Before I proceed to deliver the history
of this fever, it will be proper to give a short account
of the diseases which preceded it.
The state of the weather during the first seven
months of the year, and during the time in which
the fever prevailed in the city, as recorded by Mr.
Rittenhouse, will be inserted immediately after the
history of the disease.
The mumps, which made their appearance in
December, 1792, continued to prevail during the
month of January, 1793. Besides this disease
there were many cases of catarrh in the city,
brought on chiefly by the inhabitants exposing
themselves for several hours on the damp ground,
in viewing the aërial voyage of Mr. Blanchard, on
the 9th day of the month.
The weather, which had been moderate in December
and January, became cold in February.
The mumps continued to prevail during this month
with symptoms so inflammatory as to require, in
some cases, two bleedings. Many people complained
this month of pains and swellings in the
jaws. A few had the scarlatina anginosa.
The mumps, pains in the jaws, and scarlatina
continued throughout the month of March. I was
called to two cases of pleurisy in this month, which
terminated in a temporary mania. One of them
was in a woman of ninety years of age, who recovered.
The blood drawn in the other case (a
gentleman from Maryland) was dissolved. The
continuance of a tense pulse induced me, notwithstanding,
to repeat the bleeding. The blood was
now sizy. A third bleeding was prescribed, and
my patient recovered. Several cases of obstinate
erysipelas succeeded inoculation in children during
this and the next month, one of which proved fatal.
Blossoms were universal on the fruit-trees, in
the gardens of Philadelphia, on the first day of April.
The scarlatina anginosa continued to be the reigning
epidemic in this month.
There were several warm days in May, but the
city was in general healthy. The birds appeared
two weeks sooner this spring than usual.
The register of the weather shows, that there
were many warm days in June. The scarlatina
continued to maintain its empire during this month.
The weather was uniformly warm in July. The
scarlatina continued during the beginning of this
month, with symptoms of great violence. A son
of James Sharswood, aged seven years, had, with
the common symptoms of this disease, great pains
and swellings in his limbs, accompanied with a
tense pulse. I attempted in vain to relieve him by
vomits and purges. On the 10th day of the
month, I ordered six ounces of blood to be drawn
from his arm, which I observed afterwards to be
very sizy. The next day he was nearly well. Between
the 22d and the 24th days of the month,
there died three persons, whose respective ages
were 80, 92, and 96½. The weather at this time
was extremely warm. I have elsewhere taken notice
of the fatal influence of extreme heat, as well
as cold, upon human life in old people. A few
bilious remitting fevers appeared towards the close
of this month. One of them under my care ended
in a typhus or chronic fever, from which the patient
was recovered with great difficulty. It was the
son of Dr. Hutchins, of the island of Barbadoes.
The weather, for the first two or three weeks in
August, was temperate and pleasant. The cholera
morbus and remitting fevers were now common.
The latter, were attended with some inflammatory
action in the pulse, and a determination to the
breast. Several dysenteries appeared at this time,
both in the city and in its neighbourhood. During
the latter part of July, and the beginning of this
month, a number of the distressed inhabitants of
St. Domingo, who had escaped the desolation of
fire and sword, arrived in the city. Soon after
their arrival, the influenza made its appearance,
and spread rapidly among our citizens. The scarlatina
still kept up a feeble existence among children.
The above diseases were universal, but
they were not attended with much mortality. They
prevailed in different parts of the city, and each
seemed to appear occasionally to be the ruling
epidemic. The weather continued to be warm
and dry. There was a heavy rain on the 25th of
the month, which was remembered by the citizens
of Philadelphia, as the last that fell for many weeks
afterwards.
There was something in the heat and drought of
the summer months which was uncommon, in
their influence upon the human body. Labourers
every where gave out (to use the country phrase)
in harvest, and frequently too when the mercury
in Fahrenheit's thermometer was under 84°. It
was ascribed by the country people to the calmness
of the weather, which left the sweat produced
by heat and labour to dry slowly upon the body.
The crops of grain and grass were impaired by
the drought. The summer fruits were as plentiful
as usual, particularly the melons, which were of an
excellent quality. The influence of the weather
upon the autumnal fruits, and upon vegetation in
general, shall be mentioned hereafter.
I now enter upon a detail of some solitary cases
of the epidemic, which soon afterwards spread
distress through our city, and terror throughout
the United States.
On the 5th of August, I was requested by Dr.
Hodge to visit his child. I found it ill with a fever
of the bilious kind, which terminated (with a
yellow skin) in death on the 7th of the same
month.
On the 6th of August, I was called to Mrs.
Bradford, the wife of Mr. Thomas Bradford. She
had all the symptoms of a bilious remittent, but
they were so acute as to require two bleedings,
and several successive doses of physic. The last
purge she took was a dose of calomel, which operated
plentifully. For several days after her recovery,
her eyes and face were of a yellow colour.
On the same day, I was called to the son of
Mrs. M'Nair, who had been seized violently with
all the usual symptoms of a bilious fever. I
purged him plentifully with salts and cremor tartar,
and took ten or twelve ounces of blood from
his arm. His symptoms appeared to yield to
these remedies; but on the 10th of the month a
hæmorrhage from the nose came on, and on the
morning of the 12th he died.
On the 7th of this month I was called to visit
Richard Palmer, a son of Mrs. Palmer, in Chesnut-street.
He had been indisposed for several
days with a sick stomach, and vomiting after eating.
He now complained of a fever and head-ach.
I gave him the usual remedies for the bilious fever,
and he recovered in a few days. On the 15th day
of the same month I was sent for to visit his brother
William, who was seized with all the symptoms
of the same disease. On the 5th day his
head-ach became extremely acute, and his pulse
fell to sixty strokes in a minute. I suspected congestion
to have taken place in his brain, and ordered
him to lose eight ounces of blood. His
pulse became more frequent, and less tense after
bleeding, and he recovered in a day or two afterwards.
On the 14th day of this month I was sent for to
visit Mrs. Leaming, the wife of Mr. Thomas Leaming.
I suspected at first that she had the influenza,
but in a day or two her fever put on bilious
symptoms. She was affected with an uncommon
disposition to faint. Her pulse was languid, but
tense. I took a few ounces of blood from her,
and purged her with salts and calomel. I afterwards
gave her a small dose of laudanum which
disagreed with her. In my note book I find I
have recorded that “she was worse for it.” I
was led to make this remark by its being so very
uncommon for a person, who had been properly
bled and purged, to take laudanum in a common
bilious fever without being benefited by it. She
recovered, however, slowly, and was yellow for
many days afterwards.
On the morning of the 18th of this month I was
requested to visit Peter Aston, in Vine-street, in
consultation with Dr. Say. I found him on the
third day of a most acute bilious fever. His eyes
were inflamed, and his face flushed with a deep
red colour. His pulse seemed to forbid evacuations.
We prescribed the strongest cordials, but
to no purpose. We found him, at 6 o'clock in
the evening, sitting upon the side of his bed, perfectly
sensible, but without a pulse, with cold clammy
hands, and his face of a yellowish colour. He
died a few hours after we left him.
None of the cases which I have mentioned excited
the least apprehension of the existence of a
malignant or yellow fever in our city; for I had
frequently seen sporadic cases in which the common
bilious fever of Philadelphia had put on symptoms
of great malignity, and terminated fatally in a
few days, and now and then with a yellow colour
on the skin, before or immediately after death.
On the 19th of this month I was requested to
visit the wife of Mr. Peter Le Maigre, in Water-street,
between Arch and Race-streets, in consultation
with Dr. Foulke and Dr. Hodge. I found
her in the last stage of a highly bilious fever. She
vomited constantly, and complained of great heat
and burning in her stomach. The most powerful
cordials and tonics were prescribed, but to no purpose.
She died on the evening of the next day.
Upon coming out of Mrs. Le Maigre's room
I remarked to Dr. Foulke and Dr. Hodge, that I
had seen an unusual number of bilious fevers, accompanied
with symptoms of uncommon malignity,
and that I suspected all was not right in our
city. Dr. Hodge immediately replied, that a fever
of a most malignant kind had carried off four or
five persons within sight of Mr. Le Maigre's door,
and that one of them had died in twelve hours after
the attack of the disease. This information
satisfied me that my apprehensions were well founded.
The origin of this fever was discovered to
me at the same time, from the account which Dr.
Foulke gave me of a quantity of damaged coffee
which had been thrown upon Mr. Ball's wharf,
and in the adjoining dock, on the 24th of July,
nearly in a line with Mr. Le Maigre's house, and
which had putrefied there to the great annoyance
of the whole neighbourhood.
After this consultation I was soon able to trace
all the cases of fever which I have mentioned to
this source. Dr. Hodge lived a few doors above
Mr. Le Maigre's, where his child had been exposed
to the exhalation from the coffee for several
days. Mrs. Bradford had spent an afternoon in a
house directly opposite to the wharf and dock on
which the putrid coffee had emitted its noxious
effluvia, a few days before her sickness, and had
been much incommoded by it. Her sister, Mrs.
Leaming, had visited her during her illness at her
house, which was about two hundred yards from
the infected wharf. Young Mr. M'Nair and Mrs.
Palmer's two sons had spent whole days in a compting
house near where the coffee was exposed, and
each of them had complained of having been made
sick by its offensive smell, and Mr. Aston had frequently
been in Water-street near the source of the
exhalation.
This discovery of the malignity, extent, and origin
of a fever which I knew to be attended with
great danger and mortality, gave me great pain. I
did not hesitate to name it the bilious remitting yellow
fever. I had once seen it epidemic in Philadelphia,
in the year 1762. Its symptoms were
among the first impressions which diseases made
upon my mind. I had recorded some of these
symptoms, as well as its mortality. I shall here introduce
a short account of it, from a note book
which I kept during my apprenticeship.
“In the year 1762, in the months of August,
September, October, November, and December,
the bilious yellow fever prevailed in Philadelphia,
after a very hot summer, and spread like a plague,
carrying off daily, for some time, upwards of
twenty persons.
“The patients were generally seized with rigours,
which were succeeded with a violent fever,
and pains in the head and back. The pulse
was full, and sometimes irregular. The eyes
were inflamed, and had a yellowish cast, and a
vomiting almost always attended.
“The 3d, 5th, and 7th days were mostly critical,
and the disease generally terminated on one
of them, in life or death.
“An eruption on the 3d or 7th day over the body
proved salutary.
“An excessive heat and burning about the
region of the liver, with cold extremities, portended
death to be at hand.”
I have taken notice, in my note book, of the
principal remedy which was prescribed in this fever
by my preceptor in medicine, but this shall be
mentioned hereafter.
Upon my leaving Mrs Le Maigre's, I expressed
my distress at what I had discovered, to several of
my fellow-citizens. The report of a malignant and
mortal fever being in town spread in every direction,
but it did not gain universal credit. Some of those
physicians who had not seen patients in it denied
that any such fever existed, and asserted (though
its mortality was not denied) that it was nothing
but the common annual remittent of the city.
Many of the citizens joined the physicians in endeavoring
to discredit the account I had given of
this fever, and for a while it was treated with ridicule
or contempt. Indignation in some instances
was excited against me, and one of my friends,
whom I advised in this early stage of the disease
to leave the city, has since told me that for that
advice “he had hated me.”
My lot in having thus disturbed the repose of
the public mind, upon the subject of general health,
was not a singular one. There are many instances
upon record, of physicians who have rendered
themselves unpopular, and even odious to their
fellow-citizens, by giving the first notice of the
existence of malignant and mortal diseases. A
physician, who asserted that the plague was in
Messina, in the year 1743, excited so much rage
in the minds of his fellow-citizens against him, as
to render it necessary for him to save his life by
retreating to one of the churches of that city.
In spite, however, of all opposition, the report of
the existence of a malignant fever in the city gained
so much ground, that the governor of the state directed
Dr. Hutchinson, the inspector of sickly
vessels, to inquire into the truth of it, and into the
nature of the disease.
In consequence of this order, the doctor wrote
letters to several of the physicians in the city, requesting
information relative to the fever. To his
letter to me, dated the 24th of August, I replied
on the same day, and mentioned not only the existence
of a malignant fever, but the streets it occupied,
and my belief of its being derived from a
quantity of coffee which had putrified on a wharf
near Arch-street. This, and other information
collected by the doctor, was communicated to the
health officer, in a letter dated the 27th of August,
in which he mentioned the parts of the city where
the disease prevailed, and the number of persons
who had died of it, supposed by him to be about
40, but which subsequent inquiries proved to be
more than 150. He mentioned further, in addition
to the damaged coffee, some putrid hides, and
other putrid animal and vegetable substances, as
the supposed cause of the fever, and concluded by
saying, as he had not heard of any foreigners or
sailors being infected, nor of its being found in any
lodging-houses, that “it was not an imported
disease.”
In the mean while the disease continued to
spread, and with a degree of mortality that had never
been known from common fevers.
On the 25th of the month, the college of physicians
was summoned by their president to meet, in
order to consult about the best methods of checking
the progress of the fever in the city. After some
consideration upon the nature of the disease, a committee
was appointed to draw up some directions
for those purposes; and the next day the following
were presented to the college, and adopted unanimously
by them. They were afterwards published
in most of the newspapers.
Philadelphia, August 26th, 1793.
The college of physicians having taking into consideration
the malignant and contagious fever that
now prevails in this city, have agreed to recommend
to their fellow-citizens the following means of preventing
its progress.
1st. That all unnecessary intercourse should be
avoided with such persons as are infected by it.
2d. To place a mark upon the door or window
of such houses as have any infected persons in it.
3d. To place the persons infected in the centre
of large and airy rooms, in beds without curtains,
and to pay the strictest regard to cleanliness, by frequently
changing their body and bed linen, also
by removing, as speedily as possible, all offensive
matters from their rooms.
4th. To provide a large and airy hospital, in the
neighbourhood of the city, for the reception of
such poor persons as cannot be accommodated with
the above advantages in private houses.
5th. To put a stop to the tolling of the bells.
6th. To bury such persons as die of this fever
in carriages, and in as private a manner as possible.
7th. To keep the streets and wharves of the city
as clean as possible. As the contagion of the disease
may be taken into the body, and pass out of
it without producing the fever, unless it be rendered
active by some occasional cause, the following
means should be attended to, to prevent the contagion
being excited into action in the body.
8th. To avoid all fatigue of body and mind.
9th. To avoid standing or sitting in the sun; also
in a current of air, or in the evening air.
10th. To accommodate the dress to the weather,
and to exceed rather in warm, than in cool
clothing.
11th. To avoid intemperance, but to use fermented
liquors, such as wine, beer, and cyder, in
moderation.
The college conceive fires to be very ineffectual,
if not dangerous means of checking the progress of
this fever. They have reason to place more dependence
upon the burning of gunpowder. The
benefits of vinegar and camphor are confined chiefly
to infected rooms, and they cannot be used too frequently
upon handkerchiefs, or in smelling-bottles,
by persons whose duty calls to visit or attend the
sick.
Signed by order of the college,
WILLIAM SHIPPEN, jun.
Vice president.
SAMUEL P. GRIFFITTS,
Secretary.
From a conviction that the disease originated in
the putrid exhalations from the damaged coffee, I
published in the American Daily Advertiser, of
August 29th, a short address to the citizens of Philadelphia,
with a view of directing the public attention
to the spot where the coffee lay, and thereby
of checking the progress of the fever as far as
it was continued by the original cause.
This address had no other effect than to produce
fresh clamours against the author; for the citizens,
as well as most of the physicians of Philadelphia,
had adopted a traditional opinion that the yellow
fever could exist among us only by importation
from the West-Indies.
In consequence, however, of a letter from Dr.
Foulke to the mayor of the city, in which he had
decided, in a positive manner, in favour of the generation
of the fever from the putrid coffee, the
mayor gave orders for the removal of the coffee, and
the cleaning of the wharf and dock. It was said
that measures were taken for this purpose; but
Dr. Foulke, who visited the place where the coffee
lay, repeatedly assured me, that they were so
far from being effectual, that an offensive smell was
exhaled from it many days afterwards.
I shall pass over, for the present, the facts and
arguments on which I ground my assertion of the
generation of this fever in our city. They will
come in more properly in the close of the history
of the disease.
The seeds of the fever, when received into the
body, were generally excited into action in a few
days. I met with several cases in which they acted
so as to produce a fever on the same day in which
they were received into the system, and I heard of
two cases in which they excited sickness, fainting,
and fever within one hour after the persons were
exposed to them. I met with no instance in which
there was a longer interval than sixteen days between
their being received into the body and the
production of the disease.
This poison acted differently in different constitutions,
according to previous habits, to the degrees
of predisposing debility, or to the quantity
and concentration of the miasmata which had
been received into the body.
In some constitutions, the miasmata were at
once a remote, a predisposing, and an exciting
cause of the disease; hence some persons were affected
by them, who had not departed in any instance
from their ordinary habits of living, as to
diet, dress, and exercise. But it was more frequently
brought on by those causes acting in succession
to each other.
I shall here refer the reader to the principles laid
down in the outlines of the theory of fever, for an
account of the manner in which the system was
predisposed to this disease, by the debility induced
by the reduction of its excitement, by action and
abstraction, and by subsequent depression. Where
a predisposition was thus produced, the fever was
excited by the following causes, acting directly or
indirectly upon the system. Where this predisposition
did not exist, the exciting causes produced
both the predisposition and the disease. They
were,
1. Great labour, or exercises of body or mind,
in walking, riding, watching, or the like. It was
labour which excited the disease so universally
among the lower class of people. A long walk
often induced it. Few escaped it after a day, or
even a few hours spent in gunning. A hard trotting
horse brought it on two of my patients. Perhaps
riding on horseback, and in the sun, was the
exciting cause of the disease in most of the citizens
and strangers who were affected by it in their flight
from the city. A fall excited it in a girl, and a
stroke upon the head excited it in a young man
who came under my care. Many people were
seized with the disease in consequence of their exertions
on the night of the 7th of September, in
extinguishing the fire which consumed Mr. Dobson's
printing-office, and even the less violent exercise
of working the fire engines, for the purpose
of laying the dust in the streets, added frequently to
the number of the sick.
2. Heat, from every cause, but more especially
the heat of the sun, was a very common exciting
cause of the disease. The register of the weather
during the latter end of August, the whole of September,
and the first two weeks in October will
show how much the heat of the sun must have
contributed to excite the disease, more especially
among labouring people. The heat of common
fires likewise became a frequent cause of the activity
of the miasmata where they had been received
into the body; hence the greater mortality of the
disease among bakers, blacksmiths, and hatters
than among any other class of people.
3. Intemperance in eating or drinking. A plentiful
meal, and a few extra glasses of wine seldom
failed of exciting the fever. But where the body
was strongly impregnated with the seeds of the disease,
even the smallest deviation from the customary
stimulus of diet, in respect to quality or quantity,
roused them into action. A supper of twelve
oysters in one, and of but three in another, of my
patients produced the disease. Half an ounce of
meat excited it in a lady who had lived, by my
advice, for two weeks upon milk and vegetables,
and even a supper of sallad, dressed after the French
fashion, excited it in one of Dr. Mease's patients.
4. Fear. In many people the disease was excited
by a sudden paroxysm of fear; but I saw
some remarkable instances where timid people escaped
the disease, although they were constantly
exposed to it. Perhaps a moderate degree of fear
served to counteract the excessive stimulus of the
miasmata, and thereby to preserve the body in a state
of healthy equilibrium. I am certain that fear did no
harm after the disease was formed, in those cases
where great morbid excess of action had taken place.
It was an early discovery of this fact which led me
not to conceal from my patients the true name of
this fever, when I was called to them on the day
of their being attacked by it. The fear co-operated
with some of my remedies (to be mentioned
hereafter) in reducing the morbid excitement of the
arterial system.
5. Grief. It was remarkable that the disease
was not excited in many cases in the attendants
upon the sick, while there was a hope of their recovery.
The grief which followed the extinction
of hope, by death, frequently produced it within a
day or two afterwards, and that not in one person
only, but often in most of the near relations of the
deceased. But the disease was also produced by a
change in the state of the mind directly opposite to
that which has been mentioned. Many persons
that attended patients who recovered, were seized
with the disease a day or two after they were relieved
from the toils and anxiety of nursing. The
collapse of the mind from the abstraction of the stimulus
of hope and desire, by their ample gratification,
probably produced that debility, and loss of
the equilibrium in the system, which favoured the
activity of the miasmata in the manner formerly
mentioned[14].
The effects of both the states of mind which
have been described, have been happily illustrated
by two facts which are recorded by Dr. Jackson[15].
He tells us, that the garrisons of Savannah and
York-Town were both healthy during the siege of
those towns, but that the former became sickly
as soon as the French and American armies retreated,
from before it, and the latter, immediately
after its capitulation.
6. Cold. Its action, in exciting the disease,
depended upon the diminution of the necessary and
natural heat of the body, and thereby so far destroying
the equilibrium of the system, as to enable
the miasmata to produce excessive or convulsive
motions in the blood-vessels. The night air,
even in the warm month of September, was often
so cool as to excite the disease, where the dress and
bed-clothes were not accommodated to it. It was
excited in one case by a person's only wetting his
feet, in the month of October, and neglecting afterwards
to change his shoes and stockings. Every
change in the weather, that was short of producing
frost, evidently increased the number of sick people.
This was obvious after the 18th and 19th of
September, when the mercury fell to 44° and 45°.
The hopes of the city received a severe disappointment
upon this occasion, for I well recollect there
was a general expectation that this change in the
weather would have checked the disease. The
same increase of the number of sick was observed
to follow the cool weather which succeeded the 6th
and 7th of October, on which days the mercury
fell to 43° and 46°.
It was observed that those persons who were
habitually exposed to the cool air, were less liable
to the disease than others. I ascribe it to the habitual
impression of the cool night air upon the
bodies of the city watchmen, that but four or five
of them, out of twenty-five, were affected by the
disease.
After the body had been heated by violent exercise,
a breeze of cool air sometimes excited the
disease in those cases where there had been no
change in the temperature of the weather.
7. Sleep. A great proportion of all who were affected
by this fever, were attacked in the night.
Sleep induced what I have called debility from abstraction,
and thereby disposed the miasmata which
floated in the blood, to act with such force upon
the system as to destroy its equilibrium, and thus
to excite a fever. The influence of sleep as a predisposing,
and exciting cause was often assisted by
the want of bed-clothes, suited to the midnight or
morning coolness of the air.
8. Immoderate evacuations. The efficacy of
moderate purging and bleeding in preventing the
disease, led some people to use those remedies in
an excess, which both predisposed to the disease,
and excited it. The morbid effects of these evacuations,
were much aided by fear, for it was this
passion which perverted the judgment in such a
manner, as to lead to the excessive use of remedies,
which, to be effectual, should only be used in moderate
quantities.
The disease appeared with different symptoms,
and in different degrees, in different people. They
both varied likewise with the weather. In describing
the disease, I shall take notice of the
changes in the symptoms, which were produced
by changes in the temperature of the air.
The precursors, or premonitory signs of this
fever were, costiveness, a dull pain in the right
side, defect of appetite, flatulency, perverted taste,
heat in the stomach, giddiness, or pain in the head,
a dull, watery, brilliant, yellow, or red eye, dim
and imperfect vision, a hoarseness, or slight sore
throat, low spirits, or unusual vivacity, a moisture
on the hands, a disposition to sweat at nights, or
after moderate exercise, or a sudden suppression
of night sweats. The dull eye, and the lowness of
spirits, appeared to be the effects of such an excess
in the stimulus of the miasmata as to induce depression,
while the brilliant eye, and the unusual
vivacity, seemed to have been produced by a less
quantity of the miasmata acting as a cordial upon
the system. More or less of these symptoms frequently
continued for two or three days before the
patients were confined to their beds, and in some
people they continued during the whole time of its
prevalence in the city, without producing the disease.
I wish these symptoms to be remembered
by the reader. They will form the corner stone of
a system which I hope will either eradicate the disease
altogether, or render it as safe as an intermitting
fever, or as the small-pox when it is received
by inoculation.
Frequent as these precursors of the fever were,
they were not universal. Many went to bed in
good health, and awoke in the night with a chilly fit.
Many rose in the morning after regular and natural
sleep, and were seized at their work, or after a walk,
with a sudden and unexpected attack of the fever.
In most of these cases the disease came on with a
chilly fit, which afforded by its violence or duration
a tolerable presage of the issue of the disease.
Upon entering a sick room where a patient was
confined by this fever, the first thing that struck
the eye of a physician was the countenance. It
was as much unlike that which is exhibited in the
common bilious fever, as the face of a wild, is
unlike the face of a mild domestic animal. The
eyes were sad, watery, and so inflamed, in some
cases, as to resemble two balls of fire. Sometimes
they had a most brilliant or ferocious appearance.
The face was suffused with blood, or of a dusky
colour, and the whole countenance was downcast
and clouded. After the 10th of September, when
a determination of blood to the brain became universal,
there was a preternatural dilatation of the
pupil. Sighing attended in almost every case.
The skin was dry, and frequently of its natural
temperature. These were the principal symptoms
which discovered themselves to the eye and hand
of a physician. The answers to the first questions
proposed upon visiting a patient, were calculated to
produce a belief in the mind of a physician, that the
disease under which the patient laboured was not
the prevailing malignant epidemic. I did not for
many weeks meet with a dozen patients, who acknowledged
that they had any other indisposition
than a common cold, or a slight remitting or intermitting
fever. I was particularly struck with this
self-deception in many persons, who had nursed
relations that had died with the yellow fever,
and who had been exposed to it in neighbourhoods
where it had prevailed for days and even
weeks with great mortality. I shall hereafter trace
a part of this disposition in the sick to deceive
themselves to the influence of certain publications,
which appeared soon after the disease became epidemic
in the city.
In the further history of this fever, I shall describe
its symptoms as they appeared,
I. In the sanguiferous system.
II. In the liver, lungs, and brain.
III. In the alimentary canal; in which I include
the stomach as well as the bowels.
IV. In the secretions and excretions.
V. In the nervous system.
VI. In the senses and appetites.
VII. In the lymphatic and glandular system.
VIII. Upon the skin.
IX. In the blood.
After having finished this detail, I shall mention
some general characters of the disease, and afterwards
subdivide it into classes, according to its degrees
and duration.
I. The blood-vessels were affected more or less in
every case of this fever. I have elsewhere said,
that a fever is occasioned by a convulsion in the
arterial system[16]. When the epidemic, which we
are now considering, came on with a full, tense,
and quick pulse, this convulsion was very perceptible;
but it frequently came on with a weak pulse,
often without any preternatural frequency or quickness,
and sometimes so low as not to be perceived
without pressing the artery at the wrists. In many
cases the pulse intermitted after the fourth, in some
after the fifth, and in others after the fourteenth
stroke. These intermissions occurred in several
persons who were infected, but who were not confined
by the fever. They likewise continued in
several of my patients for many days after their
recovery. This was the case in particular in Mrs.
Clymer, Mrs. Palmer's son William, and in a son
of Mr. William Compton. In some, there was a
preternatural slowness of the pulse. It beat 44
strokes in a minute in Mr. B. W. Morris, 48 in
Mr. Thomas Wharton, jun. and 64 in Mr. William
Sansom, at a time when they were in the most
imminent danger. Dr. Physick informed me, that
in one of his patients the pulse was reduced in frequency
to 30 strokes in a minute. All these different
states of the pulse have been taken notice of
by authors who have described pestilential fevers[17].
They have been improperly ascribed to the absence
of fever: I would rather suppose that they are occasioned
by the stimulus of the remote cause acting
upon the arteries with too much force to admit
of their being excited into quick and convulsive
motions. The remedy which removed it (to be
mentioned hereafter) will render this explanation of
its cause still more probable. Milton describes
a darkness from an excess of light. In like manner
we observe, in this small, intermitting, and
slow pulse, a deficiency of strength from an excess
of force applied to it. In nearly every case of it
which came under my notice, it was likewise tense
or chorded. This species of pulse occurred chiefly
in the month of August, and in the first ten days
in September. I had met with it formerly in a
sporadic case of yellow fever. It was new to all
my pupils. One of them, Mr. Washington, gave
it the name of the “undescribable pulse.” It aided
in determining the character of this fever before the
common bilious remittent disappeared in the city.
For a while, I ascribed this peculiarity in the
pulse, more especially its slowness, to an affection
of the brain only, and suspected that it was produced
by what I have taken the liberty elsewhere
to call the phrenicula, or inflammatory state of the
internal dropsy of the brain, and which I have remarked
to be an occasional symptom and consequence
of remitting fever. I was the more disposed
to adopt this opinion, from perceiving this
slow, chorded, and intermitting pulse more frequently
in children than in adults. Impressed
with this idea, I requested Mr. Coxe, one of my
pupils, to assist me in examining the state of the
eyes. For two days we discovered no change in
them, but on the third day after we began to inspect
them, we both perceived a preternatural dilatation
of the pupils, in different patients; and we seldom
afterwards saw an eye in which it was absent. In
Dr. Say it was attended by a squinting, a symptom
which marks a high degree of a morbid affection
of the brain. Had this slowness or intermission
in the pulse occurred only after signs of inflammation
or congestion had appeared in the brain,
I should have supposed that it had been derived
wholly from that cause; but I well recollect having
felt it several days before I could discover the
least change in the pupil of the eye. I am forced
therefore to call in the operation of another cause,
to assist in accounting for this state of the pulse,
and this I take to be a spasmodic affection, accompanied
with preternatural dilatation or contraction
of the heart. Lieutaud mentions this species of
pulse in several places, as occurring with an undue
enlargement of that muscle[18]. Dr. Ferriar describes
a case, in which a low, irregular, intermitting,
and hardly perceptible pulse attended a morbid
dilatation of the heart[19]. In a letter I received
from Mr. Hugh Ferguson, then a student of medicine
in the college of Edinburgh, written from
Dublin, during the time of a visit to his father,
and dated September 30th, 1793, I find a fact
which throws additional light upon this subject.
“A case (says my young correspondent) where a
remarkable intermission of pulse was observed,
occurred in this city last year. A gentleman of
the medical profession, middle aged, of a delicate
habit of body, and who had formerly suffered
phthisical attacks, was attacked with the acute
rheumatism. Some days after he was taken ill,
he complained of uncommon fulness, and a very
peculiar kind of sensation about the præcordia,
which it was judged proper to relieve by copious
blood-letting. This being done, the uneasiness
went off. It returned, however, three or four
times, and was as often relieved by bleeding. During
each of his fits (if I may call them so), the patient
experienced an almost total remission of his
pains in his limbs; but they returned with equal
or greater violence after blood-letting. During
the fit there was an intermission of the pulse (the
first time) of no less than thirteen strokes. It was
when beating full, strong, and slow. The third
intermission was of nine strokes. The gentleman
soon recovered, and has enjoyed good health for
ten months past. The opinion of some of his physicians
was, that the heart was affected, as a muscle,
by the rheumatism, and alternated with the
limbs.”
I am the more inclined to believe the peculiarity
in the pulse which has been mentioned in the
yellow fever, arose in part from a spasmodic affection
of the heart, from the frequency of an uncommon
palpitation of this muscle, which I discovered
in this disease, more especially in old people. The
disposition, likewise, to syncope and sighing,
which so often occurred, can be explained upon no
other principle than inflammation, spasm, dilatation,
or congestion in the heart. After the 10th
of September this undescribable or sulky pulse (for
by the latter epithet I sometimes called it) became
less observable, and, in proportion as the weather
became cool, it totally disappeared. It was gradually
succeeded by a pulse full, tense, quick, and as
frequent as in pleurisy or rheumatism. It differed,
however, from a pleuritic or rheumatic pulse, in
imparting a very different sensation to the fingers.
No two strokes seemed to be exactly alike. Its
action was of a hobbling nature. It was at this
time so familiar to me that I think I could have
distinguished the disease by it without seeing the
patient. It was remarkable that this pulse attended
the yellow fever even when it appeared in the
mild form of an intermittent, and in those cases
where the patients were able to walk about or go
abroad. It was nearly as tense in the remissions
and intermissions of the fever as it was in the exacerbations.
It was an alarming symptom, and
when the only remedy which was effectual to remove
it was neglected, such a change in the system
was induced as frequently brought on death in
a few days.
This change of the pulse, from extreme lowness
to fulness and activity, appeared to be owing to
the diminution of the heat of the weather, which,
by its stimulus, added to that of the remote cause,
had induced those symptoms of depression of the
pulse which have been mentioned.
The pulse most frequently lessened in its fulness,
and became gradually weak, frequent, and imperceptible
before death, but I met with several cases
in which it was full, active, and even tense in the
last hours of life.
Hæmorrhages belong to the symptoms of this
fever as they appeared in the sanguiferous system.
They occurred in the beginning of the disease,
chiefly from the nose and uterus. Sometimes but
a few drops of blood distilled from the nose. The
menses were unusual in their quantity when they
appeared at their stated periods, but they often
came on a week or two before the usual time of
their appearance. I saw one case of a hæmorrhage
from the lungs on the first day of the fever, which
was supposed to be a common hæmoptysis. As
the disease advanced the discharges of blood became
more universal. They occurred from the
gums, ears, stomach, bowels, and urinary passages.
Drops of blood issued from the inner canthus of
the left eye of Mr. Josiah Coates. Dr. Woodhouse
attended a lady who bled from the holes in
her ears which had been made by ear-rings.
Many bled from the orifices which had been made
by bleeding, several days after they appeared to
have been healed, and some from wounds which
had been made in veins in unsuccessful attempts
to draw blood. These last hæmorrhages were
very troublesome, and in some cases precipitated
death.
II. I come now to mention the symptoms of
this fever as they appeared in the liver, the lungs,
and the brain. From the histories which I had
read of this disease, I was early led to examine the
state of the liver, but I was surprised to find so few
marks of hepatic affection. I met with but two
cases in which the patient could lie only on the
right side. Many complained of a dull pain in the
region of the liver, but very few complained, in the
beginning of the disease, of that soreness to the
touch, about the pit of the stomach, which is taken
notice of by authors, and which was universal in
the yellow fever in 1762. In proportion as the cool
weather advanced, a preternatural determination of
the blood took place chiefly to the lungs and brain.
Many were affected with pneumonic symptoms,
and some appeared to die of sudden effusions of
blood or serum in the lungs. It was an unexpected
effusion of this kind which put an end to the life of
Mrs. Keppele after she had exhibited hopeful signs
of a recovery.
I saw one person who recovered from an affection
of the lungs, by means of a copious expectoration
of yellow phlegm and mucus. But the brain was
principally affected with morbid congestion in this
disease. It was indicated by the suffusion of blood
in the face, by the redness of the eyes, by a dilatation
of the pupils, by the pain in the head, by the
hæmorrhages from the nose and ears, by the sickness
or vomiting, and by an almost universal costive
state of the bowels. I wish to impress the
reader with these facts, for they formed one of the
strongest indications for the use of the remedies
which I adopted for the cure of this disease. It is
difficult to determine the exact state of these viscera
in every case of bilious and yellow fever. Inflammation
certainly takes place in some cases, and internal
hæmorrhages in others; but I believe the
most frequent affection of these viscera consists in
a certain morbid accumulation of blood in them,
which has been happily called, by Dr. Clark, an
engorgement or choaking of the blood-vessels. I
believe further, with Dr. Clark[20] and Dr. Balfour[21],
that death in most cases in bilious fevers is the
effect of these morbid congestions, and wholly unconnected
with an exhausted state of the system,
or a supposed putrefaction in the fluids. It is true,
the dissections of Dr. Physick and Dr. Cathrall
(to be mentioned hereafter) discovered no morbid
appearances in any of the viscera which have been
mentioned, but it should be remembered, that these
dissections were made early in the disease. Dr.
Annan attended the dissection of a brain of a patient
who died at Bush-hill some days afterwards,
and observed the blood-vessels to be unusually
turgid. In those cases where congestion only
takes place, it is as easy to conceive that all morbid
appearances in the brain may cease after death, as
that the suffusion of blood in the face should disappear
after the retreat of the blood from the extremities
of the vessels, in the last moments of life.
It is no new thing for morbid excitement of the
brain to leave either slender, or no marks of disease
after death. This, I have said, is often the case
where it exceeds that degree of action which produces
an effusion of red blood into serous vessels,
or what is called inflammation[22]. Dr. Quin has
given a dissection of the brain of a child that died
with all the symptoms of hydrocephalus internus,
and yet nothing was discovered in the brain but a
slight turgescence of its blood-vessels. Dr. Girdlestone
says, no injury appeared in the brains of
those persons who died of the symptomatic apoplexy,
which occurred in a spasmodic disease which
he describes in the East-Indies; and Mr. Clark
informs us, that the brain was in a natural state in
every case of death from puerperile fever, notwithstanding
it seemed to be affected in many cases
soon after the attack of that disease[23].
I wish it to be remembered here, that the yellow
fever, like all other diseases, is influenced by climate
and season. The determination of the fluids
is seldom the same in different years, and I am
sure it varied with the weather in the disease which
I am now describing. Dr. Jackson speaks of the
head being most affected in the West-India fevers
in dry situations. Dr. Hillary says, that there was
an unusual determination of the blood towards the
brain, after a hot and dry season, in the fevers of
Barbadoes in the year 1753; and Dr. Ferriar, in
his account of an epidemic jail fever in Manchester,
in 1789, 1790, informs us, that as soon as frost set
in, a delirium became a more frequent symptom
of that disease, than it had been in more temperate
weather.
III. The stomach and bowels were affected in
many ways in this fever. The disease seldom appeared
without nausea or vomiting. In some
cases, they both occurred for several days or a
week before they were accompanied by any fever.
Sometimes a pain, known by the name of gastrodynia,
ushered in the disease. The stomach was
so extremely irritable as to reject drinks of every
kind. Sometimes green or yellow bile was rejected
on the first day of the disease by vomiting;
but I much oftener saw it continue for two days
without discharging any thing from the stomach,
but the drinks which were taken by the patient. If
the fever in any case came on without vomiting,
or if it had been checked by remedies that were
ineffectual to remove it altogether, it generally appeared,
or returned, on the 4th or 5th day of the
disease. I dreaded this symptom on those days,
for although it was not always the forerunner of
death, yet it generally rendered the recovery more
difficult and tedious. In some cases the vomiting
was more or less constant from the beginning to
the end of the disease, whether it terminated in
life or death.
The vomiting which came on about the 4th or
5th day, was accompanied with a burning pain in
the region of the stomach. It produced great anxiety,
and tossing of the body from one part of the
bed to another. In some cases, this painful burning
occurred before any vomiting had taken place.
Drinks were now rejected from the stomach so
suddenly, as often to be discharged over the hand
that lifted them to the head of the patient. The
contents of the stomach (to be mentioned hereafter)
were sometimes thrown up with a convulsive
motion, that propelled them in a stream to a great
distance, and in some cases all over the clothes of
the by-standers.
Flatulency was an almost universal symptom, in
every stage of this disease. It was very distressing
in many cases. It occurred chiefly in the stomach.
The bowels were generally costive, and in some
patients as obstinately so as in the dry gripes. In
some cases there was all the pain and distress of a
bilious colic, and in others, the tenesmus, and mucous
and bloody discharges of a true dysentery. A
diarrhœa introduced the disease in a few persons,
but it was chiefly in those who had been previously
indisposed with weak bowels. A painful tension
of the abdomen took place in many, accompanied
in some instances by a dull, and in others by an
acute pain in the lower part of the belly.
IV. I come now to describe the state of the
secretions and excretions as they appeared in different
stages of this fever.
In some cases there was a constipation of the
liver, if I may be allowed that expression, or a total
obstruction of secretion and excretion of bile,
but more frequently a preternatural secretion and
excretion of it took place. It was discharged, in
most cases, from the stomach and bowels in large
quantities, and of very different qualities and colours.
1. On the first and second days of the disease
many patients puked from half a pint to nearly a
quart of green or yellow bile. Four cases came
under my notice in which black bile was discharged
on the first day. Three of these patients recovered.
2. There was frequently, on the 4th or 5th day,
a discharge of matter from the stomach, resembling
coffee impregnated with its grounds. This was
always an alarming symptom. I believed it at first
to be a modification of vitiated bile, but subsequent
dissections by Dr. Physick have taught me that
it was the result of the first stage of those morbid
actions in the stomach, which afterwards produce
the black vomit. Many recovered who discharged
this coffee-coloured matter.
3. Towards the close of this disease, there was a
discharge of matter of a deep or pale black colour,
from the stomach. Flakey substances frequently
floated in the bason or chamber-pot upon the surface
of this matter. It was what is called the black
vomit. It was formerly supposed to be vitiated
bile, but it has been proved by Dr. Stewart, and
afterwards by Dr. Physick, to be the effect of disease
in the stomach.
4. There was frequently discharged from the
stomach in the close of the disease, a large quantity
of grumous blood, which exhibited a dark colour
on its outside, resembling that of some of the matters
which have been described, and which I believe
was frequently mistaken for what is commonly
known by the name of the black vomit. Several of
my patients did me the honour to say, I had cured
them after that symptom of approaching dissolution
had made its appearance; but I am inclined to believe,
dark-coloured blood only, or the coffee-coloured
matter, was mistaken for the matters which
constitute the fatal black vomiting. I except here
the black discharge before-mentioned, which took
place in three cases on the first day of the disease.
This I have no doubt was bile, but it had not acquired
its greatest acrimony, and it was discharged
before mortification, or even inflammation could
have taken place in the stomach. Several persons
died without a black vomiting of any kind.
Along with all the discharges from the stomach
which have been described, there was occasionally
a large worm, and frequently large quantities of
mucus and tough phlegm.
The colour, quality, and quantity of the fæces
depended very much upon the treatment of the disease.
Where active purges had been given, the
stools were copious, fœtid, and of a black or dark
colour. Where they were spontaneous, or excited
by weak purges, they had a more natural appearance.
In both cases they were sometimes of a
green, and sometimes of an olive colour. Their
smell was more or less fœtid, according to the time
in which they had been detained in the bowels. I
visited a lady who had passed several days without
a stool, and who had been treated with tonic remedies.
I gave her a purge, which in a few hours
procured a discharge of fæces so extremely fœtid,
that they produced fainting in an old woman who
attended her. The acrimony of the fæces was
such as to excoriate the rectum, and sometimes to
produce an extensive inflammation all around its
external termination. The quantity of the stools
produced by a single purge was in many cases
very great. They could be accounted for only by
calling in the constant and rapid formation of them,
by preternatural effusions of bile into the bowels.
I attended one person, and heard of two others,
in whom the stools were as white as in the jaundice.
I suspected, in these cases, the liver to be
so constipated or paralyzed by the disease, as to be
unable to secrete or excrete bile to colour the
fæces. Large round worms were frequently discharged
with the stools.
The urine was in some cases plentiful, and of a
high colour. It was at times clear, and at other
times turbid. About the 4th or 5th day, it sometimes
assumed a dark colour, and resembled strong
coffee. This colour continued, in one instance,
for several days after the patient recovered. In
some, the discharge was accompanied by a burning
pain, resembling that which takes place in a gonorrhœa.
I met with one case in which this burning
came on only in the evening, with the exacerbation
of the fever, and went off with its remission in the
morning.
A total deficiency of the urine took place in
many people for a day or two, without pain. Dr.
Sydenham takes notice of the same symptom in
the highly inflammatory small-pox[24]. It generally
accompanied or portended great danger. I heard
of one case in which there was a suppression of
urine, which could not be relieved without the use
a the catheter.
A young man was attended by Mr. Fisher, one
of my pupils, who discharged several quarts of
limpid urine just before he died.
Dr. Arthaud informs us, in the history of a dissection
of a person who died of the yellow fever,
that the urine after death imparted a green colour
to the tincture of radishes[25].
Many people were relieved by copious sweats
on the first day of the disease. They were in
some instances spontaneous, and in others they
were excited by diluting drinks, or by strong
purges. These sweats were often of a yellow colour,
and sometimes had an offensive smell. They
were in some cases cold, and attended at the same
time with a full pulse. In general, the skin was
dry in the beginning, as well as in the subsequent
stages of the disease. I saw but few instances of
its terminating like common fevers, by sweat after
the third day. I wish this fact to be remembered
by the reader, for it laid part of the foundation of
my method of treating this fever.
There was in some cases a preternatural secretion
and excretion of mucus from the glands of
the throat. It was discharged by an almost constant
hawking and spitting. All who had this
symptom recovered.
The tongue was in every case moist, and of a
white colour, on the first and second days of the
fever. As the disease advanced, it assumed a red
colour, and a smooth shining appearance. It was
not quite dry in this state. Towards the close of
the fever, a dry black streak appeared in its middle,
which gradually extended to every part of it. Few
recovered after this appearance on the tongue took
place.
V. In the nervous system the symptoms of the
fever were different, according as it affected the
brain, the muscles, the nerves, or the mind. The
sudden and violent action of the miasmata induced
apoplexy in several people. In some, it brought
on syncope, and in others, convulsions in every
part of the body. The apoplectic cases generally
proved fatal, for they fell chiefly upon hard drinkers.
Persons affected by syncope, or convulsions, sometimes
fell down in the streets. Two cases of this
kind happened near my house. One of them came
under my notice. He was supposed by the by-standers
to be drunk, but his countenance and convulsive
motions soon convinced me that this was
not the case.
A coma was observed in some people, or an obstinate
wakefulness in every stage of the disease.
The latter symptom most frequently attended the
convalescence. Many were affected with immobility,
or numbness in their limbs.
These symptoms were constant, or temporary,
according to the nature of the remedies which
were made use of to remove them. They extended
to all the limbs, in some cases, and only to a part
of them in others. In some, a violent cramp, both
in the arms and legs, attended the first attack of
the fever. I met with one case in which there
was a difficulty of swallowing, from a spasmodic
affection of the throat, such as occurs in the locked
jaw.
A hiccup attended the last stage of this disease,
but I think less frequently than the last stage of
the common bilious fever. I saw but five cases of
recovery where this symptom took place.
There was, in some instances, a deficiency of
sensibility, but, in others, a degree of it extending
to every part of the body, which rendered the application
of common rum to the skin, and even the
least motion of the limbs painful.
I was surprised to observe the last stage of this
fever to exhibit so few of the symptoms of the
common typhus or chronic fever. Tremors of
the limbs and twitchings of the tendons were uncommon.
They occurred only in those cases in
which there was a predisposition to nervous diseases,
and chiefly in the convalescent state of the
disease.
While the muscles and nerves in many cases exhibited
so many marks of preternatural weakness,
in some they appeared to be affected with preternatural
excitement. Hence patients in the close of
the disease often rose from their beds, walked
across their rooms, or came down stairs, with as
much ease as if they had been in perfect health.
I lost a patient in whom this state of morbid
strength occurred to such a degree, that he stood
up before his glass and shaved himself, on the day
on which he died.
The mind suffered with the morbid states of the
brain and nerves. A delirium was a common
symptom. It alternated in some cases with the
exacerbations and remissions of the fever. In
some, it continued without a remission, until a few
hours before death. Many, however, passed
through the whole course of the disease without
the least derangement in their ideas, even where
there were evident signs of a morbid congestion
in the brain. Some were seized with maniacal
symptoms. In these there was an apparent absence
of fever. Such was the degree of this mania
in one man, that he stripped off his shirt, left
his bed, and ran through the streets, with no other
covering than a napkin on his head, at 8 o'clock
at night, to the great terror of all who met him.
The symptoms of mania occurred most frequently
towards the close of the disease, and sometimes
continued for many days and weeks, after all other
febrile symptoms had disappeared.
The temper was much affected in this fever.
There were few in whom it did not produce great
depression of spirits. This was the case in many,
in whom pious habits had subdued the fear of
death. In some the temper became very irritable.
Two cases of this kind came under my notice, in
persons who, in good health, were distinguished
for uncommon sweetness of disposition and manners.
I observed in several persons the operations of
the understanding to be unimpaired, throughout
the whole course of the fever, who retained no remembrance
of any thing that passed in their sickness.
My pupil, Mr. Fisher, furnished a remarkable
example of this correctness of understanding,
with a suspension of memory. He neither said
nor did any thing, during his illness, that indicated
the least derangement of mind, and yet he recollected
nothing that passed in his room, except my
visits to him. His memory awakened upon my
taking him by the hand, on the morning of the 6th
day of his disease, and congratulating him upon his
escape from the grave.
In some, there was a weakness, or total defect
of memory, for several weeks after their recovery.
Dr. Woodhouse informed me that he had met with
a woman, who, after she had recovered, could not
recollect her own name.
Perhaps it would be proper to rank that self-deception
with respect to the nature and danger of
the disease, which was so universal, among the instances
of derangement of mind.
The pain which attended the disease was different,
according to the different states of the system.
In those cases in which it sunk under the violence
of the disease, there was little or no pain. In proportion
as the system was relieved from this oppression,
it recovered its sensibility. The pain in
the head was acute and distressing. It affected
the eye-balls in a peculiar manner. A pain extended,
in some cases, from the back of the head
down the neck. The ears were affected, in several
persons, with a painful sensation, which they compared
to a string drawing their two ears together
through the brain. The sides, and the regions of
the stomach, liver, and bowels, were all, in different
people, the seats of either dull or acute pains.
The stomach, towards the close of the disease, was
affected with a burning or spasmodic pain of the
most distressing nature. It produced, in some
cases, great anguish of body and mind. In others
it produced cries and shrieks, which were often
heard on the opposite side of the streets to where
the patients lay. The back suffered very much in
this disease. The stoutest men complained, and
even groaned under it. An acute pain extended,
in some cases, from the back to one or both thighs.
The arms and legs sympathized with every other
part of the body. One of my patients, upon whose
limbs the disease fell with its principal force, said
that his legs felt as if they had been scraped with a
sharp instrument. The sympathy of friends with
the distresses of the sick extended to a small part
of their misery, when it did not include their sufferings
from pain. One of the dearest friends I ever
lost by death declared, in the height of her illness,
that “no one knew the pains of a yellow fever,
but those who felt them.”
VI. The senses and appetites exhibited several
marks of the universal ravages of this fever upon
the body. A deafness attended in many cases,
but it was not often, as in the nervous fever, a favourable
symptom. A dimness of sight was very
common in the beginning of the disease. Many
were affected with temporary blindness. In some
there was a loss of sight in consequence of gutta
serena, or a total destruction of the substance of
the eye. There was in many persons a soreness
to the touch which extended all over the body. I
have often observed this symptom to be the forerunner
of a favourable issue of a nervous fever,
but it was less frequently the case in this disease.
The thirst was moderate or absent in some
cases, but it occurred in the greatest number of
persons whom I saw in this fever. Sometimes it
was very intense. One of my patients, who suffered
by an excessive draught of cold water, declared,
just before he died, that “he could drink
up the Delaware.” It was always an alarming
symptom when this thirst came on in this extravagant
degree in the last stage of the disease. In
the beginning of the fever it generally abated upon
the appearance of a moist skin. Water was preferred
to all other drinks.
The appetite for food was impaired in this, as
in all other fevers, but it returned much sooner
than is common after the patient began to recover.
Coffee was relished in the remissions of the fever,
in every stage of the disease. So keen was the
appetite for solid, and more especially for animal
food, after the solution of the fever, that many suffered
from eating aliment that was improper from
its quality or quantity. There was a general disrelish
for wine, but malt liquors were frequently
grateful to the taste.
Many people retained a relish for tobacco much
longer after they were attacked by this fever, and
acquired a relish for it much sooner after they began
to recover, than are common in any other febrile
disease. I met with one case in which a man,
who was so ill as to require two bleedings, continued
to chew tobacco through every stage of his
fever.
The convalescence from this disease was marked,
in some instances, by a sudden revival of the
venereal appetite. Several weddings took place in
the city between persons who had recovered from
the fever. Twelve took place among the convalescents
in the hospital at Bush-hill. I wish I
could add that the passion of the sexes for each
other, among those subjects of public charity, was
always gratified only in a lawful way. Delicacy
forbids a detail of the scenes of debauchery which
were practised near the hospital, in some of the
tents which had been appropriated for the reception
of convalescents. It was not peculiar to this
fever to produce this morbid excitability of the
venereal appetite. It was produced in a much
higher degree by the plague which raged in Messina
in the year 1743.
VII. The lymphatic and glandular system did
not escape without some signs of this disease. I
met with three cases of swellings in the inguinal,
two in the parotid, and one in the cervical glands:
all these patients recovered without a suppuration
of their swellings. They were extremely painful
in one case in which no redness or inflammation
appeared. In the others there was considerable inflammation
and but little pain.
In one of the cases of inguinal buboes, the whole
force of the disease seemed to be collected into the
lymphatic system. The patient walked about, and
had no fever nor pain in any part of his body, except
in his groin. In another case which came
under my care, a swelling and pain extended from
the groin along the spermatic cord into one of the
testicles. These glandular swellings were not peculiar
to this epidemic. They occurred in the
yellow fever of Jamaica, as described by Dr. Williams,
and always with a happy issue of the disease[26].
A similar concentration of the contagion of the
plague in the lymphatic glands is taken notice of by
Dr. Patrick Russel.
VIII. The skin exhibited many marks of this
fever. It was preternaturally warm in some cases,
but it was often preternaturally cool. In some
there was a distressing coldness in the limbs for
two or three days. The yellow colour from which
this fever has derived its name, was not universal.
It seldom appeared where purges had been given
in sufficient doses. The yellowness rarely appeared
before the third, and generally about the fifth or
seventh day of the fever. Its early appearance always
denoted great danger. It sometimes appeared
first on the neck and breast, instead of the eyes.
In one of my patients it discovered itself first behind
one of his ears, and on the crown of his head,
which had been bald for several years. The remissions
and exacerbations of the fever seemed to
have an influence upon this colour, for it appeared
and disappeared altogether, or with fainter or deeper
shades of yellow, two or three times in the course
of the disease. The eyes seldom escaped a yellow
tinge; and yet I saw a number of cases in which
the disease appeared with uncommon malignity and
danger, without the presence of this symptom.
There was a clay-coloured appearance in the
face, in some cases, which was very different from
the yellow colour which has been described. It
occurred in the last stage of the fever, and in no
instance did I see a recovery after it.
There were eruptions of various kinds on the
skin, each of which I shall briefly describe.
1. I met with two cases of an eruption on the
skin, resembling that which occurs in the scarlet
fever. Dr. Hume says, pimples often appear on
the pit of the stomach, in the yellow fever of Jamaica.
I examined the external region of the stomach
in many of my patients, without discovering
them.
2. I met with one case in which there was an
eruption of watery blisters, which, after bursting,
ended in deep, black sores.
3. There was an eruption about the mouth in
many people, which ended in scabs, similar to
those which take place in the common bilious fever.
They always afforded a prospect of a favourable
issue of the disease.
4. Many persons had eruptions which resembled
moscheto bites. They were red and circumscribed.
They appeared chiefly on the arms, but
they sometimes extended to the breast. Like the
yellow colour of the skin, they appeared and disappeared
two or three times in the course of the
disease.
5. Petechiæ were common in the latter stage
of the fever. They sometimes came on in large,
and at other times in small red blotches; but they
soon acquired a dark colour. In most cases they
were the harbingers of death.
6. Several cases of carbuncles, such as occur in
the plague, came under my notice. They were
large and hard swellings on the limbs, with a black
apex, which, upon being opened, discharged a thin,
dark-coloured, bloody matter. From one of these
malignant sores a hæmorrhage took place, which
precipitated the death of the amiable widow of
Dr. John Morris.
7. A large and painful anthrax on the back succeeded
a favourable issue of the fever in the Rev.
Dr. Blackwell.
8. I met with a woman who showed me the
marks of a number of small boils on her face and
neck, which accompanied her fever.
Notwithstanding this disposition to cutaneous
eruptions in this disease, it was remarkable that
blisters were much less disposed to mortify than in
the common nervous fever. I met with only one
case in which a deep-seated ulcer followed the application
of blisters to the legs. Such was the insensibility
of the skin in some people, that blisters
made no impression upon it.
IX. The blood in this fever has been supposed to
undergo a change from a healthy to a putrid state,
and many of its symptoms which have been described,
particularly the hæmorrhages and eruptions
on the skin, have been ascribed to this supposed
putrefaction of the blood. It would be easy to
multiply arguments, in addition to those mentioned
in another place[27], to prove that no such thing as
putrefaction can take place in the blood, and that
the symptoms which have been supposed to prove
its existence are all effects of a sudden, violent, and
rapid inflammatory action or pressure upon the
blood-vessels, and hence the external and internal
hæmorrhages. The petechiæ on the surface of
the skin depend upon the same cause. They are
nothing but effusions of serum or red blood, from
a rupture or preternatural dilatation of the capillary
vessels[28]. The smell emitted from persons affected
by this disease was far from being of a putrid nature;
and if this had been the case, it would not
have proved the existence of putrefaction in the
blood, for a putrid smell is often discharged from
the lungs, and from the pores in sweat, which is
wholly unconnected with a putrid, or perhaps any
other morbid state of the blood. There are plants
which discharge an odour which conveys to the
nose a sensation like that of putrefaction; and yet
these plants exist, at the same time, in a state of
the most healthy vegetation: nor does the early
putrid smell of a body which perishes with this fever
prove a putrid change to have taken place in
the blood before death. All animals which die
suddenly, and without loss of blood, are disposed
to a speedy putrefaction. This has long been remarked
in animals that have been killed after a
chase, or by lightning. The poisonous air called
samiel, which is described by Chardin, produces,
when it destroys life, instant putrefaction. The
bodies of men who die of violent passions, or after
strong convulsions, or even after great muscular
exertion, putrify in a few hours after death. The
healthy state of the body depends upon a certain
state of arrangement in the fluids. A derangement
of these fluids is the natural consequence of the
violent and rapid motions, or of the undue pressure
upon the solids, which have been mentioned.
It occurs in cases of death which are induced by
the excessive force of stimulus, whether it be from
miasmata, or the volatile vitriolic acid which is
supposed to constitute the destructive samiel wind,
or from violent commotions excited in the body by
external or internal causes. The practice among
fishermen, in some countries, of breaking the heads
of their fish as soon as they are taken out of the
water, in order to retard their putrefaction, proves
the truth of the explanation I have given of its
cause, soon after death. The sudden extinction
of life in the fish prevents those convulsive or violent
motions, which induce sudden disorganization
in their bodies. It was observed that putrefaction
took place most speedily after death from the yellow
fever, where the commotions of the system were
not relieved by evacuations. In those cases where
purges and bleeding had been used, putrefaction
did not take place sooner after death than is common
in any other febrile disease, under equal circumstances
of heat and air.
Thus have I described the symptoms of this fever.
From the history I have given, it appears
that it counterfeited nearly all the acute and chronic
forms of disease to which the human body is
subject. An epitome, both of its symptoms and
its theory, is happily delivered by Dr. Sydenham,
in the following words. After describing the epidemic
cough, pleurisy, and peripneumony of 1675,
he adds, “But in other epidemics, the symptoms
are so slight from the disturbance raised in the
blood by the morbific particles contained in the
mass, that nature being in a manner oppressed, is
rendered unable to produce regular symptoms
that are suitable to the disease; and almost all the
phenomena that happen are irregular, by reason
of the entire subversion of the animal economy;
in which case the fever is often depressed, which,
of its own nature, would be very high. Sometimes
also fewer signs of a fever appear than the
nature of the disease requires, from a translation
of the malignant cause, either to the nervous system,
or to some other parts of the body, or to some
of the juices not contained in the blood; whilst
the morbific matter is yet turgid[29].”
The disease ended in death in various ways. In
some it was sudden; in others it came on by gradual
approaches. In some the last hours of life
were marked with great pain, and strong convulsions;
but in many more, death seemed to insinuate
itself into the system, with all the gentleness of
natural sleep. Mr. Powell expired with a smile
on his countenance. Dr. Griffitts informed me
that Dr. Johnson exhibited the same symptom in
the last hours of his life. This placid appearance
of the countenance, in the act of dying, was not
new to me. It frequently occurs in diseases which
affect the brain and nerves. I lost a patient, in the
year 1791, with the gout, who not only smiled, but
laughed, a few minutes before he expired.
I proceed now to mention some peculiarities of
the fever, which could not be brought in under any
of the foregoing heads.
In every case of this disease which came under
my notice, there were evident remissions, or intermissions
of the fever, or of such symptoms as were
substituted for fever. I have long considered, with
Mr. Senac, a tertian as the only original type of
all fevers. The bilious yellow fever indicated its
descent from this parent disease. I met with
many cases of regular tertians, in which the patients
were so well on the intermediate days as to
go abroad. It appeared in this form in Mr. Van
Berkel, the minister of the United Netherlands.
Nor was this mild form of the fever devoid of
danger. Many died who neglected it, or who took
the common remedies for intermittents to cure it.
It generally ended in a remittent before it destroyed
the patient. The tertian type discovered itself in
some people after the more violent symptoms of
the fever had been subdued, and continued in them
for several weeks. It changed from a tertian to a
quartan type in Mr. Thomas Willing, nearly a
month after his recovery from the more acute and
inflammatory symptoms of the disease.
It is nothing new for a malignant fever to appear
in the form of a tertian. It is frequently the garb
of the plague. Riverius describes a tertian fever
which proved fatal on the third day, which was evidently
derived from the same exhalation which produced
a continual malignant fever[30].
The remissions were more evident in this, than
in the common bilious fever. They generally occurred
in the forenoon. It was my misfortune to
be deprived, by the great number of my patients, of
that command of time which was necessary to watch
the exacerbations of this fever under all their various
changes, as to time, force, and duration. From
all the observations that were suggested by visits,
at hours that were seldom left to my choice, I was
led to conclude, that the fever exhibited in different
people all that variety of forms which has been described
by Dr. Cleghorn, in his account of the tertian
fever of Minorca. A violent exacerbation on
even days was evidently attended with more danger
than on odd days. The same thing was observed
by Dr. Mitchell in the yellow fever of Virginia,
in the year 1741. “If (says he) the exacerbations
were on equal days, they generally died in the
third paroxysm, or the sixth day; but if on unequal
days, they recovered on the seventh.”
The deaths which occurred on the 3d, 5th, and
7th days, appeared frequently to be the effects of
the commotions or depression, produced in the
system on the 2d, 4th, and 6th days.
The remission on the third day was frequently
such as to beget a belief that the disease had run
its course, and that all danger was over. A violent
attack of the fever on the 4th day removed this
deception, and, if a relaxation had taken place in
the use of proper remedies on the 3d day, death
frequently occurred on the 5th or the 7th.
The termination of this fever in life and death
was much more frequent on the 3d, 5th, 7th, 9th,
and 11th days, than is common in the mild remitting
fever. Where death occurred on the even
days, it seemed to be the effect of a violent paroxysm
of the fever, or of great vigour of constitution,
or of the force of medicines which protracted some
of the motions of life beyond the close of the odd
days which have been mentioned.
I think I observed the fever to terminate on the
third day more frequently in August, and during
the first ten days in September, than it did after
the weather became cool. In this it resembled the
common bilious remittents of our city, also the
simple tertians described by Dr. Cleghorn[31]. The
danger seemed to be in proportion to the tendency
of the disease to a speedy crisis, hence more died
in August in proportion to the number who were
affected than in September or October, when the
disease was left to itself. But, however strange
after this remark it may appear, the disease yielded
to the remedies which finally subdued it more
speedily and certainly upon its first appearance in
the city, than it did two or three weeks afterwards.
The disease continued for fifteen, twenty, and
even thirty days in some people. Its duration was
much influenced by the weather, and by the use
or neglect of certain remedies (to be mentioned
hereafter) in the first stage of the disease.
It has been common with authors to divide the
symptoms of this fever into three different stages.
The order I have pursued in the history of those
symptoms will render this division unnecessary.
It will I hope be more useful to divide the patients
affected with the disease into three classes.
The first includes those in whom the stimulus
of the miasmata produced coma, languor, sighing,
a disposition to syncope, and a weak or slow pulse.
The second includes those in whom the miasmata
acted with less force, producing great pain in the
head, and other parts of the body; delirium, vomiting,
heat, thirst, and a quick, tense, or full
pulse, with obvious remissions or intermissions of
the fever.
The third class includes all those persons in
whom the miasmata acted so feebly as not to confine
them to their beds or houses. This class of
persons affected by the yellow fever was very numerous.
Many of them recovered without medical
aid, or by the use of domestic prescriptions;
many of them recovered in consequence of a spontaneous
diarrhœa, or plentiful sweats; many were
saved by moderate bleeding and purging; while
some died, who conceived their complaints to be occasioned
by a common cold, and neglected to take
proper care of themselves, or to use the necessary
means for their recovery. It is not peculiar to the
yellow fever to produce this feeble operation upon
the system, It has been observed in the southern
states of America, that in those seasons in
which the common bilious fever is epidemic “no
body is quite well,” and that what are called in
those states “inward fevers” are universal. The
small-pox, even in the natural way, does not always
confine the patient; and thousands pass through
the plague without being confined to their beds or
houses. Dr. Hodges prescribed for this class of
patients in his parlour in London, in the year 1665,
and Dr. Patrick Russel did the same from a chamber
window fifteen feet above the level of the street
at Aleppo. Notwithstanding the mild form the
plague put on in these cases, it often proved fatal
according to Dr. Russel. I have introduced these
facts chiefly with a view of preparing the reader
to reject the opinion that we had two species of
fever in the city at the same time; and to show
that the yellow fever appears in a more simple form
than with “strongly marked” characters; or, in
other words, with a yellow skin and a black vomiting.
It was remarkable that this fever always found
out the weak part of every constitution it attacked.
The head, the lungs, the stomach, the bowels,
and the limbs, suffered more or less, according as
they were more or less debilitated by previous
inflammatory or nervous diseases, or by a mixture
of both, as in the gout.
I have before remarked, that the influenza, the
scarlatina, and a mild bilious remittent, prevailed
in the city, before the yellow fever made its appearance.
In the course of a few weeks they all
disappeared, or appeared with symptoms of the
yellow fever; so that, after the first week of September,
it was the solitary epidemic of the city.
The only case like influenza which I saw after
the 5th of September, was in a girl of 14 years of
age, on the 13th of the month. It came on with
a sneezing and cough. I was called to her on
the third day of her disease. The instant I felt
her pulse, I pronounced her disease to be the yellow
fever. Her father was offended with this
opinion, although he lived in a highly infected
neighbourhood, and objected to the remedies I
prescribed for her. In a few days she died. In
the course of ten days, her father and sister were
infected, and both died, I was informed, with the
usual symptoms of the yellow fever.
It has been an axiom in medicine, time immemorial,
that no two fevers of unequal force can
exist long together in the same place. As this
axiom seems to have been forgotten by many of
the physicians of Philadelphia, and as the ignorance
or neglect of it led to that contrariety of opinion
and practice, which unhappily took place in the
treatment of the disease, I hope I shall be excused
by those physicians to whom this fact is as familiar
as the most simple law of nature, if I fill a few
pages with proofs of it, from practical writers.
Thucydides long ago remarked, that the plague
chased all other diseases from Athens, or obliged
them to change their nature, by assuming some of
its symptoms.
Dr. Sydenham makes the same remark upon
the plague in London, in 1665. Dr. Hodges, in
his account of the same plague, says, that “at the
rise of the plague all other distempers went into it,
but that, at its declension, it degenerated into
others, as inflammations, head-ach, quinsies, dysenteries,
small-pox, measles, fevers, and hectics,
wherein the plague yet predominated[32].”
During the prevalence of the plague in Grand
Cairo, no sporadic disease of any kind makes its
appearance. The same observation is made by
Sauvage, in his account of the plague at Alais, in
the province of Languedoc[33].
The small-pox, though a disease of less force
than the plague, has often chased it from Constantinople,
probably from its being in a declining
state. But this exclusive prevalence of a single
epidemic is not confined to the plague and small-pox.
Dr. Sydenham's writings are full of proofs
of the dominion of febrile diseases over each other.
Hence, after treating upon a symptomatic pleurisy
which sometimes accompanied a slow fever, in the
year 1675, and which had probably been injudiciously
treated by some of those physicians who
prescribe for the name of a disease, he delivers the
following aphorism: “Whoever, in the cure of
fevers, hath not always in view the constitution of
the year, inasmuch as it tends to produce some
particular epidemic disease, and likewise to reduce
all the cotemporary diseases to its own form and
likeness, proceeds in an uncertain and fallacious
way[34].” It appears further, from the writings of
this excellent physician, that where the monarchy
of a single disease was not immediately acknowledged,
by a sudden retreat of all cotemporary diseases,
they were forced to do homage to it, by
wearing its livery. It would be easy to multiply
proofs of this assertion, from the numerous histories
of epidemics which are to be found in his works.
I shall mention only one or two of them. A continual
fever, accompanied by a dry skin, had prevailed
for some time in the city of London. During
the continuance of this fever, the regular
small-pox made its appearance. It is peculiar to
the small-pox, when of a distinct nature, to be attended
by irregular sweats before the eruption of
the pock. The continual fever now put on a new
symptom. It was attended by sweats in its first
stage, exactly like those which attended the eruptive
fever of the small-pox[35]. This despotism of a
powerful epidemic extended itself to the most
trifling indispositions. It even blended itself, Dr.
Sydenham tells us, with the commotions excited
in the system by the suppression of the lochia, as
well as with the common puerperile fever[36]. Dr.
Morton has left testimonies behind him, in different
parts of his works, which establish, in the most
ample manner, the truth of Dr. Sydenham's observations.
Dr. Huxham describes the small-pox
as blending some of its symptoms with those of a
slow fever, at Plymouth, in the year 1729[37]. Dr.
Cleghorn mentions a constitution of the air at Minorca,
so highly inflammatory, “that not only tertian
fevers, but even a common hurt or bruise required
more plentiful evacuations than ordinary[38].”
Riverius informs us, in his history of a pestilential
fever that prevailed in France, that “it united itself
with phrenitis, angina, pleurisy, peripneumony, hepatitis,
dysentery, and many other diseases[39].”
The bilious remitting fever which prevailed in
Philadelphia, in 1780, chased away every other
febrile disease; and the scarlatina anginosa which
prevailed in our city, in 1783 and 1784, furnished
a striking proof of the influence of epidemics over
each other. In the account which I published of
this disease, in the year 1789, there are the following
remarks. “The intermitting fever which
made its appearance in August was not lost during
the month of September. It continued to prevail,
but with several peculiar symptoms. In
many persons it was accompanied by an eruption
on the skin, and a swelling of the hands and feet.
In some it was attended with sore throat, and
pains behind the ears. Indeed such was the prevalence
of the contagion which produced the scarlatina
anginosa, that many hundred people complained
of sore throats, without any other symptom
of indisposition. The slightest exciting cause,
and particularly cold, seldom failed of producing
the disease[40].”
I shall mention only one more authority in favour
of the influence of a single epidemic upon
diseases. It is taken from Mr. Clark's essay on
the epidemic disease of lying-in women, of the
years 1787 and 1788. “There does not appear
to be any thing in a parturient state which can
prevent women from being affected by the general
causes of disease at that time; and should they
become ill, their complaints will probably partake
of the nature of the reigning epidemic[41].” I have
said that the fever sometimes put on the symptoms
of dysentery, pleurisy, rheumatism, colic, palsy,
and even of the locked jaw. That these were not
original diseases, but symptomatic affections only
of the reigning epidemic, will appear from other
histories of bilious fevers. Dr. Balfour tells us, in
his account of the intestinal remitting fever of Bengal[42],
that it often appeared with symptoms of dysentery,
rheumatism, and pleurisy. Dr. Cleghorn
and Dr. Lind mention many cases of the bilious
fever appearing in the form of a dysentery. Dr.
Clark ascribes the dysentery, the diarrhœa, the colic,
and even the palsy, to the same cause which
produced the bilious fever in the East-Indies[43];
and Dr. Hunter, in his treatise upon the diseases
of Jamaica, mentions the locked jaw as one of its
occasional symptoms. Even the different grades
of this fever, from the mildest intermittent to the
most acute continual fever, have been distinctly
traced by Lancissi to the same marsh exhalation[44].
However irrefragably these numerous facts and
authorities establish the assertion of the prevalence
of but one powerful epidemic at a time, the proposition
will receive fresh support, from attending to
the effects of two impressions of unequal force made
upon the system at the same time: only one of
them is felt; hence the gout is said to cure all other
diseases. By its superior pain it destroys sensations
of a less painful nature. The small-pox and measles
have sometimes existed together in the body; but
this has, I believe, seldom occurred, where one of
them has not been the predominating disease[45].
In this respect, this combination of epidemics only
conforms to the general law which has been mentioned.
I beg pardon for the length of this digression.
I did not introduce it to expose the mistakes of
those physicians, who found as many diseases in
our city as the yellow fever had symptoms, but to
vindicate myself from the charge of innovation, in
having uniformly and unequivocally asserted, after
the first week in September, that the yellow fever
was the only febrile disease which prevailed in the
city.
Science has much to deplore from the multiplication
of diseases. It is as repugnant to truth in
medicine, as polytheism is to truth in religion.
The physician who considers every different affection
of the different systems in the body, or every
affection of different parts of the same system, as
distinct diseases, when they arise from one cause,
resembles the Indian or African savage, who considers
water, dew, ice, frost, and snow, as distinct
essences; while the physician who considers the
morbid affections of every part of the body (however
diversified they may be in their form or degrees)
as derived from one cause, resembles the
philosopher who considers dew, ice, frost, and
snow, as different modifications of water, and as
derived simply from the absence of heat.
Humanity has likewise much to deplore from
this paganism in medicine. The sword will probably
be sheathed for ever, as an instrument of
death, before physicians will cease to add to the
mortality of mankind, by prescribing for the names
of diseases.
The facts I have delivered upon this subject will
admit of a very important application to the cure,
not only of the yellow fever, but of all other acute
and dangerous epidemics. I shall hereafter assign
a final cause for the law of epidemics which has
been mentioned, which will discover a union of the
goodness of the Supreme Being with one of the
greatest calamities of human life.
All ages were affected by this fever, but persons
between fourteen and forty years of age were most
subject to it. Many old people had it, but it was
not so fatal to them as to robust persons in middle
life. It affected children of all ages. I met with
a violent case of the disease, in a child of four
months, and a moderate case of it, in a child of but
ten weeks old. The latter had a deep yellow skin.
Both these children recovered.
The proportion of children who suffered by this
fever may be conceived from a single fact. Seventy-five
persons were buried in the grave-yard of
the Swedish church in the months of August, September,
and October, twenty-four of whom were
children. They were buried chiefly in September
and October; months in which children generally
enjoy good health in our city.
Men were more subject to the disease than women.
Pregnancy seemed to expose women to it.
The refugees from the French West-Indies
universally escaped it. This was not the case with
the natives of France, who had been settled in the
city.
It is nothing new for epidemics to affect persons
of one nation, and to pass by persons of other
nations, in the same city or country. At Nimeguen,
in the year 1736, Deigner informs us, that
the French people (two old men excepted), and
the Jews, escaped a dysentery which was universal
among persons of all other nations. Ramazini
tells us, that the Jews at Modena escaped a tertian
fever which affected nearly all the other inhabitants
of the town. Shenkius says, that the Dutch and
Italians escaped a plague, which prevailed for two
years in one of the towns of Switzerland; and Dr.
Bell, in an inaugural dissertation, published at
Edinburgh, in 1779, remarks, that the jail fever,
which attacked the soldiers of the duke of Buccleugh's
regiment, spared the French prisoners who
were guarded by them. It is difficult to account
for these facts. However numerous their causes
may be, a difference in diet, which is as much a
distinguishing mark of nations as dress or manners,
will probably be found to be one of them.
From the accounts of the yellow fever which
had been published by many writers, I was led to
believe that the negroes in our city would escape
it. In consequence of this belief, I published the
following extract in the American Daily Advertiser,
from Dr. Lining's history of the yellow fever, as it
had four times appeared in Charleston, in South-Carolina.
“There is something very singular (says the
doctor) in the constitution of the negroes, which
renders them not liable to this fever; for though
many of them were as much exposed as the nurses
to the infection, yet I never knew of one instance
of this fever among them, though they are equally
subject with the white people to the bilious fever[46].”
A day or two after this publication the following
letter from the mayor of the city, to Mr. Claypoole,
the printer of the Mail, appeared in his
paper.
“Sir,
“It is with peculiar satisfaction that I
communicate to the public, through your paper,
that the African Society, touched with the distresses
which arise from the present dangerous disorder,
have voluntarily undertaken to furnish nurses
to attend the afflicted; and that, by applying to
Absalom Jones and William Gray, both
members of that society, they may be supplied.
MATTH. CLARKSON,
September 6th, 1793.Mayor.”
It was not long after these worthy Africans undertook
the execution of their humane offer of services
to the sick before I was convinced I had been
mistaken. They took the disease in common with
the white people, and many of them died with it.
I think I observed the greatest number of them to
sicken after the mornings and evenings became
cool. A large number of them were my patients.
The disease was lighter in them than in white
people. I met with no case of hæmorrhage in a
black patient.
The tobacconists and persons who used tobacco
did not escape the disease. I observed snuff-takers
to be more devoted to their boxes than usual, during
the prevalence of the fever.
I have remarked, formerly, that servant maids
suffered much by the disease. They were the only
patients I lost in several large families. I ascribe
their deaths to the following causes:
1st. To the great and unusual debility induced
upon their systems by labour in attending their
masters and mistresses, or their children. Debility,
according to its degrees and duration, seems to
have had the same effect upon the mortality of this
fever that it has upon the mortality of an inflammation
of the lungs. When it is moderate and of
short duration it predisposes only to a common
pneumony, but when it is violent and protracted,
in its degrees and duration, it predisposes to a pulmonary
consumption.
2dly. To their receiving large quantities of impure
air into their bodies, and in a most concentrated
state, by being obliged to perform the most
menial offices for the sick, and by washing, as well
as removing foul linen, and the like.
3dly. To their being left more alone in confined
or distant rooms, and thereby suffering from
depression of spirits, or the want of a punctual supply
of food and medicines.
There did not appear to be any advantage from
smelling vinegar, tar, camphor, or volatile salts, in
preventing the disease. Bark and wine were
equally ineffectual for that purpose. I was called
to many hundred people who were infected after
using one or more of them. Nor did the white
washing of walls secure families from the disease.
I am disposed to believe garlic was the only substance
that was in any degree useful in preventing
it. I met with several persons who chewed it constantly,
and who were much exposed to the miasmata,
without being infected. All other substances
seemed to do harm by begetting a false confidence
in the mind, to the exclusion of more rational preservatives.
I have suspected further, that such of
them as were of a volatile nature helped to spread
the disease by affording a vehicle for miasmata
through the air.
There was great mortality in all those families
who lived in wooden houses. Whether this arose
from the small size of these houses, or from the
want of cleanliness of the people who occupied
them, or from the miasmata becoming more accumulated,
by adhering to the wood, I am unable to
determine. Perhaps it was the effect of the co-operation
of all three of those causes.
I have said, formerly, that intemperance in drinking
predisposed to the disease; but there were several
instances of persons having escaped it who
were constantly under the influence of strong
drink. The stimulus of ardent spirits probably
predominated over the stimulus of the miasmata,
and thus excited an artificial fever which defended
the system from that which was epidemic.
I heard of some sea-faring people who lived on
board their vessels who escaped the disease. The
smell of the tar was supposed to have preserved
them; but, from its being ineffectual in other cases,
I am disposed to ascribe their escape to the infected
air of the city being destroyed by a mixture with
the water of the Delaware.
Many people who were infected in the city were
attacked by the disease in the country, but they did
not propagate it, even to persons who slept in the
same room with them.
Dr. Lind informs us that many persons escaped
the yellow fever which prevailed in Pensacola in
the year 1765, by retiring to the ships which lay
in the harbour, and that when the disease had been
taken, the pure air of the water changed it into an
intermitting fever[47]. The same changes have frequently
been produced in malignant fevers, by sending
patients infected with them from the foul air of
a city, into the pure air of the country.
Persons confined in the house of employment,
in the hospital, and in the jail, escaped the fever.
The airy and remote situation of those buildings
was probably the chief means of their preservation.
Perhaps they derived additional security from their
simple diet, their exemption from hard labour,
and from being constantly sheltered from heat and
cold.
Several families, who shut up their front and
back doors and windows, and avoided going out of
their houses except to procure provisions, escaped
the disease.
I have taken some pains to ascertain, whether
any class of tradesmen escaped the fever, or whether
there was any species of labour which protected
from it. The result of my inquiries is as
follows: Three butchers only, out of nearly one
hundred who remained in the city, died with the
disease. Many of them attended the markets
every day. Two painters, who worked at their
business during the whole time of the prevalence
of the fever, and in exposed situations, escaped it.
Out of forty scavengers who were employed in
collecting and carrying away the dirt of the streets,
only one was affected by the fever and died. Very
few grave-diggers, compared with the number who
were employed in that business, were infected; and
it is well known, that scarcely an instance was
heard of persons taking the disease, who were constantly
employed in digging cellars. The fact is
not new that grave-diggers escape malignant fevers.
It is taken notice of by Dr. Clark.
It was said by some physicians in the public papers,
that the neighbourhood of the grave-yards
was more infected than other parts of the city.
The reverse of this assertion was true in several
cases, owing probably to the miasmata being diluted
and weakened by its mixture with the air of the
grave-yards: for this air was pure, compared with
that which stagnated in the streets.
It was said further, that the disease was propagated
by the inhabitants assembling on Sundays
for public worship; and, as a proof of this assertion,
it was reported, that the deaths were more
numerous on Sundays than on other days; occasioned
by the infection received on one Sunday
producing death on the succeeding first day of the
week. The register of the deaths shows that this
was not the case. I am disposed to believe that
fewer people sickened on Sundays, than on any
other day of the week; owing to the general rest
from labour, which I have before said was one of
the exciting causes of the disease. From some
facts to be mentioned presently, it will appear probable,
that places of public worship, in consequence
of their size, as well as of their being shut up during
the greatest part of the week, were the freest
from miasmata of any houses in the city. It is
agreeable to discover in this, as well as in all other
cases of public and private duty, that the means of
health and moral happiness are in no one instance
opposed to each other.
The disease, which was at first confined to Water-street,
soon spread through the whole city.
After the 15th of September, the atmosphere of
every street in the city was charged with miasmata;
and there were few citizens in apparent good health,
who did not exhibit one or more of the following
marks of their presence in their bodies.
1. A yellowness in the eyes, and a sallow colour
upon their skin.
2. A preternatural quickness in the pulse. I
found but two exceptions to this remark, out of a
great number of persons whose pulses I examined.
In one of them it discovered several preternatural
intermissions in the course of a minute. This
quickness of pulse occurred in the negroes, as
well as in the white people. I met with it in a
woman who had had the yellow fever in 1762.
In two women, and in one man above 70, the pulse
beat upwards of 90 strokes in a minute. This
preternatural state of the pulse during the prevalence
of a pestilential fever, in persons in health, is
taken notice of by Riverius[48].
3. Frequent and copious discharges by the skin
of yellow sweats. In some persons these sweats
sometimes had an offensive smell, resembling that
of the washings of a gun.
4. A scanty discharge of high coloured or turbid
urine.
5. A deficiency of appetite, or a greater degree
of it than was natural.
6. Costiveness.
7. Wakefulness.
8. Head-ach.
9. A preternatural dilatation of the pupils. This
was universal. I was much struck in observing
the pupil in one of the eyes of a young man who
called upon me for advice, to be of an oblong
figure. Whether it was natural, or the effect of
the miasmata acting on his brain, I could not determine.
It will be thought less strange that the miasmata
should produce these changes in the systems of
persons who resided constantly in the city, when
I add, that many country people who spent but a
few hours in the streets in the day, in attending the
markets, were infected by the disease, and sickened
and died after they returned home; and that
others, whom business compelled to spend a day
or two in the city during the prevalence of the fever,
but who escaped an attack of it, declared that
they were indisposed, during the whole time, with
languor or head-ach.
I was led to observe and record the above effects
of the miasmata upon persons in apparent
good health, by a fact I met with in Dr. Mitchell's
history of the yellow fever in Virginia, in the year
1741. In that fever, blood drawn from a vein was
always dissolved. The same state of the blood
was observed in many persons who had been exposed
to the miasmata, who discovered no other
symptom of the disease.
A woman whom I had formerly cured of a mania,
who lived in an infected neighbourhood, had
a fresh attack of that disease, accompanied by an
unusual menstrual flux. I ascribed both these
complaints to the action of the miasmata upon her
system.
The smell emitted from a patient, in a clean room,
was like that of the small-pox, but in most cases
of a less disagreeable nature. Putrid smells in sick
rooms were the effects of the excretions, or of some
other filthy matters. In small rooms, crowded in
some instances with four or five sick people, there
was an effluvia that produced giddiness, sickness at
stomach, a weakness of the limbs, faintness, and in
some cases a diarrhœa. I met with a fœtid breath
in one patient, which was not the effect of that medicine
which sometimes produces it.
The state of the atmosphere, during the whole
month of September, and the first two weeks in
October, favoured the accumulation of the miasmata
in the city.
The register of the weather shows how little the
air was agitated by winds during the above time.
In vain were changes in the moon expected to
alter the state of the air. The light of the morning
mocked the hopes that were raised by a cloudy sky
in the evening. The sun ceased to be viewed with
pleasure. Hundreds sickened every day beneath
the influence of his rays: and even where they did
not excite the disease, they produced a languor in
the body unknown to the oldest inhabitant of the
city, at the same season of the year.
A meteor was seen at two o'clock in the morning,
on or about the twelfth of September. It fell
between Third-street and the hospital, nearly in a
line with Pine-street. Moschetoes (the usual attendants
of a sickly autumn) were uncommonly
numerous. Here and there a dead cat added to
the impurity of the air of the streets. It was supposed
those animals perished with hunger in the
city, in consequence of so many houses being deserted
by the inhabitants who had fled into the
country, but the observations of subsequent years
made it more probable they were destroyed by the
same morbid state of the atmosphere which produced
the reigning epidemic.
It appears further, from the register of the weather,
that there was no rain between the 25th of
August and the 15th of October, except a few
drops, hardly enough to lay the dust of the streets,
on the 9th of September, and the 12th of October.
In consequence of this drought, the springs
and wells failed in many parts of the country.
The dust in some places extended two feet below
the surface of the ground. The pastures were deficient,
or burnt up. There was a scarcity of autumnal
fruits in the neighbourhood of the city.
But while vegetation drooped or died from the
want of moisture in some places, it revived with
preternatural vigour from unusual heat in others.
Cherry-trees blossomed, and apple, pear, and
plum-trees bore young fruit in several gardens in
Trenton, thirty miles from Philadelphia, in the
month of October.
However inoffensive uniform heat, when agitated
by gentle breezes, may be, there is, I believe, no
record of a dry, warm, and stagnating air, having
existed for any length of time without producing
diseases. Hippocrates, in describing a pestilential
fever, says the year in which it prevailed was without
a breeze of wind[49]. The same state of the atmosphere,
for six weeks, is mentioned in many of
the histories of the plague which prevailed in London,
in 1665[50]. Even the sea air itself becomes
unwholesome by stagnating; hence Dr. Clark informs
us, that sailors become sickly after long
calms in East-India voyages[51]. Sir John Pringle
delivers the following aphorism from a number of
similar observations upon this subject: “When
the heats come on soon, and continue throughout
autumn, not moderated by winds or rains, the season
proves sickly, distempers appear early, and are
dangerous[52].”
Who can review this account of the universal
diffusion of the miasmata which produced this disease,
its universal effects upon persons apparently
in good health, and its accumulation and concentration,
in consequence of the calmness of the air, and
believe that it was possible for a febrile disease to
exist at that time in our city that was not derived
from that source?
The West-India writers upon the yellow fever
have said that it is seldom taken twice, except by
persons who have spent some years in Europe or
America in the interval between its first and second
attack. I directed my inquiries to this question,
and I now proceed to mention the result of them.
I met with five persons, during the prevalence of
the disease, who had had it formerly, two of them
in the year 1741, and three in 1762, who escaped
it in 1793, although they were all more or less exposed
to the infection. One of them felt a constant
pain in her head while the disease was in her
family. Four of them were aged, and of course
less liable to be acted upon by the miasmata than
persons in early or middle life. Mr. Thomas
Shields furnished an unequivocal proof that the disease
could be taken after an interval of many years.
He had it in the year 1762, and narrowly escaped
from a violent attack of it this year. Cases of reinfection
were very common during the prevalence
of this fever. They occurred most frequently
where the first attack had been light. But they
succeeded attacks that were severe in Dr. Griffitts,
Dr. Mease, my pupil Mr. Coxe, and several others,
whose cases came under my notice.
I have before remarked that the miasmata sometimes
excited a fever as soon as they were taken
into the body, but that they often lay there from
one to sixteen days before they produced the disease.
How long they existed in the body after a
recovery from the fever I could not tell, for persons
who recovered were, in most cases, exposed to their
action from external sources. The preternatural
dilatation of the pupils was a certain mark of the
continuance of some portion of them in the system.
In one person who was attacked with the fever on
the night of the 9th of October, the pupils did not
contract to their natural dimensions until the 7th of
November.
Having described the effects of the miasmata
upon the body, I proceed now to mention the
changes induced upon it by death.
Let us first take a view of it as it appeared soon
after death. Some new light may perhaps be
thrown upon the proximate cause of the disease by
this mode of examining the body.
My information upon this subject was derived
from the attendants upon the sick, and from the
two African citizens who were employed in burying
the dead, viz. Richard Allen and Absalom
Jones. The coincidence of the information received
from different persons satisfied me that all
that I shall here relate is both accurate and just.
A deep yellow colour appeared in many cases
within a few minutes after death. In some the
skin became purple, and in others black. I heard
of one case in which the body was yellow above,
and black below its middle. In some the skin
was as pale as it is in persons who die of common
fevers. A placid countenance was observed in
many, resembling that which occurs in an easy
and healthful sleep.
Some were stiff within one hour after death.
Others were not so for six hours afterwards. This
sudden stiffness after death, Dr. Valli informs us,
occurred in persons who died of the plague in
Smyrna, in the year 1784[53].
Some grew cold soon after death, while others
retained a considerable degree of heat for six hours,
more especially on their backs.
A stream of tears appeared on the cheeks of a
young woman, which seemed to have flowed after
her death.
Some putrified in a short time after their dissolution,
but others had no smell for twelve, eighteen,
and twenty hours afterwards. This absence
of smell occurred in those cases in which evacuations
had been used without success in the treatment
of the disease.
Many discharged large quantities of black matter
from the bowels, and others blood from the
nose, mouth, and bowels after death. The frequency
of these discharges gave rise to the practice
of pitching the joints of the coffins which were used
to bury the dead.
The morbid appearances of the internal parts of
the body, as they appear by dissection after death
from the yellow fever, are different in different
countries, and in the same countries in different
years. I consider them all as effects only of a stimulus
acting upon the whole system, and determined
more or less by accidental circumstances to
particular viscera. Perhaps the stimulus of the
miasmata determines the fluids more violently in
most cases to the liver, stomach, and bowels, and
thereby disposes them more than other parts to
inflammation and mortification, and to similar effusions
and eruptions with those which take place on
the skin. There can be no doubt of the miasmata
acting upon the liver, and thereby altering the qualities
of the bile. I transcribe, with great pleasure,
the following account of the state of the bile in a
female slave of forty years of age, from Dr. Mitchell's
History of the Yellow Fever, as it prevailed
in Virginia, in the years 1737 and 1741, inasmuch
as it was part of that clue which led me to adopt
one of the remedies on which much of the success
of my practice depended.
“The gall bladder (says the doctor) appeared
outwardly of a deep yellow, but within was full
of a black ropy coagulated atrabilis, which sort
of substance obstructed the pori biliarii, and ductus
choledochus. This atrabilis was hardly fluid,
but upon opening the gall bladder, it retained its
form and shape, without being evacuated, being
of the consistence of a thin extract, and, within,
glutinous and ropy, like soap when boiling. This
black matter seemed so much unlike bile, that I
doubted if there were any bile in the gall bladder.
It more resembled bruised or mortified blood, evacuated
from the mortified parts of the liver, surrounding
it, although it would stain a knife or
probe thrust into it of a yellow colour, which, with
its ropy consistence, seemed more peculiar to a
bilious humour.”
The same appearance of the bile was discovered
in several other subjects dissected by Dr. Mitchell.
The liver, in the above-mentioned slave, was
turgid and plump on its outside, but on its concave
surface, two thirds of it were of a deep black colour,
and round the gall bladder it seemed to be
mortified and corrupted.
The duodenum was lined on its inside, near the
gall bladder, with a viscid ropy bile, like that
which has been described. Its villous coat was
lined with a thick fur or slime, which, when scraped
or pealed off, the other vascular and muscular
coats of the gut appeared red and inflamed.
The omentum was so much wasted, that nothing
but its blood-vessels could be perceived.
The stomach was inflamed, both on its outside
and inside. It contained a quantity of bile of the
same consistence, but of a blacker colour than that
which was found in the gall bladder. Its villous
coat, like that of the duodenum, was covered with
fuzzy and slimy matter. It moreover appeared to
be distended or swelled. This peculiarity in the
inner coat of the stomach was universal in all the
bodies that were opened, of persons who died of
this disease.
The lungs, instead of being collapsed, were inflated
as in inspiration. They were all over full of
black or livid spots. On these spots were to be
seen small vesicles or blisters, like those of an
erysipelas or gangrene, containing a yellow humour.
The blood-vessels in general seemed empty of
blood, even the vena cava and its branches; but
the vena portarum was full and distended as usual.
The blood seemed collected in the viscera; for upon
cutting the lungs or sound liver or spleen, they
bled freely.
The brain was not opened in this body, but it
was not affected in three others whose brains were
examined.
Dr. Mackittrick, in his inaugural dissertation,
published at Edinburgh in the year 1766, “De Febre
Indiæ Occidentalis, Maligna Flava,” or upon
the yellow fever of the West-Indies, says, that in
some of the patients who died of it, he found the
liver sphacelated, the gall bladder full of black
bile, and the veins turgid with black fluid blood.
In others he found the liver no ways enlarged, and
its “texture only vitiated.” The stomach, the
duodenum, and ilium, were remarkably inflamed
in all cases. The pericardium contained a viscid
yellow serum, and in a larger quantity than common.
The urinary bladder was a little inflamed.
The lungs were sound.
Dr. Hume, in describing the yellow fever of Jamaica,
informs us, that in several dead bodies
which he opened, he found the liver enlarged and
turgid with bile, and of a pale yellow colour. In
some he found the stomach and duodenum inflamed.
In one case he discovered black spots in
the stomach, of the size of a crown piece. To
this account he adds, “that he had seen some subjects
opened, on whose stomachs no marks of inflammation
could be discovered; and yet these had
excessive vomiting.”
Dr. Lind has furnished us with an account of
the state of the body after death, in his short history
of the yellow fever, which prevailed at Cadiz,
in the year 1764. “The stomach (he says), mesentery,
and intestines, were covered with gangrenous
spots; there were ulcers on the orifice of the
stomach, and the liver and lungs were of a putrid
colour and texture[54].”
To these accounts of the morbid appearances of
the body after death from the yellow fever I shall
only add the account of several dissections, which
was given to the public in Mr. Brown's Gazette,
during the prevalence of this epidemic, by Dr.
Physick and Dr. Cathrall.
“Being well assured of the great importance of
dissections of morbid bodies in the investigation of
the nature of diseases, we have thought it of
consequence that some of those dead of the present
prevailing malignant fever should be examined;
and, without enlarging on our observations, it
appears at present sufficient to state the following facts.
“1st. That the brain in all its parts has been
found in a natural condition.
“2d. That the viscera of the thorax are perfectly
sound. The blood, however, in the heart
and veins is fluid, similar, in its consistence, to the
blood of persons who have been hanged, or destroyed
by electricity.
“3d. That the stomach, and beginning of the
duodenum, are the parts that appear most diseased.
In two persons who died of the disease on the 5th
day, the villous membrane of the stomach, especially
about its smaller end, was found highly inflamed;
and this inflammation extended through
the pylorus into the duodenum, some way. The
inflammation here was exactly similar to that induced
in the stomach by acrid poisons, as by arsenic,
which we have once had an opportunity of
seeing in a person destroyed by it.
“The bile in the gall-bladder was quite of its
natural colour, though very viscid.
“In another person, who died on the 8th day
of the disease, several spots of extravasation were
discovered between the membranes, particularly
about the smaller end of the stomach, the inflammation
of which had considerably abated. Pus
was seen in the beginning of the duodenum, and
the villous membrane at this part was thickened.
“In two other persons, who died at a more advanced
period of the disease, the stomach appeared
spotted in many places with extravasations, and the
inflammation disappeared. It contained, as did
also the intestines, a black liquor, which had been
vomited and purged before death. This black liquor
appears clearly to be an altered secretion from
the liver; for a fluid in all respects of the same
qualities was found in the gall bladder. This liquor
was so acrid, that it induced considerable inflammation
and swelling on the operator's hands,
which remained some days. The villous membrane
of the intestines, in these last two bodies, was
found inflamed in several places.
“The liver was of its natural appearance, excepting
in one of the last persons, on the surface of
which a very few distended veins were seen: all
the other abdominal viscera were of a healthy
appearance.
“The external surface of the stomach, as well as
of the intestines, was quite free from inflammation;
the veins being distended with blood, which appeared
through the transparent peritonium, gave
them a dark colour.
“The stomach of those who died early in the
disease was always contracted; but in those who
died at a more advanced period of it, where extravasations
appeared, it was distended with air.
“P. S. PHYSICK,
“J. CATHRALL.”
I have before remarked, that these dissections
were made early in the disease, and that Dr. Annan
attended a dissection of a body at Bush-hill,
some time afterwards, in which an unusual turgescence
appeared in the vessels of the brain.
Thus far have I delivered the history of the yellow
fever, as it affected the human body with sickness
and death. I shall now mention a few of
those circumstances of public and private distress
which attended it. I have before remarked, that
the first reports of the existence of this fever were
treated with neglect or contempt. A strange apathy
pervaded all classes of people. While I bore
my share of reproach for “terrifying our citizens
with imaginary danger,” I answered it by lamenting
“that they were not terrified enough.” The
publication from the college of physicians soon
dissipated this indifference and incredulity. Fear
or terror now sat upon every countenance. The
disease appeared in many parts of the town, remote
from the spot where it originated; although, for a
while, in every instance, it was easily traced to it.
This set the city in motion. The streets and roads
leading from the city were crowded with families
flying in every direction for safety to the country.
Business began to languish. Water-street, between
Market and Race-streets, became a desert.
The poor were the first victims of the fever.
From the sudden interruption of business they suffered
for a while from poverty as well as from disease.
A large and airy house at Bush-hill, about a mile
from the city, was opened for their reception.
This house, after it became the charge of a committee
appointed by the citizens on the 14th of
September, was regulated and governed with the
order and cleanliness of an old and established hospital.
An American and French physician had
the exclusive medical care of it after the 22d of
September.
The disease, after the second week in September,
spared no rank of citizens. Whole families
were confined by it. There was a deficiency of
nurses for the sick, and many of those who were
employed were unqualified for their business.
There was likewise a great deficiency of physicians,
from the desertion of some, and the sickness and
death of others. At one time there were but three
physicians who were able to do business out of their
houses, and at this time there were probably not
less than 6000 persons ill with the fever.
During the first three or four weeks of the prevalence
of the disease I seldom went into a house
the first time, without meeting the parents or children
of the sick in tears. Many wept aloud in my
entry, or parlour, who came to ask for advice for
their relations. Grief after a while descended below
weeping, and I was much struck in observing
that many persons submitted to the loss of relations
and friends without shedding a tear, or manifesting
any other of the common signs of grief.
A cheerful countenance was scarcely to be seen
in the city for six weeks. I recollect once, in entering
the house of a poor man, to have met a
child of two years old that smiled in my face. I
was strangely affected with this sight (so discordant
to my feelings and the state of the city) before I
recollected the age and ignorance of the child. I
was confined the next day by an attack of the fever,
and was sorry to hear, upon my recovery, that the
father and mother of this little creature died a few
days after my last visit to them.
The streets every where discovered marks of the
distress that pervaded the city. More than one
half the houses were shut up, although not more
than one third of the inhabitants had fled into the
country. In walking for many hundred yards, few
persons were met, except such as were in quest of
a physician, a nurse, a bleeder, or the men who
buried the dead. The hearse alone kept up the
remembrance of the noise of carriages or carts in
the streets. Funeral processions were laid aside.
A black man, leading or driving a horse, with a
corpse on a pair of chair wheels, with now and
then half a dozen relations or friends following at
a distance from it, met the eye in most of the
streets of the city, at every hour of the day, while
the noise of the same wheels passing slowly over
the pavements, kept alive anguish and fear in the
sick and well, every hour of the night[55].
But a more serious source of the distress of the
city arose from the dissentions of the physicians,
about the nature and treatment of the fever. It
was considered by some as a modification of the
influenza, and by others as the jail fever. Its various
grades and symptoms were considered as so
many different diseases, all originating from different
causes. There was the same contrariety in
the practice of the physicians that there was in
their principles. The newspapers conveyed accounts
of both to the public, every day. The
minds of the citizens were distracted by them, and
hundreds suffered and died from the delays which
were produced by an erroneous opinion of a plurality
of diseases in the city, or by indecision in
the choice, or a want of confidence in the remedies
of their physician.
The science of medicine is related to every
thing, and the philosopher as well as the christian
will be gratified by knowing the effects of a great
and mortal epidemic upon the morals of a people.
It was some alleviation of the distress produced
by it, to observe its influence upon the obligations
of morality and religion. It was remarked during
this time, by many people, that the name of the Supreme
Being was seldom profaned, either in the
streets, or in the intercourse of the citizens with
each other. But two robberies, and those of a
trifling nature, occurred in nearly two months, although
many hundred houses were exposed to
plunder, every hour of the day and night. Many
of the religious societies met two or three times a
week, and some of them every evening, to implore
the interposition of Heaven to save the city from
desolation. Humanity and charity kept pace with
devotion. The public have already seen accounts
of their benevolent exercises in other publications.
It was my lot to witness the uncommon activity of
those virtues upon a smaller scale. I saw little to
blame, but much to admire and praise in persons
of different professions, both sexes, and of all colours.
It would be foreign to the design of this
work to draw from the obscurity which they
sought, the many acts of humanity and charity, of
fortitude, patience, and perseverance, which came
under my notice. They will be made public and
applauded elsewhere.
But the virtues which were excited by our calamity
were not confined to the city of Philadelphia.
The United States wept for the distresses
of their capital. In several of the states, and in
many cities and villages, days of humiliation and
prayer were set apart to supplicate the Father of
Mercies in behalf of our afflicted city. Nor was
this all. From nearly every state in the union the
most liberal contributions of money, provisions,
and fuel were poured in for the relief and support
of such as had been reduced to want by the suspension
of business, as well as by sickness and the
death of friends.
The number of deaths between the 1st of August
and the 9th of November amounted to four thousand
and forty-four. I shall here insert a register of
the number which occurred on each day, beginning
on the 1st of August, and ending on the 9th of
November. By comparing it with the register of
the weather it will show the influence of the latter
on the disease. Several of the deaths in August
were from other acute diseases, and a few in the
succeeding months were from such as were of a
chronic nature.
| |
|
died. |
| August |
1 |
9 |
| 2 |
8 |
| 3 |
9 |
| 4 |
10 |
| 5 |
10 |
| 6 |
3 |
| 7 |
12 |
| 8 |
5 |
| 9 |
11 |
| 10 |
6 |
| 11 |
7 |
| 12 |
5 |
| 13 |
11 |
| 14 |
4 |
| 15 |
9 |
| 16 |
7 |
| 17 |
6 |
| 18 |
5 |
| 19 |
9 |
| 20 |
7 |
| 21 |
8 |
| 22 |
13 |
| 23 |
10 |
| 24 |
17 |
| 25 |
12 |
| 26 |
17 |
| 27 |
12 |
| 28 |
22 |
| 29 |
24 |
| 30 |
20 |
| 31 |
17 |
| September |
1 |
17 |
| 2 |
18 |
| 3 |
11 |
| 4 |
23 |
| 5 |
20 |
| 6 |
24 |
| 7 |
18 |
| 8 |
42 |
| 9 |
32 |
| 10 |
29 |
| 11 |
23 |
| 12 |
33 |
| 13 |
37 |
| 14 |
48 |
| 15 |
56 |
| 16 |
67 |
| 17 |
81 |
| 18 |
68 |
| 19 |
61 |
| 20 |
67 |
| 21 |
57 |
| 22 |
76 |
| 23 |
68 |
| 24 |
96 |
| 25 |
87 |
| 26 |
52 |
| 27 |
60 |
| 28 |
51 |
| 29 |
57 |
| 30 |
63 |
| October |
1 |
74 |
| 2 |
66 |
| 3 |
78 |
| 4 |
58 |
| 5 |
71 |
| 6 |
76 |
| 7 |
82 |
| 8 |
90 |
| 9 |
102 |
| 10 |
93 |
| 11 |
119 |
| 12 |
111 |
| 13 |
104 |
| 14 |
81 |
| 15 |
80 |
| 16 |
70 |
| 17 |
80 |
| 18 |
59 |
| 19 |
65 |
| 20 |
55 |
| 21 |
59 |
| 22 |
82 |
| 23 |
54 |
| 24 |
38 |
| 25 |
35 |
| 26 |
23 |
| 27 |
13 |
| 28 |
24 |
| 29 |
17 |
| 30 |
16 |
| 31 |
21 |
| November |
1 |
13 |
| 2 |
21 |
| 3 |
15 |
| 4 |
15 |
| 5 |
14 |
| 6 |
11 |
| 7 |
15 |
| 8 |
8 |
| 9 |
6 |
| |
Total[56] |
3881 |
From this table it appears that the principal
mortality was in the second week of October. A
general expectation had obtained, that cold weather
was as fatal to this fever as heavy rains. The
usual time for its arrival had come, but the weather
was still not only moderate, but warm. In this
awful situation, the stoutest hearts began to fail.
Hope sickened, and despair succeeded distress in
almost every countenance. On the fifteenth of
October, it pleased God to alter the state of the air.
The clouds at last dropped health in showers of
rain, which continued during the whole day, and
which were succeeded for several nights afterwards
by cold and frost. The effects of this change in
the weather appeared first in the sudden diminution
of the sick, for the deaths continued for a week
afterwards to be numerous, but they were of persons
who had been confined before, or on the day
in which the change had taken place in the weather.
The appearance of this rain was like a dove
with an olive branch in its mouth to the whole
city. Public notice was given of its beneficial
effects, in a letter subscribed by the mayor of Philadelphia,
who acted as president of the committee,
to the mayor of New-York. I shall insert the
whole of this letter. It contains, besides the above
information, a record of the liberality of that city
to the distressed inhabitants of Philadelphia.
“Sir,
“I am favoured with your letter of the 12th
instant, which I have communicated to the committee
for the relief of the poor and afflicted of this
city.
“It is with peculiar satisfaction that I execute
their request, by making, in their name, on behalf
of our suffering fellow-citizens, the most grateful
acknowledgements for the seasonable benevolence
of the common council of the city of New-York.
Their sympathy is balm to our wounds.
“We acknowledge the Divine interposition,
whereby the hearts of so many around us have
been touched with our distress, and have united in
our relief.
“May the Almighty Disposer of all events be
graciously pleased to protect your citizens from the
dreadful calamity with which we are now visited;
whilst we humbly kiss the rod, and improve by
the dispensation.
“The part, sir, which you personally take in
our afflictions, and which you have so pathetically
expressed in your letter, excites in the breasts of
the committee the warmest sensations of fraternal
affection.
“The refreshing rain which fell the day before
yesterday, though light, and the cool weather which
hath succeeded, appear to have given a check to
the prevalence of the disorder: of this we have
satisfactory proofs, as well in the decrease of the
funerals, as in the applications for removal to the
hospital.
“I have, at your request, this day drawn upon
you, at sight, in favour of the president and directors
of the Bank of North America, for the sum
of five thousand dollars, the benevolent donations
of the common council of the city of New-York.
“With sentiments of the greatest esteem and
regard,
“I am, sir,
“Your most obedient humble servant,
“MATTH. CLARKSON.
“Philadelphia, Oct. 17, 1793.
“Richard Varick, mayor
of the city of New-York.”
It is no new thing for bilious fevers, of every
description, to be checked or subdued by wet and
cold weather.
The yellow fever which raged in Philadelphia
in 1699, and which is taken notice of by Thomas
Story in his journal, ceased about the latter end of
October, or the beginning of November. Of this
there are satisfactory proofs, in the register of the
interments in the friends' burying-ground, and in
a letter, dated November 9th, old style, 1699, from
Isaac Norris to one of his correspondents, which
his grandson, Mr. Joseph P. Norris, politely put
into my hands, with several others, which mention
the disease, and all written in that memorable year
in Philadelphia. The letter says, “It has pleased
God to put a stop to our sore visitation, and town
and country are now generally healthy.” The
same disease was checked by wet and cold weather
in the year 1741. Of this there is a proof in
a letter from Dr. Franklin to one of his brothers,
who stopped at Burlington, on his way from Boston
to Philadelphia, on account of the fever, until
he was assured by the doctor, that a thunder gust,
which had cooled the air, had rendered it safe for
him to come into the city[57]. Mr. Lynford Lardner,
in a letter to one of his English friends, dated
September 24, 1747, old style, after mentioning
the prevalence of the fever in the city, says, “the
weather is now much cooler, and those under the
disorder revive. The symptoms are less violent,
and the fever gradually abates.”
I have in vain attempted to procure an account
of the time of the commencement of cold weather
in the autumn of 1762. In the short history of
the fever of that year, which I have inserted from
my note book, I have said that it continued to
prevail in the months of November and December.
The register of the interments in the friends' burying-ground
in those months confirms that account.
They were nearly as numerous in November and
December as in September and October, viz. in
September 22, in October 27, in November 19,
and in December 26.
The bilious remitting fever of 1780 yielded to
cool weather, accompanied by rain and an easterly
wind[58].
Sir John Pringle will furnish ample satisfaction
to such of my readers as wish for more proofs of
the efficacy of heavy rains, and cold weather, in
checking the progress and violence of autumnal
remitting fevers[59].
From the 15th of October the disease not only
declined, but assumed more obvious inflammatory
symptoms. It was, as in the beginning, more necessarily
fatal where left to itself, but it yielded
more certainly to art than it did a few weeks before.
The duration of it was now more tedious
than in the warmer weather.
There were a few cases of yellow fever in November
and December, after the citizens who had
retired to the country returned to the city.
I heard of but three persons who returned to the
city being infected with the disease; so completely
was its cause destroyed in the course of a few
weeks.
In consequence of a proclamation by the governor,
and a recommendation by the clergy of Philadelphia,
the 12th of December was observed as
a day of thanksgiving throughout the state, for the
extinction of the disease in the city.
It was easy to distinguish, in walking the streets,
the persons who had returned from the country to
the city, from those who had remained in it during
the prevalence of the fever. The former appeared
ruddy and healthy, while the latter appeared of a
pale or sallow colour.
It afforded a subject of equal surprise and joy to
behold the suddenness with which the city recovered
its former habits of business. In the course
of six weeks after the disease had ceased, nothing
but fresh graves, and the black dresses of many of
the citizens, afforded a public trace of the distress
which had so lately prevailed in the city.
The month of November, and all the winter
months which followed the autumnal epidemic,
were in general healthy. A catarrh affected a
number of people in November. I suspected it
to be the influenza which had revived from a dormant
state, and which had not spent itself, when
it yielded to the predominance of the yellow fever.
This opinion derives some support from a curious
fact related by the late Mr. Hunter of the revival
of the small-pox in a patient, in whom it had
been suspended for some time by the measles[60].
The few fevers which prevailed in the winter were
highly inflammatory. The small-pox in the natural
way was in several instances confluent; and in one
or two fatal. I was prepared to expect this inflammatory
diathesis in the fevers of the winter; for I
had been taught by Dr. Sydenham, that the diseases
which follow a great and mortal epidemic
partake more or less of its general character. But
the diseases of the winter had a peculiarity still
more extraordinary; and that was, many of them
had several of the symptoms of the yellow fever,
particularly a puking of bile, dark-coloured stools,
and a yellow eye. Mr. Samuel D. Alexander, a
student of medicine from South-Carolina, who was
seized with a pneumony about Christmas, had,
with a yellow eye, a dilated pupil and a hard pulse,
which beat only fifty strokes in a minute. His
blood was such as I had frequently observed in
the yellow fever. Dr. Griffitts informed me that
he attended a patient on the 9th of January, in a
pneumony, who had a universal yellowness on his
skin. I met with a case of pneumony on the 20th
of the same month, in which I observed the same
degrees of redness in the eyes that were common
in the yellow fever. My pupil, Mr. Coxe, lost
blood in an inflammatory fever, on the 18th of February,
which was dissolved. Mr. Innes, the
brewer, had a deep yellow colour in his eyes, on
the fourth day of a pneumony, on the 27th of the
same month; and Mr. Magnus Miller had the
same symptom of a similar disease on the 16th
of March. None of these bilious and anomalous
symptoms of the inflammatory fevers of the
winter and spring surprised me. I had been early
taught, by Dr. Sydenham, that the epidemics of
autumn often insinuate some of their symptoms into
the winter diseases which follow them. Dr.
Cleghorn informs us, that “the pleurisies which
succeeded the autumnal tertians in Minorca, were
accompanied by a vomiting and purging of green
or yellow bilious matters[61].”
It belongs to powerful epidemics to be followed
by similar diseases after they disappear, as well as
to run into others at their first appearance. In the
former case it is occasioned by a peculiar state of
the body, created by the epidemic constitution of
the air, not having been changed by the weather
which succeeded it.
The weather in March resembled that of May;
while the weather in April resembled that of March
in common years. A rash prevailed in many families,
in April, accompanied in a few cases by a
sore throat. It was attended with an itching, a
redness of the eyes, and a slight fever in a few instances.
The small-pox by inoculation in this
month was more mortal than in former years.
However unimportant these facts may appear at
this time, future observations may perhaps connect
them with a similar constitution of the air which
produced the previous autumnal epidemic.
The appearance of bilious symptoms in the diseases
of the winter, excited apprehensions in several
instances of the revival of the yellow fever.
The alarms, though false, served to produce vigilance
and industry in the corporation, in airing and
purifying such houses and articles of furniture as
belonged to the poor; and which had been neglected
in the autumn, after the ceasing of the disease.
The modes of purifying houses, beds, and
clothes were various. Fumigations of nitre and
aromatic substances were used by some people.
Burying infected articles of furniture under ground,
and baking them in ovens, were used by others.
Some destroyed all their beds and clothing that
had been infected, or threw them into the Delaware.
Many white-washed their walls, and painted
the wood-work of their house. I did not conceive
the seeds of the disease required all, or any
of those means to destroy it. I believed cold and
water to be sufficient for that purpose. I therefore
advised keeping the windows of infected rooms
open night and day, for a few days; to have the
floors and walls of houses well washed; and to expose
beds and such articles of household furniture
as might be injured by washing, upon the bare
earth for a week or two, taking care to turn them
every day. I used no other methods of destroying
the accumulated miasmata in my house and furniture,
and experience showed that they were sufficient.
It is possible a portion of the excretions of the
sick may be retained in clothes or beds, so as to
afford an exhalation that may in the course of a
succeeding summer and autumn, or from accidental
warmth at any time, create a solitary case of fever,
but it cannot render it epidemic. A trunk full of
clothes, the property of Mr. James Bingham, who
died of the yellow fever in one of the West-India
islands about 50 years ago, was opened, some
months after they were received by his friends, by
a young man who lived in his brother's family.
This young man took the disease, and died; but
without infecting any of the family; nor did the
disease spread afterwards in the city. The father
of Mr. Joseph Paschall was infected with the yellow
fever of 1741, by the smell of a foul bed in
passing through Norris's Alley, in the latter end of
December, after the disease had left the city. He
died on the 25th of the month, but without reviving
the fever in the city, or even infecting his family.
The matter which produced the fever in both
these cases, had nothing specific in it. It acted in
the same manner that the exhalation from any
other putrid matters would have done in a highly
concentrated state.
In a letter from Dr. Senter of Newport, dated
January 7th, 1794, I find the following fact, which
I shall communicate in his own words. It is introduced
to support the principle, that the yellow
fever does not spread by contagion. “This place
(says the doctor) has traded formerly very much to
the West-India islands, and more or less of our
people have died there every season, when the disease
prevails in those parts. Clothes of these unfortunate
people have been repeatedly brought home
to their friends, without any accident happening to
them.”
I feel with my reader the fatigue of this long
detail of facts, and equal impatience with him to
proceed to the history of the treatment of the fever;
but I must beg leave to detain him a little longer
from that part of the work, while I resume the subject
of the origin of the fever. It is an interesting
question, as it involves in it the means of preventing
the return of the disease, and thereby of saving
the lives of thousands of our citizens.
Soon after the fever left the city, the governor
of the state addressed a letter to the college of physicians,
requesting to know their opinion of its origin;
if imported, from what place, at what time,
and in what manner. The design of this inquiry
was to procure such information as was proper to
lay before the legislature, in order to improve the
laws for preventing the importation or generation
of infectious diseases, or to enact new ones, if necessary
for that purpose. To the governor's letter
the college of physicians sent the following answer:
”Sir,
”It has not been from a want of respect to
yourself, nor from inattention to the subject, that
your letter of the 30th ult. was not sooner answered;
but the importance of the questions proposed
has made it necessary for us to devote a considerable
portion of time and attention to the subject, in
order to arrive at a safe and just conclusion.
”No instance has ever occurred of the disease
called the yellow fever having been generated in
this city, or in any other parts of the United States,
as far as we know; but there have been frequent
instances of its having been imported, not only into
this, but into other parts of North-America, and
prevailing there for a certain period of time; and
from the rise, progress, and nature of the malignant
fever, which began to prevail here about the
beginning of last August, and extended itself gradually
over a great part of the city, we are of opinion
that this disease was imported into Philadelphia,
by some of the vessels which arrived in the
port after the middle of July. This opinion we
are further confirmed in by various accounts we
have received from unquestionable authorities.
”Signed, by order of the college of physicians,
”JOHN REDMAN, President.
”November 26th, 1793.
”To the governor of Pennsylvania.”
Dr. Redman, the president of the college, Dr.
Foulke, and Dr. Leib, dissented from the report
contained in this letter. I have been necessarily
led to continue it in the present edition of this work,
not only because all the other members of that body
still retain their belief of the importation of the fever,
but as a reason for republishing the facts and
arguments in support of its domestic origin.
I have asserted, in the introduction to the history
of this fever, that I believed it to have been generated
in our city; I shall now deliver my reasons
for that belief.
1. The yellow fever in the West-Indies, and in
all other countries where it is endemic, is the offspring
of vegetable putrefaction. Heat, exercise,
and intemperance in drinking (says Dr. Lind) dispose
to this fever in hot climates, but they do not
produce it without the concurrence of a remote
cause. This remote cause exists at all times, in
some spots of the islands, but in other parts even
of the same islands, where there are no marsh exhalations,
the disease is unknown. I shall not waste
a moment in inquiring into the truth of Dr. Warren's
account of the origin of this fever. It is fully
refuted by Dr. Hillary, and it is treated as chimerical
by Dr. Lind. They have very limited ideas
of the history of this fever who suppose it to be
peculiar to the East or West-Indies. It was admitted
to have been generated in Cadiz after a hot and
dry summer in 1764, and in Pensacola in 1765[62].
The tertian fever of Minorca, when it attacked
Englishmen, put on the usual symptoms of the
yellow fever[63]. In short, this disease appears, according
to Dr. Lind, in all the southern parts of
Europe, after hot and dry weather[64].
2. The same causes (under like circumstances)
must always produce the same effects. There is
nothing in the air of the West-Indies, above other
hot countries, which disposes it to produce a yellow
fever. Similar degrees of heat, acting upon
dead and moist vegetable matters, are capable of
producing it, together with all its various modifications,
in every part of the world. In support of
this opinion, I shall transcribe part of a letter from
Dr. Miller, formerly of the Delaware state, and now
of New-York.
“Dover, Nov. 5, 1793.
“Dear Sir,
“Since the middle of last July we have
had a bilious colic epidemic in this neighbourhood,
which exhibits phænomena very singular in this
climate; and, so far as I am informed, unprecedented
in the medical records, or popular traditions
of this country. To avoid unnecessary details it
will suffice at present to observe, that the disease,
on this occasion, has assumed, not only all the
essential characters, but likewise all the violence,
obstinacy, and malignity described by the East
and West-Indian practitioners. If any difference
can be observed it seems here to manifest higher
degrees of stubbornness and malignity than we
usually meet in the histories of tropical writers.
In the course of the disease, not only extreme constipation,
frequent vomiting, and the most excruciating
pains of the bowels and limbs, harass the
unhappy patient; but to these succeed paralysis,
convulsions, [**amp]c. and almost always uncommon
muscular debility, oppression of the præcordia,
[**amp]c. are the consequence of a severe attack. Bile
discharged in enormous quantities constantly assumes
the most corrupted and acrimonious appearances,
commonly æruginous in a very high degree,
and sometimes quite atrabilious.
“The inference I mean to draw from the phænomena
of this disease, as it appears in this neighbourhood,
and which I presume will also apply to
your epidemic, is this, that from the uncommon
protraction and intenseness of our summer and
autumnal heats, but principally from the unusual
drought, we have had, since the middle of July,
a near approach to a tropical season, and that of
consequence we ought not to be surprised if tropical
diseases, even of the most malignant nature, are
engendered amongst us.”
To the above information it may be added, that
the dysentery which prevailed during the autumn
of 1793, in several of the villages of Pennsylvania,
was attended with a malignity and mortality unknown
before in any part of the state. I need not
pause to remark that this dysentery arose from putrid
exhalation, and that it is, like the bilious colic,
only a modification of bilious fever.
But further, a malignant fever, resembling that
which was epidemic in our city, prevailed during
the autumn in many parts of the United States,
viz. at Lynn in Massachusetts, at Weatherfield
and Coventry in Connecticut, at New-Galloway
in the state of New-York, on Walkill and on Pensocken
creeks in New-Jersey, at Harrisburgh and
Hummelstown in Pennsylvania, in Caroline county
in Maryland, on the south branch of the Potowmac
in Hardie county, also in Lynchburgh and in Alexandria
in Virginia, and in several counties in North-Carolina.
In none of these places was there a suspicion
of the disease being imported from abroad,
or conveyed by an intercourse with the city of Philadelphia.
It is no objection to the inference which follows
from these facts, that the common remitting fever
was not known during the above period in the
neighbourhood of this city, and in many other
parts of the state, where it had usually appeared in
the autumnal months. There is a certain combination
of moisture with heat, which is essential to the
production of the remote cause of a bilious fever.
Where the heat is so intense, or of such long duration,
as wholly to dissipate moisture, or when
the rains are so great as totally to overflow the
marshy ground, or to wash away putrid masses of
matter, no fever can be produced.
Dr. Dazilles, in his treatise upon the diseases of
the negroes in the West-Indies, informs us, that
the rainy season is the most healthy at Cayenne,
owing to the neighbouring morasses being deeply
overflowed; whereas, at St. Domingo, a dry season
is most productive of diseases, owing to its
favouring those degrees of moisture which produce
morbid exhalations. These facts will explain the
reason why, in certain seasons, places which are
naturally healthy in our country become sickly,
while those places which are naturally sickly escape
the prevailing epidemic. Previously to the dissipation
of the moisture from the putrid masses of
vegetable matters in our streets, and in the neighbourhood
of the city, there were (as several practitioners
can testify) many cases of mild remittents,
but they all disappeared about the first week in
September.
It is worthy of notice, that the yellow fever prevailed
in Virginia in the year 1741, and in Charleston,
in South-Carolina, in the year 1699, in both
which years it prevailed in Philadelphia. Its prevalence
in Charleston is taken notice of in a letter,
dated November 18th, O. S. 1699, from Isaac
Norris to one of his correspondents. The letter
says, that “150 persons had died in Charleston in
a few days,” that “the survivors fled into the
country,” and that “the town was thinned to a
very few people.” Is it not probable, from the
prevalence of this fever twice in two places in the
same years, that it was produced (as in 1793) by
a general constitution of air, co-operating with
miasmata, which favoured its generation in different
parts of the continent? But again, such was
the state of the air in the summer of 1793, that it
predisposed other animals to diseases, besides the
human species. In some parts of New-Jersey, a
disease prevailed with great mortality among the
horses, and in Virginia among the cows, during
the autumn. The urine in both was yellow.—Large
abscesses appeared in different parts of the
body in the latter animals, which, when opened,
discharged a yellow serous fluid. From the colour
of these discharges, and of the urine, the disease
got the name of the yellow water.
3. I have before remarked, that a quantity of
damaged coffee was exposed at a time (July the
24th) and in a situation (on a wharf and in a dock)
which favoured its putrefaction and exhalation.
Its smell was highly putrid and offensive, insomuch
that the inhabitants of the houses in Water and
Front-streets, who were near it, were obliged, in
the hottest weather, to exclude it by shutting their
doors and windows. Even persons, who only
walked along those streets, complained of an intolerable
fœtor, which, upon inquiring, was constantly
traced to the putrid coffee. It should not
surprise us, that this seed, so inoffensive in its natural
state, should produce, after its putrefaction, a
violent fever. The records of medicine (to be
mentioned hereafter) furnish instances of similar
fevers being produced, by the putrefaction of many
other vegetable substances.
4. The rapid progress of the fever from Water-street,
and the courses through which it travelled
into other parts of the city, afford a strong evidence
that it was at first propagated by exhalation from
the putrid coffee. It was observed that it passed
first through those alleys and streets which were
in the course of the winds that blew across the
dock and wharf, where the coffee had been thrown
in a state of putrefaction.
5. Many persons who had worked, or even visited,
in the neighbourhood of the exhalation from
the coffee, early in the month of August, were indisposed
afterwards with sickness, puking, and
yellow sweats, long before the air of Water-street
was so much impregnated with the exhalation, as
to produce such effects; and several patients, whom
I attended in the yellow fever, declared to me, or
to their friends, that their indispositions began exactly
at the time they inhaled the offensive effluvia
of the coffee.
6. The first cases of the yellow fever have been
clearly traced to the sailors of the vessel who were
first exposed to the effluvia of the coffee. Their
sickness commenced with the day on which the
coffee began to emit its putrid smell. The disease
spread with the increase of the poisonous exhalation.
A journeyman of Mr. Peter Brown's, who
worked near the corner of Race and Water-streets,
caught the disease on the 27th of July. Elizabeth
Hill, the wife of a fisherman, was infected by only
sailing near the pestilential wharf, about the 1st of
August, and died at Kensington on the 14th of the
same month. Many other names might be mentioned
of persons who sickened during the last
week in July or the first week in August, who
ascribed their illnesses to the smell of the coffee.
7. It has been remarked that this fever did not
spread in the country, when carried there by persons
who were infected, and who afterwards died
with it. During four times in which it prevailed
in Charleston, in no one instance, according to Dr.
Lining, was it propagated in any other part of the
state.
8. In the histories of the disease which have
been preserved in this country, it has six times
appeared about the first or middle of August, and
declined or ceased about the middle of October:
viz. in 1732, 1739, 1745, and 1748 in Charleston,
in 1791 in New-York, and in 1793 in Philadelphia.
This frequent occurrence of the yellow fever
at the usual period of our common bilious remittents,
cannot be ascribed to accidental coincidence,
but must be resolved, in most cases, into the combination
of more active miasmata with the predisposition
of a tropical season. In speaking of a
tropical season, I include that kind of weather in
which rains and heats are alternated with each other,
as well as that which is uniformly warm.
9. Several circumstances attended this epidemic,
which do not occur in the West-India yellow fever.
It affected children as well as adults, in common
with our annual bilious fevers. In the West-Indies,
Dr. Hume tells us, it never attacked any person
under puberty. It had, moreover, many peculiar
symptoms (as I have already shown) which
are not to be met with in any of the histories of the
West India yellow fever.
10. Why should it surprise us to see a yellow
fever generated amongst us? It is only a higher
grade of a fever which prevails every year in our
city, from vegetable putrefaction. It conforms,
in the difference of its degrees of violence and danger,
to season as well as climate, and in this respect
it is upon a footing with the small-pox, the measles,
the sore-throat, and several other diseases. There
are few years pass, in which a plethoric habit, and
more active but limited miasmata, do not produce
sporadic cases of true yellow fever in Philadelphia.
It is very common in South and North-Carolina
and in Virginia, and there are facts which prove,
that not only strangers, but native individuals, and,
in one instance, a whole family, have been carried
off by it in the state of Maryland. It proved fatal
to one hundred persons in the city of New-York
in the year of 1791, where it was evidently generated
by putrid exhalation. The yellow colour of the
skin has unfortunately too often been considered
as the characteristic mark of this fever, otherwise
many other instances of its prevalence might be
discovered, I have no doubt, in every part of the
United States. I wish, with Dr. Mosely, the term
yellow could be abolished from the titles of this
fever, for this colour is not only frequently absent,
but sometimes occurs in the mildest bilious remittents.
Dr. Haller, in his pathology, describes an
epidemic of this kind in Switzerland, in which this
colour generally attended, and I have once seen it
almost universal in a common bilious fever, which
prevailed in the American army, in the year 1776.
I cannot help taking notice, in this place, of an
omission in the answer to the governor's letter, by
the college of physicians. The governor requested
to know whether it was imported; if it were, from
what place, at what time, and in what manner. In
the answer of the college of physicians to the governor's
letter no notice was taken of any of those
questions. In vain did Dr. Foulke call upon the
college to be more definite in their answer to them.
They had faithfully sought for the information required,
but to no purpose. The character of their
departed brother, Dr. Hutchinson, for capacity
and vigilance in his office, as inspector of sickly
vessels, was urged without effect as an argument
against the probability of the disease being imported.
Public report had derived it from several different
islands; had chased it from ship to ship, and
from shore to shore; and finally conveyed it at
different times into the city, alternately by dead and
living bodies; and from these tales, all of which,
when investigated, were proved to be without
foundation, the college of physicians composed
their letter. It would seem, from this conduct of
the college, as if medical superstition had changed
its names, and that, in accounting for the origin of
pestilential fevers, celestial, planetary, and demoniacal
influence had only yielded to the term importation.
Let not the reader reject the opinion I have delivered
because it is opposed by so great a majority
of the physicians of Philadelphia. A single physician
supported an opinion of the existence of the
plague at Messina, in the year 1743, in opposition
to all the physicians (33 in number) of that city.
They denied the disease in question to exist, because
it was not accompanied by glandular swellings.
Time showed that they were all mistaken,
and the plague, which might probably have been
checked, at its first appearance, by their united efforts,
was, by means of their ignorance, introduced
with great mortality into every part of the city.
This disposition of physicians to limit the symptoms
of several other diseases, cannot be sufficiently
lamented. The frequent absence of a yellow
colour, in this epidemic, led to mistakes which cost
the city of Philadelphia several hundred lives.
The letter of the college of physicians has served
to confirm me in an opinion, that the plagues which
occasionally desolated most of the countries of
Europe, in former centuries, and which were always
said to be of foreign extraction, were of domestic
origin. Between the years 1006 and 1680,
the plague was epidemic fifty-two times all over
Europe. It prevailed fourteen times in the 14th
century. The state of Europe, in this long period,
is well known. Idleness, a deficiency of vegetable
aliment, a camp life, from the frequency of wars,
famine, an uncultivated and marshy soil, small
cabins, and the want of cleanliness in dress, diet,
and furniture, all concurred to generate pestilential
diseases. The plagues which prevailed in London,
every year from 1593 to 1611, and from 1636 to
1649, I believe were generated in that city. The
diminution of plagues in Europe, more especially
in London, appears to have been produced by the
great change in the diet and manners of the people;
also by the more commodious and airy forms of
the houses of the poor, among whom the plague
always makes its first appearance. It is true, these
plagues were said by authors to have been imported,
either directly or indirectly, from the Levant;
but the proofs of such importation were as
vague and deficient as they were of the West-India
origin of our epidemic. The pestilential
fevers which have been mentioned, have been described
by authors by the generic name of the
plague, but they appear to have originated from
putrid vegetable exhalations, and to have resembled,
in most of their symptoms, the West-India
and North-American yellow fever.
I shall resume this interesting subject in another
place, in which I shall mention a number of additional
facts, not only in support of the domestic
origin of the bilious yellow fever, but of its not
spreading by contagion, and of course of its being
impossible to import it. I shall at the same time
enumerate all its different sources, and point out
the means of destroying or removing them, and
thus of exterminating the disease from our country.
With these observations I conclude the history
of the epidemic fever of the year 1793. A few of
its symptoms, which have been omitted in this history,
will be included in the method of cure, for
they were discovered or produced by the remedies
which were given for that purpose.
☞ The following page begins an account of the
states of the thermometer and weather, from the
1st of January to the 1st of August, and of the
states of the barometer, thermometer, winds,
and weather, from the 1st of August to the 9th
of November, 1793. The times of observation,
for the first three months are at 7 in the morning,
and 2 in the afternoon; for the next five
months they are at 6 in the morning, and 3 in
the afternoon. From the 1st of October to the
9th of November, they are as in the first three
months.
| January, 1793. |
February, 1793. |
| Therm. |
Weather. |
Therm. |
Weather. |
| D. |
7h |
2h |
|
7h |
2h |
|
| 1 |
27 |
30 |
Cloudy. |
9 |
26 |
Fair, hazy. |
| 2 |
30 |
41 |
Fair, cloudy. |
25 |
34 |
Rain, ditto. |
| 3 |
30 |
33 |
Cloudy, rain. |
33 |
37 |
Cloudy, fair. |
| 4 |
38 |
41 |
Rain, cloudy. |
25 |
46 |
Cloudy, fair. |
| 5 |
35 |
42 |
Fair, cloudy. |
36 |
44 |
Cloudy, ditto. |
| 6 |
33 |
47 |
Cloudy, fair. |
35 |
46 |
Cloudy, rain. |
| 7 |
38 |
51 |
Fair, fair. |
36 |
40 |
Cloudy, fair. |
| 8 |
32 |
49 |
Fair, ditto. |
28 |
44 |
Cloudy, ditto. |
| 9 |
33 |
48 |
Hazy, fair. |
42 |
50 |
Rain, fair. |
| 10 |
38 |
51 |
Fair, ditto. |
38 |
40 |
Cloudy, fair. |
| 11 |
35 |
48 |
Fair, clouds. |
19 |
27 |
Fair, cloudy. |
| 12 |
31 |
42 |
Fair, ditto. |
20 |
28 |
Snow, cloudy. |
| 13 |
28 |
42 |
Fair, ditto. |
22 |
31 |
Cloudy, snow. |
| 14 |
25 |
27 |
Hail, snow, sleet. |
27 |
39 |
Cloudy, fair. |
| 15 |
32 |
37 |
Clouds, mist. |
18 |
40 |
Fair, ditto. |
| 16 |
37 |
39 |
Rain, ditto. |
29 |
42 |
Cloudy, ditto. |
| 17 |
37 |
45 |
Rain, snow, fair. |
44 |
48 |
Rain, ditto. |
| 18 |
32 |
52 |
Fair, ditto. |
39 |
49 |
Cloudy, fair. |
| 19 |
37 |
48 |
Fair, ditto. |
31 |
41 |
Cloudy, rain. |
| 20 |
33 |
47 |
Hazy, cloudy. |
52 |
53 |
Rain, rain. |
| 21 |
36 |
47 |
Cloudy, fair. |
37 |
49 |
Fair, ditto. |
| 22 |
27 |
32 |
Fair, ditto. |
29 |
34 |
Fair, ditto. |
| 23 |
22 |
37 |
Fair, ditto. |
22 |
34 |
Snow, cloudy. |
| 24 |
30 |
39 |
Cloudy, ditto. |
54 |
59 |
Rain, cloudy. |
| 25 |
30 |
41 |
Fair, hazy. |
34 |
35 |
Cloudy, ditto. |
| 26 |
31 |
— |
Fair. |
35 |
43 |
Rain, mist. |
| 27 |
23 |
38 |
Fair, cloudy, snow. |
43 |
43 |
Rain, cloudy. |
| 28 |
35 |
45 |
Cloudy, fair. |
14 |
26 |
Fair, ditto. |
| 29 |
29 |
37 |
Fair, ditto. |
|
|
|
| 30 |
22 |
23 |
Snow, hail. |
|
|
|
| 31 |
25 |
32 |
Cloudy, fair. |
|
|
|
| March, 1793. |
April, 1793. |
| Therm. |
Weather. |
Therm. |
Weather. |
| D. |
7h |
2h |
|
7h |
2h |
|
| 1 |
20 |
38 |
Fair, ditto. |
45 |
70 |
Cloudy, fair. |
| 2 |
31 |
51 |
Hazy, cloudy. |
47 |
71 |
Fair, ditto. |
| 3 |
48 |
63 |
Rain, fair. |
56 |
80 |
Fair, ditto. |
| 4 |
43 |
61 |
Hazy, ditto. |
51 |
72 |
Cloudy, fair. |
| 5 |
51 |
52 |
Rain, fair. |
53 |
61 |
Cloudy, rain. |
| 6 |
32 |
50 |
Fair, ditto. |
60 |
76 |
Misty, fair. |
| 7 |
36 |
62 |
Fair, ditto, clouds. |
51 |
65 |
Fair, ditto. |
| 8 |
54 |
60 |
Cloudy, rain. |
46 |
74 |
Fair, ditto. |
| 9 |
26 |
41 |
Fair, ditto. |
55 |
71 |
Fair, cloudy. |
| 10 |
29 |
51 |
Fair, ditto. |
50 |
56 |
Fair, ditto. |
| 11 |
43 |
55 |
Rain, ditto. |
37 |
63 |
Fair, ditto. |
| 12 |
40 |
43 |
Cloudy, ditto. |
54 |
62 |
Cloudy, rain, fair. |
| 13 |
38 |
39 |
Cloudy, fair. |
49 |
62 |
Fair, ditto. |
| 14 |
26 |
44 |
Fair, ditto. |
50 |
70 |
Fair, ditto. |
| 15 |
32 |
59 |
Fair, ditto. |
45 |
55 |
Rain, cloudy. |
| 16 |
52 |
62 |
Cloudy, fair. |
46 |
62 |
Cloudy, fair. |
| 17 |
51 |
72 |
Cloudy, fair. |
48 |
67 |
Fair, clouds, fair. |
| 18 |
58 |
69 |
Hazy, cloudy. |
52 |
66 |
Cloudy, fair. |
| 19 |
53 |
59 |
Fair, ditto. |
52 |
75 |
Fair, ditto. |
| 20 |
42 |
61 |
Fair, ditto. |
52 |
49 |
Rain, cloudy. |
| 21 |
41 |
43 |
Rain, cloudy. |
44 |
47 |
Cloudy, ditto. |
| 22 |
31 |
47 |
Fair, ditto. |
43 |
46 |
Rain, cloudy. |
| 23 |
35 |
57 |
Fair, ditto. |
42 |
63 |
Fair, ditto. |
| 24 |
37 |
50 |
Fair, ditto. |
44 |
68 |
Fair, ditto. |
| 25 |
35 |
59 |
Fair, ditto. |
45 |
65 |
Cloudy, ditto. |
| 26 |
47 |
54 |
Cloudy, rain. |
53 |
57 |
Cloudy, rain. |
| 27 |
43 |
51 |
Fair, cloudy. |
47 |
46 |
Rain, ditto. |
| 28 |
33 |
45 |
Fair, clouds, fair. |
44 |
44 |
Rain, cloudy. |
| 29 |
34 |
57 |
Fair, ditto. |
40 |
59 |
Fair, ditto. |
| 30 |
41 |
58 |
Cloudy, fair. |
40 |
65 |
Fair, ditto. |
| 31 |
42 |
61 |
Cloudy, fair. |
|
|
|
| May, 1793. |
June, 1793. |
| Therm. |
Weather. |
Therm. |
Weather. |
| D. |
7h |
2h |
|
7h |
2h |
|
| 1 |
45 |
69 |
Foggy, cloudy. |
53 |
61 |
Rain, showery. |
| 2 |
52 |
73 |
Fog, clouds, fair. |
54 |
64 |
Clouds, showers. |
| 3 |
60 |
63 |
Rain, ditto. |
55 |
62 |
Cloudy, rain, fair. |
| 4 |
60 |
80 |
Fair, ditto. |
54 |
60 |
Rain, do. cloudy. |
| 5 |
55 |
56 |
Cloudy, ditto. |
58 |
72 |
Cloudy, fair, rain. |
| 6 |
47 |
58 |
Cloudy, fair. |
— |
71 |
Cloudy, rain. |
| 7 |
50 |
68 |
Cloudy, fair. |
68 |
78 |
Fair, ditto. |
| 8 |
59 |
78 |
Cloudy, fair. |
65 |
— |
Fair, ditto. |
| 9 |
61 |
79 |
Foggy, fair. |
70 |
88 |
Fog, fair. |
| 10 |
65 |
71 |
Rain, hazy. |
74 |
90 |
Fair, ditto. |
| 11 |
55 |
75 |
Cloudy, fair. |
76 |
90 |
Fair, ditto. |
| 12 |
61 |
76 |
Cloudy, rain. |
75 |
88 |
Fair, showers. |
| 13 |
57 |
78 |
Fair, ditto. |
74 |
81 |
Cloudy, rain. |
| 14 |
59 |
83 |
Fair, cloudy. |
63 |
77 |
Fair, ditto. |
| 15 |
60 |
71 |
Fair, ditto. |
63 |
82 |
Fair, hazy. |
| 16 |
50 |
69 |
Fair, ditto. |
67 |
85 |
Fair, ditto. |
| 17 |
48 |
74 |
Fair, ditto. |
74 |
89 |
Fair, showers. |
| 18 |
61 |
81 |
Cloudy, fair. |
73 |
88 |
Fair, ditto. |
| 19 |
65 |
85 |
Fair, rain. |
77 |
91 |
Fair, ditto. |
| 20 |
65 |
87 |
Fair, ditto. |
79 |
88 |
Fair, rain, fair. |
| 21 |
68 |
86 |
Fair, ditto, clouds. |
75 |
85 |
Cloudy, rain. |
| 22 |
72 |
80 |
Clouds, gusts. |
58 |
78 |
Cloudy, fair. |
| 23 |
94 |
79 |
Cloudy, fair. |
58 |
78 |
Fair, ditto. |
| 24 |
58 |
75 |
Fair, ditto. |
60 |
79 |
Fair, ditto. |
| 25 |
52 |
70 |
Fair, cloudy. |
67 |
74 |
Cloudy, rain. |
| 26 |
61 |
66 |
Rain, ditto. |
66 |
69 |
Cloudy, rain. |
| 27 |
68 |
84 |
Cloudy, fair. |
68 |
80 |
Cloudy, fair. |
| 28 |
70 |
68 |
Fair, clouds, rain. |
71 |
85 |
Cloudy, fair. |
| 29 |
57 |
62 |
Cloudy, rain, clouds. |
77 |
88 |
Cloudy, ditto. |
| 30 |
54 |
57 |
Cloudy, rain. |
74 |
90 |
Fair, ditto. |
| 31 |
54 |
60 |
Cloudy, ditto. |
|
|
|
| JULY, 1793. |
| |
Barom. |
Ther. |
Winds. |
Weather. |
| Days. |
6 A. M. |
|
3 P. M. |
6 A. M. |
|
3 P. M. |
6 A. M. |
|
3 P. M. |
|
| 1 |
30 |
0 |
|
29 |
8 |
77 |
|
88 |
W |
|
W |
fair. |
| 2 |
29 |
8 |
|
29 |
7 |
77 |
|
81 |
W |
|
|
fair, showers. |
| 3 |
29 |
9 |
|
30 |
0 |
74 |
|
80 |
E |
|
E |
cloudy. |
| 4 |
30 |
1 |
|
30 |
0 |
70 |
|
83 |
E |
|
SW |
cloudy, fair, rain. |
| 5 |
30 |
0 |
|
29 |
9 |
76 |
|
90 |
NW |
|
SW |
fair, ditto. |
| 6 |
29 |
9 |
|
30 |
0 |
78 |
|
91 |
SW |
|
SW |
cloudy, thunder. |
| 7 |
29 |
9 |
|
30 |
0 |
73 |
|
88 |
NE |
|
NW |
fair, clouds. |
| 8 |
30 |
1 |
|
30 |
1 |
72 |
|
85 |
E |
|
E |
cloudy, fair. |
| 9 |
30 |
0 |
|
29 |
8 |
73 |
|
81 |
S |
|
SW |
cloudy, ditto. |
| 10 |
30 |
0 |
|
30 |
0 |
70 |
|
84 |
W |
|
NW |
fair, ditto. |
| 11 |
30 |
0 |
|
30 |
0 |
74 |
|
88 |
NW |
|
NW |
fair, clouds. |
| 12 |
30 |
1 |
|
30 |
2 |
70 |
|
84 |
N |
|
N |
fair, ditto. |
| 13 |
30 |
1 |
|
30 |
0 |
68 |
|
83 |
NW |
|
NW |
fair, ditto. |
| 14 |
30 |
0 |
|
30 |
0 |
65 |
|
80 |
N |
|
Calm |
fair, hazy. |
| 15 |
30 |
0 |
|
29 |
9 |
66 |
|
75 |
SW |
|
SW |
cloudy, ditto. |
| 16 |
29 |
8 |
|
29 |
7 |
70 |
|
83 |
W |
|
W |
rain, fair. |
| 17 |
29 |
8 |
|
29 |
9 |
68 |
|
81 |
NW |
|
NW |
fair, ditto. |
| 18 |
30 |
0 |
|
30 |
0 |
66 |
|
86 |
W |
|
SW |
fair, ditto. |
| 19 |
29 |
9 |
|
29 |
9 |
75 |
|
85 |
SW |
|
W |
fair, cloudy, rain. |
| 20 |
30 |
0 |
|
30 |
0 |
72 |
|
87 |
W |
|
NW |
fair, ditto, shower. |
| 21 |
30 |
1 |
|
30 |
1 |
70 |
|
86 |
NW |
|
NW |
fair, ditto. |
| 22 |
30 |
0 |
|
30 |
0 |
72 |
|
87 |
SW |
|
SW |
fair, ditto. |
| 23 |
30 |
0 |
|
30 |
0 |
73 |
|
91 |
SW |
|
SW |
fair, cloudy. |
| 24 |
29 |
9 |
|
29 |
9 |
75 |
|
89 |
Calm |
|
W |
cloudy, fair. |
| 25 |
30 |
1 |
|
30 |
1 |
71 |
|
83 |
NW |
|
NNW |
fair, ditto. |
| 26 |
30 |
2 |
|
30 |
2 |
63 |
|
82 |
N |
|
NE |
fair, ditto. |
| 27 |
30 |
2 |
|
30 |
1 |
64 |
|
81 |
S calm |
|
S |
fair, cloudy. |
| 28 |
30 |
1 |
|
30 |
0 |
72 |
|
85 |
Calm |
|
NNE |
cloudy, fair. |
| 29 |
30 |
1 |
|
30 |
1 |
74 |
|
85 |
SSE |
|
NE |
cloudy, ditto, rain. |
| 30 |
30 |
1 |
|
30 |
0 |
73 |
|
86 |
S |
|
SW |
cloudy, fair. |
| 31 |
29 |
9 |
|
29 |
8 |
76 |
|
80 |
SSW |
|
SW |
cloudy, rain, fair. |
| AUGUST, 1793. |
| |
Barom. |
Ther. |
Winds. |
Weather. |
| Days. |
6 A. M. |
|
3 P. M. |
6 A. M. |
|
3 P. M. |
6 A. M. |
|
3 P. M. |
6 A. M. |
|
3 P. M. |
| 1 |
29 |
95 |
|
30 |
0 |
65 |
|
77 |
WNW |
|
NW |
cloudy, |
|
fair, |
| 2 |
30 |
1 |
|
30 |
1 |
63 |
|
81 |
NW |
|
SW |
fair, |
|
fair, |
| 3 |
30 |
6 |
|
29 |
95 |
62 |
|
82 |
N |
|
NNE |
fair, |
|
fair, |
| 4 |
29 |
97 |
|
30 |
0 |
65 |
|
87 |
S |
|
SW |
fair, |
|
fair, |
| 5 |
30 |
5 |
|
30 |
1 |
73 |
|
90 |
SSW |
|
SW |
fair, |
|
fair, |
| 6 |
30 |
2 |
|
30 |
0 |
77 |
|
87 |
SW |
|
W |
cloudy, |
|
fair, |
| 7 |
30 |
12 |
|
30 |
1 |
68 |
|
83 |
NW |
|
W |
fair, |
|
fair, |
| 8 |
30 |
1 |
|
29 |
95 |
69 |
|
86 |
SSE |
|
SSE |
fair, |
|
rain, |
| 9 |
29 |
8 |
|
29 |
75 |
75 |
|
85 |
SSW |
|
SW |
cloudy, |
|
fair, |
| 10 |
29 |
9 |
|
29 |
9 |
67 |
|
82 |
W |
|
SW |
fair, |
|
fair, |
| 11 |
30 |
0 |
|
30 |
0 |
70 |
|
84 |
SW |
|
WSW |
cloudy, |
|
cloudy, |
| 12 |
30 |
0 |
|
30 |
0 |
70 |
|
87 |
W |
|
W |
fair, |
|
fair, |
| 13 |
30 |
5 |
|
30 |
0 |
71 |
|
89 |
SW |
|
W |
fair, |
|
fair, |
| 14 |
30 |
0 |
|
29 |
95 |
75 |
|
82 |
SW |
|
SW |
fair, |
|
rain, |
| 15 |
30 |
0 |
|
30 |
1 |
72 |
|
75 |
NNE |
|
NE |
fair, |
|
cloudy, |
| 16 |
30 |
1 |
|
30 |
1 |
70 |
|
83 |
NNE |
|
NE |
fair, |
|
fair, |
| 17 |
30 |
1 |
|
30 |
0 |
71 |
|
86 |
SW |
|
SW |
fair, |
|
fair, |
| 18 |
30 |
1 |
|
30 |
1 |
73 |
|
89 |
calm |
|
SW |
fair, |
|
fair, |
| 19 |
30 |
1 |
|
30 |
0 |
72 |
|
82 |
N |
|
N |
fair, |
|
cloudy, |
| 20 |
30 |
1 |
|
30 |
12 |
69 |
|
82 |
NNE |
|
NNE |
fair, |
|
fair, |
| 21 |
30 |
15 |
|
30 |
25 |
62 |
|
83 |
N |
|
NNE |
fair, |
|
fair, |
| 22 |
30 |
3 |
|
30 |
35 |
63 |
|
86 |
NE |
|
SE |
fair, |
|
fair, |
| 23 |
30 |
25 |
|
30 |
15 |
63 |
|
85 |
calm |
|
S |
fair, |
|
fair, |
| 24 |
30 |
1 |
|
30 |
1 |
73 |
|
81 |
calm |
|
calm |
cloudy, |
|
rain, |
| 25 |
30 |
1 |
|
30 |
1 |
71 |
|
66 |
NE |
|
NE |
rain, |
|
gr. rain, |
| 26 |
30 |
15 |
|
30 |
2 |
59 |
|
69 |
NE |
|
NE |
cloudy, |
|
cloudy, |
| 27 |
30 |
2 |
|
30 |
2 |
65 |
|
73 |
NE |
|
NE |
cloudy, |
|
cloudy, |
| 28 |
30 |
2 |
|
30 |
15 |
67 |
|
80 |
S |
|
calm |
cloudy, |
|
clearin. |
| 29 |
30 |
16 |
|
30 |
15 |
72 |
|
86 |
calm |
|
SW |
cloudy, |
|
fair, |
| 30 |
30 |
1 |
|
30 |
1 |
74 |
|
87 |
calm |
|
SW |
fair, |
|
fair, |
| 31 |
30 |
0 |
|
30 |
0 |
74 |
|
84 |
SW |
|
NW |
rain, |
|
fair, |
| SEPTEMBER, 1793. |
| |
Barom. |
Ther. |
Winds. |
Weather. |
| Days. |
6 A. M. |
|
3 P. M. |
6 A. M. |
|
3 P. M. |
6 A. M. |
|
3 P. M. |
6 A. M. |
|
3 P. M. |
| 1 |
30 |
0 |
|
29 |
30 |
71 |
|
86 |
calm |
|
SW |
fog, |
|
fair, |
| 2 |
29 |
75 |
|
29 |
8 |
73 |
|
86 |
SW |
|
SW |
fair, |
|
fair, |
| 3 |
30 |
0 |
|
|
|
60 |
|
|
NW |
|
N |
fair, |
|
fair, |
| 4 |
30 |
15 |
|
30 |
15 |
55 |
|
75 |
W |
|
W |
fair, |
|
fair, |
| 5 |
30 |
15 |
|
30 |
1 |
62 |
|
80 |
SE |
|
S |
fair, |
|
cloudy, |
| 6 |
29 |
97 |
|
29 |
95 |
70 |
|
89 |
WSW |
|
W |
fair, |
|
cloudy, |
| 7 |
30 |
0 |
|
30 |
0 |
65 |
|
77 |
WNW |
|
NW |
fair, |
|
fair, |
| 8 |
30 |
1 |
|
30 |
1 |
64 |
|
70 |
calm |
|
calm |
cloudy, |
|
cloudy, |
| 9 |
30 |
0 |
|
30 |
0 |
66 |
|
80 |
SE |
|
NW |
rain, |
|
fair, |
| 10 |
30 |
0 |
|
30 |
0 |
64 |
|
72 |
N |
|
NNE |
fair, |
|
cloudy, |
| 11 |
30 |
1 |
|
30 |
0 |
62 |
|
72 |
NNE |
|
N |
cloudy, |
|
fair, |
| 12 |
29 |
96 |
|
29 |
9 |
58 |
|
76 |
NW |
|
NNW |
fair, |
|
fair, |
| 13 |
29 |
95 |
|
30 |
0 |
57 |
|
72 |
NW |
|
N |
fair, |
|
fair, |
| 14 |
30 |
0 |
|
30 |
5 |
58 |
|
79 |
NW |
|
NW |
fair, |
|
fair, |
| 15 |
30 |
0 |
|
29 |
97 |
65 |
|
80 |
N |
|
S |
fair, |
|
fair, |
| 16 |
29 |
9 |
|
29 |
|
70 |
|
84 |
S |
|
SW |
cloudy, |
|
fair, |
| 17 |
29 |
8 |
|
29 |
85 |
66 |
|
67 |
N |
|
N |
cloudy, |
|
cloudy, |
| 19 |
30 |
4 |
|
30 |
35 |
45 |
|
70 |
calm |
|
SW |
fair, |
|
fair, |
| 20 |
30 |
3 |
|
30 |
15 |
54 |
|
69 |
calm |
|
SE |
hazy, |
|
hazy, |
| 21 |
30 |
0 |
|
29 |
0 |
59 |
|
78 |
calm |
|
|
cloudy, |
|
fair, |
| 22 |
30 |
0 |
|
30 |
0 |
63 |
|
83 |
calm |
|
|
cloudy, |
|
fair, |
| 23 |
30 |
1 |
|
30 |
1 |
62 |
|
80 |
calm |
|
SE |
cloudy, |
|
cloudy, |
| 24 |
30 |
2 |
|
30 |
2 |
65 |
|
70 |
NE |
|
ENE |
cloudy, |
|
fair, |
| 25 |
30 |
15 |
|
30 |
0 |
61 |
|
68 |
NE |
|
NE |
cloudy, |
|
cloudy, |
| 26 |
29 |
8 |
|
29 |
7 |
58 |
|
79 |
N |
|
N |
cloudy, |
|
fair, |
| 27 |
29 |
7 |
|
|
|
64 |
|
|
NW |
|
NW |
cloudy, |
|
fair, |
| 28 |
30 |
5 |
|
30 |
15 |
54 |
|
73 |
NW |
|
NW |
fair, |
|
fair, |
| 29 |
30 |
3 |
|
30 |
3 |
56 |
|
74 |
NE |
|
ENE |
cloudy, |
|
fair, |
| 30 |
30 |
35 |
|
30 |
3 |
57 |
|
75 |
calm |
|
SW |
foggy, |
|
fair, |
| OCTOBER, 1793. |
| |
Barom. |
Ther. |
Winds. |
Weather. |
| Days. |
7 A. M. |
|
2 P. M. |
7 A. M. |
|
2 P. M. |
7 A. M. |
|
2 P. M. |
7 A. M. |
|
2 P. M. |
| 1 |
30 |
15 |
|
30 |
5 |
64 |
|
80 |
SW |
|
SW |
cloudy, |
|
fair, |
| 2 |
29 |
9 |
|
30 |
5 |
70 |
|
72 |
W |
|
NNW |
cloudy, |
|
fair, |
| 3 |
30 |
2 |
|
30 |
15 |
50 |
|
72 |
W |
|
SW |
fair, |
|
fair, |
| 4 |
29 |
75 |
|
29 |
7 |
50 |
|
72 |
SW |
|
W |
cloudy, |
|
cloudy, |
| 5 |
30 |
0 |
|
30 |
1 |
58 |
|
66 |
N |
|
N |
fair, |
|
fair, |
| 6 |
30 |
3 |
|
30 |
3 |
43 |
|
66 |
NE |
|
W |
fair, |
|
fair, |
| 7 |
30 |
45 |
|
|
|
46 |
|
|
calm |
|
|
fair, |
|
|
| 8 |
30 |
6 |
|
30 |
6 |
53 |
|
68 |
N |
|
N |
fair, |
|
fair, |
| 9 |
30 |
5 |
|
30 |
4 |
53 |
|
70 |
NW |
|
NW |
fair, |
|
fair, |
| 10 |
30 |
2 |
|
30 |
2 |
49 |
|
74 |
E |
|
NW |
fair, |
|
fair, |
| 11 |
30 |
0 |
|
29 |
85 |
51 |
|
74 |
W |
|
W |
fair, |
|
fair, |
| 12 |
29 |
6 |
|
29 |
55 |
58 |
|
64 |
SW |
|
NW |
rain, |
|
rain, |
| 13 |
29 |
85 |
|
29 |
9 |
49 |
|
69 |
NW |
|
NW |
fair, |
|
fair, |
| 14 |
30 |
5 |
|
30 |
0 |
52 |
|
76 |
SW |
|
SW |
calm, |
|
fair, |
| 15 |
29 |
75 |
|
29 |
8 |
56 |
|
54 |
SW |
|
N |
fair, |
|
rain, |
| 16 |
30 |
0 |
|
30 |
0 |
37 |
|
53 |
NNW |
|
N |
fair, |
|
fair, |
| 17 |
30 |
1 |
|
30 |
1 |
37 |
|
60 |
NE |
|
NE |
fair, |
|
fair, |
| 18 |
30 |
1 |
|
30 |
1 |
41 |
|
62 |
NW |
|
NW |
fair, |
|
fair, |
| 19 |
30 |
0 |
|
29 |
9 |
51 |
|
66 |
N |
|
N |
cloudy, |
|
fair, |
| 20 |
30 |
0 |
|
30 |
0 |
44 |
|
54 |
NW |
|
N |
fair, |
|
fair, |
| 21 |
30 |
0 |
|
30 |
2 |
49 |
|
59 |
N |
|
NW |
fair, |
|
fair, |
| 22 |
29 |
6 |
|
29 |
5 |
51 |
|
65 |
NW |
|
NW |
fair, |
|
fair, |
| 23 |
29 |
8 |
|
29 |
8 |
47 |
|
60 |
W |
|
W |
fair, |
|
fair, |
| 24 |
30 |
3 |
|
30 |
4 |
36 |
|
59 |
W |
|
NW |
fair, |
|
fair, |
| 25 |
30 |
4 |
|
30 |
3 |
46 |
|
71 |
S |
|
S |
cloudy, |
|
do. h-w. |
| 26 |
30 |
2 |
|
30 |
2 |
60 |
|
72 |
calm |
|
SW |
cloudy, |
|
cloudy, |
| 27 |
30 |
3 |
|
30 |
3 |
44 |
|
44 |
NNE |
|
NNE |
cloudy, |
|
cloudy, |
| 28 |
30 |
2 |
|
30 |
1 |
34 |
|
37 |
N |
|
N |
cloudy, |
|
cloudy, |
| 29 |
29 |
85 |
|
29 |
85 |
28 |
|
44 |
NNW |
|
NW |
fair, |
|
fair, |
| 30 |
30 |
1 |
|
30 |
1 |
28 |
|
49 |
calm |
|
SW |
hazy, |
|
hazy, |
| 31 |
30 |
15 |
|
30 |
2 |
42 |
|
45 |
calm |
|
NNE |
cloudy, |
|
rain, |
| NOVEMBER, 1793. |
| |
Barom. |
Ther. |
Winds. |
Weather. |
| Days. |
7 A. M. |
|
2 P. M. |
7 A. M. |
|
2 P. M. |
7 A. M. |
|
2 P. M. |
7 A. M. |
|
2 P. M. |
| 1 |
30 |
1 |
|
30 |
1 |
40 |
|
41 |
NNE |
|
NE |
rain, |
|
cloudy, |
| 2 |
30 |
3 |
|
30 |
25 |
32 |
|
49 |
NNE |
|
NE |
fair, |
|
fair, |
| 3 |
30 |
1 |
|
30 |
0 |
43 |
|
56 |
calm |
|
SW |
cloudy, |
|
cloudy, |
| 4 |
29 |
8 |
|
29 |
9 |
55 |
|
67 |
SW |
|
SW |
cloudy, |
|
fair, |
| 5 |
30 |
15 |
|
30 |
1 |
50 |
|
64 |
NE |
|
NE |
rain, |
|
rain, |
| 6 |
29 |
8 |
|
29 |
65 |
63 |
|
67 |
S |
|
S |
cloudy, |
|
cloudy, |
| 7 |
29 |
8 |
|
29 |
8 |
44 |
|
64 |
calm |
|
SW |
fair, |
|
fair, |
| 8 |
29 |
8 |
|
29 |
85 |
43 |
|
56 |
SSW |
|
SW |
fair, |
|
fair, |
| 9 |
29 |
9 |
|
29 |
95 |
42 |
|
65 |
SW |
|
SW |
fair, |
|
fair, |
In the introduction to the history of the fever,
I mentioned the remedies which I used with
success, in several cases which occurred in the
beginning of August. I had seen, and recorded
in my note book, the efficacy of gentle purges in
the yellow fever of 1762; but finding them unsuccessful
after the 20th of August, and observing the
disease to assume uncommon symptoms of great
prostration of strength, I laid them aside, and
had recourse to a gentle vomit of ipecacuanha,
on the first day of the fever, and to the usual remedies
for exciting the action of the sanguiferous
system. I gave bark in all its usual forms of infusion,
powder, and tincture. I joined wine,
brandy, and aromatics with it. I applied blisters
to the limbs, neck, and head. Finding them all
ineffectual, I attempted to rouse the system by
wrapping the whole body, agreeably to Dr.
Hume's practice, in blankets dipped in warm vinegar.
To these remedies I added one more:
I rubbed the right side with mercurial ointment,
with a view of exciting the action of the vessels in
the whole system, through the medium of the liver,
which I then supposed to be principally, though
symptomatically, affected by the disease. None of
these remedies appeared to be of any service; for
although three out of thirteen recovered, of those
to whom they were applied, yet I have reason to
believe that they would have recovered much
sooner had the cure been trusted to nature. Perplexed
and distressed by my want of success in
the treatment of this fever, I waited upon Dr.
Stephens, an eminent and worthy physician from
St. Croix, who happened then to be in our city,
and asked for such advice and information upon
the subject of the disease, as his extensive practice
in the West-Indies would naturally suggest.
He politely informed me, that he had long ago
laid aside evacuations of all kinds in the yellow
fever; that they had been found to be hurtful,
and that the disease yielded more readily to
bark, wine, and, above all, to the use of the cold
bath. He advised the bark to be given in large
quantities by way of glyster, as well as in the
usual way; and he informed me of the manner in
which the cold bath should be used, so as to derive
the greatest benefit from it. This mode of
treating the yellow fever appeared to be reasonable.
I had used bark, in the manner he recommended
it, in several cases of sporadic yellow fever, with
success, in former years. I had, moreover, the
authority of several other physicians of reputation
in its favour. Dr. Cleghorn tells us, that “he
sometimes gave the bark when the bowels were
full of vicious humours. These humours (he
says) are produced by the fault of the circulation.
The bark, by bracing the solids, enables them to
throw off the excrementitious fluids, by the proper
emunctories[65].”
I began the use of each of Dr. Stevens's remedies
the next day after my interview with him,
with great confidence of their success. I prescribed
bark in large quantities: in one case I ordered
it to be injected into the bowels every four
hours. I directed buckets full of cold water to
be thrown frequently upon my patients. The
bark was offensive to the stomach, or rejected by
it, in every case in which I prescribed it. The
cold bath was grateful, and produced relief in several
cases, by inducing a moisture on the skin. For
a while I had hopes of benefit to my patients from
the use of these remedies, but, in a few days, I
was distressed to find they were not more effectual
than those I had previously used. Three out of
four of my patients died, to whom the cold bath
was administered, in addition to the tonic remedies
before-mentioned.
Baffled in every attempt to stop the ravages of
this fever, I anticipated all the numerous and complicated
distresses in our city, which pestilential
diseases have so often produced in other countries.
The fever had a malignity and an obstinacy
which I had never before observed in any disease,
and it spread with a rapidity and mortality far
beyond what it did in the year 1762. Heaven
alone bore witness to the anguish of my soul in
this awful situation. But I did not abandon a
hope that the disease might yet be cured. I had
long believed that good was commensurate with
evil, and that there does not exist a disease for
which the goodness of Providence has not provided
a remedy. Under the impression of this belief
I applied myself with fresh ardour to the investigation
of the disease before me. I ransacked
my library, and pored over every book that treated
of the yellow fever. The result of my researches
for a while was fruitless. The accounts of the
symptoms and cure of the disease by the authors
I consulted were contradictory, and none of them
appeared altogether applicable to the prevailing
epidemic. Before I desisted from the inquiry to
which I had devoted myself, I recollected that I
had, among some old papers, a manuscript account
of the yellow fever as it prevailed in Virginia in
the year 1741, which had been put into my hands
by Dr. Franklin, a short time before his death. I
had read it formerly, and made extracts from it
into my lectures upon that disease. I now read
it a second time. I paused upon every sentence;
even words in some places arrested and fixed my
attention. In reading the history of the method of
cure I was much struck with the following passages.
“It must be remarked, that this evacuation
(meaning by purges) is more necessary in this
than in most other fevers. The abdominal viscera
are the parts principally affected in this disease,
but by this timely evacuation their feculent corruptible
contents are discharged, before they corrupt
and produce any ill effects, and their various
emunctories and secerning vessels are set open,
so as to allow a free discharge of their contents,
and consequently a security to the parts themselves,
during the course of the disease. By this
evacuation the very minera of the disease, proceeding
from the putrid miasmata fermenting with
the salivary, bilious, and other inquiline humours
of the body, is sometimes eradicated by timely
emptying the abdominal viscera, on which it first
fixes, after which a gentle sweat does as it were
nip it in its bud. Where the primæ viæ, but
especially the stomach, is loaded with an offensive
matter, or contracted and convulsed with the irritation
of its stimulus, there is no procuring a
laudable sweat till that is removed; after which
a necessary quantity of sweat breaks out of its own
accord, these parts promoting it when by an absterging
medicine they are eased of the burden or
stimulus which oppresses them.”
“All these acute putrid fevers ever require
some evacuation to bring them to a perfect crisis
and solution, and that even by stools, which must
be promoted by art, where nature does not do
the business herself. On this account an ill-timed
scrupulousness about the weakness of the body is
of bad consequence in these urging circumstances;
for it is that which seems chiefly to make evacuations
necessary, which nature ever attempts, after
the humours are fit to be expelled, but is not able
to accomplish for the most part in this disease;
and I can affirm that I have given a purge in this
case, when the pulse has been so low, that it could
hardly be felt, and the debility extreme, yet both
one and the other have been restored by it.”
“This evacuation must be procured by lenitive
chologoque purges.”
Here I paused. A new train of ideas suddenly
broke in upon my mind. I believed the weak and
low pulse which I had observed in this fever, to
be the effect of debility from a depressed state of the
system, but the unsuccessful issue of purging, and
even of a spontaneous diarrhœa, in a patient of Dr.
Hutchinson, had led me not only to doubt of, but to
dread its effects. My fears from this evacuation
were confirmed, by the communications I had received
from Dr. Stevens. I had been accustomed
to raising a weak and low pulse in pneumony and
apoplexy, by means of blood-letting, but I had attended
less to the effects of purging in producing
this change in the pulse. Dr. Mitchell in a moment
dissipated my ignorance and fears upon this
subject. I adopted his theory and practice, and
resolved to follow them. It remained now only to
fix upon a suitable purge to answer the purpose of
discharging the contents of the bowels. I have before
described the state of the bile in the gall-bladder
and duodenum, in an extract from the history
of a dissection made by Dr. Mitchell. I suspected
that my want of success in discharging this bile,
in several of the cases in which I attempted the
cure by purging, was owing the feebleness of my
purges. I had been in the habit of occasionally
purging with calomel in bilious and inflammatory
fevers, and had recommended the practice the year
before in my lectures, not only from my own experience,
but upon the authority of Dr. Clark. I
had, moreover, other precedents for its use in the
practice of sir John Pringle, Dr. Cleghorn, and
Dr. Balfour, in diseases of the same class with the
yellow fever. But these were not all my vouchers
for the safety and efficacy of calomel. In my attendance
upon the military hospitals during the
late war, I had seen it given combined with jalap
in the bilious fever by Dr. Thomas Young, a senior
surgeon in the hospitals. His usual dose was
ten grains of each of them. This was given once
or twice a day until it procured large evacuations
from the bowels. For a while I remonstrated with
the doctor against this purge, as being disproportioned
to the violence and danger of the fever;
but I was soon satisfied that it was as safe as cremor
tartar or glauber's salts. It was adopted by
several of the surgeons of the hospital, and was
universally known, and sometimes prescribed, by
the simple name of ten and ten. This mode of
giving calomel occurred to me in preference to
any other. The jalap appeared to be a necessary
addition to it, in order to quicken its passage
through the bowels; for calomel is slow in its
operation, more especially when it is given in large
doses. I resolved, after mature deliberation, to
prescribe this purge. Finding ten grains of jalap
insufficient to carry the calomel through the bowels
in the rapid manner I wished, I added fifteen
grains of the former to ten of the latter; but even
this dose was slow and uncertain in its operation.
I then issued three doses, each consisting of fifteen
grains of jalap and ten of calomel; one to be given
every six hours until they procured four or five
large evacuations. The effects of this powder not
only answered, but far exceeded my expectations.
It perfectly cured four out of the first five patients
to whom I gave it, notwithstanding some of them
were advanced several days in the disease. Mr.
Richard Spain, a block-maker, in Third-street,
took eighty grains of calomel, and rather more of
rhubarb and jalap mixed with it, on the two last
days of August, and on the first day of September.
He had passed twelve hours, before I began to give
him this medicine, without a pulse, and with a cold
sweat on all his limbs. His relations had given
him over, and one of his neighbours complained to
me of my neglecting to advise them to make immediate
preparations for his funeral. But in this
situation I did not despair of his recovery, Dr.
Mitchell's account of the effects of purging in raising
the pulse, exciting a hope that he might be
saved, provided his bowels could be opened. I
now committed the exhibition of the purging
medicine to Mr. Stall, one of my pupils, who
mixed it, and gave it with his own hand, three or
four times a day. At length it operated, and produced
two copious, fœtid stools. His pulse rose
immediately afterwards, and a universal moisture
on his skin succeeded the cold sweat on his limbs.
In a few days he was out of danger, and soon afterwards
appeared in the streets in good health, as
the first fruits of the efficacy of mercurial purges
in the yellow fever.
After such a pledge of the safety and success of
my new medicine, I gave it afterwards with confidence.
I communicated the prescription to such
of the practitioners as I met in the streets. Some
of them I found had been in the use of calomel for
several days, but as they had given it in small and
single doses only, and had followed it by large doses
of bark, wine, and laudanum, they had done little
or no good with it. I imparted the prescription
to the college of physicians, on the third of September,
and endeavoured to remove the fears of my
fellow-citizens, by assuring them that the disease
was no longer incurable. Mr. Lewis, the lawyer,
Dr. M'Ilvaine, Mrs. Bethel, her two sons, and a
servant maid, and Mr. Peter Baynton's whole family
(nine in number), were some of the first trophies of
this new remedy. The credit it acquired, brought
me an immense accession of business. It still continued
to be almost uniformly effectual in all those
which I was able to attend, either in person, or by
my pupils. Dr. Griffitts, Dr. Say, Dr. Pennington,
and my former pupils who had settled in the city,
viz. Dr. Leib, Dr. Porter, Dr. Annan, Dr. Woodhouse,
and Dr. Mease, were among the first physicians
who adopted it. I can never forget the
transport with which Dr. Pennington ran across
Third-street to inform me, a few days after he began
to give strong purges, that the disease yielded
to them in every case. But I did not rely upon
purging alone to cure the disease. The theory of
it which I had adopted led me to use other remedies
to abstract excess of stimulus from the system.
These were blood-letting, cool air, cold drinks, low
diet, and applications of cold water to the body.
I had bled Mrs. Bradford, Mrs. Leaming, and one
of Mrs. Palmer's sons with success, early in the
month of August. But I had witnessed the bad
effects of bleeding in the first week in September,
in two of my patients who had been bled without
my knowledge, and who appeared to have died in
consequence of it. I had, moreover, heard of a
man who had been bled on the first day of the disease,
who died in twelve hours afterwards. These
cases produced caution, but they did not deter me
from bleeding as soon as I found the disease to
change its type, and instead of tending to a crisis
on the third, to protract itself to a later day. I began
by drawing a small quantity at a time. The
appearance of the blood, and its effects upon the
system, satisfied me of its safety and efficacy.
Never before did I experience such sublime joy
as I now felt in contemplating the success of my
remedies. It repaid me for all the toils and studies
of my life. The conquest of this formidable
disease was not the effect of accident, nor of the
application of a single remedy; but it was the triumph
of a principle in medicine. The reader will
not wonder at this joyful state of my mind when I
add a short extract from my note book, dated the
10th of September. “Thank God! out of one
hundred patients, whom I have visited or prescribed
for this day, I have lost none.”
Being unable to comply with the numerous demands
which were made upon me for the purging
powders, notwithstanding I had requested my sister,
and two other persons to assist my pupils in
putting them up; and, finding myself unable to
attend all the persons who sent for me, I furnished
the apothecaries with the recipe for the mercurial
purges, together with printed directions for giving
them, and for the treatment of the disease.
Hitherto there had been great harmony among
the physicians of the city, although there was a diversity
of sentiment as to the nature and cure of
the prevailing fever. But this diversity of sentiment
and practice was daily lessening, and would
probably have ceased altogether in a few days, had
it not been prevented by two publications, the one
by Dr. Kuhn, and the other by Dr. Stevens, in
which they recommended bark, wine, and other
cordials, and the cold bath, as the proper remedies
for the disease. The latter dissuaded from the
use of evacuations of all kinds. This method of
cure was supported by a letter from Alexander
Hamilton, Esq. then secretary of the treasury
of the United States, to the college of physicians,
in which he ascribed his recovery from the fever
to the use of those remedies, administered by the
hand of Dr. Stevens. The respectable characters
of those two physicians procured an immediate
adoption of the mode of practice recommended by
them, by most of the physicians of the city, and a
general confidence in it by all classes of citizens.
Had I consulted my interest, or regarded the certain
consequences of opposing the use of remedies
rendered suddenly popular by the names that were
connected with them, I should silently have pursued
my own plans of cure, with my old patients
who still confided in them; but I felt, at this season
of universal distress, my professional obligations
to all the citizens of Philadelphia to be superior
to private and personal considerations, and
therefore determined at every hazard to do every
thing in my power to save their lives. Under the
influence of this disposition, I addressed a letter to
the college of physicians, in which I stated my objections
to Dr. Kuhn and Dr. Stevens's remedies,
and defended those I had recommended. I likewise
defended them in the public papers against
the attacks that were made upon them by several
of the physicians of the city, and occasionally addressed
such advice to the citizens as experience
had suggested to be useful to prevent the disease,
particularly low diet, gentle doses of laxative physic,
avoiding its exciting causes, and prompt
applications for medical aid. In none of the recommendations
of my remedies did I claim the
credit of their discovery. On the contrary, I constantly
endeavoured to enforce their adoption, by
mentioning precedents in favour of their efficacy,
from the highest authorities in medicine. This
controversy with my brethren, with whom I had
long lived in friendly intercourse, carried on amidst
the most distressing labours, was extremely painful
to me, and was submitted to only to prevent
the greater evil of the depopulation of our city by
the use of remedies which had been prescribed by
myself, as well as others, not only without effect,
but with evident injury to the sick. The repeated
and numerous instances of their inefficacy, in some
of the most opulent families in the city, and the
almost uniform success of the depleting remedies,
happily restored the public mind, after a while,
from its distracted state, and procured submission
to the latter from nearly all the persons who were affected
by the fever.
Besides the two modes of practice which have
been described, there were two others: the one
consisted of moderate purging with calomel only,
and moderate bleeding, on the first or second day
of the fever, and afterwards by the copious use of
bark, wine, laudanum, and aromatic tonics. This
practice was supported by an opinion, that the fever
was inflammatory in its first, and putrid in its
second stage. The other mode referred to was
peculiar to the French physicians, several of whom
had arrived in the city from the West-Indies, just
before the disease made its appearance. Their remedies
were various. Some of them prescribed
nitre, cremor tartar, camphor, centaury tea, the
warm bath, glysters, and moderate bleeding, while
a few used lenient purges, and large quantities of
tamarind water, and other diluting drinks. The
dissentions of the American physicians threw a
great number of patients into the hands of these
French physicians. They were moreover supposed
to be better acquainted with the disease than
the physicians of the city, most of whom, it was
well known, had never seen it before.
I shall hereafter inquire into the relative success
of each of the four modes of practice which have
been mentioned.
Having delivered a general account of the remedies
which I used in this disease, I shall now proceed
to make a few remarks upon each of them.
I shall afterwards mention the effects of the remedies
used by other physicians.
I have already mentioned my reasons for
promoting this evacuation, and the medicine I preferred
for that purpose. It had many advantages
over any other purge. It was detergent to the bile
and mucus which lined the bowels. It probably
acted in a peculiar manner upon the biliary ducts,
and it was rapid in its operation. One dose was
sometimes sufficient to open the bowels; but from
two to six doses were often necessary for that purpose;
more especially as part of them was frequently
rejected by the stomach. I did not observe
any inconvenience from the vomiting which
was excited by the jalap. It was always without
that straining which was produced by emetics; and
it served to discharge bile when it was lodged in
the stomach. Nor did I rest the discharge of the
contents of the bowels on the issue of one cleansing
on the first day. There is, in all bilious fevers, a
reproduction of morbid bile as fast as it is discharged.
I therefore gave a purge every day while
the fever continued. I used castor oil, salts, cremor
tartar, and rhubarb (after the mercurial purges
had performed their office), according to the inclinations
of my patients, in all those cases where the
bowels were easily moved; but where this was
not the case, I gave a single dose of calomel and
jalap every day. Strong as this purge may be supposed
to be, it was often ineffectual; more especially
after the 20th of September, when the bowels
became more obstinately constipated. To supply
the place of the jalap, I now added gamboge to the
calomel. Two grains and a half of each, made into
a pill, were given to an adult every six hours,
until they procured four or five stools. I had other
designs in giving a purge every day, besides discharging
the re-accumulated bile. I had observed
the fever to fall with its principal force upon such
parts of the body as had been previously weakened
by any former disease. By creating an artificial
weak part in the bowels, I diverted the force of the
fever to them, and thereby saved the liver and brain
from fatal or dangerous congestions. The practice
was further justified by the beneficial effects
of a plentiful spontaneous diarrhœa in the beginning
of the disease[66]; by hæmorrhages from the
bowels, when they occurred from no other parts
of the body, and by the difficulty or impracticability
of reducing the system by means of plentiful
sweats. The purges seldom answered the intentions
for which they were given, unless they
produced four or five stools a day. As the fever
showed no regard to day or night in the hours of
its exacerbations, it became necessary to observe
the same disregard to time in the exhibition of
purges: I therefore prescribed them in the evening,
at all times when the patient had passed a day
without two or three plentiful stools. When
purges were rejected, or slow in their operation,
I always directed opening glysters to be given
every two hours. The effects of purging were as
follow:
1. It raised the pulse when low, and reduced it
when it was preternaturally tense or full.
2. It revived and strengthened the patient.
This was evident in many cases, in the facility with
which patients who had staggered to a close-stool,
walked back again to their beds after a copious
evacuation. Dr. Sydenham takes notice of a similar
increase of strength after a plentiful sweat in the
plague. They both acted by abstracting excess of
stimulus, and thereby removing the depression of
the system.
3. It abated the paroxysm of the fever. Hence
arose the advantage of giving a purge in some cases
in the evening, when an attack of the fever was expected
in the course of the night.
4. It frequently produced sweats when given on
the first or second day of the fever, after the most
powerful sudorifics had been taken to no purpose.
5. It sometimes checked that vomiting which
occurs in the beginning of the disease, and it always
assisted in preventing the more alarming occurrence
of that symptom about the 4th or 5th
day.
6. It removed obstructions in the lymphatic system.
I ascribe it wholly to the action of mercury,
that in no instance did any of the glandular
swellings, which I formerly mentioned, terminate
in a suppuration.
7. By discharging the bile through the bowels
as soon and as fast as it was secreted, it prevented,
in most cases, a yellowness of the skin.
However salutary the mercurial purge was, objections
were made to it by many of our physicians;
and prejudices, equally weak and ill-founded, were
excited against it. I shall enumerate, and answer
those objections.
1. It was said to be of too drastic a nature. It
was compared to arsenic; and it was called a dose
for a horse. This objection was without foundation.
Hundreds who took it declared they had
never taken so mild a purge. I met with but one
case in which it produced bloody stools; but I
saw the same effect from a dose of salts. It sometimes,
it is true, operated from twenty to thirty
times in the course of twenty-four hours; but I
heard of an equal number of stools in two cases
from salts and cremor tartar. It is not an easy
thing to affect life, or even subsequent health, by
copious or frequent purging. Dr. Kirkland mentions
a remarkable case of a gentleman who was
cured of a rheumatism by a purge, which gave
him between 40 and 50 stools. This patient had
been previously affected by his disease 16 or 18
weeks[67]. Dr. Mosely not only proves the safety,
but establishes the efficacy of numerous and copious
stools in the yellow fever. Dr. Say probably
owes his life to three and twenty stools procured
by a dose of calomel and gamboge, taken by
my advice. Dr. Redman was purged until he
fainted, by a dose of the same medicine. This
venerable gentleman, in whom 70 years had not
abated the ardour of humanity, nor produced obstinacy
of opinion, came forward from his retirement,
and boldly adopted the remedies of purging
and bleeding, with success in several families,
before he was attacked by the disease. His recovery
was as rapid, as the medicine he had used
was active in its operation. Besides taking the
above purge, he lost twenty ounces of blood by
two bleedings[68].
But who can suppose that a dozen or twenty
stools in a day could endanger life, that has seen
a diarrhœa continue for several months, attended
with fifteen or twenty stools every day, without
making even a material breach in the constitution?
Hence Dr. Hillary has justly remarked, that “it
rarely or never happens that the purging in this
disease, though violent, takes the patient off, but
the fever and inflammation of the bowels[69].” Dr.
Clark in like manner remarks, that evacuations do
not destroy life in the dysentery, but the fever, with
the emaciation and mortification which attend and
follow the disease[70].
2. A second objection to this mercurial purge
was, that it excited a salivation, and sometimes
loosened the teeth. I met with but two cases in
which there was a loss of teeth from the use of this
medicine, and in both the teeth were previously
loose or decayed. The salivation was a trifling
evil, compared with the benefit which was derived
from it. I lost only one patient in whom it occurred.
I was taught, by this accidental effect of
mercury, to administer it with other views than
merely to cleanse the bowels, and with a success
which added much to my confidence in the power
of medicine over this disease. I shall mention
those views under another head.
3. It was said that the mercurial purge excoriated
the rectum, and produced the symptoms of
pain and inflammation in that part, which were
formerly mentioned.
To refute this charge, it will be sufficient to
remark that the bile produces the same excoriation
and pain in the rectum in the bilious and yellow
fever, where no mercury has been given to discharge
it. In the bilious remitting fever which
prevailed in Philadelphia in 1780, we find the bile
which was discharged by “gentle doses of salts,
and cream of tartar, or the butternut pill, was so
acrid as to excoriate the rectum, and so offensive
as to occasion, in some cases, sickness and faintness
both in the patients, and in their attendants[71].”
Dr. Hume says further upon this subject, that
the rectum was so much excoriated by the natural
discharge of bile in the yellow fever, as to render
it impossible to introduce a glyster pipe into it.
4. It was objected to this purge, that it inflamed
and lacerated the stomach and bowels. In support
of this calumny, the inflamed and mortified appearances,
which those viscera exhibited upon dissection
in a patient who died at the hospital at Bush-hill,
were spoken of with horror in some parts of the
city. To refute this objection it will only be necessary
to review the account formerly given of the
state of the stomach and bowels after death from the
yellow fever, in cases in which no mercury had been
given. I have before taken notice that sir John
Pringle and Dr. Cleghorn had prescribed mercurial
purges with success in the dysentery, a disease in
which the bowels are affected with more irritation
and inflammation than in the yellow fever. Dr.
Clark informs us that he had adopted this practice.
I shall insert the eulogium of this excellent physician
upon the use of mercury in the dysentery in
his own words. “For several years past, when
the dysentery has resisted the common mode of
practice, I have administered mercury with the
greatest success; and am thoroughly persuaded
that it is possessed of powers to remove inflammation
and ulceration of the intestines, which are the
chief causes of death in this distemper[72].”
5. It was urged against this powerful and efficacious
medicine, that it was prescribed indiscriminately
in all cases, and that it did harm in all
weak habits. To this I answer, that there was
no person so weak by constitution or a previous
disease, as to be injured by a single dose of this
medicine. Mrs. Meredith, the wife of the treasurer
of the United States, a lady of uncommon
delicacy of constitution, took two doses of the
powder in the course of twelve hours, not only
without any inconvenience, but with an evident
increase of strength soon afterwards. Many similar
cases might be mentioned. Even children
took two or three doses of it with perfect safety.
This will not surprise those physicians who have
been in the practice of giving from ten to twenty
grains of mercury, with an equal quantity of jalap
as a worm purge, and from fifty to a hundred
grains of calomel, in the course of four or five
days, in the internal dropsy of the brain. But I
am happy in being able to add further, that many
women took it in every stage of pregnancy without
suffering the least inconvenience from it. Out
of a great number of pregnant women whom I attended
in this fever I did not lose one to whom I
gave this medicine, nor did any of them suffer an
abortion. One of them had twice miscarried in
the course of the two or three last years of her
life. She bore a healthy child three months after
her recovery from the yellow fever.
No one has ever objected to the indiscriminate
mode of preparing the body for the small-pox by
purging medicines. The uniform inflammatory
diathesis of that disease justifies the practice, in
a certain degree, in all habits. The yellow fever
admits of a sameness of cure much more than the
small-pox, for it is more uniformly and more highly
inflammatory. An observation of Dr. Sydenham
upon epidemics applies, in its utmost extent, to
our late fever. “Now it must be observed (says
this most acute physician) that some epidemic diseases,
in some years, are uniformly and constantly
the same[73].” However diversified our fever was
in some of its symptoms, it was in all cases accompanied
by more or less inflammatory diathesis, and
by a morbid state of the alimentary canal.
Much has been said of the bad effects of this
purge from its having been put up carelessly by
the apothecaries, or from its having been taken
contrary to the printed directions, by many people.
If it did harm in any one case (which I do
not believe) from the former of the above causes
the fault is not mine. Twenty men employed constantly
in putting up this medicine would not have
been sufficient to have complied with all the demands
which were made of me for it. Hundreds
who were in health called or sent for it as well as
the sick, in order to have it in readiness in case
they should be surprised by the disease in the
night, or at a distance from a physician.
In all the cases in which this purge was supposed
to have been hurtful, when given on the first
or second day of the disease, I believe it was because
it was not followed by repeated doses of the
same, or of some other purge, or because it was
not aided by blood-letting. I am led to make
this assertion, not only from the authority of Dr.
Sydenham, who often mentions the good effects
of bleeding in moderating or checking a diarrhœa,
but by having heard no complaints of patients
being purged to death by this medicine, after
blood-letting was universally adopted by all the
physicians in the city.
It was remarked that the demand for this purging
powder continued to increase under all opposition,
and that the sale of it by the apothecaries
was greatest towards the close of the disease. I
shall hereafter say that this was not the case with
the West-India remedies.
It is possible that this purge sometimes proved
hurtful when it was given on the fifth day of the
disease, but it was seldom given for the first time
after the third day, and when it was, the patient
was generally in such a situation that nothing did
him either good or harm.
I derived great pleasure from hearing, after the
fever had left the city, that calomel had been
given with success as a purge in bilious fevers in
other parts of the union besides Philadelphia. Dr.
Lawrence informed me that he had cured many
patients by it of the yellow fever which prevailed
in New-York, in the year 1791, and the New-York
papers have told us that several practitioners
had been in the habit of giving it in the autumnal
fevers, with great success, in the western parts of
that state. They had probably learned the use
of it from Dr. Young, who formerly practised in
that part of the United States, and who lost no
opportunity of making its praises public wherever
he went.
I have only to add to my account of that purging
medicine, that, under an expectation that the
yellow fever would mingle some of its bilious symptoms
with the common inflammatory fevers of the
winter and first spring months, I gave that purge
in the form of pills, in every case of inflammatory
fever to which I was called. The fatal issue of
several fevers in the city, during the winter, in
which this precaution had been neglected, convinced
me that my practice was proper and useful.
It is to be lamented that all new remedies are
forced to pass through a fiery ordeal. Opium and
bark were long the objects of terror and invective
in the schools of medicine. They were administered
only by physicians for many years, and that
too with all the solemnity of a religious ceremony.
This error, with respect to those medicines, has at
last passed away. It will, I hope, soon be succeeded
by a time when the prejudices against ten
and ten, or ten and fifteen, will sleep with the vulgar
fears which were formerly entertained of the
bark producing diseases and death, years after it
had been taken, by “lying in the bones.”
The theory of this fever which led me to
administer purges, determined me to use blood-letting,
as soon as it should be indicated. I am
disposed to believe that I was tardy in the use of
this remedy, and I shall long regret the loss of
three patients, who might probably have been saved
by it. I cannot blame myself for not having
used it earlier, for the immense number of patients
which poured in upon me, in the first week of September,
prevented my attending so much to each
of them, as was necessary to determine upon the
propriety of this evacuation. I was in the situation
of a surgeon in a battle, who runs to every call,
and only stays long enough with each soldier to stop
the bleeding of his wound, while the increase of
the wounded, and the unexpected length of the
battle, leave his original patients to suffer from the
want of more suitable dressings. The reasons
which determined me to bleed were,
1. The state of the pulse, which became more
tense, in proportion as the weather became cool.
2. The appearance of a moist and white tongue,
on the first day of the disease, a certain sign of an
inflammatory fever.
3. The frequency of hæmorrhages from every
part of the body, and the perfect relief given in
some cases by them.
4. The symptoms of congestion in the brain,
resembling those which occur in the first stage of
hydrocephalus internus, a disease in which I had
lately used bleeding with success.
5. The character of the diseases which had preceded
the yellow fever. They were all more or
less inflammatory. Even the scarlatina anginosa
had partaken so much of that diathesis, as to require
bleeding to subdue it.
6. The warm and dry weather which had likewise
preceded the fever. Dr. Sydenham attributes
a highly inflammatory state of the small-pox to a
previously hot and dry summer; and I have since
observed, that Dr. Hillary takes notice of inflammatory
fevers having frequently succeeded hot and
dry weather in Barbadoes[74]. He informs us further,
that the yellow fever is always most acute and
inflammatory after a very hot season[75].
7. The authority of Dr. Mosely had great weight
with me in advising the loss of blood, more especially
as his ideas of the highly inflammatory nature
of the fever accorded so perfectly with my own.
8. I was induced to prescribe blood-letting by
recollecting its good effects in Mrs. Palmer's son,
whom I bled on the 20th of August, and who appeared
to have been recovered by it.
Having begun to bleed, I was encouraged to
continue it by the appearance of the blood, and by
the obvious and very great relief my patients derived
from it.
The following is a short account of the appearances
of the blood drawn from a vein in this disease.
1. It was, in the greatest number of cases, without
any separation into crassamentum and serum,
and of a scarlet colour.
2. There was in many cases a separation of the
blood into crassamentum and yellow serum.
3. There were a few cases in which this separation
took place, and the serum was of a natural
colour.
4. There were many cases in which the blood
was as sizy as in pneumony and rheumatism.
5. The blood was in some instances covered
above with blue pellicle of sizy lymph, while the part
which lay in the bottom of the bowl was dissolved.
The lymph was in two cases mixed with green
streaks.
6. It was in a few instances of a dark colour,
and as fluid as molasses. I saw this kind of blood
in a man who walked about his house during the
whole of his sickness, and who finally recovered.
Both this, and the fifth kind of blood which has
been mentioned, occurred chiefly where bleeding
had been omitted altogether, or used too sparingly
in the beginning of the disease.
7. In some patients the blood, in the course of
the disease, exhibited nearly all the appearances
which have been mentioned. They were varied
by the time in which the blood was drawn, and by
the nature and force of the remedies which had been
used in the disease.
The effects of blood-letting upon the system were
as follow:
1. It raised the pulse when depressed, and quickened
it, when it was preternaturally slow, or subject
to intermissions.
2. It reduced its force and frequency.
3. It checked in many cases the vomiting which
occurred in the beginning of the disease, and thereby
enabled the stomach to retain the purging medicine.
It likewise assisted the purge in preventing
the dangerous or fatal vomiting which came on
about the fifth day.
4. It lessened the difficulty of opening the bowels.
Upon this account, in one of my addresses to
the citizens of Philadelphia, I advised bleeding to
be used before, as well as after taking the mercurial
purge. Dr. Woodhouse informed me that he
had several times seen patients call for the close-stool
while the blood was flowing from the vein.
5. It removed delirium, coma, and obstinate
wakefulness. It also prevented or checked hæmorrhages;
hence perhaps another reason why not
a single instance of abortion occurred in such of
my female patients as were pregnant.
6. It disposed, in some cases, to a gentle perspiration.
7. It lessened the sensible debility of the system;
hence patients frequently rose from their beds,
and walked across their rooms, in a few hours after
the operation had been performed.
8. The redness of the eyes frequently disappeared
in a few hours after bleeding. Mr. Coxe
observed a dilated pupil to contract to its natural
size within a few minutes after he had bound up
the arm of his patient. I remarked, in the former
part of this work, that blindness in many instances
attended or followed this fever. But two such
cases occurred among my patients. In one of
them it was of short continuance, and in the other
it was probably occasioned by the want of sufficient
bleeding. In every case of blindness that came to
my knowledge bleeding had been omitted, or used
only in a very moderate degree.
9. It eased pain. Thousands can testify this
effect of blood-letting. Many of my patients whom
I bled with my own hand acknowledged to me,
while the blood was flowing, that they were better;
and some of them declared, that all their pains
had left them before I had completely bound up
their arms.
10. But blood-letting had, in many cases, an
effect the opposite of easing pain. It frequently
increased it in every part of the body, more especially
in the head. It appeared to be the effect of
the system rising suddenly from a state of great
depression, and of an increased action of the blood-vessels
which took place in consequence of it. I
had frequently seen complaints of the breast, and
of the head, made worse by a single bleeding, and
from the same cause. It was in some cases an
unfortunate event in the yellow fever, for it prevented
the blood-letting being repeated, by exciting
or strengthening the prejudices of patients
and physicians against it. In some instances the
patients grew worse after a second, and, in one,
after a third bleeding. This was the case in Miss
Redman. Her pains increased after three bleedings,
but yielded to the fourth. Her father, Dr.
Redman, concurred in this seemingly absurd practice.
It was at this time my old preceptor in medicine
reminded me of Dr. Sydenham's remark,
that moderate bleeding did harm in the plague
where copious bleeding was indicated, and that in
the cure of that disease, we should leave nature
wholly to herself, or take the cure altogether out of
her hands. The truth of this remark was very
obvious. By taking away as much blood as restored
the blood-vessels to a morbid degree of
action, without reducing this action afterwards,
pain, congestion, and inflammation were frequently
increased, all of which were prevented, or occurred
in a less degree, when the system rose gradually
from the state of depression which had been
induced by the great force of the disease. Under
the influence of the facts and reasonings which
have been mentioned I bore the same testimony in
acute cases, against what was called moderate bleeding
that I did against bark, wine, and laudanum in
this fever.
11. Blood-letting, when used early on the first
day, frequently strangled the disease in its birth,
and generally rendered it more light, and the convalescence
more speedy and perfect. I am not
sure that it ever shortened the duration of the fever
where it was not used within a few hours of
the time of its attack. Under every mode of treatment
it seemed disposed, after it was completely
formed, to run its course. I was so satisfied of
this peculiarity in the fever, that I ventured in
some cases to predict the day on which it would
terminate, notwithstanding I took the cure entirely
out of the hands of nature. I did not lose a patient
on the third, whom I bled on the first or second
day of the disease.
12. In those cases which ended fatally, blood-letting
restored, or preserved the use of reason,
rendered death easy, and retarded the putrefaction
of the body after death.
I shall now mention some of the circumstances
which directed and regulated the use of this
remedy.
1. Where bleeding had been omitted for three
days, in acute cases, it was seldom useful. Where
purging had been used, it was sometimes successful.
I recovered two patients who had taken the
mercurial purges, whom I bled for the first time on
the seventh day. One of them was the daughter
of Mr. James Cresson, the other was a journeyman
ship-carpenter at Kensington. In those cases
where bleeding had been used on the first day, it
was both safe and useful to repeat it every day afterwards,
during the continuance of the fever.
2. I preferred bleeding in the exacerbation of
the fever. The remedy here was applied when the
disease was in its greatest force. A single paroxysm
was like a sudden squall to the system, and,
unless abated by bleeding or purging, often produced
universal disorganization. I preferred the
former to the latter remedy in cases of great danger,
because it was more speedy, and more certain
in its operation.
3. I bled in several instances in the remission of
the fever, where the pulse was tense and corded.
It lessened the violence of the succeeding paroxysm.
4. I bled in all those cases in which the pulse
was preternaturally slow, provided it was tense.
Mr. Benj. W. Morris, Mr. Thomas Wharton,
jun. and Mr. Wm. Sansom, all owe their lives
probably to their having been bled in the above
state of the pulse. I was led to use bleeding in
this state of the pulse, not only by the theory of the
disease which I had adopted, but by the success
which had often attended this remedy, in a slow
and depressed state of the pulse in apoplexy and
pneumony. I had moreover the authority of Dr.
Mosely in its favour, in the yellow fever, and of
Dr. Sydenham, in his account of a new fever,
which appeared in the year 1685. The words of
the latter physician are so apposite to the cases
which have been mentioned, that I hope I shall be
excused for inserting them in this place. “All
the symptoms of weakness (says our author) proceed
from nature's being in a manner oppressed
and overcome by the first attack of the disease, so
as not to be able to raise regular symptoms adequate
to the violence of the fever. I remember to
have met with a remarkable instance of this, several
years ago, in a young man I then attended; for
though he seemed in a manner expiring, yet the
outward parts felt so cool, that I could not persuade
the attendants he had a fever, which could not disengage,
and show itself clearly, because the vessels
were so full as to obstruct the motion of the blood.
However, I said, that they would soon find the fever
rise high enough upon bleeding him. Accordingly,
after taking away a large quantity of blood, as
violent a fever appeared as ever I met with, and
did not go off till bleeding had been used three or
four times[76].”
5. I bled in those cases in which the fever appeared
in a tertian form, provided the pulse was
full and tense. I well recollect the surprise with
which Mr. Van Berkel heard this prescription
from me, at a time when he was able to walk and
ride out on the intermediate days of a tertian fever.
The event which followed this prescription showed
that it was not disproportioned to the violence of
his disease, for it soon put on such acute and inflammatory
symptoms as to require six subsequent
bleedings to subdue it.
6. I bled in those cases where patients were able
to walk about, provided the pulse was the same as
has been mentioned under the fourth head. I was
determined as to the propriety of bleeding in these
two supposed mild forms of the fever, by having
observed each of them, when left to themselves,
frequently to terminate in death.
7. I paid no regard to the dissolved state of the
blood, when it appeared on the first or second day
of the disease, but repeated the bleedings afterwards
in every case, where the pulse continued to
indicate it. It was common to see sizy blood succeed
that which was dissolved. This occurred in
Mr. Josiah Coates, and Mr. Samuel Powel. Had
I believed that this dissolved state of the blood
arose from its putrefaction, I should have laid aside
my lancet as soon as I saw it; but I had long ago
parted with all ideas of putrefaction in bilious fevers.
The refutation of this doctrine was the object of
one of my papers in the Medical Society of Edinburgh,
in the year 1767. The dissolved appearance
of the blood, I suppose to be the effect of a
certain action of the blood-vessels upon it. It occurs
in fevers which depend upon the sensible qualities
of the air, and in which no putrid or foreign
matter has been introduced into the system.
8. The presence of petechiæ did not deter me
from repeating blood-letting, where the pulse retained
its fulness or tension. I prescribed it with
success in the cases of Dr. Mease, and of Mrs. Gebler,
in Dock-street, in each of whom petechiæ had
appeared. Bleeding was equally effectual in the
case of the Rev. Mr. Keating, at a time when his
arms were spotted with that species of eruptions
which I have compared to moscheto-bites. I had
precedents in Dr. De Haen[77] and Dr. Sydenham[78],
in favour of this practice. So far from viewing
these eruptions as signs of putrefaction, I considered
them as marks of the highest possible inflammatory
diathesis. They disappeared in each of the
above cases after bleeding.
9. In determining the quantity of blood to be
drawn, I was governed by the state of the pulse,
and by the temperature of the weather. In the
beginning of September, I found one or two moderate
bleedings sufficient to subdue the fever;
but in proportion as the system rose by the diminution
of the stimulus of heat, and the fever put
on more visible signs of inflammatory diathesis,
more frequent bleedings became necessary. I
bled many patients twice, and a few three times
a day. I preferred frequent and small, to large
bleedings, in the beginning of September; but towards
the height and close of the epidemic, I saw
no inconvenience from the loss of a pint, and even
twenty ounces of blood at a time. I drew from
many persons seventy and eighty ounces in five
days; and from a few, a much larger quantity.
Mr. Gribble, cedar-cooper, in Front-street, lost by
ten bleedings a hundred ounces of blood; Mr.
George, a carter in Ninth-street, lost about the
same quantity by five bleedings; and Mr. Peter
Mierken, one hundred and fourteen ounces in five
days. In the last of the above persons the quantity
taken was determined by weight. Mr. Toy,
blacksmith near Dock-street, was eight times bled
in the course of seven days. The quantity taken
from him was about a hundred ounces. The
blood in all these cases was dense, and in the last,
very sizy. They were all attended in the month
of October, and chiefly by my pupil, Mr. Fisher;
and they were all, years afterwards, living and
healthy instances of the efficacy of copious blood-letting,
and of the intrepidity and judgment of their
young physician. Children, and even old people,
bore the loss of much more blood in this fever than
in common inflammatory fevers. I took above
thirty ounces, in five bleedings, from a daughter
of Mr. Robert Bridges, who was then in the 9th
year of her age. Even great debility, whether natural
or brought on by previous diseases, did not,
in those few cases in which it yielded to the fever,
deprive it of the uniformity of its inflammatory
character. The following letter from Dr. Griffitts,
written soon after his recovery from a third attack
of the fever, and just before he went into the
country for the re-establishment of his health, will
furnish a striking illustration of the truth of the
above observation.
“I cannot leave town without a parting adieu
to my kind friend, and sincere prayers for his preservation.
“I am sorry to find that the use of the lancet
is still so much dreaded by too many of our physicians;
and, while lamenting the death of a valuable
friend this morning, I was told that he was bled
but once during his disease. Now if my poor
frame, reduced by previous sickness, great anxiety,
and fatigue, and a very low diet, could bear seven
bleedings in five days, besides purging, and no
diet but toast and water, what shall we say of physicians
who bleed but once?
“October 19th, 1793.”
I have compared a paroxysm of this fever to a
sudden squall; but the disease in its whole course
was like a tedious equinoctial gale acting upon a
ship at sea; its destructive force was only to be opposed
by handing every sail, and leaving the system
to float, as it were, under bare poles. Such
was the fragility (if I may be allowed the expression)
of the blood-vessels, that it was necessary to
unload them of their contents, in order to prevent
the system sinking from hæmorrhages, or from
effusions in the viscera, particularly the brain.
9. Such was the indomitable nature of the pulse,
in some patients, that it did not lose its force after
numerous and copious bleedings. In all such
cases I considered the diminution of its frequency,
and the absence of a vomiting, as signals to lay
aside the lancet. The continuance of this preternatural
force in the pulse appeared to be owing to
the miasmata, which were universally diffused in
the air, acting upon the arterial system in the same
manner that it did in persons who were in apparent
good health.
Thus have I mentioned the principal circumstances
which were connected with blood-letting
in the cure of the yellow fever. I shall now consider
the objections that were made to it at the
time, and since the prevalence of the fever.
It was said that the bleeding was unnecessarily
copious; and that many had been destroyed by it.
To this I answer, that I did not lose a single patient
whom I bled seven times or more in this fever.
As a further proof that I did not draw an
ounce of blood too much it will only be necessary
to add, that hæmorrhages frequently occurred after
a third, a fourth, and in one instance (in the
only son of Mr. William Hall) after a sixth bleeding
had been used; and further, that not a single
death occurred from natural hæmorrhages in the
first stage of the disease. A woman, who had
been bled by my advice, awoke the night following
in a bath of her blood, which had flowed from
the orifice in her arm. The next day she was
free from pain and fever. There were many recoveries
in the city from similar accidents. There
were likewise some recoveries from copious natural
hæmorrhages in the more advanced stages of
the disease, particularly when they occurred from
the stomach and bowels. I left a servant maid of
Mrs. Morris's, in Walnut-street, who had discharged
at least four pounds of blood from her
stomach, without a pulse, and with scarcely a
symptom that encouraged a hope of her life; but
the next day I had the pleasure of finding her out
of danger.
It was remarked that fainting was much less
common after bleeding in this fever than in common
inflammatory fevers. This circumstance was
observed by Dr. Griffitts, as well as myself. It
has since been confirmed to me by three of the
principal bleeders in the city, who performed the
operation upwards of four thousand times. It occurred
chiefly in those cases where it was used for
the first time on the third or fourth day of the disease.
A swelling of the legs, moreover, so common
after plentiful bleeding in pneumony and
rheumatism, rarely succeeded the use of this remedy
in the yellow fever.
2. Many of the indispositions, and much of the
subsequent weakness of persons who had been
cured by copious blood-letting, have been ascribed
to it. This is so far from being true that the reverse
of it has occurred in many cases. Mr. Mierken
worked in his sugar-house, in good health,
nine days after his last bleeding; and Mr. Gribble
and Mr. George seemed, by their appearance, to
have derived fresh vigour from their evacuations.
I could mention the names of many people who
assured me their constitutions had been improved
by the use of those remedies; and I know several
persons in whom they have carried off habitual
complaints. Mr. Richard Wells attributed his
relief from a chronic rheumatism to the copious
bleeding and purging which were used to cure
him of the yellow fever; and Mr. William Young,
the bookseller, was relieved of a chronic pain in
his side, by means of the same remedies.
3. It was said, that blood-letting was prescribed
indiscriminately in all cases, without any regard to
age, constitution, or the force of the disease. This
is not true, as far as it relates to my practice. In
my prescriptions for patients whom I was unable
to visit, I advised them, when they were incapable
of judging of the state of the pulse, to be guided in
the use of bleeding, by the degrees of pain they
felt, particularly in the head; and I seldom advised
it for the first time, after the second or third day
of the disease.
In pneumonies which affect whole neighbourhoods
in the spring of the year, bleeding is the
universal remedy. Why should it not be equally
so, in a fever which is of a more uniform inflammatory
nature, and which tends more rapidly to
effusions, in parts of the body much more vital
than the lungs?
I have before remarked, that the debility which
occurs in the beginning of the yellow fever, arises
from a depressed state of the system. The debility
in the plague is of the same nature. It has long
been known that debility from the sudden abstraction
of stimuli is to be removed by the gradual
application of stimuli, but it has been less observed,
that the excess of stimulus in the system is best
removed in a gradual manner, and that too in proportion
to the degrees of depression, which exist
in the system.
This principle in the animal economy has been
acknowledged by the practice of occasionally stopping
the discharge of water from a canula in tapping,
and of blood from a vein, in order to prevent
fainting.
Child-birth induces fainting, and sometimes
death, only by the sudden abstraction of the stimulus
of distention and pain.
In all those cases where purging or bleeding have
produced death in the yellow fever or plague, when
they have been used on the first or second day of
those diseases, I suspect that it was occasioned by
the quantity of the stimulus abstracted being disproportioned
to the degrees of depression in the
system. The following facts will I hope throw
light upon this subject.
1. Dr. Hodges informs us, that “although
blood could not be drawn in the plague, even in
the smallest quantity without danger, yet a hundred
times the quantity of fluids was discharged in
pus from buboes without inconvenience[79].”
2. Pareus, after condemning bleeding in the
plague, immediately adds an account of a patient,
who was saved by a hæmorrhage from the nose,
which continued two days[80].
3. I have before remarked that bleeding proved
fatal in three cases in the yellow fever, in the
month of August; but at that time I saw one, and
heard of another case, in which death seemed to
have been prevented by a bleeding at the nose.
Perhaps the uniform good effects which were observed
to follow a spontaneous hæmorrhage from
an orifice in the arm, arose wholly from the gradual
manner in which the stimulus of the blood
was in this way abstracted from the body. Dr.
Williams relates a case of the recovery of a gentleman
from the yellow fever, by means of small
hæmorrhages, which continued three days, from
wounds in his shoulders made by being cupped.
He likewise mentions several other recoveries by
hæmorrhages from the nose, after “a vomiting
of black humours and a hiccup had taken
place[81].”
4. There is a disease in North-Carolina, known
among the common people by the name of the
“pleurisy in the head.” It occurs in the winter,
after a sickly autumn, and seems to be an evanescent
symptom of a bilious remitting fever. The
cure of it has been attempted by bleeding, in the
common way, but generally without success. It
has, however, yielded to this remedy in another
form, that is, to the discharge of a few ounces of
blood obtained by thrusting a piece of quill up the
nose.
5. Riverius describes a pestilential fever which
prevailed at Montpellier, in the year 1623, which
carried off one half of all who were affected by
it[82]. After many unsuccessful attempts to cure it,
this judicious physician prescribed the loss of two
or three ounces of blood. The pulse rose with
this small evacuation. Three or four hours afterwards
he drew six ounces of blood from his patients,
and with the same good effect. The next
day he gave a purge, which, he says, rescued his
patients from the grave. All whom he treated
in this manner recovered. The whole history of
this epidemic is highly interesting, from its agreeing
with our late epidemic in so many of its symptoms,
more especially as they appeared in the different
states of the pulse.
An old and intelligent citizen of Philadelphia,
who remembers the yellow fever of 1741, says
that when it first made its appearance bleeding
was attended with fatal consequences. It was laid
aside afterwards, and the disease prevailed with
great mortality until it was checked by the cold
weather. Had blood been drawn in the manner
mentioned by Riverius, or had it been drawn in
the usual way, after the abstraction of the stimulus
of heat by the cool weather, the disease might
probably have been subdued, and the remedy of
blood-letting thereby have recovered its character.
Dr. Hodges has another remark, in his account
of the plague in London in the year 1665, which
is still more to our purpose than the one which I
have quoted from it upon this subject. He says
that “bleeding, as a preventive of the plague, was
only safe and useful when the blood was drawn by
a small orifice, and a small quantity taken at different
times[83].”
I have remarked, in the history of this fever,
that it was often cured on the first or second day
by a copious sweat. The Rev. Mr. Ustick was
one among many whom I could mention, who
were saved from a violent attack of the fever by
this evacuation. It would be absurd to suppose
that the miasmata which produced the disease
were discharged in this manner from the body.
The sweat seemed to cure the fever only by
lessening the quantity of the fluids, and thus gradually
removing the depression of the system.
The profuse sweats which sometimes cure the
plague, as well as the disease which is brought on
by the bite of poisonous snakes, seem to act in the
same way.
The system, in certain states of malignant fever,
resembles a man struggling beneath a load of two
hundred weight, who is able to lift but one hundred
and seventy-five. In order to assist him it
will be to no purpose to attempt to infuse additional
vigour into his muscles by the use of a whip
or of strong drink. Every exertion will serve only
to waste his strength. In this situation (supposing
it impossible to divide the weight which confines
him to the ground) let the pockets of this man be
emptied of their contents, and let him be stripped
of so much of his clothing as to reduce his weight
five and twenty or thirty pounds. In this situation
he will rise from the ground; but if the
weights be abstracted suddenly, while he is in an
act of exertion, he will rise with a spring that will
endanger a second fall, and probably produce a
temporary convulsion in his system. By abstracting
the weights from his body more gradually, he
will rise by degrees from the ground, and the system
will accommodate itself in such a manner to
the diminution of its pressure, as to resume its
erect form, without the least deviation from the
natural order of its appearance and motions.
It has been said that the stimulating remedies of
bark, wine, and the cold bath, were proper in our
late epidemic in August, and in the beginning of
September, but that they were improper afterwards.
If my theory be just, they were more
improper in August and the beginning of September,
than they were after the disease put on the
outward and common signs of inflammatory diathesis.
The reason why a few strong purges cured
the disease at its first appearance, was, because
they abstracted in a gradual manner some of the
immense portion of stimulus under which the arterial
system laboured, and thus gradually relieved
it from its low and weakening degrees of depression.
Bleeding was fatal in these cases, probably because
it removed this depression in too sudden a manner.
The principle of the gradual abstraction, as well
as of the gradual application of stimuli to the body,
opens a wide field for the improvement of medicine.
Perhaps all the discoveries of future ages will consist
more in a new application of established principles,
and in new modes of exhibiting old medicines,
than in the discovery of new theories, or of
new articles of the materia medica.
The reasons which induced me to prescribe
purging and bleeding, in so liberal a manner, naturally
led me to recommend cool and fresh air
to my patients. The good effects of it were obvious
in almost every case in which it was applied.
It was equally proper whether the arterial system
was depressed, or whether it discovered, in the
pulse, a high degree of morbid excitement. Dr.
Griffitts furnished a remarkable instance of the
influence of cool air upon the fever. Upon my
visiting him, on the morning of the 8th of October,
I found his pulse so full and tense as to indicate
bleeding, but after sitting a few minutes by
his bed-side, I perceived that the windows of his
room had been shut in the night by his nurse, on
account of the coldness of the night air. I desired
that they might be opened. In ten minutes afterwards
the doctor's pulse became so much slower
and weaker that I advised the postponement of
the bleeding, and recommended a purge instead of
it. The bleeding notwithstanding became necessary,
and was used with great advantage in the afternoon
of the same day.
The cool air was improper only in those cases
where a chilliness attended the disease.
For the same reason that I advised cool air, I
directed my patients to use cold drinks. They
consisted of lemonade, tamarind, jelly and raw
apple water, toast and water, and of weak balm,
and camomile tea. The subacid drinks were preferred
in most cases, as being not only most agreeable
to the taste, but because they tended to compose
the stomach. All these drinks were taken in
the early stage of the disease. Towards the close
of it, I permitted the use of porter and water, weak
punch, and when the stomach would bear it, weak
wine-whey.
I forbade all cordial and stimulating food in the
active state of the arterial system. The less my
patients ate, of even the mildest vegetable food,
the sooner they recovered. Weak coffee, which
(as I have formerly remarked) was almost universally
agreeable, and weak tea were always inoffensive.
As the action of the pulse diminished, I indulged
my patients with weak chocolate; also
with milk, to which roasted apples, or minced
peaches, and (where they were not to be had),
bread or Indian mush were added.
Towards the crisis, I advised the drinking of
weak chicken, veal, or mutton broth, and after the
crisis had taken place, I permitted mild animal food
to be eaten in a small quantity, and to be increased
according to the waste of the excitability of the
system. This strict abstinence which I imposed
upon my patients did not escape obloquy; but the
benefits they derived from it, and the ill effects
which arose in many cases from a contrary regimen,
satisfied me that it was proper in every case
in which it was prescribed.
Cold water was a most agreeable and powerful
remedy in this disease. I directed it to be applied
by means of napkins to the head, and to be injected
into the bowels by way of glyster. It gave the
same ease to both, when in pain, which opium
gives to pain from other causes. I likewise advised
the washing of the face and hands, and sometimes
the feet, with cold water, and always with
advantage. It was by suffering the body to lie for
some time in a bed of cold water, that the inhabitants
of the island of Massuah cured the most violent
bilious fevers[84]. When applied in this way,
it gradually abstracts the heat from the body, and
thereby lessens the action of the system. It differs
as much in its effects upon the body from the cold
bath, as rest in a cold room, differs from exercise
in the cold and open air.
I was first led to the practice of the partial application
of cold water to the body, in fevers of
too much force in the arterial system, by observing
its good effects in active hæmorrhages, and by
recollecting the effects of a partial application of
warm water to the feet, in fevers of an opposite
character. Cold water when applied to the feet as
certainly reduces the pulse in force and frequency,
as warm water, applied in the same way, produces
contrary effects upon it. In an experiment
which was made at my request, by one of my
pupils, by placing his feet in cold pump water for
a few minutes, the pulse was reduced 24 strokes
in a minute, and became so small as hardly to be
perceptible.
But this effect of cold water, in reducing the
frequency of the pulse, is not uniform. In weak
and irritable habits, it increases its frequency. This
has been fully proved by a number of experiments,
made by my former pupil, Dr. Stock, of Bristol,
in England, and published in his “Medical Collections
of the Effects of Cold, as a Remedy in certain
Diseases[85].”
In the use of the remedies which were necessary
to overcome the inflammatory action of the system,
I was obliged to reduce it below its natural point
of excitement. In the present imperfect state of
our knowledge in medicine, perhaps no disease of
too much action can be cured without it.
Besides the remedies which have been mentioned,
I was led to employ another of great efficacy.
I had observed a favourable issue of the
fever, in every case in which a spontaneous discharge
took place from the salivary glands. I had
observed further, that all such of my patients (one
excepted) as were salivated by the mercurial purges
recovered in a few days. This early suggested an
idea to me that the calomel might be applied to
other purposes than the discharging of bile from
the bowels. I ascribed its salutary effects, when
it salivated in the first stage of the disease, to the
excitement of inflammation and effusion in the
throat, diverting them from more vital parts of the
body. In the second stage of the disease, I was
led to prescribe it as a stimulant, and, with a view
of obtaining this operation from it, I aimed at exciting
a salivation, as speedily as possible, in all
cases. Two precedents encouraged me to make
trial of this remedy.
In the month of October, 1789, I attended a gentleman
in a bilious fever, which ended in many of
the symptoms of a typhus mitior. In the lowest
state of his fever, he complained of a pain in his
right side, for which I ordered half an ounce of
mercurial ointment to be rubbed on the part affected.
The next day, he complained of a sore
mouth, and, in the course of four and twenty hours,
he was in a moderate salivation. From this time
his pulse became full and slow, and his skin moist;
his sleep and appetite suddenly returned, and in a
day or two he was out of danger. The second
precedent for a salivation in a fever, which occurred
to me, was in Dr. Haller's short account of the
works of Dr. Cramer[86]. The practice was moreover
justified, in point of safety, as well as the probability
of success, by the accounts which Dr.
Clark has lately given of the effects of a salivation
in the dysentery[87]. I began by prescribing the
calomel in small doses, at short intervals, and afterwards
I directed large quantities of the ointment to
be rubbed upon the limbs. The effects of it, in
every case in which it affected the mouth, were
salutary. Dr. Woodhouse improved upon my method
of exciting the salivation, by rubbing the
gums with calomel, in the manner directed by Mr.
Clare. It was more speedy in its operation in this
way than in any other, and equally effectual. Several
persons appeared to be benefited by the mercury
introduced into the system in the form of an
ointment, where it did not produce a salivation.
Among these, were the Rev. Dr. Blackwell, and
Mr. John Davis.
Soon after the above account was written of the
good effects of a mercurial salivation in this fever,
I had great satisfaction in discovering that it had
been prescribed with equal, and even greater success,
by Dr. Wade in Bengal, in the year 1791,
and by Dr. Chisholm in the island of Granada, in
the cure of bilious yellow fevers[88]. Dr. Wade did
not lose one, and Dr. Chisholm lost only one out of
forty-eight patients in whom the mercury affected
the salivary glands. The latter gave 150 grains of
calomel, and applied the strongest mercurial ointment
below the groin of each side, in some cases.
He adds further, that not a single instance of a relapse
occurred, where the disease was cured by salivation.
After the reduction of the system, blisters were
applied with great advantage to every part of the
body. They did most service when they were applied
to the crown of the head. I did not see a
single case, in which a mortification followed the
sore, which was created by a blister.
Brandy and water, or porter and water, when
agreeable to the stomach, with now and then a cup
of chicken broth, were the drinks I prescribed to
assist in restoring the tone of the system.
In some cases I directed the limbs to be wrapped
in flannels dipped in warm spirits, and cataplasms
of bruised garlic to be applied to the feet. But
my principal dependence, next to the use of mercurial
medicines, for exciting a healthy action in
the arterial system, was upon mild and gently stimulating
food. This consisted of rich broths, the
flesh of poultry, oysters, thick gruel, mush and
milk, and chocolate. I directed my patients to
eat or drink a portion of some of the above articles
of diet every hour or two during the day, and in cases
of great debility, from an exhausted state of the
system, I advised their being waked for the same
purpose two or three times in the night. The appetite
frequently craved more savoury articles of
food, such as beef-stakes and sausages; but they
were permitted with great caution, and never till
the system had been prepared for them by a less
stimulating diet.
There were several symptoms which were very
distressing in this disease, and which required a
specific treatment.
For the vomiting, with a burning sensation in
the stomach, which came on about the fifth day,
I found no remedy equal to a table spoonful of
sweet milk, taken every hour, or to small draughts
of milk and water. I was led to prescribe this
simple medicine from having heard, from a West-India
practitioner, and afterwards read, in Dr.
Hume's account of the yellow fever, encomiums
upon the milk of the cocoa-nut for this troublesome
symptom. Where sweet milk failed of giving
relief, I prescribed small doses of sweet oil, and
in some cases a mixture of equal parts of milk,
sweet oil, and molasses. They were all intended
to dilute or blunt the acrimony of the humours,
which were either effused or generated in the stomach.
Where they all failed of checking the vomiting,
I prescribed weak camomile tea, or porter,
or cyder and water, with advantage. In some of
my patients the stomach rejected all the mixtures
and liquors which have been mentioned. In such
cases I directed the stomach to be left to itself for
a few hours, after which it sometimes received and
retained the drinks that it had before rejected, provided
they were administered in a small quantity at
a time.
The vomiting was sometimes stopped by a blister
applied to the external region of the stomach.
A mixture of liquid laudanum and sweet oil,
applied to the same place, gave relief where the
stomach was affected by pain only, without a vomiting.
I have formerly mentioned that a distressing
pain often seized the lower part of the bowels. I
was early taught that laudanum was not a proper
remedy for it. It yielded in almost every case to
two or three emollient glysters, or to the loss of a
few ounces of blood.
The convalescence from this fever was in general
rapid, but in some cases it was very slow.
I was more than usually struck by the great resemblance
which the system in the convalescence
from this fever bore to the state of the body and
mind in old age. It appeared, 1. In the great
weakness of the body, more especially of the
limbs. 2. In uncommon depression of mind, and
in a great aptitude to shed tears. 3. In the absence
or short continuance of sleep. 4. In the frequent
occurrence of appetite, and, in some cases,
in its inordinate degrees. And 5. In the loss of the
hair of the head, or in its being suddenly changed
in some cases to a grey colour.
Pure air, gentle exercise, and agreeable society
removed the debility both of body and mind of this
premature and temporary old age. I met with a
few cases, in which the yellow colour continued
for several weeks after the patient's recovery from
all the other symptoms of the fever. It was removed
most speedily and effectually by two or
three moderate doses of calomel and rhubarb.
A feeble and irregular intermittent was very
troublesome in some people, after an acute attack
of the fever. It yielded gradually to camomile or
snake-root tea, and country air.
In a publication, dated the 16th of September,
I recommended a diet of milk and vegetables, and
cooling purges to be taken once or twice a week,
to the citizens of Philadelphia. This advice was
the result of the theory of the disease I had adopted,
and of the successful practice which had arisen
from it. In my intercourse with my fellow-citizens,
I advised this regimen to be regulated by
the degrees of fatigue and foul air to which they
were exposed. I likewise advised moderate blood-letting
to all such persons as were of a plethoric
habit. To men whose minds were influenced by
the publications in favour of bark and wine, and
who were unable at that time to grasp the extent
and force of the remote cause of this terrible fever,
the idea of dieting, purging, or bleeding the inhabitants
of a whole village or city appeared to be
extravagant and absurd: but I had not only the
analogy of the regimen made use of to prepare the
body for the small-pox, but many precedents in favour
of the advice. Dr. Haller has given extracts
from the histories of two plagues, in which the
action of the miasmata was prevented or mitigated
by bleeding[89]. Dr. Hodges confirms the utility of
the same practice. The benefits of low diet, as a
preventive of the plague, were established by many
authors, long before they received the testimony of
the benevolent Mr. Howard in their favour. Socrates
in Athens, and Justinian in Constantinople,
were preserved, by means of their abstemious modes
of living, from the plagues which occasionally ravaged
those cities. By means of the low diet,
gentle physic, and occasional bleedings, which I
thus publicly recommended, the disease was prevented
in many instances, or rendered mild where
it was taken. But my efforts to prevent the disease
in my fellow-citizens did not end here. I advised
them, not only in the public papers, but in my intercourse
with them, to avoid heat, cold, labour,
and every thing else that could excite the miasmata
(which I knew to be present in all their bodies)
into action. I forgot, upon this occasion, the usual
laws which regulate the intercourse of man with
man in the streets, and upon the public roads, in
my excursions into the neighbourhood of the city.
I cautioned many persons, whom I saw walking or
riding in an unsafe manner, of the danger to which
they exposed themselves; and thereby, I hope,
prevented an attack of the disease in many people.
It was from a conviction of the utility of low
diet, gentle evacuations, and of carefully shunning
all the exciting causes which I have mentioned,
that I concealed, in no instance, from my patients
the name of their disease. This plainness, which
was blamed by weak people, produced strict obedience
to my directions, and thereby restrained the
progress of the fever in many families, or rendered
it, when taken, as mild as inoculation does the
small-pox. The opposite conduct of several physicians,
by preventing the above precautions, increased
the mortality of the disease, and, in some
instances, contributed to the extinction of whole
families.
I proceed now to make a few remarks upon the
remedies recommended by Doctors Kuhn and Stevens,
and by the French physicians. The former
were bark, wine, laudanum, spices, the elixir of
vitriol, and the cold bath.
In every case in which I prescribed bark, it was
offensive to the stomach. In several tertians which
attended the convalescence from a common attack
of the fever, I found it always unsuccessful, and
once hurtful. Mr. Willing took it for several
weeks without effect. About half a pint of a weak
decoction of the bark produced, in Mr. Samuel
Meredith, a paroxysm of the fever, so violent as to
require the loss of ten ounces of blood to moderate
it. Dr. Annan informed me that he was forced to
bleed one of his patients twice, after having given
him a small quantity of bark, to hasten his convalescence.
It was not in this epidemic only that the bark
was hurtful. Baron Humboldt informed me, that
Dr. Comoto had assured him, it hastened death in
every case in which it was given in the yellow fever
of Vera Cruz. If, in any instance, it was inoffensive,
or did service, in our fever, I suspect it must
have acted upon the bowels as a purge. Dr. Sydenham
says the bark cured intermittents by this
evacuation[90]; and Mr. Bruce says it operated in
the same way, when it cured the bilious fevers at
Massuah.
Wine was nearly as disagreeable as the bark to
the stomach, and equally hurtful. I tried it in
every form, and of every quality, but without success.
It was either rejected by the stomach, or
produced in it a burning sensation. I should suspect
that I had been mistaken in my complaints
against wine, had I not since met with an account
in Skenkius of its having destroyed all who took
it in the famous Hungarian fever, which prevailed,
with great mortality, over nearly every country in
Europe, about the middle of the 16th century[91].
Dr. Wade declares wine to be “ill adapted to the
fevers of Bengal, where the treatment has been
proper in other respects.”
Laudanum has been called by Dr. Mosely “a
fatal medicine” in the yellow fever. In one of my
patients, who took only fifteen drops of it, without
my advice, to ease a pain in his bowels, it produced
a delirium, and death in a few hours. I
was much gratified in discovering that my practice,
with respect to the use of opium in this fever,
accorded with Dr. Wade's in the fever of Bengal.
He tells us, “that it was mischievous in
almost every instance, even in combination with
antimonials.”
The spices were hurtful in the first stage of the
fever, and, when sufficient evacuations had been
used, they were seldom necessary in its second.
The elixir of vitriol was, in general, offensive
to the stomach.
The cold bath was useful in those cases where
its sedative prevailed over its stimulating effects.
But this could not often happen, from the suddenness
and force, with which the water was thrown
upon the body. In two cases in which I prescribed
it, it produced a gentle sweat, but it did not save
life. In a third it removed a delirium, and reduced
the pulse for a few minutes, in frequency and force,
but this patient died. The recommendation of it
indiscriminately, in all cases, was extremely improper.
In that chilliness and tendency to fainting
upon the least motion, which attended the disease
in some patients, it was an unsafe remedy. I
heard of a woman who was seized with delirium
immediately after using it, from which she never
recovered; and of a man who died a few minutes
after he came out of a bathing tub. Had this remedy
been the exclusive antidote to the yellow
fever, the mortality of the disease would have been
but little checked by it. Thousands must have
perished from the want of means to procure tubs,
and of a suitable number of attendants to apply the
water, and to lift the patient in and out of bed.
The reason of our citizens ran before the learning
of the friends of this remedy, and long before it
was abandoned by the physicians, it was rejected
as useless, or not attempted, because impracticable,
by the good sense of the city. It is to be lamented
that the remedy of cold water has suffered in its
character by the manner in which it was advised.
In fevers of too much action, it reduces the morbid
excitement of the blood-vessels, provided it be
applied without force, and for a considerable time,
to the body. It is in the jail fever, and in the second
stage of the yellow fever only, in which its
stimulant and tonic powers are proper. Dr. Jackson
establishes this mode of using it, by informing
us, that when it did service, it “gave vigour and
tone” to the system[92].
A mode of practice which I formerly mentioned
in this fever, consisted of a union of the evacuating
and tonic remedies. The physicians who adopted
this mode gave calomel by itself, in small doses, on
the first or second day of the fever, bled once or
twice, in a sparing manner, and gave the bark,
wine, and laudanum, in large quantities, upon the
first appearance of a remission. After they began
the use of these remedies purging was omitted,
or, if the bowels were moved, it was only by
means of gentle glysters. This practice, I shall
say hereafter, was not much more successful than
that which was recommended by Dr. Kuhn and
Dr. Stevens. It resembled throwing water and oil
at the same time upon a fire, in order to extinguish
it.
The French remedies were nitre and cremor
tartar, in small doses, centaury tea, camphor, and
several other warm medicines; subacid drinks,
taken in large quantities, the warm bath, and moderate
bleeding.
After what has been said it must be obvious to
the reader, that the nitre and cremor tartar, in small
doses, could do no good, and that camphor and all
cordial medicines must have done harm. The
diluting subacid drinks, which the French physicians
gave in large quantities, were useful in diluting
and blunting the acrimony of the bile, and to
this remedy, assisted by occasional bleeding, I ascribe
most of the cures which were performed by
those physicians.
Those few persons in whom the warm bath produced
copious and universal sweats recovered, but,
in nearly all the cases which came under my notice,
it did harm.
I come now to inquire into the comparative success
of all the different modes of practice which
have been mentioned.
I have already said that ten out of thirteen patients
whom I treated with bark, wine, and laudanum,
and that three out of four, in whom I added
the cold bath to those remedies, died. Dr. Pennington
informed me, that he had lost all the patients
(six in number) to whom he had given the
above medicines. Dr. Johnson assured me, with
great concern, about two weeks before he died,
that he had not recovered a single patient by them.
Whole families were swept off where these medicines
were used. But further, most of those
persons who received the seeds of the fever in the
city, and sickened in the country, or in the neighbouring
towns, and who were treated with tonic
remedies, died. There was not a single cure performed
by them in New-York, where they were
used in several sporadic cases with every possible
advantage. But why do I multiply proofs of their
deadly effects? The clamours of hundreds whose
relations had perished by them, and the fears of
others, compelled those physicians who had been
most attached to them to lay them aside, or to prepare
the way for them (as it was called) by purging
and bleeding. The bathing tub soon shared a
worse fate than bark, wine, and laudanum, and,
long before the disease disappeared, it was discarded
by all the physicians in the city.
In answer to these facts we are told, that
Mr. Hamilton and his family were cured by Dr.
Stevens's remedies, and that Dr. Kuhn had administered
them with success in several instances.
Upon these cures I shall insert the following
judicious remarks from Dr. Sydenham. “Success
(says the doctor) is not a sufficient proof of the
excellency of a method of cure in acute diseases,
since some are recovered by the imprudent procedure
of old women; but it is further required, that
the distemper should be easily cured, and yield
conformably to its own nature[93].” And again, speaking
of the cure of the new fever of 1685, this incomparable
physician observes, “If it be objected
that this fever frequently yields to a quite contrary
method to that which I have laid down, I answer,
that the cure of a disease by a method which is
attended with success only now and then, in a few
instances, differs extremely from that practical method,
the efficacy whereof appears both from its
recovering greater numbers, and all the practical
phenomena happening in the cure[94].”
Far be it from me to deny that the depression
of the system may not be overcome by such stimuli
as are more powerful than those which occasion it.
This has sometimes been demonstrated by the
efficacy of bark, wine, and laudanum, in the confluent
and petechial small-pox; but even this state
of that disease yields more easily to blood-letting,
or to plentiful evacuations from the stomach and
bowels, on the first or second day of the eruptive
fever. This I have often proved, by giving a
large dose of tartar emetic and calomel, as soon as
I was satisfied from circumstances, that my patient
was infected with the small-pox. But the depression
produced by the yellow fever appears to be
much greater than that which occurs in the small-pox,
and hence it more uniformly resisted the most
powerful tonic remedies.
In one of my publications during the prevalence
of the fever I asserted, that the remedies of which
I have given a history cured a greater proportion
than ninety-nine out of a hundred, of all who applied
to me on the first day of the disease, before
the 15th day of September. I regret that it is not
in my power to furnish a list of them, for a majority
of them were poor people, whose names are
still unknown to me. I was not singular in this
successful practice in the first appearance of the
disease. Dr. Pennington assured me on his death
bed, that he had not lost one, out of forty-eight patients
whom he had treated agreeably to the principles
and practice I had recommended. Dr. Griffitts
triumphed over the disease in every part of the
city, by the use of what were called the new remedies.
My former pupils spread, by their success,
the reputation of purging and bleeding, wherever
they were called. Unhappily the pleasure we derived
from this success in the treatment of the disease,
was of short duration. Many circumstances
contributed to lessen it, and to revive the mortality
of the fever. I shall briefly enumerate them.
1. The distraction produced in the public mind,
by the recommendation of remedies, the opposites
in every respect of purging and bleeding.
2. The opinion which had been published by
several physicians, and inculcated by others, that
we had other fevers in the city besides the yellow
fever. This produced a delay in many people in
sending for a physician, or in taking medicines, for
two or three days, from a belief that they had nothing
but a cold, or a common fever. Some people
were so much deceived by this opinion, that
they refused to send for physicians, lest they should
be infected by them with the yellow fever. In
most of the cases in which these delays took place,
the disease proved mortal.
To obviate a suspicion that I have laid more
stress upon the fatal influence of this error than is
just, I shall here insert an extract of a letter I received
from Mr. John Connelly, one of the city
committee, who frequently left his brethren in the
city hall, and spent many hours in visiting and
prescribing for the sick. “The publications (says
he) of some physicians, that there were but few
persons infected with the yellow fever, and that
many were ill with colds and common remitting
and fall fevers, proved fatal to almost every family
which was credulous enough to believe them.
That opinion slew its hundreds, if not its thousands,
many of whom did not send for a physician until
they were in the last stage of the disorder, and beyond
the power of medicine.”
3. The interference of the friends of the stimulating
system, in dissuading patients from submitting
to sufficient evacuations.
4. The deceptions which were practised by
some patients upon their physicians, in their reports
of the quantity of blood they had lost, or of
the quality and number of their evacuations by
stool.
5. The impracticability of procuring bleeders
as soon as bleeding was prescribed. Life in this
disease, as in the apoplexy, frequently turned upon
that operation being performed within an hour.
It was often delayed, from the want of a bleeder,
one or two days.
6. The inability of physicians, from the number
of their patients, and from frequent indisposition,
to visit the sick, at such times as was necessary to
watch the changes in their disease.
7. The great accumulation and concentration of
the miasmata in sick rooms, from the continuance
of the disease in the city, whereby the system was
exposed to a constant stimulus, and the effect of
the evacuations was thus defeated.
8. The want of skill or fidelity in nurses to administer
the medicines properly; to persuade patients
to drink frequently; also to supply them
with food or cordial drinks when required in the
night.
9. The great degrees of debility induced in the
systems of many of the people who were affected
by the disease, from fatigue in attending their relations
or friends.
10. The universal depression of mind, amounting
in some instances to despair, which affected
many people. What medicine could act upon a
patient who awoke in the night, and saw through
the broken and faint light of a candle, no human
creature, but a black nurse, perhaps asleep in a
distant corner of the room; and who heard no noise,
but that of a hearse conveying, perhaps, a neighbour
or a friend to the grave? The state of mind
under which many were affected by the disease, is
so well described by the Rev. Dr. Smith, in the
case of his wife, in a letter I received from him in
my sick room, two days after her death, that I hope
I shall be excused for inserting an extract from it.
It forms a part of the history of the disease. The
letter was written in answer to a short note of condolence
which I sent to the doctor immediately
after hearing of Mrs. Smith's death. After some
pathetic expressions of grief, he adds, “The scene
of her funeral, and some preceding circumstances,
can never depart from my mind. On our return
from a visit to our daughter, whom we had been
striving to console on the death of Mrs. Keppele,
who was long familiar and dear to both, my dear
wife, passing the burying-ground gate, led me into
the ground, viewed the graves of her two children,
called the old grave-digger, marked a spot for herself
as close as possible to them and the grave of
Dr. Phineas Bond, whose memory she adored.
Then, by the side of the spot she had chosen, we
found room and chose mine, pledging ourselves to
each other, and directing the grave-digger that this
should be the order of our interment. We returned
to our house. Night approached. I hoped my
dear wife had gone to rest, as she had chosen,
since her return from nursing her daughter, to
sleep in a chamber by herself, through fear of infecting
her grandchild and me. But it seems she
closed not her eyes; sitting with them fixed through
her chamber window on Mrs. Keppele's house,
till about midnight she saw her hearse, and followed
it with her eyes as far as it could be seen.
Two days afterwards Mrs. Rodgers, her next only
surviving intimate friend, was carried past her window,
and by no persuasion could I draw her from
thence, nor stop her sympathetic foreboding tears,
so long as her eyes could follow the funeral, which
was through two squares, from Fourth to Second-street,
where the hearse disappeared.” The doctor
proceeds in describing the distress of his wife.
But pointed as his expressions are, they do not
convey the gloomy state of her mind with so much
force as she has done it herself in two letters to
her niece, Mrs. Cadwallader, who was then in the
country. The one was dated the 9th, the other
the 11th of October. I shall insert a few extracts
from each of them.
October 9th. “It is not possible for me to pass
the streets without walking in a line with the dead,
passing infected houses, and looking into open
graves. This has been the case for many weeks.”
“I don't know what to write; my head is gone,
and my heart is torn to pieces.” “I intreat you
to have no fears on my account. I am in the hands
of a just and merciful God, and his will be done.”
October 11th. “Don't wonder that I am so low
to-day. My heart is sunk down within me.”
The next day this excellent woman sickened,
and died on the 19th of the same month.
If in a person possessed naturally of uncommon
equanimity and fortitude, the distresses of our city
produced such dejection of spirits, what must have
been their effect upon hundreds, who were not endowed
with those rare and extraordinary qualities
of mind! Death in this, as well as in many other
cases in which medicine had done its duty, appeared
to be the inevitable consequence of the total
abstraction of the energy of the mind in restoring
the natural motions of life.
Under all the circumstances which have been
mentioned, which opposed the system of depletion
in the cure of this fever, it was still far more successful
than any other mode of cure that had been
pursued before in the United States, or in the
West-Indies.
Three out of four died of the disease in Jamaica,
under the care of Dr. Hume.
Dr. Blane considers it as one of the “most mortal”
of diseases, and Dr. Jackson places a more
successful mode of treating it among the subjects
which will admit of “innovation” in medicine.
After the 15th of September, my success was
much limited, compared with what it had been
before that time. But at no period of the disease
did I lose more than one in twenty of those whom
I saw on the first day, and attended regularly
through every stage of the fever, provided they had
not been previously worn down by attending the
sick.
The following statement, which will admit of
being corrected, if it be inaccurate, will, I hope,
establish the truth of the above assertions.
About one half of the families whom I have attended
for many years, left the city. Of those
who remained, many were affected by the disease.
Out of the whole of them, after I had adopted my
second mode of practice, I lost but five heads of
families, and about a dozen servants and children.
In no instance did I lose both heads of the same
family. My success in these cases was owing to
two causes: 1st, To the credit my former patients
gave to my public declaration, that we had only
one fever in the city: hence they applied on the
first day, and sometimes on the first hour of their
indisposition; and 2dly, To the numerous pledges
many of them had seen of the safety and efficacy of
copious blood-letting, by my advice, in other diseases:
hence my prescription of that necessary remedy
was always obeyed in its utmost extent. Of
the few adults whom I lost, among my former
patients, two of them were old people, two took
laudanum, without my knowledge, and one refused
to take medicine of any kind; all the rest had been
worn down by previous fatigue.
I have before said that a great number of the
blacks were my patients. Of these not one died
under my care. This uniform success, among
those people, was not owing altogether to the mildness
of the disease, for I shall say presently, that a
great proportion of a given number died, under
other modes of practice.
In speaking of the comparative effects of purging
and bleeding, it may not be amiss to repeat,
that not one pregnant woman, to whom I prescribed
them, died, or suffered abortion. Where the tonic
remedies were used, abortion or death, and, in
many instances, both, were nearly universal.
Many whole families, consisting of five, six, and,
in three instances, of nine members, were recovered
by plentiful purging and bleeding. I could
swell this work by publishing a list of those families;
but I take more pleasure in adding, that I
was not singular in my success in the use of the
above remedies. They were prescribed with great
advantage by many of the physicians of the city,
who had for a while given tonic medicines without
effect. I shall not mention the names of any of
the physicians who totally renounced those medicines,
lest I should give offence by not mentioning
them all. Many large families were cured by
some of them, after they adopted and prescribed
copious purging and blood-letting. One of them
cured ten in the family of Mr. Robert Haydock,
by means of those remedies. In one of that family,
the disease came on with a vomiting of black bile.
But the use of the new remedies was not directed
finally by the physicians alone. The clergy,
the apothecaries, many private citizens, several intelligent
women, and two black men, prescribed
them with great success. Nay more, many persons
prescribed them to themselves, and, as I shall
say hereafter, with a success that was unequalled
by any of the regular or irregular practitioners in
the city.
It was owing to the almost universal use of
purging and bleeding, that the mortality of the disease
diminished, in proportion as the number of
persons who were affected by it increased, about
the middle of October. It was scarcely double of
what it was in the middle of September, and yet
six times the number of persons were probably at
that time confined by it.
The success of copious purging and bleeding
was not confined to the city of Philadelphia. Several
persons, who were infected in town, and
sickened in the country, were cured by them.
Could a comparison be made of the number of
patients who died of the yellow fever in 1793, after
having been plentifully bled and purged, with those
who died of the same disease in the years 1699,
1741, 1747, and 1762, I am persuaded that the
proportion would be very small in the year 1793,
compared with the former years[95]. Including all
who died under every mode of treatment, I suspect
the mortality to be less, in proportion to the
population of the city, and the number of persons
who were affected, than it was in any of the other
years that have been mentioned.
Not less than 6000 of the inhabitants of Philadelphia
probably owe their lives to purging and
bleeding, during the autumn.
I proceed with reluctance to inquire into the
comparative success of the French practice. It
would not be difficult to decide upon it from many
facts that came under my notice in the city;
but I shall rest its merit wholly upon the returns
of the number of deaths at Bush-hill. This hospital,
after the 22d of September, was put under
the care of a French physician, who was assisted
by one of the physicians of the city. The hospital
was in a pleasant and airy situation; it was provided
with all the necessaries and comforts for sick people
that humanity could invent, or liberality supply.
The attendants were devoted to their duty;
and cleanliness and order pervaded every room in
the house. The reputation of this hospital, and
of the French physician, drew patients to it in the
early stage of the disease. Of this I have been
assured in a letter from Dr. Annan, who was appointed
to examine and give orders of admission
into the hospital, to such of the poor of the district
of Southwark, as could not be taken care of
in their own houses. Mr. Olden has likewise informed
me, that most of the patients who were
sent to the hospital by the city committee (of
which he was a member) were in the first stage of
the fever. With all these advantages, the deaths
between the 22d of September and the 6th of
November, amounted to 448 out of 807 patients
who were admitted into the hospital within that
time. Three fourths of all the blacks (nearly 20)
who were patients in this hospital died. A list of
the medicines prescribed there may be seen in the
minutes of the proceedings of the city committee.
Calomel and jalap are not among them. Moderate
bleeding and purging with glauber's salts, I have
been informed, were used in some cases by the
physicians of this hospital. The proportion of
deaths to the recoveries, as it appears in the minutes
of the committee from whence the above report is
taken, is truly melancholy! I hasten from it therefore
to a part of this work, to which I have looked
with pleasure, ever since I sat down to compose it.
I have said that the clergy, the apothecaries, and
many other persons who were uninstructed in the
principles of medicine, prescribed purging and
bleeding with great success in this disease. Necessity
gave rise to this undisciplined sect of practitioners,
for they came forward to supply the places
of the regular bred physicians who were sick or
dead. I shall mention the names of a few of those
persons who distinguished themselves as volunteers
in this new work of humanity. The late Rev.
Mr. Fleming, one of the ministers of the catholic
church, carried the purging powders in his pocket,
and gave them to his poor parishioners with great
success. He even became the advocate of the new
remedies. In a conversation I had with him, on
the 22d of September, he informed me, that he
had advised four of our physicians, whom he met
a day or two before, “to renounce the pride of
science, and to adopt the new mode of practice,
for that he had witnessed its good effects in many
cases.” Mr. John Keihmle, a German apothecary,
has assured me, that out of 314 patients whom he
visited, and 187 for whom he prescribed from the
reports of their friends, he lost but 47 (which is
nearly but one in eleven), and that he treated them
all agreeably to the method which I had recommended.
The Rev. Mr. Schmidt, one of the ministers
of the Lutheran church, was cured by him.
I have before mentioned an instance of the judgment
of Mr. Connelly, and of his zeal in visiting
and prescribing for the sick. His remedies were
bleeding and purging. He, moreover, bore a constant
and useful testimony against bark, wine, laudanum,
and the warm bath[96]. Mrs. Paxton, in
Carter's-alley, and Mrs. Evans, the wife of Mr.
John Evans, in Second-street, were indefatigable;
the one in distributing mercurial purges composed
by herself, and the other in urging the necessity
of copious bleeding and purging among her friends
and neighbours, as the only safe remedies for the
fever. These worthy women were the means of
saving many lives[97]. Absalom Jones and Richard
Allen, two black men, spent all the intervals of
time, in which they were not employed in burying
the dead, in visiting the poor who were sick,
and in bleeding and purging them, agreeably to
the directions which had been printed in all the
newspapers. Their success was unparalleled by
what is called regular practice. This encomium
upon the practice of the blacks will not surprise the
reader, when I add that they had no fear of putrefaction
in the fluids, nor of the calumnies of a body
of fellow-citizens in the republic of medicine to deter
them from plentiful purging and bleeding.
They had, besides, no more patients than they
were able to visit two or three times a day. But
great as their success was, it was exceeded by
those persons who, in despair of procuring medical
aid of any kind, purged and bled themselves.
This palm of superior success will not be withheld
from those people when I explain the causes of it.
It was owing to their early use of the proper remedies,
and to their being guided in the repetition of
them, by the continuance of a tense pulse, or of
pain and fever. A day, an afternoon, and even an
hour, were not lost by these people in waiting for
the visit of a physician, who was often detained
from them by sickness, or by new and unexpected
engagements, by which means the precious moment
for using the remedies with effect passed irrevocably
away. I have stated these facts from faithful
inquiries, and numerous observations. I could
mention the names and families of many persons
who thus cured themselves. One person only
shall be mentioned, who has shown by her conduct
what reason is capable of doing when it is forced
to act for itself. Mrs. Long, a widow, after having
been twice unsuccessful in her attempts to procure
a physician, undertook at last to cure herself.
She took several of the mercurial purges, agreeably
to the printed directions, and had herself bled seven
times in the course of five or six days. The indication
for repeating the bleeding was the continuance
of the pain in her head. Her recovery was
rapid and complete. The history of it was communicated
to me by herself, with great gratitude,
in my own house, during my second confinement
with the fever. To these accounts of persons who
cured themselves in the city, I could add many
others, of citizens who sickened in the country, and
who cured themselves by plentiful bleeding and
purging, without the attendance of a physician.
From a short review of these facts, reason and
humanity awake from their long repose in medicine,
and unite in proclaiming, that it is time to
take the cure of pestilential epidemics out of the
hands of physicians, and to place it in the hands of
the people. Let not the reader startle at this proposition.
I shall give the following reasons for it.
1. In consequence of these diseases affecting a
great number of people at one time, it has always
been, and always will be impossible, for them all
to have the benefit of medical aid, more especially
as the proportion of physicians to the number of
sick, is generally diminished upon these occasions,
by desertion, sickness, and death.
2. The safety of committing to the people the
cure of pestilential fevers, particularly the yellow
fever and the plague, is established by the
simplicity and uniformity of their causes, and of
their remedies. However diversified they may be
in their symptoms, the system, in both diseases, is
generally under a state of undue excitement or
great depression, and in most cases requires the
abstraction of stimulus in a greater or less degree,
or in a sudden or gradual manner. There can
never be any danger of the people injuring themselves
by mistaking any other disease for an epidemic
yellow fever or plague, for no other febrile disease
can prevail with them. It was probably to prevent
this mistake, that the Benevolent Father of
mankind, who has permitted no evil to exist which
does not carry its antidote along with it, originally
imposed that law upon all great and mortal epidemics.
3. The history of the yellow fever in the West-Indies
proves the advantage of trusting patients to
their own judgment. Dr. Lind has remarked,
that a greater proportion of sailors who had no
physicians recovered from that fever, than of those
who had the best medical assistance. The fresh
air of the deck of a ship, a purge of salt water, and
the free use of cold water, probably triumphed here
over the cordial juleps of physicians.
4. By committing the cure of this and other pestilential
epidemics to the people, all those circumstances
which prevented the universal success of
purging and bleeding, in this disease, will
have no operation. The fever will be mild in
most cases, for all will prepare themselves to receive
it, by a vegetable diet, and by moderate
evacuations. The remedies will be used the moment
the disease is felt, or even seen, and its
violence and danger will thereby be obviated.
There will then be no disputes among physicians,
about the nature of the disease, to distract the public
mind, for they will seldom be consulted in it.
None will suffer from chronic debility induced by
previous fatigue in attending the sick, nor from
the want of nurses, for few will be so ill as to require
them, and there will be no “foreboding”
fears of death, or despair of recovery, to invite an
attack of the disease, or to ensure its mortality.
The small-pox was once as fatal as the yellow
fever and the plague. It has since yielded as
universally to a vegetable diet and evacuations, in
the hands of apothecaries, the clergy, and even of
the good women, as it did in the hands of doctors
of physic.
They have narrow conceptions, not only of the
Divine goodness, but of the gradual progress of
human knowledge, who suppose that all pestilential
diseases shall not, like the small-pox, sooner or later
cease to be the scourge and terror of mankind.
For a long while, air, water, and even the light
of the sun, were dealt out by physicians to their
patients with a sparing hand. They possessed, for
several centuries, the same monopoly of many artificial
remedies. But a new order of things is
rising in medicine. Air, water, and light are
taken without the advice of a physician, and bark
and laudanum are now prescribed every where by
nurses and mistresses of families, with safety and
advantage. Human reason cannot be stationary
upon these subjects. The time must and will
come, when, in addition to the above remedies, the
general use of calomel, jalap, and the lancet, shall
be considered among the most essential articles of
the knowledge and rights of man.
It is no more necessary that a patient should be
ignorant of the medicine he takes, to be cured by
it, than that the business of government should be
conducted with secrecy, in order to insure obedience
to just laws. Much less is it necessary that
the means of life should be prescribed in a dead
language, or dictated with the solemn pomp of a
necromancer. The effects of imposture, in every
thing, are like the artificial health produced by
the use of ardent spirits. Its vigour is temporary,
and is always followed by misery and death.
The belief that the yellow fever and the plague
are necessarily mortal, is as much the effect of a
superstitious torpor in the understanding, as the
ancient belief that the epilepsy was a supernatural
disease, and that it was an offence against Heaven
to attempt to cure it. It is partly from the influence
of this torpor in the minds of some people,
that the numerous cures of the yellow fever, performed
by a few simple remedies, were said to be
of other diseases. It is necessary, for the conviction
of such persons, that patients should always
die of that, and other dangerous diseases, to prove
that they have been affected by them.
The repairs which our world is destined to undergo
will be incomplete, until pestilential fevers
cease to be numbered among the widest outlets of
human life.
There are many things which are now familiar
to women and children, which were known a century
ago only to a few men who lived in closets,
and were distinguished by the name of philosophers.
We teach a hundred things in our schools less
useful, and many things more difficult, than the
knowledge that would be necessary to cure a yellow
fever or the plague.
In my attempts to teach the citizens of Philadelphia,
by my different publications, the method
of curing themselves of yellow fever, I observed
no difficulty in their apprehending every thing
that was addressed to them, except what related
to the different states of the pulse. All the knowledge
that is necessary to discover when blood-letting
is proper, might be taught to a boy or girl
of twelve years old in a few hours. I taught it in
less time to several persons, during the prevalence
of the epidemic.
I would as soon believe that ratafia was intended
by the Author of Nature to be the only drink of
man, instead of water, as believe that the knowledge
of what relates to the health and lives of a
whole city, or nation, should be confined to one,
and that a small or a privileged order of men. But
what have physicians, what have universities or
medical societies done, after the labours and studies
of many centuries, towards lessening the mortality
of pestilential fevers? They have either
copied or contradicted each other, in all their publications.
Plagues and malignant fevers are still
leagued with war and famine, in their ravages upon
human life.
To prevent the formation and mortality of this
fever, it will be necessary, when it makes its appearance
in a city or country, to publish an account of
those symptoms which I have called the precursors
of the disease, and to exhort the people, as soon
as they feel those symptoms, to have immediate
recourse to the remedies of purging or bleeding.
The danger of delay in using one, or both these
remedies, should be inculcated in the strongest
terms, for the disease, like Time, has a lock on its
forehead, but is bald behind. The bite of a rattle-snake
is seldom fatal, because the medicines which
cure it are applied or taken as soon as the poison
comes in contact with the blood. There is less
danger to be apprehended from the yellow fever
than from the poison of the snake, provided the
remedies for it are administered within a few hours
after it is excited into action.
Let persons who are subject to chronic pains, or
diseases of any kind, be advised not to be deceived
by them. Every pain, at such a time, is the
beginning of the disease; for it always acts first on
debilitated parts of the body. From an ignorance
of this law of epidemics many persons, by delaying
their applications for help, perished with our fever.
Let nature be trusted into no case whatever, to
cure this disease; and let no attack of it, however
light, be treated with neglect. Death as certainly
performs his work, when he steals on the
system in the form of a mild intermittent, as he
does, when he comes on with the symptoms of
apoplexy, or a black vomiting.
Cleanliness, in houses and dress, cannot be too
often inculcated during the prevalence of a yellow
fever.
Let it not be supposed, that I mean that the
history which I have given of the method of cure
of this epidemic, should be applied, in all its
parts, to the yellow fevers which may appear
hereafter in the United States, or which exist at
all times in the West-India islands. Season and
climate vary this, as well as all other diseases.
Bark and wine, so fatal in this, may be proper in a
future yellow fever. But in the climate of the
United States, I believe it will seldom appear with
such symptoms of prostration and weakness, as not
to require, in its first stage, evacuations of some
kind.
The only inquiry, when the disease makes its
appearance, should be, from what part of the body
these evacuations should be procured; the order
which should be pursued in obtaining them; and
the quantity of each of the matters to be discharged,
which should be withdrawn at a time.
Thus far did I venture, from my theory of the
disease, and from the authorities of Dr. Hillary and
Dr. Mosely, to decide in favour of evacuations in
the yellow fever; but Dr. Wade, and Mr. Chisholm
again support me by their practice in the fevers
of the East and West-Indies. They both
gave strong mercurial purges, and bled in some
cases. Dr. Wade confirmed, by his practice, the
advantage of gradually abstracting stimulus from
the system. He never drew blood, even in the
most inflammatory cases, until he had first discharged
the contents of the bowels. The doctor
has further established the efficacy of a vegetable
diet and of water as a drink, as the best means of
preventing the disease in a hot climate.
The manner in which the miasmata that produce
the plague act upon the system is so much
like that which has been described in the yellow
fever, and the accounts of the efficacy of low diet,
in preparing the body for its reception, and of copious
bleeding, cold air, and cold water, in curing
it, are so similar, that all the directions which relate
to preventing, mitigating, or curing the yellow
fever may be applied to it. The fluids in the
plague show a greater tendency to the skin, than
they do in the yellow fever. Perhaps, upon this
account, the early use of powerful sudorifics may
be more proper in the former than in the latter
disease. From the influence of early purging and
bleeding in promoting sweats in the yellow fever,
there can be little doubt but the efforts of nature
to unload the system in the plague, through the
channel of the pores, might be accelerated by the
early use of the same remedies. One thing, with
respect to the plague, is certain, that its cure depends
upon the abstraction of stimulus, either by
means of plentiful sweats, or of purulent matter
from external sores. Perhaps the efficacy of these
remedies depends wholly upon their elevating the
system from its prostrated state in a gradual manner.
If this be the case, those natural discharges
might be easily and effectually imitated by small
and repeated bleedings.
To correspond in quantity with the discharge
from the skin, blood-letting in the plague, when indicated,
should be copious. A profuse sweat, continued
for twenty-four hours, cannot fail of wasting
many pounds of the fluids of the body. This was
the duration of the critical sweats in the famous
plague which was known by the name of the English
sweating sickness, and which made its appearance
in the army of Henry VII. in Milford-Haven
in Wales, and spread from thence through every
part of the kingdom.
The principles which lead to the prevention and
cure of the yellow fever and the plague, apply
with equal force to the mitigation of the measles,
and to the prevention or mitigation of the scarlatina
anginosa, the dysentery, and the inflammatory jail
fever. I have remarked elsewhere[98], that a previous
vegetable diet lessened the violence and danger of
the measles. Dr. Sims taught me, many years
ago, to prevent or mitigate the scarlatina anginosa,
by means of gentle purges, after children are infected
by it[99]. Purges of salts have in many instances
preserved whole families and neighbourhoods from
the dysentery, where they have been exposed to its
remote cause. During the late American war, an
emetic seldom failed of preventing an attack of the
hospital fever, when given in its forming state[100]. I
have had no experience of the effects of previous
evacuations in abating the violence, or preventing
the mortality of the malignant sore throat, but I
can have no doubt of their efficacy, from the sameness
of the state of the system in that disease, as in
other malignant fevers. The debility induced in it
is from depression, and the supposed symptoms of
putrefaction are nothing but the disguised effects of
a sudden and violent pressure of an inflammatory
stimulus upon the arterial system.
With these observations I close the history of
the rise, progress, symptoms, and treatment of the
bilious remitting yellow fever, which appeared in
Philadelphia in the year 1793. My principal aim
has been to revive and apply to it the principles and
practice of Dr. Sydenham, and, however coldly
those principles and that practice may be received
by some physicians of the present day, I am convinced
that experience, in all ages and in all countries,
will vouch for their truth and utility.
Narratives of escapes from great
dangers of shipwreck, war, captivity, and famine
have always formed an interesting part of the history
of the body and mind of man. But there are
deliverances from equal dangers which have hitherto
passed unnoticed; I mean from pestilential
fevers. I shall briefly describe the state of my
body and mind during my intercourse with the sick
in the epidemic of 1793. The account will throw additional
light upon the disease, and probably illustrate
some of the laws of the animal economy. It
will, moreover, serve to furnish a lesson to all who
may be placed in similar circumstances to commit
their lives, without fear, to the protection of that
Being, who is able to save to the uttermost, not
only from future, but from present evil.
Some time before the fever made its appearance,
my wife and children went into the state of New-Jersey,
where they had long been in the habit of
spending the summer months. My family, about
the 25th of August, consisted of my mother, a sister,
who was on a visit to me, a black servant man,
and a mulatto boy. I had five pupils, viz. Warner
Washington and Edward Fisher, of Virginia,
John Alston, of South-Carolina, and John Redman
Coxe (grandson to Dr. Redman) and John Stall,
both of this city. They all crowded around me
upon the sudden increase of business, and with one
heart devoted themselves to my service, and to the
cause of humanity.
The credit which the new mode of treating the
disease acquired, in all parts of the city, produced
an immense influx of patients to me from all quarters.
My pupils were constantly employed; at
first in putting up purging powders, but, after a
while, only in bleeding and visiting the sick.
Between the 8th and the 15th of September
I visited and prescribed for between a hundred
and a hundred and twenty patients a day. Several
of my pupils visited a fourth or fifth part of that
number. For a while we refused no calls. In
the short intervals of business, which I spent at my
meals, my house was filled with patients, chiefly
the poor, waiting for advice. For many weeks I
seldom ate without prescribing for numbers as I
sat at my table. To assist me at these hours, as
well as in the night, Mr. Stall, Mr. Fisher, and
Mr. Coxe accepted of rooms in my house, and became
members of my family. Their labours now
had no remission.
Immediately after I adopted the antiphlogistic
mode of treating the disease, I altered my manner
of living. I left off drinking wine and malt
liquors. The good effects of the disuse of these
liquors helped to confirm me in the theory I had
adopted of the disease. A troublesome head-ach,
which I had occasionally felt, and which excited
a constant apprehension that I was taking the fever,
now suddenly left me. I likewise, at this
time, left off eating solid animal food, and lived
wholly, but sparingly, upon weak broth, potatoes,
raisins, coffee, and bread and butter.
From my constant exposure to the sources of
the disease, my body became highly impregnated
with miasmata. My eyes were yellow, and sometimes
a yellowness was perceptible in my face.
My pulse was preternaturally quick, and I had profuse
sweats every night. These sweats were so
offensive, as to oblige me to draw the bed-clothes
close to my neck, to defend myself from their
smell. They lost their fœtor entirely, upon my
leaving off the use of broth, and living entirely upon
milk and vegetables. But my nights were rendered
disagreeable, not only by these sweats, but
by the want of my usual sleep, produced in part
by the frequent knocking at my door, and in part
by anxiety of mind, and the stimulus of the miasmata
upon my system. I went to bed in conformity
to habit only, for it ceased to afford me rest
or refreshment. When it was evening I wished for
morning; and when it was morning, the prospect
of the labours of the day, at which I often shuddered,
caused me to wish for the return of evening.
The degrees of my anxiety may be easily conceived
when I add, that I had at one time upwards
of thirty heads of families under my care; among
these were Mr. Josiah Coates, the father of eight,
and Mr. Benjamin Scull and Mr. John Morell,
both fathers of ten children. They were all in imminent
danger; but it pleased God to make me
the instrument of saving each of their lives. I rose
at six o'clock, and generally found a number of
persons waiting for advice in my shop or parlour.
Hitherto the success of my practice gave a tone to
my mind, which imparted preternatural vigour to
my body. It was meat and drink to me to fulfil
the duties I owed to my fellow-citizens, in this
time of great and universal distress. From a hope
that I might escape the disease, by avoiding every
thing that could excite it into action, I carefully
avoided the heat of the sun, and the coldness of the
evening air. I likewise avoided yielding to every
thing that should raise or depress my passions.
But, at such a time, the events which influence the
state of the body and mind are no more under our
command than the winds or weather. On the
evening of the 14th of September, after eight
o'clock, I visited the son of Mrs. Berriman, near
the Swedes's church, who had sent for me early in
the morning. I found him very ill. He had been
bled in the forenoon, by my advice, but his pulse
indicated a second bleeding. It would have been
difficult to procure a bleeder at that late hour. I
therefore bled him myself. Heated by this act,
and debilitated by the labours of the day, I rode
home in the evening air. During the ensuing
night I was much indisposed. I rose, notwithstanding,
at my usual hour. At eight o'clock I
lost ten ounces of blood, and immediately afterwards
got into my chair, and visited between forty
and fifty patients before dinner. At the house of one
of them I was forced to lie down a few minutes.
In the course of this morning's labours my mind
was suddenly thrown off its pivots, by the last
look, and the pathetic cries, of a friend for help,
who was dying under the care of a French physician.
I came home about two o'clock, and was
seized, immediately afterwards, with a chilly fit
and a high fever. I took a dose of the mercurial
medicine, and went to bed. In the evening I took
a second purging powder, and lost ten ounces more
of blood. The next morning I bathed my face,
hands, and feet in cold water for some time. I
drank plentifully, during the day and night, of weak
hyson tea, and of water, in which currant jelly had
been dissolved. At eight o'clock I was so well as
to admit persons who came for advice into my
room, and to receive reports from my pupils of the
state of as many of my patients as they were able
to visit; for, unfortunately, they were not able to
visit them all (with their own) in due time; by
which means several died. The next day I came
down stairs, and prescribed in my parlour for not
less than a hundred people. On the 19th of the
same month, I resumed my labours, but in great
weakness. It was with difficulty that I ascended
a pair of stairs, by the help of a banister. A slow
fever, attended with irregular chills, and a troublesome
cough, hung constantly upon me. The fever
discovered itself in the heat of my hands, which
my patients often told me were warmer than their
own. The breath and exhalations from the sick
now began to affect me, in small and infected
rooms, in the most sensible manner. On the
morning of the 4th of October I suddenly sunk
down, in a sick room, upon a bed, with a giddiness
in my head. It continued for a few minutes,
and was succeeded by a fever, which confined me to
my house the remaining part of the day.
Every moment in the intervals of my visits to
the sick was employed in prescribing, in my own
house, for the poor, or in sending answers to messages
from my patients; time was now too precious
to be spent in counting the number of persons
who called upon me for advice. From circumstances
I believe it was frequently 150, and
seldom less than 50 in a day, for five or six weeks.
The evening did not bring with it the least relaxation
from my labours. I received letters every
day from the country, and from distant parts of the
union, containing inquiries into the mode of treating
the disease, and after the health and lives of
persons who had remained in the city. The business
of every evening was to answer these letters,
also to write to my family. These employments,
by affording a fresh current to my thoughts, kept
me from dwelling on the gloomy scenes of the
day. After these duties were performed, I copied
into my note book all the observations I had collected
during the day, and which I had marked
with a pencil in my pocket-book in sick rooms, or
in my carriage. To these constant labours of body
and mind were added distresses from a variety of
causes. Having found myself unable to comply
with the numerous applications that were made to
me, I was obliged to refuse many every day. My
sister counted forty-seven in one forenoon before
eleven o'clock. Many of them left my door with
tears, but they did not feel more distress than I did
from refusing to follow them. Sympathy, when
it vents itself in acts of humanity, affords pleasure,
and contributes to health; but the reflux of pity,
like anger, gives pain, and disorders the body.
In riding through the streets, I was often forced
to resist the entreaties of parents imploring a visit
to their children, or of children to their parents.
I recollect, and even yet with pain, that I tore myself
at one time from five persons in Moravian-alley,
who attempted to stop me, by suddenly
whipping my horse, and driving my chair as speedily
as possible beyond the reach of their cries.
The solicitude of the friends of the sick for
help may further be conceived of, when I add,
that the most extravagant compensations were
sometimes offered for medical services, and, in one
instance, for only a single visit. I had no merit in
refusing these offers, and I have introduced an account
of them only to inform such physicians as
may hereafter be thrown into a similar situation,
that I was favoured with an exemption from the
fear of death, in proportion as I subdued every
selfish feeling, and laboured exclusively for the benefit
of others. In every instance in which I was
forced to refuse these pathetic and earnest applications,
my distress was heightened by the fear
that the persons, whom I was unable to visit, would
fall into improper hands, and perish by the use of
bark, wine, and laudanum.
But I had other afflictions besides the distress
which arose from the abortive sympathy which I
have described. On the 11th of September, my
ingenious pupil, Mr. Washington, fell a victim to
his humanity. He had taken lodgings in the country,
where he sickened with the disease. Having
been almost uniformly successful in curing others,
he made light of his fever, and concealed the
knowledge of his danger from me, until the day
before he died. On the 18th of September Mr.
Stall sickened in my house. A delirium attended
his fever from the first hour it affected him. He
refused, and even resisted force when used to compel
him to take medicine. He died on the 23d of
September[101]. Scarcely had I recovered from the
shock of the death of this amiable youth, when I
was called to weep for a third pupil, Mr. Alston,
who died in my neighbourhood the next day. He
had worn himself down, before his sickness, by
uncommon exertions in visiting, bleeding, and even
sitting up with sick people. At this time Mr.
Fisher was ill in my house. On the 26th of the
month, at 12 o'clock, Mr. Coxe, my only assistant,
was seized with the fever, and went to his grandfather's.
I followed him with a look, which I feared
would be the last in my house. At two o'clock
my sister, who had complained for several days,
yielded to the disease, and retired to her bed. My
mother followed her, much indisposed, early in the
evening. My black servant man had been confined
with the fever for several days, and had on that
day, for the first time, quitted his bed. My little
mulatto boy, of eleven years old, was the only person
in my family who was able to afford me the
least assistance. At eight o'clock in the evening
I finished the business of the day. A solemn stillness
at that time pervaded the streets. In vain did
I strive to forget my melancholy situation by answering
letters, and by putting up medicines, to be
distributed next day among my patients. My faithful
black man crept to my door, and at my request
sat down by the fire, but he added, by his silence
and dullness, to the gloom which suddenly overpowered
every faculty of my mind.
On the first day of October, at two o'clock in the
afternoon, my sister died. I got into my carriage
within an hour after she expired, and spent the afternoon
in visiting patients. According as a sense
of duty, or as grief has predominated in my mind,
I have approved, and disapproved of this act, ever
since. She had borne a share in my labours. She
had been my nurse in sickness, and my casuist in
my choice of duties. My whole heart reposed
itself in her friendship. Upon being invited to a
friend's house in the country, when the disease
made its appearance in the city, she declined accepting
the invitation, and gave as a reason for so
doing, that I might probably require her services
in case of my taking the disease, and that, if she
were sure of dying, she would remain with me,
provided that, by her death, she could save my
life. From this time I declined in health and
strength. All motion became painful to me. My
appetite began to fail. My night sweats continued.
My short and imperfect sleep was disturbed
by distressing or frightful dreams. The scenes of
them were derived altogether from sick rooms and
grave-yards. I concealed my sorrows as much as
possible from my patients; but when alone, the
retrospect of what was past, and the prospect of
what was before me, the termination of which was
invisible, often filled my soul with the most poignant
anguish. I wept frequently when retired
from the public eye, but I did not weep over the
lost members of my family alone. I beheld or
heard every day of the deaths of citizens, useful in
public, or amiable in private life. It was my misfortune
to lose as patients the Rev. Mr. Fleming
and Mr. Graesel, both exhausted by their labours
of piety and love among the poor, before they sickened
with the disease. I saw the last struggles of
departing life in Mr. Powel, and deplored, in his
death, an upright and faithful servant of the public,
as well as a sincere and affectionate friend. Often
did I mourn over persons who had, by the most
unparalleled exertions, saved their friends and families
from the grave, at the expence of their own
lives. Many of these martyrs to humanity were
in humble stations. Among the members of my
profession, with whom I had been most intimately
connected, I had daily cause of grief and distress.
I saw the great and expanded mind of Dr. Pennington,
shattered by delirium, just before he died.
He was to me dear and beloved, like a younger
brother. He was, moreover, a Joab in the contest
with the disease. Philadelphia must long deplore
the premature death of this excellent physician.
Had he lived a few years longer, he would have
filled an immense space in the republic of medicine[102].
It was my affliction to see my friend Dr.
John Morris breathe his last, and to hear the first
effusions of the most pathetic grief from his mother,
as she bursted from the room in which he died.
But I had distress from the sickness, as well as the
deaths of my brethren in physic. My worthy
friends, Dr. Griffitts, Dr. Say, and Dr. Mease,
were suspended by a thread over the grave, nearly
at the same time. Heaven, in mercy to me, as
well as in kindness to the public and their friends,
preserved their lives. Had they died, the measure
of my sorrows would have been complete.
I have said before, that I early left off drinking
wine; but I used it in another way. I carried a
little of it in a vial in my pocket, and when I felt
myself fainty, after coming out of a sick room, or
after a long ride, I kept about a table spoonful of it
in my mouth for half a minute, or longer, without
swallowing it. So weak and excitable was my
system, that this small quantity of wine refreshed
and invigorated me as much as half a pint would
have done at any other time. The only difference
was, that the vigour I derived from the wine in the
former, was of shorter duration than when taken in
the latter way.
For the first two weeks after I visited patients
in the yellow fever, I carried a rag wetted with
vinegar, and smelled it occasionally in sick rooms:
but after I saw and felt the signs of the universal
presence of miasmata in my system, I laid aside
this and all other precautions. I rested myself on
the bed-side of my patients, and I drank milk or
ate fruit in their sick rooms. Besides being saturated
with miasmata, I had another security against
being infected in sick rooms, and that was, I went
into scarcely a house which was more infected than
my own. Many of the poor people, who called
upon me for advice, were bled by my pupils in my
shop, and in the yard, which was between it and
the street. From the want of a sufficient number
of bowls to receive their blood, it was sometimes
suffered to flow and putrify upon the ground.
From this source, streams of miasmata were constantly
poured into my house, and conveyed into
my body by the air, during every hour of the day
and night.
The deaths of my pupils and sister have often
been urged as objections to my mode of treating
the fever. Had the same degrees of labour and
fatigue, which preceded the attack of the yellow
fever in each of them, preceded an attack of a common
pleurisy, I think it probable that some, or perhaps
all of them, would have died with it. But
when the influence of the concentrated miasmata
which filled my house was added to that of constant
fatigue upon their bodies, what remedies could be
expected to save their lives? Under the above
circumstances, I consider the recovery of the other
branches of my family from the fever (and none of
them escaped it) with emotions, such as I should
feel had we all been revived from apparent death
by the exertions of a humane society.
For upwards of six weeks I did not taste animal
food, nor fermented liquors of any kind.
The quantity of aliment which I took, inclusive
of drinks, during this time, was frequently not
more than one or two pounds in a day. Yet
upon this diet I possessed, for a while, uncommon
activity of body. This influence of abstinence
upon bodily exertion has been happily illustrated
by Dr. Jackson, in his directions for preserving the
health of soldiers in hot climates. He tells us,
that he walked a hundred miles in three days, in
Jamaica, during which time he breakfasted on tea,
supped on bread and salad, and drank nothing but
lemonade or water. He adds further, that he
walked from Edinburgh to London in eleven days
and a half, and that he travelled with the most ease
when he only breakfasted and supped, and drank
nothing but water. The fatigue of riding on
horseback is prevented or lessened by abstinence
from solid food. Even the horse suffers least from
a quick and long journey when he is fed sparingly
with hay. These facts add weight to the arguments
formerly adduced, in favour of a vegetable diet, in
preventing or mitigating the action of the miasmata
of malignant fevers upon the system. In both
cases the abstraction of stimulus removes the body
further from the reach of undue excitement and
morbid depression.
Food supports life as much by its stimulus, as
by affording nourishment to the body. Where
an artificial stimulus acts upon the system the natural
stimulus of food ceases to be necessary. Under
the influence of this principle, I increased or
diminished my food with the signs I discovered
of the increase or diminution of the seeds of the
disease in my body. Until the 15th of September
I drank weak coffee, but after that time I drank
nothing but milk, or milk and water, in the intervals
of my meals. I was so satisfied of the efficacy
of this mode of living, that I believed life might
have been preserved, and a fever prevented, for
many days, with a much greater accumulation of
miasmata in my system, by means of a total abstinence
from food. Poison is a relative term, and
an excess in quantity, or a derangement in place,
is necessary to its producing deleterious effects.
The miasmata of the yellow fever produced sickness
and death only from the excess of their quantity,
or from their force being increased by the addition
of those other stimuli which I have elsewhere
called exciting causes.
In addition to low diet, as a preventive of the
disease, I obviated costiveness by taking occasionally
a calomel pill, or by chewing rhubarb.
I had read and taught, in my lectures, that fasting
increases acuteness in the sense of touch.
My low living had that effect, in a certain degree,
upon my fingers. I had a quickness in my perception,
of the state of the pulse in the yellow
fever, that I had never experienced before in any
other disease. My abstemious diet, assisted perhaps
by the state of my feelings, had likewise an
influence upon my mind. Its operations were performed
with an ease and a celerity, which rendered
my numerous and complicated duties much less
burdensome than they would probably have been
under other circumstances of diet, or a less agitated
state of my passions.
My perception of the lapse of time was new to
me. It was uncommonly slow. The ordinary
business and pursuits of men appeared to me in a
light that was equally new. The hearse and the
grave mingled themselves with every view I took
of human affairs. Under these impressions I recollect
being as much struck with observing a
number of men, employed in digging the cellar of
a large house, as I should have been, at any other
time, in seeing preparations for building a palace
upon a cake of ice. I recollect, further, being
struck with surprise, about the 1st of October, in
seeing a man busily employed in laying in wood for
the approaching winter. I should as soon have
thought of making provision for a dinner on the
first day of the year 1800.
In the account of my distresses, I have passed
over the slanders which were propagated against
me by some of my brethren. I have mentioned
them only for the sake of declaring, in this public
manner, that I most heartily forgive them; and
that if I discovered, at any time, an undue sense
of the unkindness and cruelty of those slanders, it
was not because I felt myself injured by them, but
because I was sure they would irreparably injure
my fellow-citizens, by lessening their confidence
in the only remedies that I believed to be effectual
in the reigning epidemic. One thing in my conduct
towards these gentlemen may require justification;
and that is, my refusing to consult with
them. A Mahometan and a Jew might as well
attempt to worship the Supreme Being in the
same temple, and through the medium of the
same ceremonies, as two physicians of opposite
principles and practice attempt to confer about
the life of the same patient. What is done in
consequence of such negotiations (for they are
not consultations) is the ineffectual result of neutralized
opinions; and wherever they take place,
should be considered as the effect of a criminal
compact between physicians, to assess the property
of their patients, by a shameful prostitution of the
dictates of their consciences. Besides, I early discovered
that it was impossible for me, by any reasonings,
to change the practice of some of my brethren.
Humanity was, therefore, on the side of
leaving them to themselves; for the extremity of
wrong in medicine, as in morals and government,
is often a less mischief than that mixture of right
and wrong which serves, by palliating, to perpetuate
evil.
After the loss of my health I received letters
from my friends in the country, pressing me, in the
strongest terms, to leave the city. Such a step had
become impracticable. My aged mother was too
infirm to be removed, and I could not leave her.
I was, moreover, part of a little circle of physicians,
who had associated themselves in support of
the new remedies. This circle would have been
broken by my quitting the city. The weather
varied the disease, and, in the weakest state of my
body, I expected to be able, from the reports of
my pupils, to assist my associates in detecting its
changes, and in accommodating our remedies to
them. Under these circumstances it pleased God
to enable me to reply to one of the letters that
urged my retreat from the city, that “I had resolved
to stick to my principles, my practice, and my
patients, to the last extremity.”
On the 9th of October, I visited a considerable
number of patients, and, as the day was warm, I
lessened the quantity of my clothing. Towards
evening I was seized with a pain in the back,
which obliged me to go to bed at eight o'clock.
About twelve I awoke with a chilly fit. A violent
fever, with acute pains in different parts of my
body, followed it. At one o'clock I called for Mr.
Fisher, who slept in the next room. He came instantly,
with my affectionate black man, to my relief.
I saw my danger painted in Mr. Fisher's
countenance. He bled me plentifully, and gave
me a dose of the mercurial medicine. This was
immediately rejected. He gave me a second dose,
which likewise acted as an emetic, and discharged
a large quantity of bile from my stomach. The
remaining part of the night was passed under an
apprehension that my labours were near an end.
I could hardly expect to survive so violent an attack
of the fever, broken down, as I was, by
labour, sickness, and grief. My wife and seven
children, whom the great and distressing events
that were passing in our city had jostled out of
my mind for six or seven weeks, now resumed
their former place in my affections. My wife had
stipulated, in consenting to remain in the country,
to come to my assistance in case of my sickness;
but I took measures which, without alarming her,
proved effectual in preventing it. My house was
enveloped in foul air, and the probability of my death
made her life doubly necessary to my family. In
the morning the medicine operated kindly, and
my fever abated. In the afternoon it returned,
attended with a great inclination to sleep. Mr.
Fisher bled me again, which removed the sleepiness.
The next day the fever left me, but in so
weak a state, that I awoke two successive nights
with a faintness which threatened the extinction of
my life. It was removed each time by taking a
little aliment. My convalescence was extremely
slow. I returned, in a very gradual manner, to my
former habits of diet. The smell of animal food,
the first time I saw it at my table, forced me to
leave the room. During the month of November,
and all the winter months, I was harassed with a
cough, and a fever somewhat of the hectic kind.
The early warmth of the spring removed those
complaints, and restored me, through Divine goodness,
to my usual state of health.
I should be deficient in gratitude, were I to conclude
this narrative without acknowledging my
obligations to my surviving pupils, Mr. Fisher and
Mr. Coxe, for the great support and sympathy I
derived from them in my labours and distresses.
I take great pleasure likewise in acknowledging
my obligations to my former pupil, Dr. Woodhouse,
who assisted me in the care of my patients,
after I became so weak as not to be able to attend
them with the punctuality their cases required.
The disinterested exploits of these young gentlemen
in the cause of humanity, and their success in the
treatment of the disease, have endeared their names
to hundreds, and, at the same time, afforded a prelude
of their future eminence and usefulness in
their profession.
But wherewith shall I come before the great
FATHER and REDEEMER of men, and what
shall I render unto him for the issue of my life
from the grave?
———Here all language fails:———
Come then, expressive silence, muse his praise.