Brian Altonen, MPH, MS

The American Medical and Philosophical Register.  Vol. 1. (1814)  pp. 176-180.

Account of the Spotted Fever, which lately prevailed in Orange County, (N. Y.) read at the last Anniversary Meeting of the Medical Society of said County. By Dr. D. R. Arnell, and communicated to Dr. Hosack, M. D.

The appearance and prevalence of the spotted fever or typhus petechialis in this district of country has been so considerable, and its progress, in many instances, so fatal, that it has arrested the attention of the most of our society, and induced me to write on that disease. Perhaps I shall not be able to throw any new light upon the subject after so much has been written by the eastern physicians, who have been more acquainted with its progress, duration, extent, and termination. From what I have read of their writing they have uniformly considered it a new disease ; for my own part, I think it only a species of the typhus petechialis of Cullen, and in reading the Medicus Novissimus which was published one hundred years ago, I find a fever there described as prevailing about London at that time, partaking of all its most prominent symptoms. A short extract from that work, page 272, may be of service in establishing the analogy of the disease there described as the prevailing malignant fever with the one which we are now considering.

It is attended with very severe symptoms, as violent pains of the head and stomach, frequent shivering, and a sudden but very great weakness, without manifest cause, anxiety and pains in the back and loins, the breath smells strong; there is great thirst, continual waking, spots sometimes appear on the body, the pulse is unequal and very low ; urine not so high coloured as in simple fevers. There are sometimes convulsions, deliriums, &c. &c. It may be caused by an infectious air; by eating corrupt food, or drinking unwholesome liquors, as stinking water and the like. This is a very dangerous disease and oftens kills in a very little time. An unequal, quick, and weak pulse is a bad sign. If the hands tremble much when the pulse is felt, the disease doth most commonly end in death, especially if there be a foul tongue, a ghastly countenance, and the eyes sunk in the head. The cure must be undertaken as soon as possible, for this disease admits of no delay.

The medicines recommended for the cure consist of spirituous and heating remedies and alexipharmics, and when the spots appear on the surface of the body they are to be promoted by sweating medicines ; blistering plasters are to be applied to the legs and thighs, especially if the cuticular eruptions advance but slowly or seem to retract before the state of the disease.

I have omitted Dr. Woodman’s theory of the coagulation and dissolution of the blood, as the proximate cause of this disease, and only taken the leading symptoms to shew that the spotted fever is one hundred years old. Nay, I believe the fever described by the celebrated Dr. Sydenham under the title of ” the new fever,” and which prevailed in several parts of England, and began in February 1684, to be the very same disease * and I am inclined to believe that it has been frequently and perhaps at

* See Dr. Pechey’s translation of Sydenham, page 410.

regular periods a visitant among the nations of the earth in some and perhaps distant parts of the world. No regular history of fevers since the time of Sydenham has been handed down to us until the yellow fever made its appearance, since which time, until lately, the spotted or petechial fever has never made its appearance. The first cases of it which occurred were in Winchester, Litchfield county, Connecticut, about the 10th April, 1807. It has since prevailed in many places in that state, Massachusetts, and in Vermont, as well as in this part of the state of New-York.

I shall now proceed to describe the symptoms of the disease as it appeared here. The patient is generally seized with a pain in some particular part, most frequently in one of the limbs, the hip or the shoulder, shifting from place to place and often to the head or stomach, with great anxiety and restlessness. These symptoms are accompanied with cold shiverings and other marks of fever, which are soon succeeded by sickness at the stomach, indescribable distress about the precordia, numbness of the extremities, a remarkable and general prostration of strength, and a depraved action of the sensitive organs. In some violent cases the sight is much impaired, and even totally, though temporarily, lost. The pupil of the eyes is for the most part contracted in the beginning of the disease, though after its continuance for some time, it becomes considerably dilated or enlarged. The tongue has been invariably covered with a whitish coat and moist, The pulse is generally low, a little increased in frequency, remarkably intermittent, and unequal both in strength and weakness ; but in some few mild cases it is very little altered* Respiration is in all cases much disordered. Petechiae or livid blotches, or a red, fiery eruption in most cases, appear on some part of the body and sometimes they are general; though they are not always a constant attendant. There is in most cases a delirium attending from the attack through the whole course of the disease, though this was not universally the case. The duration of the disease has generally been from twenty-four to forty-eight hours, when the patient has either died or the disorder run into the form of a mild typhus of uncertain duration.

The indications of cure are as various and deceptive as the symptoms which accompany the disease. There is, however, one object to be kept constantly in view, and that is to restore the vital powers by bringing about a reaction of the system, or in other words, to reverse or overcome the prevailing morbid actions, and to force a new train of actions upon the system.

I have generally pursued the following method of cure with those whom I have attended. To an adult, I have immediately given about twelve grains of calomel and if the vomiting was considerable, a solution of volatile alkaline salts until the vomiting had in some measure abated; then another dose of calomel according to the age and strength of the patient : this has been followed with an injection. I have next given the compound powder of ipecacuanha which if it did not soon produce a pretty general and copious perspiration, I have made use of blocks boiled in water and applied hot in the bed to the sides and extremities, together with a drink of tea made of the Rad. Serp. Virg. to which if the pulse was low and sunk, I added spirits, diluted alcohol or brandy. The blocks I have generally used were o£ hemlock, though I did not believe them better than any others, yet I generally found that my patients had more confidence in them than others, which confidence I was willing to increase by every means in my power, and I have frequently found it to act like a cordial in very low and debilitated cases.

The stimulants.which I have used were mostly of the diffusible kind such as brandy, laudanum, ether, and whiskey, and always proportioned to the violence of the disease. In some cases I have given a quart of brandy in six or eight hours with the happiest effect; though I have not generally used stimulants to so great an extent. But frequently in the latter stages of the disease it has been found necessary to add wine, bark, and other durable stimuli, more effectually to invigorate and strengthen the system. Wherever I have found a considerable affection of the brain (which was the case in several instances) I have omitted the stimulants altogether and depended entirely upon calomel together with the employment of the several means which tended most powerfully to the surface of the body. The sweating should always be continued until the disorder gives way, which will frequently take one, two, and sometimes three days. In the hazardous stages of this disease, when an evacuation from the bowels is necessary, it is better promoted by injections than cathartics as the former do not debilitate so much as the latter.

This is the treatment which I have generally pursued and I am happy to add, that in about forty cases which I have attended, only two have proved fatal. I consider its mortality to be ascribed to the general law of epidemics, that those most susceptible of disease are liable not only to receive it the soonest but with the most severity, and that on its first appearance it is most mortal, when, after a certain period it becomes as much under the control of medicine and as manageable, as ordinary diseases*

As I know we have generally little time to spare on our anniversary meetings, I have endeavoured to make the history and treatment as concise as possible. I do not believe that this disease is contagious, for I cannot discover a single instance where it appears to have been communicated from one to another; neither have I ever known a single person who has had the cow-pock to have the spotted fever. As preventives, will not emetics be useful ? And what will be the effect of mineral acid fumigations, made of oxygenated muriatic gas ?