. Med. Gazette. j mend. N. Y. Journal of Medicine. 
 
 BY THE SAME AUTHOR. 
 
 BOTANY; or, a Description of all the more important Plants used 
 
 in Medicine, and of their Properties, Uses, and Modes of Administration. In one large octavo 
 volume, of 704 pages, handsomely printed, with nearly 350 illustrations on wood. 
 
 and Surg. Journal. 
 This is a work of six hundred and fifty one pages, 
 unbracing all on the subject of preparing and admi 
 nistering medicines that can be desired by the physi 
 cian and pharmaceutist. Western Lancet. 
 
 In short, it is a full and complete work of the kind, 
 and should be in the hands of every physician and 
 apothecary. O. Med. and Surg. Journal 
 
 We predict a great sale for this work, and we espe- 
 ciallv recommend it to all medical teachers. Iliek- 
 mond Stethoscope. 
 
 This edition of Dr. Griffith s work has been greatly 
 improved by the revision and ample additions of Dr. 
 Thomas, and is now, wo believe, one of the most 
 complete works of its kind in any lai guage. The 
 additions amount to about seventy pages, and no 
 
 GLUGE (GOTTLIEB), M. D., 
 
 Professor of Physiology and Pathological Anatomy in the University of Brussels, &c. 
 
 AN ATLAS OF PATHOLOGICAL HISTOLOGY. Translated, with Notes 
 
 and Additions, by JOSEPH LEIDY, M. D., Professor of Anatomy in the University of Pennsylva 
 nia. In one volume, very large imperial quarto, with three hundred and twenty figures, plain 
 and colored, on twelve copperplates. 
 
 This being, as far as we know, the only work in 
 which pathological histology is separately treated 
 - " in a comprehensive manner, it will, we think, for 
 
 the unconnected observations of a great number of 
 authors. The development of the morbid tissues, 
 and the formation of abnormal products, may now 
 
 this reason, be of infinite service to those who desire be followed and studied with the same ease and 
 systematically, and who satisfaction as the best arranged 
 arranging in their mind | siology. American Med. Journal. 
 
 to investigate the subject systematically, and who j satisfaction as the best arranged system of phy- 
 have felt the difficulty of arranging in their mind 
 
 GREGORY (WILLIAM), F. R. S. E., 
 
 Professor of Chemistry in the University of Edinburgh, &c. 
 
 LETTERS TO A CANDID INQUIRER ON ANIMAL MAGNETISM. 
 
 In one neat volume, royal 12mo., extra cloth. 
 
 GARDNER (D. PEREIRA), M . D. 
 MEDICAL CHEMISTRY, for the use of Students and the Profession: being a 
 
 Manual of the Science, with its Applications to Toxicology, Physiology, Therapeutics, Hygiene, 
 &c. In one handsome royal 12mo. volume, with illustrations. 
 
 HASSE (C. E.), M. D. 
 
 AN ANATOMICAL DESCRIPTION OF THE DISEASES OF RESPIRA 
 TION AND CIRCULATION. Translated and Edited by SWAINE. Iu one volume, octavo. 
 
 HARRISON (JOHN), M.D. 
 AN ESSAY TOWARDS A CORRECT THEORY OF THE NERVOUS 
 
 SYSTEM. In one octavo volume, 292 pages. 
 
 HUNTER (JOHN). 
 TREATISE ON THE VENEREAL DISEASE. With copious Additions, by 
 
 DR. PH. RICOKI), Surgeon to the Venereal Hospital of Paris. Edited, with additional Notes, by 
 F. J. BUIUSTEAD, M. D. In one octavo volume, with plates. (Now Ready.) E2T 3 See RICORD. 
 ALSO, HUNTER S COMPLETE WORKS, with Memoir, Notes, &c. &c. In four neat octavo 
 volumes, with plates. 
 
AND SCIENTIFIC PUBLICATIONS. 17 
 
 HUGHES (H. M.), M. D., 
 
 Assistant Physician to Guy s Hospital, &c. 
 
 A CLINICAL INTRODUCTION TO THE PRACTICE OF AUSCULTA- 
 
 TION, and other Modes of Physical Diagnosis, in Diseases of the Lungs and Heart. Second 
 American from the Second and Improved London Edition. In one royal 12mo. vol. (Now Ready.) 
 It has been carefully revised throughout. Some small portions have been erased; much has 
 been, I trust, amended; and a great deal of new matter has been added; so that, though funda 
 mentally it is the same book, it is in many respects a new work. Preface. 
 
 HORNER (WILLIAM E.), M. D., 
 
 Professor of Anatomy in the University of Pennsylvania. 
 
 SPECIAL ANATOMY AND HISTOLOGY. Eighth edition. Extensively 
 
 revised and modified. In two large octavo volumes, of more than one thousand pages, hand 
 somely printed, with over three hundred illustrations. 
 
 This work has enjoyed a thorough and laborious revision on the part of the author, with the 
 view of bringing it fully up to the existing state of knowledge on the subject of general and special 
 anatomy. To adapt it more perfectly to the wants of the student, he has introduced a large number 
 of additional wood-engravings, illustrative of the objects described, while the publishers have en 
 deavored to render the mechanical execution of the work worthy of the extended reputation which 
 it has acquired. The demand which has carried it to an EIGHTH EDITION is a sufficient evi 
 dence of the value of the work, and of its adaptation to the wants of the student and professional 
 reader. 
 
 HOBLYN (RICHARD D.), A. M. 
 A DICTIONARY OF THE TERMS USED IN MEDICINE AND THE 
 
 COLLATERAL SCIENCES. Second and Improved American Edition. Revised, with nu 
 merous Additions, from the second London edition, by ISAAC HAYS, M. D., &c. In one large 
 royal 12mo. volume, of over four hundred pages, double columns. (Nearly Ready.) 
 In passing this work a second time through the press, the editor has subjected it to a very tho 
 rough revision, making such additions as the progress of science has rendered desirable, and sup 
 plying any omissions that may have previously existed. As a concise and convenient Dictionary 
 of Medical Terms, at an. exceedingly low price, it will therefore be found of great value to the stu 
 dent and practitioner. 
 
 HOPE (J.), M. D., F. R. S., &c. 
 A TREATISE ON THE DISEASES OF THE HEART AND GREAT 
 
 VESSELS. Edited by PENNOCK. In one volume, octavo, with plates, 572 pages. 
 
 JONES (C. HANDFIELD), F. R. S., & EDWARD H. SIEVEKING, M.D., 
 
 Assistant Physicians and Lecturers in St. Mary s Hospital, London. 
 
 A MANUAL OF PATHOLOGICAL ANATOMY. First American Edition, 
 
 Revised. With three hundred and ninety-seven handsome wood engravings. In one large and 
 beautiful octavo volume of nearly seven hundred and fifty pages. 
 
 In a work like the present, intended as a text-book for the student of pathology, accurate engrav 
 ings of the various results of morbid action are of the greatest assistance. The American pub 
 lishers have, therefore, considered that the value of the work might be enhanced by increasing the 
 number of illustrations, and, with this object, many wood-cuts, from the best authorities, have been 
 introduced, increasing the number from one hundred and sixty-seven, in the London Edition, to 
 three hundred and ninety-seven in this. The selection of these wood-cuts has been made by a 
 competent member of the profession, who has supervised the progress of the work through the 
 press, with the view of securing an accurate reprint, and of correcting such errors as had escaped 
 the attention of the authors. 
 
 With these improvements, the volume is therefore presented in the hope of supplying the ac 
 knowledged want of a work which, within a moderate compass, should embody a condensed and 
 accurate digest of the present state of pathological science, as extended by recent microscopical, 
 chemical, and physiological researches. 
 
 A comprehensive English work on pathological i to existed, and Drs. Jones and Sieveking deserve 
 anatomy has long been a. desideratum in medical j great credit for the manner in which they have per- 
 literature. The progress of pathological science has formed their task. They have availed themselves 
 been so rapid, and the contributions of pathologists of the best existing sources of information, and they 
 have been so numerous, that the learner has been have confirmed or contested the conclusions of pre- 
 compelled to resort to various books in different Ian- ceding authors by observations made by themselves, 
 guages, and to monographs on special subjects, in ; The book is also abundantly illustrated by -well- 
 order to become acquainted with the morbid affec- < executed wood-engravings, many of which are 
 tions of the human body. The present work fills up | drawn from specimens examined by the authors. 
 in a great measure the deficiency which has hither- j Med. Times and Gazette. 
 
 JONES (T. WHARTON), F. R. S., c. 
 THE PRINCIPLES AND PRACTICE OF OPHTHALMIC MEDICINE 
 
 AND SURGERY. Edited by ISAAC HAYS, M. D., &c. In one very neat volume, large royal 
 ]2mo., of 5 29 pages, with four plates, plain or colored, and ninety-eight wood-cuts. 
 
 The work amply sustains, in every point the al 
 ready high reputation of the author as an ophthalmic 
 surgeon as well as a physiologist and pathologist. 
 The book is evidently the result of much labor arid 
 research, and has be en written with the greatest 
 care and attention. We entertain little doubt that 
 this book will become what its author hoped it 
 
 might become, a manual for daily reference and 
 consultation by the student and the general practi 
 tioner. The work is marked by that correctness, 
 clearness, and precision of style which distinguish 
 all the productions of the learned author. British 
 and Foreign Medical Review. 
 
IS 
 
 BLANCHARD & LEA S MEDICAL 
 
 KIRKES (WILLIAM SENHOUSE), M. D., 
 
 Demonstrator of Morbid Anatomy at St. Bartholomew s Hospital, &c.; and 
 
 JAMES PAGET, F. R. S., 
 
 Lecturer on General Anatomy and Physiology in St. Bartholomew s Hospital. 
 
 A MANUAL OF PHYSIOLOGY. Second American, from the second and 
 
 improved London edition. With one hundred and sixty-five illustrations. In one large and 
 handsome royal 12mo. volume, pp.550. (Just Issued.) 
 
 In the present edition, the Manual of Physiology 
 has been brought up to the actual condition of the 
 science, and fully sustains the reputation which it 
 has already so deservedly attained. We consider 
 the work of MM. Kirkes and Paget to constitute one 
 of the very best handbooks of Physiology we possess 
 presenting just such an outline of the science, com 
 prising an account of its leading facts and generally 
 admitted principles, as the student requires during 
 his attendance upon a course of lectures, or for re 
 ference whilst preparing for examination. The text 
 is fully and ably illustrated by a series of very supe 
 rior wood-engravings, by which a comprehension of 
 some of the more intricate of the subjects treated of 
 is greatly facilitated. Am. Medical Journal, 
 
 We need only say, that, without entering into dis 
 cussions of unsettled questions, it contains all the 
 recent improvements in this department of medical 
 science. For the student beginning this study, and 
 the practitioner who has but leisure to refresh his 
 memory, this book is invaluable, as it contains all 
 
 that it is important to know, without special details, 
 which are read with interest only by those who 
 would make a specialty, or desire to possess a criti 
 cal knowledge of the subject. Charleston Medical 
 Journal. 
 
 One of the best treatises that can be put into the 
 hands of the student. London Medical Gazette. 
 
 The general favor with which the first edition of 
 this work was received, and its adoption as a favor 
 ite text-book by many of our colleges, will insure a 
 large circulation to this improved edition. It will 
 fully meet the wants of the student. Southern 
 Med. and Surg. Journal. 
 
 Particularly adapted to those who desire to pos 
 sess a concise digest of the facts of Human Physi 
 ology. British and Foreign Med.-Chirurg. Review. 
 
 We conscientiously recommend it as an admira 
 ble " Handbook of Physiology." London Journal 
 of Medicine. 
 
 KNAPP (F.), PH. D., &c. 
 
 TECHNOLOGY ; or, Chemistry applied to the Arts and to Manufactures. Edited, 
 with numerous Notes and Additions, by Dr. EDMUND RONALDS and Dr. THOMAS KICHARDSON. 
 First American edition, with Notes and Additions, by Prof. WALTER K. JOHNSON. In two hand 
 some octavo volumes, printed and illustrated in the highest style of art, with about five hundred 
 wood-engravings. 
 
 PHYSIOLOGICAL 
 
 (Preparing.) 
 
 LEHMANN. 
 CHEMISTRY. Translated by GEORGE E. DAY, M. D. 
 
 LEE (ROBERT), M. D., F. R. S., &c. 
 CLINICAL MIDWIFERY; comprising the Histories of Five Hundred and 
 
 Forty-five Cases of Difficult, Preternatural, and Complicated Labor, with Commentaries. From 
 the second London edition. In one royal 12mo. volume, extra cloth, of 238 pages. 
 
 LA ROCHE (R.), M. D., &c. 
 
 PNEUMONIA ; its Supposed Connection, Pathological and Etiological, with Au 
 tumnal Fevers, including an Inquiry into the Existence and Morbid Agency of Malaria. In one 
 handsome octavo volume, extra cloth, of 500 pages. 
 
 A more simple, clear, and forcible exposition of | the periodical press, and yet in the work before us 
 the groundless nature and dangerous tendency of | he has exhibited an amount of industry and learning-, 
 certain pathological and etiological heresies, has I research and ability, beyond what we are accustomed 
 seldom been presented to our notice. N. Y. Journal \ to discover in modern medical writers; while his 
 of Medicine and Collateral Science, March, 1854. | own extensive opportunities for observation and 
 
 This work should be carefully studied by Southern 
 physicians, embodying as it does the reflections of 
 an original thinker and close observer on a subject 
 peculiarly their own. Virginia Med. and Surgical 
 Journal. 
 
 The author had prepared us to expect a treatise 
 
 | experience have been improved by the most laudable 
 diligence, and display a familiarity with the whole 
 subject in every aspect, which commands both our 
 respect and confidence. As a corrective of prevalent 
 and mischievous error, sought to be propagated by 
 novices and innovators, we could wish that Dr. La 
 Roche s book could be widely read. N. Y. Medical 
 
 from him, by his brief papers on kindred topics in 1 Gazette. 
 
 BY THE SAME AUTHOR. (Ll Press.) 
 
 YELLOW FEVER, considered in its Historical, Pathological, and Etiological 
 
 Relations. In one very large and handsome octavo volume. 
 
 LONGET (F. A.) 
 
 TREATISE ON PHYSIOLOGY. With numerous Illustrations. Translated 
 from the French by F. G. Smith, M. D., Professor of Institutes of Medicine in the Pennsylvania 
 Medical College. (Preparing.) 
 
AND SCIENTIFIC PUBLICATIONS. 19 
 
 LAWRENCE (W.) } F. R. S., &c. 
 A TREATISE ON DISEASES OF THE EYE. A new edition, edited, 
 
 with numerous additions, and 243 illustrations, by ISAAC HAYS, M. D., Surgeon to Wills Hospi 
 tal, &c. In one very large and handsome octavo volume, of 950 pages, strongly bound in leather 
 with raised bands. (Now Ready.) 
 This work is thoroughly revised and brought up to 1854. 
 
 This work is so universally recognized as the standard authority on the subject, that the pub- 
 Kshers in presenting this new edition have only to remark that in its preparation the editor has 
 carefully revised every portion, introducing additions and illustrations wherever the ndvance of 
 science has rendered them necessary or desirable. In this manner it will be found to con 
 tain over one hundred pages more than the last edition, while the list of wood-engravings 
 has been increased by sixty-seven figures, besides numerous improved illustrations substituted 
 for such as were deemed imperfect or unsatisfactory. The various important contributions to 
 o-phthalmological science, recently made by Dalrymple, Jacob, Walton, Wilde, Cooper, &c., 
 both in the form of separate treatises and contributions to periodicals, have been carefully 
 examined by the editor, and, combined with the results of his own experience, have been 
 freely introduced throughout the volume, rendering it a complete and thorough exponent of 
 the most advanced state of the subject. 
 
 In a future number we shall notice more at length | octavo pages has enabled both author and editor to 
 this admirable treatise- the safest guide and most do justice to all the details of this subject, and con- 
 cornprehensive work of reference, which is within dense in this single volume the present state of our 
 the reach of all classes of the profession. -Stetlio- [ knowledge of the whole science in this department, 
 scope, March, 1854. j whereby its practical value cannot be excelled. We 
 
 heartily commend it, especially as a book of refe- 
 
 This standard text-book on the department of ! rence, indispensable in every medical library. The 
 which it treats, has not been superseded, by any or additions of the American editor very greatly en- 
 all of the numerous publications on the subject hance the value of the work, exhibiting the learning 
 heretofore issued. Nor with the multiplied improve- ! and experience of Dr. Hays, in the light in which he 
 ments of Dr. Hays, the American editor, is it at all ought to be held, as a standard authority on all sub- 
 likely that this great work will cease to merit the ; jects appertaining to this specialty, to which he has 
 confidence and preference of students or practition- rendered so many valuable contributions. N. Y. 
 era. Its ample extent nearly one thousand large , Medical Gazette. 
 
 BY THE SAME AUTHOR. 
 
 A TREATISE ON RUPTURES; from the fifth London edition. In one octavo 
 volume, sheep, 480 pages. 
 
 LUDLOW (J. L.), M. D., 
 
 Lecturer on Clinical Medicine at the Philadelphia Almshouse, &c. 
 
 A MANUAL OF EXAMINATIONS upon Anatomy and Physiology, Surgery, 
 
 Practice of Medicine, Chemistry, Obstetrics, Materia Medica, Pharmacy, and Therapeutics. 
 Designed for Students of Medicine throughout the United States. A new edition, revised and 
 extensively improved. In one large royal 12mo. volume, with several hundred illustrations. 
 (Preparing.) 
 
 LISTON (ROBERT), F. R. S., &c. 
 LECTURES ON THE OPERATIONS OF SURGERY, and on Diseases and 
 
 Accidents requiring Operations. Edited, with numerous Additions and Alterations, by T. D. 
 MUTTER, M. D. In one large and handsome octavo volume, of 566 pages, with 216 wood-cuts. 
 
 LALLEMAND (M.). 
 
 THE CAUSES, SYMPTOMS, AND TREATMENT OF SPERMATOR 
 RHOEA. Translated and edited by HENRY J. McDouGAL. In one volume, octavo, 320 pages. 
 Second American edition. (Just Issued.) 
 
 LARDNER (DIONYSIUS), D. C. L., &c. 
 HANDBOOKS OF NATURAL PHILOSOPHY AND ASTRONOMY. 
 
 Revised, with numerous Additions, by the American editor. FIRST COURSE, containing Mecha 
 nics, Hydrostatics, Hydraulics, Pneumatics, Sound, and Optics. In one large royal 12rno. 
 volume, of 750 pages, with 424 wood-cuts. SECOND COURSE, containing Heat, Electricity, Mag 
 netism, and Galvanism, one volume, large royal 12mo., of 450 pages, with 250 illustrations. 
 THIRD COURSE ( now ready), containing Meteorology and Astronomy, in one large volume, royal 
 12mo. of nearly eight hundred pages, with thirty-seven plates and two hundred wood-cuts. The 
 whole complete in three volumes, of about two thousand large pages, with over one thousand 
 figures on steel and wood. 
 
 The various sciences treated in this work will be found brought thoroughly up to the latest period. 
 The work furnishes a very clear and satisfactory | factory^ manner the information they desire. The 
 
 account of our knowledge in the important depart- 
 
 it depart 
 
 ment of science of which it treats. Although the 
 medical schools of this country do not include the 
 
 study of physics in their course of instruction, yet all that has been developed in relation to the great 
 no student or practitioner should be ignorant of its forces of nature, Heat, Magnetism, and Electricity 
 
 Virginia Med. and Surg. Journal. 
 The present treatise is a most complete digest of 
 
 laws. Besides being of constant application in prac 
 tice, such knowledge is of inestimable utility in fa 
 cilitating the study of other branches of science. T( 
 
 Their laws are elucidated in a manner both pleasing 
 and familiar, and at the same time perfectly intelli 
 gible to the student. The illustrations are suffi- 
 
 tudents, then, and to those who. having already en- | ciently numerous and appropriate, and altogether 
 
 tered upon the active pursuits of business, are desir 
 ous to sustain and improve their knowledge of the 
 general truths of natural philosophy, we can recom 
 mend this work as supplying in a clear and satis- 
 
 we can cordially recommend the work as well-de 
 serving the notice both of the practising physician 
 and the student of medicine. The Med. Examiner. 
 
This book will add more to his fame than either 
 of those which bear his name. Indeed we doubt 
 whether any material improvement will be made on 
 the teachings of this volume for a century to come, 
 since it is so eminently practical, and based on pro 
 found knowledge of the science and consummate 
 skill in the art of healing, and ratified by an ample 
 and extensive experience, such as few men have the 
 industry or good fortune to acquire. N. Y. Med. 
 Gazette. 
 
 20 BLANCHARD & LEA S MEDICAL 
 
 MEIGS (CHARLES D.) f M. D., 
 
 Professor of Obstetrics, &c. in the Jefferson Medical College, Philadelphia. 
 
 ON THE NATURE, SIGNS, AND TREATMENT OE CHILDBED 
 
 FEVER. In a Series of Letters addressed to the Students of his Class. In one handsome 
 
 octavo volume, of three hundred and sixty-five pages. (Now Ready.) 
 
 The instructive and interesting author of this 
 work, whose previous labors in the department of 
 medicine which he so sedulously cultivates, have 
 placed his countrymen under deep and abiding obli 
 gations, again challenges their admiration in the 
 r resh and vigorous, attractive and racy pages before 
 us. It is a delectable book. * * * This treatise 
 upon child-bed fevers will have an extensive sale, 
 being destined, as it deserves, to find a place in the 
 library of every practitioner who scorns to lag in the 
 rear of his brethren. Nashville Journal of Medi 
 cine and Surgery. 
 
 BY THE SAME AUTHOR. 
 
 WOMAN : HER DISEASES AND THEIR REMEDIES. A Series of Lec 
 tures to his Class. Third and Improved edition. In one large and beautifully printed octavo 
 volume. (Just Issued. Revised and enlarged to 1854.) 
 
 The gratifying appreciation of his labors, as evinced by the exhaustion of two large impressions* 
 ef this work within a few years, has not been lost upon the author, who has endeavored in every 
 way to render it worthy of the favor with which it has been received. The opportunity thus 
 afforded for a second revision has been improved, and the work is now presented as in every way 
 superior to its predecessors, additions and alterations having been made whenever the advance of 
 science has rendered them desirable. The typographical execution of the work will also be found 
 to have undergone a similar improvement and the work is now confidently presented as in every 
 way worthy the position it has acquired as the standard American text-book on the Diseases of 
 Females. 
 
 It contains a vast amount of practical knowledge, | such bold relief, as to produce distinct impressions 
 by one who has accurately observed and retained upon the mind and memory of the reader. The 
 
 the experience of many years, and who tells the re 
 sult in a free, familiar, and pleasant manner. Dub 
 lin Quarterly Journal. 
 
 Charleston Med. Journal. 
 
 Professor Meigs has enlarged and amended this 
 great work, for such it unquestionably is, having 
 
 There is an off-hand fervor, a glow, and a warm- i passed the ordeal of criticism at home and abroad, 
 heartedness infecting the effort of Dr. Meigs, which j but been improved thereby ; for in this new edition 
 is entirely captivating, and which absolutely hur- I the author has introduced real improvements, and 
 ries the reader through from beginning to end. Be- j increased the value and utility of the book im- 
 sides, the book teems with solid instruction, and i measurably. It presents so many novel, bright, 
 it shows the very highest evidence of ability, viz., and sparkling thoughts; such an exuberance of new 
 
 the clearness with which the information is pre 
 sented. We know of no better test of one s under 
 standing a subject than the evidence of the power 
 
 ideas on almost every page, that we confess our 
 selves to have become enamored with the book 
 and its author ; and cannot withhold our congratu- 
 
 of lucidly explaining it. The most elementary, as j lations from our Philadelphia confreres, that such a 
 well as the obscurest subjects, under the pencil of i teacher is in their service. N. Y. Med. Gazette. 
 Prof. Meigs, are isolated and made to stand out in | 
 
 BY THE SAME AUTHOR. 
 
 OBSTETRICS : THE SCIENCE AND THE ART. Second edition, revised 
 
 and improved. With one hundred and thirty-one illustrations. In one beautifully printed octavo 
 volume, of seven hundred and fifty-two large pages. (Lately Published.) 
 
 The rapid demand for a second edition of this work is a sufficient evidence that it has supplied 
 a desideratum of the profession, notwithstanding the numerous treatises on the same subject which 
 have appeared within the last few years. Adopting a system of his own, the author has combined 
 the leading principles of his interesting and difficult subject, with a thorough exposition of its rules 
 of practice, presenting the results of long and extensive experience and of familiar acquaintance 
 with all the modern writers on this department of medicine. As an American Treatise on Mid 
 wifery, which has at once assumed the position of a classic, it possesses peculiar claims to the at 
 tention and study of the practitioner and student, while the numerous alterations and revisions 
 which it has undergone in the present edition are shown by the great enlargement of the work, 
 which is not only increased as to the size of the page, but also in the number. 
 
 BY THE SAME AUTHOR. (Now Ready.) 
 
 A TREATISE ON ACUTE AND CHRONIC DISEASES OF THE NECK 
 
 OF THE UTERUS. With numerous plates, drawn and colored from nature in the highest 
 style of art. In one handsome octavo volume, extra cloth. 
 
 The object of the author in this work has been to present in a small compass the practical results 
 of his long experience in this important and distressing class of diseases. The great changes intro 
 duced into practice, and the accessions to our knowledge on the subject, within the last few years, 
 resulting from the use of the metroscope, brings within the ordinary practice of every physician 
 numerous cases which were formerly regarded as incurable, and renders of great value a work like 
 the present combining practical directions for diagnosis and treatment with an ample series of illus 
 trations, copied accurately from colored drawings made by the author, after nature. 
 
 BY THE SAME AUTHOR. 
 
 OBSERVATIONS ON CERTAIN OF THE DISEASES OF YOUNG 
 
 CHILDREN. In one handsome octavo volume, of 214 pages. 
 
AND SCIENTIFIC PUBLICATIONS. 21 
 
 MILLER (JAMES), F. R. S. E., 
 
 Professor of Surgery in the University of Edinburgh, &c. 
 
 PRINCIPLES OF SURGERY. Third American, from the second and revised 
 
 Edinburgh edition. Revised, with Additions, by F. W. SARGENT, M. D., author of " Minor Sur 
 gery," &c. In one large and very beautiful volume, of seven hundred and fifty-two pages, with 
 two hundred and forty exquisite illustrations on wood. 
 
 This edition is far superior, both in the abundance j guage. This opinion, deliberately formed after a 
 and quality of its material, to any of the preceding, careful study of the first edition, we have had no 
 We hope it will be extensively read, and the sound | cause to change on examining the second. This 
 
 principles which are herein taught treasured up for 
 future application. The work takes rank with 
 Watson s Practice of Physic ; it certainly does not 
 fall behind that great work in soundness of princi 
 ple or depth of reasoning and research. No physi 
 cian .who values his reputation, or seeks the interests 
 of his clients, can acquit himself before his God and 
 the world without making himself familiar with the 
 sound and philosophical views developed in the fore 
 going book. New Orleans Med. and Surg. Journal. 
 Without doubt the ablest exposition of the prin 
 ciples of that branch of the healing art in any lan- 
 
 edit.ion has undergone thorough revision by the 
 thor; many expressions have been modified, and a 
 mass of new matter introduced. The book is got up 
 in the finest style, and is an evidence of the progress 
 of typography in our country. Charleston Medical 
 Journal and Review. 
 
 We recommend it to both student and practitioner, 
 feeling assured that as it now comes to us, it pre 
 sents the most satisfactory exposition of the modern 
 doctrines of the principles of surgery to be found in 
 any volume in any language. N. Y. Journal of 
 
 Medicine. 
 BY THE SAME AUTHOR. (NoiV Ready.) 
 
 THE PRACTICE OF SURGERY. Third American from the second Edin 
 burgh edition. Edited, with Additions, by F. W. SARGENT, M. D , one of the Surgeons to Will s 
 Hospital, fcc. Illustrated by three hundred and nineteen engravings on wood. In one large 
 octavo volume, of over seven hundred pages. 
 
 No encomium of ours could add to the popularity j By the almost unanimous voice of the profession, 
 of Miller s Surgery. Its reputation in this country j his works, both on the principles and practice of 
 is unsurpassed by that of any other work, and, when surgery have been assigned the highest rank. If we 
 taken in connection with the author s Principles of\ were limited to but one work on surgery, that one 
 Surgery, constitutes a whole, without reference to j should be Miller s, as we regard it superior to all 
 which no conscientious surgeon would be willing others. St. Louis Med. and Surg. Journal. 
 to practice his art. The additions, by Dr. Sargent, 
 
 have materially enhanced the value of the work.- I Tlie " utllor distinguished alike as a practitioner 
 Southern Medical and Surgical Journal. nd writer, has m this and his " Principles, 1 pre- 
 
 . . ., sen ted to the profession one of the moat complete and 
 
 It is seldom that two volumes have ever made so | re i ial)le syst ems of Surgery extant. His st.vle of 
 profound an impression in so short a time as the j wririn? is original, impressive, and engaging, ener- 
 Principles" and the " Practice" of Surgery by j tic concise, and lucid. Few have the faculty of 
 Mr. Miller or so richly merited the reputation they j Condensing so much in small space, and at the same 
 have acquired. The author is an eminently sensi- \ tjme so persistently holding the attention; indeed, 
 ble, practical, and well-informed man, who knows j he appears to make the very process of condensation 
 exactly what he is talking about, and exactly how to a me;ms of eliminating attractions. Whether as a 
 
 talk it. Kentucky Medical Recorder. 
 
 mating 
 text-book for students or a book of reference for 
 
 The two volumes together form a complete expose practitioners, it cannot be too strongly recommend- 
 of the present state of Surgery, and they ought to be : ed. Southern Journal of the Medical and Physical 
 on the shelves of every surgeon. N. J. Med. Re- j Sciences, 
 porter. 
 
 MALGAIGNE (J. F.). 
 
 OPERATIVE SURGERY, based on Normal and Pathological Anatomy. Trans 
 lated from the French, by FREDERICK BRITTAN, A. B., M. D. With numerous illustrations on 
 wood. In one handsome octavo volume, of nearly six hundred pages. 
 We unhesitatingly pronounce it the very best 1 profession in any language. Charleston Med. and 
 
 guide in surgical operations that has come before the | Surg. Journal. 
 
 MOHR (FRANCIS), PH. D., AND REDWOOD (TH EOPH I LUS). 
 PRACTICAL PHARMACY. Comprising the Arrangements, Apparatus, and 
 
 Manipulations of the Pharmaceutical Shop and Laboratory. Edited, with extensive Additions, 
 by Prof. WILLIAM PROCTER, of the Philadelphia College of Pharmacy. In one handsomely 
 printed octavo volume, of 570 pages, with over 500 engravings on wood. 
 
 It is a book, however, which will be in the hands sary thereto. On these matters, this work is very 
 of almost every one who is much interested in phar- [full and complete, and details, in a style uncom- 
 maceutical operations, as we know of no other pub- j monly clear and lucid, not only the more compli- 
 lication so well calculated to fill a void long felt. cated and difficult processes, but those not less im- 
 Medical Examiner. portant ones, the most simple and common. B uffalo 
 
 Tiie book is strictly practical, and describes only j Medical Journal . 
 manipulations or methods of performing the nume- j The country practitioner who is obliged to dis 
 
 pense his own medicines, will find it a most valuable 
 assistant. Monthly Journal and Retrospect. 
 
 rous processes the pharmaceutist has to go through, 
 in the preparation and manufacture of medicines, 
 together with all the apparatus and fixtures neces- 
 
 MACKENSIE (W.), M . D., 
 
 Surgeon Oculist in Scotland in ordinary to Her Majesty, Ac. &c. 
 
 A PRACTICAL TREATISE OX DISEASES OF THE EYE. To which is 
 
 prefixed an Anatomical Introduction explanatory of a Horizontal Section of the Human Eyeball. 
 
 Bv THOMAS WHARTON JONES, F. R. S. From the Fourth Revised and Enlarged London Edition. 
 
 With Notes and Additions by ADDINELL HEWSON, M. D-, Physician to Wills Hospital. &:c. &c. 
 
 In one very large and handsome octavo volume, with plates and numerous wood-cuts. (Preparing.) 
 
 The reputation which this work has universally attained will be enhanced by the present edition. 
 Besides the thorough revision by the author which it has enjoyed in recently passing through the 
 press in London, the additions by the editor will embrace whatever is necessary to adapt it com 
 pletely to the wants of the American practitioner, constituting it a library of Ophthalmic Medicine 
 and Surgery. 
 
22 
 
 BLANCHARD & LEA S MEDICAL 
 
 MACLISE (JOSEPH), SURGEON. 
 SURGICAL ANATOMY. Forming one volume, very large imperial quarto. 
 
 With sixty-eight large and splendid Plates, drawn in the best style and beautifully colored. Con 
 taining one hundred and ninety Figures, many of them the size of life. Together with copious 
 and explanatory letter-press. Strongly and handsomely bound in extra cloth, being one of the 
 cheapest and best executed Surgica works as yet issued in this country. 
 
 Copies can be sent by mail, in five parts, done up in stout covers. 
 
 This great work being now concluded, the publishers confidently present it to the attention of the 
 profession as worthy in every respect of their approbation and patronage. No complete work of 
 the kind has yet been published in the English language, and it therefore will supply a want long 
 felt in this country of an accurate and comprehensive Atlas of Surgical Anatomy to which the 
 student and practitioner can at all times refer, to ascertain the exact relative position of the various 
 portions of the human frame towards each other and to the surface, as well as their abnormal de 
 viations. The importance of such a work to the student in the absence of anatomical material, and 
 to the practitioner when about attempting an operation, is evident, while the price of the book, not 
 withstanding the large size, beauty, and finish of the very numerous illustrations, is so low as to 
 place it within the reach of every member of the profession. The publishers therefore confidently 
 anticipate a very extended circulation for this magnificent work. 
 
 One of the greatest artistic triumphs of the age 
 in Surgical Anatomy. British American Medical 
 Journal, 
 
 Too much cannot be said in its praise; indeed, 
 we have not language to do it justice. Ohio Medi 
 cal and Surgical Journal, 
 
 The most admirable surgical atlas we have seen. 
 To the practitioner deprived of demonstrative dis 
 sections upon the human subject, it is an invaluable 
 companion. N. J. Medical Reporter. 
 
 The most accurately engraved and beautifully 
 colored plates we have ever seen in an American 
 book one of the best and cheapest surgical works 
 ever published. Buffalo Medical Journal. 
 
 It is very rare that so elegantly printed, so well 
 illustrated, and so useful a work, is offered at so 
 moderate a price. Charleston Medical Journal, 
 
 Its plates can boast a superiority which places 
 them almost beyond the reach of competition. Medi 
 cal Examiner, 
 
 Every practitioner, we think, should have a work 
 of this kind within reach. Southern Medical and 
 Surgical Journal. 
 
 No such lithographic illustrations of surgical re 
 gions have hitherto, we think, been given. Boston 
 Medical and Surgical Journal. 
 
 As a surgical anatomist, Mr. Maclise has proba 
 bly no superior. British and Foreign Medico-Chi- 
 rurgical Review. 
 
 Of great value to the student engaged in dissect 
 ing, and to the surgeon at a distance from the means 
 
 of keeping up his anatomical knowledge. Medical 
 Times. 
 
 The mechanical execution cannot be excelled. 
 Transylvania Medical Journal. 
 
 A work which has no parallel in point of accu 
 racy and cheapness in the English language. N. Y. 
 Journal of Medicine. 
 
 To all engaged in the study or practice of their 
 profession, such a work is almost indispensable. 
 Dublin Quarterly Medical Journal. 
 
 No practitioner whose means will admit should 
 fail to possess it. Ranking s Abstract. 
 
 Country practitioners will find these plates of im 
 mense value. N. Y. Medical Gazette. 
 
 We are extremely gratified to announce to the 
 profession the completion of this truly magnificent 
 work, which, as a whole, certainly stands unri 
 valled, both for accuracy of drawing, beauty of 
 coloring, und all the requisite explanations of the 
 subject in hand. The New Orleans Medical and 
 Surgical Journal. 
 
 This is by far the ablest work on Surgical Ana 
 tomy that has come under our observation. We 
 know of no other work that would justify a stu 
 dent, in any degree, for neglect of actual dissec 
 tion. Jn those sudden emergencies that so often 
 arise, and which require the instantaneous command 
 of minute anatomical knowledge, a work of this kind 
 keeps the details of the dissecting-room perpetually- 
 fresh in the memory. The Western Journal of Medi 
 cine and Surgery. 
 
 The very low price at which this work is furnished, and the beauty of its execution, 
 require an extended sale to compensate the publishers for the heavy expenses incurred. 
 
 MULLER (PROFESSOR J.), M.D. 
 
 PRINCIPLES OF PHYSICS AND METEOROLOGY. Edited, with Addi 
 tions, by R. EGLESFELD GRIFFITH, M. D. In one large and handsome octavo volume, extra 
 cloth, with 550 wood-cuts, and two colored plates. 
 
 The Physics of Mflller is a work superb, complete. | tion to the scientific records of this country may be 
 
 jience 
 
 supplied. The work is 
 of surpassing interest. The value of this contribu- 
 
 unique: the greatest want known to English Science j duly estimated by the fact that the cost of the origi- 
 coukl not have been better supplied. The work is I nal drawings and engravings alone has exceeded the 
 
 sum of 2,000. Lancet. 
 
 MAYNE (JOHN), M. D., M. R. C. S. 
 
 A DISPENSATORY AND THERAPEUTICAL REMEMBRANCER. Com 
 prising the entire lists of Materia Mediea, with every Practical Formula contained m the three 
 British Pharmacopoeias. With relative Tables subjoined, illustrating, by upwards of six hundred 
 and sixty examples, the Extemporaneous Forms and Combinations suitable for the different 
 Medicines. Edited, with the addition of the Formulae of the United States Pharmacopoeia, by 
 K. EGLESFELD GRIFFITH, M. D. In one 12mo. volume, extra cloth, of over 300 large pages. 
 
 MATTEUCCI (CARLO). 
 LECTURES ON THE PHYSICAL PHENOMENA OF LIVING BEINGS. 
 
 Edited by J. PEREIRA, M. D. In one neat royal 12mo. volume, extra cloth, with cuts, 388 pages- 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 23 
 
 NEILL (JOHN), M. D., 
 
 Surgeon to the Pennsylvania Hospital, &c.j and 
 FRANCIS GURNEY SMITH, M.D., 
 
 Professor of Institutes of Medicine in the Pennsylvania Medical College. 
 
 AN ANALYTICAL COMPENDIUM OF THE VARIOUS BRANCHES 
 
 OF MEDICAL SCIENCE ; for the Use and Examination of Students. Second edition, revised 
 and improved. In one very large and handsomely printed royal 12mo. volume, of over one 
 thousand pages, with three hundred and fifty illustrations on wood. Strongly bound in leather, 
 with raised bands. 
 
 The speedy sale of a large impression of this work has afforded to the authors gratifying evidence 
 of the correctness of the views which actuated them in its preparation. In meeting the demand 
 for a second edition, they have therefore been desirous to render it more worthy of the favor with 
 which it has been received. To accomplish this, they have spared neither time nor labor in embo 
 dying in it such discoveries and improvements as have been made since its first appearance, and 
 such alterations as have been suggested by its practical use in the class and examination-room. 
 Considerable modifications have thus been introduced throughout all the departments treated of in 
 the volume, but more especially in the portion devoted to the " Practice of Medicine," which has 
 been entirely rearranged and rewritten. The authors therefore again submit their work to the 
 profession, with the hope that their efforts may tend, however humbly, to advance the great caus-e 
 of medical education. 
 
 Notwithstanding the enlarged size and improved execution of this work, the price has not been 
 increased, and it is confidently presented as one of the cheapest volumes now before the profession. 
 
 Having made free use of this volume in our ex 
 aminations of pupils, we can speak from experi 
 ence in recommending it as an admirable compend 
 for students, and as especially useful to preceptors 
 who examine their pupils. It will save the teacher 
 much labor by enabling him readily to recall all of 
 the points upon whicp his pupils should be ex 
 amined. A work of this sort should be in the hands 
 of every one who takes pupils into his office with a 
 view of examining them; and this is unquestionably 
 the best of its class. Let every practitioner who has 
 pupils provide himself with it, and he will find the 
 labor of refreshing his knowledge so much facilitated 
 that he will be able to do justice to his pupils at very- 
 little cost of time or trouble to himself. Transyl 
 vania Med. Journal. 
 
 In the rapid course of lectures, where work for 
 the students is heavy, and review necessary for an 
 examination, a compend is not only valuable, but 
 it is almost a sine qua non. The one before us is, 
 in most of the divisions, the most unexceptionable 
 of all books of the kind that we know of. The 
 newest and soundest doctrines and the latest im 
 provements and discoveries are explicitly, though 
 concisely, laid before the student. Of course it is 
 useless for us to recommend it to all last course 
 students, but there is a class to whom we very 
 sincerely commend this cheap book as worth its 
 weight in silver that class is the graduates in 
 medicine of more than ten years standing, who 
 have not studied medicine since. They will perhaps 
 find out from it that the science is not exactly now 
 what it was when they left it off. The. Stethoscope 
 
 NELIGAN (J. MOORE), M. D., M. R. I. A., &c. 
 A PRACTICAL TREATISE ON DISEASES OF THE SKIN. In one 
 
 neat royal 12mo. volume, of 334 pages. 
 
 OWEN (PROF. R.), 
 
 Author of " Lectures on Comparative Anatomy," " Archetype of the Skeleton," &c. 
 
 ON THE DIFFERENT FORMS OF THE SKELETON, AND OF THE 
 
 TEETH. One vol. royal 12mo., with numerous illustrations. (Now Ready.) 
 The name of the distinguished author is a sufficient guarantee that this little volume will prove 
 a satisfactory manual and guide to all students of Comparative Anatomy and Osteology. The im 
 portance of this subject in geological investigations will also render this work a most valuable 
 assistant to those interested in that science. 
 
 PHILLIPS (BENJAMIN), F. R. S., &c. 
 
 SCROFULA ; its Nature, its Prevalence, its Causes, and the Principles of its 
 Treatment. In one volume, octavo, with a plate. 
 
 PANCOAST (J.), M. D., 
 Professor of Anatomy in the Jefferson Medical College, Philadelphia, &c. 
 
 OPERATIVE SURGERY; or, A Description and Demonstration of the various 
 Processes of the Art; including all the New Operations, and exhibiting the State of Surgical 
 Science in its present advanced condition. Complete in one royal 4to. volume, of 380 pages of 
 letter-press description and eighty large 4to. plates, comprising 486 illustrations. Second edition, 
 improved. 
 Blanchard & Lea having become the publishers of this important book, have much pleasure in 
 
 offering it to the profession. 
 
 This excellent work is constructed on the model 
 of the French Surgical Works by Velpeau and Mal- 
 gaigne; and, so far as the English language is con 
 
 cerned, we are proud as an American to say that, 
 
 OF ITS KIND IT HAS NO SUPERIOR. N. Y. Journal of 
 
 Medicine. 
 
 PARKER (LANGSTON), 
 
 Surgeon to the Queen s Hospital, Birmingham. 
 
 THE MODERN TREATMENT OF SYPHILITIC DISEASES, BOTH PRI 
 MARY AND SECONDARY; comprising the Treatment of Constitutional and Confirmed Syphi 
 lis, by a safe and successful method. With numerous Cases, Formulae, and Clinical Observa 
 tions. From the Third and entirely rewritten London edition. In one neat octavo volume. 
 (Now Ready.) 
 
BLANC HARD & LEA S MEDICAL 
 
 (Now Complete. ) 
 
 PEREIRA (JONATHAN), M. D., F. R. S., AND L. S. 
 THE ELEMENTS OF MATERIA MEDICA AND THERAPEUTICS. 
 
 Third American edition, enlarged and improved by the author; including Notices of most of the 
 Medicinal Substances in use in the civilized world, and forming an Encyclopaedia of Materia 
 Medica. Edited, with Additions, by JOSEPH CARSON, M. D., Professor of Materia Medica and 
 Pharmacy in the University of Pennsylvania. In two very large octavo volumes of 2100 pages, 
 on small type, with over four hundred and fifty illustrations. 
 VOLUME I. Lately issued, containing the Inorganic Materia Medica, over 800 pages, with 145 
 
 illustrations. 
 
 VOLUME II. Now ready, embraces the Organic Materia Medica, and forms a very large octavo 
 volume of 1250 pages, with two plates and three hundred handsome wood-cuts. 
 The present edition of this valuable and standard work will enhance in every respect its well- 
 deserved reputation. The care bestowed upon its revision by the author may be estimated by the 
 fact that its size has been increased by about five hundred pages. These additions have extended 
 to every portion of the work, and embrace not only the materials afforded by the recent editions of 
 the pharmacopoeias, but also all the important information accessible to the care and industry of 
 the author in treatises, essays, memoirs, monographs, and from correspondents in various parts of 
 the globe. In this manner the work comprises the most recent and reliable information respecting 
 all the articles of the Materia Medica, their natural and commercial history, chemical and thera 
 peutical properties, preparation, uses, doses, and modes of administration, brought up to the present 
 lime, with a completeness not to be met with elsewhere. A considerable portion of the work 
 which preceded the remainder in London, has also enjoyed the advantage of a further revision by 
 the author expressly for this country, and in addition to this the editor, Professor Carson, has made 
 whatever additions appeared desirable to adapt it thoroughly to the U. S. Pharmacopoeia, and to 
 the wants of the American profession. An equal improvement will likewise be observable in every 
 department of its mechanical execution. It is printed from new type, on good white paper, with a 
 greatly extended and improved series of illustrations. 
 
 Gentlemen who have the first volume are recommended to complete their copies without delay. 
 The first volume will no longer be sold separate. 
 
 When we remember that Philology, Natural His 
 tory, Botany, Chemistry, Physics, and the Micro 
 scope, are all brought forward to elucidate the sub 
 ject, one cannot fail to see that the reader has here 
 a work worthy of the name of an encyclopedia of 
 Materia Medica. Our own opinion of its merits is 
 that of its editors, and also that of the -whole profes 
 sion, both of this and foreign countries namely, 
 " that in copiousness of details, in extent, variety, 
 and accuracy of information, and in lucid explana 
 tion of difficult and recondite subjects, it surpasses 
 all other works on Materia Medica hitherto pub 
 lished." We cannot close this notice without allud 
 ing to the special additions of the American editor, 
 which pertain to the prominent vegetable produc 
 tions of this country, and to the directions of the 
 United States Pharmacopeia, in connection with all 
 the articles contained in the volume which are re- 
 
 Medica, although completed under the supervision of 
 others, is by far the most elaborate treatise in the 
 English language, and will, while medical literature 
 is cherished, continue a monument alike honorable 
 to his genius, as to his learning and industry. 
 American Journal of Pharmacy, March, 1854. 
 
 The work, in its present shape, and so far as can 
 be judged from the portion before the public, forms 
 the most comprehensive and complete treatise on 
 materia medica extant in the English language. 
 Dr. Pereira has been at great pains to introduce 
 into his work, not only all the information on the 
 natural, chemical, and commercial history of medi 
 cines, which might be serviceable to the physician 
 and surgeon, but whatever might enable his read 
 ers to understand thoroughly the mode of prepar 
 ing and manufacturing various articles employed 
 fe7re~dToTfit7hen7usTraU^ \ either for preparing medicines, or for certain pur 
 
 j ^i i *.. i -r-k ^ it i r*/-o*ic in tViA nrta nnnnpptpn \*n t" h rrmtpria mp(.if>; 
 
 and this edition by Dr. Carson cannot well be re- 
 garded in any other light than that of a treasure 
 which should be found in the library of every physi 
 cian. New York Journal of Medical and Collateral 
 Science, March, 1854. 
 
 The third edition of his " Elements of Materia 
 
 poses in the arts connected with materia niecaea 
 and the practice of medicine. The accounts of the 
 physiological and therapeutic effects of remedies aye 
 given with great clearness and accuracy, and in a 
 manner calculated to interest as well as instruct 
 the reader. The Edinburgh Medical and Surgical 
 Journal. 
 
 PEASELEE (E. R.), M. D., 
 
 Professor of Anatomy and Physiology in Dartmouth College, &c. 
 
 HUMAN HISTOLOG-Y, in its applications to Physiology and General Pathology; 
 
 designed as a Text-Book for Medical Students. With numerous illustrations. In one handsome 
 
 royal 12mo. volume. (Preparing.} 
 
 The subject of this work is one, the growing importance of which, as the basis of Anatomy and 
 Physiology, demands for it a separate volume. The book will therefore supply an acknowledged 
 deficiency in medical text-books, while the name of the author, and his experience as a teacher for 
 the last thirteen years, is a guarantee that it will be thoroughly adapted to the use of the student. 
 
 PIRRIE (WILLIAM), F. R. S. E., 
 
 Professor of Surgery in the University of Aberdeen. 
 
 THE PRINCIPLES AND PllACTICE OF SURGERY. Edited by JOHN 
 
 NEILL, M. D., Demonstrator of Anatomy in the University of Pennsylvania, Surgeon to the 
 Pennsylvania Hospital, &c. In one very handsome octavo volume, of 780 pages, with 316 illus- 
 tratioiu-i. (Just Issued.) 
 
 We know of no other surgical work of a reason 
 able size, wherein there is so much theory and prac 
 tice, or where subjects are more soundly or clearly 
 taught. The Stethoscope. 
 
 There is scarcely a disease of the bone or soft 
 parts, fracture, or dislocation, that is not illustrated 
 by accurate wood-engravings. Then, again, every 
 instrument employed by the surgeon is thus repre 
 sented. These engravings are not only correct, but 
 really beautiful, showing the astonishing degree of 
 perfection to which the art of wood-engraving has 
 
 arrived. Prof. Pirrie, in the work before us, has 
 elaborately discussed the principles of surgery, and 
 a safe and effectual practice predicated upon them. 
 Perhaps no work upon this subject heretofore issued 
 is so full upon the science of the art of surgery. 
 Nashville Journal of Medicine and Surgery. 
 
 One of the best treatises on surgery in the English 
 language. Canada Med. Journal. 
 
 Our impression is, that, as a manual for students, 
 Pirrie s is the best work extant. Western Med. and 
 Surg. Journal. 
 
AND SCIENTIFIC PUBLICATIONS. 25 
 
 RAMS BOTH AM (FRANCIS H .), M.D. 
 THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND 
 
 SURGERY, in reference to the Process of Parturition. A new and enlarged edition, thoroughly 
 revised by the Author. With Additions by W. V. KEATING, M. 1). In one large and handsome 
 imperial octavo volume, with sixty-four beautiful Plates, and numerous Wood-cuts in the text, 
 containing in all nearly two hundred large and beautiful figures. (Now Ready.) 
 
 In calling the attention of the profession to the new edition of this standard work, the publishers 
 would remark that no efforts have been spared to secure for it a continuance and extension of the 
 remarkable favor with which it has been received. The last London issue, which was considera 
 bly enlarged, has received a further revision from the author, especially for this country. Its pas 
 sage through the press here has been supervised by Dr. Keating, who has made numerous addi 
 tions with a view of presenting more fully whatever was necessary to adapt it thoroughly to 
 American modes of practice. In its mechanical execution, a like superiority over former editions 
 will be found. The plates have all been re-engraved in a new and beautiful style ; many additional 
 illustrations have been introduced, and in every point of typographical finish it will be found one of 
 the handsomest issues of the American press. In its present improved and enlarged form the pub 
 lishers therefore confidently ask for it a place in every medical library, as a text-book for the student, 
 or a manual for daily reference by the practitioner. 
 
 From Prof. Hodge, of the University of Pa. 
 
 To the American public, it is most valuable, from its intrinsic undoubted excellence, and as being 
 Hie best authorized exponent of British Midwifery. Its circulation will, I trust, be extensive throughout 
 our country. 
 
 We recommend the student who desires to mas 
 ter this difficult subject with the least possible 
 trouble, to possess himself at once of a copy of this 
 work. American Journal of the Med. Sciences. 
 
 When the whole profession is thus unanimous 
 in placing such a work in the very first rank as 
 regards the extent and correctness of all the details 
 of the theory and practice of so important a branch 
 
 It stands at the head of the long list of excellent I of learning, our commendation or condemnation 
 istetric works published in the last few years in would be of little consequence; but regarding it 
 reat Britain, Ireland, and the Continent of Eu- a , s . th e. most useful of all works of the kind, we 
 
 obst 
 
 Great 
 
 rope. We consider this book indispensable to the 
 library of every physician engaged in the practice 
 of midwifery. Southern Med. and Surg. Journal. 
 
 think it but an act of justice to urge its claims 
 upon the profession. N. 0. Med. Journal. 
 
 RICORD (P.), M. D., 
 Surgeon to the Hopital du Midi, Paris, &c. 
 
 ILLUSTRATIONS OF SYPHILITIC DISEASE. Translated from the French, 
 
 by THOMAS F. BETTON, M. D. With the addition of a History of Syphilis, and a complete Bib 
 liography and Formulary of Remedies, collated and arranged, by PAUL, B. GODDARD, M. D. With 
 fifty large quarto plates, comprising one hundred and seventeen beautifully colored illustrations. 
 In one large and handsome quarto volume. 
 
 BY THE SAME AUTHOR. (Now Ready.) 
 
 A TREATISE ON THE VENEREAL DISEASE. By JOHN HUNTER, F. R. S. 
 
 With copious Additions, by PH. RICORD, M. D. Edited, with Notes, by FREEMAN J. BUMSTEAD, 
 M. D. In one handsome octavo volume, with plates. 
 
 Every one will recognize the attractiveness and [ In the notes to Hunter, the master substitutes him- 
 value which this work derives from thus preseniing | self for his interpreters, and gives his original thought? 
 
 the opinions of these two masters side by side. But, 
 it must be admitted, what has made the fortune of 
 the book, i? ihe fact that it contains the "most com 
 plete embodiment of the veritable doctrines of the 
 Hopital du Midi," which has ever been made public. 
 The doctrinal ideas of M. Ricord, ideas which, if not 
 universally adopted, are incontestably dominant, have 
 heretofore only been interpreted by more or less skilful 
 secretaries, sometimes accredited and sometimes not. 
 
 to the world, in a summary form it is true, but in a 
 lucid and perfectly intelligible manner. In conclu 
 sion we can say that this is incontestably the best 
 treatise on syphilis with which we are acquainted, 
 and. as we do not often employ the phrase, we may 
 be excused for expressing the hope that it may find 
 a place in the library of every physician Virginia 
 Med. and Surg Journal. 
 
 BY THE SAME AUTHOR. 
 
 LETTERS ON SYPHILIS, addressed to the Chief Editor of the Union Medicale. 
 With an Introduction, by Amedee Latour. Translated by W. P. Lattimore, M. D. In one neat 
 octavo volume. 
 
 Blanchard & Lea are now the publishers of this valuable work. 
 
 From the Translator s Preface. 
 
 To those who have listened to the able and interesting lectures of our author at the Hopital du 
 Midi, this volume will need no commendation; while to those who have not had the pleasure to 
 which we allude, the book will commend itself by the truths it contains, told as they are in the 
 same inimitable style in which M. Ricord delivers his clinical lectures. 
 
 BY THE SAME AUTHOR. 
 
 A PRACTICAL TREATISE ON VENEREAL DISEASES. With a There- 
 
 peutical Summary and Special Formulary. Translated by SIDNEY DOANE, M. D. Fourth edition. 
 One volume, octavo, 340 pages. 
 
BLANCHARD & LEA S MEDICAL 
 
 RIGBY (EDWARD), M. D., 
 
 Physician to the General Lying-in Hospital, &c. 
 
 A SYSTEM OF MIDWIFERY. With Notes and Additional Illustrations. 
 
 Second American Edition. One volume octavo, 422 pages. 
 
 ROYLE (J. FORBES), M . D. 
 MATERIA MEDICA AND THERAPEUTICS; including the Preparations of 
 
 the Pharmacopoeias of London, Edinburgh, Dublin, and of the United States. With many new 
 medicines. Edited by JOSEPH CARSON, M. D., Professor of Materia Medica and Pharmacy in 
 the University of Pennsylvania. With ninety-eight illustrations. In one large octavo volume, 
 of about seven hundred pages. 
 
 This work is, indeed, a most valuable one, and 
 will fill up an important vacancy that existed be 
 tween Dr. Pereira s most learned and complete 
 system of Materia Medica, and the class of pro 
 
 ductions on the other extreme, which are neces 
 sarily imperfect from their small extent. British 
 and Foreign Medical Review, 
 
 SKEY (FREDERICK C.), F. R. S., &c. 
 OPERATIVE SURGERY. In one very handsome octavo volume of over 650 
 
 pages, with about one hundred wood-cuts. 
 
 Its literary execution is superior to most surgical 
 treatises. It abounds in excellent moral hints, and 
 is replete with original surgical expedients and sug 
 gestions. Buffalo Med. and Surg. Journal. 
 
 With high talents, extensive practice, and a long 
 experience, Mr. Skey is perhaps competent to the 
 task of writing a complete work on operative sur 
 gery. Charleston Med. Journal. 
 
 We cannot withhold from this work our high com 
 mendation. Students and practitioners will find it an 
 invaluable teacher and guide upon every topic con 
 nected with this department. N. Y. Medical Ga 
 zette. 
 
 A work of the very highest, importance a work 
 by itself. London Med. Gazette. 
 
 SHARPEY (WILLIAM), M.D., JONES QUAIN, M.D., AND 
 RICHARD QUAIN, F. R. S., &c. 
 
 HUMAN ANATOMY. Revised, with Notes and Additions, by JOSEPH LEIDY, 
 
 M. D. Complete in two large octavo volumes, of about thirteen hundred pages. Beautifully 
 illustrated with over five hundred engravings on wood. 
 
 It is indeed a work calculated to make an era in 
 anatomical study, by placing before the student 
 every department of his science, with a view to 
 
 ^Ve have no hesitation in recommending this trea 
 tise on anatomy as the most complete on that sub 
 ject in the English language; and the only one, 
 
 the relative importance of each ; and so skilfully perhaps, in any language, which brings the state 
 have the different parts been interwoven, that no i of knowledge forward to the most recent disco- 
 one who makes this work the basis of his studies, ~, ~.- , ., .-- . __ . ~ 
 \vill hereafter have any excuse for neglecting or 
 undervaluing any important particulars connected 
 with the structure of the human frame; and 
 whether the bias of his mind lead him in a more 
 especial manner to surgery, physic, or physiology, 
 he will find here a work at once so comprehensive 
 and practical as to defend him from exclusiveness 
 on the one hand, and pedantry on the other. 
 Monthly Journal and Retrospect of the Medical 
 Sciences. 
 
 veries. The Edinburgh Med. and Surg. Journal. 
 
 Admirably calculated to fulfil the object for which 
 it is intended. Prom nciaZ Medical Journal. 
 
 The most complete Treatise on Anatomy in the 
 English language. Edinburgh Medical Journal. 
 
 There is no work in the English language to be 
 preferred to Dr. Quain s Elements of Anatomy. 
 London Journal of Medicine. 
 
 SMITH (HENRY H.), M.D., AND HO RN ER (W I LLI AM E.), M.D. 
 
 AN ANATOMICAL ATLAS, illustrative of the Structure of the Human Body. 
 In one volume, large imperial octavo, with about six hundred and fifty beautiful figures. 
 
 These figures are well selected, and present a 
 complete and accurate representation of that won 
 derful fabric, the human body. The plan of this 
 Atlas, which renders it so peculiarly convenient 
 for the student, and its superb artistical execution, 
 have been already pointed out. We must congratu 
 
 late the student upon the completion of this Atlas, 
 as it is the most convenient work of the kind that 
 has yet appeared ; and we must add, the very beau 
 tiful manner in which it is " got up" is so creditable 
 to the country as to be flattering to our national 
 pride. American Medical Journal. 
 
 SARGENT (F. W.), M. D. 
 ON BANDAGING AND OTHER POINTS OF MINOR SURGERY. In 
 
 one handsome royal 12mo. volume of nearly 400 pages, with 128 wood-cuts. 
 
 The very best manual of Minor Surgery we have } We have carefully examined this work, and find it 
 seen; an American volume, with nearly four hundred well executed and admirably adapted to the use of 
 pages of good practical lessons, illustrated by about the student. Besides the subjects usually embraced 
 one hundred sind thirty wood-cuts. In these days in works on Minor Surgery, there is a short chapter 
 of "trial," when a doctor s reputation hangs upon on bathing, another on anaesthetic agents, and an 
 a clove hitch, or the roll of a bandage, it would be appendix of formulae. The author has given an ex- 
 well, perhaps, to carry such a volume as Mr. Sar- eel lent work on this subject, and his publishers have 
 gent s always in our coat-pocket, or, at all events, illustrated and printed it in most beautiful style. 
 to listen attentively to his instructions at home. The Charleston Medical Journal. 
 Buffalo Med. Journal. 
 
 STANLEY (EDWARD). 
 A TREATISE ON DISEASES OF THE BONES. In one volume, octavo, 
 
 extra cloth, 286 pages. 
 
AND SCIENTIFIC PUBLICATIONS. 27 
 
 STILLE (ALFRED), M. D. 
 PRINCIPLES OF THERAPEUTICS. In one handsome volume. (Preparing.) 
 
 SIMON (JOHN), F. R. S. 
 GENERAL PATHOLOGY, as conducive to the Establishment of Rational 
 
 Principles for the Prevention and Cure of Disease. A Course of Lectures delivered at St. 
 Thomas s Hospital during- the summer Session of 1850. In one neat octavo volume. 
 
 SMITH (TYLER W.), M. D., 
 
 Lecturer on Obstetrics in the Hunterian School of Medicine. 
 
 ON PARTURITION, AND THE PRINCIPLES AND PRACTICE OF 
 
 OBSTETRICS. In one large duodecimo volume, of 400 pages. 
 
 SIBSON (FRANCIS), M. D., 
 
 Physician to St. Mary s Hospital. 
 
 MEDICAL ANATOMY. Illustrating the Form, Structure, and Position of the 
 Internal Organs in Health and Disease. In large imperial quarto, with splendid colored plates. 
 To match "Maclise s Surgical Anatomy." (I?i Press.) 
 
 SOLLY (SAMUEL), F. R. S. 
 
 THE HUMAN BRAIN; its Structure, Physiology, and Diseases. With a 
 Description of the Typical Forms of the Brain in the Animal Kingdom. From the Second and 
 much enlarged London edition. In one octavo volume, with 120 wood-cuts. 
 
 SCHOEDLER (FRIEDRICH), PH.D., 
 
 Professor of the Natural Sciences at Worms, &c. 
 
 THE BOOK OF MATURE; an Elementary Introduction to the Sciences of 
 
 Physics, Astronomy. Chemistry, Mineralogy, Geology, Botany, Zoology, and Physiology. First 
 American edition, with a Glossary and other Additions and Improvements; from the second 
 English edition. Translated from the sixth German edition, by HENRY MEDLOCK, F. C. S. v &c. 
 In one thick volume, small octavo, of about seven hundred pages, with 679 illustrations on wood. 
 Suitable for the higher Schools and private students. (Now Heady.) 
 
 This volume, as its title shows, covers nearly all 
 the sciences, and embodies a vast amount of informa 
 tion for instruction. No other work that we have 
 
 seen presents the reader with so wide a range of ele 
 mentary knowledge, with so full illustrations, at so 
 cheap a rate.Silliman-s Journal, Nov. 1853. 
 
 TAYLOR (ALFRED S.), M . D., F. R. S., 
 
 Lecturer on Medical Jurisprudence and Chemistry in Guy s Hospital. 
 
 MEDICAL JURISPRUDENCE. Third American, from the fourth and improved 
 
 English Edition. With Notes and References to American Decisions, by EDWARD HARTSHORNE, 
 M. D. In one large octavo volume, of about seven hundred pages. (Just issued.) 
 
 reference, that would be more likely to afford the aid 
 desired. We therefore recommend it as the best and 
 
 We know of no work on Medical Jurisprudence 
 which contains in the same space anything like the 
 same amount of valuable matter. N. Y. Journal of 
 Medicine. 
 
 The American editor has appended several im 
 portant facts, the whole constituting by far the best, 
 most reliable, and interesting treatise on Medical 
 Jurisprudence, and one that we cannot too strongly 
 recommend to all who desire to become acquainted 
 with the true and correct exposition of this depart 
 ment of medical literature. Northern Lancet. 
 
 afest manual for daily use. American Journal of 
 Medical Sciences. 
 
 We have heretofore had reason to refer to it in 
 terms of commendation, and need now only state 
 that, in the edition before us, the author has com 
 pletely revised the whole work, making many addi 
 tions and alterations, and brought it fully up to the 
 present state of knowledge. The task of the Ameri 
 can editor has been to present all the important 
 
 No work upon the subject can be put into the facts and cases that have recently occurred in our 
 
 hands of students either of law or medicine which 
 
 own country, bearing on the subjects treated of. 
 
 will engage them more closely or profitably ; and j No better work can be placed in the hands of the 
 none could be offered to the busy practitioner of j physician or jurist. St. Louis Medical and Surgical 
 either calling, for the purpose of casual or hasty Journal. 
 
 BY THE SAME AUTHOR. 
 
 ON POISONS, IN RELATION TO MEDICAL JURISPRUDENCE AND 
 
 MEDICINE. Edited, with Notes and Additions, by R. E. GRIFFITH, M. D. In one large octavo 
 volume, of 688 pages. 
 
 The most elaborate work on the subject that our 
 literature possesses. British and Foreign Medico- 
 Chirurgical Review. 
 
 It contains a vast body of facts, which embrace 
 all that is important in toxicology, all that is 
 necessary to the guidance of the medical jurist, and 
 all that can be desired by the lawyer. Medico- 
 
 a. - 
 
 Chiru-rgical Review. { N. Y. Annalist 
 
 One of the most practical and trustworthy works 
 on Poisons in our language. Western Journal of 
 Medicine . 
 
 It is, so far as our knowledge extends, incompa 
 rably the best upon the subject; in the highest de 
 gree creditable to the author, entirely trustworthy, 
 and indispensable to the student and practitioner. 
 
 THOMSON (A. T.), M. D., F. R. S., &c. 
 DOMESTIC MANAGEMENT OF THE SICK ROOM, necessary in aid of 
 
 Medical Treatment for the Cure of Diseases. Edited by R. E. GRIFFITH, M. D. In one large 
 royal 12mo. volume, with wood-cuts, 360 pages. 
 
28 BL AN CHARD& LEA S MEDICAL 
 
 TOMES (JOHN), F. R. S. 
 A MANUAL OF DENTAL PRACTICE. Illustrated by numerous engravings 
 
 on wood. In one handsome volume. (Preparing.} 
 
 TODD (R. B.), M. D., AND BOWMAN (WILLIAM), F. R. S. 
 PHYSIOLOGICAL ANATOMY AND PHYSIOLOGY OF MAN. With 
 
 numerous handsome wood-cuts. Paris I, II, and III, in one octavo volume, 552 pages. Part IV 
 
 will complete the work. 
 
 The distinguishing peculiarity of this work is, that the authors investigate for themselves every 
 fact asserted ; and it is the immense labor consequent upon the vast number of observations re 
 quisite to curry out this plan, which has so long delayed the appearance of its completion. The 
 first portion ot Part IV, with numerous original illustrations, was published in the Medical News 
 and Library for 1853, and the completion will be issued immediately on its appearance in London. 
 Those who have subscribed since the appearance of the preceding portion of the work can have 
 the three pacts by mail, on remittance of $2 50 to the publishers. 
 
 WATSON (THOMAS), M. D., &c. 
 LECTURES ON THE PRINCIPLES AND PRACTICE OF PHYSIC. 
 
 Third American, from the last London edition. Revised, with Additions, by D. FRANCIS CONDIE, 
 M. D., author of a "Treatise on the Piseases of Children," &c. In one octavo volume, of nearly 
 eleven hundred large pages, strongly bound with raised bands. 
 
 To say that it is the very best work on the sub 
 ject now extant, is but to echo the sentiment of the 
 medical press throughout the country. N. O. 
 Medical Journal. 
 
 Of the text-books recently republished Watson is 
 very justly the principal favorite. Holmes s Rep. 
 to Nat. Med. Assoc. 
 
 By universal consent the work ranks among the 
 very best text-books in our language. Illinois and 
 Indiana Med. Journal. 
 
 Regarded on all hands as one of the very best, if 
 
 Confessedly one of the very best works on the 
 principles and practice of physic in the English or 
 any other language. Med. Examiner. 
 
 Asa text- book it has no equal ; as a compendium 
 of pathology and practice no superior. New York 
 Annalist. 
 
 We know of no work better calculated for being 
 
 E laced in the hands of the student, and for a text- 
 ook; on every impojtfant point the author seems 
 to have posted up hH knowledge to the day. 
 Amer. Med. Journal. 
 
 One of the most practically useful books that 
 
 not the very best, systematic treatise on practical j ever was presented to the student. N. Y. Med. 
 medicine extant. St. Louis Med. Journal. \ Journal. 
 
 WALSHE (W. H.)f M. D., 
 
 Professor of the Principles and Practice of Medicine in University College, London. 
 
 DISEASES OF THE HEART, LUNGS, AND APPENDAGES; their 
 
 Symptoms and Treatment. In one handsome volume, large royal 12mo., 512 pages. 
 We consider this as the ablest work in the En- 1 the author being the first stethoscopist of the day. 
 glish language, on the subject of which it treats; | Charleston Medical Journal. 
 
 WHAT TO OBSERVE 
 AT THE BEDSIDE AND AFTER DEATH, IN MEDICAL CASES. 
 
 Published under the authority of the London Society for Medical Observation. A new American, 
 
 from the second and revised London edition. In one very handsome volume, royal 12mo., extra 
 
 cloth. (Note Ready.} 
 
 The demand which has so rapidly exhausted the first edition of this little work, shows that the 
 advantages it offers to the profession have been duly appreciated, and has stimulated the authors to 
 render it more worthy of its reputation. It has therefore been thoroughly revised, and such im 
 provements (among which is a section on TREATMENT) have been made as further experience in 
 its use has shown to be desirable. 
 
 We hail the appearance of this book as the grand ! given to the world, through a small but useful 
 
 desideratum. Charleston Medical Journal. \ medical organization, a cheap but invaluable book. 
 
 ... , , , , , , i We do advise every reader of this notice to buy it 
 
 This is truly a very capital book. The whole , am , uge it Unless he is S() yain ftg f() iinagine h f m . 
 medical world will reap advantages from its puoli- ge lf superior to the ordinary human capacity, he will 
 cation. The medical journals will soon show its | in six months see its inestimable advantages. 
 influence on the character of the " Reports of Cases" i stethoscope. 
 which they publish. Drs. Bullard and Walshe have ] 
 
 WILDE (W. R.), 
 
 Surgeon to St. Mark s Ophthalmic and Aural Hospital, Dublin. 
 
 AURAL SURGERY, AND THE NATURE AND TREATMENT OF DIS- 
 
 EASES OF THE EAR. In one handsome octavo volume, with illustrations. (Now Ready.) 
 So little is generally known in this country concerning the causes, symptoms, and treatment ot 
 aural affections, that a practical and scientitie work on that subject, from a practitioner of Mr. 
 Wilde s great experience, cannot fail to be productive of much benefit, by attracting attention 
 to this obscure class of diseases, which too frequently escape attention until past relief. The im 
 mense number of cases which have come under Mr. Wilde s observation for many years, have 
 afforded him opportunities rarely enjoyed for investigating this branch of medical science, and his 
 work may thereto re be regarded as of the highest authority. 
 
 This work certainly contains more information on 
 the subject to which it is devoted than any other 
 wilh which we are acquainted. We feel grateful to 
 the author for his manful effort to rescue this depart 
 ment of surgery from the hands of the empirics who 
 nearly monopolize it. We think he has successfully 
 
 shown" that aural diseases are not beyond the re- | Med. Journal. 
 sources of art; that they are governed by the same 
 
 laws, and amenable to the same general methods 01 
 treatment as other morbid processes. The work ig 
 not written to supply the cravings of popular patro 
 nage, but it is wholly addressed to the profession, 
 and bears on every page the impress of the reflections 
 of a sagacious and practical surgeon. Va. Surg. and 
 
AND SCIENTIFIC PUBLICATIONS. 29 
 
 WILSON (ERASMUS), M.D., F. R. S., 
 
 Lecturer on Anatomy, London. 
 
 A SYSTEM OF HUMAN ANATOMY, General and Special. Fourth Ameri 
 can, from the last English edition. Edited hy PAT;L B. GODDARD, A. M., M. D. With two hun 
 dred and fifty illustrations. Beautifully printed, in one large octavo volume, of nearly six hun 
 dred pages. 
 
 In many, if not all the Colleges of the Union, it 
 has become a standard text-book. This, of itself, 
 is sufficiently expressive of its value. A work very 
 desirable to the student; one, the possession of 
 which will greatly facilitate his progress in the 
 study of Practical Anatomy. New York Journal of 
 Medicine. 
 
 It offers to the student all the assistance that can 
 be expected from such a work. Medical Examiner. 
 
 The most complete and convenient manual for the 
 student we possess. American Journal of Medical 
 Science. 
 
 In every respect, this work as an anatomical 
 guide for the student and practitioner, merits our 
 Its author ranks with the highest on Anatomy. I warmest and most decided praise. London Medical 
 Southern Medical and Surgical Journal. I Gazette. 
 
 BY THE SAME AUTHOR. 
 
 THE DISSECTOR; or, Practical and Surgical Anatomy. Modified and Re 
 arranged, by PAUL BECK GODDARD, M. L>. A new edition, with Revisions and Additions. la 
 one large and handsome volume, royal 12mo., with one hundred and fifteen illustrations. 
 
 In passing this work again through the press, the editor has made such additions and improve 
 ments as the advance of anatomical knowledge has rendered necessary to maintain the work in the 
 high reputation which it has acquired in the schools of the United States, as a complete and faithful 
 guide to the student of practical anatomy. A number of new illustrations have been added, espe 
 cially in the portion relating to the complicated anatomy of Hernia. In mechanical execution the 
 work will be ibund superior to former editions. 
 
 BY THE SAME AUTHOR. 
 
 ON DISEASES OF THE SKIN. Third American, from the third London 
 edition. In one neat octavo volume, of about five hundred pages, extra cloth. (Just Issued.) 
 Also, to be had done up with fifteen beautiful steel plates, of which eight are exquisitely colored ; 
 representing the Normal and Pathological Anatomy of the Skin, together with accurately colored 
 delineations of more than sixty varieties of disease, most of them the size of nature. The Plates 
 are also for sale separate, done up in boards. 
 
 The increased size of this edition is siifflcient evidence that the author has not been content 
 with a mere republication, but has endeavored to maintain the high character of his work as the 
 standard text-book on this interesting and difficult class of diseases. He has thus introduced such 
 new matter as the experience of the last three or four years has suggested, and has made such 
 alterations as the progress of scientific investigation has rendered expedient. The illustrations have 
 a-lso been materially augmented, the number of plates being increased from eight to sixteen. 
 
 Of these plates it is impossible to speak too highly . 
 The representations of the various forms of cuta 
 neous disease are singularly accurate, and the color 
 ing exceeds almost anything we have met with hi 
 point of delicacy and finish. British and Foreign 
 Medical Review. 
 
 The "Diseases of the Skin," by Mr. Erasmus 
 Wilson, may now be regarded as the standard work 
 in that department of medical literature. The 
 plates by which this edition is accompanied leave 
 nothing to be desired, so far as excellence of delinea 
 tion and perfect accuracy of illustration are con 
 cerned. Medico-Chirurgical Review. 
 
 BY THE SAME AUTHOR. 
 
 ON CONSTITUTIONAL AND HEREDITARY SYPHILIS, AND ON 
 
 SYPHILITIC ERUPTIONS. In one small octavo volume, beautifully printed, with four exqui 
 site colored plates, presenting more than thirty varieties of syphilitic eruptions. 
 
 Dr. Wilson s views on the general subject of 
 Syphilis appear to us in the main sound and judi 
 cious, and we commend the book as an excellent 
 monograph on the subject. Dr. Wilson has pre 
 sented us a very faithful and lucid description of 
 Syphilis and has cleared up many obscure points in 
 
 connection with its transmissibility, pathology and 
 sequelae. His facts and references will, we are satis 
 fied, be received as decisive, in regard to many 
 questiones vexatae. They appear to us entitled to 
 notice at some length. Medical Examiner. 
 
 BY THE SAME AUTHOR. (NoiV Ready.) 
 
 HEALTHY SKIN; A Popular Treatise on the Skin and Hair, their Preserva- 
 
 tion and Management. Second American, from the fourth London edition. One neat volume, 
 royal 12mo., with numerous illustrations. 
 
 Copies can be had done up in paper covers for mailing, price 75 cents. 
 
 WHITEHEAD (JAMES), F. R. C. S., &c. 
 THE CAUSES AND TREATMENT OF ABORTION AND STERILITY; 
 
 being the Result of an Extended Practical Inquiry into the Physiological and Morbid Conditions 
 
 of the Uterus. Second American Edition. In one volume, octavo, 308 pages. (Now Ready.) 
 
 The simple title of this work gives a very imper- : this department of our profession, that the praeti- 
 
 fect idea of its contents. The subject of sterility ! tioner who does not consult the recent works on the 
 
 occupies a mere fraction of space, and upwards of i complaints of females, will soon find himself in the 
 
 one-half of the whole volume is taken up with an I rear of his more studious brethren. This is one of 
 
 elaborate account of menstruation as a physiological the works which must be studied by those who 
 
 process, and of the disorders which its deviations I would know what the present state of our knowledge 
 
 from health are apt to produce. Medical Chirurg. \ is respecting the causes and treatment of abortion 
 
 Revieiv. j and sterility. The Western Journal of Medicine and 
 
 Such are the advances made from year to year in Surgery. 
 
30 BLANCHARD & LEA S MEDICAL 
 
 WEST (CHARLES), M. D., 
 
 Physician to the Hospital for Sick Children, &c. 
 
 LECTURES ON TPIE DISEASES OF INFANCY AND CHILDHOOD. 
 
 Second American, from the Second and Enlarged London edition. In one volume, octavo, of 
 nearly five hundred pages. (Now Ready.) 
 
 From the Preface to the Second Edition. 
 
 In the preparation of the second edition of these Lecture?, the whole work has been carefully 
 revised. A few formula; have been introduced and a minute alphabetical index has been appended 
 while additions amounting altogether to fifty pages, have been made, wherever I felt that more 
 extended observation, or more careful reflection had enabled me to supply some of those deficiencies 
 which I am well aware, are still far too numerous. The work now contains the result of 640 
 observations, and 199 post-mortem examinations, chiefly made among 16,276 children who came 
 under my notice during the ten years of my connection with the Children s Infirmary in Lambeth. 
 
 We take leave of Dr. \Vest with great respect for 
 his attainments, a due appreciation of his acute 
 powers of observation, and a deep sense of obliga 
 tion for this valuable contribution to our profes 
 sional literature. His book is undoubtedly in many 
 respects the best we possess on diseases of children. 
 The extracts we have given will, we hope, satisfy 
 our readers of its value; and yet in all candor we 
 must say that they are even inferior to some other 
 parts, the length of which prohibited our entering 
 upon them. That the book will shortly be in the 
 hands of most of our readers we do not doubt, and it 
 will give us much pleasure if our strong recommend 
 ation of it may contribute towards the result. The 
 Dublin Quarterly Journal of Medical Science, 
 
 Dr. West has placed the profession under deep ob 
 ligation by this able, thorough, and finished work 
 
 upon a subject which almost daily taxes to the ut 
 most the skill of the general practitioner. He has 
 with singular felicity threaded his way through all 
 the tortuous labyrinths of the difficult subject he has 
 undertaken to elucidate, and has in many of the 
 darkest corners left a light, for the benefit of suc 
 ceeding travellers, which will never be extinguished. 
 Not the least captivating feature in this admirable 
 performance is its easy, conversational style, which 
 acquires force from its very simplicity, and leaves 
 an impression upon the memory, of the truths it 
 conveys, as clear and refreshing as its own purity. 
 The author s position secured him extraordinary fa 
 cilities for the investigation of children s diseases, 
 and his powers of observation and discrimination 
 have enabled him to make the most of these great 
 advantages. Nashville Medical Journal, 
 
 BY THE SAME AUTHOR. (Now Ready.) 
 
 AN ENQUIRY INTO THE PATHOLOGICAL IMPORTANCE OF ULCER- 
 
 ATION OF THE OS UTERI. Being the Croonian Lectures for the year 1854. In one neat 
 octavo volume, extra cloth. 
 
 WILLIAMS (C. J. B.), M. D., F. R. S., 
 
 Professor of Clinical Medicine in University College, London, &c. 
 
 PRINCIPLES OF MEDICINE; comprising General Pathology and Therapeu 
 tics, and a brief general view of Etiology, Nosology, Semeiology, Diagnosis, Prognosis, and 
 Hygienics. Edited, with Additions, by MEREDITH CLYMER, M. D. Fourth American, from the 
 last and enlarged London edition. In one octavo volume, of 476 pages. (Now Ready.) 
 
 This new edition has been materially enlarged and brought up by the editor. 
 
 It possesses the strongest claims to the attention of the medical student and practitioner, from 
 the admirable manner in which the various inquiries in the different branches of pathology are 
 investigated, combined, and generalized by an experienced practical physician, and directly applied 
 to the investigation and treatment of disease. EDITOR. S PREFACE. 
 
 The best exposition in our language, or, we be 
 lieve, in any language, of rational medicine, in its 
 present improved and rapidly improving state. 
 British and Foreign Medico-Chirurg. Review, 
 
 Few books have proved more useful, or met with 
 a more ready sale than this, and no practitioner 
 should regard his library as complete without it. 
 Ohio Med. and Surg. Journal. 
 
 BY THE SAME AUTHOR. 
 
 A PRACTICAL TREATISE ON DISEASES OF THE RESPIRATORY 
 
 ORGANS; including Diseases of the Larynx, Trachea, Lungs, and Pleurae. With numerous 
 Additions and Notes, by M. CLYMER, M. D. With wood-cuts. In one octavo volume, pp. 508. 
 
 YOUATT (WILLIAM), V. S. 
 THE HORSE. A new edition, with numerous illustrations; together with a 
 
 general history of the Horse; a Dissertation on the American Trotting Horse ; how Trained and 
 Jockeyed; an Account of his Remarkable Performances; and an E*say on the Ass and t lie Mule. 
 By J. S. SKINNER, formerly Assistant Postmaster-General, and Editor of the Turf Register. 
 One large octavo volume. 
 
 BY THE SAME AUTHOR. 
 
 THE DOG. Edited by E. J. LEWIS, M. D. With numerous and beautiful 
 illustrations. In one very handsome volume, crown 8vo., crimson cloth, gilt. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 31 
 
 B. & L. subjoin a condensed list of their publications in general and educational 
 literature, of which more detailed catalogues will be furnished on application. 
 
 HISTORY AND BIOGRAPHY. 
 
 BROWNING S HISTORY OF THE HUGUE 
 NOTS, 1 vol. 8vo. 
 
 CAMPBELL S (LORD) LIVES OF THE LORD 
 CHANCELLORS OF ENGLAND, from the earl 
 iest Times to the Reign of George IV. In seven 
 handsome crown octavo volumes, extra cloth or 
 half niorocco. 
 
 CAMPBELL S (LORD) LIVES OF THE CHIEF 
 JUSTICES OF ENGLAND, from the Norman 
 Conquest. In two handsome crown octavo vols., 
 to match the "Chancellors." 
 
 DIXON S LIFE OF WILLIAM PENN. A new 
 work. 1 vol. royal 12mo., extra cloth. 
 
 GRAHAME S COLONIAL HISTORY OF THE 
 UNITED STATES. 2 vols. 8vo. A new edition. 
 
 GUIZOT S LIFE OF CROMWELL. Two large 
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 HERVEY S MEMOIRS OF GEORGE II. 2 vols. 
 roval T2mo., extra cloth. 
 
 HUGHES S OUTLINES OF SCRIPTURE GEO 
 GRAPHY AND HISTORY, L vol., royal 12mo., 
 with colored maps. (Just issued.) 
 
 INGERSOLL S HISTORY OF THE LATE WAR. 
 
 KENNEDY S LIFE OF WILLIAM WIRT. 2d 
 
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 trait. 
 
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 MARSH (MRS.) ROMANTIC HISTORY OF THE 
 
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 EXPLORING EXPEDITION, NARRATIVE OF. 
 
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 LYNCH S NARRATIVE OF THE U. S. EXPE 
 DITION TO THE DEAD SEA AND RIVER 
 JORDAN. 1 large octavo volume, with numerous 
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 MACFARLANE S TURKEY AND ITS DES 
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32 
 
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