and of carefully shunning all the exciting causes which I have mentioned,
that I concealed, in no instance, from my patients the name of their
disease. This plainness, which was blamed by weak people, produced strict
obedience to my directions, and thereby restrained the progress of the
fever in many families, or rendered it, when taken, as mild as
inoculation does the small-pox. The opposite conduct of several
physicians, by preventing the above precautions, increased the mortality
of the disease, and, in some instances, contributed to the extinction of
whole families.
I proceed now to make a few remarks upon the remedies recommended by
Doctors Kuhn and Stevens, and by the French physicians. The former were
bark, wine, laudanum, spices, the elixir of vitriol, and the cold bath.
In every case in which I prescribed bark, it was offensive to the
stomach. In several tertians which attended the convalescence from a
common attack of the fever, I found it always unsuccessful, and once
hurtful. Mr. Willing took it for several weeks without effect. About half
a pint of a weak decoction of the bark produced, in Mr. Samuel Meredith,
a paroxysm of the fever, so violent as to require the loss of ten ounces
of blood to moderate it. Dr. Annan informed me that he was forced to
bleed one of his patients twice, after having given him a small quantity
of bark, to hasten his convalescence.
It was not in this epidemic only that the bark was hurtful. Baron
Humboldt informed me, that Dr. Comoto had assured him, it hastened death
in every case in which it was given in the yellow fever of Vera Cruz. If,
in any instance, it was inoffensive, or did service, in our fever, I
suspect it must have acted upon the bowels as a purge. Dr. Sydenham says
the bark cured intermittents by this evacuation[90]; and Mr. Bruce says
it operated in the same way, when it cured the bilious fevers at Massuah.
[90] Vol. i. p. 440.
_Wine_ was nearly as disagreeable as the bark to the stomach, and equally
hurtful. I tried it in every form, and of every quality, but without
success. It was either rejected by the stomach, or produced in it a
burning sensation. I should suspect that I had been mistaken in my
complaints against wine, had I not since met with an account in Skenkius
of its having destroyed all who took it in the famous Hungarian fever,
which prevailed, with great mortality, over nearly every country in
Europe, about the middle of the 16th century[91]. Dr. Wade declares wine
to be "ill adapted to the fevers of Bengal, where the treatment has been
proper in other respects."
[91] Omnes qui vini potione non abstinuerunt, interiere, adeo ut summa
spes salvationis in vini abstinentia collocata videreter. Lib. vi.
p. 847.
_Laudanum_ has been called by Dr. Mosely "a fatal medicine" in the yellow
fever. In one of my patients, who took only fifteen drops of it, without
my advice, to ease a pain in his bowels, it produced a delirium, and
death in a few hours. I was much gratified in discovering that my
practice, with respect to the use of opium in this fever, accorded with
Dr. Wade's in the fever of Bengal. He tells us, "that it was mischievous
in almost every instance, even in combination with antimonials."
The _spices_ were hurtful in the first stage of the fever, and, when
sufficient evacuations had been used, they were seldom necessary in its
second.
The _elixir of vitriol_ was, in general, offensive to the stomach.
The _cold bath_ was useful in those cases where its sedative prevailed
over its stimulating effects. But this could not often happen, from the
suddenness and force, with which the water was thrown upon the body. In
two cases in which I prescribed it, it produced a gentle sweat, but it
did not save life. In a third it removed a delirium, and reduced the
pulse for a few minutes, in frequency and force, but this patient died.
The recommendation of it indiscriminately, in all cases, was extremely
improper. In that chilliness and tendency to fainting upon the least
motion, which attended the disease in some patients, it was an unsafe
remedy. I heard of a woman who was seized with delirium immediately after
using it, from which she never recovered; and of a man who died a few
minutes after he came out of a bathing tub. Had this remedy been the
exclusive antidote to the yellow fever, the mortality of the disease
would have been but little checked by it. Thousands must have perished
from the want of means to procure tubs, and of a suitable number of
attendants to apply the water, and to lift the patient in and out of bed.
The reason of our citizens ran before the learning of the friends of this
remedy, and long before it was abandoned by the physicians, it was
rejected as useless, or not attempted, because impracticable, by the good
sense of the city. It is to be lamented that the remedy of cold water has
suffered in its character by the manner in which it was advised. In
fevers of too much action, it reduces the morbid excitement of the
blood-vessels, provided it be _applied without force_, and for a
considerable time, to the body. It is in the jail fever, and in the
second stage of the yellow fever only, in which its stimulant and tonic
powers are proper. Dr. Jackson establishes this mode of using it, by
informing us, that when it did service, it "gave vigour and tone" to the
system[92].
[92] Fevers of Jamaica.
A mode of practice which I formerly mentioned in this fever, consisted of
a union of the evacuating and tonic remedies. The physicians who adopted
this mode gave calomel by itself, in small doses, on the first or second
day of the fever, bled once or twice, in a sparing manner, and gave the
bark, wine, and laudanum, in large quantities, upon the first appearance
of a remission. After they began the use of these remedies purging was
omitted, or, if the bowels were moved, it was only by means of gentle
glysters. This practice, I shall say hereafter, was not much more
successful than that which was recommended by Dr. Kuhn and Dr. Stevens.
It resembled throwing water and oil at the same time upon a fire, in
order to extinguish it.
The _French_ remedies were nitre and cremor tartar, in small doses,
centaury tea, camphor, and several other warm medicines; subacid drinks,
taken in large quantities, the warm bath, and moderate bleeding.
After what has been said it must be obvious to the reader, that the nitre
and cremor tartar, in small doses, could do no good, and that camphor and
all cordial medicines must have done harm. The diluting subacid drinks,
which the French physicians gave in large quantities, were useful in
diluting and blunting the acrimony of the bile, and to this remedy,
assisted by occasional bleeding, I ascribe most of the cures which were
performed by those physicians.
Those few persons in whom the _warm bath_ produced copious and universal
sweats recovered, but, in nearly all the cases which came under my
notice, it did harm.
I come now to inquire into the comparative success of all the different
modes of practice which have been mentioned.
I have already said that ten out of thirteen patients whom I treated with
bark, wine, and laudanum, and that three out of four, in whom I added the
cold bath to those remedies, died. Dr. Pennington informed me, that he
had lost all the patients (six in number) to whom he had given the above
medicines. Dr. Johnson assured me, with great concern, about two weeks
before he died, that he had not recovered a single patient by them. Whole
families were swept off where these medicines were used. But further,
most of those persons who received the seeds of the fever in the city,
and sickened in the country, or in the neighbouring towns, and who were
treated with tonic remedies, died. There was not a single cure performed
by them in New-York, where they were used in several sporadic cases with
every possible advantage. But why do I multiply proofs of their deadly
effects? The clamours of hundreds whose relations had perished by them,
and the fears of others, compelled those physicians who had been most
attached to them to lay them aside, or to prepare the way for them (as it
was called) by purging and bleeding. The bathing tub soon shared a worse
fate than bark, wine, and laudanum, and, long before the disease
disappeared, it was discarded by all the physicians in the city.
In answer to these facts we are told, that Mr. Hamilton and his family
were cured by Dr. Stevens's remedies, and that Dr. Kuhn had administered
them with success in several instances.
Upon these cures I shall insert the following judicious remarks from Dr.
Sydenham. "Success (says the doctor) is not a sufficient proof of the
excellency of a method of cure in acute diseases, since some are
recovered by the imprudent procedure of old women; but it is further
required, that the distemper should be _easily cured_, and yield
conformably to its _own_ nature[93]." And again, speaking of the cure of
the new fever of 1685, this incomparable physician observes, "If it be
objected that this fever frequently yields to a quite contrary method to
that which I have laid down, I answer, that the cure of a disease by a
method which is attended with success only _now_ and _then_, in a _few_
instances, differs extremely from that practical method, the efficacy
whereof appears both from its recovering _greater numbers_, and all the
practical phenomena happening in the cure[94]."
[93] Vol. ii. p. 254.
[94] Vol, ii. p. 354.
Far be it from me to deny that the depression of the system may not be
overcome by such stimuli as are more powerful than those which occasion
it. This has sometimes been demonstrated by the efficacy of bark, wine,
and laudanum, in the confluent and petechial small-pox; but even this
state of that disease yields more easily to blood-letting, or to
plentiful evacuations from the stomach and bowels, on the first or second
day of the eruptive fever. This I have often proved, by giving a large
dose of tartar emetic and calomel, as soon as I was satisfied from
circumstances, that my patient was infected with the small-pox. But the
depression produced by the yellow fever appears to be much greater than
that which occurs in the small-pox, and hence it more uniformly resisted
the most powerful tonic remedies.
In one of my publications during the prevalence of the fever I asserted,
that the remedies of which I have given a history cured a greater
proportion than ninety-nine out of a hundred, of all who applied to me on
the first day of the disease, before the 15th day of September. I regret
that it is not in my power to furnish a list of them, for a majority of
them were poor people, whose names are still unknown to me. I was not
singular in this successful practice in the first appearance of the
disease. Dr. Pennington assured me on his death bed, that he had not lost
one, out of forty-eight patients whom he had treated agreeably to the
principles and practice I had recommended. Dr. Griffitts triumphed over
the disease in every part of the city, by the use of what were called the
new remedies. My former pupils spread, by their success, the reputation
of purging and bleeding, wherever they were called. Unhappily the
pleasure we derived from this success in the treatment of the disease,
was of short duration. Many circumstances contributed to lessen it, and
to revive the mortality of the fever. I shall briefly enumerate them.
1. The distraction produced in the public mind, by the recommendation of
remedies, the opposites in every respect of purging and bleeding.
2. The opinion which had been published by several physicians, and
inculcated by others, that we had other fevers in the city besides the
yellow fever. This produced a delay in many people in sending for a
physician, or in taking medicines, for two or three days, from a belief
that they had nothing but a cold, or a common fever. Some people were so
much deceived by this opinion, that they refused to send for physicians,
lest they should be infected by them with the yellow fever. In most of
the cases in which these delays took place, the disease proved mortal.
To obviate a suspicion that I have laid more stress upon the fatal
influence of this error than is just, I shall here insert an extract of a
letter I received from Mr. John Connelly, one of the city committee, who
frequently left his brethren in the city hall, and spent many hours in
visiting and prescribing for the sick. "The publications (says he) of
some physicians, that there were but few persons infected with the yellow
fever, and that many were ill with colds and common remitting and fall
fevers, proved fatal to almost every family which was credulous enough to
believe them. That opinion slew its hundreds, if not its thousands, many
of whom did not send for a physician until they were in the last stage of
the disorder, and beyond the power of medicine."
3. The interference of the friends of the stimulating system, in
dissuading patients from submitting to sufficient evacuations.
4. The deceptions which were practised by some patients upon their
physicians, in their reports of the quantity of blood they had lost, or
of the quality and number of their evacuations by stool.
5. The impracticability of procuring bleeders as soon as bleeding was
prescribed. Life in this disease, as in the apoplexy, frequently turned
upon that operation being performed within an _hour_. It was often
delayed, from the want of a bleeder, one or two days.
6. The inability of physicians, from the number of their patients, and
from frequent indisposition, to visit the sick, at such times as was
necessary to watch the changes in their disease.
7. The great accumulation and concentration of the miasmata in sick
rooms, from the continuance of the disease in the city, whereby the
system was exposed to a constant stimulus, and the effect of the
evacuations was thus defeated.
8. The want of skill or fidelity in nurses to administer the medicines
properly; to persuade patients to drink frequently; also to supply them
with food or cordial drinks when required in the night.
9. The great degrees of debility induced in the systems of many of the
people who were affected by the disease, from fatigue in attending their
relations or friends.
10. The universal depression of mind, amounting in some instances to
despair, which affected many people. What medicine could act upon a
patient who awoke in the night, and saw through the broken and faint
light of a candle, no human creature, but a black nurse, perhaps asleep
in a distant corner of the room; and who heard no noise, but that of a
hearse conveying, perhaps, a neighbour or a friend to the grave? The
state of mind under which many were affected by the disease, is so well
described by the Rev. Dr. Smith, in the case of his wife, in a letter I
received from him in my sick room, two days after her death, that I hope
I shall be excused for inserting an extract from it. It forms a part of
the history of the disease. The letter was written in answer to a short
note of condolence which I sent to the doctor immediately after hearing
of Mrs. Smith's death. After some pathetic expressions of grief, he adds,
"The scene of her funeral, and some preceding circumstances, can never
depart from my mind. On our return from a visit to our daughter, whom we
had been striving to console on the death of Mrs. Keppele, who was long
familiar and dear to both, my dear wife, passing the burying-ground gate,
led me into the ground, viewed the graves of her two children, called the
old grave-digger, marked a spot for herself as close as possible to them
and the grave of Dr. Phineas Bond, whose memory she adored. Then, by the
side of the spot she had chosen, we found room and chose _mine_, pledging
ourselves to each other, and directing the grave-digger that this should
be the order of our interment. We returned to our house. Night
approached. I hoped my dear wife had gone to rest, as she had chosen,
since her return from nursing her daughter, to sleep in a chamber by
herself, through fear of infecting her grandchild and me. But it seems
she closed not her eyes; sitting with them fixed through her chamber
window on Mrs. Keppele's house, till about midnight she saw her hearse,
and followed it with her eyes as far as it could be seen. Two days
afterwards Mrs. Rodgers, her next only surviving intimate friend, was
carried past her window, and by no persuasion could I draw her from
thence, nor stop her sympathetic foreboding tears, so long as her eyes
could follow the funeral, which was through two squares, from Fourth to
Second-street, where the hearse disappeared." The doctor proceeds in
describing the distress of his wife. But pointed as his expressions are,
they do not convey the gloomy state of her mind with so much force as she
has done it herself in two letters to her niece, Mrs. Cadwallader, who
was then in the country. The one was dated the 9th, the other the 11th of
October. I shall insert a few extracts from each of them.
October 9th. "It is not possible for me to pass the streets without
walking in a line with the dead, passing infected houses, and looking
into open graves. This has been the case for many weeks." "I don't know
what to write; my head is gone, and my heart is torn to pieces." "I
intreat you to have no fears on my account. I am in the hands of a just
and merciful God, and his will be done."
October 11th. "Don't wonder that I am so low to-day. My heart is sunk
down within me."
The next day this excellent woman sickened, and died on the 19th of the
same month.
If in a person possessed naturally of uncommon equanimity and fortitude,
the distresses of our city produced such dejection of spirits, what must
have been their effect upon hundreds, who were not endowed with those
rare and extraordinary qualities of mind! Death in this, as well as in
many other cases in which medicine had done its duty, appeared to be the
inevitable consequence of the total abstraction of the energy of the mind
in restoring the natural motions of life.
Under all the circumstances which have been mentioned, which opposed the
system of depletion in the cure of this fever, it was still far more
successful than any other mode of cure that had been pursued before in
the United States, or in the West-Indies.
Three out of four died of the disease in Jamaica, under the care of Dr.
Hume.
Dr. Blane considers it as one of the "most mortal" of diseases, and Dr.
Jackson places a more successful mode of treating it among the subjects
which will admit of "innovation" in medicine.
After the 15th of September, my success was much limited, compared with
what it had been before that time. But at no period of the disease did I
lose more than one in twenty of those whom I saw on the first day, and
attended regularly through every stage of the fever, provided they had
not been previously worn down by attending the sick.
The following statement, which will admit of being corrected, if it be
inaccurate, will, I hope, establish the truth of the above assertions.
About one half of the families whom I have attended for many years, left
the city. Of those who remained, many were affected by the disease. Out
of the whole of them, after I had adopted my second mode of practice, I
lost but five heads of families, and about a dozen servants and children.
In no instance did I lose both heads of the same family. My success in
these cases was owing to two causes: 1st, To the credit my former
patients gave to my public declaration, that we had only _one_ fever in
the city: hence they applied on the _first_ day, and sometimes on the
_first_ hour of their indisposition; and 2dly, To the numerous pledges
many of them had seen of the safety and efficacy of copious
blood-letting, by my advice, in other diseases: hence my prescription of
that necessary remedy was always obeyed in its utmost extent. Of the few
adults whom I lost, among my former patients, two of them were old
people, two took laudanum, without my knowledge, and one refused to take
medicine of any kind; all the rest had been worn down by previous
fatigue.
I have before said that a great number of the blacks were my patients. Of
these not one died under my care. This uniform success, among those
people, was not owing altogether to the mildness of the disease, for I
shall say presently, that a great proportion of a given number died,
under other modes of practice.
In speaking of the comparative effects of purging and bleeding, it may
not be amiss to repeat, that not one pregnant woman, to whom I prescribed
them, died, or suffered abortion. Where the tonic remedies were used,
abortion or death, and, in many instances, both, were nearly universal.
Many whole families, consisting of five, six, and, in three instances, of
nine members, were recovered by plentiful purging and bleeding. I could
swell this work by publishing a list of those families; but I take more
pleasure in adding, that I was not singular in my success in the use of
the above remedies. They were prescribed with great advantage by many of
the physicians of the city, who had for a while given tonic medicines
without effect. I shall not mention the names of any of the physicians
who _totally_ renounced those medicines, lest I should give offence by
not mentioning them all. Many large families were cured by some of them,
after they adopted and prescribed copious purging and blood-letting. One
of them cured ten in the family of Mr. Robert Haydock, by means of those
remedies. In one of that family, the disease came on with a vomiting of
black bile.
But the use of the new remedies was not directed finally by the
physicians alone. The clergy, the apothecaries, many private citizens,
several intelligent women, and two black men, prescribed them with great
success. Nay more, many persons prescribed them to themselves, and, as I
shall say hereafter, with a success that was unequalled by any of the
regular or irregular practitioners in the city.
It was owing to the almost universal use of purging and bleeding, that
the mortality of the disease diminished, in proportion as the number of
persons who were affected by it increased, about the middle of October.
It was scarcely double of what it was in the middle of September, and yet
six times the number of persons were probably at that time confined by
it.
The success of copious purging and bleeding was not confined to the city
of Philadelphia. Several persons, who were infected in town, and sickened
in the country, were cured by them.
Could a comparison be made of the number of patients who died of the
yellow fever in 1793, after having been plentifully bled and purged, with
those who died of the same disease in the years 1699, 1741, 1747, and
1762, I am persuaded that the proportion would be very small in the year
1793, compared with the former years[95]. Including all who died under
every mode of treatment, I suspect the mortality to be less, in
proportion to the population of the city, and the number of persons who
were affected, than it was in any of the other years that have been
mentioned.
[95] It appears from one of Mr. Norris's letters, dated the 9th of
November, O. S. that there died 220 persons, in the year 1699,
with the yellow fever. Between 80 and 90 of them, he says,
belonged to the society of friends. The city, at this time,
probably, did not contain more than 2 or 3000 people, many of
whom, it is probable, fled from the disease.
Not less than 6000 of the inhabitants of Philadelphia probably owe their
lives to purging and bleeding, during the autumn.