_Of the Cure of the Plague._
From what has already been laid down in a former section concerning
the nature of this distemper, it appears, in its worst and most
deadly form, to consist in the sudden breaking forth of a kind of
hard mortifications, or rather eschars, like those made by fire, in
different parts of the body. When these happen to fall upon any of
the vital parts, it is evident that no cure can be applied. When such
eschars discover themselves in abundance on the external parts, it is
likewise observed that the patient certainly dies; whether from the
same taking place inwardly, or from nature not being able to bear the
loss of substance, and to separate so many deep eschars, is uncertain:
but this kind, which attacks without fever, has always been reckoned
absolutely incurable. When the tendency to internal mortification
is less, and the fiery blasts, if we may so call them, approach the
surface, so that buboes or carbuncles begin to appear, there is
then some hope that the patient may recover. Even here, however,
the case must be considered as very doubtful, and we have seen that
in Dr. Russel’s three first classes of patients not one recovered;
nevertheless, as we are not always able to distinguish with certainty
whether the patient is altogether beyond the power of medicine or not,
excepting where the _tokens_ formerly mentioned appear, this kind only
is here distinguished by the name of the _fatal_ or inevitably mortal
kind of plague. In all cases, where there is time allowed, medicine
ought to be employed; but, as in other diseases, different theories
have bred such a contradiction of opinions, that it is with no small
difficulty we can judge which has any _probability_ of success. In
this uncertainty, however, we must look upon those who have recently
had an opportunity of seeing the disease as superior not only to those
who have only _read_ of it, but even to the most celebrated ancient
physicians who have written upon the subject. Those who have had
the best and latest opportunities of seeing the distemper are Drs.
Alexander and Patrick Russel at Aleppo, and the physicians to the
Russian army when the plague raged in it in 1770, &c.
Dr. Alexander Russel begins with observing that “the discordant
opinions of medical writers concerning the method of treating the
plague are innumerable. In regard to bleeding and other evacuations,
they maintain opinions diametrically opposite; some recommending
them as indispensably requisite, others decrying them as invariably
pernicious; while both parties, with equal confidence, appeal to
experience. But, in a disease wherein reason is often perplexed, and
experience itself fallacious, it is greatly to be lamented that nature
is not more, and opinion less, consulted.
“No traces of any satisfactory method of cure are to be met with among
the natives at Aleppo. The Mahommedans, holding the plague to be a
penal curse inflicted by Almighty God on a sinful people, have less
faith in the efficacy of medicine in that disease than any other: and,
as the chief of those who practise physic are either Christians or
Jews, not armed with the doctrine of predestination, and consequently
apprehensive of contracting the infection, they (the physicians)
endeavour to confirm the vulgar notion of the inutility of their art
in the plague, with a prudential view of evading the danger of being
forced to visit the sick. Hence the greatest part of the infected are
either left to struggle with the disease without any assistance from
medicine, or are under the necessity of submitting to the direction of
the meanest and most ignorant of mankind.”
The whole practice of the native physicians consists in bleeding, let
the stage of the distemper be what it will, and afterwards attempting
to raise a sweat with the insignificant remedy of a few grains of
bezoar mixed with the distilled water of scorzonera. On the subject of
evacuations our author remarks, that bleeding, even very plentifully,
was always useful in the beginning, but as constantly prejudicial after
the first day. Vomiting was equally useful at the same period; with
mere warm water, if that would answer the purpose, but if not, small
drops of ipecucuanha or sal vitrioli might be added. Violent cathartics
were hurtful, but an emollient clyster or laxative of manna and cream
of tartar were not only safe but serviceable. “On the second day of
the disease (says the Doctor) where the remissions of the symptoms
were tolerably distinct, I have frequently and successfully given an
infusion of senna with manna and cream of tartar; and it is a fact
confirmed to me by repeated experience, that a purgative of this
lenient kind, given after the critical sweat, was the most effectual
means of promoting the suppuration of the buboes.
“The natural crisis of the disease was always by the skin. When a
copious sweat could be procured by art, it was likewise of service;
but the attempt, if made the first day, was attended with two material
inconveniences: the first, that the common diaphoretic medicines, if
given in the usual dose, if they failed in their operation, threw
the patient into a flame, and greatly augmented all their symptoms;
the second, that, though they produced the desired effect, it was
necessary to keep up the sweat a much longer time than most people
of that country could be persuaded to endure; and, if the sweat was
prematurely checked by exposure to the air, all the symptoms were
either exasperated, or (what was often the case) a diarrhœa was
induced, which, though at first it might seem to relieve, yet generally
proved fatal in the end.”
Contrayerva and valerian, saffron, the compound powder of contrayerva
of the Edinburgh College, are recommended as sudorifics; given in
small doses every four hours, with acidulated diluent drinks. These
medicines were occasionally joined with anodynes, among which syrup of
poppies was reckoned preferable to opium. In cases of diarrhœa, Venice
treacle or diascordium were joined with the diaphoretics. Neither bark
nor snakeroot could have a fair trial, on account of the prejudices
of the people: and on this occasion our author observes, that “the
physician who would obtain a ready compliance with his directions, in
that country, must as seldom as possible offend the palates of his
patients with nauseous remedies; for, whatever may be the consequence,
they will often rather choose to incur distant though great risks, than
avoid them by submitting to present inconveniences.” Nitrous medicines
were found ineligible on various accounts: 1. They did not, as in other
diseases, allay heat. 2. The sick could not bear them in ordinary
doses without languor and dejection. 3. They were apt to bring on a
diarrhœa.--The following is an epitome of our author’s practice:
1. Bleeding from ten to twenty ounces as soon as possible after the
seizure. The quantity seldom exceeded sixteen ounces, and even this is
greatly above what is taken in any other disease in that country.
2. After bleeding, where the nausea was considerable, the stomach was
cleansed with warm water; or, if that failed, with ipecucuanha or salt
of vitriol. It was of such importance to have both these evacuations
performed early, that our author instructed most of his acquaintance
how to act if they should be infected.
3. A gentle anodyne succeeded the vomit. If by it the stomach was not
quieted, an ounce of diascordium, or 15 drops of laudanum, were added
to the saline draught of Riverius.
4. Small doses of cordial and diaphoretic medicines, with a very small
quantity of antimoniated nitre, were exhibited every four hours; the
sick were encouraged to drink freely of a decoction of scorzonera
roots and barley, or spring water moderately acidulated with spirit of
vitriol. A mixture of the acid with syrup of violets was kept ready to
be added to plain water. All the drink was given warm if the patient
would be prevailed upon to take it so.
5. In the winter the sick were removed into more airy lodgings than
those in which they usually slept, and the air of the room was warmed
or corrected by a moderate fire. In summer only the windows opposite to
the patient’s bed were ordered to be shut; but even this restriction
was not universally complied with; many insisting upon setting all the
windows open in the day time, and sleeping on the house top at night.
6. In case of faintness and uneasiness, a cordial, composed of some
of the simple distilled waters, tinctures of saffron and valerian,
alkermes, and spirit of vitriol, was used with advantage and great
refreshment to the sick. This with plenty of acidulated drinks was the
chief prescription for infected children.
Under the above treatment, a sweat often broke out on the second or
beginning of the third day; after which the sick were covered up, and
the sweat encouraged as long as they could be persuaded to bear it.
By this first sweat, especially if it happened on the second day, the
patient was never freed from the fever, though greatly relieved. It
was therefore necessary to continue the same medicines, in order, by
a more plentiful sweat, to procure a perfect crisis. Where the sweat
was supposed to be sufficiently copious, and had greatly mitigated the
symptoms, a mild cathartic was given in the morning, though some degree
of fever still remained; the other medicines not being intermitted
during its operation. An anodyne was given in the evening.
In case of an exacerbation of the symptoms or the depression of the
buboes, as sometimes happened on the second or third day, it was useful
to apply a blister just below the tumour. A blister to the head was
useful in cases of coma and debility of the tongue. The natives were
exceedingly averse to the use of blisters; but, having observed that
some who had been judged past recovery had nevertheless struggled
through, apparently from the use of blisters, they at last came into
some degree of credit. Cataplasms, composed of garlic, bread and
vinegar, were advantageously applied to the soles of the feet. These,
as well as blisters, were useful in cases of coma; also emollient
laxative clysters. The dose of the alexipharmics was increased, and
acidulated drinks, in small quantities at a time, given frequently.
To the buboes it was customary to apply suppurative cataplasms; but, as
these could not, where the patient was desirous of walking, be easily
kept on, a diachylon gum plaster was substituted, with the addition
of few cantharides, or a little euphorbium, if a greater stimulus
was judged necessary. In most cases the buboes were left to open of
themselves; the natives being afraid of the lancet or caustic, and
sometimes operators being wanting. No bad consequence ensued on their
being left to open of themselves, nor was any particular treatment
necessary. Where they mortified, the treatment was the same as in
carbuncles, and though, after the separation of the gangrened parts,
the ulcer often remained wide and deep, yet they healed kindly and in a
short time.
Sometimes the carbuncles were scarified, but oftener not. The best
dressings were pledgits of yellow basilicon, with a small proportion of
oil of turpentine, or sometimes tincture of myrrh, with an emollient
cataplasm over all.
Dr. Patrick Russel complains that, in Turky, physicians are laid under
such restraints, by popular prejudices, that they are sometimes obliged
to remain almost passive spectators of the disease. The natives are
fond of bleeding, and will at any time let blood in the hot stages,
when the febrile symptoms run high. About two thirds of the infected
were bled at the arm; but from the rapid progress of the disease, and
the quick transition to the low, languid state, few were bled more
than once, and that usually within the first forty hours. The time of
bleeding was usually the first night, or some time on the second day;
but sometimes not till the third. Where the operation was repeated,
it was usually on the third, sometimes on the fifth, and even on the
sixth; he has even met with instances wherein the patient was three
or four times bled, the last being as late as the seventh day. In his
own practice he usually advised one bleeding at the beginning, except
in the very young, aged, or infirm. On the first day, if not forbid by
circumstances, bleeding was ordered by way of precaution; but on the
succeeding days it was regulated by the state of the pulse, and other
symptoms. Where the infection was slight, and the febrile symptoms
moderate, or did not come on till some days after the eruptions, it
was wholly omitted. The quantity of blood taken away seldom exceeded
eight or ten ounces. Cupping was used by the natives, but never ordered
by Dr. Russel. Children were scarified in the legs. He seldom had an
opportunity of examining the blood drawn from a vein; but, in such
cases as occurred, the general appearance was little different from
that of healthy blood; the crassamentum was sometimes of a darkish
colour, but never sizy or resolved.
With regard to the propriety or impropriety of bleeding, or at least
the success attending it, we can best judge from the histories of
cases given by Dr. Russel at the end of his work. Of these there are
an hundred and twenty, with some supernumeraries, giving an account of
the cases of the attendants, &c. Of these, sixty-five were bled; forty
died, and twenty-five recovered.
Of these hundred and twenty cases at large, fifty-seven recovered, as
many died, and the event of six was unknown. This would tend to give
us some considerable idea of the Doctor’s success; but, when we take
into account the time of the year in which these cases were treated,
the matter will appear in a quite different light. Twenty-seven took
place mostly in the earlier part of the season, and were of consequence
more violent than the others; and, of these, twenty-one died, five
recovered, and the event of the other case was uncertain. Of the rest
only thirty-six died, and fifty-four recovered. Such an excessive
disproportion cannot be ascribed to the medical treatment, but to the
nature of the disease itself, growing milder as it extended wider. In
many of these cases it is not mentioned whether the patients took any
medicines or not; nevertheless, as it must always be supposed that a
physician would prescribe something for his patient, it must also be
supposed that all took medicines, excepting where we are expressly
told that they did not. The cases in which he mentions the medicines
employed were the following:
1. A young man of 20, suddenly seized, was bled largely; had a vomit of
ipecacuanha, which brought off a quantity of bile, but without putting
a stop to the natural retchings. Some diaphoretic medicines were given,
which did not remain on his stomach, and he did not sweat. These were
stopped by a draught of juice of lemons and alkaline salt taken in the
act of effervescence. Sinapisms were applied to the feet, and he died
the third night at midnight.
2. A widow lady about 40, of a thin, delicate habit, in whom the
disease came on gradually, was bled on the third day, and took
diaphoretic medicines and acidulated cordials till the 9th. She died on
the 11th.
3. A Jewish rabbi, between 30 and 40, of a thin, spare habit, was bled
on the 2d day, and died early on the morning of the 4th.
4. A Jewish boy, between seven and eight years old, of a pale,
unhealthy complexion, was repeatedly purged, and had suppurative
cataplasms applied to the buboes without effect. He recovered slowly.
Dr. Russel was not called till the seventh day of the disease, and we
are not informed when the purgatives were administered.
5. A Jewish lad of 14, healthy and florid, was visited on the third
day. He had already been scarified in the legs, and bleeding was
ordered; but, as he became faint, only a small tea-cupful could be
taken away. The blood, after two hours, was found to have a soft and
loose texture, somewhat blackish on the surface; but the quantity of
serum was not greater than usual. It had appeared of a blackish colour
at first. He had a vomit, draughts with spiritus mindereri; afterwards
a diaphoretic mixture and acidulated cordial, and sinapisms to the
feet. On the seventh day he sweated copiously, and was much relieved,
but soon relapsed. On the 10th he sweated early in the morning, and had
a temporary relief, but soon became worse than ever. On the eleventh he
had three stools of black blood. One of these, kept for the Doctor’s
inspection, consisted of about three tea-cupfuls, without any fœtor;
the others were “inconsiderably small.” Some tincture of bark was now
added to his usual mixture. On the 15th he had a purging potion which
operated five times, had an opiate at night, and tincture of bark with
elixir of vitriol was ordered twice a day. Next day he was quite free
of fever, and quickly recovered.
6. A Jew of a thin, spare habit, who took no medicines, died on the
sixth day. His wife, of a delicate frame, and six months gone with
child, was bled in the arm, had “proper drinks” directed for her,
brought forth a child in the agonies of death, and expired on the
sixth day. They were extremely poor, and Dr. Russel says of the house
they inhabited, that it “was one of those miserable dwellings which he
had always considered as one of the receptacles of contagion.” It did
not, however, appear to be so; for, though there were other six in the
family, only one of them was infected, who died in ten days.
7. A youth of a delicate constitution, a French native of Aleppo, was
visited on the morning of the third day. He had a carbuncle on his
neck, which had been mistaken for an ordinary inflammation, and a
physician who had previously visited him applied a galbanum plaster,
ordering also some nitrous medicines; but the plaster giving much pain,
it was changed for a common poultice. Live pigeons were applied to the
feet. On the fourth he had a diaphoretic medicine, and his drinks were
acidulated with spirit of vitriol. The symptoms increasing, sinapisms
were applied to the feet, but without effect. Cataplasms of garlic were
applied next night; he had two copious black stools, not very fœtid,
and two bilious ones in the morning of the sixth. By these stools he
was greatly weakened, and was ordered a cordial with diascordium. He
had another stool, and became much worse. Cataplasms were applied
without effect, and he died on the seventh day. This patient had
a great number of eruptions; but, though six people attended him
constantly, none of them were infected.
8. A Jewish girl of nine years old, of a delicate frame, and sprightly
disposition, was visited on the 4th day. The usual regimen and
medicines were ordered, but she could not be prevailed on to take any
thing besides an acidulated cordial. Palm-oil was externally applied
to a carbuncle near the corner of the mouth, about an inch long, and
the third of an inch broad. This seemed to ease the pain, but did not
prevent it from spreading. The face was also strangely disfigured by
three or four streaks of a pale red colour, shooting up on each side
from the cheeks towards the temples. The gangrene spread rapidly, and
she died on the evening of the tenth day.
9. A stout, healthy Armenian youth, about 20, was visited on the first
day, and took a vomit of ipecacuanha, which brought up a good deal of
bile. An anodyne was given at night, but without effect. He took no
medicines afterwards but an acidulated cordial. On the third he eat a
quantity of cherries, and drank some iced water. He died on the fourth.
Here the infection spread violently, only one out of six in the same
house escaping the disease. Three died.
10. An Armenian woman in the seventh month of her pregnancy. She was
bled the first day, had afterwards diaphoretic boluses, but did not
sweat. On the third day she was delivered of a dead child, and seemed
much better, but died at night. After death the body was entirely
covered with purple marks.
11. A boy was bled and had an alexipharmic mixture the first day. A
diarrhœa came on, and diascordium was added to the mixture without
success. He died the third night. The infection was violent, only one
in the house escaping.
12. A Jew of middle age and gross habit of body was bled on the
second day. He was visited on the fifth, had diaphoretic powders, and
sinapisms were ordered without success. He died on the 6th.
13. A Christian youth of 17, taken suddenly, was visited on the second
day. A cataplasm was applied to the groin; he had a vomit of ipecacuan,
and a diaphoretic draught with nitre and diascordium at night, but did
not sweat. Next day he had acidulated drinks, a mixture with sweet
spirit of nitre, and a small proportion of nitre itself. On the fourth,
he had two stools, of a reddish colour like blood, after which he
became much worse. In the night he had two other stools, which seemed
to lower him. Throughout the day a larger portion of nitre had been
added to his mixture, and three tea-cupfuls of blood were taken away,
without the Doctor’s knowledge, by cupping. On the fifth the nitre
was omitted; he was ordered an astringent cordial, but it was not
given; however, the diaphoretic medicines were continued, and he had
three loose stools, which sunk him greatly. Next day he seemed past
recovery; lying motionless, insensible, his breathing quick, laborious
and interrupted; the skin not cold, but the feverish heat gone, and
his countenance ghastly. From this lethargic state the women attempted
frequently to rouse him, by applying vinegar to his nostrils, calling
him loudly by his name, and such like means, by which they sometimes
succeeded; but, though he opened his eyes, and gave signs of sense, he
could not be prevailed on to drink; and he remained silent. He would
then, for some time, writhe his body as in mortal agony, and again
relapse into lethargy. This dreadful paroxysm, however, began to wear
off about noon; and at night he was less disturbed than usual. On the
seventh day he was manifestly better; he had a looseness, with gripes,
for which the white decoction was ordered; and he had tincture of
bark thrice in twenty-four hours. On the sixteenth day the fever was
entirely gone. The Doctor observes that this patient sweated much less
than was usual with those who recovered.
14. A Christian boy about 17 was visited on the 4th day, having taken
some absorbent powders on the 2d from another physician. The family
would allow no other medicines to be given, except a few grains of
bezoar, and he died next day.
15. An Italian, a man about 40, of a gross habit of body, and addicted
to drinking, but who, finding himself somewhat indisposed, had for two
or three days lived temperately, was visited on the second day of his
illness, had a diaphoretic mixture, and a laxative medicine, without
relief. In the night between the 5th and 6th he had some retchings to
vomit. Next day he complained of a pain at the pit of the stomach, had
a vomit of ipecacuanha, which brought off a considerable quantity of
bile by vomit and stool, but without any apparent relief. He had two
fœtid stools, and was ordered a cordial with volatiles. On the 7th
his pulse was exceedingly sunk, and his extremities had been as cold
as ice, but with very little alteration in the eyes or countenance.
The patient did not know that these parts had lost their heat; and,
notwithstanding this change, the sensation still remained in them. He
died on the afternoon of the 8th day. This patient had no eruptions.
16. A Christian merchant about 50, of an atrabilious habit, and subject
to the hæmorrhoids, on being taken ill drank immoderately of cold
water. He was visited next day. In the afternoon about ten ounces of
blood were taken away, and, as his pulse rose after the operation,
he lost, by Dr. Russel’s order, six ounces more. Three ounces
were afterwards taken away by cupping, and about as much more was
accidentally lost by the loosening of the bandage of the arm; so that
about 24 ounces were taken away in all. Next day he got a few drops of
Carmelite water, a kind of spiritous cordial, which he vomited, had a
blister and sinapisms applied, and died between 10 and 11 at night. He
had no eruptions.
17. An Armenian youth was visited on the morning of the third day, was
bled, and had a saline draught every four or five hours. On the fifth
he was removed into a more airy chamber, and had Huxham’s tincture of
the bark. He died on the ninth day.
18. A young lady of French extraction, of a thin, slender make,
was visited on the morning of the second day. On the third she had
diaphoretic powders, and lost a few ounces of blood by cupping, without
the Doctor’s knowledge; she had a diaphoretic mixture, and died on the
sixth day.
From these accounts it is easy to see, that, in violent cases of the
plague, medicine can do little or nothing. Such cases generally occur
in the earlier months of the season, though they may take place, and
do take place in great numbers, at any time. In the beginning of the
season the patients are almost all attacked in this violent manner, and
very seldom recover, whether they take medicines or not. It being then
an established fact, that as the epidemic season advances the disease
grows milder, and many more continue to recover of themselves than
did so at first, we are naturally led to suppose that a multitude of
those who recovered after taking the medicines would have done the same
without them. Little therefore needs be said of the immense number of
prescriptions found in authors who have written upon the plague, as it
may generally be supposed that at certain times these would have been
ineffectual, and at others they were useless.--The following is an
epitome of Dr. Patrick Russel’s practice:
1. Bleeding as early as possible, seldom repeated, except where
manifestly indicated by circumstances.
2. Vomiting, if spontaneous, was encouraged by warm water. If the
patient was affected by nausea, vomiting was provoked by warm water or
camomile tea, assisted by a feather. If a bitter taste in the mouth was
complained of, ten or fifteen grains of ipecacuanha were given. The
times of remission were laid hold of for those remedies.
3. Where spontaneous vomiting continued too long, a saline mixture was
given, sometimes with opiates and external applications.
4. The stomach being settled, mild sudorifics were given in small
doses, every five or six hours. In the beginning, nitre was joined
with contrayerva, but where it occasioned loose stools, was left off.
Spiritus mindereri and saline mixture were also given as sudorifics.
5. In case of diarrhœa, dilution was first prescribed and then the
white decoction. Laxative medicines were seldom admitted by the friends
of the patient. Diascordium and opiates were used in cases of obstinate
diarrhœa.
6. In the advance of the distemper it was found more eligible to give
the sudorifics at shorter intervals, when occasion required, than to
augment the dose, which was apt to occasion disgust, and a rejection
of medicine entirely; consequences which also attended an attempt to
heighten the power of the medicines themselves. The general design was
to make their operation coincide with the periodical determination to
the skin naturally occurring in the disease.
7. The sudorifics exhibited having but small power by themselves, it
was found necessary to assist them by dilution, as well as in every
other method which could be attempted. If the patient was not naturally
inclined to drink, he was encouraged to it by offering agreeable
liquids, either hot or cold at the person’s option.
8. The diet was the same as in other acute distempers. No animal
food stronger than chicken broth was allowed; the rest confided of
farinacea and leguminous vegetables. “It was certainly necessary (says
our author) to a certain degree, to support nature by proper food; but
to force it upon a nauseating stomach seems to have been irrationally
recommended; and, where attempted, which the over care of the nurses
frequently did, usually excited vomiting. I sometimes wished to
give wine, but a religious bar lay in the way of Mahommedans, and a
prejudice against it, in all fevers, rendered it equally inadmissible
among the Christians and Jews.”
9. For oppression at the præcordia, mild cordials, acidulated drinks
and cool air were found useful. Throughout the disease access of cool
air to the chamber was constantly allowed, and, where the chamber
itself was not sufficiently airy, the bed was removed to the house top.
Towards the height of the exacerbations, however, when there happened
to be the least appearance of moisture on the skin, the sick were kept
moderately covered up from the chin downward.
10. After the height, and through the decline of the disease, the bark
in substance, or Huxham’s tincture, were given instead of the ordinary
sudorifics.
In the plague which took place in the Russian army, the greatest
confidence seems to have been put in vomits. The disease commonly began
with a dull pain in the head, resembling that produced by the fumes
of charcoal, accompanied with shivering, universal weakness, &c.[135]
On the first appearance of these a vomit was given, working it off
with acid drinks. “If the nausea and bitter taste in the mouth was not
removed by the first, they gave a second, and sometimes a third or
fourth; nay, they sometimes, if the symptoms were very urgent, gave
two or three in the space of twelve hours, as there is no time to be
lost in this disease; for they did not find this species of evacuation
subject to the same inconvenience with purges, which a man in the
plague is unable to support; nay, they are even dangerous, though he
bears brisk vomits, and a repetition of them, when the nature of the
case requires it.
[135] Duncan’s Med. Comment. vol. viii, p. 352.
“The stomach being thus cleansed, they gave every morning a powder
composed of twenty grains of rhubarb, mixed with as much flower of
brimstone, and three grains of ipecacuanha, exhibiting also, every
hour, five grains of pure nitre mixed with two grains of camphor; and,
if costive, a laxative clyster was given every evening, composed of
decoction of camomile, wine vinegar, with or without soap, according to
circumstances.
“The head, temples and buboes were frequently washed with warm vinegar,
and the last urged to suppuration with emollient cataplasms; but, in
case they were found to baffle all attempts to bring them forward,
they were then scarified or extirpated, and the patient ordered to
drink plentifully of _lime-water_. Bark was given after evacuation,
joined to the flower of brimstone in the proportion of one ounce of
the former to a drachm of the latter, divided into sixteen powders,
and taken in twenty-four hours. When delirium came on, blisters were
applied to the legs and arms, and camphor given largely. Vegetable and
mineral acids were given indiscriminately; but they found the vegetable
kind sometimes remain on the stomach when the other was thrown up; and
of the latter they preferred the vitriolic. Acidulated drinks were
given in quantity through the whole disease, and the food consisted of
acidulated water-gruel, and fruit when they could procure any. The air
of the room was kept charged with acetous vapours, as much as possible,
and it was remarked, that, while the bitter taste remained, there was
little hope of the disease abating.”
According to Baron Ash, “the plague does not depend upon any
constitution of the air, but is communicated only by contact, and they
had repeatedly succeeded in suppressing it in different divisions
of the army, by the immediate separation of the infected with their
attendants, and burning every thing belonging to them, or that they
had touched. They found the greatest advantage in keeping the soldiers
ignorant of its existence till suppressed; for by this means they
preserved their peace of mind, and health of body; and they found an
exact military discipline the best preservative against the disease.
For the cure of those infected they found the cold regimen, a free
circulation of air, vegetable and mineral acids, ipecacuanha, rhubarb
and bark, to be the properest remedies. That, to purify the air in
hospitals appropriated for their reception, gun-powder was found most
efficacious, probably from the commotion given to the air in explosion,
over and above its action in common with other fumes. To resist
infection, courage and fortitude of mind is necessary, as consternation
and terror seem to prepare the body for the reception of the disease.”
Dr. Sydenham seemed to have as great an opinion of bleeding, as
the Russian physicians of vomits. Considering the plague as merely
inflammatory, he lays the whole strength of the cure upon bleeding,
which he greatly prefers to any other remedy. The quantities he took
away were very considerable; and he gives an instance of a patient
who died from not having enough taken away. He also informs us, that,
during the civil wars in England, the plague raged in several places.
Being accidentally brought to Dunstar castle in Somersetshire, a
surgeon, who had travelled much in foreign parts, applied for leave
to give the garrison what assistance he could. This being granted, he
bled them, every man as he stood, without distinction, till ready to
drop down; the blood was suffered to flow down upon the ground, so
that no account could be taken of the quantity. They were then ordered
to lie in their tents; and, though no kind of remedy was given after
bleeding, every one recovered.[136] Notwithstanding his opinion of
bleeding, however, this celebrated physician was obliged to attempt the
cure by sweating, which he says he preferred to bleeding on account of
its not weakening the patient so much, nor hazarding the reputation of
the physician; yet he says it is prejudicial in young people where the
powers of life are strong. His improved method therefore was, first
to bleed moderately, if no swelling had appeared, by which means a
sweat would be more safely and easily raised. The bleeding is to be
performed in bed, after which the patient must be covered up with the
bed-clothes, and a piece of flanel applied to the forehead. This last
expedient, he says, contributes more to the raising of a sweat than
one would imagine. If no vomiting ensued, he administered sudorific
medicines internally. But, if the stomach cannot retain any thing, he
proposes to begin the sweating merely by the weight of the clothes,
and now and then throwing part of the sheet over the face. The sweat
being thus begun, the vomiting, however violent, generally stops, and
the medicines will be retained, so that as plentiful a perspiration as
we can desire may be excited. An instance of his success in this way
he gives in an apothecary who applied to him in behalf of his brother.
A sweat being proposed, the apothecary told him that he had given
him several strong sudorifics, all of which had been thrown up; but
the Doctor, having first sweated him moderately by the bed-clothes,
afterwards gave him a large dose of Venice treacle; which operating
powerfully, he recovered from the disease. He advises the sweat to be
kept up without intermission for twenty-four hours; a smaller time
being insufficient to remove the disease, and a stoppage of the
perspiration certainly attended with a return of the bad symptoms. On
this occasion he censures Diemerbroeck and others for advising to stop
the sweat on every slight occasion. The linen is to be allowed to dry
on the patient’s body, he must take all his liquids warm, and continue
the use of a diluting fluid. Sage posset drink is what he recommends.
Next morning the cure was finished by a purge of senna, tamarinds,
&c. Where a swelling appears, he directs to forbear bleeding even in
such as are not apt to sweat, least the patient should die suddenly
from a return of the morbific matter into the vessels. Bleeding,
however, might be used with safety even in this case, provided a sweat
was instantly to be raised; and thus he thinks the swelling might be
dispersed perhaps with more safety than by waiting for its suppuration.
[136] Dr. Dover, who wrote, in 1732, the _Ancient
Physician’s Legacy_, had lodged his soldiers in a church in which
those who died of a plague had been buried. An hundred and eighty of
the soldiers were seized either with petechiæ or buboes. He ordered
them all to be bled in such quick succession, that the arm of the
first was not bound up till the blood flowed from the last. Thus
every one lost about an hundred ounces (upwards of three quarts.) He
then ordered them water acidulated with spirit of vitriol for their
drink; and by this treatment all recovered excepting eight, who would
not refrain from spiritous liquors. This was transacted in Peru:
but in Europe the plague will scarce bear bleeding to a few ounces.
(Sauvages.)
This may be accounted an epitome of the most approved modern practice
in pestilential cases. The Russian physicians above quoted seem to
speak with most confidence of their success. They, however, “lay
great stress upon distinguishing the plague from the worst kind of
malignant fever in hot countries; and it is not without reason, as bad
consequences have attended the confounding of them on the breaking
out of the plague. I am credibly informed that the great havock made
in Moscow was principally owing to this circumstance; for it obtained
some time before it was discovered by gentlemen unacquainted with the
disease, and before they would acknowledge its existence, although
some veteran army practitioners recognised its appearance under one of
its forms, and endeavoured to alarm their brethren, but in vain, for a
time.”[137]
[137] Duncan’s Med. Comment. vol. viii, p. 359.
From this it is natural to conclude, that, when the disease was once
fairly discovered and attacked by the powers of medicine, it could
not make much resistance; yet Dr. Mertens, speaking of this very
plague, says, that owing to the rapidity of the distemper, and many
inducements to conceal it, _little can be said of remedies_ in the
plague. He divides the distemper into two kinds, the nervous and
putrid; the former “comprehending merely that degree of confusion and
disturbance given to the nervous system on the first introduction of
the miasma, and the latter commencing at the time the miasma begins to
operate upon the blood and other fluids by assimilating them to their
own putrid nature.” In the nervous state the miasma has sometimes been
carried off by sweat, gentle diaphoretics, camphorated emulsions,
juleps of camphor and musk. Gentle emetics, particularly ipecacuanha,
were found useful; but James’s powder (which was imported from England
in great quantity) did not answer any good purpose. In the putrid
state, the bark and mineral acids were useful; purgatives were hurtful,
blood-letting inadvisable, and scarifying the carbuncles, recommended
by almost every writer, attended with no good effect.
Few of the modern travellers who have visited the countries in which
the plague is frequent, being versed in medicine, have said much about
the cure of it. Mariti only says, that, in the island of Cyprus,
infected patients were allowed no other diet than pure water, panada,
rice, tea, &c. Some thought to ward off the disease by drinking strong
liquors, but these _almost always_ fell victims to it. Whatever their
methods were, indeed, they must certainly have been very ineffectual,
since the same author informs us that, in the plague of 1759, in many
parts of that island there were not a sufficiency of inhabitants left
to cultivate the ground.
Diemerbroeck, whose name justly ranks high among those who have
written on the plague, trusts mostly to sudorific medicines. Bleeding,
according to him, is absolutely to be avoided, as well as purging
and vomiting. He directed first that the chambers of the sick should
be kept clean, and the air purified three or four times a day by
fumigations, and that the sick should take (in the beginning, the
first, second, or third day) a _sweating draught_, and being well
covered with blankets plentiful sweats were promoted for two or three
hours or more (always having a regard to the patient’s strength.) If
the patient did not sweat easily, bags filled with hot, dry sand were
applied to the feet, armpits and groin. If the sick were not eased by
the first sweat, it was repeated in a few hours; but if, after the
second sweat, the fever and other symptoms still increased, it was the
worst sign. After ten or twelve hours, and on the following days, they
were repeated four or five times as occasion required. Besides this he
directed apozems, antidotes, &c. which, as it is most probable they had
no effect in removing the disease, it is needless to trouble the reader
with.[138]
[138] As it might by some be deemed an affront offered to the wisdom
of antiquity, should we pass over in silence the opinions of the more
ancient physicians, I shall in this note give a short account of some
of their most remarkable modes of practice, as they are recorded in
Burnet’s _Thesaurus_.
1. Forestus, in many respects a respectable author, recommends an
_antidote_ composed of equal parts of rue, figs and almonds, beat
into a pulp in a stone mortar with a wooden pestle till united
(which is not very easily done) into an uniform mass, adding as
much syrup of citrons with vinegar as would render it soft, with a
little powdered salt put in last. The efficacy of this he tells us
he experienced in himself as well as all his family as a preventive;
himself taking in the morning the bigness of a small nutmeg of this,
made up into a confection with the ancient theriac, mithridate,
Armenian bole, terrasigillata, &c.
In his regular practice (for the above must be accounted quackery)
he advises bleeding within the first twelve, or at most twenty-four,
hours; such as were bled afterwards he says died. If performed in
seven or eight hours after the commencement of the disease the
cure went on the better. Where bleeding was inadvisable he used
cupping with scarifications, finishing the cure with sweating and
cordials. He remarks that where black tumours or eschars, lentil
shaped, appeared, the disease always proved mortal, without a single
exception. These were small, like a grain of black pepper, and
therefore called by the vulgar _peppercorn_; undoubtedly the _tokens_
of Dr. Hodges.
2. Hildanus, also a respectable writer, has an high opinion of issues
as a preventive. He says he never knew but one or two (and those of
a very bad habit of body) who had issues in their legs and arms that
perished in the plague, and says that he has known its efficacy as
a preventive not only in himself but many others. He says he kept
two issues in his own body, one in the left arm, the other in the
right leg. (See above p. 339) To the same purpose Mercurialis relates
that he never knew but one, and he was a _priest_, who died of the
plague having an issue. He says also that he had inquired of many
other physicians, who all gave a similar testimony. According to
him, in the plague at Lausanne, all who were attacked by vomiting or
looseness, and almost all who were bled, fell victims to the disease.
As preventives he advises amulets made up of arsenic, powder of
_toads_, and _other things_. These are to be hanged round the neck in
times of plague, and are _undoubtedly_ of great virtue (_maximam_ ad
_præservationem vim habere, non est quod dubites!_) This remedy he
says he had from his preceptor _Cosmas Slotanus_, a very celebrated
surgeon.
Brine of pork is another preventive, which he never tried himself,
but asks Sennerius about it. It was recommended to Hildanus by a
lawyer of his acquaintance. The brine is first to be boiled in a
kettle, and well skimmed, till it becomes clear, poured into earthen
vessels. and kept shut up from the air for a twelvemonth; after which
it was fit for use. A draught of this was given to people infected
with plague, and operated by sweat, stool or vomit, or perhaps both
by vomit and stool. The patient was to abstain from drink for some
hours after. The brine of _anchovies_ is recommended by Sam. Formius,
as useful in the plague at Montpelier in 1630.
3. The same author (Formius) tells us of a man and his wife and
wife’s sister, in Montpelier, who, being taken with the plague,
swallowed a solution of their own excrements in urine, _strained
through a linen cloth_, and thus got clear of the distemper. It
produced excessive vomiting and purging. Dr. Russel mentions one of
his patients, who, he suspected, had got a dose of bezoar in urine.
4. Johannes Helmontius says, that _to his certain knowledge_ (me
conscio) _Hibernus Butlerus_ cured some thousands of the plague, at
London; though unhappily our author got only part of the secret,
and which is to the following purpose. “He ordered me to suspend
by the legs before the fire, a large _toad_ taken in the afternoon
in the month of June; putting below him a cake of yellow wax. At
length, after three days suspension, the toad vomited earth, and some
_walking insects_ (insectas ambulantes) viz. _flies_ with shining
wings of a greenish colour, as if gilt: the toad died immediately
after this evacuation, nor did it take place, notwithstanding his
suspension till the third day. He (Butlerus) then told me that I had
medicine enough for curing _forty thousand_ people infected with
the plague, and promised to show me the mystery of the matter (rei
cardinem) but being suddenly sent into banishment he departed.” The
best part of the secret being thus lost, it is needless to trouble
the reader with any further account of experiments made with other
toads roasted alive, powdered and made up into troches,&c. presuming
that these could not equal the value of the original receipt. I
proceed therefore,
5. To the antidote of the celebrated Avenzoar, who drove away the
plague by the smell of the _urine_ of an _he goat_; and Mercurialis
says that in the house of a most reverend canon in Hungary, he saw a
large he goat kept for this purpose.
6. From such horribly disgusting remedies we certainly turn with
pleasure to the elegant tablets prepared for the Emperor Maximilian
II. These were composed of Armenian bole, prepared pearl, prepared
coral, prepared emeralds, prepared jacinct, gold-leaves (ingredients
in a medical view equally efficacious with chalk or oyster shells)
along with a little ambergrease and some other ingredients of
little value, as medicines, and made into tablets with conserve
of roses----It is needless to spend time in commenting on such
ridiculous remedies; suffice it to say, that the intention of all
rational practice both ancient and modern has been to effect a cure
by sweating. From the instance related by Sydenham, as well as that
of Dr. Power above mentioned, it seems, that if the exact time in
which the disease begins could be known, it might be carried off
by profuse blood-letting; but as this for the most part cannot be
discovered, it is certainly better to wait, even though the event
should not prove favourable, than to run the risk of killing, the
patient instantly by an ignorant effort to save him.
That a free perspiration is the natural cure of the plague, seems
to be allowed by almost all writers of credit. Dr. Russel says,
“Of all excretions, _that_ by the skin would seem to be the most
materially important in the plague. Where the skin remains perpetually
dry, or where short and precipitate sweats are attended with no
favourable alteration, danger is always to be apprehended. On the
other hand, sweats, at certain periods of the disease, appeared
clearly critical in a greater or less degree. They were followed by a
manifest alteration for the better, and by their repetition the fever
was carried entirely off, or reduced to symptomatic exacerbations,
seemingly dependent on the eruptions.” He adds, that he never observed
blood exude through the pores, nor did he observe the sweat to be
remarkably offensive; or in any degree so remarkable as in some
eruptive fevers, particularly in the small-pox before eruption.
Dr. Hodges, however, says that in the plague of London sweats were
sometimes extremely acrid and fœtid; and that they were met with of
various colours, such as purple, green, black, or blood-coloured.
Sometimes it was cold, though the patient was tormented with
intolerable inward heat and drought; and would continue even after
death; but he was of opinion that sweat is the natural crisis of the
distemper.
Besides those symptoms of the plague which have been enumerated, there
are others, particularly hæmorrhages and convulsions, with which it is
sometimes attended. These it has in common with the yellow fever, and
therefore are considered in the second part of the work. I now conclude
this part with a short retrospect of the principal facts which to me
seem to be the result of the investigation. 1. That the plague is of an
unknown (I believe it of _divine_) original. 2. That in the countries
on which it first was sent, it still remains, and from them has always
been propagated to others, without a single well attested instance to
the contrary. 3. That the means by which the distemper usually has been
propagated are _war_ and _commerce_. 4. That the disease differs from
all others in having a more violent tendency to inflammation, insomuch
that it approaches to actual accension; nay, that the extraordinary
instances of spontaneous burning we read of are to be accounted only
the highest degree of this disease. 5. That the immediate or proximate
cause of the plague is a tendency in the blood and other fluids to
discharge upon certain parts the latent heat they contain, in such
quantity as to destroy these parts entirely, and to convert them
into a kind of coaly substance. 6. That this tendency depends on a
certain inexplicable action of the external atmosphere, particularly
of the elementary fire contained in it, and of which it principally
consists.[139] 7. The approach of a plague cannot be foretold, either
from the constitution of the atmosphere, earthquakes, storms, or any
other natural phenomena. 8. The plague is an eruptive disease, and it
is known to be so by the _certain death_ of all in whom eruptions do
not appear; a tendency to eruption being _always_ observed where life
remained long enough. 9. The contagion of the plague diffuses itself
from a small space all around, lessening in violence the farther it
is diffused. In its most concentrated state it hath proved invincible
by medicine; in its mild state it requires none;[140] so that in the
plague the medical powers are found of less avail than in any other
acute distemper. 10. The natural cure of the plague is by perspiration
or sweat, and this perhaps is the only evacuation which ought to be
kept in view, as having a salutary tendency, by those who attend the
sick.[141]
[139] These two last conclusions (though I believe them myself) are
proposed only as probable conjectures, which as yet I see nothing to
contradict.
[140] See p. 282.
[141] The operation of oil so much recommended by Mr. Baldwin is said
to be by producing sweat. (See above p. 341.)
END OF THE FIRST PART.
A TREATISE ON THE Plague and Yellow Fever.
PART SECOND.
_Of the Yellow Fever._
We now come to treat of a disease, less fatal indeed than the Asiatic
plague, but yet so deadly in its nature in the Western World, that
it has of late been confounded with the former, and attempts made
to prove that they are both to be considered only as degrees of
the same disease, and that both have been recorded by historians
indiscriminately under the common appellation of _plague_ or
pestilence. To investigate this matter candidly, and to show that
there is a real and essential difference between the two, as far as
we can credit testimonies drawn from the most respectable writers,
shall be the work of the following part of this treatise.
SECTION I.
_History of the Yellow Fever._
The distemper now under consideration has been commonly distinguished
by two different names; one of which is the _Yellow Fever_, the other
the _Black Vomit_. Both of these are taken from symptoms so remarkable
(though not occurring in every case) that, had the disease existed
in ancient times, we can scarce think but some of the historians of
antiquity would have taken notice that in such a plague those who died
generally became yellow, or that they had a continual vomiting of black
matter, which could not be stopped. Black or bilious vomitings are
indeed mentioned, though not as the principal symptom, but the yellow
colour is not once taken notice of. Dr. Hodges indeed mentions a single
instance of a patient who became all over of a _green_ colour; but as
a change of colour is not taken notice of in the plague as a general
symptom, either by him or by any other writer, we must conclude that
this distemper (the yellow fever) has been observed only in modern
times.
When Columbus first visited the West India islands, we hear nothing of
his having found such a disease existing there; nor does it appear that
it was known among the many Spanish adventurers who succeeded him, and
who subdued such immense tracts on the Southern Continent. Soon after
the settlement of some of the West India islands, however, by other
European nations, this disease began to make its appearance, though
at what time is still uncertain. Dr. Hillary says, that, “as we have
no accounts of this disease in the ancients, nor even in the Arabian
writers, who lived and practised in the hot climate, we must give it
_some name_;” and he calls it the _putrid bilious fever_. “From the
best and most authentic account (adds he) that I can obtain, as also
from the nature and symptoms of the disease, it appears to be a disease
that is indigenous[142] to the West India islands and the continent of
America which is situated between the tropics, and most probably to all
other countries within the torrid zone. But I cannot conceive what were
the motives which induced Dr. Warren to think that this fever was first
brought from Palestine to Marseilles, and from thence to Martinique,
and so to Barbadoes, about thirty-seven years since (1721 or 1722.) A
better inquiry would have informed him, that this fever had frequently
appeared, in this and the other West India islands, many years before:
for several judicious practitioners, who were then, and are now, living
here, whose business was, visiting the sick the greatest part of their
life time, some of them almost eighty years of age, remember to have
seen this fever frequently in this island, not only many years before
that time, but many years before that learned gentleman came to it.”
[142] Naturally belonging to the climate.
To the same purpose Dr. Mosely says, “Warren, though he lived at
Barbadoes in 1739, supposes it never appeared in that island till about
the year 1721, and that it was then brought from Martinique in the Lynn
man of war. He says the second appearance of it there was in 1733,
and that it then came also from Martinique. He undertakes to show,
that it is a disease of Asiatic extract; and says, that a _Provencale_
fleet arrived at Port St. Pierre in Martinique, from Marseilles, on
board which were several bales of Levant goods which were taken in at
Marseilles from a ship just arrived from St. Jean D’Acre (probably
the Ptolemais of the ancients.) Upon opening these bales of goods at
Port St. Pierre, this distemper immediately shewed itself; many of
the people were instantly seized, some died almost suddenly, others
in a few days, and some lingered longer; and the contagion, still
spreading, made great havock at the beginning. He says he had this
account from Mr. Nelson, an English surgeon, who was seized with the
disease at Martinique, and died of it a few days after his arrival at
Barbadoes. He says, it is very probable that the same fever, or one of
very near resemblance and affinity, may first have been carried among
the American Spaniards (among whom it is now endemic) in somewhat a
like manner; and that possibly some peculiar qualities in the air and
climate might have fostered and maintained it there ever since.”
Dr. Mosely at once concludes the whole of this account to be
_fabulous_, but whether fabricated by Dr. Warren or the surgeon, he
does not say. He then appeals to Dr. Towne, who wrote before Warren,
in 1776, but takes no notice of this _chimerical_ origin of the yellow
fever, but considers it as an endemical disease in the West Indies.
Hillary’s opinion already given is also quoted.
The next evidence is that of Mr. Hughes, who, though not a medical man,
has written on the first appearance of the yellow fever in Barbadoes
in the following terms: Dr. _Gamble_ remembers that it was very
“fatal here in the year 1691, and that it was then called the _new
distemper_, and afterwards _Kendal’s fever_, the _pestilential fever_,
and the _bilious fever_. The same symptoms did not always appear in
all patients, nor alike in every year when it visited us. It is most
commonly rife and fatal in May, June, July and August, and then mostly
among strangers; though a great many of the inhabitants, in the year
1696, died of it; and a great many at different periods since.”
As to the first appearance of the disease in the West India islands
we have no accounts which have been deemed sufficiently authentic,
though indeed it must be confessed that the doubts seem to be derived
as much from an attachment to theory as to the investigation of truth.
“The _endemial causus_, or _yellow fever_, (says Dr. Mosely) which is
the terror of Europeans newly arrived in the West Indies, is called
by the French _la maladie de Siam_. Monsieur Pouppe Desportes, who
practised physic at _St. Dominique_ from 1732 to 1748, and who had more
experience, and has written from better information on the diseases of
that colony, than any of his countrymen, says that this fever was so
called from its being first taken notice of in the island of Martinique
at a time when some vessels were there from Siam. This account, though
probably true enough as to the time of its being first observed in
the French colonies, is extremely incorrect in other respects: for
M. Desportes has not only admitted a supposition that the disease
originated among these East Indian mariners, but calls it pestilential,
and says that the Europeans are almost the only victims to it.
“The generality of the French writers say that it was brought directly
from Siam, in a merchant ship, and communicated to the people of
Martinique, whence the contagion was carried to St. Dominique, but that
sailors were the only people attacked by it, whence it was called _la
fievre matelotte_.”
This account seems to carry no improbability in it; nevertheless
Dr. Mosely rejects it upon grounds that are very far from being
indisputable. “The French writers (says he) have not been at the
trouble to consider that a disease brought from Siam in the East
Indies, in a similar latitude to the West India islands, would be most
likely to affect the natives, living in a climate similar to that in
which the disease originated, rather than the Europeans of so different
a temperament of body.” But this argument would prove too much; for if
the disease would be most likely to affect the natives in a climate
_similar_ to that in which the disease originated, surely it would
be still more likely to attack the natives in _that very climate_ in
which the disease did originate, and that Europeans would be free. But
the very reverse is the case. The disease, according to Dr. Moseley
himself, originates in the West Indies; and yet Europeans, especially
those newly arrived, are particularly objects of its vengeance.
“But (adds our author) the fact is, that this disease never attacks
either white or black natives of hot climates; neither was it brought
from Siam; and though it is possible, from the heat of the climate,
that it may frequently appear there, or in any other tropical
country (though BARRERE says it is unknown at _Cayenne_) no history
of that country that I have yet met with mentions such a disease;
notwithstanding what many writers have boldly advanced to the contrary.”
Here it is evident we have no argument, but a parcel of assertions,
the first of which contradicts what he had just before quoted from Mr.
Hughes. For the latter informs us that in 1696 a great many of the
_inhabitants_ died of it as well as strangers. His not meeting with
it in any history of Siam is not a proof of its non-existence in the
country, neither indeed does he himself think that it is so, as he
tells us that it may possibly appear there, or in any other tropical
country.
In Sauvages’s Nosology we find the plague distinguished into a number
of different species, among which there is one called the _plague
of Siam_. This, he says, was in the year 1685 brought from Siam to
Martinico, in the ship called the _Oriflame_. This seems to have been
the _yellow fever_, and the symptoms are considered in the following
section. This date agrees exactly with what Mr. Hughes says in the
place above quoted, that it was violent in Barbadoes in the year 1691,
when it went by the names of the _new fever_, and _Kendal’s fever_.
Both these names imply that the disease had been but lately known, and
that it was by no means a native of the climate. It must either have
been _imported_ therefore from some other country, or it must have
_originated_ in consequence of the settlement of some Europeans in a
climate so dissimilar to their own, while some of them still continued
to ramble from one country to another, occasionally visiting all,
without taking up their residence in any.
Martinique seems to have been the first place where this distemper
made its appearance; and from thence it seems quickly to have extended
itself to St. Domingo and Barbadoes. Its farther progress, however,
cannot be traced, nor can we tell exactly what time it first entered
the continent. Whether the true plague was ever imported into the
Western Continent cannot at present be ascertained, neither can we
tell what diseases the Indians were subject to before the arrival of
the Europeans. The Spaniards, who first arrived, are allowed to have
been less subject to the plague than other nations,[143] but they were
quickly followed by those who had no such exemption. Sebastian Cabot
discovered the North American Continent for Henry VII of England, very
soon after, if not before Columbus discovered the Southern Continent
for the king of Spain. This was a very suspicious time; for Henry
VII himself had introduced the sweating sickness into England only
thirteen years before;[144] and in those days the plague seems never to
have been eradicated; so that it is by no means impossible that these
first adventurers might have communicated to the Indians with whom they
had any communication, the seeds of diseases totally unknown to them
before. Certain it is, that the North American Indians were subject to
epidemics before the settlement of any English colonies among them.
Hutchinson in his History of Massachusetts takes notice of the Indians
having been greatly weakened by an epidemic, which was attributed to
an unfavourable season, in consequence of which they were obliged to
feed upon unripe squashes, fruits, &c. We know not the nature of the
distemper, though, from the circumstance just mentioned, we may not
unreasonably conjecture it to have been of the pestilential kind.
That epidemics still continue among these people we also know from
the testimony of Capt. Carver, who found one of their towns deserted,
and the inhabitants fled into the woods, on account of an epidemic
disorder; but what the nature of it was he does not inform us.[145]
[143] See p. 319.
[144] See p. 17.
[145] In Belknap’s Biography we have a more particular account of
this _pestilence_, as it is called, and which, if the relations
there given are to be credited, certainly determines the disease
in question to have been the yellow fever. The account is to the
following purpose: Lord Arundel, of Wardour, had employed a captain
Weymouth to search for a N. W. passage to India. In this he failed,
but falling in with a river, supposed to be either the Kennebeck or
Penobscot, he brought from thence five of the natives, with whom he
landed at Plymouth in July 1605. Three of the Indians were taken into
the family of Sir Ferdinando Gorges; and from these many particulars
were obtained respecting their country, which being eagerly attended
to by Gorges, he formed a plan of advancing his fortune by a thorough
discovery of the country. Two vessels were accordingly fitted out;
one of which failed, but the other brought such information as gave
encouragement to attempt the founding of a colony. Two of the natives
who had been brought to England were sent back, and 45 persons were
left on the continent to begin the settlement; but these, having
undergone great hardships, quitted the place in 1608. Gorges,
however was not discouraged. He sent out one of his servants, by
name _Richard Vines_, and some others, whom he hired to stay in the
country all winter.
“Mr. Vines and his companions were received by the Indians with
great hospitality, though their residence among them was rendered
hazardous; both by a war which raged among them, and by a pestilence
which accompanied or succeeded it.
“This war and pestilence are frequently spoken of by the historians
of New England, as remarkable events, in the course of Providence,
which prepared the way for the establishment of an European colony.
Concerning the war, we know nothing more than this, that it was begun
by the Tarratenes, a nation who resided eastward of Penobscot. These
formidable people surprised the bashaba, or chief sachem, at his head
quarters, and destroyed him with all his family; upon which all the
other sachems who were subordinate to him quarrelled among themselves
for the sovereignty; and in these dissensions many of them as well
as of their unhappy people perished. Of what particular kind the
pestilence was, we have no certain[146] information, but it seems to
have been a disorder peculiar to the Indians, for Mr. Vines and his
companions, who were intimately conversant with them, and frequently
lodged in their wigwams, were not in the least degree affected by it,
though it swept off the Indians at such a prodigious rate that the
living were not able to bury the dead, and their bones were found
several years after, lying about the villages where they had resided.
The extent of this pestilence was between Penobscot in the east,
and Narraganset in the west. These two tribes escaped, whilst the
intermediate people were wasted and destroyed.”
This distemper appears to have raged among the Indians in the year
1616. The following particulars are further given in Belknap’s
Biography, vol. ii, p. 208: “Hitherto they (the English colonists)
had not seen any of the natives at this place. The mortal pestilence
which raged through the country, four years before, had almost
depopulated it. One remarkable circumstance attending this pestilence
was not known till after this settlement was made. A French ship had
been wrecked on Cape Cod. The men were saved, with their provisions
and goods. The natives kept their eye on them, till they found an
opportunity to kill all but three or four, and divide their goods.
The captives were sent from one tribe to another, as slaves. One of
them learned so much of their language, as to tell them that God was
angry with them for their cruelty, and would destroy them, and give
their country to another people. They answered that they were too
many for God to kill. He replied, that if they were ever so many,
God had many ways to kill them, of which they were then ignorant.
When the pestilence came among them (a _new disease_, probably the
_yellow fever_) they remembered the Frenchman’s words; and when the
Plymouth settlers arrived at Cape Cod, the few survivors imagined
that the other part of his prediction would soon be accomplished.
Soon after their arrival, the Indian priests or powows convened, and
performed their incantations in a dark swamp three days successively,
with a view to curse and destroy the new comers. Had they known the
mortality which raged among them, they would doubtless have rejoiced
in the success of their endeavours, and might very easily have taken
advantage of their weakness to exterminate them. But none of them
were seen till after the sickness had abated; though some tools,
which had been left in the woods, were missing, which they had stolen
in the night.”
[146] “The Pawkunnawkutts were a great people heretofore. They
lived to the east and northeast of the Narragansitts, and their
chief sachem held dominion over divers other petty sagamores; as
the sagamores upon the island of Nantuckett, and Nope, or Martha’s
Vineyard, of Nawsett, of Mannamoyk, of Sawkattukett, Nobsquasitt,
Matakees, and several others, and some of the Nipmucks. Their
country, for the most part, falls within the jurisdiction of New
Plymouth colony. This people were a potent nation in former times,
and could raise, as the most credible and ancient Indians affirm,
about three thousand men. They held war with the Narragansitts, and
often joined the Massachusetts as friends and confederates against
the Narragansitts. This nation, a very great number of them, were
swept away by an epidemical and unwonted sickness, an. 1612 and 1613,
about seven or eight years before the English first arrived in those
parts to settle the colony of New Plymouth. Thereby Divine Providence
made way for the quiet and peaceable settlement of the English in
those nations. What this disease was, that so generally and mortally
swept away, not only these but other Indians, their neighbours, I
cannot well learn. Doubtless it was some pestilential disease. I have
discoursed with some old Indians, that were then youths, who say,
that the bodies all over were exceeding _yellow_ (describing it by a
yellow garment they showed me) both before they died, and afterward.
“The Massachusetts, being the next great people northward, inhabited
principally about that place in Massachusetts bay, where the body
of the English now dwell. These were a numerous and great people.
Their chief sachem held dominion over many other petty governors;
as those of Weechagaskas, Neponsitt, Punkapaog, Nonantum, Nashaway,
some of the Nipmuck people, as far as Pocomtacuke, as the old men of
Massachusetts affirmed. This people could, in former times, arm for
war about three thousand men, as the old Indians declare. They were
in hostility very often with the Narragansitts, but held amity for
the most part with the Pawkunnawcutts, who lived on the south border,
and with the Pawtucketts, who inhabited on their north and northeast
limits. In an. 1612 and 1613 these people were also sorely smitten
by the hand of God with the same disease before mentioned; which
destroyed the most of them, and made room for the English people of
Massachusetts colony, which people this country, and the next called
Pawtuckett. There are not of this people left at this day above three
hundred men, besides women and children.
“Pawtuckett is the fifth and last great sachemship of Indians. Their
country lieth north and northeast from the Massachusetts, whose
dominion reacheth so far as the English jurisdiction, or colony
of the Massachusetts, doth now extend, and had under them several
other smaller sagamores; as the Pennakoaks, Agawomes, Naamkeeks,
Pascatawayes, Accomintas, and others. They were also a considerable
people heretofore, about three thousand men, and held amity with the
people of Massachusetts. But these also were almost totally destroyed
by the great sickness before mentioned; so that at this day they are
not above two hundred and fifty men, besides women and children.
This country is now inhabited by the English under the government of
Massachusetts.” (Gookin’s Historical Collections of the Indians in
New England.)
The following was communicated to Benjamin Basset, esq. of Chilmark,
by Thomas Cooper, a half blooded Indian, of Gay Head, aged about
sixty years; and which, he says, he obtained of his grandmother, who,
to use his own expression, was a stout girl when the English came to
the island: “Before the English came among the Indians, there were
two disorders of which they generally died, viz. the consumption and
the yellow fever. The latter they could always _lay_ in the following
manner: After it had raged and swept off a number, those who were
well, met to lay it. The rich, that is, such as had a canoe, skins,
axes, &c. brought them; They took their seat in a circle, and all the
poor sat around without. The richest then proposed to begin to lay
the sickness; and, having in his hand something in shape resembling
his canoe, skin, or whatever his riches were, he threw it up in the
air; and whoever of the poor without could take it, the property it
was intended to resemble became for ever transferred to him or her.
After the rich had thus given away all their moveable property to
the poor, they looked out the handsomest and most sprightly young
man in the assembly, and put him into an entire new wigwam, built of
every thing new for that purpose. They then formed into two files
at a small distance from each other; one standing in the space at
each end put fire to the bottom of the wigwam on all parts, and fell
to singing and dancing. Presently the youth would leap out of the
flames, and fall down to appearance dead. Him they committed to the
care of five virgins, prepared for that purpose, to restore to life
again. The term required for this would be uncertain, from six to
forty-eight hours, during which time the dance must be kept up. When
he was restored he would tell, that he had been carried in a large
thing high up in the air, where he came to a great company of white
people, with whom he had interceded hard to have the distemper laid,
and generally, after much persuasion, would obtain a promise, or
answer of peace, which never failed of laying the distemper.”
The following is extracted from Prince’s Chronological History of
New England, p. 46: “This winter (1617) and the spring ensuing, a
great plague befals the natives in New England, which wasteth them
exceedingly; and so many thousands of them die, that the living are
not able to bury them, and their skulls and bones remain above ground
at the places of their habitations for several years after.
“By Capt. Dermer’s letter of Dec. 27, 1619, in Purchas, and of
June 30, 1620, in Gov. Bradford, compared with Gov. Bradford’s own
account, it seems that the Narragansitts in the west, and Penobscots
in the east, escaped this plague, or that it raged only in the
countries lying between them, and prepared the way for another
people.”
Mr. Webster, in his eighth letter to Dr. Currie on the subject of
pestilential diseases, quotes from the Doctor’s letter to Mr. Wynkoop,
of October 5th, 1797, the following passages: “Thomas Story and Joseph
Gough relate, that a malignant fever prevailed in Philadelphia in 1699,
introduced from the West India islands.... Dr. Mitchill ascribes the
yellow fever as it appeared in Virginia in 1741 and 47 to specific
contagion, and mentions that it had been twice imported into Virginia
by his Majesty’s ships of war. Dr. _Leamy_ (_Lining_) in the Physical
Essays in Edinburgh, informs us, that the yellow fever which has
prevailed at different periods at Charleston, South Carolina, was
always traced to some infected person recently from the West Indies.
In 1741 it was introduced by a chest of wearing apparel which had
belonged to a person who died of it from Barbadoes.” These quotations
are made by Mr. Webster with a view to dispute the contagious nature of
the disease. Here they are introduced only to show if possible the time
that the disease first entered the United States; and the introduction
of it into Philadelphia in 1699 (though we are not sure if even this
was its first appearance), still corresponds extremely well with the
date of its introduction into Martinique mentioned by Sauvages. Dr.
Lining says it had been four times epidemic in Charleston before the
time that he wrote; viz. in 1732, 1739, 1745, and 1748. Hence we may
conclude, that this fever, on the northern part of the continent of
America, has been nearly coeval with the settlement of the British
colonies there; for we cannot suppose that we have accounts of the
very first time that it made its appearance any where. Numbers of
individuals would probably be affected with it, and their cases pass
unnoticed, till the general malady attracted the public attention.
In the Spanish dominions it seems to have been otherwise. Dr. Moseley
quotes Don Ulloa saying that “the _vomito prieto_, or black vomit, was
unknown at Carthagena, and all along the coast, till the years 1729 and
1730. In 1729 Don Domingo Justiniani, commodore of the guarda costas,
lost so considerable a part of his ships’ companies at _Santa Martha_,
that the survivors were struck with astonishment and horror at the
havock made among their comrades. In 1730, when the galleons under Don
Manuel Lopez Pintado came to Carthagena, the seamen were seized with
the same dreadful mortality, and so sudden were the attacks of the
disease, that persons, walking about one day, were the next carried to
their graves. Unhappily, after all the experiments of the surgeons of
the galleons, and physicians of the country, no good method of treating
the disease has been discovered; no specific for curing it.”
This fatal disease, however common in the southern and warm part of the
continent of America, seems not to have exerted its power in the more
northern and temperate climates till the year 1793. Since that time
its ravages have been too well known to require an enumeration here.
To describe the symptoms, inquire into the causes, and the means of
prevention and cure, is a work of more importance, and to this we must
now proceed.
SECTION. II.
_Symptoms of the Yellow Fever, as described by various
authors.--Comparison between them and those of the Plague, with an
inquiry into the Causes.--History of the Distemper as it has appeared
in various parts of the United States since the year 1793.--A
discussion of the question Whether the Yellow Fever is Contagious or
not._
Of all those who have attempted to give an account of this fatal
disease, none appear to have exceeded Dr. Moseley, either in his
accuracy in enumeration, or perspicuity in description, of the
symptoms. According to him the yellow fever is a species of the
_kausos_ of Hippocrates, Aretœus and Galen; that is, the _febris
ardens_ or _causus_, aggravated by climate, incidental only to the
gross, inflammatory and plethoric at any season of the year, totally
different from the remitting bilious fever to which all habits of body
are subject in hot climates, particularly after rains, and in the fall
of the year. The causus, seldom seen in the temperate climates of
Europe, never appears there with the violent symptoms which attend it
in hot climates. “Whether in the latitudes (says he) so mild as those
of Spain, Greece, Italy and the Archipelagan islands, the causus has
ever been attended with black vomiting, as in the West-Indies, I cannot
tell. Lommius mentions the vomiting of blood, and voiding black liquid
stools and black urine. Critical and symptomatical yellowness of the
skin in the causus are enumerated by Hippocrates among its symptoms,
and Lommius mentions the danger of that appearance before the seventh
day. The affinity of the symptoms, progress and termination of a causus
in Europe to those of the yellow fever in the West-Indies, excepting
the black vomiting, leaves no room to doubt that the difference of
climate constitutes all the difference that is found between them.”
For these reasons Dr. Moseley adopts the name of _endemial causus_;
and he takes notice that many difficulties have arisen to young
practitioners, and to strangers in the West-Indies, from the various
names improperly given to it from its ultimate and not from its primary
symptoms. Some call it a _burning_ bilious fever; Warren, a _putrid_
bilious fever; but, though they have disputed about their terms, Dr.
Moseley thinks that neither of them have proved whether bile be the
cause or the effect of the disease. To call it the black vomit or the
yellow fever, he thinks also improper, as a stranger would not know
the disease until some of these symptoms appear; both of which are
generally fatal, and neither of them constant.
The West-India causus he says is no more putrid than the small-pox,
or any other acute disease; which may, after it has passed its
inflammatory state, change to putrefaction, and end in death with an
extraordinary dissolution of the fluids. The disease is in truth an
inflammatory one in the highest degree possible; accompanied with such
symptoms in a greater extent as attend all inflammatory fevers, and
most strikingly the reverse of any disease that is putrid, or of one
exacerbation. It obeys no season of the year, and attacks such people,
and under such circumstances, as are seldom the objects of putrid
diseases, viz. all who are of an inflammatory diathesis, and do not
perspire freely.
This distemper attacks sailors in the West-Indies more than any other
set of men, even of new comers. For this the Dr. assigns as a reason,
that they eat, drink, and sleep, so much at sea, use no exercise,
and are always of gross habit of body. To this he adds the heat and
dampness of harbours, generally in the neighbourhood of marshes, and
their exposure to land winds at night; the labour they endure on board
vessels in port, and the carelessness and excesses frequently committed
by these people after long voyages.
When a stranger newly arrived feels a sudden loss of strength, with
a continual desire of changing his position without finding rest in
any, we may expert a causus. If he has exposed himself to any of the
causes just mentioned, the probable consequences would be, that on the
morrow he would feel an heaviness, lassitude, oppression and loss of
appetite.[147] Next day, or perhaps within twelve hours from the first
indisposition, the violence of the disease commences with faintness,
generally giddiness of the head, with a small degree of chillness and
horror, but never any rigor. These symptoms are succeeded by a high
fever, great heat, and strong beatings of the arteries, particularly
those of the temples and carotids; flushings of the face, gasping for
cool air; tongue white tinged with yellow, after the retchings have
commenced; excessive thirst; redness, heaviness, and sensations of
burning in the eyes; heaviness and darting pains in the head, small
of the back, and often down the thighs; the pulse generally full and
strong, but sometimes quick, low, and vacillating; the skin hot and
dry, though sometimes it has a partial and momentary moisture. There is
a sickness of stomach from the beginning; retchings succeed immediately
after any liquid is swallowed, which bring up bilious matter. There
is an anxiety with stricture, soreness, and intense heat about the
præcordia; great restlessness, heavy respiration, sighing, urine deep
coloured and in small quantity.
[147] “This (says the Doctor) is the time to extinguish the disease;
but Europeans and North Americans generally neglect it, as they are
not accustomed at home to have recourse to medicine on the first
moment of indisposition.”
Thus the fever goes on during its first stage, which constitutes the
inflammatory period, and continues from twenty-four to sixty hours.
The second, which our author calls the _metaptosis_, is comparatively
mild, and is an intermediate state between the inflammatory and
gangrenous stages. In this there is an abatement of many of the former
symptoms, and a kind of deceitful tranquillity, accompanied, however,
with a perturbation, if the patient should happen to sleep. There now
appears a yellow tinge in the eyes, neck and breast; the heat subsides,
sometimes accompanied with chillness, but never with that kind of
rigor, which, when it happens, terminates the disease by sweat, or
by copious bilious evacuations, upwards or downwards. The retchings
increase and become porraceous: the pulse flags, but is sometimes
high, and sometimes soft; the skin moist and clammy; urine of a dark
saffron colour, and in small quantity; the tongue in some cases is
dry, hard, and discoloured, in others furred and moist; the head is
confused, sometimes with delirium, with a glossiness of the eyes. This
stage of the disease continues sometimes only for a few hours, at
others from twelve to forty-eight, seldom longer, and too frequently
the disease hurries on rapidly from the first to the third stage, which
is the gangrenous or fatal state. Now the pulse sinks, intermits, and
becomes unequal, sometimes very quick; the vomiting becomes frequent
with great straining and noise. The matter discharged is now in greater
quantity, appearing like the grounds of coffee, or of a slate colour,
and the stomach can retain nothing: the breathing is difficult, the
tongue black, the sweats cold and clammy, the eyes yellow and sunk;
there is a yellowness round the mouth and temples, and soon after
over the whole body. The deepening of the yellow colour, with an
aggravation of the other symptoms, is a forerunner of death. There is
a deep respiration, subsultus tendinum, a convulsive kind of sighing;
the urine is quite black, and sometimes totally suppressed. There is a
death-like coldness of the hands, feet and legs, while the heat still
remains about the stomach; the patient is delirious, and struggles to
get up in bed; he trembles, his speech falters; blood oozes from the
mouth and nostrils, sometimes from the corners of the eyes and ears; a
black bloody cruor is discharged both by vomit and stool: livid spots
appear on different parts of the body, particularly the præcordia;
hiccup, muttering, coma, and death, follow in quick succession.
The affecting case of capt. Mawhood, who died on the fourth day of
the disease, at Port-Royal in Jamaica, in the year 1780, exhibits a
dreadful picture of this disease in its last stage. “When I entered
the room, (says Dr. Moseley) he was vomiting a black, bloody cruor,
and he was bleeding at the nose. A bloody ichor was oozing from
the corners of his eyes, and from his mouth and gums. His face was
besmeared with blood, and with the dullness of his eyes it presented
a most distressing contrast to his natural visage. His abdomen was
swelled and inflated most prodigiously. His body was all over of a deep
yellow, interspersed with livid spots. His hands and feet were of a
livid hue. Every part of him was cold, excepting about his heart. He
had a deep, strong hiccup, but neither delirium nor coma; and was, at
my first seeing him, as I thought, in his perfect senses. He looked
at the changed appearance of his skin, and expressed, though he could
not speak, by his sad countenance, that he knew life was soon to yield
up her citadel, now abandoning the rest of his body. Exhausted with
vomiting, he was at last suffocated with the blood he was endeavouring
to bring up, and expired.”
The symptoms just now enumerated generally take place in those who
die from the third to the seventh day of the disease. But in this,
as in other fevers, the symptoms vary considerably according to the
constitution of the patient, and habit of the body. In some it begins
neither with chillness, faintness, nor flushings of the face. Sometimes
the pulse is much depressed and not quick; and in sultry weather,
and damp situations, where the inflammatory state has been only of
a few hours duration, the _metaptosis_ has been so rapid, that the
black vomiting and the mortified state have unexpectedly appeared,
and have ended the patient in 24, 36 or 48 hours. But our author says
that he never saw or heard of an instance of what Lind says, that the
black vomit may attack a man when newly arrived, without any previous
complaint; or of that mentioned by the same author, viz. “an uneasy
itching sensation, commonly in the legs; and upon pulling down the
stockings, streams of thin-dissolved blood followed, and a ghastly
yellow colour quickly diffused itself all over the body.”
In some cases the disease is much more mild. There are instances where
it has been protracted to the eighth, ninth or tenth day; and others
where it has never passed from the inflammatory stage; but being
checked, though not extinguished, it has been lengthened out, and at
last converted into a remittent of great duration, most difficult of
cure, and tedious of recovery.
According to our author, the stomach seems to bear the principal burden
of the disease, and accordingly, after death, appears to have been
principally affected. Great heat is perceived near the præcordia during
all the stages of the disease, and pain and uneasiness are complained
of when those parts are pressed with the hand. After death, livid
spots appear over the whole body, particularly about the præcordia.
On dissection, the stomach, in some part or other, is generally found
mortified, especially if the black vomiting has continued long, and the
livid spots have appeared before death. Frequently the upper part of
the duodenum is in a gangrenous state, and always bears the marks of
inflammation, lest the disease have been of ever so short a duration.
Though both liver and gall-bladder must be very much affected in this
disease, yet Dr. Moseley is of opinion that nothing can be depended
upon from an inspection of them after death. Some symptoms there are
in common with inflammations of the liver, but none of those which
distinguish it from other diseases. It never terminates in suppuration
of the liver as the hepatitis sometimes does, though it is frequently
carried off by an enormous secretion of bile. “Dissections (says the
Doctor) have never discovered any certain and uniform appearance in the
liver of those who have died of this disease. In hot climates a sound
state of the liver is never to be expected after death, whether the
disease has been acute or chronical. Of the latter class of diseases it
is almost always either the seat, or the origin.”
Dr. Lining, in a letter to Dr. Whytt at Edinburgh, published in the
Physical and Literary Essays, defines the disease, to be “that fever,
which continues two or three days, and terminates without any critical
discharge by sweat, urine, stool, &c. leaving the patient excessively
weak, with a small pulse, easily depressible by very little motion, or
by an erect posture; and _which_ is soon succeeded by an icteritious
(jaundice) colour in the white of the eyes and the skin; vomiting,
hæmorrhages, &c. and those without being accompanied with any degree of
a febrile pulse and heat.”
In the four times in which he mentions it to have been epidemic at
Charleston, our author says, that none of the years (excepting 1739,
the summer and autumn of which had been remarkably rainy) were either
warmer or more rainy (and some of them less so) than the summers and
autumns were in several other years in which there was not one instance
of any one being seized with it. The subjects were whites of both
sexes, especially strangers lately arrived from cold climates, Indians,
Mistees, Mulattoes of all ages, excepting young children, and of those
only such as had formerly escaped the infection. Negroes were not
liable to it.
Those affected with the fever, for a day or two previous to the attack
generally complained of head-ach, pain in the loins and extremities,
but principally in the knees and legs, debility and lassitude; but
some were taken ill suddenly without any warning. The symptoms were,
shivering; frequent, full, hard and strong pulse; though sometimes
small and hard, and in others soft and small; but towards the end of
the fever it became smaller, harder, and less frequent. Sometimes there
was a remarkable throbbing in the hypochondria and carotids, the former
causing in some a tremulous motion of the whole abdomen. The heat was
about 102 of Fahrenheit, and nearly equal over the whole body; some had
frequent returns of chilliness without any diminution of temperature of
the body. “In a few there happened so great a remission of the heat for
some hours, when at the same time the pulse was soft and less frequent,
and the skin moist, that one from these circumstances might reasonably
have hoped that the fever would only prove a remittent or intermittent.
About the end of the second day the heat began to abate.” Here Dr.
Moseley takes notice that when the fever abates, some, who have
mistaken the _bilious remittent_ for the _causus_, speak of remissions
which do not happen in this fever. “This circumstance of the endemial
causus (says he) I believe, has never been mentioned before.”
Dr. Lining goes on to inform us, that the skin was rarely dry in this
disease, there being generally a propensity to sweat. “On the first day
the sweating was commonly profuse and general, on the second it was
more moderate; but on both those, there happened frequent and short
remissions of the sweatings, at which times the febrile heat increased,
and the patient became more uneasy. On the third day the disposition
to sweat was so much abated that the skin was generally dry; only the
forehead and backs of the hands continued moist.” A great despondency
and prostration of strength took place from the first attack. On the
first day they generally dozed much, but were afterwards very watchful.
On the second day the pains in the head, loins, &c. of which they had
complained before the attack, and which were sometimes very acute in
the forehead, generally went off. Many on the first day were a little
delirious, but afterwards not until the recess of the fever.
The blood had no inflammatory crust; in warm weather it was florid
like arterial blood, and continued in one soft homogeneous like mass,
without any separation of the serum after it was cold. When there was
any separation, the crassamentum was of too loose a texture.
This disease was not attended with any remarkable thirst; but, on the
third day, as the fever began to lessen, or rather, says the Doctor,
as the fulness of the pulse, heat and disposition to sweat, began to
abate, a nausea, vomiting, or frequent reachings to vomit, came on
especially after the exhibition of either medicines or food. A very few
had a vomiting, either bilious or phlegmatic, on the first day. The
whole febrile state was attended with an obstinate costiveness.
These were the principal symptoms with which the febrile state was
attended, and which generally went off on the third day, or in
seventy-two hours from the first attack, without any salutary crisis,
and was soon succeeded by the second _stadium_, as our author calls it;
a state, though without a fever, much more terrible than the former.
The symptoms now were,
1. The pulse, though hard and small, became less frequent; very little
more so than in health. Soon after it became much slower, and very
soft; this softness remaining while any pulse could be felt. In many it
gradually subsided, till it became scarce perceptible; neither could
it be supported by any of the ordinary means used for that purpose.
After this the yellow suffusion, the vomiting, delirium, restlessness,
&c. increased to a great degree. Sometimes the pulse would recover its
strength, but only for a short time.
2. The heat did not exceed the natural, and was still farther
diminished as the pulse sunk; the skin became cold, and the face,
breast and extremities acquired something of a livid colour. There was
no great thirst, though the sick had a great inclination for strong
liquors.
3. The vomiting or reaching to vomit increased, and in some were so
constant, that neither medicines nor aliment of any kind could be
retained. Some vomited blood, others only what was last exhibited,
mixed with phlegm, while others had what is called the _black vomit_.
But this, though its general appearance is black, appears not to be
entirely so, but owes its colour to a great number of black flakey
substances. These are by our author supposed to be the bile mixed with
the mucus of the stomach, or adhering to it. He founds his opinion upon
observations from dissection, where the mucus of the stomach was always
found abraded, and the bile in its cystis black, and sometimes very
viscid. This change in the state of the bile he has always observed
in such as died of this disease, and likewise that the blood was very
fluid, and the vessels of the viscera much distended. In one case he
found the bile of the consistence of turpentine, and carbuncles or
gangrenous specks on the stomach.
The reaching to vomit continued a longer or shorter time, according
to the state of the pulse; an increase of fulness of the pulse being
attended with an abatement of the reaching, and the contrary.
In this state the patients were extremely unquiet, even their sleep
being frequently attended with dejection of spirits and debility. This
last symptom was so excessive that if the patient was only raised
up in bed, or sometimes if the head was only raised from the pillow,
while a little drink was given, the pulse sunk immediately, and became
sometimes so small, that it could scarce be felt: they became cold,
the skin became clammy, the delirium increased, their lips and skin,
especially about the neck, face and extremities, as well as the nails,
acquired a livid colour. The restlessness and tossing were so great,
that it was sometimes scarce possible to keep the sick in bed, though,
even in this state, they made no particular complaint, and if asked how
they did, the reply was, _Very well_.
A yellowness in the eyes became now very observable, and this was
soon diffused all over the body; but in some, this colour did not
appear until a little before death, when it spread surprisingly quick,
especially about the breast and neck. Along with this were a number
of small spots of a scarlet, purple or livid colour. These appeared
principally about the neck and breast.
Some were obstinately costive, others the contrary, with large, liquid
and black stools, but others were relieved by moderate stools, even
though black. In some they resembled tar, in smoothness, tenacity,
colour and consistence.
In this disease there was such a putrid dissolution of the blood that
hæmorrhages took place from almost all parts of the body. In women
the menstrua flowed, sometimes in great quantity, even at irregular
periods. Blood flowed also from the eyes, nose, mouth and ears, and
from those parts where blisters had been laid on. “Nay, (says our
author) in the year 1739 or 1745, there were one or two instances of an
hæmorrhage from the skin, without any apparent puncture, or any loss of
the scarf-skin.” The urine was pale while the patient was not yellow,
but a deep saffron colour when the yellowness had come on. Sometimes it
was turbid, at others bloody, and the quantity of blood was always in
proportion to the state of the pulse; diminishing as the pulse became
more full, and increasing as it became weaker.
In the third stage, which always terminated in death, the pulse was
exceedingly small and unequal, though soft; the extremities were cold,
clammy and livid; the face and lips in some flushed, in others they
were of a livid colour; the livid specks increased so fast, that in
some the whole breast and neck appeared livid; the heart palpitated
strongly; the heat about the præcordia was greatly increased,
respiration became difficult, with frequent sighing; the patient became
anxious and extremely restless, the sweat flowed from the face, neck
and breast, blood from the mouth or nose or ears, and in some from
all together; the deglutition became difficult, hiccup and subsultus
tendinum came on, the patient picked the bed-clothes, was comatous or
constantly delirious. In this terrible state some continued eight, ten
or twelve hours before they died, even after they had been so long
speechless, and without any perceptible pulsation of the arteries and
wrists; whereas in all other acute diseases, death follows immediately
after the pulse in the wrists ceases. When the disease was very acute,
violent convulsions seized the unhappy patient, and quickly brought
this stadium to its fatal end. After death the livid blotches increased
fast, especially about the face, neck and breast, and the putrefaction
began very early, or rather increased very quickly. In hot weather,
and when the symptoms at first were very violent, there was little
difference to be observed between the stadia, the whole tragedy being
completed in less than forty-eight hours.
On this disease in general Dr. Lining remarks, that the infection was
increased by warm, and lessened by cold, weather. In hot days the
violence of the symptoms were augmented to such a degree as sometimes
to become fatal to those who, in moderate weather, seemed to be in no
danger; while, on the other hand, in cold days, some who had been in
great danger were apparently saved from the jaws of death. The disease
was also more fatal to those who lay in small chambers without a
proper ventilation, to such as were of an athletic and full habit, to
strangers, natives of a cold climate, and to such as were most afraid
of it, as well as to those who had previously overheated themselves
by exercise in the sun, or by excessive drinking of strong liquors. It
proved also most certainly fatal to valetudinarians, or to such as had
been previously weakened by any disease.
Dr. Lind observes that “a yellow colour of the skin is observed not
only in common agues, but likewise in other fevers; sometimes denoting,
as in contagious fevers, their malignant nature, at other times, as
in some West Indian fevers, an universal dissolution of the blood and
humours; and frequently this symptom accompanies gentle discharges of
the bile, and a diseased liver.” In speaking of the disease in the West
Indies, he mentions some fevers, which he derives from stagnated air,
“of such a malignant nature, that the people after being there a few
days are suddenly seized with violent vomitings, head-achs, deliriums,
&c. and in two or three days more the whole body putrefies, and the
dissolved mass of blood issues from every pore.... On considering
the yellow fever particularly he is of opinion that the remarkable
dissolution of the blood, together with the tendency to putrefaction in
the whole body, the black vomit, and other characteristic symptoms, are
often accidental though fatal appearances in fevers of the West Indies.
They proceed, according to him, in such as are newly arrived, sometimes
from a gross habit of body, excessive drinking of spiritous liquors,
and from being afterwards overheated in the sun; but the intense heat
and unhealthfulness of the air does much more frequently produce
all those symptoms. This fever was once supposed to have been first
carried into the West Indies by a ship from Siam: _an opinion truly
chimerical_; as similar diseases have made their appearance, not only
in the East Indies, but in some of the southern parts of Europe, during
a season when the air was intensely hot and unwholesome. This happened
in the months of September and October 1764, when excessive heat and
want of rain for some months gave rise to violent epidemic bilious
diseases, resembling those of the West Indies, in the city of Cadiz in
Spain, of which an hundred persons often died in a day. At this time
the winds blew mostly from the south, and after sunset there fell an
unusual and very heavy dew. The disease began with alternate heats and
chills, nausea, pains of the head, back, and loins, and at the pit of
the stomach, These symptoms were often followed, in less than 24 hours,
with violent reachings, and a vomiting of green and yellow bile, the
smell of which was very offensive. Some threw up an humour as black as
ink, and died soon after, in violent convulsions and in a cold sweat.
The pulse was sometimes sunk, sometimes quick, but often varying. After
the first day, the surface of the body was generally either cold, or
dry and parched. The head-ach and stupor often ended in a furious
delirium, which quickly proved fatal. The dead bodies having been
examined by order of the court of Madrid, the stomach, mesentery and
intestines were found covered with gangrenous spots. The orifice of the
stomach appeared to have been greatly affected, the spots upon it being
ulcerated. The liver and lungs were both of a putrid colour and texture.
“The stomach contained a quantity of an atrabilious liquor, which, when
poured on the ground, produced a sensible effervescence; but, when
mixed with spirit of vitriol, a violent ebullition ensued. The dead
bodies turned so quickly putrid, that at the end of six hours their
stench was intolerable, and in some of them worms were already found
lodged in the stomach. His Majesty’s ship the Tweed being at that time
in Cadiz bay, several of her men were taken ill when on shore, but, by
being carried on board, all of them recovered. Neither did the black
vomit or any other deadly symptom of that fever make its appearance
in any of the ships. The dread of this distemper forced many people
of fashion to retire into the country, where they remained in perfect
safety.”
Dr. Lind further remarks, that in the yellow fever it is a bad sign if
the skin is very dry and rough; “and the longer it continues in this
state, the greater is the danger, as such patients seldom recover,
though the pulse may give hopes, and the other symptoms also be
fluttering; for many have a good pulse in this fever a little before
death.” He also quotes Dr. Bruce, an eminent physician of Barbadoes,
whose account of the disease is to the same purpose. He says it may
come on at any season of the year, but that the symptoms are most
severe when there is great heat joined with moisture. The blood, even
in the beginning of the disease, is of a florid red colour, and as
it were rarefied; the crassamentum scarcely cohering; the serum of a
clay-coloured yellow. It sometimes finishes its course in 24 hours.
The account given by Dr. Hillary corresponds also very much with that
already given. The subjects of the disease are the same with those
already mentioned. He has seen it at all seasons of the year, but it
is worst in a hot season, especially if it was preceded by moist and
warm weather. “Blood, taken even at the beginning of the disease, is
often of an exceeding florid red colour, much rarefied and thin, and
without the least appearance of fiziness; and the crassamentum, when
it has stood till it is cold, will scarce cohere, but fluctuates; the
serum is very yellow.... On the second or third day the blood is much
more dissolved, the serum more yellow, and the crassamentum loose,
scarcely cohering, but undulates like sizy water when shaken, and
sometimes has dark, blackish spots on its surface, showing a strong
gangrenescent diathesis.... In the latter stage of this fever the blood
is so attenuated and dissolved, that we frequently see it flowing not
only out of the nose and mouth, but from the eyes, and even through the
very pores of the skin; also great quantities of black, half-baked,
half-mortified blood is frequently voided, both by vomiting and
stool, with great quantities of yellow and blackish putrid bile, by
the same ways; and the urine, which was before of a high icteritious
colour, is now almost black, and is frequently mixed with a quantity
of half-dissolved blood.... Soon after death the body appears much
fuller of livid, large, blackish, mortified spots, particularly about
the præcordia and hypocondres, especially the right; which parts seem
to be, even from the first seizure, the principal seat of this terrible
disease. And upon opening the bodies of those who die of it, we
generally find the gall-bladder and biliary ducts filled with a putrid
blackish bile, and the liver and stomach, and adjoining parts, full
of blackish and mortified spots, and sometimes gangrenes, in those,
as also in several other parts of the body. And the whole corpse soon
putrefies after death, and can be kept but a few hours above ground.”
Dr. Jackson, in describing the yellow fever of Jamaica, acknowledges
the difficulty of characterising the disease, even though he is of
opinion that it “possesses some characteristics of its own, different
from those of any other.” In a note at the end of his work, he
observes the impropriety of calling it the _yellow_ fever; because
that yellowness sometimes does not appear at all; and in no one case
does it ordinarily show itself till the latter stages. “I know also
(says he) that most of the practitioners of Jamaica consider it only
as an aggravated species of the remittent, the common endemic of hot
climates. It appeared to me, I must confess, in a different light....
It may not, however, be improper here to take notice of the opinion of
Dr. Moseley, who has endeavoured to persuade us that it is no other
than the _kausos_, or ardent fever, of the ancients. But the yellow
fever of the West Indies is, by Dr. Moseley’s own confession, in some
measure peculiar to strangers newly arrived in tropical climates.
The _kausos_, we are informed, made its appearance in the islands
of the Archipelago, and on the coasts of the contiguous continents,
indiscriminately among men and women, natives and foreigners: in fact
it has not, as far as I can perceive, any claim to be considered
as a distinct disease. If I rightly understand Hippocrates, or the
description of the still more accurate Aretæus, _kausos_ in reality is
only an accidental condition of the common endemic of the country,
where the force of the fever is chiefly exerted upon the stomach and
alimentary canal. In this manner it appears frequently in Jamaica, and
in the southern provinces of America. In the hot months of summer,
it appears occasionally in every climate; and is not necessarily
accompanied with, nor does it depend upon, a general inflammatory
diathesis of the system for its existence.”