OUTLINES OF FEVER

CHAPTER I.

GENERAL OBSERVATIONS.

WE commence to-day the study of the most remarkable and the most important class of diseases to which the human kind is liable.

In its varied history, Medicine presents nothing which more forcibly arrests our attention, than the great fever epidemics, notices of which are to be found in the records of all ages, and in the annals of every race and people. And when, as in more recent times especially, we are enabled to realise, by numerical estimate, a full and accurate conception of the vast extent to which fevers prevail in great epidemic visitations, it becomes evident that the study of this dire scourge of humanity, with a view to the possible mitigation of its ravages, constitutes a social as well as a medical problem of the highest importance.

In all times we find the great masters of our art labouring assiduously and devotedly in this grand work, the import of which they well knew-few in the present day better than Sydenham in the eighteenth century.

If you desire to follow in their footsteps, you must

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emulate their learning and zeal, and their devotion to their art. And truly a great task lies before you, great in its purposes, noble in its ends. It ranks second to but one: that which ministers to the glory of our Maker.

By far the most important of the duties to which you will be called, when you pass into the world as practising physicians, no matter in what clime your lot may be cast, will be those which will devolve on you in connection with the treatment of fevers.

"Et profecto haud oscitanter impugnandum est hoc morborum tam pestiferum agmen, quod nullo non die cum genere humano bellum gerit internecinum atque acordo et cujus telis duo ad minimum hominum trientes (si eos demas qui violentâ morte perimuntur), confossi quotannis occumbunt."

In the words which I have here quoted from Sydenham, that great observer states, that excluding deaths from violence, fevers constitute nearly two thirds of all the diseases by which mankind perishes annually. And I believe that this statement is hardly in any way to be regarded as an exaggeration for his day. It is not perhaps in the generations of men that pass silently away by disease, as it invades the homes of the poor year after year, that its effects are most terribly felt, and most strikingly manifested. It is in the midst of war's mingled triumphs and alarms, when the false pride, or the insulted honour of nations, or the love of conquest, pits against each other the flower of their youth on the battle-field, that disease, and pre-eminently febrile disease, makes its most deadly havoc. To take no other example, I think I should be justified in saying that considerably more than half of the whole deaths

of that splendid army of over 300,000 men which France supplied in the late Russian war, was caused by fevers, or the diseases secondary to fevers. The whole of the French losses by injury and diseases in the Crimean campaign, may be taken at very close to 70,000; the report of the French Minister at War gives the numbers at 66,000. On the side of England 10,000 men of the flower of the British army were carried off by disease in seven months, in the first winter's campaign in the Crimea. From the 1st September, 1854, to April 1855, 4,228 men perished from disease in the hospitals of Scutari alone, of whom but 359 died of wounds. Accurate figures are out of the question, and were unattainable even on the spot; but from my own personal observation, I am induced to believe that an immense proportion of these deaths was the result of fever and the diseases secondary to fever. When dealing with the subject of typhus, I shall perhaps be induced to give you some brief historic notices of the great ravages committed within the present century, and at the close of the past, by the terrible fever epidemic known as the Kriegs-pest, or war plague, and which, originating in the great armies that then turned the plains of Europe into a series of vast slaughter-houses, continued to ravage camp and battle-field, cities and country districts, for many years subsequently.

But if we want the most striking evidence from figures, of the terrible waste and destruction of life involved in great fever epidemics, we need not go beyond the records of our own country, in which, for ages, the typhus has had its home.

At no time, as it would seem, within the historic period in Ireland, has a century passed unmarked by