MITCHELL ON FEVEHS / By order of the College, This Book is, upon no account whatsoever, to be taken out of the Reading-Room until after the expiry of One Month, from this date. /c^ Physicians’ Hali Digitized by the Internet Archive in 2016 https://archive.org/detaiis/b21953697 I 1%' I *. « V. • •> p * w ». .1/ ON THE CllYPTOGAMOUS ORIGIN OF MALAKIOUS AND EPIDEMIC TROFESSOR OF PRACTICAL MEDICINE IN THE JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA. “ It has also liappened that reflecting men, guided by g-eiieral ideas and analogic.^, have enunciated truths which, only at some future period, could cornuiaiid general acceptance and acknowledgment. This always has happened, and always will happen, when the direct proofs of such a truth are wanting.” — Bischoff. ” The itifection may be aptly compared to the seeds of vegetables or the eggs of ani- mals, which require a nice concurrence of certain degrees of heat, moisture, rest, nutriment, See,., to animate them.”— Sir Gilbert Blank. J. K. MITCHELL, A.M., M.D., PHILADELPHIA: LEA AND BLANCHARD. 1849. Entered according; to the Act of Congress, in the year 1849, by LEA AND BLANCHARD, tlie Clerk’s Office of the District Court for the Eastern District of Pennsylvania. ruinADELriiiA : T. Iv. AMD r. G. COLLINS, ritlNXEKS. INTRODUCTION AND DEDICATION. TO THE CANDIDATES FOR GRADUATION IN THE JEFFERSON MEDICAL COLLEGE, OF THE SESSION OF 1846-1847 : Gentlemen : To you, I had the honor of delivering, nearly in their present shape, the lectures which I now send to the press. Previously, I had not put my ideas on the subject of Avhich they treat, into so formal a shape, although I had an- nounced for years, to each successive class, my impression, that possibly, the protophytes might afford a good expla- nation of the eausation of malarious, and other diseases of a febrile nature. Of the production thus, at least of yellow fever and cholera, I entertained less doubt, and taught, therefore, the sentiment with less reserve. But, although urged by some of you, and more formally re- rpiested by the class by which you were immediately suc- ceeded, to place my opinions on this subject before the public, I refrained from their publication through aversion to controversy, and the hope that time would bring more conclusive evidence of their truth or falsehood. Other friends, whose age, position, and learning, entitled their opinions to the highest respect, did me the honor to listen to my elucidations, and to recommend their publication. Indeed, "one of them, well known to you for his great learning and refined eloquence, wrote to Dr. Forbes, of IV INTRODUCTION AND DEDICATION. London, offering these lectures to him for his reprint of American Medical Tracts. Ilis plan, not embracing un- published manuscripts, excluded them ; hut he kindly sug- gested the propriety of their immediate publication by myself, as he thought an essay on a subject of so much novelty ought not, through my aversion to publicity, to remain inedited. Since that time, a work of some merit has been printed in England, and dedicated, by permission, to John Forbes, M.D., by its author, Charles Cowdell, M.B., M.R.C.S., London, 1848. It professes to be, “A Disquisition on Pestilential Cholera, being an attempt to explain its phe- nomena, nature, cause, prevention, and treatment, by re- ference to an extrinsic fungous origin.” A review of works on cholera, inclusive of that of Dr. Cowdell, ap- peared in the July number of the British and Foreign Medico-Qhirurgical Review, for 1848, in which the re- viewer recommends to Dr. Cowdell to extend his hypo- thesis, which he thinks ingenious and interesting, “ to all epidemics. He would, perhaps, find yellow fever and plague still more to his purpose than cholera.” Dr. Cowdell’s book, and the review of it, reached me nearly at the same time, and left me no further excuse for withholding these lectures from the public, unless I pre- ferred to lose what little of reputation might be obtained by sending them to the press. It will be seen that I have not attempted to conceal the sentiments of former writers on this subject, although my ignorance of German prevents me from knowing exactly, how far the authors of that country, Ilenle, Muller, and others, have carried their ideas. Nothing in Dr. Cow- dell’s book occurs to show that he Avas aware of any pre- existent fungous theory of fevers, nor of the wide dissemi- INTRODUCTION AND DEDICATION. V nation of that hypothesis on this side of the Atlantic; so that he is apparently entitled to the credit of having made, if not a new, at least an original theory of the cause of cholera. As you have heard these lectures, gentlemen, you may not have forgotten that, in making my selection of facts and observations, I have, with a single exception, studi- ously avoided an appeal to phenomena perceived only by myself. I have created no facts for this subject; because I have long learned, as you will learn, to trust reservedly to alleged truths observed by a theorist, who cannot avoid, however just he may be, the coloring which, through a blinding partiality for a new discovery or hypothesis, is too often given. I have not, however, been idle. Experiments are in progress which seem to promise more direct and unques- tionable proof of the validity of our hypothesis ; but they are yet incomplete, and therefore should not now appear, lest they might load so young a conception with a too dubious weight. As there may, in the future, arise some dispute respect- ing the paternity of the theory which is now proposed, I may be indulged with the liberty of quoting the follow- ing extract from a letter by Professor J. W. Bailey, in answer to one from me: “ West Point, March 5th, 1845. ‘ ‘ Doctor J. K. Mitchell : “ My dear Sir : Please accept my thanks for your favor of the 29th ultimo. I was interested in your letter on the fungous origin of fevers; and it ap- pears to me that you make out a very strong case, and one which appears more satisfactory than Liebig’s somdwhat vague ideas of ‘communication of motion, being the cause of the propagation of contagious poisons, fer- VI INTRODUCTION AND DEDICATION. mentation, &c. Your theory will, at least, lead to experiment, while his, if I comprehend it, leads to nothing, and is only a way of saying that we don't understand the subject.’’ It would scarcely be proper, gentlemen, to overlook the kind note addressed to me by a committee from the class which immediately followed you, and which formed a principal inducement for correcting for the press, the fol- lowing lectures. Jefferson Medical College, December 8lh, 1847. “ Professor Mitciiele. “ Sir ; At a meeting of the class held last evening, the following resolu- tion was unanimously adopted ; ‘“Resolved — That a committee be appointed to wait upon Professor Mitchell, and request him to furnish for publication, his new and original views of the nature and cause of malarious diseases.’ “Allow us, in fulfilling the agreeable duty imposed by the class, to ex- press the high gratification we have derived from listening to the lectures referred to, and to add our personal solicitations that you will grant the favor which it is the object of the resolution to ask. “ Yours respectfully, “W. P. THORNTON, of Mississippi. “ R. S. HAYNES, of Virginia. “JNO. HORACE SELTZER, of Pennsylvania. “Chas. F. Stansburt, of the District of Columbia, Chairman. "John 0. McRetnolds, of Kentucky, Secretary.” In reply to this kind request, I promised, when at lei- sure, to cause the lectures to bo published; and now com- mence the work by offering to you, who heard them first, in the form and substance in which they now appear, a dedication of them. With the most sincere desire for the promotion of your welfare, and with the greatest respect, I have the honor to be. Gentlemen, Your friend and preceptor, J. K. MITCHELL. TABLE OF CONTENTS LECTURE I. Theories of Malaria. — The Vegeto-animal Theory. — The Atmosi)heric Theory. — The Sulphur-product Theory of Daniel. — Theory of Holi- man. — Gaseous Theories. — Miscellaneous Theories. — Theory of Dr. Robert Jackson. — Theory of Dr. Ferguson. — The Anitnalcular Theory. - - ..... 13 — 33 LECTURE II. Habitudes of the Fungi. — Traces, among Airthors, of the Fungous The- ory.— Rapid growth of the Fungi.' — Their Poisonous Properties in- crease as the Latitude decreases. — They are found chielly in Au- tumn. 34 — 50 LECTURE III. The E'ungi arc active almost exclusively at Night. — Fungiferous irower of Epidemic Periods and Seasons. — Sudor Jlnglicanus. — The Milz- brand. — The Milk-sickness of the Western Country. - - 51 — 72 LECTURE IV. Poisonous Quality of the Fungi. — They produce Fevers. — They pro- duce Fevers which Remit or Intermit. — They produce Fevers with Gangrene. — Fungi cause the Potato Rot. — The Fungi in the Atmo- sphere.— Fungi cause many Cutaneous Diseases. — They also cause Aphthre, a disease of the Mucous Membrane. — They are found in Vlll CONTENTS. tlie Stomach, in the Bowels, in the Peritoneal Cavity, are asso- ciated with Indigestion, appear in Typhoid Fever, in the Bladder, on the Pleura, in Cholera, and in Diabetic Urine. — The Fungi cause many diseases of Insects and Reptiles, as the Muscardine of the Silk-worm, &c. — They seem, according to Scripture, to produce Scalls and Leprosy. — They are found after death in Pigeons, Fowls, and other winged animals. - ..... 73 — 95 LECTURE V. The Fungous Theory explains the cause of the Postponement of the Eflects of a Malarious Infection, and accounts for the nice Limita- tion of Malaria, for the Effects of Dried Air, of Damp Sheets, of Fo- mites. — Yellow Fever. — Cholera. — The Plague. — Localization of Peculiar Diseases. — Quarantines. — Pestilential Premonitions. 96—116 LECTURE VI. Hygienic Inconsistencies of Seasons and Places, explained. — The Ma- remma of Italy. — Volcanic Eruptions affect the Health of the fol- lowing, and not of the current year. — Fairy Rings. — Liebig’s Theory of the Cause and Non-recurrence of Diseases, refuted. — A new Ex- planation of these, offered. — Why the First Cases of an Epidemic are most Fatal. — Why Barren Plains are sometimes Sickly. — Re- capitulation. ...... 117 — 138 ON THE CRYPTOGAMOUS ORIGIN OF MALARIOUS AND EPIDEMIC FEVERS. LECTURE I. THEORIES OF MALARIA. The most ancient authors allude to the noxious influence of the air of marshes and stagnant pools. Some of them indulge in speculations respecting the immediate cause of its morbific power ; and here and there, in their Avritings, may be detected, more or less vaguely expressed by them, the opinions, by the publication of which, Lancisi, less than two centuries ago, acquired so much reputation. Ilis treatise de noxiis pahidum eijiiiviis, gave consistency and authority to the impression of the miasmatists, and the loose idea of a former age, became the accepted sentiment of the eighteenth century. By degrees, the medical pro- fession, almost everyAvhere, adopted the theory of the causation of periodical fevers by marsh air, and even ascribed the poison to a decomposition of the vegetable remains of low and wet places. After that time (1695), o 14 THEORIES ■Nvlth occasional modification from the fancy of each author, the vegetable theory of miasm became almost an esta- blished dogma of the schools, not often questioned until the very time in which we live. Nowq writers, dissatisfied with the inexact condition of the subject, demand proofs in favor of the marsh theory, which they cannot find ; and I may, perhaps, feel safe in asserting, that, at tlie present day, few well-informed physicians accept the theory of the miasmatists, as detailed by McCulloch. Whatever view may be taken of the nature of the pes- tilential cause, it is usually most potent in places of a moist and marshy character, such as are the borders of lakes and rivers ; and in such places it commonly most abounds, Avhen accompanied by a luxuriant vegetation and a high temperature. As heat, moisture, and vegetation, so commonly attend the production of malarious influ- ence, careless observers, naturally enough, believe the action of heat and moisture upon the vegetation, to bo the efficient cause of miasm; while they refer to con- trasts of temperature and moisture as exhibited by day and night, as the exciting causes of the periodical fevers of such places. Such conditions, predisposing and exciting, no doubt cause such maladies ; but inquirers take very different views of the mode of production, and of the immediate agents concerned. Some conceive, as already stated, that by decomposition, a predisposing poison is produced, suf- ficient of itself often to excite disease, whilst dews and change of temperature may occasionally precipitate or determine an attack. Others think that the mephitic va- pors of marshes only enfeeble health, and thus enable the obvious changes of heat and moisture to excite disease, which they often produce without any such preparation. OF MALARIA. 15 A third party refers all cases of periodical disease exclu- sively to sensible changes, and thinks the proximity of a marsh only efficient as presenting an evaporating surface, by which the air is made colder and damper. Dissatisfied for many reasons, to be hereafter offered, with the vegetable theory, and with the evaporating theory, and indeed with the hypothesis by which both are united, authors of our own time have suggested a variety of ex- planations, wdiich it may not be inexpedient to pass in cursory review. The commonly received marsh theory is well stated and supported by McCulloch, to whose work on malaria I re- fer you for a view of that side of the question. It is, in a much more masterly and precise manner, sustained by Dr. Craigie, of Edinburgh, to whose volumes on the Practice of Medicine, you may most profitably resort for a learned, lucid and, I think, impartial array of the facts and opin- ions bearing on that side of the question. McCulloch in- volves himself in difficulties without seeming to see them, Avhilst Craigie, although inclined to the same conclusions, views with a master’s eye, the whole of the impediments and objections. The objections presented by the latter are : the low temperature at which these disease-producing changes may take place ; the unaccountable production of them in places where there is no apparent vegetation and often no marsh ; the exemption of certain places where occur all the seeming elements of decomposition; the inex- plicable effects of rural cultivation ; and the unexplained vicissitudes of health in the same places in different though similar years. Denying the vegetable theory, and indeed assuming the position that we are as yet totally ignorant of the nature and true source of the cause of malarious fevers, my emi- 16 THEORIES nent colleague, Professor Dunglison, in liis work on Hy- giene, ably exposes the fallacy of the received opinions on this subject. He is not favorably impressed, indeed, by any of the many hypotheses with which an obscure, but highly important subject like this, is sure to be loaded. Not less antagonistic to the received theory, is my friend. Hr. J ohn Bell, who, hoAvever ingenious and learned in his opposition to it, does not also arrive at a negative conclusion, but refers the morbid phenomena to the modification of the sensible or appreciable conditions of the atmosphere. His paper, contained in the Medical and Physical Journal, for 1825, 1826, pp. 274-316, is worthy of an attentive perusal, although Avritten at a very early period of his medical life. NotAvithstanding, therefore, the seeming supererogation, my duty as a teacher compels me to offer to you at least a summary of the objections to current opinions on this subject. The most forcible argument against the vegeto-aerial theory, consists in the extraordinary exemption from ma- larious diseases of places Avhich, Avere it true, could not escape a seA^ere infliction. It is the more forcible, because the theory is founded mainly upon the concurrence of such diseases with heat, moisture and vegetation. If, then, it can be shoAvn that the alleged conditions exist in the most perfect state, in very many places, without morbid results, the universality of the coincidence can no longer be brought to sustain the opinion. Again, if many can be cited, where these sup- posed elements are not at work, which are nevertheless noted for their insalubrity, the opinion becomes even less tenable. It is still farther AA’eakened by the fact, often observed, that under precisely the same apparent circum- OF MALARIA. 17 stances, liealtliy places become nnliealtliy, and sickly places, salubrious. The marsh, the beat, the moisture and the vegetation, remaining apparently the same, the health of a region may vary from one extreme to the other. I -will now offer you some examples in illustration of these positions: McCulloch, the unqualified advocate of the Marsh theo- ry, seems to have been very much perplexed by an excep- tion to his rule, which lay just under his own eje. The canal in St. James’ Park, London, was, at the time he wrote, notorious for the abundance of its aquatic plants, causing, in autumn, an even intolerable stench. Yet he congratulates the inhabitants, on their miraculous exemp- tion from malarious fevers, “ it being, perhaps, the only exception in the ivorld^ at least wherever the climate equals (in temperature) that of England.” — (p. 50.) Let us see how far his assertion is sustainable. The town of Kingston, in the island of St. Vincent, is situated at the bottom of a semicircular bay, and at the foot of a mountain range, with high land on each side. The soil consists of a black alluvial mould, evidently arising from decaying vegetable matter. In one place, the bed of a dried up water-course, branches of trees were found, and the neighboring ground was covered with leaves, in dif- ferent stages of decomposition, for upwards of eight inches in depth, into which the feet sank at every step. ‘‘There, then,” says the deputy inspector of British hospitals and fleets, Robert Armstrong, “we have all the elements ne- cessary for the production of this vegeto-animal poison, heat, moisture, decayed and decaying vegetable matter, with as large a proportion of reptiles, insects and other animal matters, as is found in other tropical countries ; yet strange to say, the town of Kingston is one of the most 2* 18 THEOIIIES healthy spots in the West Indies. I was informed by the staff-surgeon to the forces, who had long resided there, that it ivas as healthy as the most favored spots in Eng- layidE As a very curious contrast to the statement of Armstrong, we learn from Bishop Heber, that the wood tracts of Nepaul and Malwa, having neither swamps nor perceptible moisture, become in summer and autumn, so pestiferous as to cause their abandonment even by the birds and beasts. Fordyce too, tells us that, in a part of Peru, where there is almost a total absence of water, and of course of vegeta- tion, fever and dysenteries render the country almost un- inhabitable; and according to Pringle, the dry unproduc- tive sandy plains of Brabant, excite malarious fevers of great intensity. New South Wales extends from 10° 5' to 38° south la- titude, embracing a region similarly situated to that of America from the West Indies to the Chesapeake Bay. It is subject to a rainy season, has streams, estuaries, and extensive swamps. Around some of its towns there lies a deep, black, highly productive vegetable mould. It is liable to extraordinary inundations, which lay the country, as far as the eye can reach, under a sheet of muddy water. The temperature is quite as high as that of any other like latitude. The coast is covered with mangroves, and skirt- ed by rocks, reefs and islets. Among its products are mahogany, oranges, lemons, guavas. The mosquito, with myriads of insects and reptiles; parrots, paroquets and other tropical birds, announce a hot, productive climate, and lead us to look for a tainted air and a pestilential habitude. But, notwithstanding all these threatening con- ditions, the usual symbols of a sickly clime. New Holland is remarkable for its hcalthfulness. Pulmonary diseases OF MALARIA. 19 and, in the wet season, dysenteries are observed, but the fevers incident to warm climates elsewhere, are here of rare occurrence. In speaking of this country, Malte Brun has this expression : “ Hitherto we have heard of no such fatal epidemic fevers as are frequent in some other colonies situated in warm climates.” Mr. Titian Peale, the zealous and successful naturalist, who accompanied Captain Wilkes on the exploring expedi- tion to the Southern Ocean, writes to Professor Dunglison, that he never saw a case of intermitting fever in either natives or strangers, in the Polynesian Islands, although the officers and men of the expedition lived and slepjt in the midst of marsh stenches and mosquitoes, when the days were hot, and the huts open and exposed. Captain Wilkes himself describes these islands as fer- tile, moist, hot, — but, yet as remarkably salubrious, as is evinced by the general good health of the men, who were often exposed at night, by the shore duties of the service, to fatigue, night air and heavy dews. The following examples of the truth of his general statement, are found in the same work. Toxgataboo is an organic island., formed by coral, is rich, flat luxuriant, and oppressed by a temperature rising to 98° F., offering a mean, during the sojourn of the expedition, of 79° 25. There was much rain, and, when clear, heavy dews. The writer supposes that these phenomena must create sickness, but he sees many old people, and admits that, although ashore at night, the people of the expedition were not sufferers. Mr. Peale, also, testifies to the good health of the place. OvoLAU (Fegee) is a volcanic island, the mean tempe- rature of which, for six weeks, was 77° 81; maximum^ 96°; minimum, 62°. Turnips, radishes, and mustard 20 THEORIES seed appeared above ground’ in twenty-four hours; melons in three days; while marroAvfat peas, fit for use, were produced in five weeks. On this island, volcanic as Sar- dinia, and hot as the Maremma, “ fevers, whether re- mittent or intermittent, were unknown.” In the two instances cited above, the islands closely re- sembled each other in climate, temperature, and fertility, but were contrasted as to origination, geology, and sur- fiice, the one being organic, the other volcanic ; the one being flat, the other mountainous; yet both enjoyed a de- gree of salubrity totally at variance with our preconcep- tions. The Island of Soloo, in latitude 6° 01' North, enjoys a temperature seldom below 70°, or above 90°; that is, about the mean of that of the pestilential Avestern coast of Africa. It is, hoAvever, healthy. Menouf, the capital of Menoufyez, in LoAA’er Egypt, is situated on the banks of a canal formcrlv navi