The correspondence of Ferdinand von Mueller: Carpentaria, June 10th, 1867. ¶ My Dear Dr. Mueller, ¶ ¶ In compliance with your request, I have given an account of those fevers which, in this region, have hitherto been observed to exist. ¶ ¶ The...

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Letter not found. For the text given here, see Australian medical journal, vol. 12 (1867), pp. 361-5, where the letter is printed under the heading 'On the fevers of the Gulf of Carpentaria'.

Carpentaria, June 10th, 1867.

My Dear Dr. Mueller,

In compliance with your request, I have given an account of those fevers which, in this region, have hitherto been observed to exist.

The population has suffered from three fevers; two non-contagious and periodic; and one contagious and continued; the former are endemic, and embrace the well known intermittent and a remittent, which latter presents so many grades, according to whether the attack be mind, inflammatory, or malignant, that one who has had no experience in observing and treating tropical fevers, would have difficulty in recognising the same disease under such varied faces

The continued fever seems to have been an epidemic of a typhoid character, which I believe to have been introduced into the Gulf districts by the small vessel "Margaret and Mary," and is the disease which caused the death of so many of the northern pioneers, and unfortunately stamped the north of Carpentaria as a dangerous fever district. There seems to have been no doubt about this being the febris typhoides, as the daily recurrence of the "taches roseés lenticulaires"

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Lenticular roseate spots.

of Louis was observed, which, I believe, is considered diagnostic of this disease.

Dr. Robert Dundas, of Liverpool, considers intermittent, remittent, and continued fever to be mere varieties of the same affection, the one merging into the other.

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Dundas (1852), 'Introductory remarks'.

I have observed patients who have been suffering from decided and unquestionable remittent fever, during apparent convalescence, suffer from decided tertian ague, and I am sure there are few medical men who have not often observed the paroxysms to have become indistinct, and have, consequently, a continued fever in place of a periodic one to treat. This continuous fever, however, I have not found any more contagious than when the remissions were distinct, and very different from the typhoid and typhus fevers.

Concerning the intermittent and typhoid fevers it is unnecessary that I should say anything. An account of the remittent, as observed by me, I give to you. Predisposing causes: Europeans persisting in a rich carbonaceous diet (sugar, fat, alcohol); debilitated state of the system produced by any cause, the most common being, sudden discontinuance of stimulants; previous attack; intense heat:

Exciting causes: Inhalation, especially at night, of a heavy noxious malarious vapour, which floats close to the surface of the soil, and is considered to be more particularly present on land that has been inundated and is drying (probably the malaria is more condensed at night, or the nervous system may be more fatigued then, and less able to combat with it). Drinking marsh water which has not been previously boiled, seems to be an almost sure way to become the victim of this disease. (Vide Sect. xli. of Dr. Thos. Watson on the Principles and Practice of Physic.)

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i.e. Lecture XLI in T. Watson (1857), vol. 1, pp. 757 ff. (or perhaps an earlier edition?).

Symptoms. — This disease consists of consecutive pyrexial paroxysms, each of which may last six, twelve, twenty-four, or forty-eight hours; generally the first lasts twelve hours, and I have known it only to last six hours. The second is always of longer duration, and attended with more severe symptoms than its predecessor. Although the symptoms towards the close of a paroxysm are much mitigated, still the patient is never free from fever, the second paroxysm commencing before the first has exhausted itself. Each paroxysm consists of a hot stage, which may or may not be preceded by rigors or chilliness; in like manner there is the same absence of certainty as to whether it will or will not be succeeded by perspiration; generally five paroxysms occur, this occupies ten days, When under treatment, the patient is generally free from disease.

The disease generally manifests itself suddenly, from 11 a.m. to 2 or 3 p.m., and consists of dizziness, slight chills and flushes, wandering pains in the extremities, fixed pain in the back and epigastrium, with an agonizing pain in the frontal and supra-orbital region; nausea exists, and towards evening a quantity (generally small) of dark yellow, acrid, intensely bitter fluid, having a foul odour, is discharged from the stomach. The pulse is generally 100, full and strong. The tongue presents on the lateral margin a dark purplish colour, but is covered with a whitish slightly yellow fur.

The patient is delirious, and generally unable to sleep. Towards 2 or 3 a.m. the symptoms abate, but do not disappear. The following paroxysms generally ensue about 10 a.m. on the morning of each day, abate about 3 on the morning of the following days. The second is generally the most severe, and the fifth, in cases of recovery, the mildest and the last.

There is consistent insomnia. The delirium is of a weak and cowardly kind. The tongue and teeth become black, and the vomiting continues at indefinite intervals; the matter may contain blood. Headache is constant and much complained of. On the fourth day epistaxis often occurs, and relieves slightly the head. The urine is of the specific gravity of 1028 to 1034, contains no albumen (which I have carefully tested for), changes blue litmus red, is scanty and high coloured, and often accompanied by ardor urinae, and in the latter stages with blood. On the eleventh day the patient is convalescent, and rapidly regains his strength. An exacerbation, however, has a strong tendency to occur on the morning of the fourteenth day.

If unfavourable, the remissions are so indistinct as to resemble a case of continued bilious fever; there is marked prostration; the delirium changes to coma; the pulse becomes wiry and fluttering, and death occurs on the seventh or eighth day from coma or exhaustion.

Unfavourable Signs and Symptoms. — The disease losing its periodicity and assuming a continued type; long first paroxysm; loss of hearing; aphthous vesicles forming in the mouth and pharynx, and subsequently ulcerating; wiry fluttering pulse; copious and frequent epistaxis and haematemesis; patient lying motionless on his back with manifest perfect indifference to his fate: Sequelae, nephritis, hepatitis, pneumonia, chronic congestion of the liver, ulceration of the stomach and bowels.

Treatment. — As this fever is marked by active congestion of the liver, we have a consequent redundancy of badly formed bile, which, by poisoning the blood, appears to produce the same effect upon the system as a narcotic poison. Obviously out first object is to rid the stomach and duodenum of this badly formed bile. 2. To neutralize the poisoned blood. 3. To take especial care of the kidneys, relieving their functions by urging the skin to increased action. 4. To sustain the strength of the patient. 5. To avoid visceral inflammation.

To attain the first object, I administer ℈ j.

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Apothecaries' scruple = 20 grains, equivalent to 1.296 gram.

Ipecacuanhae, irrespective of the stage.

Two hours after vomiting has been induced, a powder composed of 8 grains of Calomel, with 10 grains of Rhubarb; this generally clears well out the bowels.

To neutralize the poisoned blood, a powder composed of 6 grains of Quinine with half a grain of P. Capsici is given every four hours, and continuously persisted in irrespective of exacerbations or remissions. Should the stomach be too irritable to retain this, an enema may be administered of

Dec. Amyli, ℥

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Apothecaries' ounce, 480 grains, equivalent to 31.1 gram.

j.

Quinae, gr.

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Apothecaries' grain, equivalent to 64.8 mg.

vi.

Tr. Opii, 𝔪

8

Apothecaries' minum, equivalent to 0.062 ml.

x. M.

Especial care should be taken that the Quinine be not discontinued on account of the head symptoms, nor in the event of the disease being continued and evidencing no periodicity. The Quinine should not be regarded so much as an anti-periodic, as an antidote to the poisoned blood.

Most astonishing and pleasing are the results which often ensue under this plan of treatment; every symptom seems subdued, a marked effect being had upon the delirium, which is most probably alleviated by a purer condition of the blood.

Diuretics, as a rule, should be avoided, but if used they must be most cautiously administered.

A draught containing 𝔪 xxx. of Chlorodyne, prepared according to the formula of Dr. Collis Brown,

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John Collis Browne.

administered at night, gives great comfort to the patient, and has a tendency to produce diaphoresis. The strength of the patient should be sustained by administering 4 gills of concentrated beef-tea daily; ℥ j. of brandy may be given three or four times a-day, if a typhoid character should ensue.

The bowels require careful attention, generally they are much constipated. Ten grains of the Ext. Coloc Co., divided into two pills, may be given each alternate night. Organic complications, when they ensue, generally succeed the fever and exist as sequelae; these require treating secundum artem; however, diarrhoea and pneunomia often co-exist with the fever. The use of quinine here, must still be persisted in, as these complications in a great measure result from the irritation produced by the poisoned state of the blood. Other remedies may be employed in conjunction, as astringents, counter-irritants, &c.; bleeding should be carefully avoided, as it often causes the disease to assume a low continued type. The head may be much relieved by a spirit poultice (lint saturated with brandy is placed on the forehead and evaporation prevented by a covering of oiled silk). This induces copious local diaphoresis and relief.

Care should be taken that the treatment be continued in for eight or ten days after apparent recovery, only in diminished doses.

This is the most common type of this fever and is the one which now mostly exists. There are two other types, viz., a very mild form, which may last but twelve or twenty-four hours, and terminate in recovery, or may persist, the patient gradually losing strength and reason and becoming eventually the victim of organic disease, and a malignant form which, by the intensity of the poison, produces death in from seven to twelve hours.

Yours faithfully

J. Atkin White.

The correspondence of

Ferdinand von Mueller

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