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propagation of the disease at that period from one individual to another. 'It is difficult to conceive what motive could have influenced the Spanish physicians, who reported on the first cases which are supposed to have arisen from a communication with the vessels in the harbour, when they declared that those cases possessed none of the characters of yellow fever: but we believe that they acted conscientiously in making this declaration ; and we must refuse our assent to a contrary opinion, which is attempted to be forced on us because yellow fever had prevailed at the Havannah when the vessels sailed, and afterward raged with dreadful fury in the suburbs and city of Barcelona. It is very remarkable that nearly a month elapsed between the first appearance of the fever in Barcelonetta and the known occurrence of any case of it in Barcelona ; (see the present volume, p. 326.) - a circumstance which was not likely to have taken place if the disease had been highly contagious, - if it had been the malignant pestilential fever of Dr. Chisholm: for it must be observed that the inhabitants of Barcelona did not use any precautions, nor was the communication between the city and suburbs cut off until the 3d of September, more than a month after the disease is supposed to have shewn itself in Barcelonetta. This fact seems to give strong countenance to the opinion that the fever was originally endemic, and afterward acquired a new virulence, with the power of propagating itself by contagion. During the prevalence of this destructive malady, the inmates of several public establishments escaped its ravages: the poor-house, (containing 1119 persons,) and not fewer than five nunneries, being stated to have enjoyed this happy immunity. The monks, on the other hand, were carried off in great numbers, as well as all those who were connected with the medical profession; - a fact that may be explained by a recollection of the anxious and fatiguing duties which all these persons had to perform at the bedside of the sick, without assuming the existence of contagion. In one nunnery, the disease seems to have been satisfactorily traced to the reception of the linen of two individuals who had died of the complaint; and in another, the fever began in the persons of the tourriere and portress. In several other instances which are related, the persons seized appear to have been completely insulated ; and, if they actually received the disease by contagion, it must have been through the medium of the air admitted by the windows. (pp. 363. 365.) In the citadel, which contained 1000 individuals, including convicts, only ten cases of the fever occurred, and only four died. To shew the beneficial effects of free ventilation, Dr. A. states


that, in the street de la Fon Seca, instances of the fever were very numerous on that side of the way on which the houses are contiguous; while on the opposite, where the houses stand free, and many of them have gardens, very few cases occurred. This fact, however, admits of a different explanation. In the street de San Olaguer, which is not far from that just named, there had been no case of the disease up to the 20th of November; although it was surrounded by other streets, in which great numbers had died. It is probable,' says the author,' that the contagion did not find access into the houses wbich were at the two extremities of the street, and that the inhabitants lived so retired as not to introduce among themselves the malady.' (P.366.) Can we suppose, however, that the inhabitants of any street in Barcelona could have adopted such measures of precaution as to prevent the introduction of a highly contagious disease, without this circumstance becoming matter of general notoriety ?

No exact estimate has been made of the mortality in the city during the prevalence of yellow fever. The population was rated at 140,000: but, on the breaking out of the disease, the wealthier families emigrated to so great an extent as to leave, it is said, only half of that number of persons exposed to the malady. Of these, it is supposed, from sixteen to seventeen thousand died within the city and suburbs, the proportion of deaths being estimated by the author at fourfifths of all the persons seized ; --- a mortality truly appalling. This is, however, obviously an exaggerated view ; for even the returns of the Lazaretto and Seminario hospital do not furnish so large a proportion of deaths. In the Lazaretto, the mortality does not appear to have quite amounted to twothirds : for of 74 patients admitted from the 9th to the 31st of August, only 48 died. In the Seminario it was greater, but still not equal to four-fifths : for of 1706 patients admitted into this hospital during the months of September, October, and November, 1238 died. Little difference was perceptible between the two sexes, with regard to the rate of mortality. Up to the 15th of October, rather more men in the full vigor of life had died: but, at this period, women, children approaching to the age of puberty, and old men, became peculiarly the victims of the disease. Young children, however, appear to have suffered less from the fever : but their fate became almost as deplorable, from the loss of their parents. Thus unfortunately circumstanced, they were driven by misery and famine to wander about the streets : till they were collected together by the charity of the citizens, food was provided for the elder, and the younger were nou

rished by means of she-goats. The inhabitants of Barcelonetta suffered much more from the disease than those of the city: above half of the population of the former, which was estimated at 8000, having fallen a sacrifice.

Dr. AUDOUARD has presented us with a very distinct account of the symptoms which marked the fever, and has illustrated his general observations by numerous cases. The disease appears to have been, in all respects, the same with the yellow fever of the West Indies. Very great praise is due to the author for the minuteness of his reports, and the calm intrepidity with which he pursued his pathological investigations, under the firm conviction of the contagious nature of the malady; ard he was the first of the French physicians at Barcelona who ventured to inspect the body of any patient that had died of the yellow fever. In these examinations after death, which appear to have been conducted with laborious accuracy, he found in every instance the matter of the black vomit in the stomach or in the intestines; in the former, resembling coffee-grounds ; in the latter, of a more uniform and pitchy color and consistence, the result (he believes) of the process of digestion. He seems never to have observed gangrene

of the viscera, as some have stated : but he mentions that the black matter shone through the coats of the intestine in many cases, so as to mislead a superficial observer. Marks of slight inflammation, both in the stomach and the intestines, were frequently seen, but he regards it as secondary, and refers it to the irritating effects of the matter of the black vomit. The liver was often of a clear yellow color on its upper surface, while the under presented a leaden grey;--the consequence, according to Dr. A., of the gravitation of the blood. The gall-bladder was found in various states, but never turgid; nor were any indications discovered of a superabundance of bile. Within the right auricle and ventricle of the heart, he very often remarked what he has named a fibro-albuminous concretion, formed by the coagulation of the fibrin of the blood. This fact calls irresistibly to our mind the fever described by Dr. Chisholm as occurring among the negroes of Grenada in, 1790, to which he gave the extraordinary name of epidemic polypus. -— Marks of inflammation, though slight, were occasionally perceptible in the lungs; and in two cases the tonsils were inflamed. Within the cranium, marks of congestion were often visible; sometimes extravasation of blood in the folds of the pia mater; and often serous fluid within the ventricles. The membranes of the spinal cord were also observed to contain a similar liquids occasionally to the extent

of any

of two ounces. The internal membrane of the urinary bladder was in one instance covered with a thin layer of black matter, similar to that which is seen lining the abdomen of some fishes.

The distinctive pathological appearance in yellow fever is the matter of the black vomit; which Dr. A. assures us is always discernible after death, in every case of this disease, whether any vomiting of this fluid has occurred or not. Many experiments were made by him on this substance, all of which serve to prove that it is not bilious, but formed from effused blood. It was found to be separable by the filter into two parts; the first being a clear chesnut-colored liquor, soapy to the touch, and possessing a nauseous sweetish or styptic taste : -- while the second was black and viscid, resembling soot mixed with mucus, and having a faint odor.

A yellow color in the skin was perceptible in the great bulk of cases before death, though in some it did not take place till after the fatal event; and, in a few, nothing but an increased darkness of color could be seen either before or after dissolution. In: explaining the cause of the yellow color, Dr. A. is led by his investigations to reject at once the idea of the absorption of bile: he compares it, as an eminent northern physician did long ago, to the discoloration produced by contusion of soft parts; and he considers it as of the nature of ecchymosis.

The theory of yellow fever which Dr. A. has offered is not very clear or satisfactory, He supposes that the matter of contagion acts first on the mucous surface of the stomach, that congestion follows, and then effusion of entire blood; and to the irritating properties of this extravasated fluid, he refers the appearances of inflammation discovered after death, as well as many of the symptoms which present themselves during the progress of the disease. That the stomach is the grand centre of irritation in yellow fever is now established beyond any doubt: but we do not agree with Dr. A. in believing that its morbid contents are productive of those effects which he has ascribed to them.

With regard to the treatment of the fever by Dr. AudouARD, we find as little promptitude and vigour as we formerly remarked in the Report of the Spanish physicians : his practice appearing to have been limited, in the great proportion of cases, to infusion of tamarinds, barley-water with honey, camphorated oil rubbed on the belly, and camphorated enemata. The only case in which he employed leeches, and it was towards the close of the disease, proved fatal. Venesection was not tried by the author; and he states that, when


it was employed by others, the patients were cut off with uncommon rapidity ; but he is led, by the observation of a case in which a cure followed a copious hæmorrhage from the tongue and mouth, to ask whether early blood-letting might not prove beneficial ? - Purgatives are mentioned by him as likely to produce advantageous effects : but none of greater strength than tamarinds and cream of tartar seem to have been administered; calomel, or mercury in any shape, not appearing to have been once used in the practice of the writer. Several instances are detailed, in which the patients were cured by the administration of cinchona: but two cases, in which sulphate of quinine was given, terminated fatally.

A monk of the order of Minims, named Constans, appears to have been more successful in his treatment of the disease than any of the faculty in Barcelona. He began by administering oily emulsions, and then gave copious draughts of warm diluents, so as to produce a profuse perspiration, Of nine diseased persons among his brethren of the convent, he lost only one; and, according to the reverend father's assertion, that one would have been saved if he had consented to drink abundantly. - In estimating the success of M. Constans, it is deserving of remark that his patients were all placed under his care during the incipient stage of the fever, and that they were of regular habits, accustomed to discipline, and with minds much less likely to be agitated with alarm for their situation than those of the commonalty. We may add, also, that their accommodations and attendance within the convent were such as to favour, in a remarkable degree, the chance of recovery.

The latter part of this volume, which indeed forms a large proportion of it, is dedicated to the consideration of the means best adapted for limiting the diffusion and effecting the suppression, of yellow fever. These are very nearly such as are recommended by all writers on contagion, and more especially by those who have written on plague. Entertaining, as we do, sentiments somewhat different from this author on the subject of the contagion of yellow fever, we do not conceive that the very severe measures which he has recommended are altogether necessary. Precautions, no doubt, are imperatively requisite in order to limit the extension of the disease, wherever there is reason to believe that it has assumed, or is likely to acquire, a contagious character : but the grand point, above all others, is to urge earnestly and perhaps to compel emigration, even to a short distance from the affected city. Dr. AUDOUARD states a fact, before known to us from the Report of the Spanish physicians, (already cited)

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