as the day was warm, I lessened the quantity of my clothing. Towards
evening I was seized with a pain in the back, which obliged me to go to
bed at eight o'clock. About twelve I awoke with a chilly fit. A violent
fever, with acute pains in different parts of my body, followed it. At
one o'clock I called for Mr. Fisher, who slept in the next room. He came
instantly, with my affectionate black man, to my relief. I saw my danger
painted in Mr. Fisher's countenance. He bled me plentifully, and gave me
a dose of the mercurial medicine. This was immediately rejected. He gave
me a second dose, which likewise acted as an emetic, and discharged a
large quantity of bile from my stomach. The remaining part of the night
was passed under an apprehension that my labours were near an end. I
could hardly expect to survive so violent an attack of the fever, broken
down, as I was, by labour, sickness, and grief. My wife and seven
children, whom the great and distressing events that were passing in our
city had jostled out of my mind for six or seven weeks, now resumed their
former place in my affections. My wife had stipulated, in consenting to
remain in the country, to come to my assistance in case of my sickness;
but I took measures which, without alarming her, proved effectual in
preventing it. My house was enveloped in foul air, and the probability of
my death made her life doubly necessary to my family. In the morning the
medicine operated kindly, and my fever abated. In the afternoon it
returned, attended with a great inclination to sleep. Mr. Fisher bled me
again, which removed the sleepiness. The next day the fever left me, but
in so weak a state, that I awoke two successive nights with a faintness
which threatened the extinction of my life. It was removed each time by
taking a little aliment. My convalescence was extremely slow. I returned,
in a very gradual manner, to my former habits of diet. The smell of
animal food, the first time I saw it at my table, forced me to leave the
room. During the month of November, and all the winter months, I was
harassed with a cough, and a fever somewhat of the hectic kind. The early
warmth of the spring removed those complaints, and restored me, through
Divine goodness, to my usual state of health.
I should be deficient in gratitude, were I to conclude this narrative
without acknowledging my obligations to my surviving pupils, Mr. Fisher
and Mr. Coxe, for the great support and sympathy I derived from them in
my labours and distresses.
I take great pleasure likewise in acknowledging my obligations to my
former pupil, Dr. Woodhouse, who assisted me in the care of my patients,
after I became so weak as not to be able to attend them with the
punctuality their cases required. The disinterested exploits of these
young gentlemen in the cause of humanity, and their success in the
treatment of the disease, have endeared their names to hundreds, and, at
the same time, afforded a prelude of their future eminence and usefulness
in their profession.
But wherewith shall I come before the great FATHER and REDEEMER of men,
and what shall I render unto him for the issue of my life from the grave?
----Here all language fails:----
Come then, expressive silence, muse his praise.
AN ACCOUNT
OF THE
BILIOUS REMITTING AND INTERMITTING
_YELLOW FEVER_,
AS IT
APPEARED IN PHILADELPHIA,
IN THE YEAR 1794.
I concluded the history of the symptoms of the bilious remitting yellow
fever, as it appeared in Philadelphia in the year 1793, by taking notice,
that the diseases which succeeded that fatal epidemic were all of a
highly inflammatory nature.
In that history I described the weather and diseases of the months of
March and April, in the spring of 1794.
The weather, during the first three weeks of the month of May, was dry
and temperate, with now and then a cold day and night. The strawberries
were ripe on the 15th, and cherries on the 22d day of the month, in
several of the city gardens. A shower of hail fell on the afternoon of
the 22d, which broke the glass windows of many houses. A single stone of
this hail was found to weigh two drachms. Several people collected a
quantity of it, and preserved it till the next day in their cellars, when
they used it for the purpose of cooling their wine. The weather, after
this hail storm, was rainy during the remaining part of the month. The
diseases were still inflammatory. Many persons were afflicted with a sore
mouth in this month.
The weather in June was pleasant and temperate. Several intermittents,
and two very acute pleurisies, occurred in my practice during this month.
The intermittents were uncommonly obstinate, and would not yield to the
largest doses of the bark.
In a son of Mr. Samuel Coates, of seven years old, the bark produced a
sudden translation of this state of fever to the head, where it produced
all the symptoms of the first stage of internal dropsy of the brain. This
once formidable disease yielded, in this case, to three bleedings, and
other depleting medicines. The blood drawn in every instance was sizy.
From the inflammatory complexion of the diseases of the spring, and of
the beginning of June, I expected the fevers of the summer and autumn
would be of a violent and malignant nature. I was the more disposed to
entertain this opinion from observing the stagnating filth of the gutters
of our city; for the citizens of Philadelphia, having an interest in
rejecting the proofs of the generation of the epidemic of 1793 in their
city, had neglected to introduce the regulations which were necessary to
prevent the production of a similar fever from domestic putrefaction.
They had, it is true, taken pains to remove the earth and offal matters
which accumulated in the streets; but these, from their being always dry,
were inoffensive as remote causes of disease. Perhaps the removal of the
earth did harm, by preventing the absorption of the miasmata which were
constantly exhaled from the gutters.
On the 6th of June, Dr. Physick called upon me, and informed me that he
had a woman in the yellow fever under his care. The information did not
surprise me, but it awakened suddenly in my mind the most distressing
emotions. I advised him to inform the mayor of the city of the case, but
by no means to make it more public, for I hoped that it might be a
sporadic instance of the disease, and that it might not become general in
the city.
On the 12th of the month, my fears of the return of the yellow fever were
revived by visiting Mr. Isaac Morris, whom I found very ill with a
violent puking, great pain in his head, a red eye, and a slow tense
pulse. I ordered him to be bled, and purged him plentifully with jalap
and calomel. His blood had that appearance which has been compared by
authors to the washings of raw flesh in water. Upon his recovery, he told
me that he "suspected he had had the yellow fever, for that his feelings
were exactly such as they had been in the fall of 1793, at which time he
had an attack of that disease."
On the 14th of June, I was sent for, in the absence of Dr. Mease, to
visit his sister in a fever. Her mother, who had become intimately
acquainted with the yellow fever, by nursing her son and mother in it,
the year before, at once decided upon the name of her daughter's disease.
Her symptoms were violent, but they appeared in an intermitting form.
Each paroxysm of her fever was like a hurricane to her whole system. It
excited apprehensions of immediate dissolution in the minds of all her
friends. The loss of sixty ounces of blood, by five bleedings, copious
doses of calomel and jalap, and a large blister to her neck, soon
vanquished this malignant intermittent, without the aid of a single dose
of bark.
During the remaining part of the month, I was called to several cases of
fever, which had symptoms of malignity of an alarming nature. The son of
Mr. Andrew Brown had a hæmorrhage from his nose in a fever, and a case of
menorrhagia occurred in a woman, who was affected with but a slight
degree of fever.
In the course of this month, I met with several cases of swelled
testicles, which had succeeded fevers so slight as to have required no
medical aid. Dr. Desportes records similar instances of a swelling in the
testicles, which appeared during the prevalence of the yellow fever in
St. Domingo, in the year 1741[103].
[103] Histoire des Maladies de Saint Domingue, p. 112.
In the month of July, I visited James Lefferty and William Adams, both of
whom had, with the usual symptoms of yellow fever, a yellow colour on
their skin. I likewise attended three women, in whom I discovered the
disease under forms in which I had often seen it in the year 1793. In two
of them it appeared with symptoms of a violent colic, which yielded only
to frequent bleedings. In the third, it appeared with symptoms of
pleurisy, which was attended with a constant hæmorrhage from the uterus,
although blood was drawn almost daily from her arm, for six or seven
days. About the middle of this month many people complained of nausea,
which in some cases produced a puking, without any symptoms of fever.
During the month of August, I was called to Peter Denham, Mrs. Bruce, a
son of Jacob Gribble, Mr. Cole, John Madge, Mrs. Gardiner, Miss Purdon,
Mrs. Gavin, and Benjamin Cochran, each of whom had all the usual symptoms
of the yellow fever. I found Mr. Cochran sitting on the side of his bed,
with a pot in his hand, into which he was discharging black matter from
his stomach, on the 6th day of the disease. He died on the next day. Mrs.
Gavin died on the 6th day of her disease, from a want of sufficient
bleeding, to which she objected from the influence of her friends.
Besides the above persons, I visited Mr. George Eyre at Kensington, Mr.
Thomas Fitzsimons, and Thomas M'Kean, jun. son of the chief justice of
Pennsylvania, all of whom had the disease, but in a moderate degree.
During this time I took no steps to alarm my fellow-citizens with the
unwelcome news of its being in town. But my mind was not easy in this
situation, for I daily heard of persons who died of the disease, who
might probably have been saved had they applied early for relief, or had
a suspicion become general among all our physicians of the existence of
the yellow fever in the city. The cholera infantum was common during
this, and part of the preceding month. It was more obstinate and more
fatal than in common years.
On the 12th of this month, a letter from Baltimore announced the
existence of the yellow fever in that city. One of the patients whom I
visited in this month, in the fever, Mr. Cole, brought the seeds of it in
his body from that place.
On the 25th of the month, two members of a committee, lately appointed by
the government of the state, for taking care of the health of the city,
called upon me to know whether the yellow fever was in town. I told them
it was, and mentioned some of the cases that had come under my notice;
but informed them, at the same time, that I had seen no case in which it
had been contagious, and that, in every case where I had been called
early, and where my prescriptions had been followed, the disease had
yielded to medicine.
On the 29th of the month I received an invitation to attend a meeting of
the committee of health, at their office at Walnut-street. They
interrogated me respecting the intelligence I had given to two of their
members on the 25th. I repeated it to them, and mentioned the names of
all the persons I had attended in the yellow fever since the 9th of June.
Neither this, nor several subsequent communications to the committee of
health produced the effect that was intended by them. Dr. Physick and Dr.
Dewees supported me in my declaration, but their testimony did not
protect me from the clamours of my fellow-citizens, nor from the
calumnies of some of my brethren, who, while they daily attended or lost
patients in the yellow fever, called it by the less unpopular names of
1. A common intermittent. 2. A bilious fever. 3. An inflammatory
remitting fever. 4. A putrid fever. 5. A nervous fever. 6. A dropsy of
the brain. 7. A lethargy. 8. Pleurisy. 9. Gout. 10. Rheumatism. 11.
Colic. 12. Dysentery. And 13. Sore throat.
It was said further, by several of the physicians of the city, not to be
the yellow fever, because some who had died of it had not a sighing in
the beginning, and a black vomiting in the close of the disease. Even
where the black vomiting and yellow skin occurred, they were said not to
constitute a yellow fever, for that those symptoms occurred in other
fevers.
Let not the reader complain of the citizens and physicians of
Philadelphia alone. A similar conduct has existed in all cities upon the
appearance of great and mortal epidemics.
Nor is it any thing new for mortal diseases to receive mild and harmless
names from physicians. The plague was called a spotted fever, for several
months, by some of the physicians of London, in the year 1665.
Notwithstanding the pains which were taken to discredit the report of the
existence of the yellow fever in the city, it was finally believed by
many citizens, and a number of families in consequence of it left the
city. And in spite of the harmless names of intermitting and remitting
fever, and the like, which were given to the disease, the bodies of
persons who had died with it were conveyed to the grave, in several
instances, upon a hearse, the way in which those who died of the yellow
fever were buried the year before.
From the influence of occasional showers of rain, in the months of
September and October, the disease was frequently checked, so as to
disappear altogether for two or three days in my circle of practice. It
was observed, that while showers of rain lessened, moist or damp weather,
without rain, increased it.
The cold weather in October checked the fever, but it did not banish it
from the city. It appeared in November, and in all the succeeding winter
and spring months. The weather, during these months, being uncommonly
moderate, will account for its not being destroyed at the time in which
the disease usually disappeared in former years.
The causes which predisposed to this fever were the same as in the year
1793. Persons of full habits, strangers, and negroes, were most subject
to it. It may seem strange to those persons who have read that the
negroes are seldom affected with this fever in the West-Indies, that they
were so much affected by it in Philadelphia. There were two reasons for
it. Their manner of living was as plentiful as that of white people in
the West-Indies, and they generally resided in alleys and on the skirts
of the city, where they were more exposed to noxious exhalation, than in
its more open and central parts.
The summer fruits, from being eaten before they were ripe, or in too
large a quantity, became frequently exciting causes of this fever. It was
awakened in one of my patients by a supper of peaches and milk.
Cucumbers, in several instances, gave vigour to the miasmata which had
been previously received into the system. Terror excited it in two of my
patients. In one of them, a young woman, this terror was produced by
hearing, while she sat at dinner, that a hearse had passed by her door
with a person on it who had died of the yellow fever. Vexation excited it
in a foreign master of a vessel, in consequence of a young woman suddenly
breaking an engagement to marry him. The disease terminated fatally in
this instance.
It was sometimes unfortunate for patients when the disease was excited by
an article of diet, or by any other cause which acted suddenly upon the
system; for it led both them, and in some instances their physicians, to
confound those exciting causes with its remote cause, and to view the
disease without the least relation to the prevailing epidemic. It was
from this mistake that many persons were said to die of intemperance, of
eating ice creams, and of trifling colds, who certainly died of the
yellow fever. The rum, the ice creams, and the changes in the air, in all
these cases, acted like sparks of fire which set in motion the quiescent
particles of tinder or gunpowder.
I shall now proceed to describe the symptoms which this fever assumed
during the periods which have been mentioned. This detail will be
interesting to physicians who wish to see how little nature regards the
nosological arrangement of authors, in the formation of the symptoms of
diseases, and how much the seasons influence epidemics. A physician, who
had practised medicine near sixty years in the city of Philadelphia,
declared that he had never seen the dysentery assume the same symptoms in
any two _successive_ years. The same may be said probably of nearly all
epidemic diseases.
In the arrangement of the symptoms of this fever, I shall follow the
order I adopted in my Account of the Yellow Fever of 1793, and describe
them as they appeared in the sanguiferous system, the liver, lungs, and
brain, the alimentary canal, the secretions and excretions, the nervous
system, the senses and appetites, upon the skin, and in the blood.
Two premonitory symptoms struck me this year, which I did not observe in
1793. One of them was a frequent discharge of pale urine for a day or two
before the commencement of the fever; the other was sleep unusually
sound, the night before the attack of the fever. The former symptom was a
precursor of the plague of Bassora, in the year 1773.
I. I observed but few symptoms in the sanguiferous system different from
what I have mentioned in the fever of the preceding year. The slow and
intermitting pulse occurred in many, and a pulse nearly imperceptible, in
three instances. It was seldom very frequent. In John Madge, an English
farmer, who had just arrived in our city, it beat only 64 strokes in a
minute, for several days, while he was so ill as to require three
bleedings a day, and at no time of his fever did his pulse exceed 96
strokes in a minute. In Miss Sally Eyre, the pulse at one time was at
176, and at another time it was at 140; but this frequency of pulse was
very rare. In a majority of the cases which came under my notice, where
the danger was great, it seldom exceeded 80 strokes in a minute. I have
been thus particular in describing the frequency of the pulse, because
custom has created an expectation of that part of the history of fevers;
but my attention was directed chiefly to the different degrees of _force_
in the pulse, as manifested by its tension, fulness, intermissions, and
inequality of action. The _hobbling_ pulse was common. In John Geraud, I
perceived a quick stroke to succeed every two strokes of an ordinary
healthy pulse. The intermitting, chorded, and depressed pulse occurred in
many cases. I called it the year before a _sulky_ pulse. One of my
pupils, Mr. Alexander, called it more properly a _locked_ pulse. I think
I observed this state of the pulse to occur chiefly in persons in whom
the fever came on without a chilly fit.
Hæmorrhages occurred in all the grades of this fever, but less frequently
in my practice this year than in the year before. It occurred, after a
ninth bleeding, in Miss Sally Eyre, from the nose and bowels. It occurred
from the nose, after a sixth bleeding, in Mrs. Gardiner, who was at that
time in the sixth month of her pregnancy. This symptom, which was
accompanied by a tense and quick pulse, induced me to repeat the bleeding
a seventh time. The blood was very sizy. I mention this fact to establish
the opinion that hæmorrhages depend upon too much action in the
blood-vessels, and that they are not occasioned by a dissolved state of
the blood.
There was a disposition at this time to hæmorrhage in persons who were in
apparent good health. A private, in a company of volunteers commanded by
Major M'Pherson, informed me that three of his messmates were affected by
a bleeding at the nose, for several days after they left the city, on
their way to quell the insurrection in the western counties of
Pennsylvania.
II. The liver did not exhibit the usual marks of inflammation. Perhaps my
mode of treating the fever prevented those symptoms of hepatic affection
which belong to the yellow fever in tropical climates. The lungs were
frequently affected; and hence the disease was in many instances called a
pleurisy or a catarrh. This inflammation of the lungs occurred in a more
especial manner in the winter season. It was distinguished from the
pleurisies of common years by a red eye, by a vomiting of green or yellow
bile, by black stools, and by requiring very copious blood-letting to
cure it.
The head was affected, in this fever, not only with coma and delirium,
but with mania. This symptom was so common as to give rise to an opinion
that madness was epidemic in our city. I saw no case of it which was not
connected with other symptoms of the bilious remitting fever. The Rev.
Mr. Keating, one of the ministers of the Roman church, informed me that
he had been called to visit seven deranged persons in his congregation,
in the course of one week, in the month of March. Two of them had made
attempts upon their lives. This mania was probably, in each of the above
cases, a symptom only of general fever. The dilatation of the pupil was
universal in this fever.
Sore eyes were common during the prevalence of this fever. In Mrs.
Leaming, this affection of the eyes was attended with a fever of a
tertian type.
III. The alimentary canal suffered as usual in this fever. A vomiting was
common upon the first attack of the disease. I observed this symptom to
be less common after the cold and rainy weather which took place about
the first of October.
I have in another place mentioned the influence of the weather upon the
symptoms of this disease. In addition to the facts which have been
formerly recorded, I shall add one more from Dr. Desportes. He tells us,
that in dry weather the disease affects the head, and that the bowels in
this case are more obstinately costive than in moist weather. This
influence of the atmosphere on the yellow fever will not surprise those
physicians who recollect the remarkable passage in Hippocrates, in which
he says, that in the violent heats of summer, fevers appeared, but
without any sweat; but if a shower, though ever so slight, appeared, a
sweat broke out in the beginning[104]. I observed further, that a
vomiting rarely attended those cases in which there was an absence of a
chilly fit in the beginning of the fever. The same observation is made by
Dr. Desportes[105].
[104] Epidemics, book XI. sect. I.
[105] Les Maladies de St. Domingue, vol. I. p. 193.
The matter discharged by vomiting was green or yellow bile in most cases.
Mrs. Jones, the wife of Captain Lloyd Jones, and one other person,
discharged black bile within one hour after they were attacked by the
fever. I have taken notice, in the History of the Yellow Fever of 1793,
that a discharge of bile in the beginning of this fever was always a
favourable symptom. Dr. Davidson of St. Vincents, in a letter to me,
dated the 22d July, 1794, makes the same remark. It shows that the
biliary ducts are open, and that the bile is not in that viscid and
impacted state which is described in the dissections of Dr. Mitchel[106].
A distressing pain in the stomach, called by Dr. Cullen gastrodynia,
attended in two instances. A burning pain in the stomach, and a soreness
to the touch of its whole external region, occurred in three or four
cases. Two of them were in March, 1795. In Mrs. Vogles, who had the fever
in September, 1794, the sensibility of the pit of the stomach was so
exquisite, that she could not bear the weight of a sheet upon it.
[106] Account of the Yellow Fever of 1793.
Pains in the bowels were very common. They formed the true bilious colic,
so often mentioned by West-India writers. In John Madge these pains
produced a hardness and contraction of the whole external region of the
bowels. They were periodical in Miss Nancy Eyre, and in Mrs. Gardiner,
and in both cases were attended with diarrh[oe]a.
Costiveness without pain was common, and, in some cases, so extremely
obstinate as to resist, for several days, the successive and alternated
use of all the usual purges of the shops.
Flatulency was less common in this fever than in the year 1793.
The disease appeared with symptoms of dysentery in several cases.
IV. The following is an account of the state of the _secretions_ and
_excretions_ in this fever.
A puking of bile was more common this year than in the year 1793. It was
generally of a green or yellow colour. I have remarked before, that two
of my patients discharged black bile within an hour after they were
affected by the fever, and many discharged that kind of matter which has
been compared to coffee grounds, towards the close of the disease.
The fæces were black in most cases where the symptoms of the highest
grade of the fever attended. In one very malignant case the most drastic
purges brought away, by fifty evacuations, nothing but natural stools.
The purges were continued, and finally black fæces were discharged, which
produced immediate relief[107]. In one person the fæces were of a light
colour. In this patient the yellowness in the face was of an orange
colour, and continued so for several weeks after his recovery.
[107] In the account of the effects of morbid action and inflammation,
in the Outlines of the Theory of Fever, the author neglected to
mention the change of certain fluids from their natural to a dark
colour. It appears in the secretions of the stomach and bowels,
in the bile, in the urine, in carbuncles, and occasionally in the
matter which is produced by blisters. All these changes occur in
the yellow fever, and, in common with the other effects of fever
that have been enumerated, are the result of peculiar actions in
the vessels, derived from _one_ cause, viz. morbid excitement.