and vomiting. And
4. In the _bowels_, griping, diarrh[oe]a, and, in some instances, bloody
stools. The diarrh[oe]a occurred in every stage of the disease, but it
was bloody and most painful in its decline. I attended a black girl who
discharged a great many worms, but without the least relief of any of
her symptoms.
There was a great variety in this disease. 1. In the _time_ of the
attack of the fever, from the _time_ of the reception of the contagion.
In general the interval was fourteen days, but it frequently appeared
before, and sometimes later than that period.
2. In the _time of the eruption_, from the beginning of the fever. It
generally appeared on the third and fourth days. In one case, Dr. Waters
informed me, it did not appear till the eighth day.
3. In the _abatement_ or _continuance_ of the fever after the eruption.
4. In the _colour_ and _figure_ of the eruption. In some it put on
a _pale_ red, in others a _deep_, and in a few a _livid_ colour,
resembling an incipient mortification. In some there appeared red
blotches, in others an equally diffused redness, and in a few, eruptions
like the small-pox, called by Dr. Cullen, rubiola varioloides.
5. In the _duration_ of the eruption on the skin. It remained in most
cases only three or four days; but in one, which came under my care, it
remained nine days.
6. In the _manner of its retrocession_. I saw very few cases of its
leaving the branny appearance so generally spoken of by authors on the
skin.
7. In _not affecting_ many persons, and even families who were exposed
to it.
The symptoms which continued in many after the retrocession of the
measles, were cough, hoarseness, or complete aphonia, which continued
in two cases for two weeks; also diarrh[oe]a, opthalmy, a bad taste in
the mouth, a defect or excess of appetite, and a fever, which in some
instances was of the intermitting kind, but which in more assumed the
more dangerous form of the typhus mitior. Two cases of internal dropsy
of the brain followed them. One was evidently excited by a fall. They
both ended fatally.
During the prevalence of the disease I observed several persons (who had
had the measles, and who were closely confined to the rooms of persons
ill with them) to be affected with a slight cough, sore throat, and even
sores in the mouth. I find a similar fact taken notice of by Dr. Quier.
But I observed further, many children to be affected by a fever,
cough, and all the other symptoms of the measles which have been
mentioned, except a general eruption, for in some there was a trifling
efflorescence about the neck and breast. I observed the same thing
in 1773 and 1783. In my note book I find the following account of
the appearance of this disease in children in the year 1773. "The
measles appeared in March; a catarrh (for by that name I then called
it) appeared at the same time, and was often mistaken for them, the
symptoms being nearly the same in both. In the catarrh there was in some
instances a trifling eruption. A lax often attended it, and some who had
it had an extremely sore mouth."
I was the more struck with this disease, from finding it was taken
notice of by Dr. Sydenham. He calls it a morbillous fever. I likewise
find an account of it in the 2d article of the 5th volume of the
Edinburgh Medical Essays. The words of the author, who is anonymous,
are as follow. "During this measly season, several persons, who never
had the measles, had all the symptoms of measles, which went off in a
few days without any eruptions. The same persons had the measles months
or years afterwards." Is this disease a common fever, marked by the
reigning epidemic, and produced in the same manner, and by the same
causes, as the variolous fever described by Dr. Sydenham, which he says
prevailed at the same time with the small-pox? I think it is not. My
reasons for this opinion are as follow.
1. I never saw it affect any but children, in the degree that has been
mentioned, and such only as had never had the measles.
2. It affected whole families at the same time. It proved fatal to one
of three children whom it affected on the same day.
3. It terminated in a pulmonary consumption in a boy of ten years old,
with all the symptoms which attend that disease when it follows the
regular measles.
4. It affected a child in one family, on the same day that two other
members of the same family were affected by the genuine measles.
5. It appeared on the usual days of the genuine measles, from the time
the persons affected by it were exposed to its contagion. And,
6. It communicated the disease in one family, in the usual time in which
the disease is taken from the genuine measles.
The measles, then, appear to follow the analogy of the small-pox, which
affects so superficially as to be taken a second time, and which produce
on persons who have had them what are called the nurse pock. They follow
likewise the analogy of another disease, viz. the scarlatina anginosa.
In the account of the epidemic for 1773, published in the third volume
of the Edinburgh Medical Essays, we are told, that such patients as had
previously had the scarlet fever without sore throats, took the sore
throat, and had no eruption, while those who had previously had the sore
throat had a scarlet eruption, but the throat remained free from the
distemper. All other persons who were affected had both.
From these facts, I have taken the liberty of calling it the _internal
measles_, to distinguish it from those which are _external_. I think
the discovery of this new state of this disease of some application to
practice.
1. It will lead us to be cautious in declaring any disease to be the
external measles, in which there is not a general eruption. From
my ignorance of this, I have been led to commit several mistakes,
which were dishonourable to the profession. I was called, during the
prevalence of the measles in the above-named season, to visit a girl
of twelve years old, with an eruption on the skin. I called it the
measles. The mother told me it was impossible, for that I had in 1783
attended her for the same disease. I suspect the anonymous author
before-mentioned has fallen into the same error. He adds to the account
before quoted the following words. "Others, who had undergone the
measles formerly, had _at this time_ a fever of the erysipelatous kind,
with eruptions like to which nettles cause, and all the _previous_ and
concomitant symptoms of the measles, from the beginning to the end of
the disease."
2. If inoculation, or any other mode of lessening the violence of the
disease, should be adopted, it will be of consequence to know what
persons are secure from the attacks of it, and who are still exposed to
it.
I shall now add a short account of my method of treating this disease.
Many hundred families came through the disease without the help of a
physician. But in many cases it was attended with peculiar danger, and
in some with death. I think it was much more fatal than in the years
1773 and 1783, probably owing to the variable weather in the winter,
and the coldness and dampness of the succeeding spring. Dr. Huxham
says, he once saw the measles attended with peculiar mortality, during
a late cold and damp spring in England. It was much more fatal (cæteris
paribus) to adults than to young people.
The remedies I used were,
1. _Bleeding_, in all cases where great pain and cough with a hard pulse
attended. In some I found it necessary to repeat this remedy. But I met
with many cases in which it was forbidden by the weakness of the pulse,
and by other marks of a feeble action in the blood-vessels.
2. _Vomits._ These were very useful in removing a nausea; they likewise
favoured the eruption of the measles.
3. _Demulcent_ and _diluting drinks_. These were barley water, bran,
and flaxseed tea, dried cherry and raw apple water, also beverage, and
cyder and water. The last drink I found to be the most agreeable to my
patients of any that have been mentioned.
4. _Blisters_ to the neck, sides, and extremities, according to the
symptoms. They were useful in every stage of the disease.
5. _Opiates._ These were given not only at night, but in small doses
during the day, when a troublesome cough or diarrh[oe]a attended.
6. Where a catarrhal fever ensued, I used bleeding and blisters. In
those cases in which this fever terminated in an intermittent, or in a
mild typhus fever, I gave the bark with evident advantage. In that case
of measles, formerly mentioned, which was accompanied by symptoms of
cynanche trachealis, I gave calomel with the happiest effects. In the
admission of _fresh air_ I observed a medium as to its temperature, and
accommodated it to the degrees of action in the system. In different
parts of the country, in Pennsylvania and New-Jersey, I heard with great
pleasure of the _cold air_ being used as freely and as successfully in
this disease, as in the inflammatory small-pox. The same people who
were so much benefited by _cool air_, I was informed, drank plentifully
of cold water during every stage of the fever. One thing in favour of
this country practice deserves to be mentioned, and that is, evident
advantage arose in all the cases which I attended, from patients leaving
their beds in the febrile state of this disease. But this was practised
only by those in whom inflammatory diathesis prevailed, for these alone
had strength enough to bear it.
The convalescent state of this disease required particular attention.
1. _A diarrh[oe]a_ often continued to be troublesome after other
symptoms had abated. I relieved it by opiates and demulcent drinks.
Bleeding has been recommended for it, but I did not find it necessary in
a single case.
2. An _opthalmia_ which sometimes attended, yielded to astringent
collyria and blisters.
3. Where a cough or fever followed so slight as not to require bleeding,
I advised a milk and vegetable diet, country air, and moderate warmth;
for whatever might have been the relation of the lungs in the beginning
of the disease to cold air, they were now evidently too much debilitated
to bear it.
4. It is a common practice to prescribe purges after the measles. After
the asthenic state of this disease they certainly do harm. In all
cases, the effects of them may be better obviated by diet, full or low,
suitable clothing, and gentle exercise, or country air. I omitted them
in several cases, and no eruption or disease of any kind followed their
disuse.
I shall only add to this account of the measles, that in several
families, I saw evident advantages from preparing the body for the
reception of the contagion, by means of a vegetable diet.
AN ACCOUNT
OF
_THE INFLUENZA_,
AS IT APPEARED
IN PHILADELPHIA,
IN THE AUTUMN OF 1789, IN THE SPRING OF 1790, AND IN THE WINTER OF
1791.
The latter end of the month of August, in the summer of 1789, was so
very cool that fires became agreeable. The month of September was cool,
dry, and pleasant. During the whole of this month, and for some days
before it began, and after it ended, there had been no rain. In the
beginning of October, a number of the members of the first congress,
that had assembled in New-York, under the present national government,
arrived in Philadelphia, much indisposed with colds. They ascribed
them to the fatigue and night air to which they had been exposed in
travelling in the public stages; but from the number of persons who
were affected, from the uniformity of their complaints, and from the
rapidity with which it spread through our city, it soon became evident
that it was the disease so well known of late years by the name of the
influenza.
The symptoms which ushered in the disease were generally a hoarseness,
a sore throat, a sense of weariness, chills, and a fever. After the
disease was formed, it affected more or less the following parts of the
body. Many complained of acute pains in the _head_. These pains were
frequently fixed between the eye-balls, and, in three cases which came
under my notice, they were terminated by abscesses in the frontal sinus,
which discharged themselves through the nose. The pain, in one of these
cases, before the rupture of the abscess, was so exquisite, that my
patient informed me, that he felt as if he should lose his reason. Many
complained of a great itching in the _eye-lids_. In some, the eye-lids
were swelled. In others, a copious effusion of water took place from
the _eyes_; and in a few, there was a true ophthalmia. Many complained
of great pains in one _ear_, and some of pains in both _ears_. In some,
these pains terminated in abscesses, which discharged for some days
a bloody or purulent matter. In others, there was a swelling behind
each ear, without a suppuration.--_Sneezing_ was a universal symptom.
In some, it occurred not less than fifty times in a day. The matter
discharged from the nose was so acrid as to inflame the nostrils and
the upper lip, in such a manner as to bring on swellings, sores, and
scabs in many people. In some, the nose discharged drops, and in a
few, streams of blood, to the amount, in one case, of twenty ounces.
In many cases, it was so much obstructed, as to render breathing
through it difficult. In some, there was a total defect of _taste_. In
others, there was a bad taste in the mouth, which frequently continued
through the whole course of the disease. In some, there was a want of
_appetite_. In others, it was perfectly natural. Some complained of
a soreness in their mouths, as if they had been inflamed by holding
pepper in them. Some had _swelled jaws_, and many complained of the
_tooth-ach_. I saw only one case in which the disease produced a _coma_.
Many were affected with pains in the _breast_ and _sides_. A difficulty
of breathing attended in some, and a _cough_ was universal. Sometimes
this cough alternated with a pain in the _head_. Sometimes it
preceded this pain, and sometimes it followed it. It was at all times
distressing. In some instances, it resembled the chin-cough. One person
expired in a fit of coughing, and many persons spat blood in consequence
of its violence. I saw several patients in whom the disease affected
the trachea chiefly, producing great difficulty of breathing, and, in
one case, a suppression of the voice, and I heard of another in which
the disease, by falling on the trachea, produced a cynanche trachealis.
In most of the cases which terminated fatally, the patients died of
pneumonia notha.
The _stomach_ was sometimes affected by nausea and vomiting; but this
was far from being a universal symptom.
I met with four cases in which the whole force of the disease fell upon
the _bowels_, and went off in a diarrh[oe]a; but in general the bowels
were regular or costive.
The _limbs_ were affected with such acute pains as to be mistaken for
the rheumatism, or for the break-bone-fever of 1780. The pains were most
acute in the back and thighs.
_Profuse sweats_ appeared in many over the whole body in the beginning,
but without affording any relief. It was in some instances accompanied
by erysipelatous, and in four cases which came to my knowledge, it was
followed by miliary eruptions.
The _pulse_ was sometimes tense and quick, but seldom full. In a great
majority of those whom I visited it was quick, weak, and soft.
There was no appearance in the urine different from what is common in
all fevers.
The disease had evident remissions, and the fever seldom continued above
three or four days; but the cough, and some other troublesome symptoms,
sometimes continued two or three weeks.
In a few persons, the fever terminated in a tedious and dangerous typhus.
In several pregnant women it produced uterine hæmorrhages and abortions.
It affected adults of both sexes alike. A few old people escaped it. It
passed by children under eight years old with a few exceptions. Out of
five and thirty maniacs in the Pennsylvania hospital, but three were
affected by it. No profession or occupation escaped it. The smell of
tar and tobacco did not preserve the persons who worked in them from
the disease, nor did the use of tobacco, in snuff, smoking, or chewing,
afford a security against it.[88]
[88] Mr. Howard informs us that the use of tobacco is not a
preservative against the plague, as has formerly been supposed;
of course that apology for the use of an offensive weed should
not be admitted.
Even previous and existing diseases did not protect patients from it. It
insinuated into sick chambers, and blended itself with every species of
chronic complaint.
It was remarkable that persons who worked in the open air, such as
sailors, and 'long-shore-men, (to use a mercantile epithet) had it much
worse than tradesmen who worked within doors. A body of surveyors, in
the eastern woods of Pennsylvania, suffered extremely from it. Even the
vigour of constitution which is imparted by the savage life did not
mitigate its violence. Mr. Andrew Ellicott, the geographer of the United
States, informed me that he was a witness of its affecting the Indians
in the neighbourhood of Niagara with peculiar force. The cough which
attended this disease was so new and so irritating a complaint among
them, that they ascribed it to witchcraft.
It proved most fatal on the sea-shore of the United States.
Many people who had recovered, were affected a second time with all the
symptoms of the disease. I met with a woman, who, after recovering from
it in Philadelphia, took it a second time in New-York, and a third time
upon her return to Philadelphia.
Many thousand people had the disease who were not confined to their
houses, but transacted business as usual out of doors. A perpetual
coughing was heard in every street of the city. Buying and selling were
rendered tedious by the coughing of the farmer and the citizen who met
in market places. It even rendered divine service scarcely intelligible
in the churches.
A few persons who were exposed to the disease escaped it, and some had
it so lightly as scarcely to be sensible of it. Of the persons who were
confined to their houses, not a fourth part of them kept their beds.
It proved fatal (with few exceptions) only to old people, and to
persons who had been previously debilitated by consumptive complaints.
It likewise carried of several hard drinkers. It terminated in asthma
in three persons whose cases came under my notice, and in pulmonary
consumption, in many more. I met with an instance in a lady, who was
much relieved of a chronic complaint in her liver; and I heard of
another instance of a clergyman whose general health was much improved
by a severe attack of this disease.
It was not wholly confined to the human species. It affected two cats,
two house-dogs, and one horse, within the sphere of my observations. One
of the dogs disturbed his mistress so much by coughing at night, that
she gave him ten drops of laudanum for several nights, which perfectly
composed him. One of the cats had a vomiting with her cough. The horse
breathed as if he had been affected by the cynanche trachealis.
The scarlatina anginosa, which prevailed during the summer, disappeared
after the first of October; but appeared again after the influenza left
the city. Nor was the remitting fever seen during the prevalence of the
reigning epidemic.
I inoculated about twenty children for the small-pox during this
prevalence of the influenza, and never saw that disease exhibit a more
favourable appearance.
In the treatment of the influenza I was governed by the state of the
system. Where inflammatory diathesis discovered itself by a full or
tense pulse, or where great difficulty of breathing occurred, and the
pulse was low and weak in the beginning of the disease, I ordered
moderate bleeding. In a few cases in which the symptoms of pneumony
attended, I bled a second time with advantage. In all these instances
of inflammatory affection, I gave the usual antiphlogistic medicines.
I found that vomits did not terminate the disease, as they often do a
common catarrh, in the course of a day, or of a few hours.
In cases where no inflammatory action appeared in the system, I
prescribed cordial drinks and diet, and forbad every kind of evacuation.
I saw several instances of persons who had languished for a week or two
with the disease, who were suddenly cured by eating a hearty meal, or
by drinking half a pint of wine, or a pint of warm punch. In all these
cases of weak action in the blood-vessels, liquid laudanum gave great
relief, not only by suspending the cough, but by easing the pains in the
bones.
I met with a case of an old lady who was suddenly and perfectly cured of
her cough by a fright.
The duration of this epidemic in our city was about six weeks. It spread
from New-York and Philadelphia in all directions, and in the course of
a few months pervaded every state in the union. It was carried from the
United States to several of the West-India islands. It prevailed in
the island of Grenada in the month of November, 1789, and it was heard
of in the course of the ensuing winter in the Spanish settlements in
South-America.
The following winter was unusually mild, insomuch that the navigation
of the Delaware was not interrupted during the whole season, only from
the 7th to the 24th of February. The weather on the 3d and 4th days of
March was very cold, and on the 8th and 9th days of the same month,
the mercury in Fahrenheit's thermometer stood at 4° at 7 o'clock in
the morning. On the 10th and 11th, there fell a deep snow. The weather
during the remaining part of the month was cold, rainy, and variable. It
continued to be variable during the month of April. About the middle of
the month there fell an unusual quantity of rain. The showers which fell
on the night of the 17th will long be connected in the memories of the
citizens of Philadelphia with the time of the death of the celebrated
Dr. Franklin. Several pleurisies appeared during this month; also a few
cases of measles. In the last week of the month the influenza made its
appearance. It was brought to the city from New-England, and affected,
in its course, all the intermediate states. Its symptoms were nearly the
same as they were in the preceding autumn, but in many people it put
on some new appearances. Several persons who were affected by it had
symptoms of madness, one of whom destroyed himself by jumping out of a
window. Some had no cough, but very acute pains in the back and head.
It was remarked that those who had the disease chiefly in the breast
the last year, complained now chiefly of their heads, while those whose
heads were affected formerly, now complained chiefly of their breasts.
In many it put on the type of an intermitting fever. Several complained
of constant chills, or constant sweats; and some were much alarmed by
an uncommon blue and dark colour in their hands. I saw one case of
ischuria, another of an acute pain in the rectum, a third of anasarca,
and a fourth of a palsy in the tongue and arms; all of which appeared
to be anomalous symptoms of the influenza. Sneezing, and pains in the
ears and frontal sinus, were less common now than they were in the
fall; but a pain in the eye-balls was a universal symptom. Some had a
pain in the one eye only, and a few had sore eyes, and swellings in the
face. Many women who had it, were affected by an irregular appearance
of the catamenia. In two persons whom I saw, the cough was incessant
for three days, nor could it be composed by any other remedy than
plentiful bleeding. A patient of Dr. Samuel Duffield informed me, after
his recovery, that he had had no other symptom of the disease than an
efflorescence on his skin, and a large swelling in his groin, which
terminated in a tedious abscess.
The prisoners in the jail who had it in the autumn, escaped it this
spring.
During the prevalence of this disease, I saw no sign of any other
epidemic.
It declined sensibly about the first week in June, and after the 12th
day of this month I was not called to a single patient in it.
The remedies for it were the same as were used in the fall.