French practice. It would not be difficult to decide upon it from many
facts that came under my notice in the city; but I shall rest its merit
wholly upon the returns of the number of deaths at Bush-hill. This
hospital, after the 22d of September, was put under the care of a French
physician, who was assisted by one of the physicians of the city. The
hospital was in a pleasant and airy situation; it was provided with all
the necessaries and comforts for sick people that humanity could invent,
or liberality supply. The attendants were devoted to their duty; and
cleanliness and order pervaded every room in the house. The reputation of
this hospital, and of the French physician, drew patients to it in the
early stage of the disease. Of this I have been assured in a letter from
Dr. Annan, who was appointed to examine and give orders of admission
into the hospital, to such of the poor of the district of Southwark, as
could not be taken care of in their own houses. Mr. Olden has likewise
informed me, that most of the patients who were sent to the hospital by
the city committee (of which he was a member) were in the first stage of
the fever. With all these advantages, the deaths between the 22d of
September and the 6th of November, amounted to 448 out of 807 patients
who were admitted into the hospital within that time. Three fourths of
all the blacks (nearly 20) who were patients in this hospital died. A
list of the medicines prescribed there may be seen in the minutes of the
proceedings of the city committee. Calomel and jalap are not among them.
_Moderate_ bleeding and purging with glauber's salts, I have been
informed, were used in some cases by the physicians of this hospital. The
proportion of deaths to the recoveries, as it appears in the minutes of
the committee from whence the above report is taken, is truly melancholy!
I hasten from it therefore to a part of this work, to which I have looked
with pleasure, ever since I sat down to compose it.
I have said that the clergy, the apothecaries, and many other persons who
were uninstructed in the principles of medicine, prescribed purging and
bleeding with great success in this disease. Necessity gave rise to this
undisciplined sect of practitioners, for they came forward to supply the
places of the regular bred physicians who were sick or dead. I shall
mention the names of a few of those persons who distinguished themselves
as volunteers in this new work of humanity. The late Rev. Mr. Fleming,
one of the ministers of the catholic church, carried the purging powders
in his pocket, and gave them to his poor parishioners with great success.
He even became the advocate of the new remedies. In a conversation I had
with him, on the 22d of September, he informed me, that he had advised
four of our physicians, whom he met a day or two before, "to renounce the
pride of science, and to adopt the new mode of practice, for that he had
witnessed its good effects in many cases." Mr. John Keihmle, a German
apothecary, has assured me, that out of 314 patients whom he visited, and
187 for whom he prescribed from the reports of their friends, he lost but
47 (which is nearly but one in eleven), and that he treated them all
agreeably to the method which I had recommended. The Rev. Mr. Schmidt,
one of the ministers of the Lutheran church, was cured by him. I have
before mentioned an instance of the judgment of Mr. Connelly, and of his
zeal in visiting and prescribing for the sick. His remedies were bleeding
and purging. He, moreover, bore a constant and useful testimony against
bark, wine, laudanum, and the warm bath[96]. Mrs. Paxton, in
Carter's-alley, and Mrs. Evans, the wife of Mr. John Evans, in
Second-street, were indefatigable; the one in distributing mercurial
purges composed by herself, and the other in urging the necessity of
_copious_ bleeding and purging among her friends and neighbours, as the
only safe remedies for the fever. These worthy women were the means of
saving many lives[97]. Absalom Jones and Richard Allen, two black men,
spent all the intervals of time, in which they were not employed in
burying the dead, in visiting the poor who were sick, and in bleeding and
purging them, agreeably to the directions which had been printed in all
the newspapers. Their success was unparalleled by what is called regular
practice. This encomium upon the practice of the blacks will not surprise
the reader, when I add that they had no fear of putrefaction in the
fluids, nor of the calumnies of a body of fellow-citizens in the republic
of medicine to deter them from plentiful purging and bleeding. They had,
besides, no more patients than they were able to visit two or three times
a day. But great as their success was, it was exceeded by those persons
who, in despair of procuring medical aid of any kind, purged and bled
themselves. This palm of superior success will not be withheld from those
people when I explain the causes of it. It was owing to their _early_ use
of the proper remedies, and to their being guided in the repetition of
them, by the continuance of a tense pulse, or of pain and fever. A day,
an afternoon, and even an hour, were not lost by these people in waiting
for the visit of a physician, who was often detained from them by
sickness, or by new and unexpected engagements, by which means the
precious moment for using the remedies with effect passed irrevocably
away. I have stated these facts from faithful inquiries, and numerous
observations. I could mention the names and families of many persons who
thus cured themselves. One person only shall be mentioned, who has shown
by her conduct what reason is capable of doing when it is forced to act
for itself. Mrs. Long, a widow, after having been twice unsuccessful in
her attempts to procure a physician, undertook at last to cure herself.
She took several of the mercurial purges, agreeably to the printed
directions, and had herself bled _seven_ times in the course of five or
six days. The indication for repeating the bleeding was the continuance
of the pain in her head. Her recovery was rapid and complete. The history
of it was communicated to me by herself, with great gratitude, in my own
house, during my second confinement with the fever. To these accounts of
persons who cured themselves in the city, I could add many others, of
citizens who sickened in the country, and who cured themselves by
plentiful bleeding and purging, without the attendance of a physician.
[96] In the letter before quoted, from Mr. Connelly, he expresses his
opinion of those four medicines in the following words: "Laudanum,
bark, and wine have put a period to the existence of some, where
the fever has been apparently broken, and the patients in a fair
way of recovery; a single dose of laudanum has hurried them
suddenly into eternity. I have visited a few patients where the
hot bath was used, and am convinced that it only tended to weaken
and relax the system, without producing any good effect."
[97] The yellow fever prevailed at the Caraccos, in South-America, in
October, 1793, with great mortality, more especially among the
Spanish troops. Nearly all died who were attended by physicians.
Recourse was finally had to the old women, who were successful in
almost every case to which they were called. Their remedies were a
liquor called _narencado_ (a species of lemonade) and a tea made
of a root called _fistula_. With these drinks they drenched their
patients for the first two or three days. They induced plentiful
sweats, and, probably, after blunting, discharged the bile from
the bowels. I received this information from an American
gentleman, who had been cured, by one of those Amazons in
medicine, in the above way.
From a short review of these facts, reason and humanity awake from their
long repose in medicine, and unite in proclaiming, that it is time to
take the cure of pestilential epidemics out of the hands of physicians,
and to place it in the hands of the people. Let not the reader startle at
this proposition. I shall give the following reasons for it.
1. In consequence of these diseases affecting a great number of people at
one time, it has always been, and always will be impossible, for them
_all_ to have the benefit of medical aid, more especially as the
proportion of physicians to the number of sick, is generally diminished
upon these occasions, by desertion, sickness, and death.
2. The safety of committing to the people the cure of pestilential
fevers, particularly the yellow fever and the plague, is established by
the simplicity and uniformity of their causes, and of their remedies.
However diversified they may be in their symptoms, the system, in both
diseases, is generally under a state of undue excitement or great
depression, and in most cases requires the abstraction of stimulus in a
greater or less degree, or in a sudden or gradual manner. There can never
be any danger of the people injuring themselves by mistaking any other
disease for an _epidemic_ yellow fever or plague, for no other febrile
disease can prevail with them. It was probably to prevent this mistake,
that the Benevolent Father of mankind, who has permitted no evil to exist
which does not carry its antidote along with it, originally imposed that
law upon all great and mortal epidemics.
3. The history of the yellow fever in the West-Indies proves the
advantage of trusting patients to their own judgment. Dr. Lind has
remarked, that a greater proportion of sailors who had no physicians
recovered from that fever, than of those who had the best medical
assistance. The fresh air of the deck of a ship, a purge of salt water,
and the free use of cold water, probably triumphed here over the cordial
juleps of physicians.
4. By committing the cure of this and other pestilential epidemics to the
people, all those circumstances which prevented the universal success of
purging and bleeding, in this disease, will have no operation. The fever
will be mild in most cases, for all will prepare themselves to receive
it, by a vegetable diet, and by moderate evacuations. The remedies will
be used the _moment_ the disease is felt, or even seen, and its violence
and danger will thereby be obviated. There will then be no disputes among
physicians, about the nature of the disease, to distract the public
mind, for they will seldom be consulted in it. None will suffer from
chronic debility induced by previous fatigue in attending the sick, nor
from the want of nurses, for few will be so ill as to require them, and
there will be no "foreboding" fears of death, or despair of recovery, to
invite an attack of the disease, or to ensure its mortality.
The small-pox was once as fatal as the yellow fever and the plague. It
has since yielded as universally to a vegetable diet and evacuations, in
the hands of apothecaries, the clergy, and even of the good women, as it
did in the hands of doctors of physic.
They have narrow conceptions, not only of the Divine goodness, but of the
gradual progress of human knowledge, who suppose that all pestilential
diseases shall not, like the small-pox, sooner or later cease to be the
scourge and terror of mankind.
For a long while, air, water, and even the light of the sun, were dealt
out by physicians to their patients with a sparing hand. They possessed,
for several centuries, the same monopoly of many artificial remedies. But
a new order of things is rising in medicine. Air, water, and light are
taken without the advice of a physician, and bark and laudanum are now
prescribed every where by nurses and mistresses of families, with safety
and advantage. Human reason cannot be stationary upon these subjects. The
time must and will come, when, in addition to the above remedies, the
general use of calomel, jalap, and the lancet, shall be considered among
the most essential articles of the knowledge and rights of man.
It is no more necessary that a patient should be ignorant of the medicine
he takes, to be cured by it, than that the business of government should
be conducted with secrecy, in order to insure obedience to just laws.
Much less is it necessary that the means of life should be prescribed in
a dead language, or dictated with the solemn pomp of a necromancer. The
effects of imposture, in every thing, are like the artificial health
produced by the use of ardent spirits. Its vigour is temporary, and is
always followed by misery and death.
The belief that the yellow fever and the plague are necessarily mortal,
is as much the effect of a superstitious torpor in the understanding, as
the ancient belief that the epilepsy was a supernatural disease, and that
it was an offence against Heaven to attempt to cure it. It is partly from
the influence of this torpor in the minds of some people, that the
numerous cures of the yellow fever, performed by a few simple remedies,
were said to be of _other_ diseases. It is necessary, for the conviction
of such persons, that patients should always _die_ of that, and other
dangerous diseases, to prove that they have been affected by them.
The repairs which our world is destined to undergo will be incomplete,
until pestilential fevers cease to be numbered among the widest outlets
of human life.
There are many things which are now familiar to women and children, which
were known a century ago only to a few men who lived in closets, and were
distinguished by the name of philosophers.
We teach a hundred things in our schools less useful, and many things
more difficult, than the knowledge that would be necessary to cure a
yellow fever or the plague.
In my attempts to teach the citizens of Philadelphia, by my different
publications, the method of curing themselves of yellow fever, I observed
no difficulty in their apprehending every thing that was addressed to
them, except what related to the different states of the pulse. All the
knowledge that is necessary to discover when blood-letting is proper,
might be taught to a boy or girl of twelve years old in a few hours. I
taught it in less time to several persons, during the prevalence of the
epidemic.
I would as soon believe that ratafia was intended by the Author of Nature
to be the only drink of man, instead of water, as believe that the
knowledge of what relates to the health and lives of a _whole_ city, or
nation, should be confined to one, and that a small or a privileged order
of men. But what have physicians, what have universities or medical
societies done, after the labours and studies of many centuries, towards
lessening the mortality of pestilential fevers? They have either copied
or contradicted each other, in all their publications. Plagues and
malignant fevers are still leagued with war and famine, in their ravages
upon human life.
To prevent the formation and mortality of this fever, it will be
necessary, when it makes its appearance in a city or country, to publish
an account of those symptoms which I have called the _precursors_ of the
disease, and to exhort the people, as soon as they feel those symptoms,
to have immediate recourse to the remedies of purging or bleeding. The
danger of delay in using one, or both these remedies, should be
inculcated in the strongest terms, for the disease, like Time, has a lock
on its forehead, but is bald behind. The bite of a rattle-snake is seldom
fatal, because the medicines which cure it are applied or taken as soon
as the poison comes in contact with the blood. There is less danger to be
apprehended from the yellow fever than from the poison of the snake,
provided the remedies for it are administered within a few hours after it
is excited into action.
Let persons who are subject to chronic pains, or diseases of any kind, be
advised not to be deceived by them. Every pain, at such a time, is the
beginning of the disease; for it always acts first on debilitated parts
of the body. From an ignorance of this law of epidemics many persons, by
delaying their applications for help, perished with our fever.
Let nature be trusted into no case whatever, to cure this disease; and
let no attack of it, however light, be treated with neglect. Death as
certainly performs his work, when he steals on the system in the form of
a mild intermittent, as he does, when he comes on with the symptoms of
apoplexy, or a black vomiting.
Cleanliness, in houses and dress, cannot be too often inculcated during
the prevalence of a yellow fever.
Let it not be supposed, that I mean that the history which I have given
of the method of cure of this epidemic, should be applied, in all its
parts, to the yellow fevers which may appear hereafter in the United
States, or which exist at all times in the West-India islands. Season and
climate vary this, as well as all other diseases. Bark and wine, so fatal
in this, may be proper in a future yellow fever. But in the climate of
the United States, I believe it will seldom appear with such symptoms of
prostration and weakness, as not to require, in its first stage,
evacuations of some kind.
The only inquiry, when the disease makes its appearance, should be, from
what part of the body these evacuations should be procured; the order
which should be pursued in obtaining them; and the quantity of each of
the matters to be discharged, which should be withdrawn at a time.
Thus far did I venture, from my theory of the disease, and from the
authorities of Dr. Hillary and Dr. Mosely, to decide in favour of
evacuations in the yellow fever; but Dr. Wade, and Mr. Chisholm again
support me by their practice in the fevers of the East and West-Indies.
They both gave strong mercurial purges, and bled in some cases. Dr. Wade
confirmed, by his practice, the advantage of _gradually_ abstracting
stimulus from the system. He never drew blood, even in the most
inflammatory cases, until he had first discharged the contents of the
bowels. The doctor has further established the efficacy of a vegetable
diet and of water as a drink, as the best means of preventing the disease
in a hot climate.
The manner in which the miasmata that produce the plague act upon the
system is so much like that which has been described in the yellow fever,
and the accounts of the efficacy of low diet, in preparing the body for
its reception, and of copious bleeding, cold air, and cold water, in
curing it, are so similar, that all the directions which relate to
preventing, mitigating, or curing the yellow fever may be applied to it.
The fluids in the plague show a greater tendency to the skin, than they
do in the yellow fever. Perhaps, upon this account, the early use of
powerful sudorifics may be more proper in the former than in the latter
disease. From the influence of early purging and bleeding in promoting
sweats in the yellow fever, there can be little doubt but the efforts of
nature to unload the system in the plague, through the channel of the
pores, might be accelerated by the early use of the same remedies. One
thing, with respect to the plague, is certain, that its cure depends upon
the abstraction of stimulus, either by means of plentiful sweats, or of
purulent matter from external sores. Perhaps the efficacy of these
remedies depends wholly upon their elevating the system from its
prostrated state in a _gradual_ manner. If this be the case, those
natural discharges might be easily and effectually imitated by small and
repeated bleedings.
To correspond in quantity with the discharge from the skin, blood-letting
in the plague, when indicated, should be copious. A profuse sweat,
continued for twenty-four hours, cannot fail of wasting many pounds of
the fluids of the body. This was the duration of the critical sweats in
the famous plague which was known by the name of the English sweating
sickness, and which made its appearance in the army of Henry VII. in
Milford-Haven in Wales, and spread from thence through every part of the
kingdom.
The principles which lead to the prevention and cure of the yellow fever
and the plague, apply with equal force to the mitigation of the measles,
and to the prevention or mitigation of the scarlatina anginosa, the
dysentery, and the inflammatory jail fever. I have remarked
elsewhere[98], that a previous vegetable diet lessened the violence and
danger of the measles. Dr. Sims taught me, many years ago, to prevent or
mitigate the scarlatina anginosa, by means of gentle purges, after
children are infected by it[99]. Purges of salts have in many instances
preserved whole families and neighbourhoods from the dysentery, where
they have been exposed to its remote cause. During the late American war,
an emetic seldom failed of preventing an attack of the hospital fever,
when given in its forming state[100]. I have had no experience of the
effects of previous evacuations in abating the violence, or preventing
the mortality of the malignant sore throat, but I can have no doubt of
their efficacy, from the sameness of the state of the system in that
disease, as in other malignant fevers. The debility induced in it is from
depression, and the supposed symptoms of putrefaction are nothing but the
disguised effects of a sudden and violent pressure of an inflammatory
stimulus upon the arterial system.
[98] Vol. ii.
[99] Medical Memoirs, vol. i.
[100] Vol. i.
With these observations I close the history of the rise, progress,
symptoms, and treatment of the bilious remitting yellow fever, which
appeared in Philadelphia in the year 1793. My principal aim has been to
revive and apply to it the principles and practice of Dr. Sydenham, and,
however coldly those principles and that practice may be received by some
physicians of the present day, I am convinced that experience, in all
ages and in all countries, will vouch for their truth and utility.
A NARRATIVE
OF THE
_STATE OF THE BODY AND MIND_
OF THE AUTHOR,
DURING THE PREVALENCE OF THE FEVER.
Narratives of escapes from great dangers of shipwreck, war, captivity,
and famine have always formed an interesting part of the history of the
body and mind of man. But there are deliverances from equal dangers which
have hitherto passed unnoticed; I mean from pestilential fevers. I shall
briefly describe the state of my body and mind during my intercourse with
the sick in the epidemic of 1793. The account will throw additional light
upon the disease, and probably illustrate some of the laws of the animal
economy. It will, moreover, serve to furnish a lesson to all who may be
placed in similar circumstances to commit their lives, without fear, to
the protection of that Being, who is able to save to the uttermost, not
only from future, but from present evil.
Some time before the fever made its appearance, my wife and children went
into the state of New-Jersey, where they had long been in the habit of
spending the summer months. My family, about the 25th of August,
consisted of my mother, a sister, who was on a visit to me, a black
servant man, and a mulatto boy. I had five pupils, viz. Warner Washington
and Edward Fisher, of Virginia, John Alston, of South-Carolina, and John
Redman Coxe (grandson to Dr. Redman) and John Stall, both of this city.
They all crowded around me upon the sudden increase of business, and with
one heart devoted themselves to my service, and to the cause of humanity.
The credit which the new mode of treating the disease acquired, in all
parts of the city, produced an immense influx of patients to me from all
quarters. My pupils were constantly employed; at first in putting up
purging powders, but, after a while, only in bleeding and visiting the
sick.
Between the 8th and the 15th of September I visited and prescribed for
between a hundred and a hundred and twenty patients a day. Several of my
pupils visited a fourth or fifth part of that number. For a while we
refused no calls. In the short intervals of business, which I spent at
my meals, my house was filled with patients, chiefly the poor, waiting
for advice. For many weeks I seldom ate without prescribing for numbers
as I sat at my table. To assist me at these hours, as well as in the
night, Mr. Stall, Mr. Fisher, and Mr. Coxe accepted of rooms in my house,
and became members of my family. Their labours now had no remission.
Immediately after I adopted the antiphlogistic mode of treating the
disease, I altered my manner of living. I left off drinking wine and malt
liquors. The good effects of the disuse of these liquors helped to
confirm me in the theory I had adopted of the disease. A troublesome
head-ach, which I had occasionally felt, and which excited a constant
apprehension that I was taking the fever, now suddenly left me. I
likewise, at this time, left off eating solid animal food, and lived
wholly, but sparingly, upon weak broth, potatoes, raisins, coffee, and
bread and butter.