*[Read before the Hom. Med. Soc. of the Co. of N. Y., Sept. 14, 1859.]

BY F. W. HUNT, M. D., NEW YORK.

It is said that when the proudest of the imperial despots of Persia reviewed the largest army ever commanded by a single soverign, his heart swelled with pride when he reflected on the greatness of his power; but it immediately sank with in him, and he wept when he remembered that of the countless thousands who were before him to obey his orders, not one would be alive a hundred years from that very day.

We have been assured by wiser men than Xerxes, that of the still larger army of one thousand millions of human beings who now inhabit our earth, scarcely one will be living on it a hundred years from the present time, and that of this great number, more than one half will die of some of the forms of fever which continue to be the most common diseases of every country. Of all fevers, those which have pervaded the world most extensively in all ages and countries have been attributed to one cause, now usually designated Miasm or Malaria, Arising in the same localities, under the same conditions that could bring it into being three thousand years ago, Malaria has never been destroyed or exterminated, except in small territories under a higher civilization than the nations have yet reached. And, if it may sometimes lose ground in one place, it is always gaining. Rome, which in ancient times was uninhabitable for two months in every year, continues to be occupied by the same blighting influence. Malaria still reigns over that city and all its surrounding territories, defying all the resources of ancient and modern science, and promising well to outlive the Eternal city itself. In all the places where Febris, the goddess who presided over fevers, was ever worshiped; from the Appenines to the sea shore, and for a distance of two hundred miles north and south, her power is as great as when her temples were most honored. In modern times this whole territory has been called the region of Mal-Aria or bad air. Instead of improving under the influence of modern civilization, it has been gradually worse. From the Pontine Marshes, fifty miles south of Rome to the centre of the old city, the malignity of the marsh-poison has long been increasing. For two hundred years the Ague has disputed the supremacy of the Pope on the throne of St. Peter and Charlemagne in the Vatican; and for nearly that period, the Palatine Hill, the Circus Maxim us, the Forum, and nearly the whole of the ancient city have been abandoned to this mysterious spirit of desolation. And it still walks in darkness over the sane hills that the bird of Jove pointed out to Romulus as the proper site for his village of straw roofed huts, the future mother of empires, to which in other times

“The ancient kingdoms and the nations came,

In supplicating crowds to learn their doom.”

I propose briefly to generalize and sum up the most important part of our knowledge of the physical properties and character of Malaria. And,

First of Malarious, Autumnal or Intermittent Fever, and its varieties .

It prevails in the latter part of Summer and Autumn in all parts of the American Continent, from the Gulf of Mexico to the northern parts of the United States, or about 44° of North latitude, South of 33° it extends to the Atlantic ocean, farther North it is less known east of the Alleghany Mountains. In the South-west it is found in all the valleys on both sides of the Cordilleras of Mexico; and in the Northern territories of the United States, Malarious diseases exist on all the fertile plains and forests of the Mississippi valley, and on all the tributaries of the Missouri as far west as the Western parts of Kansas and Nebraska, six hundred miles above St. Louis.

In considering the conditions that impose geographical limits and give prevalence to Autumnal Fever it is, says Dr. Drake, “a safe generalization to affirm, that all other circumstances being equal, Autumnal Fever prevails most where the amount of organic matter is greatest, and least where it is least.” The conditions necessary to produce this fever are:

1. Decaying organic matter for supplying the material for the generation of the poisonous agent, whatever that agent may be.

2. Surface water, which, by impregnating the air with water, gives a high dew point; promotes those chemical actions in certain soils supposed to generate malarious exhalations: favors the growth and decomposition of a luxurious vegetation; produces animalculae and microscopic plants; and, through evaporation and condensation produces electrical changes, all of which effects of surface water have been supposed to cause malarious fever.

3. Elevated Temperature.-These diseases prevail extensively and virulently in warm climates, and become milder and less general as we pass from the tropics toward the poles.

These conditions which combine to originate malarious diseases and the phenomena by which they are characterized are essentially the same in all ages and countries. All observers have remarked the general vital degeneration produced on all the inhabitants of the malarious districts; and it has often been noticed that the most disastrous results may follow a residence in a marshy region in persons who have never suffered from Intermittent Fever in a regular form. The description given by Montfalcon of the inhabitants of La Bresse in France, is applicable in many places well known to me. He says:-

“Each child languishes and grows thin; a yellow tint tinges his skin and eyes, the viscera become engorged, and he probably dies before he has attained his seventh year; or if he reaches this age he does not live but vegetates, he continues cachetic, edematous, subject to putrid and malignant fevers, to endless autumnal remittents, and passive hemorrhages, to ulcers of the extremities which heal with great difficulty, and the miserable being is scarcely able to fight against the diseases which convert his life into a prolonged dying. The inhabitant of the Bresse, having perhaps arrived at his 20th or 30th year, the disorganization commences, his faculties become enfeebled, and generally the age of fifty years is the limit of his days”

When a resident of the Pontine Marshes was asked, how it was possible to live in so unhealthy a place, he replied:-“We do not live-we die!”

In every country where malaria exists, its peculiar powers are conspicuously displayed. In the worst places we remark an imperfection of physical development, engorgement of the abdominal viscera, especially of the spleen; general inertia, torpor of intelligence; an appearance of apathy passing in some cases into Idiocy: atony, and diminished power of reaction of the nervous centres,“ all of which symptoms mark the power of malaria over all the physical intellectual and emotional faculties; and the duration of life is diminished. In every country where agriculture opens to man the fairest and happiest road to earthly prosperity, the elements of disease float in every breeze. In every great city, erected by the highest civilization the world has yet reached, a large proportion of the people, crowded together in small and ill ventilated homes, breath an atmosphere that poisons, enfeebles and depresses all the powers of life. And the poorer classes only obtain final rest when

“The groaning hospitals eject the dead,

While others sigh for sad admission there.”

But the subject of Malarious diseases peculiar to cities is too extensive to be introduced here, and we must omit it entirely.

The Characteristic features of Malarious diseases vary in different seasons and indifferent localities. Besides the usual ensemble of symptoms commonly included under the term Fever, the disease may simulate almost any other disease. We may have the external symptoms of Cholera Morbus, Asiatic Cholera, Dysentery,” Bilious Diarrhea, Menorrhagia. Enteritis, Inflammation of the brain, or of any other organ. Even Tetanus may be the only outward expression of a paroxysm of Autumnal Fever.

In those sudden and violent attacks, properly called Congestive, there is a collapse, a sinking of the dynamic powers, similar to that seen in Malignant Cholera; though there is not the same exhaustion of the circulating fluids. In the congestive form of Malarious Fever, the collapse is in the nervous and cerebral systems. “The cerebral and nervous influence is prostrated as a primary effect of the specific poison that causes the disease.”

The Diagnosis of Autumnal Fever docs not rest on any generally observed assemblage of symptoms, but on the attendant circumstances which may accompany the accession of the disease in its origin. We may consider the locality, the season, the epidemic constitution of the atmosphere, the recent history of the patient, the exciting causes to which the attack may be attributed; and from these, with the concurring evidences of the existence of malaria, presented by the case before us, the true nature of the disease may be determined.

FORMS AND VARIETIES OF MALARIOUS FEVER.

In the United States, and especially throughout the Missisippi Valley, two great varieties of these fevers may be distinguished:

1. Fevers of open excitement. 2. Congestive fever: These forms of fever are not distinct cases; they are only different manifestations of the same disease, operating in a different way, on different persons, according to their individual states of general health. It is observed by Dr. Monetto of Mississippi, that “the tone of fibre, and degree of tension in the Northern constitution, resists the febrile influences, especially those of a debilitating or relaxing nature; whilst the natives of the South, whose systems are already relaxed and enervated by the climate, are obliged to take greater precautions to escape the epidemic of the country. Strangers arriving from the North, are usually only attacked by the fever in its simplest form, with open excitement, which is easily' subdued. But if the same person remains to be attacked after spending a second or third summer in the country, depletion will not be so requisite nor so well borne; and, at a later period, after migration from the North, he will be more likely to be attacked by the fever in its congestive form.” (Fevers of Mississippi, West Med. Jour., 1850.)

Farther Northward, and in the region bordering on the North Western Lakes, we only observe that the effects of Malaria are manifested in different degrees, somewhat proportioned to the powers of the constitution to resist its influence. When the atmosphere holds a large quantity of the specific poison, a few days, or even a few hours, may be sufficient to develop the disease in some form. When the amount of poison in the air is smaller, it might require a year or two to bring the system so far under its influence, that the common proximate causes of disease will excite Malarious fever.

This fever, when established, may assume any one of various types:

1. When the atmosphere is strongly saturated with moist poison, the most trifling exposure to changes of temperature or exhausting exercise will develop true Intermittent fever, or “Shaking Ague.”

2. When there is less Malaria in the air, but other causes combine with it to derange the ordinary operations of the different organs, the disease produced is characterized by less chill, but this is followed by fever of longer duration. The intermission if complete, is still very short; and we have the form of disease known in the West as “Chill Fever.”

3. When the amount of Malaria in the air is still smaller than in the last form, but it is assisted by great exposure, extreme heat of the weather, or excessive bodily fatigue, the disease resulting is called “Remitting Fever”

4. When Malaria, existing in a greater or less degree, is aided by exposure to cold air long continued, the effect of the marsh poison is almost obliterated by the strength of the exciting causes of the attack, or some epidemic influence. The remission is scarcely perceptible, and the case is called one of continued fever.

5. Any of the preceding forms of Malarious fever, inefficiently treated, may terminate at the end of the first, or of the second week in a lower form called Typhoid Fever, though improperly. The remission is not perceptible, or scarcely so.

6. An attack of fever in any of the foregoing types, occurring in an individual greatly prostrated or exhausted by previous ill health, is liable to assume the form much dreaded in the newer territories, and known as Congestive Fever, Sinking Chills, or Malignant Intermittent Fever. This form of fever is always mortal when not arrested, and it is a common remark that “none survive the third paroxysm,” and in some localities beyond the range of enlightened medical practice, it constitutes in autumn the principal outlet of human life.

We stop not now for further details of symptoms or treatment of any of these forms of a disease which continues to be in our day as in the time of Hercules, a Hydra with a hundred heads. It is sufficiently gratifying to professional pride to be able to say to them all,

''That science can elude their fatal ire

And calmly turn aside Death's level'd dart,

Soothe the sharp pang, allay the fever's fire,

And brace the nerves once more, and cheer the heart.“*[This subject will be continu ed in the next number under the title of, Causes of Malarious Fever.”]

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