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Bv
tion,
this
name
in
which,
is known an eruptive fever, or exanthematous affec1827-2S, spread extensively over the West Indian
seems
to
have appeared
it
first in
the island
town of which
invaded
in
rapid
succession almost every individual in a population of about 12,000. Towards the end of October, it passed over to the neighbouring
island of St. Croix.
We
hear of
in
it,
in
November,
It
in St.
Barthoat
lomew's, and
in
Antigua
January, 1828.
prevailed
Ha;
vanna
and
succeeding April, at New Orleans in May July and August affected very generally the inhabitants of Charleston, South Carolina, and reached Savannah (Georgia) in
in the
and June
in
During the same summer, it is said to have shown itself at several points on the Gulf of Mexico, south of America the Mississippi, and even along the Atlantic coast of South we have no authentic details of these occurrences, which were but September and October.
;
As winter approached, in the newspapers of the day. gradually, either having no new subjects to attack, or sub. it ceased period, been met siding like other epidemics, and has not, since that
merely noticed
with any where
dity of
in a definite or regularly
recognized form
appearance,
in
in this
suddenness of
its total
its
the rapi-
its
spread, and in
striking resemblance
to the
Black Death*
other shapes and the Sweating Sickness of the sixteenth, and several at different points of time arisen and died of pestilence which have Happily, affright. away, scattering among the nations horror and
however,
show,
it
bringing in its train infinitely less of in proportional mortality of mere suffering. danger and of death than
* Hecker's History of the Black Death
was
DICKSON ON DENGUE.
No
dandy
it.
definite signification
is
attached to the
at St.
title
by which
called
it
came
" the
to be universally
known.
The negroes
stiff",
Thomas
it
under
In
Cuba
a
merely
in
was termed " Dengue or Dunga ;" whether this is modification of the English slang-word dandy, thus altered
it
Spanish pronunciation,
used to
is
not clear.
One
word
is
man.
We
we proceed
Symptoms.
its
and swelling of some of the smaller joints, often of the muscles of a These limb, rigidity of the neck, aching of the back and loins. brief period, pains were followed, after an uncertain though generally
by headache
excitement.
in a great
full,
frequent pulse
hot,
The
In this
early stage the tongue was generally clean, and the stomach quiet,
The determinabut sometimes there was nausea or even vomiting. Instances occurred in tion to the head was occasionally violent.
which delirium was among the
first
symptoms, coming on
its
;
at the
until the
At
this
were some
It
with this
first
go
off*
entirely
degree of swelling,
interval
scribed as the
first
now
believed
themselves
and second stages of this strange disease. Many to have past through the attack, and
;
were by no means
an end.
DICKSON ON DENGUE.
On
obscure degree of
yellowish
fur,
and
irritable.
The
patient
was now
in
ious.
Vomiting came on
most oppressive and insufferable of the stages of the malady. On the fifth or sixth day from the invasion, the period varying
somewhat
met with
cases, that
in
in so
to
very great
proportion of the
consisted of
clearly
demands
minute papulae,
in
somewhat
irregularly-shaped patches
somewhat
first
appeared
on the face, then on the trunk and thighs, gradually spreading to the It resembled scarlatina more than measles in the hue extremities.
and aspect of the skin, but was
less diffused or confluent
than either.
When
fully developed,
it
ing of the surface, and at this time a second febrile paroxysm came
on with return or aggravation of the muscular and arthritic pains. Inflammation and enlargement of the lymphatic glands in the neck, these parts being axilla, and groin attended in a good many cases
;
some time
after convales-
The
some
des-
quamation of the
cuticle.
Of
all
the
symptoms
troublesome, adhering
weeks
to
some
loss of patients, and constituting a sort of permanent lameness or of the population Nay, even now (January, 1S35), some mobility.
of the rheumatic of cities visited by this plague persist in speaking which they labour or quasi rheumatic decrepitude and pain under
as " the effects of the
dengue."
All classes of persons were subject to this singular exanthem, and The aged and the young, the infirm and the all equally and alike.
and the white, robust, the native and the stranger, the black
* In a
all
DICKSON ON DENGUE.
Very young
it.
nay,
still
labouring under
smooth and
it
was obviously
in
if
or
if its
limbs were
moved ever
so gently.
Below
the
fifth
in
some
first,
instances
were
re-
extreme prostration.
Some
old people
were
afflicted
with erysi-
Pregnant
a
women when
The
at
came on
the
so generally
the
extended
downward
the
foetus
into
uterus
sore
and
its
functions
much
The
surface of
it
member
in every which has been "chopped" for culinary purThe ulcers formed in the mouth were often very irritable
is
which divide
difficulty.
Then followed
symptoms of mer-
ptyalism.
fauces.
gums and
Pathology.
Dengue
It is
is
to
he classed properly
among
the ex-
anthemata.
Its essential
symptoms
cutaneous eruption.
The arthritic
stage
DICKSON ON DENGUE.
inflammatory type of twenty-four
to
The
is
Let us separate the characteristic from the incidental circumstances of its history, and from the former proceed to designate its correct name and true pathology. 1. An arthritis a painful and apparently
inflammatory affection of the joints
stances
a
its
was
in a vast
majority of in-
earliest
symptom.
The
formed
of
indica-
tion
some
single
joint or limb.
stiff for
more than an
hour before any other symptom of the invasion was observed. Other joints then became successively painful, and
able interval, fever supervened, ushered
child, four years old, complained,
in
after a consider-
by headache, &c.
in the
A
&c,
on rising early
stiff,
morning, of
his
developing
itself
during a space of
at least
;
though the pulse, breathing, were frequently examined. A very old and condition of the sUrfaee negro woman was ascending a stair, when 6he was suddenly seized
febrile exacerbation could be perceived
to proceed.
Her
fin-
not be straitened, and the intensity of suffering was such that she lay Some hours elapsed prostrate with tears, and loud cries, and sobs.
before
she had any fever, and then there was but a moderate paroxysm. In a very stout and manly youth, the pain at the very tips
He of the fingers was so intolerably severe that he wept bitterly. fomentations and opiates before any had been much relieved by
degree of fever supervened. As it was the almost universal fact that these arthritic affections had thus endured for some time before the invasion of fever, with its
ordinary concomitants, headache, red eyes full, abrupt, frequent pulse hot, pungent, dry skin, thirst, &c, so it was rather uncommon
stomach notably disturbed at this period or stage. Among was an eruption already the other irregular or incidental symptoms, mentioned, which showed itself occasionally thus early. It was a mere rash, and was met with oftener in children than in adults.
to find the
2.
The
characteristic eruption
made
its
appearance
10
DICKSON ON DENGUE.
After a duration, varying in different cases, the pain and inflammatory fever above described abated, or went off to the great relief of patients, who often thought themselves now quite well, and
whose
But
it
when
the case was thus abruptly terminated without a second stage, the
patient
was
arthritic
affections
first
The
by
It
should be remarked,
which had been greatly relieved, returned at time, henceforward remaining pertinaciously annoying for an
indefinite period.
This singular union of an eruptive fever with inflammatory affecnew and pe-
malady a form of disease hitherto unknown and undescribed. The West Indian practitioners, who first met with it, did not fail to
notice this combination of circumstances
minent points
styles
it
in its history,
character.
Hence one
fever.."):
and
third designates
at St. But the vulgar appellations given it prevailed, and Thomas, and by the common people of Cuba, have
As
it
extended
itself in
its
more
striking features
impressed with certain modifications by the influences of locality, In this way, perhaps, we or by mingling with endemic diseases.
may
with
its
in the latter
months of
its
have suggested
known forms
of
fever.
it
in
posed
regard
it
under certain
and Waring of
its
f Nicholson,
ib.
% Stedman,
ib.
DICKSON ON DENGUE.
of 1826, and the epidemic fever of
11
1827"
(a bilious remittent), in
Rush*
in July. to
and both
it.
liable to
No
prevalence.
fit,
It
and often
Many instances occurred in which was introduced by a delirium. The pains which accompanied it in some they were excessively severe in the head, back, and limbs affected the neck and arms, and in one case produced a difficulty of moving the fingers of the right hand. Hence the disease was sometimes believed to be a rheumatism, but its more general name among
without any sensation of cold.
;
all
classes of people
nausea univer-
sally,
and
in
screatus or
many
in
whole
most cases
The
;
when
there was
little
or no thirst.
vourable
it
was accompanied by
burning
in the
palms of the
hands and soles of the feet. At this time, many people who were not confined to bed, and some who had no fever, had an effloresConvalescence was slow and tedious. A cence on their skins. for nearly a bitter taste in the mouth and a yellow tongue continued Most of those" who recovered complained of nausea and total week.
want of appetite.
attendant on convalescence.
Great dejection of spirits was the most remarkable A young lady proposed, he says, to
change the name of the disease, and to call it in that stage the break-heart instead of the breakbone fever. A remark to the same made to the writer by a purport, and almost in the same words, was recovering from dengue, who had never heard of Spanish woman
Rush or
his writings.
The mildness
Vol.
i.
p. 2IG.
12
DICKSON ON DENGUE.
The differences, however, are not less marked and striking. In Rush's Fever there were remissions every morning, and sometimes The exacerbations were more severe every second in the evening.
day, and sometimes two exacerbations occurred in one day.
the fever did not terminate on the third or fourth day,
it
When
often ran
on
in its
the erup-
tion as an essential
very prominent part of the disease. at all, merely terming it " a rash ;"
though he speaks of
the whole,
it
it
as a frequent
On
two maladies,
specific,
and peculiar,
autumnal remittent, a
One being an eruptive fever, new, while the other is nothing more than an mal'aria fever, somewhat modified by an unthe
known
same remark applies with equal correctepidemics referred to by Dr. Waring of Savannah, who makes his breakbone fever of 1826 identical with the autumnal fever of 1827, which again he looks upon as
agency.
ness, but with
And
more
force, to the
identical with
yellow fever
yellow fever, ordinary bilious remittent, breakbone fever, and dengue. Dr. Daniel of the same city considers " dengue to be certainly an exanthematic fever," though he does not regard sion in 1828 as
its first
its
inva-
it
to
have existed
previously in 1826,
when
bore the
name
He
contends justly for the essential nature of the eruption, and reforcibly
marks
tom.
it
as an accidental
sympis
He
states, that
when
it
which terminated
fatally.
Dr. Osgood of
and the
It would seem scarcely necessary to do more than compare the descriptions of the two to be struck with a strong impression of their utter dis-
similarity
may
be briefly
alluded
between forms of disease so distinct. In the city of Charleston, S. C, where yellow fever is frequently met with, it prevails only in the autumnal
to, as
any
relation
DICKSON ON DENGUE.
months, August, September, and October
;
13
to
occur
in July.
emphatically
may
its
invasion
a rule to
which the
exceptions are as
measles.
into the
infrequent as
It
never extends
surrounding country, and notoriously respects such portions But of the suburbs as are particularly elevated, dry, and airy. dengue made its entrance into Charleston in June, and spent its
force before the
end of July
It
it
attacked promiscuously
native
natives or Africans.
no great extent,
neighbouring country.
It is still
first
showed
itself.
an epidemic which prevailed in From the description of that Calcutta and its environs in 1S24-25. pestilence, in a paper published in the Transactions of the Medical
made
to
and Physical Society by Dr. Mellis, it would really seem to be Its Charleston. identical with the dengue of the West Indies and "attacking alike the new-born infant, the aged, the universal sway, of its robust and the weak, the rich and the poor the suddenness and intensity of pain in the muscles and joints the heat invasion of the skin the eruption or rash being succeeded red colour
scarlet
to both.
The sequelae are equally analogous." Dr. Mellis notices " great weakness of the prostration of strength and general debility, pains in the joints and cedematous swellings of
stomach, continued
the extremities."
It
is
exanthem.
Such are the familiar effects of the dengue. of this next, to inquire into the cause or source proper, Nothing has been distinctly indicated on this point in
this
Of
is
West Indian
Islands, St.
Thomas
was
first
attacked.
This
;
situations
among them
the
town being
and popu-
harbour, is always crowded with lous, and possessing an excellent St. Croix, described as the of the world. vessels from every part Thomas in its physical and political character, very reverse of St. islands, was next universally reckoned one of the healthiest
and
14
assailed.
DICKSON ON DENGUE.
" So high," says Stedman, "
is its
that
it
become a favourite resort for invalids from of America, where it is considered the Montpelier
West
Indies."
The
classes,
one of
whom
confounding
it
gard
all
investigation into
;
proas of
duction as superfluous
to its peculiar
its
will be readily inferred that the author of this article belongs to the
latter class of physicians,
and believes
it
dengue
is a
We
hear of
it
in
Bengal
shows where ships from itself in 1827 in a free port, in the Caribbean Sea, Stedman says, it every quarter of the world find ready entrance. was alleged to have been brought there by a vessel from Africa.
in 1825.
it
He
thence
traces
it
satisfactorily
it
to
St.
Croix.
Successively
affecting the
remaining islands,
it
New
it
is
regarded
as
at
which
it
however,
which
is
In
the
at a
* This
is
when
it
likely to be interminable.
The
of plague, of typhus, and even of rubeola and pertussis, has been and
The
admit
is
that, in these
impalpable virus
generated, which,
and perhaps other analogous instances, an when thus eliminated, is diffused at once
its effects in
the repro-
emanated.
DICKSON ON DENGUE.
nature and properties.
that
15
is
the utmost
sucshall
we
may always
which
ceed in throwing
our
way
oppose themselves
Two
any positive decision of the point in dispute. by those who deny the contagiousness of dengue, and the same have been, with equal correctness,
to
applied to
the
cases of measles,
scarlatina,
The
first is
spontaneous origin, or
its
assume the principle, that no disease any other mode, or by the operation of other influences, can take on in its progress a contagion, and become capable of spreading itself in this way. But even small-pox must have had a beginning, and syphilis and
also
in
They
psora, both of
although
we
is
from step
or hooping cough, or
scarlet fever.
all
They seem
occasionally to
sion
by any mode.
Few
contagiousness of typhus
large and weighty a mass of testimony could be adduced as to any But it is well understood that typhus is other in medical science. certain concurrent circumstances, with which often generated under
and that one case so generated may bewhich the disease shall diffuse itself on all sides. come a centre from The second objection alluded to is the rapid spread of dengue
the profession
is
familiar,
whenever
ture in
its
it
has appeared.
a striking fea-
its
character.
it
But
most
history, and
is
illogical
and unscientific
its
to regard the
contagious power.
phrases epidemic, epidemic constitution of the air, and the like, which are in common use among practitioners of physic, have no
The
meaning they refer exclusively to the general extension But no one, at all conversant with the history of disof disease.
definite
;
doubt of the tendency of all febrile maladies, whether contagious or not, to become epidemic ; that is, to spread
16 themselves
DICKSON ON DENGUE.
in this prompt, universal, and irresistible manner. Small-pox, measles, hooping-cough all afford frequent illustrations It would be ridiculous to pretend to trace all the of this principle.
when they
prevail in
one to another, and thus to account for every individual instance of As in dengue so in small-pox, persons are attacked its supervention. who have been altogether secluded, whether accidentally or through
caution.
step to be taken is to deand affirmative statements cide upon the relative value of negative the proper rule being that which Haller has laid down in philosophis-
In
all
first
ing upon physiological experiments and inferences, 'that negative observations are entitled to little or no weight, when in opposition to
for example, a very few instances were good testimony of the spread of any infection brought forward upon in certain specified communities, additional numbers would be of no
positive assertions.'
If,
by diversity of
posi-
comitself
mon
to all affected.
Suppose
it
to
be
made
all
malady
spread
it
among them,
seizing a few,
many, or
that in
within
its
sphere,
would
its
contagiousness
twenty,
it
fifty,
or one hundred
had
failed to occasion
any
new
cases.
consideration,
vari-
the weakest
inasmuch
as
it
number and
its
impression;
we
air
is
Every physician
fails
occasionally
in
transmitting
But when the latter becomes vaccine and small-pox by inoculation. epidemic, it is known to affect persons most perfectly secluded,
and guarded with
all
What
is
it
is
the epidemic condition of the air in this latter case, but the solution
it
What
in
any case but the diffusion throughout the atmosphere of the cause of disease, whether contagion, or mal'aria, or some other unknown and
undefined agent
?
DICKSON ON DENGUE.
Not only
by
limits
is
is
17
is
proved
its failure,
but
its
sphere of action
is
few feet probably, as most writers agree. Whether this the mere result of dilution, or whether the eliminated virus undera
its
specific properties, in
consequence of
its
admixture with
air, is
not determined.
When we
among whom
suddenly intruded, and the general absence or negation of that predisposition upon which disease requires so uniformly to be built up,
we
shall rather
wonder
far as
so often
and so
mission and
number
lost,
be suddenly
and seem
terminate abruptly, as
in
origin of
the most part a difficult task to point out the precise any form of disease, and with respect to what are called,
futile.
of course be
monia typhoides,
perature
;
example, limited
localities
to particular season
and tem-
and circumstances of soil and surBut dengue has, in face conjointly with season and temperature. its brief career and well known history, shown no correspondence with any of these, being neither limited by season, local position, Its gradual progression from one place nor atmospheric change.
to another,
its
arrival,
followed," from the time when it first coast, " the great routes of commercial inter-
appeared
in
favour of
facts
its
contagiousness.
But
no
marked
which seem
to us to leave
room
for reasonable
Dr. Stedman traces the communication of dengue clearly from Christianstcedt, which is the seat of goSt. Thomas to St. Croix.
vernment of the
to the
latter,
and on
this account,
and from
with
it,
its
proximity
a freer intercourse
was invaded
a week or two before the town in which he resided, Fredericksteedt. The first patient whom he saw had arrived three days before from
2*
18
St.
DICKSON ON DENGUE.
Thomas, and the disease appeared first in the family with whom among them, indeed, it raged exthis patient had come to reside clusively for some time, with the exception of a family residing opposite, the head of which had frequent mercantile business with
;
Christianstcedt.
From
there
it
"
The
disease," he says, explicitly, "spread from family to family, and from estate to estate, exactly in proportion to their contiguity, or to
the intercourse that might happen to exist ;" and gives an instance
of the latter kind, when, from the communication between two estates belonging to the same master, the one near town and the
other four or five miles distant, the negroes on the latter estate " got the disease at a time when it had not spread to any other in that
neighbourhood."
In the city of Charleston, the earliest cases happened in persons connected with vessels that had arrived from the Island of
Cuba where dengue then prevailed. This fact is clearly made out upon the authority of two physicians of the highest respectability.
first
patient, a negro,
whose capfew days before he left Havanna. The next persons attacked were the ship-carpenter and his family, who went on board to effect some repairs in the same vessel. From
who was
tain
Emmeline
just in port,
had been
with dengue
events occurred, Dr. P. G. Prioleau was called to attend the family of the captain of another vessel, who had arrived here about the
disease.
The
Captain
;
W.
arrived in Charleston on
the 31st of
seized
;
May,
ill
of dengue
on the
it
1st of July,
two of
Prof. Prioleau's soon extended to the rest of the family." first case, the negro above mentioned, was taken ill on the 10th of June his second case on the 23d. Here we have two central spots
son
"
itself
throughout the
the
from being
in
The
a
brig
Emmeline
lay at
Knox and
Capt.
W.
mile distant.
Farther circumstances of a similar nature deserve notice, as tending to throw some light on the nature and hfstory of this strange vicinity of affection. It made its appearance at two points in the
the citv, the qualities of the soil and atmosphere of which were as
DICKSON ON DENGUE.
strongly contrasted as possible.
19
is
One
its air,
an elevated sandy
bluff,
its
inhabit-
most
cases of
seasons of its epidemic prevalence. Yet some dengue occurred there, introduced, as he himself has stated, by a clergyman whose family resided at Haddrit's, while he attended to his official duties in the city, and by "a neighbour similarly The second instance was that of a plantation lying about situated." four miles from Charleston, in the opposite direction, in a low
pestilential
to
The head
city,
about
week
after-
ward
place.
the wife of the former was next seized, and the disease
afterwards extended
among
Prognosis. The prognosis, in this singular affection, was remarkably favourable. Perhaps no form of disease is known in which the proportion of deaths is so small compared with the numbers attacked.
sion at
all
resembling
Influenza alone spreads with a universality of invait, and even influenza is inferior in the infre-
quency of exceptions to its attack. " In a population of about 12,000 souls who occupy the town of St. Thomas," says Stedman, " scarcely whether maIn all its seats, few died a single individual escaped."
;
skill or
mere domestic
attention, or
neglected.
this suffering
Yet there was a vast difference in the degrees of undergone by different patients, and not a little in the
of their duration of this suffering, and in the rapidity and perfectness The aged were most severely handled, remaining convalescence.
The
emaciation. frequently infirm and debilitated, with languor and persons usually suffered much, and recovered very slowly. Corpulent disease, a intemperate paid in this, as in every other form of
In many it served to for their degrading indulgences. Dengue, informidable paroxysms of delirium tremens. usher in proved fatal of itself. The deed, can hardly be said to have ever which patients died, while labouring under it, prein
heavy tax
rare instances
incidental symptoms the sented some complication under whose in which or some extreme feebleness of constitution sank
patient
;
productive of fatal effects. the remedies employed were of this nature is placed on record. one example
More
than
20
DICKSON ON DENGUE.
Treatment. The violence of the early symptoms of this singuand imlar malady seemed to call imperatively for the most prompt resort of a majority pressive measures. The lancet was the favourite
of practitioners,
who
ascribe to
it
notable
power
in controlling the
force of the attack, and lessening the duration of the patient's sufferCathartics and diaphoretics were also almost universally emings.
physician selecting those formulae in which he had most confidence. Both the saline and mercurial purgatives had their advocates, and were maintained to be specially adapted to the case.
ployed
each
The
antimonials,
in
the
earlier
stages,
powder, and the other stimulating diaphoretics, were in general use. The ordinary domestic practice, and a large majority of cases were
treated without professional aid, consisted in the administration of a
mild purgative combined with or followed by a sudorific, as the solution of epsom salts in infusion of seneka, or serpentaria, or hot
the patient was lemonade, until the bowels were freely opened then covered up moderately warm, aud warm drinks given from time to time to produce and keep up free perspiration, while the
;
warm
water, or bathed in
by the writer of
care
;
few
first
cases that
fell
under his
him ultimately
to
depend on
the attack and the progress of the season, and the spread of the disease gave multiplied opportunities of noting the propriety and value
of the practice.
labour, one
A lady,
in the
were prescribed
was not only quieted in a similar manner, but absolutely relieved from all inconvenience by the same treatment rising out of bed the second day, going through the eruptive stage without illness or
;
suffering,
child.
and
in ten
days
after
When summoned
to
to a patient,
to
seemed proportioned
from
a teaspoonful of
DICKSON ON DENGUE.
21
of this preparation, or of the tinct. of camphor, as was suited to the age and other circumstances. If the head was the seat of great pain
or
it
was
;
while the feet were immersed in hot water to the swollen and suffering joints and limbs warm fomentations and The above dose of anodyne, which acted, poultices were applied.
also, as diaphoretic,
was repeated
at intervals of
until the
symptoms were
howwhich
seemed applicable when the pains were less severe with a continuance of heat and dryness of skin, and persistence of febrile excitement. On the return of pain or febrile excitement, forming the second
stage as above described, the
to,
seemed,
the gastric
no
less effectually
modes of treatment,
it
would seem
fair
remark
no more at the time than those who were emetics, actively depleted by the lancet, and cathartics, and more through a convalescence not more protracted than those, and passed
men
were they must certainly be considered as gainers, inasmuch as they annoyance and discomfort. Yet it would not be loo put to far less much to affirm, that the arthritic pains which they endured were
that they
underwent
less constitutional
fell
and
that,
though they
exemption from the did not perhaps obtain the privilege of absolute incapacity, which so long haunted rheumatic pains, stiffness, and
every community
in
itself,
notably less subject than others to these inconveniences. preceded, by In this singular disorder, the local pains usually any symptom of fever or constituperiods of considerable length, during wh.ch derangement. Hours would often intervene,
tional
occupation or amusement, the patient would limp through his usual Cases, indeed, digest well. and even eat heartily, and apparently first or quasi-rheumat.c stage occurred, in which the whole of the this way, and the nature of the attack
in
eruption.
Now,
opinions, to affirm
charactenstic only by the breaking forth of the be in' accordance with received it would hardly an ordinary that the arthritic pains here were of
22
inflammatory nature
as congestive, or
;
DICKSON ON DENGUE.
obscure as they are, they
irritative.
may
be regarded
simply
The
And
even subsequently,
it
form of inflammatory irritation transient in duration, and happily determined by the nature of its proximate cause to external parts, or parts of no vital
as
being the
effect of a peculiar
and
specific
importance.
viceable.
In this early stage, opium was, indeed, specially serAll physicians were apt to resort to the opiate in the
;
it freely in some form of combination powder being a general favourite. But although its exhibition was even here of undoubted advantage, the golden opthe main object portunity for obtaining its highest benefit was past the storm of our art, the prevention of evil, was unaccomplished
;
its
consequences were, with special difficulty, if great It is no easy matter to account for the
prostration of muscular strength and restorative energy so often left by a paroxysm so transient, and not unfrequently so little violent in
degree, yet this circumstance constituted a prominent feature in the The contest was still to history of the case under consideration.
be carried on.
of the attack, or
We
had
to deal
if
the
by the intensity
antimonials,
&c,
next essential
by the remedies employed, as the lancet, cathartics, the centrifugal determination which formed the step in its progress would be slow and imperfect, and
the stomach and other internal organs would suffer in proportion. At this juncture, many were tempted, by the great gastric uneasiness
and oppression,
and a consequent protraction necessarily of the duration of the attack. This was attended, too, for the most part, with an ultimate
aggravation of the violence of the local pains, and an increase of
and assume a chronic inflammatory disposition. The miserable stage of restlessness and oppression was soonest ended in those who remained at rest in a recumbent posture, confining themselves to the lightest diet, and avoiding all exposure to changes of temperature. In the old and infirm, and in
their tendency to
become
fixed,
such
as
petal determination,
had weakened themselves, and given tenacity to the centriby the previous employment of improper medi-
DICKSON ON DENGUE.
cines,
it
23
order
of diffusible
as
camphor,
brandy, vol alkali and ether, with sinapisms to the epigastrium and
extremities.
The
opium,
Rush
passes
somewhat
ring in Philadelphia in 1780, is worthy of notice in this connection. " Its salutary effects in procuring sweat and a remission of the fever,
led
me," he
it
in
plea-
anguish in fevers of a
use of opium. "
who know not how much of the pain and certain kind may be lessened by a judicious
In a more extended experience this benevolent delighted to find that it was entirely unne-
what he
the proper evacuations," but that this relief or diminution of pain and anguish might safely be accorded to the patient at the very commencement of the attack, and thus his severe sufferings
shortened by
degree.
many
The
writer will be pardoned for expressing, in conclusion, his much to learn upon the subject of the
admissibility of
treatment of fevers generally, and for declaring, as he does with entire sincerity, that the most agreeable and satisfactory of all his experience in the healing art, has consisted system, in the employment of this divine remedy in states of the
opium
in the
all
sects
have taught
exhibition.
THE END.