REMINISCENCES OF FEVER.

BY HENRY C. PERKINS, M.D.

OF NEWBURYPORT.

AT this day, when exactness is regarded as one of the most essential requisites in scientific research, it is a matter of regret that general impressions rather than reliable. figures should of necessity serve as the foundation of the following remarks upon fever; for although the facts may have been correctly observed and honestly attempted to be weighed and reported, it must be confessed they have not been numbered, and are garnered only from recollection.

The field of the following observations lies, for the most part, on the south-western bank of the Merrimac River, on a gentle, gravelly slope, commencing at its waters and rising gradually to an eminence sufficient to command an enchanting view of the ocean from Cape Ann to the Isle of Shoals (nearly opposite the mouth of the Piscataqua), on the one hand, and a lovely and well cultivated country, interspersed with wooded hill and dale, from the hills where Parker and his associates first settled in the south, to the rolling grounds of the Indians' Powow in the north-westconstituting a part of that picture which has been pronounced by one of America's most distinguished travellers (Bayard Taylor), as he stood upon Powow, "for quiet beauty one of the most delightful views he had ever seen."

Thus situated, although the inhabitants of the ridge and the slope have wafted over them almost daily by the west

ern breeze the exhalations of the occasionally moist plains just below, their own premises are kept sweet and clean by every summer shower, which conveys, whether they will or no, all decomposing animal and vegetable substances to the river.

The city of Newburyport and neighboring country are shaded by ancient and lofty trees, affording a salutary shelter from the scorching heats of summer to the inhabitants-an industrious, frugal, temperate race, who occupy tenements antique but comfortable, and whose habits and employments are, in the main, of a most healthy character

so that the chief thing to be feared by them on the score of health is the multiplicity of their doctors, who are to be fed by hook or by crook," by sugar plums or lobelia, by science or by craft.

The residents at the north-western extremity of the ridge (Belleville) were visited by fever in the fall of 1827. The fever was very severe, and in many instances proved fatal

no less than nineteen heads of families being lost that year to the parish at Belleville. In the autumn of 1828, dysentery, like a slowly rising cloud, overshadowed the north-western part of the town and the low land to the south-west; but whether there was anything remarkable in the preceding season or during the prevalence of the disease about to engage our attention, we are left without the means of determining. Indeed, the origin or remote cause of fever, unless it be found in animal or vegetable decompositions, or in the atmospheric fauna or flora, or in the condition of the dew-point or relative moisture and temperature of the air, seems to be now no less in the dark than ever. To the temperature and relative moisture of the air, inquiring minds have within a few years past turned attention.* Not only have the deadly fevers of the Af

* See Braithwaite's Retrospect, No. xxxiv., pp. 18, 19.

rican coast and rivers been supposed to be engendered thereby, but those of our own warm regions are regarded by a diligent and observing meteorologist, Dr. Barton,* as being directly and intimately connected therewith, if not dependent thereupon. The hygrometrical observations now in progress over a large portion of our territory, may ere long furnish decided evidence upon the value of this element in etiology.

The fever thus presenting itself in the western part of our horizon, gradually extended to other localities, being no longer confined to the ridge, but here and there to be met with, year after year, in the less elevated streets and lanes of the city, or in its neighborhood; one case only in a street, or several members of the same family, being down with the disease in the same house and at the same time; thus sparsely or more profusely dotting over our territory. One locality (Ring's Island, lying to the north-east of the city and separated from it by the river, which at this spot is not more than a quarter of a mile wide) was remarkably exempt. On this island (the residence of some two hundred or two hundred and fifty inhabitants), elevated some twenty feet above high water, and nearly surrounded by salt marshes, but five cases of fever within the last thirty years can be recalled to mind; while in one other locality of stagnant fresh water, where the land had in part been recently drained (as at the western base of Pipestave Hill in West Newbury), "in three houses, every inmate, twenty-four in number, was taken down with fever in 1829; and of the watchers or those in attendance upon the sick, who remained three days upon the spot, nine sickened, furnishing thirty-three cases and three deaths."+ Of the sick, those who were removed to the more elevated part of the town all convalesced and recovered.

* See Barton's Report on Epidemic Yellow Fever at New Orleans, p. 294. + Dr. Dean Robinson.

Unaccustomed exposure to the weather in some instances, in others unusual fatigue or anxiety and protracted watching, appeared to be the exciting cause; while in one or two cases no other explanation of its occurrence appeared more plausible than that it might have been conveyed by the physician himself.

The mode of attack was in many cases so gradual that it was for a time somewhat difficult to determine precisely under what disease the patient was about to suffer. In general, however, the cases were readily recognized, not by any chill (which was extremely rare) followed by heat and sweating, but by the stupid headache or vertigo, the clouded aspect, the soreness or lameness of the eyes, the pains in the back or limbs, the sensation of fatigue, the whitecoated tongue gradually becoming brown or black and dry, the sordes on the lips and teeth, the nausea, want of appetite, the thirst, anxiety or oppression about the præcordia, the weak and slightly accelerated pulse, the gradually forming paroxysm of fever, accompanied at night by disturbed sleep or wandering intellect. In some there was no headache, but dulness and sleepiness, with a tremor about the muscles of the mouth and limbs (resembling that seen in hard drinkers), with loss of appetite and diarrhoea.

With the exception of two cases (one of which was shipfever and imported, the other typhus having the measly eruption), fever, as seen by the writer on the banks of the Merrimac from September, 1830, to the present time, June, 1857, has been the typhoid of Louis, exhibiting, during its progress, the rose-colored spots or pimples, the sudamina, the diarrhoea, tympanitis and abdominal hæmorrhage, together with the usual nervous symptoms, deafness, coma, delirium and subsultus tendinum-arriving at its acme, or crisis, generally in about three weeks, and consuming about the same time in convalescence; commencing in the latter months of summer and running through the autumn until