highly impregnated with miasmata. My eyes were yellow, and sometimes a
yellowness was perceptible in my face. My pulse was preternaturally
quick, and I had profuse sweats every night. These sweats were so
offensive, as to oblige me to draw the bed-clothes close to my neck, to
defend myself from their smell. They lost their f[oe]tor entirely, upon
my leaving off the use of broth, and living entirely upon milk and
vegetables. But my nights were rendered disagreeable, not only by these
sweats, but by the want of my usual sleep, produced in part by the
frequent knocking at my door, and in part by anxiety of mind, and the
stimulus of the miasmata upon my system. I went to bed in conformity to
habit only, for it ceased to afford me rest or refreshment. When it was
evening I wished for morning; and when it was morning, the prospect of
the labours of the day, at which I often shuddered, caused me to wish for
the return of evening. The degrees of my anxiety may be easily conceived
when I add, that I had at one time upwards of thirty heads of families
under my care; among these were Mr. Josiah Coates, the father of eight,
and Mr. Benjamin Scull and Mr. John Morell, both fathers of ten children.
They were all in imminent danger; but it pleased God to make me the
instrument of saving each of their lives. I rose at six o'clock, and
generally found a number of persons waiting for advice in my shop or
parlour. Hitherto the success of my practice gave a tone to my mind,
which imparted preternatural vigour to my body. It was meat and drink to
me to fulfil the duties I owed to my fellow-citizens, in this time of
great and universal distress. From a hope that I might escape the
disease, by avoiding every thing that could excite it into action, I
carefully avoided the heat of the sun, and the coldness of the evening
air. I likewise avoided yielding to every thing that should raise or
depress my passions. But, at such a time, the events which influence the
state of the body and mind are no more under our command than the winds
or weather. On the evening of the 14th of September, after eight o'clock,
I visited the son of Mrs. Berriman, near the Swedes's church, who had
sent for me early in the morning. I found him very ill. He had been bled
in the forenoon, by my advice, but his pulse indicated a second bleeding.
It would have been difficult to procure a bleeder at that late hour. I
therefore bled him myself. Heated by this act, and debilitated by the
labours of the day, I rode home in the evening air. During the ensuing
night I was much indisposed. I rose, notwithstanding, at my usual hour.
At eight o'clock I lost ten ounces of blood, and immediately afterwards
got into my chair, and visited between forty and fifty patients before
dinner. At the house of one of them I was forced to lie down a few
minutes. In the course of this morning's labours my mind was suddenly
thrown off its pivots, by the last look, and the pathetic cries, of a
friend for help, who was dying under the care of a French physician. I
came home about two o'clock, and was seized, immediately afterwards, with
a chilly fit and a high fever. I took a dose of the mercurial medicine,
and went to bed. In the evening I took a second purging powder, and lost
ten ounces more of blood. The next morning I bathed my face, hands, and
feet in cold water for some time. I drank plentifully, during the day and
night, of weak hyson tea, and of water, in which currant jelly had been
dissolved. At eight o'clock I was so well as to admit persons who came
for advice into my room, and to receive reports from my pupils of the
state of as many of my patients as they were able to visit; for,
unfortunately, they were not able to visit them all (with their own) in
due time; by which means several died. The next day I came down stairs,
and prescribed in my parlour for not less than a hundred people. On the
19th of the same month, I resumed my labours, but in great weakness. It
was with difficulty that I ascended a pair of stairs, by the help of a
banister. A slow fever, attended with irregular chills, and a troublesome
cough, hung constantly upon me. The fever discovered itself in the heat
of my hands, which my patients often told me were warmer than their own.
The breath and exhalations from the sick now began to affect me, in
small and infected rooms, in the most sensible manner. On the morning of
the 4th of October I suddenly sunk down, in a sick room, upon a bed, with
a giddiness in my head. It continued for a few minutes, and was succeeded
by a fever, which confined me to my house the remaining part of the day.
Every moment in the intervals of my visits to the sick was employed in
prescribing, in my own house, for the poor, or in sending answers to
messages from my patients; time was now too precious to be spent in
counting the number of persons who called upon me for advice. From
circumstances I believe it was frequently 150, and seldom less than 50 in
a day, for five or six weeks. The evening did not bring with it the least
relaxation from my labours. I received letters every day from the
country, and from distant parts of the union, containing inquiries into
the mode of treating the disease, and after the health and lives of
persons who had remained in the city. The business of every evening was
to answer these letters, also to write to my family. These employments,
by affording a fresh current to my thoughts, kept me from dwelling on the
gloomy scenes of the day. After these duties were performed, I copied
into my note book all the observations I had collected during the day,
and which I had marked with a pencil in my pocket-book in sick rooms, or
in my carriage. To these constant labours of body and mind were added
distresses from a variety of causes. Having found myself unable to comply
with the numerous applications that were made to me, I was obliged to
refuse many every day. My sister counted forty-seven in one forenoon
before eleven o'clock. Many of them left my door with tears, but they did
not feel more distress than I did from refusing to follow them. Sympathy,
when it vents itself in acts of humanity, affords pleasure, and
contributes to health; but the reflux of pity, like anger, gives pain,
and disorders the body. In riding through the streets, I was often forced
to resist the entreaties of parents imploring a visit to their children,
or of children to their parents. I recollect, and even _yet_ with pain,
that I tore myself at one time from five persons in Moravian-alley, who
attempted to stop me, by suddenly whipping my horse, and driving my chair
as speedily as possible beyond the reach of their cries.
The solicitude of the friends of the sick for help may further be
conceived of, when I add, that the most extravagant compensations were
sometimes offered for medical services, and, in one instance, for only a
single visit. I had no merit in refusing these offers, and I have
introduced an account of them only to inform such physicians as may
hereafter be thrown into a similar situation, that I was favoured with an
exemption from the fear of death, in proportion as I subdued every
selfish feeling, and laboured exclusively for the benefit of others. In
every instance in which I was forced to refuse these pathetic and earnest
applications, my distress was heightened by the fear that the persons,
whom I was unable to visit, would fall into improper hands, and perish by
the use of bark, wine, and laudanum.
But I had other afflictions besides the distress which arose from the
abortive sympathy which I have described. On the 11th of September, my
ingenious pupil, Mr. Washington, fell a victim to his humanity. He had
taken lodgings in the country, where he sickened with the disease. Having
been almost uniformly successful in curing others, he made light of his
fever, and concealed the knowledge of his danger from me, until the day
before he died. On the 18th of September Mr. Stall sickened in my house.
A delirium attended his fever from the first hour it affected him. He
refused, and even resisted force when used to compel him to take
medicine. He died on the 23d of September[101]. Scarcely had I recovered
from the shock of the death of this amiable youth, when I was called to
weep for a third pupil, Mr. Alston, who died in my neighbourhood the next
day. He had worn himself down, before his sickness, by uncommon exertions
in visiting, bleeding, and even sitting up with sick people. At this time
Mr. Fisher was ill in my house. On the 26th of the month, at 12 o'clock,
Mr. Coxe, my only assistant, was seized with the fever, and went to his
grandfather's. I followed him with a look, which I feared would be the
last in my house. At two o'clock my sister, who had complained for
several days, yielded to the disease, and retired to her bed. My mother
followed her, much indisposed, early in the evening. My black servant man
had been confined with the fever for several days, and had on that day,
for the first time, quitted his bed. My little mulatto boy, of eleven
years old, was the only person in my family who was able to afford me the
least assistance. At eight o'clock in the evening I finished the business
of the day. A solemn stillness at that time pervaded the streets. In vain
did I strive to forget my melancholy situation by answering letters, and
by putting up medicines, to be distributed next day among my patients. My
faithful black man crept to my door, and at my request sat down by the
fire, but he added, by his silence and dullness, to the gloom which
suddenly overpowered every faculty of my mind.
[101] This accomplished youth had made great attainments in his
profession. He possessed, with an uncommon genius for science,
talents for music, painting, and poetry. The following copy of an
unfinished letter to his father (who had left the city) was found
among his papers after his death. It shows that the qualities of
his heart were equal to those of his head.
"_Philadelphia, September 15, 1793._
"MY DEAR FATHER,
"I take every moment I have to spare to write to you, which is
not many; but you must excuse me, as I am doing good to my
fellow-creatures. At this time, every moment I spend in idleness
might probably cost a life. The sickness increases every day, but
most of those who die, die for want of good attendance. We cure
all we are called to on the first day, who are well attended, but
so many doctors are sick, the poor creatures are glad to get a
doctor's servant."
On the first day of October, at two o'clock in the afternoon, my sister
died. I got into my carriage within an hour after she expired, and spent
the afternoon in visiting patients. According as a sense of duty, or as
grief has predominated in my mind, I have approved, and disapproved of
this act, ever since. She had borne a share in my labours. She had been
my nurse in sickness, and my casuist in my choice of duties. My whole
heart reposed itself in her friendship. Upon being invited to a friend's
house in the country, when the disease made its appearance in the city,
she declined accepting the invitation, and gave as a reason for so doing,
that I might probably require her services in case of my taking the
disease, and that, if she were sure of dying, she would remain with me,
provided that, by her death, she could save my life. From this time I
declined in health and strength. All motion became painful to me. My
appetite began to fail. My night sweats continued. My short and imperfect
sleep was disturbed by distressing or frightful dreams. The scenes of
them were derived altogether from sick rooms and grave-yards. I concealed
my sorrows as much as possible from my patients; but when alone, the
retrospect of what was past, and the prospect of what was before me, the
termination of which was invisible, often filled my soul with the most
poignant anguish. I wept frequently when retired from the public eye, but
I did not weep over the lost members of my family alone. I beheld or
heard every day of the deaths of citizens, useful in public, or amiable
in private life. It was my misfortune to lose as patients the Rev. Mr.
Fleming and Mr. Graesel, both exhausted by their labours of piety and
love among the poor, before they sickened with the disease. I saw the
last struggles of departing life in Mr. Powel, and deplored, in his
death, an upright and faithful servant of the public, as well as a
sincere and affectionate friend. Often did I mourn over persons who had,
by the most unparalleled exertions, saved their friends and families from
the grave, at the expence of their own lives. Many of these martyrs to
humanity were in humble stations. Among the members of my profession,
with whom I had been most intimately connected, I had daily cause of
grief and distress. I saw the great and expanded mind of Dr. Pennington,
shattered by delirium, just before he died. He was to me dear and
beloved, like a younger brother. He was, moreover, a Joab in the contest
with the disease. Philadelphia must long deplore the premature death of
this excellent physician. Had he lived a few years longer, he would have
filled an immense space in the republic of medicine[102]. It was my
affliction to see my friend Dr. John Morris breathe his last, and to hear
the first effusions of the most pathetic grief from his mother, as she
bursted from the room in which he died. But I had distress from the
sickness, as well as the deaths of my brethren in physic. My worthy
friends, Dr. Griffitts, Dr. Say, and Dr. Mease, were suspended by a
thread over the grave, nearly at the same time. Heaven, in mercy to me,
as well as in kindness to the public and their friends, preserved their
lives. Had they died, the measure of my sorrows would have been complete.
[102] Before he finished his studies in medicine, he published a volume
of ingenious and patriotic "Chemical and Economical Essays,
designed to illustrate the connection between the theory and
practice of chemistry, and the application of that science to
some of the arts and manufactures of the United States of
America."
I have said before, that I early left off drinking wine; but I used it in
another way. I carried a little of it in a vial in my pocket, and when I
felt myself fainty, after coming out of a sick room, or after a long
ride, I kept about a table spoonful of it in my mouth for half a minute,
or longer, without swallowing it. So weak and excitable was my system,
that this small quantity of wine refreshed and invigorated me as much as
half a pint would have done at any other time. The only difference was,
that the vigour I derived from the wine in the former, was of shorter
duration than when taken in the latter way.
For the first two weeks after I visited patients in the yellow fever, I
carried a rag wetted with vinegar, and smelled it occasionally in sick
rooms: but after I saw and felt the signs of the universal presence of
miasmata in my system, I laid aside this and all other precautions. I
rested myself on the bed-side of my patients, and I drank milk or ate
fruit in their sick rooms. Besides being saturated with miasmata, I had
another security against being infected in sick rooms, and that was, I
went into scarcely a house which was more infected than my own. Many of
the poor people, who called upon me for advice, were bled by my pupils in
my shop, and in the yard, which was between it and the street. From the
want of a sufficient number of bowls to receive their blood, it was
sometimes suffered to flow and putrify upon the ground. From this source,
streams of miasmata were constantly poured into my house, and conveyed
into my body by the air, during every hour of the day and night.
The deaths of my pupils and sister have often been urged as objections to
my mode of treating the fever. Had the same degrees of labour and
fatigue, which preceded the attack of the yellow fever in each of them,
preceded an attack of a common pleurisy, I think it probable that some,
or perhaps all of them, would have died with it. But when the influence
of the concentrated miasmata which filled my house was added to that of
constant fatigue upon their bodies, what remedies could be expected to
save their lives? Under the above circumstances, I consider the recovery
of the other branches of my family from the fever (and none of them
escaped it) with emotions, such as I should feel had we all been revived
from apparent death by the exertions of a humane society.
For upwards of six weeks I did not taste animal food, nor fermented
liquors of any kind. The quantity of aliment which I took, inclusive of
drinks, during this time, was frequently not more than one or two pounds
in a day. Yet upon this diet I possessed, for a while, uncommon activity
of body. This influence of abstinence upon bodily exertion has been
happily illustrated by Dr. Jackson, in his directions for preserving the
health of soldiers in hot climates. He tells us, that he walked a hundred
miles in three days, in Jamaica, during which time he breakfasted on tea,
supped on bread and salad, and drank nothing but lemonade or water. He
adds further, that he walked from Edinburgh to London in eleven days and
a half, and that he travelled with the most ease when he only breakfasted
and supped, and drank nothing but water. The fatigue of riding on
horseback is prevented or lessened by abstinence from solid food. Even
the horse suffers least from a quick and long journey when he is fed
sparingly with hay. These facts add weight to the arguments formerly
adduced, in favour of a vegetable diet, in preventing or mitigating the
action of the miasmata of malignant fevers upon the system. In both cases
the abstraction of stimulus removes the body further from the reach of
undue excitement and morbid depression.
Food supports life as much by its stimulus, as by affording nourishment
to the body. Where an artificial stimulus acts upon the system the
natural stimulus of food ceases to be necessary. Under the influence of
this principle, I increased or diminished my food with the signs I
discovered of the increase or diminution of the seeds of the disease in
my body. Until the 15th of September I drank weak coffee, but after that
time I drank nothing but milk, or milk and water, in the intervals of my
meals. I was so satisfied of the efficacy of this mode of living, that I
believed life might have been preserved, and a fever prevented, for many
days, with a much greater accumulation of miasmata in my system, by means
of a total abstinence from food. Poison is a relative term, and an excess
in quantity, or a derangement in place, is necessary to its producing
deleterious effects. The miasmata of the yellow fever produced sickness
and death only from the excess of their quantity, or from their force
being increased by the addition of those other stimuli which I have
elsewhere called exciting causes.
In addition to low diet, as a preventive of the disease, I obviated
costiveness by taking occasionally a calomel pill, or by chewing rhubarb.
I had read and taught, in my lectures, that fasting increases acuteness
in the sense of touch. My low living had that effect, in a certain
degree, upon my fingers. I had a quickness in my perception, of the state
of the pulse in the yellow fever, that I had never experienced before in
any other disease. My abstemious diet, assisted perhaps by the state of
my feelings, had likewise an influence upon my mind. Its operations were
performed with an ease and a celerity, which rendered my numerous and
complicated duties much less burdensome than they would probably have
been under other circumstances of diet, or a less agitated state of my
passions.
My perception of the lapse of time was new to me. It was uncommonly slow.
The ordinary business and pursuits of men appeared to me in a light that
was equally new. The hearse and the grave mingled themselves with every
view I took of human affairs. Under these impressions I recollect being
as much struck with observing a number of men, employed in digging the
cellar of a large house, as I should have been, at any other time, in
seeing preparations for building a palace upon a cake of ice. I
recollect, further, being struck with surprise, about the 1st of October,
in seeing a man busily employed in laying in wood for the approaching
winter. I should as soon have thought of making provision for a dinner on
the first day of the year 1800.
In the account of my distresses, I have passed over the slanders which
were propagated against me by some of my brethren. I have mentioned them
only for the sake of declaring, in this public manner, that I most
heartily forgive them; and that if I discovered, at any time, an undue
sense of the unkindness and cruelty of those slanders, it was not because
I felt myself injured by them, but because I was sure they would
irreparably injure my fellow-citizens, by lessening their confidence in
the only remedies that I believed to be effectual in the reigning
epidemic. One thing in my conduct towards these gentlemen may require
justification; and that is, my refusing to consult with them. A Mahometan
and a Jew might as well attempt to worship the Supreme Being in the same
temple, and through the medium of the same ceremonies, as two physicians
of opposite principles and practice attempt to confer about the life of
the same patient. What is done in consequence of such negotiations (for
they are not consultations) is the ineffectual result of neutralized
opinions; and wherever they take place, should be considered as the
effect of a criminal compact between physicians, to assess the property
of their patients, by a shameful prostitution of the dictates of their
consciences. Besides, I early discovered that it was impossible for me,
by any reasonings, to change the practice of some of my brethren.
Humanity was, therefore, on the side of leaving them to themselves; for
the extremity of _wrong_ in medicine, as in morals and government, is
often a less mischief than that mixture of _right_ and _wrong_ which
serves, by palliating, to perpetuate evil.
After the loss of my health I received letters from my friends in the
country, pressing me, in the strongest terms, to leave the city. Such a
step had become impracticable. My aged mother was too infirm to be
removed, and I could not leave her. I was, moreover, part of a little
circle of physicians, who had associated themselves in support of the
new remedies. This circle would have been broken by my quitting the city.
The weather varied the disease, and, in the weakest state of my body, I
expected to be able, from the reports of my pupils, to assist my
associates in detecting its changes, and in accommodating our remedies to
them. Under these circumstances it pleased God to enable me to reply to
one of the letters that urged my retreat from the city, that "I had
resolved to stick to my principles, my practice, and my patients, to the
last extremity."