MEDICAL AND SURGICAL JOURNAL.

EDITED BY

L. A. DUGÁS, M D.,

PROFESSOR OF SURGERY IN THE MEDICAL COLLEGE OF GEORGIA,

VOL. XI.-1855.-NEW SERIES.

AUGUSTA, GA.:

JAMES MCCAFFERTY, PRINTER AND PUBLISHER.

1855.

Typhoid Fever. By R. B. GARDNER, M. D., of Barnesville, Ga.

Mr. EDITOR-I propose to give your readers a succinct statement of the opinions I have been led to adopt, relative to Typhoid fever as it prevails in this section of Georgia, together with a summary account of the results of my experience in its treatment with large doses of Quinine. I would not thus submit my private views to the inspection of the profession at large, were it not for the great practical value which the truth, if it be such, possesses to Southern physicians, that, there are remedies calculated to shorten the duration of fevers, which run a long and tedious course under expectant treatment.

But before the practitioner can fully appreciate the promptness and efficacy of the invaluable agent employed to curtail the exist ence of continued or typhoid fever, it is indispensably necessary that he possess a sound and an accurate understanding of the nature and causes of this disease, as it prevails in his own climate or arises in his own locality. Without this knowledge, as far as it may be in his power to obtain it, he cannot be considered many removes in the practice of his profession from the hideous deformities of empiricism and charlatanry. With it he may dispense the blessings of an intelligent physician throughout his community, and reflect the light of philosophy upon every action of his life. After examining carefully the various accessible sources of information, and after a close enquiry into the subject, and 1

N. S.-VOL. XI. NO. I.

some observation of the disease, no theory seems more rational than that which locates the seat of the fever essentially in the cerebro-spinal system. The deficiency of nervous power, and the amount of morbid innervation observed in the course of this malady, show clearly that this hypothesis is not entirely destitute of foundation.

How the nervous system becomes implicated, is a question, an enquiry into which may somewhat gratify curiosity, notwithstanding the vague uncertainty of the conclusions at which the mind may arrive. An ærial poison, which in compliance with usage I will denominate Malaria, effects its entrance into the blood by imbibition through the cutaneous surface and the walls of the pulmonary air vesicles, and is transported upon the bosom of a thousand currents to every portion of the body, coming in contact with every particle of the same, and exerting its malign influence in some degree throughout the entire organism. This being the case, it is not surprising when the cerebro-spinal system-the centre and origin of all vitality, whether of sensation, voluntary or involuntary motion, and presiding over the various functions of health-is found giving evidence by its sufferings of the presence of this poison, so extremely attenuated as readily to be diffused throughout its entire mass, and penetrate to its utmost ramifications. The action of this noxious material, however, I do not pretend to have ascertained; yet I do feel fully persuaded, that in some unknown way, it perverts innervation, either reducing it below its healthy standard, exalting it above, or in some other manner rendering it morbid. The various organs of the body, then, that have any concern in the processes of health, being entirely dependent on the nervous system for that supply of energy indispensable to the performance of their physiological functions, are necessarily deranged and disqualified for the proper discharge of their duty, and disease is the inevitable result.

Such are some of the leading views I entertain of the origin of Typhoid no less than Periodic fever; and their probability, I may here remark, is favored by the success which follews its treatment with large doses of quinine.

I will now consider what I believe to be the essential cause of Typhoid fever, and to which I have already incidentally alluded, as it has occurred to me in my field of practice.

In this latitude, our warm weather is not confined exclusively to the summer months, but is often experienced early in the spring

and late in the fall, being no stranger even during the winter. That portion of the year, in which the temperature is sufficiently high for vegetation to put forth, cannot be estimated at less than nine months, during much of which time the solar heat is intense. Heavy floods of rain occur in connection with this protracted state of warm and often hot weather. Our rivers, creeks, and smaller streams; our marshes, broad flats, and extended bottoms-all are surcharged at various times, and in repeated instances, with water from the clouds. The low lands are overflowed, the hills saturated, and the plains steeped in the same element. The vegetable products of a fruitful soil live out their "brief span of existence," and perish under obedience to the laws of nature. Animal life soon, too, becomes extinct, and putrefaction ensues. Here we have combined, protracted heat, great moisture, and an immense quantity of decaying animal and vegetable matter.

Now, whatever other agencies may share in the origin or modification of our febrile diseases, it is exceedingly difficult to understand how, under the circumstances, a case of continued or typhoid fever can arise uninfluenced by the all-pervading malaria. Notwithstanding its symptoms be often precisely the same as are observed in the typhoid fever of France and New England, as well as others of our Northern states; still I must contend for the existence and it intimately associated with the nature and concerned in the origin of this disease as it occurs in Southern latitudes of another and an important element, fundamentally allied to, if not constituting part and parcel of miasm itself, that invisible sentinel of darkness breathing its deadly poison upon the still bosom of the serene night air. This material, too, may be evolved not only in low damp situations, but also from the surface of plains and elevated table lands; and although possessed of a specific gravity greater than that of the atmosphere, and having a tendency to collect in bodies and flow in currents after the manner of streams; still, under the full persuasion of its light ærial nature, I must believe, with the evidence before me, that it abounds in the air at varying distances from the earth's surface. The facility, too, of its transportation for short distances by means of winds is clearly shown in the books. The conclusion, then, forces itself with almost resistless power upon the mind of the philosophic physician, that typhoid fever can rarely occur in so low a latitude. as ours, altogether free from malarial influence. The theory, too, which I believe to be the most probable respecting the origin of