such cases as would probably have cured themselves.
The second mode succeeded in mild cases, and now and then in that
malignant state of the fever, in which the action of the blood-vessels
was so much prostrated by the force of the miasmata, as to permit the
mercury to pass over them, and thus to act upon the salivary glands in
the course of four or five days.
The last mode was by far the most successful. It is worthy of notice,
that the business and reputation of the physicians, during this epidemic,
were in the inverse ratio of their success. The number of deaths by it
amounted to between three and four thousand, among whom were three
physicians, and two students of medicine. Its mortality was nearly as
great as it was in 1793, and yet the number of people who were affected
by it was four times as great in 1793 as it was in 1798, for, in the
latter year, the city was deserted by nearly all its inhabitants. The
cause of this disproportion of deaths to the number who were sick, was
owing to the liberal and general use of the lancet in 1793, and to the
publications in 1797 having excited general fears and prejudices against
it in 1798. Such was the influence of these publications, that many
persons who had recovered from this fever in the two former years, by the
use of depleting remedies, deserted the physicians who had prescribed
them, and put themselves under the care of physicians of opposite modes
of practice. Most of them died. Two of them had been my patients, one of
whom had recovered of a third attack of the fever under my care.
AN ACCOUNT
OF THE
_BILIOUS YELLOW FEVER_,
AS IT
APPEARED IN PHILADELPHIA,
IN THE YEAR 1799.
The diseases which succeeded the fever of 1798, in November and December,
were highly inflammatory. A catarrh was nearly universal. Several cases
of sore throat, and one of erysipelas, came under my care in the month of
November. The weather in December was extremely cold. It was equally so
in the beginning of January, 1799, accompanied with several falls of
snow.
About the middle of the month, the weather moderated so much, so as to
open the navigation of the Delaware. I met with two cases of malignant
colic in the latter part of this month, and one of yellow fever. The last
was Swen Warner. Dr. Physick, who attended him with me, informed me that
he had, nearly at the same time, attended two other persons with the same
disease.
The weather was very cold, and bilious pleurisies were common, during the
latter part of the month of February.
March was equally cold. The newspapers contained accounts of the winter
having been uncommonly severe in Canada, and in several European
countries.
The first two weeks in April were still cold. The Delaware, which had
been frozen a second time during the winter, was crossed near its origin,
on the ice, on the 15th day of this month. The diseases, though fewer
than in the winter, were bilious and inflammatory. During this month, I
was called to a case of yellow fever, which yielded to copious bleeding,
and other depleting medicines.
May was colder than is usual in that month, but very healthy.
In the first week of June, several cases of highly bilious fever came
under my care. In one of them, all the usual symptoms of the highest
grade of that fever occurred. On the 13th of the month, Dr. Physick
informed me, that he had lost a patient with that disease. On the 23d of
the same month, Joseph Ashmead, a young merchant, died of it. Several
other cases of the disease occurred between the 20th and 29th days of the
month, in different parts of the city. About this time, I was informed
that the inhabitants of Keys's-alley had predicted a return of the yellow
fever, from the trees before their doors emitting a smell, exactly the
same which they perceived just before the breaking out of that disease in
1793.
In July, the city was alarmed, by Dr. Griffitts, with an account of
several cases of the fever in Penn-street, near the water. The strictness
with which the quarantine law had been executed, for a while rendered
this account incredible with many people, and exposed the doctor to a
good deal of obloquy. At length a vessel was discovered, that had arrived
from one of the West-India islands on the 14th of May, and one day before
the quarantine law was put into operation, from which the disease was
said to be derived. Upon investigating the state of this vessel, it
appeared that she had arrived with a healthy crew, and that no person had
been sick on board of her during her voyage.
In the latter part of July and in the beginning of August, the disease
gradually disappeared from every part of the city. This circumstance
deserves attention, as it shows the disease did not spread by contagion.
About this time we were informed by the newspapers, that dogs, geese, and
other poultry, also that wild pigeons were sickly in many parts of the
country, and that fish on the Susquehannah, and oysters in the Delaware
bay, were so unpleasant, that the inhabitants declined eating them. At
the same time, flies were found dead in great numbers, in the unhealthy
parts of the city. The weather was dry in August and September. There was
no second crop of grass. The gardens yielded a scanty supply of
vegetables, and of an inferior size and quality. Cherries were smaller
than usual, and pear and apple-trees dropped their fruits prematurely, in
large quantities. The peaches, which arrived at maturity, were small and
ill-tasted. The grain was in general abundant, and of a good quality. A
fly, of an unusual kind, covered the potatoe fields, and devoured, in
some instances, the leaves of the potatoe. This fly has lately been used
with success in our country, instead of the fly imported from Spain. It
is equal to it in every respect. Like the Spanish fly, it sometimes
induces strangury.
About the middle of August the disease revived, and appeared in different
parts of the city. A publication from the academy of medicine, in which
they declared the seeds of the disease to spread from the atmosphere
only, produced a sudden flight of the inhabitants. In no year, since the
prevalence of the fever, was the desertion of the city so general.
I shall now add a short account of the symptoms and treatment of this
epidemic.
The arterial system was in most cases active. I met with a tense pulse in
a patient after the appearance of the black vomiting. Delirium was less
frequent in adults than in former years. In children there was a great
determination of the disease to the brain.
I observed no new symptoms in the stomach and bowels. One of the worst
cases of the fever which I saw was accompanied with colic. A girl of
Thomas Shortall, who recovered, discharged 9 worms during her fever. It
appeared in Mr. Thomas Roan, one of my pupils, in the form of a
dysentery.
A stiffness, such as follows death, occurred in several patients in the
city hospital before death.
Miss Shortall had an eruption of pimples on her breast, such as I have
described in the short account I gave of the yellow fever of 1762 in this
city, in my account of the disease in 1793.
The blood exhibited its usual appearances in the yellow fever. It was
seldom sizy till towards the close of the disease.
The tongue was generally whitish. Sometimes it was of a red colour, and
had a polished appearance. I saw no case of a black tongue, and but few
that were yellow before the seventh day of the disease.
The type of this disease was nearly the same as described in 1797. It now
and then appeared in the form of a quartan, in which state it generally
proved fatal. It appeared with rheumatic pains in one of my patients. It
blended itself with gout and small-pox. Its union with the latter disease
was evident in two patients in the city hospital, in each of whom the
stools were such as were discharged in the most malignant state of the
fever.
The remedies for this fever were bleeding, vomits, purges, sweats, and a
salivation and blisters.
There were few cases that did not indicate bleeding. It was performed,
when proper, in the usual way, and with its usual good effects. It was
indicated as much when the disease appeared in the bowels as in the
blood-vessels. Mr. Roan, in whom it was accompanied with symptoms of
dysentery, lost nearly 200 ounces of blood by twenty-two bleedings.
I found the same benefit from emetics, in this fever, that I did in the
fever of 1798. They were never administered except on the first day,
before violent action had taken place in the system, or after it was
moderated by one or two bleedings.
Purges of calomel and jalap, also castor oil, salts, and injections were
prescribed with their usual advantages.
In those cases where the system was prostrated below the point of
re-action, I began the cure by sweating. Blankets, with hot bricks wetted
with vinegar, and the hot bath, as mentioned formerly, when practicable,
were used for this purpose. The latter produced, in a boy of 14 years of
age, who came into the city hospital without a pulse, and with a cold
skin, in a few hours, a general warmth and an active pulse. The
determination of the disease to the pores was evinced in one of my
patients, by her sweating under the use of the above-mentioned remedies,
for the first time in her life. A moisture upon her skin had never before
been induced, she informed me, even by the warmest day in summer.
The advantages of a salivation were as great as in former years. From the
efficacy of bleeding, purges, emetics, and sweating, I had the pleasure
of seeing many recoveries before the mercury had time to affect the
mouth. In no one case did I rest the cure exclusively upon any one of
these remedies. The more numerous the outlets were to convey off
superfluous fluids and excitement from the body, the more safe and
certain were the recoveries. A vein, the gall-bladder, the bowels, the
pores, and the salivary glands were all opened, in succession, in part,
or together, according to circumstances, so as to give the disease every
possible chance of passing out of the body without injuring or destroying
any of its vital parts.
Blisters were applied with advantage. The vomiting and sickness which
attend this fever were relieved, in many instances, by a blister to the
stomach.
In those cases in which the fever was protracted to the chronic state,
bark, wine, laudanum, and æther produced the most salutary effects. I
think I saw life recalled, in several cases in which it appeared to be
departing, by frequent and liberal doses of the last of those medicines.
The bark was given, with safety and advantage, after the seventh day,
when the fever assumed the form of an intermittent.
The following symptoms were generally favourable, viz. a bleeding from
the mouth and gums, and a disposition to weep, when spoken to in any
stage of the fever.
A hoarseness and sore throat indicated a fatal issue of the disease, as
it did in 1798. Dr. Physick remarked, that all those persons who sighed
after waking suddenly, before they were able to speak, died.
The recurrence of a redness of the eyes, after it had disappeared, or of
but one eye, was generally followed by death. I saw but one recovery with
a red face.
I saw several persons, a few hours before death, in whom the countenance,
tongue, voice, and pulse were perfectly natural. They complained of no
pain, and discovered no distress nor solicitude of mind. Their danger was
only to be known by the circumstances which had preceded this apparently
healthy and tranquil state of the system. They had all passed through
extreme suffering, and some of them had puked black matter.
The success of the mode of practice I have described was the same as in
former years, in private families; but in the city hospital, which was
again placed under the care of Dr. Physick and myself, there was a very
different issue to it, from causes that are too obvious to be mentioned.
There were two opinions given to the public upon the subject of the
origin of this fever; the one by the academy of medicine, the other by
the college of physicians. The former declared it to be generated in the
city, from putrid domestic exhalations, because they saw it only in their
vicinity, and discovered no channel by which it could have been derived
from a foreign country; the latter asserted it to be "imported, because
it had been imported in former years."
AN
ACCOUNT OF SPORADIC CASES
OF
_YELLOW FEVER_,
AS THEY
APPEARED IN PHILADELPHIA,
IN 1800.
The weather in the month of January was less cold than is common in that
month. Catarrhs, the cynanche trachealis, and bilious pleurisies were
prevalent in every part of it. A few cases of yellow fever occurred
likewise during this month.
Several cases of erysipelas appeared in February.
The month of March was unusually healthy.
The weather was warm in April, and the city as healthy as in March.
It was equally so in May and June. The spring fruits appeared early in
the latter month, in large quantities, and were of an excellent quality.
Locusts were universal in June. They had not appeared since the year
1783. A record from the journal of the Swedish missionaries was published
at this time, which described their appearance in 1715, in which year it
was said to be very healthy.
On the 14th of June there was a severe thunder gust, with more lightning
than had been known for seven years before.
There fell, during all the months that have been mentioned, frequent and
plentiful showers of rain, which rendered the crops of grass luxuriant in
the neighbourhood of Philadelphia.
The winds at this time were chiefly from the south-east.
A few intermittents appeared in June, which yielded readily to the bark.
On the 16th day of June, Dr. Physick informed me he had a black boy under
his care with the yellow fever.
In July, the hooping cough, cholera infantum, and some cases of dysentery
and bilious fever appeared in the city.
On the 30th of July, Dr. Pascalis informed me that he had lost a patient
on the fifth day of a yellow fever.
In August, the dysentery was the principal form of disease that prevailed
in the city.
On the 22d of this month, a woman died of the yellow fever in
Gaskill-street, under the care of Dr. Church.
On the 28th and 30th, there fell an unusual quantity of rain. The winds
were south-west and north-west during the greatest part of the summer
months. The latter were sometimes accompanied with rain.
On the 11th of September, a clerk of Mr. Levi Hollingsworth, and, on the
12th, a clerk of Mr. John Connelly, died with the yellow fever.
A plentiful shower of rain fell on the night of the 21st of this month.
About this time there appeared one and twenty cases of yellow fever in
Spruce-street, between Front and Second-streets. They were all in the
neighbourhood of putrid exhalations. Fourteen of them ended fatally.
No one of the above cases of malignant fever could be traced to a ship,
or to a direct or indirect intercourse with persons affected by that
disease.
While Philadelphia was thus visited by a few sporadic cases only of
yellow fever, it was epidemic in several of the cities of the United
States, particularly in New-York, Providence, in Rhode Island, Norfolk,
and Baltimore. In the last named place, it was publicly declared by the
committee of health to be of domestic origin.
The dysentery was epidemic, at the same time, in several of the towns of
Massachusetts and New-Hampshire. It was attended with uncommon mortality
at Hanover, in the latter state.
This difference in the states of health and sickness in the different
parts of the United States must be sought for chiefly in the different
states of the weather in those places. The exemption of Philadelphia from
the yellow fever, as an epidemic, may perhaps be ascribed to the strength
and vigour of the vegetable products of the year, which retarded their
putrefaction; to frequent showers of rain, which washed away the filth
of the streets and gutters; and to the perfection of the summer and
autumnal fruits.
The months of November and December this year were uncommonly healthy.
During the former, several light shocks of earthquakes were felt in
Lancaster and Harrisburg, in Pennsylvania, and in Wilmington, in the
state of Delaware.
AN
ACCOUNT OF SPORADIC CASES
OF
_YELLOW FEVER_,
AS THEY
APPEARED IN PHILADELPHIA,
IN 1801.
The month of January was intensely cold. In February it became more
moderate. The diseases, during these two months, were catarrhs and a few
pleurisies.
In March and April there fell an unusual quantity of rain. The hay
harvest began in the neighbourhood of Philadelphia on the 28th of May. A
few mild cases of scarlatina anginosa occurred during these months.
In June the weather was dry and healthy.
On the 8th of July, a case of yellow fever occurred in the practice of
Dr. Stewart. About the 15th of the month, a patient died with it in the
Pennsylvania hospital. Dr. Physick informed me that he had, at the same
time, two patients under his care with that disease. Several cases of the
measles appeared in the south end of the city during this month. In every
part of it, the weather was warm and dry, in consequence of which there
were no second crops of grass, and a smaller quantity than usual of
summer fruits and vegetables. The winds were less steady than they had
been for seven years. They blew, every two or three days, from nearly
every point of the compass.
On the 4th of August there fell a considerable quantity of rain, which
was succeeded by cool and pleasant weather. The cholera morbus was a
frequent disease among both adults and children in the city, and the
dysentery in several of the adjoining counties of the state.
A number of emigrant families arrived this month from Ireland and Wales,
who brought with them the ship fever. They were carefully attended, at
the lazaretto and the city hospital, in airy rooms, by which means they
did not propagate the disease. Contrary to its usual character, it
partook of the remissions of the bilious fever, probably from the
influence of the season upon it.
In September there were a few extremely warm days. In the beginning and
middle of the month a number of mild remittents occurred, and about the
22d there were five or six cases of yellow fever in Eighth-street,
between Chesnut and Walnut-streets, in two houses ill ventilated, and
exposed to a good deal of exhalation. I attended most of these cases in
consultation with Dr. Gallaher. One of the persons who was affected with
this fever puked black matter while I sat by his bed-side, a few hours
before he died.
During the summer and autumn of this year, a number of cases of yellow
fever appeared at New-Bedford, Portland, and Norwich, in the New-England
states; in New-York; in some parts of New-Jersey; and in Northampton and
Bucks counties, in Pennsylvania. It prevailed so generally in New-York,
as to produce a considerable desertion of the city. In none of the above
places could the least proof be adduced of the disease being imported. In
Philadelphia its existence was doubted or denied by most of the citizens,
because it appeared in situations remote from the water, and of course
could not be derived from any foreign source.
It will be difficult to tell why the fever appeared only in sporadic
cases in Philadelphia. Perhaps its prevalence as an epidemic was
prevented by the plentiful rains in the spring months, by the absence of
moisture from the filth of the streets and gutters, in consequence of the
dry weather in June and July, by the vigour and perfection of the
products of the earth, and by the variable state of the winds in the
month of July. If none of these causes defended the city from more
numerous cases of the yellow fever, it must be resolved into the want of
a concurring inflammatory constitution of the atmosphere with the common
impure sources of that disease.
On the 12th of November, about twelve o'clock in the night, an earthquake
was felt in Philadelphia, attended with a noise as if something heavy had
fallen upon a floor. Several cases of scarlet fever appeared in December,
but the prevailing disease, during the two last autumnal and the first
winter months, was the measles. I have taken notice that it appeared in
the south end of the city in July. During the months of August and
September it was stationary, but in October, November, and December it
spread through every part of the city. The following circumstances
occurred in this epidemic, as far as it came under my notice.
AN ACCOUNT
OF
THE MEASLES,
AS THEY
APPEARED IN PHILADELPHIA,
IN THE YEAR 1801.
I. The disease wore the livery of the autumnal fever in the following
particulars.
It was strongly marked by remissions and intermissions. The exacerbations
came on chiefly at night.
There were in many cases a constant nausea, and discharge of bile by
puking.
I saw one case in which the disease appeared with a violent cholera
morbus, and several in which it was accompanied with diarrh[oe]a and
dysentery.
II. Many severe cases of phrenzy, and two of cynanche trachealis appeared
with the measles.
III. A distressing sore mouth followed them, in a child of two years old,
that came under my care.
IV. A fatal hydrocephalus internus followed them in a boy of eight years
old, whom I saw two days before he died.
V. I met with a few cases in which the fever and eruption came on in the
same day, but I saw one case in which the eruption did not take place
until the tenth, and another, in which it did not appear until the
fourteenth day after the fever.
VI. Two children had pustules on their skins, resembling the small-pox,
before the eruption of the measles.
VII. Many children had coughs and watery eyes, but without the measles.
The same children had them two or three weeks afterwards.
VIII. Many people who had had the measles, had coughs during the
prevalence of the measles, resembling the cough which occurs in that
disease.
The remedies made use of in my practice were,
1. Bleeding, from four to sixty ounces, according to the age of the
patient, and the state of the pulse. This remedy relieved the cough,
eased the pains in the head, and in one case produced, when used a third
time, an immediate eruption of the measles.
2. Lenient purges.
3. Demulcent drinks.
4. Opiates at night.
5. Blisters. And,
6. Astringent medicines, where a diarrh[oe]a took place.
I saw evident advantages from advising a vegetable diet to many children,
as soon as any one of the families to which they belonged were attacked
by the measles.
I lost but one patient in this disease, and that was a child in
convulsions. I ascribed my success to bleeding more generally and more
copiously than I had been accustomed to do, in the measles of former
years.
AN ACCOUNT
OF THE
_BILIOUS YELLOW FEVER_,
AS IT
APPEARED IN PHILADELPHIA,
IN THE YEAR 1802.
The weather during the month of January was unusually moderate and
pleasant. In the latter end of it, many shrubs put forth leaves and
blossomed. I saw a leaf of the honeysuckle, which was more than an inch
in length, and above half an inch in breadth. There was but one fall of
snow, and that a light one, during the whole month.
The winds blew chiefly from the south-west in February. There was a light
fall of snow on the 6th. A shad was caught in the Delaware, near the
city, on the 17th. On the 18th and 19th of the month, the weather became
suddenly very cold. On the 22d there was a snow storm, and on the 28th,
rain and a general thaw.
In March, the weather was wet, cold, and stormy, with the exception of a
few pleasant days.
The scarlatina anginosa and the cynanche trachealis were the principal
diseases that prevailed during the three months that have been mentioned.
In April, there were several frosts, which destroyed the blossoms of the
peach-trees.
In May, the weather was so cool as to make fires agreeable to the last
day of the month. The wind blew chiefly, during the whole of it, from the
north-east.