of it, in which a redness only, without any ulcers or sloughs, appeared
in the throat; and I attended another, in which a total immobility in the
limbs was substituted by nature for the pain and swellings in those parts
which generally attend the disease. There were three distinct grades of
this epidemic. It was attended with such inflammatory or malignant
symptoms, in some instances, as to require two or three bleedings; in
others it appeared with a typhoid pulse, which yielded to emetics:
turbith mineral was preferred for this purpose; while a redness, without
a fever, which yielded to a single purge, was the only symptom of it in
many people.
The weather was cool, rainy, and hot, in succession, in the month of
June. The scarlatina continued to be the prevailing disease.
During the first and second weeks in July, there fell a good deal of
rain. On the 4th of the month I was called to visit Mrs. Harris, in
Front-street, between Arch and Market-streets, with a bilious fever. The
scarlatina had imparted to it a general redness on her skin, which
induced her to believe it was that disease, and to neglect sending for
medical relief for several days. She died on the 13th of the month, with
a red eye, a black tongue, hiccup, and a yellow skin. Three other cases
of malignant bilious fever occurred this month. Two of them were attended
by Dr. Dewees and Dr. Otto.
On the 15th of the month, the city was alarmed by an account of this
fever having appeared near the corners of Front and Vine-streets, a part
of the city which had for many weeks before been complained of by many
people for emitting a f[oe]tid smell, derived from a great quantity of
filthy matters stagnating in that neighbourhood, and from the foul air
discharged from a vessel called the Esperanza, which lay at Vine-street
wharf.
On the 2d of August, it appeared in other parts of the city, particularly
in Front and Water-streets, near the draw-bridge, where it evidently
originated from putrid sources. Reports were circulated that it was
derived from contagion, conveyed to Vine-street wharf in the timbers of a
vessel called the St. Domingo Packet, but faithful and accurate inquiries
proved that this vessel had been detained one and twenty days, and well
cleaned at the lazaretto, and that no one, of fourteen men who had worked
on board of her afterwards, had been affected with sickness of any kind.
On the 5th of August, the board of health publicly declared the fever to
be contagious, and advised an immediate desertion of the city. The advice
was followed with uncommon degrees of terror and precipitation.
The disease continued, in different parts of the city, during the whole
of August and September. On the 5th of October, the citizens were
publicly invited from the country by the board of health.
During this season, the yellow fever was epidemic in Baltimore and
Wilmington. In the former place it was admitted by their board of health,
and in the latter it was proved by Dr. Vaughan, to be of domestic origin.
It prevailed, at the same time, in Sussex county and near Woodbury, in
New-Jersey. Sporadic cases of it likewise occurred in New-York and
Boston, and in Portsmouth, in New-Hampshire. The chronic fever was
epidemic in several of the towns of North-Carolina; cases of fever, which
terminated in a swelling and mortification of the legs, and in death on
the third day, appeared on the waters of the Juniata, in Pennsylvania;
and bilious fevers, of a highly inflammatory grade, were likewise common
near Germantown and Frankford, in the neighbourhood of Philadelphia.
But few of the cases of yellow fever which have been mentioned came under
my care, but I saw a considerable number of fevers of a less violent
grade. They were the inflammatory, bilious, mild remitting, chronic, and
intermitting fevers, and the febricula. They appeared, in some instances,
distinct from each other, but they generally blended their symptoms in
their different stages. The yellow fever often came on in the mild form
of an intermittent, and even a febricula, and as often, after a single
paroxysm, ended in a mild remittent or chronic fever. When it appeared in
the latter form, it was frequently attended with a slow or low pulse, and
a vomiting and hiccup, such as attend in the yellow fever. This diversity
of symptoms, with which the summer and autumnal fever came on, made it
impossible to decide upon its type on the day of its attack. Having been
deceived in one instance, I made it a practice afterwards to watch every
case I was called to with double vigilance, lest it should contract a
malignant form in my hands, without my being prepared to meet it. Of the
five original and obvious cases of yellow fever to which I was called, I
saved none, for I saw but one of them before the last stage of the
disease. In many others, I have reason to believe I prevented that
malignant form of fever, by the early and liberal use of depleting
medicines. The practice of those physicians who attended most of the
persons who had the yellow fever, was much less successful than in our
former epidemics. I suspected at the time, and I was convinced
afterwards, that it was occasioned by relying exclusively upon bleeding,
purges, and mercury. The skin, in several of the cases which I saw, was
covered with moisture. This clearly pointed out nature's attempt to
relieve herself by sweating. Upon my mentioning this fact to the late Dr.
Pfeiffer, jun. he instantly adopted my opinion, and informed me, as a
reason for doing so, that he had heard of several whole families in the
Northern Liberties, where the disease prevailed most, who, by attacking
it in its forming state by profuse sweats, had cured themselves, without
the advice of a physician.
AN ACCOUNT
OF THE
_BILIOUS YELLOW FEVER_,
AS IT
APPEARED IN PHILADELPHIA,
IN 1803.
The weather in January was uniformly cold. On the 21st of the month, the
Delaware was completely frozen.
On the 4th of February there was a general thaw, attended with a storm of
hail, thunder, and lightning, which lasted about three quarters of an
hour. The diseases of both these winter months were catarrhs and bilious
pleurisies. The latter appeared in a tertian type. The pain in the side
was most sensible every other day.
The weather was cold and dry in March, in consequence of which,
vegetation was unusually backward in April. The hooping cough, catarrhs,
and scarlatina were the diseases of this month.
The beginning of May was very cool. There was ice on the 7th of the
month. The winds, during the greatest parts of this and the previous
month, were from the north-east.
In June, the weather was cool. Intermittents were common in this month,
as well as in May. Such was the predominance of this type of fever over
all other diseases, that it appeared in the form of profuse sweats, every
other night, in a lady under the care of Dr. Dewees and myself, in the
puerperile fever. On the intermediate nights she had a fever, without the
least moisture on her skin. There were a few choleras this month. During
the latter end of the month, I lost a patient with many of the symptoms
of yellow fever.
The weather in July was alternately hot, moderate, and cool, with but
little rain. The first two weeks of this month were healthy. A few
tertian fevers occurred, which readily yielded to bark, without previous
bleeding. Between the 25th and 31st of the month, three deaths took place
from the yellow fever.
In the month of August, the weather was the same as in July, except that
there fell more rain in it. Mild remittents and cholera infantum were
now common. There were likewise several cases of yellow fever during
this month. One of them was in Fromberger's-court. It was induced by the
f[oe]tor of putrid fish in a cellar. A malignant dysentery was epidemic
during this month in the upper part of Germantown, and in its
neighbourhood. Several persons, Dr. Bensell informed me, died of it in
thirty hours sickness. It prevailed, at the same time, in many parts of
the New-England states.
In September, cases of yellow fever appeared in different parts of the
city, but chiefly in Water, near Walnut-street. On the 12th of the month,
the board of health published a declaration of its existence in the city,
but said it was not contagious. This opinion gave great offence, for it
was generally said to have been imported by means of a packet-boat from
New-York, where the fever then prevailed, because a man had sickened and
died in the neighbourhood of the wharf where this packet was moored. It
was to no purpose to oppose to this belief, proofs that no sick person,
and no goods supposed to be infected, had arrived in this boat, and that
no one of three men, who had received the seeds of the disease in
New-York, had communicated it to any one of the families in Philadelphia,
in which they had sickened and died.
The disease assumed a new character this year, and was cured by a
different force of medicine from that which was employed in some of the
years in which it had prevailed in Philadelphia.
I shall briefly describe it in each of the systems, and then take notice
of some peculiarities which attended it. Afterwards I shall mention the
remedies which were effectual in curing it.
1. The pulse was moderately _tense_ in most cases. It intermitted in one
case, and in several others the tension was of a transient nature.
Hæmorrhages occurred in many cases. They were chiefly from the nose, but
in some instances they occurred from the stomach, bowels, and
hæmorrhoidal vessels.
2. Great flatulency attended in the stomach, but sickness and vomiting
were much less frequent than in former years. I saw but one case in which
diarrh[oe]a attended this fever.
3. I did not meet with a single instance of a glandular swelling in any
part of the body.
4. There was a general disposition to sweat in this fever from its
beginning. Two of my patients died, in whom no moisture could be excited
on the skin. But I recovered one with a dry skin, by means of a purge,
two bleedings, and blisters.
An efflorescence on the skin occurred in several instances. I saw black
matter discharged from a blister in one case, and blood in another.
5. The stools were green and black. Bile was generally discharged in
puking.
6. The blood exhibited the following appearances: siziness, lotura
carnium, sunken crassamentum, red sediment, and what is called dense or
unseparated blood. I saw no instance of its being dissolved.
7. The tongue was whitish and dark-coloured. This diseased appearance
continued, in some instances, several days after a recovery took place. I
saw no smooth, red, nor black tongue, and but one dry and one _natural_
tongue. The latter was followed by death.
I did not see a single case in which the disease came on without an
exciting cause; such as light clothing and bed-clothes, sitting at doors
after night, a long walk, gunning, and violent and unusual exercises of
any kind. It was excited in a number of people by their exertions to
extinguish a fire which took place in Water-street, between Market and
Chesnut-streets, on the morning of the 25th of August. I saw a fatal
instance of it succeed a severe tooth-ach. Whether this pain was the
exciting cause, or the first morbid symptom of the fever, I know not; but
I was led by it to bleed a young lady twice who complained of that pain,
and who had at the same time a tense pulse. Her blood had the usual
appearances which occur in the yellow fever.
The disease had different appearances in different parts of the city. It
was most malignant in Water-street; but in many instances it became less
so, as it travelled westward, so that about Ninth-street it appeared in
the form of a common intermittent.
In every part of the city it often came on, as in the year 1802, in all
the milder forms of autumnal fever formerly enumerated, and went off with
the usual symptoms of yellow fever. Again, it came on with all the force
and malignity of a yellow fever, and terminated, in a day or two, in a
common remittent or intermittent. These modes of attack were so common,
that it was impossible to tell what the character, or probable issue of a
fever would be, for two or three days.
The following remedies were found, very generally, to be effectual in
this fever.
1. Moderate bleeding. I bled but three patients three, and only one, four
times. In general, the loss of from ten to twenty ounces of blood,
reduced the pulse from a synocha to a synoichoid or typhoid state, and
thereby prepared the system for other remedies.
2. Purges were always useful. I gave calomel and jalap, castor oil,
salts, and senna, according to the grade of the disease, and often
according to the humour or taste of the patient. I aided these purges by
glysters. In one case, where a griping and black stools attended, I
directed injections of lime water and milk to be used, with the happiest
effects.
3. I gave emetics in many cases with advantage, but never while the pulse
was full or tense.
4. Having observed, as in the year 1802, a spontaneous moisture on the
skin on the first day of the disease, in several cases, I was led to
assist this disposition in nature to be relieved by the pores, by means
of sweating remedies, but in no instance did I follow it, without
previous evacuations from the blood-vessels or bowels; for, however
useful the intimations of nature may be in acute diseases, her efforts
should never be trusted to alone, inasmuch as they are in most cases too
feeble to do service, or so violent as to do mischief. I saw one death,
and I heard of another, from an exclusive reliance upon spontaneous
sweats in the beginning of this fever. The remedies I employed to promote
this evacuation by the pores were, an infusion of the eupatorium
perfoliatum in boiling water, aided by copious warm drinks, and hot
bricks and blankets, applied to the external surface of the body. The
eupatorium sometimes sickened the stomach, and puked. The sweats were
intermitted, and renewed two or three times in the course of four and
twenty hours.
5. I derived great advantage from the application of blisters to the
wrists, _before_ the system descended to what I have elsewhere called,
the blistering point. This was on the second and third days. My design,
in applying them thus early, was to attract morbid excitement to the
extremities, and thereby to create a substitute for a salivation. They
had this effect. The pain, increase of fever, and occasional strangury,
which were produced by them, served like anchors to prevent the system
being drifted and lost, by the concentration of morbid excitement in the
stomach and brain, on the fourth, fifth, sixth, and seventh days of the
disease. It gave me great pleasure to find, upon revising Dr. Home's
account of the yellow fever, that this mode of applying blisters, in the
early stage of the disease, was not a new one. He often applied them in
the first stage of the fever, more especially when the yellow colour of
the skin made its appearance on the first or second day. By the advice of
Dr. Cheney, of Jamaica, he was led to prefer them to the thighs, instead
of the trunk of the body, or the legs and arms. He forbids their ever
being applied below the calf of the legs. This caution is probably more
necessary in the West-Indies than in the United States. The pain and
inflammation excited by the blisters were mitigated by soft poultices of
bread and milk. The strangury soon yielded to demulcent drinks,
particularly to flaxseed tea.
I was happy in not being compelled, by the violence or obstinacy of this
fever, to resort to a salivation in order to cure it, in a single
instance; the discharges from the stomach and bowels, and from the veins,
pores, and skin, having proved sufficient to convey the disease out of
the system.
Two persons recovered this year who had the black vomiting. One of them
was by means of large quantities of brandy and volatile alkali,
administered by Dr. John Dorsey, in the city hospital; the other was by
means of lime and water and milk, given by an intelligent nurse to one of
my patients, during the interval of my visits to her.
From the history which has been given of the symptoms of this fever; from
the less force of medicine that was necessary to subdue it; from the
safety and advantage of blisters in its _early_ stage; and from the small
proportion which the deaths bore to the number of those who were
affected, being seldom more than five in a hundred (including all the
grades and forms of the disease), in the practice of most of the
physicians, it is evident this fever was of a less malignant nature than
it had been in most of the years in which it had been epidemic. There was
one more circumstance which proved its diminution of violence, and that
was, a more feeble operation of its remote cause. In the year 1802,
nearly all the persons who were affected with the fever in the
neighbourhood of Vine and Water-streets, and in Water, between Walnut and
Spruce-streets, died. This year, but two died of a great number who were
sick in the former, and not one out of twelve who were sick in the latter
place. The filth, in both parts of the city, was the same in both years.
This difference in the violence and mortality of the fever was probably
occasioned by a less concentrated state of the miasmata which produced
it, or by the co-operation of a less inflammatory constitution of the
atmosphere.
The yellow fever was epidemic, during the summer and autumn of this year,
in New-York, and in Alexandria, in Virginia. In the latter place, Dr.
Dick has informed the public, it was derived from domestic
putrefaction.
AN
ACCOUNT OF SPORADIC CASES
OF
_YELLOW FEVER_,
AS THEY
APPEARED IN PHILADELPHIA,
IN 1804.
The month of January was marked by deep snows, rain, clear and cold
weather, and by the general healthiness of the city.
In February there fell a deep snow, which was followed by several very
cold days. There was likewise a fall of snow in March, which was
succeeded by an uncommon degree of cold. Catarrhs and bilious pleurisies
were very common during both these months.
In the beginning of April, the weather was cold and rainy. There were but
few signs of vegetation before the 15th of the month. Bilious pleurisies
were still the principal diseases which prevailed in the city.
The month of May was wet, cool, and healthy.
In June, the winds were easterly, and the weather rainy. The crops of
grass were luxuriant. It was remarked, that the milk of cows that fed
upon this grass yielded less butter than usual, and that horses that fed
upon it, sweated profusely with but little exercise. On the third of the
month, I was called upon by Dr. Physick to visit his father, who was ill
with a bilious fever. He died on the seventh, with a red eye, hiccup, and
black vomiting.
Four persons had the yellow fever in the month of July. One of them was
in Fourth-street, between Pine and Lombard-streets, another was in
Fifth-street, between Race and Vine-streets, both of whom recovered. The
remaining two were in the Pennsylvania hospital, both of whom died.
Remitting and intermitting fevers were likewise common in this month.
In August, those fevers assumed a chronic form. During this month, there
died an unusual number of children with the cholera morbus.
The city was uncommonly healthy in September. A storm of wind and rain,
from the south-east, proved destructive to the crops of cotton this
month, on the sea coast of South-Carolina.
In October, intermittents were very common between Eighth-street and
Schuylkill. One case of yellow fever came under my care, in conjunction
with Dr. Gallaher, on the western banks of that river.
While Philadelphia and all the cities of the United States (Charleston
excepted) were thus exempted from the yellow fever as an epidemic, the
western parts of all the middle, and several of the southern states, were
visited with the bilious fever, in all its different forms. In Delaware
county, in the state of New-York, at Mill river, in Connecticut, and in
several of the middle counties of Pennsylvania, it prevailed in the form
of a yellow fever. In other parts of the United States, it appeared
chiefly as a highly inflammatory remittent. It was so general, that not
only whole families, but whole neighbourhoods were confined by it. Many
suffered from the want of medical advice and nursing, and some from the
want of even a single attendant. In consequence of the general prevalence
of this fever in some parts of Pennsylvania, the usual labours of the
season were suspended. Apples fell and perished upon the ground; no
winter grain was sowed; and even cows passed whole days and nights
without being milked.
The mortality of this fever was considerable, where those distressing
circumstances took place. In more favourable circumstances, it yielded to
early depletion, and afterwards to the bark. Relapses were frequent, from
premature exposure to the air. Those only escaped them who had been
salivated, by accident or design, for the cure of the fever.
This disease was observed very generally to prevail most in high
situations, which had been for years distinguished for their healthiness,
while the low grounds, and the banks of creeks and rivers, were but
little affected by it. The unusual quantity of rain, which had fallen
during the summer months, had produced moisture in the former places,
which favoured putrefaction and exhalation, while both were prevented, in
the latter places, by the grounds being completely covered with water.
AN ACCOUNT
OF THE
_BILIOUS YELLOW FEVER_,
AS IT
APPEARED IN PHILADELPHIA,
IN THE YEAR 1805.
For a history of the uncommonly cold and tempestuous winter of 1804 and
1805, the reader is referred to the Account of the Climate of
Pennsylvania, in the first volume of these Inquiries and Observations.
During the months of January, February, and March, there were a number of
bilious catarrhs and pleurisies.
On the 7th of April, I visited a patient in the yellow fever with Dr.
Stewart. He was cured, chiefly by copious bleeding.
The weather was rainy in May. After the middle of June, and during the
whole month of July, there fell no rain. The mercury in Fahrenheit
fluctuated, for ten days, between 90° and 94°, during this month. The
diseases which occurred in it were cholera infantum, dysenteries, a few
common bilious, and eight cases of yellow fever. Three of the last were
in Twelfth, between Locust and Walnut-streets, and were first visited, on
the 14th and 15th of the month, by Dr. Hartshorn, as out-patients of the
Pennsylvania hospital. Two of them were attended, about a week
afterwards, by Dr. Church, in Southwark, and the remaining three by Dr.
Rouisseau and Dr. Stewart, in the south end of the city.
On the third of August, there fell a heavy shower of rain, but the
weather, during the remaining part of the month, was warm and dry. The
pastures were burnt up, and there was a great deficiency of summer
vegetables in the neighbourhood of Philadelphia. The water in the
Schuylkill was lower by three inches than it had been in the memory of a
man of 70 years of age, who had lived constantly within sight of it.
In September, a number of cases of yellow fever appeared in Southwark[9],
near Catharine-street. They were readily traced to a large bed of
oysters, which had putrified on Catharine-street wharf, and which had
emitted a most offensive exhalation throughout the whole neighbourhood,
for several weeks before the fever made its appearance. This exhalation
proved fatal to a number of cats and dogs, and it now became obvious that
the two cases of yellow fever, that were attended by Dr. Church, in the
month of July, were derived from it. An attempt was made to impose a
belief that they were taken by contagion from a ship at the lazaretto,
which had lately arrived from the West-Indies, but a careful
investigation of this tale proved, that neither of the two subjects of
the fever had been on board that, nor any other ship, then under
quarantine.
[9] This extensive district is continued, from the city of
Philadelphia, along the Delaware, but is not subject to its
government.
The fever prevailed during the whole of this month in Southwark. A few
cases of it appeared in the city, most of which were in persons who had
resided in, or visited that district. It was brought on by weak exciting
causes in Southwark, but the cases which originated in the city, required
strong exciting causes to produce them.
A heavy rain, accompanied with a good deal of wind, on the 28th of
September, and a frost on the night of the 7th of October, gave a
considerable check to the fever.