Fatigue and Subsequent Excess in the Ingestion of Alcoholic Liquors. : Hippocrates could not help considering that these two antecedents had something to do with the attack of epidemic fever that his patients laboured under: he therefore gave them a prominent place in his history of the cases. I have before alluded to his observation that free livers suffered greatly from the prevailing fever; and in his detail of cases (we cannot imagine that he registered every case that came under his notice) he appears to have picked out specimens of what were daily passing under his eye.-Case II. "Silenus lived on the Broadway after fatigue, drinking, and unseasonable exercise, was seized with the fever, and on the eleventh day died." He began with having pain in the loins, urine with a dark sediment, &c. How clearly this description indicates excess of effete matter: the pain in the region of the kidneys, their highcoloured excretion, all betoken excess of disintegrated matter rushing to those emunctories to be thrown off, but not finding a sufficiently speedy outlet went back into the system, and rendered it liable to be attacked by the poison that was floating in every inspired cubic inch of air. In Case VIII. Erasinus was seized after supper; Case IX. Criton was attacked while walking; and Case XII. Hippocrates describes a man as having been attacked after eating supper, and drinking more than enough. With regard to drinking, in the common acceptation of the term, it can no longer be doubted that it induces a fermentable state of the blood; and Dr. Prout has shown that the ingestion of alcoholic liquors diminishes the amount of carbonic acid expired (a product of disintegration), and that this diminution continues until the alcohol is consumed, especially if it be taken on an empty stomach. Dr. Carpenter quotes from the Army Medical Returns the following fact:-" That when the 84th Regiment, which is distinguished for its sobriety, was quartered at Secunderabad in 1847-8, it lost only 39 men out of 1139, or 34-2 per 1000, the average mortality of the other stations in the presidency being about the same as usual. On the other hand, the 63rd Regiment, which was far from deserving a reputation for temperance, had lost 73 men during the first nine months of the preceding year, or at the rate of 78.8 per 1000 during the entire year."* Now we know that the Thasians were altogether, at least so far as regards the men, a loose, drinking set, fond of excess and venery. Such habits undoubtedly tended to increase the mortality during the prevalence of an epidemic. It is, perhaps, within the recollection of many who witnessed the progress of the cholera in 1849, how brandy was then looked upon as an amulet against this disease,—how fearful an error it proved to many. Never was Bridgewater in a lower state of moral degradation than at the time its inhabitants were suffering from pestilence. Brandy and its sequels were sought after morning, noon, and night; and to this excess I mainly attribute the great mortality that took place, a mortality that exceeded that in the worst districts of London during the epidemic of the years 1854 and 1849-viz. 210 deaths to 11,000 inhabitants. One spirit-merchant alone sold upwards of a hogshead of brandy per week in his retail department. Soldiers have been observed to be more liable to take on dysentery, fever, and cholera, during, and for some time after, the fatigue of a march, than at other times.† Parturition and Puerperal Fever.-It will be noticed, on perusing the cases of childbed that took place whilst the women were labouring under fever, that many died of subsequent fever; but that girls, on the contrary, when attacked, were relieved by the appearance of their menses, and not one died who experienced this critical state of things. In both cases we see an evident excitement of the uterine system, which in the one set of women was followed by relief; not so, however, with the * Dr. Carpenter, Hum. Phys. p. 553. + Registrar-General's Weekly Return, vol. xv. p. 547. other, who, at a time when the air was impregnated with the ferment of disease, had their blood in a most fermentable state, in consequence of the disintegration which commenced in the uterus directly it had been relieved of its burthen. Again, we know that where there is a tendency to puerperal fever, the ferment-germ of typhus, or erysipelas, will often increase it, and set up a commotion in the system, which generally ends fatally. Whether the cases recorded by Hippocrates were those of genuine puerperal fever, can only be decided by a comparison between the symptoms that he noticed, and what are now considered to be characteristic of this disease. The time of the Invasion of Puerperal Fever.-Dr. Denman believed that the third or fourth day after delivery was the most usual time for the disease to appear, although he adds that there is reason to believe that in some cases it has been formed before delivery, and at every intermediate time until five or six weeks afterwards. The first thing that attracts notice is a shivering fit, although before the rigor some slight wandering pains are felt in the abdomen, which at last fix themselves in the hypogastric region. Case IV. The wife of Philinus was seized with rigor and pain in the curdiac and right hypochondriac region on the fourteenth day after delivery. Case V. The wife of Epicrates was seized three days before her confinement, &c. Case XI. The wife of Dromeades had rigor and acute fever the second day after parturition. On reading the descriptions of this dreadful disease in the works of Denman and Hulme, we shall have no hesitation in classing the above cases with those of decided puerperal fever :--the premonitory pain in the hypogastric region and genitals, the rigor and subsequent fever, the cessation of the lochia, the looseness of the bowels, the exquisite pain over the abdomen, the return of the rigor with exacerbations of the symptoms, the thirst, hot dry state of the skin, great anxiety, the rare breathing, the thick state of the urine, the pain in the extremities, the obstinate vomiting of whatever is ingested, the delirium, twitchings of the limbs, cold extremities, and convulsions before death; and the critical diarrhoea and reappearance of the lochia in favourable cases.* That puerperal women are liable to be affected by fevers during their prevalence has for a long time been acknowledged, and the most trustworthy writers upon this subject have not neglected to give some account of the epidemic diseases coincident with puerperal fever. The epidemics mentioned by Mr. Hey as occurring in Barnsley in 1808, and at Leeds in Nov. 1809, which continued in the latter town until Christmas 1812, were coincident with erysipelas. The epidemic that raged in the Dublin Lying-in Hospital in the years 1819-20, was attributed, to a great extent, by Dr. Labatt, to contagion from typhus fever, which then prevailed in that city. The epidemic in Birmingham in 1833-4-5-6 was cotemporary with erysipelas in the hospitals and town, according to Dr. Ingleby. Again, in Dublin, in 1828, puerperal fever made its appearance at a time when typhus fever was prevalent. From a careful analysis of all the epidemics of this disease, Dr. Fleetwood Churchillt has come to the conclusion that there are often three diseases concurrent with puerperal fever,-bowel complaints (gastro-enteritis), typhus fever, and erysipelas; and I think, from what has been above stated, we may add that it was often observed by Hippocrates to be induced, during the Third Constitution, from the contagion of the epidemic bilious remittent fever. Dr. Ormerod alludes to his belief that this epidemic type is explicable on the supposition of the existence of some atmospheric condition affecting all who cannot resist it in the same way.‡ The next question with regard to these fevers is the condition of the atmosphere that induced them. On referring to the Table of this Constitution (p. 47), it will be seen that the seasons through which they prevailed were cold, northerly, and droughty. The scanty meteorological observations * Euv. d'Hipp. t. ii. p. 691. + Diseases peculiar to Women, Syd. Soc., p. 36. Clinical Observations on Continued Fevers, p. 27. of later authors, in connection with puerperal fever, hardly afford us any data to go by; the general conclusions are, however, that this disease occurs at all times of the year. During the epidemic of 1769, 1770, Dr. Leake* observed that about the 14th of March, 1770, a sharp frost commenced, with large falls of snow, and alternate showers of sleet and hail, the wind being at north-east. This weather, which was uncommonly severe, lasted till near the end of the month, at which time the malignant force of the childbed fever began to abate. He quoted Hippocrates where this author observes that a mild rainy winter, succeeded by northerly winds, was dangerous to pregnant women. Agreeably to this observation, Dr. Leake adds, that in the winter, when the childbed fever began, the weather was observed to be remarkably mild and moist, with a warmer temperature of the air than was natural for the season; and this was succeeded by cold, bleak winds in the spring (N and NE), which were very unfriendly both to animals and vegetables. M. Tenon,† in his observations on this epidemic, when it occurred after the year 1774, states that it commenced usually about the middle of November, and continued till the end of January: it is met also at other seasons of the year, even during spring. The epidemic of 1746 in Paris prevailed during the winter: of twenty women confined in February of that year scarcely one recovered. In England it appeared in the British Lying-in Hospital in London, lasting from June 1760, to the beginning of July 1761. In the Dublin Lying-in Hospital, from 1st December, 1767, to end of May the next year, of 360 women delivered, 16 died. In 1774 (Dublin), of 280 women delivered during March, April, and May, 13 died. In 1787 March and April, in 1788 November, were the most fatal months. * Practical Observations on Childbed Fevers, by John Leake, M.D. 1772. + Mémoires sur les Hôpitaux de Paris, p. 243, 1816. |