SECTION V.-COMPLICATIONS.

When local complications occur in the course of simple continued fever, the pyrexia is usually regarded as symptomatic of the local lesion. Cases, however, are occasionally met with, where the fever is out of all proportion to the local disease, or where the constitutional symptoms subside suddenly with free perspiration about the seventh day, and then it may be doubted if the local disease be not a complication of a general pyrexia. Cases of this sort, as Sir W. Jenner observes, are apt to make medical men overrate the efficacy of drugs in the treatment of acute diseases.

SECTION VI.-DIAGNOSIS.

From what has been stated, it is obvious that the diagnosis of simple continued fever is sometimes impossible. Although it differs from typhus and enteric fever in its short duration and in the absence of any eruption, yet in abortive attacks of both these fevers there may be no eruption, and the duration may not exceed a few days. An eruption of herpes on the face about the fourth or fifth day of an attack of fever would, in the absence of pneumonia, favour the supposition of simple fever, but is not incompatible with typhus (see p. 215). The diagnosis may sometimes be assisted by the very severity of the febrile symptoms, which is usually greater at the commencement than in either typhus or enteric fever. In this respect, simple fever more resembles the first paroxysm of relapsing fever, from which it is distinguished by the absence of severe muscular and arthritic pains, of enlargement of the spleen and liver, and of jaundice, and by its occurring at times or places in which relapsing fever does not prevail. The difficulty of diagnosis between simple fever and acute local ininflammations has been referred to under Complications."

SECTION VII.-PROGNOSIS AND MORTALITY.

Simple continued fever, when uncomplicated, is rarely, if ever, fatal in this country. The numerous deaths from simple fever recorded weekly by the Registrar-General are due for the most part to enteric fever with latent abdominal symptoms. The ardent fever of the tropics is a serious and often fatal disease.

SECTION VIII.—ANATOMICAL LESIONS.

Simple continued fever has no specific lesion. In the cases of ardent fever, which I dissected in India, there was great congestion of all the internal organs, particularly of the lungs, liver, and spleen. The right side of the heart was full of firmly coagulated blood. The sinuses of the brain and the pia mater were also very vascular, and occasionally there was an increased amount of intracranial fluid.

SECTION IX.-TREATMENT.

The simple continued fever of this country requires no special treatment. A purge, followed by saline diaphoretics and diuretics, and those measures recommended under the head of typhus for relieving headache and other symptoms, are usually all that is necessary.

For the ardent fever of the tropics, more active interference is necessary. All writers on Indian diseases recommend venesection, or leeches to the head, at the commencement of the attack, followed by the cold affusion, the continued application of cold to the shaven scalp, purgatives, and diaphoretics: " and from my own observations, I am inclined to think that life is often sacrificed by adopting less active measures.

W

For the asthenic form of simple continued fever, the best remedies are quinine and the mineral acids, with a nutritious diet, and wine.

MOREHEAD, op. cit. p. 166; MARTIN, op. cit. p. 208.

684

CHAPTER VII.

ON THE RATE OF MORTALITY OF CONTINUED FEVERS AT DIFFERENT PLACES.

HE rate of mortality of each of the continued fevers has been considered in the preceding chapters. But in the official returns of many hospitals, no distinction is made

The numbers given in this Table are made up of those contained in Table XI., p. 234, Table XXXI., p. 397, Table LII., p. 599, and of the cases of Simple Fever. The numbers for 1848 include the 260 doubtful cases alluded to in note P, p. 51, of which 17 were fatal.

between the different fevers; and therefore a few remarks are necessary on the rate of mortality of the four fevers taken collectively. The preceding Table shows the rate of mortality of all the cases of continued fever' admitted into the London Fever Hospital during 23 years.

From this Table, it appears that out of 28,863 cases 4,547 died, or the mortality was 15.75 per cent., or 1 in 6·34. Deducting the cases which were dead or moribund on admission, the mortality was 13.35 per cent., or I in 7:48.

The mortality from continued fevers in fourteen other hospitals I have ascertained to be as follows:-!

The excess of mortality in the London Fever Hospital was partly accounted for by the circumstance that a large proportion of the patients were the aged and the infirm inmates of the metropolitan workhouses. The remarkable effect of advanced age in increasing the mortality of typhus has already been pointed out (see p. 236). The chief explanation, however, is to be found in the circumstance that no fewer than 24,516 of the 28,863 cases (or 84'94 per cent.) admitted into the London Fever Hospital were examples of either typhus or enteric fever. Simple continued fever being rarely fatal, and the mortality of relapsing fever seldom exceeding 1 in 25 or 50, while the mortality of typhus is nearly 1 in 5, and that of enteric fever almost as great, it is evident that the mortality from continued fevers taken as a whole must always rise in accordance

These results have been obtained from the published reports, or from some of the officials, of the hospitals in question.

Brit. and For. Med. Chir Rev. Oct. 1860, p. 331.

with the preponderance of typhus and enteric fever. For example, in the year 1851, when one-half of the cases admitted into the London Fever Hospital were either relapsing fever or febricula, the total mortality from continued fevers did not exceed 7 per cent., or it was less than that in any of the hospitals above mentioned over a series of years. Again, while the total mortality from 'fever' in the Glasgow Infirmary is below that of the London Fever Hospital, that of typhus and enteric fever is about equal, and that of relapsing fever is nearly three times as great (see pp. 235, 398, and 600); the gross difference is mainly owing to the much larger proportion of relapsing cases included in the Glasgow returns (see pp. 313 and 315). Lastly, in the year 1843, when the fever in Scotland was mainly relapsing, the total mortality from 'fever' in the Edinburgh Infirmary did not exceed 6.85 per cent., while in the Glasgow Infirmary it was only 45 per cent., and in the Aberdeen Infirmary 3.75 per cent.

It is obvious that in comparing the mortality from 'fever' at different times and places, in order to judge of the merits of different plans of treatment or for other purposes, it is absolutely necessary to take into account, not only the age and other circumstances of the patients," but also the species of fever which has prevailed. If this be not done, the comparison is of little worth. It is also necessary to have recourse to large numbers. Twelve successive cases of typhus terminating in recovery may appear a remarkable success; but if 5 out of the next 8 cases die, the total mortality is 20 per cent. When large numbers are employed, there is a striking equality in the rate of mortality at different places of each of the continued fevers.

с

In Ireland, where fever has always been very prevalent, its mortality has been remarkably small, when compared with that of other places. This circumstance was pointed out in 1838 by Dr. Cowan, of Glasgow; it was dwelt on at some length in my essay on the Etiology and Mortality of Fevers; and a striking illustration of the fact is furnished by the statistics of the Fever Hospitals of Cork and Dublin in Table LXII. Moreover, the rate of mortality from fevers in Ireland varies less in different years than in England and Scotland. Thus, while in the hospitals of Britain the mortality was in some years as low as 4 per cent. and in other years upwards of 20 per cent., • MURCHISON, 1858, No. 1.

↑ J. B. RUSSELL, 1866.

↳ COWAN, 1838, p. 21.