網頁圖片
PDF
ePub 版

malignant fevers: befides, they are already enumerated by Dr. Warren. The symptoms and three remarkable stages of our disease, are much the fame as those observed by the faid author in the malignant fever of Barbadoes; but I fhall recount thofe symptoms, which appeared to me to be pathognomic and infeparable from the disease, at least when rightly formed, as they feem not yet to be fo well known; by which this fever will appear to be of the malignant kind, as it generally resembles those that are contagious, by its first appearing with a pain in the head and back and about the ftomach, fucceeded by grievous anxieties and oppreffion about the præcordia. And in general this distemper may be defined to be, a peftilential fever proceeding from a contagious* miasma fui generis, which inflames the ftomach and adjacent viscera, obstructs the biliary ducts, and diffolves the adipose humours; to which generally fucceeds an effufion of a bilious or other yellow humour upon the external or internal furface of the body, unlefs prevented by fome means or other.

"Those pathognomic fymptoms appeared to be the following fix; of which the three laft are more peculiar to it. 1. A very great and fudden debility, without any manifeft caufe. 2. A feverish anxiety, generally very grievous. 3. A short, quick and difficult orthopnaic refpiration, after the fever is formed. 4. A contracted deep pulse; the artery feels tenfe, but the pulfe is compreffible, to which fucceeds a depreffed, or foft and low pulfe, after the state of the disease, or after the yellow effufion appears. 5. A pain of the fcrobiculus cordis, either much complained of, or to be felt on squeezing that part; and more or lefs fevere according to the severity of the disease. 6. A yellowness in the eyes or all over the body at the state of the disease; unless prevented by colliquative or critical discharges; to which may be added a violent and unusual kind of pain of the head, unless it is drowned as it were, in the more grievous complaint about the præcordia.

It is to be remembered that this was written, when no doubt was entertained of the contagion of yellow fever.

E.

"The proximate causes and state of the body in this disease may be pretty evident, to those versed in the animal economy, from the following anatomical diffections.

"Feb. 14, 1741-2. At the request of Richard Chichester, Efq. in Virginia, and in the presence of him and several others, I opened the body of one of his flaves who died of this disease. This was the body of an elderly woman past forty, who died the day before, on the fourth of the disease, with the following complaints: grievous and violent anxieties, occafioned, as she faid, by the sickness of her stomach, fevere pain of her head and back returning by intervals, contracted hypochondres, and fcrobiculus cordis painful to the touch, fhort, quick and interrupted refpiration, with deep fighs and heavy groans, a flight raving rather than delirium, a black tongue, unquenchable thirst, tremors, very quick and depressed pulfe, the eyes very yellow, a fudden and fevere pain about the navel a few minutes before death,

"After cutting the teguments of the abdomen, the fat of the body appeared very yellow, fo as to be noticed by the bystanders, and was indeed as yellow as the eyes commonly are in a jaundice. Upon penetrating into the cavity of the abdomen and laying the teguments afide, I was surprised to fee no fuch thing as an omentum; at first I imagined I had tore it off, or removed it to one fide with the teguments; but in vain was it fought for in the whole body. There appeared a few things like the blood veffels of the cawl adhering to the place where it is generally connected to the stomach and colon; the traces of which connection might be difcerned; but there were no more remains of its substance, than a little yellowish thin oily liquor floating up and down among the inteftines and about the mefentery.

"The liver appeared turgid and plump without any blemish on its outer convex furface; but on the concave surface, twothirds of it was of a deep black colour, round the gall-bladder feeming to be mortified or corrupted.

"The gall-bladder appeared outwardly of a deep yellow, but within was full of a black ropy coagulated atra-bilis, which

fort of substance likewise obstructed the porus bilearius and ductus choledochus. This atra-bilis was hardly fluid; but on opening the gall-bladder, it retained its form and shape without being evacuated, being of the confiftence of a thin extract, and withal glutinous and ropy like foap when boiling: this black matter feemed fo much unlike bile, that I doubted if there was any bile in the gall: it more refembled bruised or mortified blood, evacuated from the mortified parts of the liver furrounding, although it would stain a knife or probe thrust into it of a yellow colour, which, with its ropy confiftence, seemed more peculiar to a bilious humour.

"The duodenum was of a deep yellow colour as ufual upon its outfide; but where contiguous to the cystis fellea, had a mixture of a deep green or eruginous colour intermixed with its yellow; within, it contained a viscid bile, or rather a yellow mucus, clofely adhering to its tunics mixt with a little of the black bile, like that contained in the cyftis. Its villous coat appeared to be lined with a thicker fur or flime than ordinary, which being fcraped or peeled off, the other vascular and mufcular coats of the gut appeared red and inflamed.

"The ftomach feemed manifeftly inflamed; it had on its outer furface, towards its upper orifice, two large broad spots of a dark red colour, fomewhat resembling the flushings in the cheeks, or a rofe in the leg; it had nothing within but a little drink which had been juft fwallowed, and fome of the black choler, resembling that in the gall-bladder, floating upon it, which was of a blacker colour here than in the gall-bladder itfelf; it looked ruddy within as if it had been inflamed there likewife; its villous coat appeared, like that of the duodenum, more fuzzy and flimy, as if it were fwelled or diftended, which was particularly remarked by all others who opened any bodies that died of this disease.

"The lungs, inftead of being collapfed, were rather inflated as in inspiration; they were all over full of black or livid spots, fome as broad as the palm of the hand, others much smaller; on which spots generally were to be seen small veficula or blif

ters, like those of an erysipelas or gangrene, containing a yellowifh humour.

"I did not fo curiously examine the other parts, as I faw no defect in any and these seemed fufficient to fhew the cause of her death, and account for the feveral fymptoms of her disease: only the blood veffels in general feemed very empty of blood, even the vena cava and its branches; but the vena portarum was full and diftended as ufual; the blood feemed to be collected in the vifcera; for upon cutting the lungs, or found liver, or fpleen, they bled freely. The brain was not opened, for want of conveniencies at hand; but it did not seem to be affected in the disease, and was not affected in three more who were opened.

"This woman was taken with a pain in her head and back, extending from the loins as far as the region of the liver, with great fickness at her stomach, succeeded by chillinefs, burning fever, anxieties, &c. and was treated with a fnake-root fweat in the time of her difeafe; but took a vomit at its first feizing her, which brought up much dark, bitter choler, without any relief. She was in perfect health before this distemper feized her all of a fudden, as fhe was at work.

"The day before, I opened likewise a girl about twelve or thirteen years old, who had been dead about two or three days, and was preferved on purpose for me to open. She died on the fixth or feventh day of the fame disease, with which the other and several in that family had died. In her, the distemper was left almost entirely to nature, except about four or five ounces of blood which had been taken from her, and the plentiful use of diluting teas. A little before her death, fhe complained in the fame manner with the other, of a most violent pain in her belly about the navel, fucceeded by grievous and intolerable anxieties: they had no fufpicion of a yellow fever at that time, and fo did not notice her eyes.

"There was little difference between the affection of the parts in her, and the one whofe cafe has been related. The fat of the body did not appear quite fo yellow; but the liver had a much greater and deeper mortification or blackness on it, the

whole under or concave furface of it was very black as far as to the very edges, which penetrated very deep into its fubftance about the gall-bladder, which was full of the fame atra-bilious glutinous ropy humour as in the other. The omentum was entirely confumed or destroyed in this fubject, in the fame manner as in the other, whofe cafe has been related; and a little yellow oily matter floated up and down in her abdomen. The ftomach and duodenum were affected much as in the preceding cafe, only there was little fign of any external inflammation on the ftomach. The lungs were affected in the fame manner, but not with fo large or deep black spots.

"In the fpring of the year 1737, there were two more opened, who died of the fame diftemper, in whom the parts were affected in the fame manner as has been related in the first cafe, particularly as to the destruction of the omentum, blacknefs of the concave furface of the liver, contents of the gallbladder, inflammation of the ftomach and spots on the lungs, as he who made the diffection and others that were present at it, particularly informed me. September 1742, another was opened who had died of the same diftemper, as the two perfons above related; although got from a contagion which was fuppofed to have come from a different place: in him the omentum was likewise entirely confumed and destroyed; the ftomach a little inflamed, but no blackness was difcerned on the outer furface of the liver, and its inner substance was not looked into, although the cyftis fellea and biliary ducts were full of the fame black glutinous coagulated matter, as in thofe cafes I have related.

"The following account of the state of the blood which I have carefully observed in this disease, may likewise help to illuftrate its nature, and fhew the state of the body in it. The blood extracted by venefection is of a deep red or florid colour, appearing to be thin and fluxile, with no fizy inflammation, cruft, or skin whatever upon it when cold: the craffamentum is broad, fhallow and floating, being eafily divided by the fingers; the ferum makes about two-thirds of the whole blood,

« 上一頁繼續 »