/ V
•A40&
J
MEDICAL
Inquiries and Obfervations :
CONTAINING
AN ACCOUNT
OF THE
YELLOW FEVER,
AS IT APPEARED IN PHILADELPHIA IN 1797, AND
OBSERVATIONS
UPON THE
NATURE AND CURE
OF THE
Gout, and Hydrophobia.
BY BENJAMIN RUSH, M.D.
PROFESSOR OF MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA.
VOLUME V.
PHILADELPHIA
PRINTED BY BUDD AND BARTRAM,
FOR THOMAS DOBSON, AT THE STON^^HOfltKE,
N° 41, SOUTH SECOND /T-R^EET. *>S
_I798._/^ V\
' LIBRARY
Founded 1813 ^%PI- OF MEDjg
drX^ksvd-^
PREFACE.
A
GREEABLY to my promife made in the year 1796, I herewith offer to the public a few obfervations upon the nature and cure of the gout. They are connected with a hif- tory of the yellow fever as it appeared in Philadelphia in 1797, and with fome obfer- vations upon the nature and cure of the hy- drophobia. I ftill hold myfelf bound by my promife at. the time above alluded to, to pub- lifh the refult of my inquiries into the difeafes of the mind. The extent and difficulties of this interefting branch of medicine, will ne- ceflarily delay this publication for fome time to come. In the mean while (health and life permitting) I fhall fpare no labour to render it as ufeful as poffible.
In
IV THE PREFACE.
In my attempts to explain the nature of the hydrophobia, I have affixed certain fpecific ideas to feveral medical terms which I had ufed in my former publications in the com- mon and indefinite acceptation of authors. The reader will excufe this liberty, wrhen he refleds, how much new opinions in other fciences, have been benefited by a new nomenclature. Medicine in its prefent improving ftate, muft follow thofe fciences in adopting a new language, for reason however impotent it may be for ages, in producing juft effects in morals and government, is feldom refilled longer than a fingle generation, in the fcience which relates to health and life. I am the more confident of its influence in producing a fpcedy revolution in the ufe of medical terms, from having obferved the principles which lead to it, adopted, not only by a number of refpedfoible phyficians in this city and in the neighbouring ftates, but by many ingenious gentlemen of other profeffiens. <c 'Tis time to retire" faid a Britifh general in the year 1 777, upon meeting an army of militia-men
upon
THE PREFACE. V
upon the heights of Saratoga. " The owners of the foil have come forth." In like manner, 'tis time for the impofing forms of ignorance and error in medicine to hide their heads. Unprejudiced men have come forth in defence of their own lives. Their efforts cannot fail of being fuccefsful, for they are actuated not only by the powerful motive of felf-prefervation, but they move by the light of reafon, the advantages of which in medi- cine, compared with folitary and mechanical experience, are like the extenfive benefits the fcience of navigation has derived from the loadftone, compared with the feeble aids it formerly derived from the fight of land, or the tranfient light of the ftars.
BENJAMIN RUSH.
Philadelphia, Atb July, 1798
:
CONTENTS.
o
Page.
F the weather, and dlfeafes which pre- ceded the yellow fever of the year 1797 in the
years 1795 and 1796, 3
Of the firfl appearance of the fever in 1797, 11 Of the ftate of the weather as illuftrated by meteo- rological obfervations made in the months of
Auguft, September, and October, - - 13
Of the prevalence of the fever in other places, 21
Of the difeafes which followed it, - - ibid.
Of its predifpofmg caufes, - - 22
Of its premonitory fymptoms - - 23 Of its fymptoms as they appeared
I. In the blood- veffels, - - - 23
II. in the excretions, - 24
III. in the nervous fyftem, - 26
IV. in the fenfes, - - 27
V. in the lymphatic fyftem, - 28
VI. ■ in the fkin, - - ibid.
VII. in the blood, - - ibid.
Of the different forms of the difeafe, - -31
Of the unity of the yellow and bilious fever, 35 Inftances of perfons who were twice and three times
affected by the fever, - - - 36
Account
Vlll CONTENTS,
Account of the effects of the contagion upon the au- thor, and upon Dr. Dobell, - - 38 Means of preventing an attack of the fever, - 39 Number of deaths, - - - - 41 Account of the death of Dr. Way. Letter from Governor MifHin to the author refpecting
the origin of the difeafe, - - 44
Anfwer to the faid letter, - - - 45
Memorial of the College of Phyficians to the Legifla- ture of Pennfylvania. Narrative of facts relative to the origin of the fever by the College, &c. Reply to the faid memorial, and narrative of facts by the , Academy of Medicine of Philadelphia, in a letter to Governor Mifflin, 68
Appendix, containing documents and proofs of the do- meftic origin of the yellow fever, by the Academy of Medicine, - - - 81
An account of thofe vegetable and animal matters which produce bilious, remitting, and malignant feverf, - - - - - 100
Method of cure, - - - - 106
Of bleeding, - ibid.
Of purging, - - - - no
Of a falivation, - - - - m
Of the various ways in which mercury affected the
mouth and throat, - . - 113
Of the manner in which mercury is fuppofed to act in
the cure of malignant fevers, - - u^
Of vomits, - - - - 117
Of diet and drinks, - - - 118
Of tonic remedies, - - - 121
Of the ufe of fweet oil and of iffues as preventives
of the yellow fever, - - - 123, 124
Of
CONTENTS. AX
Of the comparative fuccefs of depleting remedies in the fever, - - - - 127
Of the figns of moderate danger, and a favour- able iffue of the fever, - - 1 29
Of the figns of its great danger, and of an un- favourable iffue.
Observations upon the Nature and Cure or
the Gout, ... - 139
Perfons moft fubject to it, - - - 140
Of its remote caufes, - - - 142
Of its exciting caufes, - - 143
Of its proximate caufe, - - 144
Of its fymptoms as they appear in the ligaments, 146
in the blood-veffels, - 147
in the vifcera, - - 149
in the arterial and -t
> nervous fyftems, J -*
in the mufcles, - - 152
in the alimentary canal, 153
in the glands and lymphatics, 155
onthefkin, - - 15R
in the bones, - - 159
Ufual and various effects of the gout in different
parts of the body, - - - 160
Of the method of cure, - - 162
I. Of obviating a fit of the gout in its forming flate, 1 64 II. Of the remedies that are proper in cafes of great
morbid action in the blood- veffels and vifcera, 1 65
Of blood-letting, - - - - 166
Of purging, ... . . ,7I
Of
S CONTENTS.
Of vomits, - - - - 171
Of nitre, - - - 173
Of cool or cold air, - - ibid.
Of diluting liquors, - - - ibid.
Of abftinence, - - - - 174
Of Miners, .... ibid.
Of fear and terror, - - - 175
Of fweating, - ibid.
Of opium, - - - - 176
Of topical applications, - ibid. Of the early ufe of the limbs after a fit of the
gout, - - - - 178 III. Of the remedies which are proper in that (late of the gout in which a. feeble morbid action takes
place in the blood-veffels and vifcera, - 179
Of opium, wine, and porter, - - 180 Of ardent fpirits, - - - -181
Of aether, volatile alkali, oil of amber, and bark, 182
Of the warm bath and a falivation, - - 183 Of frictions to the ftomach and bowels, and of
ftimulating applications to the limbs, - 184 XV. Of the remedies for local fymptoms of the gout
without fever, - - - - 185
Of the head-ach and ophthalmia, - - 186
Of pains in the limbs and diarrhcea, - 187 Of angina pectoris, fpafms in the ftomach and
bowels, and pains in the rectum, - - 188 Of itching in the anus and vagina, cutaneous erup- tions, and arthritic gonorrhaea, - 189 Inftances of the radical cure of the gout, 191 V. Of the means of preventing the return of the gout,
and firft of its violent degrees by temperance, 195
Of moderate labour and gentle exercife, - 196
Of
CONTENTS, XI
Of avoiding cold, - - - 197
Of regulating the exercifes of the underflanding and pailions, - - - ^199
Of avoiding excefs in the gratification of the vene- real appetite, - ibid.
Of avoiding coftivenefs, - ibid.
Of occafional bleeding to prevent a fit of the gout, 200
Of Itiues and bitters, - - - 202
II. Of the means of preventing a return of that ftate of gout which is attended with feeble morbid action. ----- ibid.
Of a gently flimulating diet and the ufe of chaly- beate medicines, - 203
Of the ufe of the vol. tincture of gum guaiacum,
and of garlic, ginger, and fafTafras, - 204
Of warmth, of the warm and cold bath, and of regulating the ftate of the bowels and the exer- cifes of the underflanding and paflions, - 205
Of a change of climate, - 206
Observations on the Nature and Cure of the Hydrophobia, - 211
Of the remote caufes of the difeafe, - 212
Of the proximate caufe of ditto, as evidenced by its caufes, fymptoms, &c. in dogs, - 215
Alfo by its caufes, fymptoms, &c. in the human fpecies, - - - - 217
Of the remedies for hydrophobia. I. Of fuch as are proper to prevent the difeafe after the infection of the rabid animal is received into the body, - - - - 225
IL
Xll CONTENTS.
II. Of the remedies which are proper to cure it, 227
Of blood-letting, ... ibid.
Of purges and glyfters, - - - 231
Of fweating and a falivation, - - 232
Of tonic remedies, - ibid.
Of blifters and the cold bath, - - 233 Of the cure of the hydrophobia which occurs from
fear. - 236
A N
ACCOUNT
OF THE
BILIOUS, REMITTING, AND INTERMITTING
YELLOW FEVER,
AS IT APPEARED IN
PHILADELPHIA,
IN I797.
8
WTTOFMM
1813 J
AN
ACCOUNT, &c.
|^N my account of the yellow fever, as it ap- peared in Philadelphia in the year 1794, I tool: notice of feveral cafes of it which occurred in the fpring of the year 1795. Before I proceed to de- liver the hiftory of this difeafe as it appeared in 1797, I fliall mention the difeafes and ftate of the weather which occurred during the remaining part of. the year 1795, and the whole of the year 1796. This detail of facts, apparently uninterefling to the reader in the prefent flate of our knowledge of epidemics, may poffibly lead to principles at a fu- ture day.
The month of April 1795 was wet, and cold. All the difeafes of this month partook of the in- flammatory character of the preceding winter and B 2 autumn.
4 AN ACCOUNT OF THE
autumn, except the meafles which were unufually mild.
The weather in May was alternately wet, cool, and warm. A few cafes of malignant fever occur- red this month, but with moderate fymptoms. In June the weather was cool and pleafant. The meafles put on more inflammatory fymptoms than in the preceding months. I had two cafes of mania under my care this month, and one of rheumatifm, which were attended with intermifhons and exacer- bations every other day.
The weather on the 19th, 20th, 2 ill, and 2 2d days of July was very warm, the mercury being at 90 ° in Farenheit's thermometer. The fevers of this month were all accompanied with black difcharges from the bowels. Mr. Kittera one of the reprefentatives of Pennfylvania in the Congrefs of the United States, in confequence of great fatigue on a warm day, was affected with the ufual fymptoms of the yellow fever. During his illnefs he conftantly com- plained of more pain in the left, than in the right fide of his head. His pulfe was more tenfe in his left, than in his right arm. During his convale- fcence, it was more quick in the left arm, than it was in the right. He was cured by a falivation and the lofs of above 100 ounces of blood. His head-
ach
BILIOUS YELLOW FEVER IN 1797. 5
ach was relieved by the application of a bladder half filled with ice to his forehead.
Moft of the cafes of bilious fever which came under my notice, were attended with quotidian, tertian or quartan intermiflions. In a few of my patients there was an univerfal ram.
Dr. Woodhoufe informed me, that he had feen feveral inftances in which the yellow fever had been taken from fome foldiers who had laboured under the dyfentery. Thefe fa£h fhew the unity cf fe- ver, and the impracticability of a nofological ar- rangement of difeafes.
The cholera infantum was fevere and fatal in many inftances during this month. It yielded to bloodletting in a child of Mr. Gonyngham which was but four months old. In a child of feven weeks eld which came under my care, I obferved the coldnefs, chills, hot fits, and remiifions of the bi- lious fever to be as diftin&ly marked as ever I had feen them in adult patients. In a child of Mr. Darrach aged 5 months, the difcharges from the bowels were of a black colour. I mention thefe facts in fupport of an opinion I formerly publifhed, that the cholera infantum is a bilious fever, and
that
6 AN ACCOUNT OF THE
that it riles and falls in its violence with the bilious fever of grown perfons.
About the latter end of this month and the be- ginning of Augufl, there were heavy fhowers of rain which carried away fences, bridges, barns, nulls and dwelling houfes in many places. Several cafes of bilious yellow fever occurred in the month of Auguit. In one of them it was accompanied with that morbid affection in the wind-pipe which has been called cynanche trachealis. It was re- markable that fweating became a more frequent fymptom of the fevers of this month than it had been in July. Hippocrates afcribes this change in the character of bilious fevers to rainy weather. Perhaps it was induced by the rain which fell in the beginning of the month, in the fevers which have been named.
On the 30th and 31ft of Auguft there was a fall of rain which fuddenly checked the fever of the feafon, infomuch that the fucceeding autumnal months were uncommonly healthy. Several fhow- ers of rain had nearly the fame effect, in New- York where this fever carried off in a few weeks above 700 perfons. It prevailed at the fame time, and with great mortality, in the city of Norfolk in Vir- ginia.
In
BILIOUS YELLOW FEVER IN 1797. 7
In both thofe cities as well as in Philadelphia the difeafe was evidently derived from putrid exha- lation.
In the fame month, the dyfentery prevailed in Newhaven in Connecticut, and in the fame part of the town in which the yellow fever had prevailed the year before. The latter difeafe was faid to have been imported, but the prevalence of the dyfentery under the above circumftances, rendered it proba- ble that both difeafes were of domeftic origin.
The fever as it appeared in Philadelphia yielded in moft cafes to depleting remedies. After purging and bloodletting, I gave bark where the fever intermitted, with advantage. It was effectual, only when given in large dofes. In one inftance it induced a fpitting of blood which obliged me to lay it afide.
The winter of 1796 was uncommonly moderate. There fell a good deal of rain, but little fnow. The navigation of the Delaware was flopped but two or three days during the whole fcafon. Ca- tarrhs were frequent, but very few violent or acute difeafes occurred in my practice. The month of March and the firft week in April were uncommon- ly dry. Several cafes of malignant bilious fever came under my care during thefe months. In two
families
O AN ACCOUNT OF THE
families it appeared to be contagious. — A little girl of five years old whom I loft in this fever, became yellow in two hours after her death.
The meafles prevailed in April and were of a moft inflammatory nature. The weather in May and June was uncommonly wet. The fruit was much injured, and a great deal of hay deftroyed by it. On the 14th of June General Stewart died with all the ufual fymptoms of a fatal yellow fever. Several other cafes of yellow fever in this, and in the fucceeding month, proved mortal, but they ex- cited no alarm in the city, as the phyficians who at- tended them, called them by other names.
The rain which fell about the middle of July check- ed this fever. Auguft, September and October, were unufually healthy. A few cafes of malignant fore-throat appeared in November. They were in all the patients that came under my notice, attended with bilious difcharges from the ftomach, and bow- els. So little rain fell during the autumnal months that the wheat perifhed in many places. The wea- ther in December was extremely cold. The lamps of the city were in feveral inflances extinguifhed by it on the night of the 23d of the month at which time the mercury ftood at 2 ° below o in the thermome- ter.
The
BILIOtfS YELLOW FEVER IN 1 797. 9
The yellow fever prevailed this year in Charlefton in South Carolina, where it was produced by putrid exhalations from the cellars of houfes which had been lately burnt. It was faid by the phyficians of that place not to be contagious. The fame fever prevailed at the fame time at Wilmington in North Carolina, and at Newbury port in the flate of Maffachufetts. In the latter place it was produced by the exhalation of putrid Mi which had been carelefsly thrown upon a wharf. Mr. Webfler has difcovered that great and extenfive peftilential difeafes, and earthquakes or eruptions ofvolcanos, comets and meteors, general- ly appear about at the fame time. Men of genius and obfervation may perhaps difcover hereafter a connection between certain phenomena in the hea- vens of another kind, and a morbid confiitution of the atmofphere. — The following narrative taken from Mr. Brown's paper may ferve as a ray of light upon this fubjecl.
For the PHILADELPHIA GAZETTE.
Mr. Brown, I have juft taken up my pen to throw together a few hafty remarks on a very beautiful Corona or Halo which appeared this morning. I firft obferved it about half after nine, though, I prefume, it made its appearance much earlier : It then confided of a
bright
IO AN ACCOUNT OF THE
bright circle, of which the fun was the centre, form- ed, as nearly as I could difcern, as is ufual with large Coronas, of the feven primary colours, the inner circumference being red, and the outer violet. This appearance is not uncommon, though they fel- dom appear as luminous as this : But this was accom- panied by a phenomenon, which I cannot difcover to have been mentioned by any writer on this fubjecl:, which was a large white circle, which paffed through the body of the fun.
About 1 1 o'clock I obferved them with Hadley's quadrant, and found the diameter of the halo to be about 440 ; that of the white circle about 6o° ; and the altitude of the Sun 66°. The nodes or points of interferon, continued horizontal during the whole time. The appearance of it changed feveral times during the morning ; fometimes both circles would grow faint, and then again would become vivid j at one time they both difappeared, but again appeared in a few minutes more bright than ever j until finally about one quarter after eleven, the white circle vanifhed, and in 15 minutes more the halo dif- appeared. All the morning, fmall, light clouds, from the S. E.
July 25, 1796. T. S.
The
BILIOUS YELLOW FEVER IN 1797. II
The winter of 1797 was in general healthy. During the fpring, which was cold and wet, no dif- eafes of any confequence occurred. The fpring vegetables were late in coming to maturity, and there were every where in the neighbourhood of Philadelphia fcanty crops of hay. In June and July, there fell but little rain. Dy ferneries, chole- ras, fcarlitina, and mumps, appeared in the fub- urbs in the latter month. On the 8th of July I vifited Mr. Friik, and on the 25th of the fame month I vifited Mr. Charles Burrel in the yellow fever in confultation with Dr. Phyfick. They both recovered by the plentiful ufe of depleting reme- dies.
The weather from the 2d to the 9th of Augufl was rainy. On the ift of this month I was called to vifit Mr. Nathaniel Lewis in a violent bilious fe- ver. On the 3d I vifited Mr. Eliflia Hall with the fame difeafe. He had been ill feveral days before I faw him. Both thefe gentlemen died on the 6th of the month. They were both very yellow after death. Mr. Hall had a black vomiting on the day he died.
The news of the death of thefe two citizens, with unequivocal fymptoms of yellow fever, excited a general alarm in the city. Attempts were made
to
12 AN ACCOUNT OF THE
to trace it to importation, but a little inveftigation foon proved that it was derived from the foul air of a fhip which had juft arrived from Marfeilles, and which difcharged her cargo at Pine flreet wharf, near the flores occupied by Mr. Lewis and Mr. Hall. Many other perfons about the fame time wTere affected with the fever from the fame caufe, in Water and Penn ftreets. About the middle of the month, a fhip from Hamburgh communicated the difeafe, by means of her foul air, to the village of Kenfmgton. It prevailed moreover in many in- flances in the fuburbs, and in Kenfmgton from pu- trid exhalations from gutters and marfhy grounds, at a diftance from the Delaware, and from the foul {hips which have been mentioned. Proofs of the truth of each of thefe affertions ftiall be given in their proper place.
The difeafe was confined chiefly to the diftricl of Southwark and the village of Kenfmgton for fe- veral weeks. In September and October many cafes occurred in the city, but mofl of them were eafily traced to the above fources.
The following account of the weather during the months of Auguft, September and October was obtained from Mr. Thomas Pryor. It is diffe- rent from the weather in 1793. It is of confe-
quence
BILIOUS YELLOW FEVER IN 1797. 13
quence to attend to this fa£t, inafmuch as it (hows that an inflammatory conflitution of the atmofphere can exift under different circumstances of the wea- ther. It likewife accounts for the variety in the fymptoms of the fever in different years and coun- tries. Such is the influence of feafon and climate upon the fymptoms of this fever, that it led Dr. M'Kitterick to fuppofe that the yellow fever of Charleflon, fo accurately defcribed by Dr. Lining in the 2d volume of the Phyfical and Literary EfTays of Edinburgh, was a different difeafe from the yellow fever of the Well Indies. *
METEOROLOGICAL OBSERVATIONS,
MADE IN PHILADELPHIA,
AUGUST, 1797.
Thermo- Baro- WINDS and WEATHER.
meter. met.r.
1 73 to 75 30 o S. E. E. Rain in the forenoon and
afternoon.
2 72 to 76 30 o N. E. by E. Cloudy with rain in the
afternoon and night. Wind E. by N.
3 72 to 78 30 6 E. \ N. Rain in the morning, and
all day and night. 4721078 30 4 E. Rained hard all day and at night.
* De febre Indiae Occidentalis maligna flava, p. 12.
14 AN ACCOUNT OF THE
Therm. Baro. WINDS and WEATHER.
5 74 to 79 29 84 Wind light — S. W. Cloudy. Rain
this morning. The air extremely
damp; wind fhifted to N. W. This
evening heavy fhowers, with thunder.
W. N. W. Cloudy.
N. W. Clofe day. Rain in the even- ing and all night. Wind to E.
E. Rain this morning.
S. W. Cloudy morning.
N. W. Clear.
N. W. Clear. Rain all night.
S. W. Cloudy. Rain in the morn- ing— Cloudy all day. — Rain at night.
S. W. Cloudy. Rain all day.
N. W. Clear fine morning.
N. W. Clear fine morning.
N. W. Clear fine morning.
N. W. Air damp.
S. W. Cloudy. Rain, with thunder at night — a fine fhower. 19 72 to 78 29 7 N. W. Clear. Cloudy in the even- ing, with thunder.
W. N. W. Fine clear morning.
N. W. Clear to E.
E. Small ftiower this morning.
Hard ftiower at 11, A. M. Wind N. E.
E. Cloudy. At noon calm.
Calm morning and clear.
N. E. Clear. Rain in the afternoon, with thunder.
26
|
6 73 to 76 |
3086 |
|
7 70 to 76 |
30 4 |
|
8 72 to 76 |
2995 |
|
9 72 to 76 |
29 86 |
|
10 69 to 73 |
30 16 |
|
11 70 to 734 |
3025 |
|
12 71 to 74 |
3° 5 |
|
13 73 to 75 |
2987 |
|
14 70 to 74 |
29 9 |
|
15 56 to 60 |
30 J5 |
|
16 60 to 64 |
30 24 |
|
17 60 to 65 |
30 24 |
|
18 68 to 75 |
3° 4 |
|
20 70 to 77 |
29 8 |
|
21 74 to 76 |
29 9 |
|
22 68 to 76 |
|
|
23 71 to 76 |
29 92 |
|
24 71 to 75 |
2995 |
|
25 70 to 75 |
30 5 |
BILIOUS YELLOW FEVER IN 1797.
15
|
Therm. |
Baro. |
WINDS and WEATHER. |
|
26 70 to 75 |
30 5 |
S. E. Rain in the morning. Rained hard in the night, -with thunder N. W. |
|
27 68 to 76 |
29 9 |
N. W. Fine clear morning. |
|
28 64 to 75 |
29 96 |
N. W. Clear. |
|
29 59 to 70 |
30 0 |
E. Clear. |
|
30 70 to 76 |
30 1 |
E. by S. Rain in the morning. |
|
31 68 to 74 |
30 H |
S. E. Cloudy. Damp air and fultry. |
SEPTEMBER, 1797.
Thermo- Baro- meter meter.
1 73 to 80 30 6
2 79 to 80 29 9
3 68 to 74 30 o
4 66 to 74 30 7
5 58 to 724 30 1
6 58 to 72 30 13
7 $6 to 76 30 28
8 54 to 6$ 30 1
9 56 to 6$ 30 1 10 58 to 6^ 30 26
WINDS and WEATHER.
S. W. Cloudy. Damp air. Rain in the morning.
N. W. Clear. Cloudy in the even- ing, with lightning to the fouthward.
N. by W. Cloudy. Clear in the af- ternoon and night.
W. N. W. Clear fine morning.
N. W. Clear. Cloudy in the evening.
Frefh at E. Clear. Rain in the even- ing.
E. Clear. Cloudy in the evening.
N. E. Clear and cool morning
Flying clouds at noon.
E. N. E. Clear.
N. E. Clear fine morning. Wind frefh at N. E. all xday.
21
l6 AN ACCOUNT OF THE
|
Therm. |
Baro. |
WINDS and WEATHER. |
|
ii 53 to 64 |
3° J3 |
N. to E. with flying clouds. |
|
12 51 to 62 |
30 6 |
W. N. W. Clear cool morning. |
|
13 56 to 67 |
30 3 |
S. W. Cloudy. Clear in the afternoon. |
|
14 64 to 70 |
29 98 |
S. W. Clear. |
|
15 66 to 73 |
2985 |
S. W. Rain in the morning. Cloudy in the afternoon. |
|
16 62 to 70 |
2995 |
N. W. Clear. |
|
17 56 to 67 |
30 0 |
N.W. Clear. |
|
18 58 to 6$ |
29 88 to E. Cloudy. Rained all day, and thun- |
|
|
29 62 |
der. Rained very heavy at night. |
|
|
19 55 to 63 |
29 15 |
W. N. W. Clear fine morning. |
|
20 47 to 6$ |
30 8 |
W. N. W. Clear fine morning. D Moon at 9 50 morning. |
|
21 46 to 60 |
30 0 |
N. E. Clear fine morning; — to S. E. in the evening. Cloudy at night. |
|
22 56 to 6$ |
3° 4 |
N. W. Rain in the morning. Rain at night. |
|
23 56 to 66 |
30 0 |
N. N. E. Cloudy. |
|
24 52 to 66 |
29 9 to E. by S. Clear fine morning. Clou- |
|
|
29 7S |
dy at night. |
|
|
25 56 to 68 |
29 37 |
W. N. W. Clear fine morning — clear all day. |
|
26 58 to 68 |
29 95 |
E. In the morning flying clouds. |
|
27 48 to 63 |
30 2 |
N. W. Clear fine morning — clear all day. |
|
28 54 to 63 |
30 2 |
W. N. W. Clear fine morning — clear all day. |
|
29 54 to 63 |
30 *5 |
E. Clear fine morning. |
|
30 60 to 65 |
30 26 |
E. Frefh. Cloudy morning. Rain in the night. |
OCTOBER,
BILIOUS YELLOW FEVER IN 1797. 17
OCTOBER, 1797.
Thermo- Baro- WINDS and WEATHER,
meter. meter.
1 55 to 65 30 16 N. E. Rain this morning and great
part of the day.
2 55 to 66 30 o N. W. Clear.
3 to to 70 29 9 S. E. Clear. Air damp.
4 60 to 70 29 5 W. N. W. Rain this morning.
5 46 to 60 30 o W. N. W. to S. by W. in the evening.
Clear all day. White froft this morning.
6 55 to 65 30 o S. W. Clear fine morning. White
froft.
7 56 to 76 10 o S. W. Cloudy. Rain in the night.
8 56 to 70 3029 S. Cloudy this morning — air damp.
Wind ihifted to W. N. W. Blows frefh.
9 50 to 60 29 85 W. N. W. Clear morning. Frefh at
N. W. in the evening. W. N. W. Clear. Froft this morning. W. N. W. Cloudy. W. N. W. Clear. Ice this morning. N. Clear fine morning. Ice this
morning. N. E. Cloudy. W. N. W. Clear. W. N. W. Clear fine morning. W. N. W. Clear fine morning. W. N. W. Clear fine weather. N. W. Clear fine day.
C ?Q
|
10 4c to 58 |
3° 1 |
|
11 38 to 56 |
30 2 |
|
12 34 tO 52 |
30 3* |
|
*3 35 t0 55 |
30 5 |
|
14 40 to 60 |
30 28 |
|
15 50 to 65 |
30 16 |
|
16 36 to 56 |
30 2 |
|
17 37 to 56 |
30 18 |
|
18 47 to 60 |
29 86 |
|
19 48 to 60 |
30 6 |
Io AN ACCOUNT OF THE
Therm. Baro. WINDS and WEATHER.
20 42 to 55 30 8 N. E. Cloudy. Rain in the afternoon
and night. Blows frefli at N. E.
21 42 to 50 29 92 N. E. Blows frefli, (with a little
rain.) — Thunder in the night, with rain.
22 44 to 56 2957 N. W. Rain in the morning.
23 44 to 56 29 95 S. W. Clear fine morning. 24421054 30 5 N. E. Cloudy. A great deal of rain
in the night. 25 40 to 52 30 15 N. E. Clear fine morning. 16 36 to 48 30 29 W. N. W. Clear.
27 34 to 46 30 23 Frefh at S. W. Clear.
28 40 to 52 29 95 W. N. W. Cloudy.
29 34 to 46 29 82 W. Cloudy.
30 32 to 42 29 93 N. W. Clear. Hard trod this morning.
31 38 to 48 30 18 W. S. W. Cloudy part of this day;
clear the remainder.
In addition to the regifter of the weather, it may not be improper to add, that mufquetoes were more numerous during the prevalence of the fever than in 1793. An unufual number of ants and cock- roaches were likewife obferved ; and it was faid that the martins and fwallows difappeared for a while, from the city and its neighbourhood.
A difeafe prevailed among the cats fame weeks before the yellow fever appeared in the city. It
excited
BILIOUS YELLOW FEVER IN 179?. 19
excited a belief in an unwholefome ftate of the at- mofphere, and apprehenfions of a fickly fall. It was generally fatal.
After the firft week in September, there were no difeafes to be feen but yellow fever. In that part of the town which is between Walnut and Vine ftreets it was uncommonly healthy. A fimi- lar retreat of inferior difeafes has been obferved to take place during the prevalence of the plague in London, Holland, and Germany, according to the hiftories of that difeafe by Sydenham, Diemer- broek, Sennertus and Hildanus. It appears from the regifter of the weather, that it rained during the greatest part of the day on the ifl of October. The effects of this rain upon the difeafe mall be mentioned hereafter. On the ioth the weather became cool, and on the nights of the 12th and 13th of the month, there was a frofl accompanied with ice, which appeared to give a fudden and com- plete check to the difeafe. *
* It has been fuppofed that the yellow fever is checked only by heavy rains and froft. Dr. Irvine lately informed me, that the cafes of it were always leifened in Charleiton in the year 1796 when the wind came from the call or fouth eafl;, and that they revived when it blew from the weft or fouth weft.
C 2 The
CLO AN ACCOUNT OF THE
The reader will probably expert an account of the effects of this diflreffmg epidemic upon the public mind. — The terror of the citizens for a while was very great. Rumors of an oppofite and contradictory nature of the increafe and mortality of the fever were in conflant circulation. A floppage was put to bufmefs, and it was computed that about two- thirds of the inhabitants left the city.
The legiflature of the ftate early pafTed a law- granting 10,000 dollars for the relief of the fufFer- ers by the fever. The citizens in and out of town, as alfo many of the citizens of our filler flates, contributed more than that fum for the fame cha- ritable purpofe. This money was ilfued by a com- mittee appointed by the governor of the flate. A hofpital for the reception of the poor was eflablifh- ed on the eafl fide of the river Schuylkill, and amply provided with every thing neceffary for the accommodation of the fick. Tents were likewife pitched on the eafl fide of Schuylkill, to which all thofe people were invited who were expofed to the danger of taking the difeafe, and who had not means to provide a more comfortable retreat for themfelves in the country.
I am forry to add, that the moral effecls of the fever upon the minds of our citizens were confined
chiefly
BILIOUS YELLOW FEVER IN IJQJ. 21
chiefly to thefe acts of benevolence. Many of the publications in the newfpapers upon its exiflence, mode of cure and origin, partook of a virulent fpirit which illy accorded with the diftreiTes of the city. It was a caufe of lamentation likewife to many ferious people, that the citizens in general were lefs difpofed than in 1793, to acknowledge the agency of a divine hand in their afflictions. In fome, a levity of mind appeared upon this folemn occafion. A worthy bookfeller gave me a melan- choly proof of this aflertion, by informing me, that he had never been afked for playing cards fo often in the fame time, as he had been during the prevalence of the fever.
Philadelphia was not the only place in the Unit- ed States which fuffered by the yellow ftvew It prevailed at the fame time at Providence in Rhode Ifland, at Norfolk in Virginia, at Baltimore, and in many of the country towns of New England, New Jerfey, and Pennfylvania.
The influenza followed the yellow fever as it did in the year 1793. It made its appearence in the latter end of October, and affected chiefly thofe citizens who had been out of town.
The
1$ AN ACCOUNT OF THE
The weather became feverely cold about the middle of November, and continued fo during the greateft part of the winter. The navigation of the Delaware was completely obftructed on the 5th of December. Cafes of bilious pleurify and of the hydrocephalic ftate of fever, were common in all the winter months. They yielded in every inftance which came under my care, to copious depletion by the lancet, and mercury.
In the months of February and March, a ca- tarrhal fever, attended in fome instances with fymp- toms of cynanche trachealis, prevailed among chil- dren. It was cured by gentle pukes, purges of calomel and blood-letting. I bled a child of Mr. PiiTo, of fix weeks old, twice, and a child of Mr. Bi'lington, of three weeks old, once in this fever, and thereby I believe faved their lives.
The predifpofmg caufes of the yellow fever in the year 1797 were the fame as in the year 1793. Strangers were as ufual moil fubjeel: to it. The heat of the body in fuch perfons in the Weft In- dies has been found to be between three and four degrees above that of the temperature of the na- tives. This fa& is taken notice of by Dr. M'Kit- terick, and to this he afcribes, in part, the predif- pofition of new comers to the yellow fever.
In
BILIOUS YELLOW FEVER IN 1797. 2$
In addition to the common exciting caufes of this difeafe formerly enumerated, I have only to add, that it was induced in one of my patients byfmoak- ing a fegar. He had not been accuftomed to the ufe of tobacco.
I faw no new premonitory fymptoms of this fever except a tooth-ach. It occurred in Dr. Phyfick, Dr. Caldwell, and in Mr. Bellenger, one of my pupils. In Mifs Elliot there was fuch a forenefs in her teeth, that ilie could hardly clofe her mouth on the day in which fhe was attacked by the fever. Neither of thefe perfons had taken mercury to ob- viate the difeafe.
I fhall now deliver a fliort account of the fymp- toms of the yellow fever, as they appeared in feve- ral of the different fyftems of the body.
I. There was but little difference in the (late of the pulfe in this epidemic from what has been recorded in the fevers of 1793 and 1794. I per- ceived a pulfe in feveral cafes which felt like a foft quill which had been /battered by being trodden upon. It occurred in Dr. Jones and Dr. Dobell, and in feveral other perfons who had been worn down by great fatigue, and it was in every inflance, followed by a fatal iflue of the fever. In Dr. Jones
this
24 AN ACCOUNT OF THE
this ftate of the pulfe was accompanied with fuch a difficulty of breathing, that every breath he drew on the day of his attack, he informed me, was the effort of a figh. He died on the 17th of Septem- ber, and on the fixth day of his fever*
The action of the arteries was as ufual very irre- gular in many cafes. In fome there was a diftreff- ing throbbing of the veffels in the brain, and in one of my patients a fimilar fenfation in the bowels, but without pain. — Many people had iffues of blood from their blifters in this fever.
I faw nothing new in the effects of the fever upon the liver, lungs, brain, nor upon the ftomach and bowels.
II. The excretions were diftinguiflied by no un- ufual marks. I met with no recoveries where there were not black flools. They excoriated the reftum in Dr. Way. It was a happy circumftance where morbid bilious matter came away in the beginning of the diforder. But it frequently refilled the mofl powerful cathartics until the 5th or 7th day of the fever, at which time it appeared rather to yield to the diforganization of the liver than to medi- cine. Where fufficient blood-letting had been pre- vioufly ufed, the patient frequently recovered, even
after
BILIOUS YELLOW FEVER IN 1 797. 25
after the black difcharges from the bowels took place in a late ftage of the difeafe.
Dr. Coxe informed me that he attended a child of feventeen months old which had white ftools for feveral days. Towards the dole of its difeafe, it had black ftools, and foon afterwards died.
Dr. Stewart ventured to tafte the black matter which was difcharged from the ftomach jufl before death in two inftances. In both cafes it bliftered his tongue.
Several of my patients difcharged worms during the fever. In one inflance they were difcharged from the mouth.
A preternatural frequency in making pale water attended the firft attack of the difeafe in Mr. Jo- feph Fifher.
A difcharge of an unufual quantity of urine preceded, a few hours, the death of the daughter of Mrs. Read.
In two of my patients there was a total fuppref- fion of urine. In one of them it continued five days without exciting any pain.
There
i6 AN ACCOUNT or THE
There was no difpoiition to fweat after the firft and fecond days of the fever. Even in thofe flares of the fever in which the intermiiTions were mod complete, there was fel dom any moifturc or even foftnefs on the fkin. This was fo characteriftic of malignity in the bilious fever, that where I found the oppofite date of the fkin towards the clofe of a paroxyfm, I did not hefitate to encourage my pa- tient, by alluring him that his- fever was of a mild nature, and would molt probably be fafe in its hTue.
III. I faw no unufual marks of the difeafe in the nervous fyftem. The mind was feldom affected by delirium after the lofs of blood. There was a dif- pofition to ihed tears in two of my patients. One of them wrept during the whole time of a paroxyfm of the fever. In one cafe I obferved an uncommon dulnefs of apprehenfion, with no other mark of a difeafed flate of the mind. It was in a man whofe faculties in ordinary health, acted with celerity and vigor.
Dr. Caldwell informed me of a lingular change which took place in the operations of his mind during his recovery from the fever. His imagina- tion carried him to an early period of his life, and engaged him for a day or two in playing with a bow and arrow, and in amufements of which he had
been
BILIOUS YELLOW FEVER IN 1797. 1J
been fond when a boy. A fimilar change occurred in the mind of my former pupil Dr. Fifher, during his convalefcence from the yellow fever in 1793. He amufed himfelf for two days in looking over the pictures of a family Bible which lay in his room, and declared that he found the fame kind of plea- fure in this employment that he did when a child. However uninterefting thefe facts may now appear, the time will come, when they may probably fur- nifh ufeful hints for completing the phyfiology, and pathology of the mind.
Where blood-letting had not been ufed, patients frequently died of convulfions.
IV. The fenfes of feeing and feeling were impair- ed in feveral cafes. Mrs. Bradford's vifion was fo weak that fhe hardly knew her friends at her bed- fide. I had great pleafure in obferving this alarm- ing fyrnptom fuddenly yield to the lofs of four ounces of blood.
Several perfons who died of this fever, did not from the beginning to the end of the difeafe feel any pain. I {hall hereafter endeavour to explain the caufe of this infenfible ftate of the nerves.
The
2 3 AN ACCOUNT OF THE
The appetite for food was unimpaired for three days in Mr. Andrew Brown, at a time when his pulfe indicated a high grade of the fever. I heard of feveral perfons who ate with avidity jufl before they died.
V. Glandular fwellings were very uncommon in this fever. I fhould have afcribed their abfence to the copious ufe of depleting remedies in my prac- tice, had I not been informed that morbid affections of the lymphatic glands were unknown in the city hofpital where blood-letting was feldom ufed, and where the patients in many inflances died before they had time to take medicine of any kind.
VI. The /kin was cool, dry, fmooth, and even Alining in fome cafes. Yellownefs was not univerfal. Thofe fmall red fpots which have been compared to mufqueto bites, occurred in feveral of my patients. Dr. John Duffield, who acted as houfe furgeon emd apothecary at the city hofpital, informed me that he faw vibices on the ikin in many cafes, and that they were all more or lefs fore to the touch.
VII. The blood was diffolved in a few cafes. That appearance of the blood which has been compared to the warnings of fiefh, was very common. It was more or lefs fizy towards the clofe of the dif-
eafe
BILIOUS YELLOW FEVER IN 1797. 29
cafe in moft cafes. I have fufpe&ed, from this cir- cumftance, that this mark of ordinary morbid ac- tion, or inflammation, was in part the effect of the mercury acting upon the blood-velfeJs. It is well known that fizy blood generally accompanies a fali- vation. If this conjecture be well founded, it will not militate againfl the ufe of mercury in malignant fevers, for it fhews that this valuable medicine pof- feffes a power of changing an extraordinary and dangerous degree of morbid action in the blood- veffels, to that which is more common and fafe. I have feldom feen a yellow fever terminate fatally- after the appearance of fizy blood.
Dr. Stewart informed me that in thofe cafes in which the ferum of the blood had a yellow colour, it imparted a faline tafte only to his tongue. He was the more ftruck with this fact, as he perceived a flrong bitter ftate upon his /kin in a fevere at- tack of the yellow fever in 1793.
I proceed next to take notice of the type of the fever.
In many cafes it appeared in the form of a remit- ting and intermitting fever. The quotidian and tertian forms were moft common. In Mr. Robert Wharton it appeared in the form of a quartan.
But
30 AN ACCOUNT OF THE
But it frequently affumed the character which is given of the fame fever in Charlefton by Dr. Lin- ing. It came on without chills, and continued with- out any remiffion for three days ; after which the patient believed himfelf to be well, and fometimes rofe from his bed, and applied to bufinefs. On the fourth or fifth day the fever returned, and un- lefs copious evacuations had been ufed in the early flage of the difeafe, it generally proved fatal. Sometimes the powers of the fyftem were deprefled below the return of active fever, and the patient funk away by an eafy death without pain, heat, or a quick pulfe. I have been much puzzled to diftin- guiih a crifis of the fever on the third or fourth day, from the infidious appearance which has been de- fcribed. It deceived me in 1793. It may be known by a preternatural coolnefs in the /kin, and languor in the pulfe, by an inability to fit up long without fatigue, or faintnefs, by a dull eye, and by great depreflion of mind, or fuch a flow of fpirits as fometimes to produce a declaration from the patient that " he feels too well." Where fhefe fymp- toms appear, the patient mould be informed of his danger, and urged to the continuance of fuch re- medies as are proper for him.
The following flates or forms were obfervable in the fever :
1. la
BILIOUS YELLOW FEVER IN 1 797. Jf
i. In a few cafes the contagion or miafmata pro- duced death in four and twenty hours with convulfi- ons, coma, or apoplexy.
2. There were open cafes in which the pulfe was full and tenfe as in a pleurify or rheumatifm from the beginning to the end of the fever. They were ge- nerally attended with a good deal of pain.
3. There were depreffed or locked cafes, in which there were a fenfe of great debility, but little or no pain, a depreffed and flow pulfe, a cool fkin, cold hands and feet, and obftructed excretions.
4. There wrere divided or mixed cafes in which the pulfe was active until the 4th day, after which it became depreffed. All the other fymptoms of the locked date of the fever accompanied this depreffed ftatc of the pulfe.
5. There were cafes in which the pulfe imparted a perception like that of a foft and shattered quill. I have before mentioned that this ftate of the pulfe occurred in Dr. Jones and Dr. Dobell. I felt it but once and on the day of his attack in the latter gentleman, and expreffed my opinion of his ex- treme danger to my fon upon my return from
viiitine
$2 AN ACCOUNT OF THE
vifiting him. I did not meet with a cafe which termi- nated favourably, where I perceived this shatter- ed pulfe. A difpofition to fweat occurred in this flatc of the fever.
6. There were what Dr. Caldwell happily called walking cafes. The patients here were flufliedor pale, had a full or tenfe pulfe, but complained of no pain, had a good appetite, and walked about their rooms or houfes as if they were but little indifpofed until a day or two, and in fome inftances, until a few hours before they died. The impreffion of the remote caufe of the fever in thefe cafes was beyond fenfation, for upon removing a part of it by bleeding or purging, the patients complained of pain, and the excitement of the mufcles paiTed fo completely in- to the blood-veflels and alimentary canal, as to con- vert the fever into a common and more natural form. Thefe cafes were always dangerous, and when ne- gle&ed, generally terminated in death. Mr. Brown's fever came on in this infidious fhape. It was cured by the lofs of upwards of an ioo ounces of blood, and a plentiful falivation.
7. There was the intermitting form in this fever. This, like the laft, often deceived the patient by leading him to fuppofe his difeafe was of a com- mon or trifling nature. It prevented Mr. Richard
Smith
BILIOUS YELLOW FEVER IN 1797. 33
Smith from applying for medical aid in an attack of the fever for feveral days, by which means it made fuch an impreiTion upon his vifcera, that depleting re- medies were in vain ufed to cure him. He died in the prime of life, beloved and lamented by a numerous circle of relations and friends.
8. There was a form of this fever in which it re- fembled the mild remittent of common feafons. It was diflinguilhed from it chiefly by the black colour of the inteflinal evacuations.
9. There were cafes of this fever fo light, that patients were faid to be neither Jick, nor well: or in other words, they were fick and well, half a do- zen times in a day. Such perfons walked about, and tranfa&ed their ordinary bufmefs, but complained of dulnefs, and occafionally, of {hooting pains in their heads. Sometimes the flomach was affected with ficknefs, and the bowels with diarrhoea or cof- tivenefs. All of them complained of night fweats. The pulfe was quicker than natural, but feldom had that convulfive action which conftitutes fever. Pur- ges always brought away black (tools from fuch pa- tients, and this circumftance ferved to eftablifh its relationfhip to the prevailing epidemic. Now and then by neglect, or improper treatment, it affumed a higher and more dangerous grade of the fever, and
D became
34 AN ACCOUNT OF THS
became fatal, but it more commonly yielded to na- ture, or to a fingle dofe of purging phyfic.
10. There were a few cafes in which the fkin was affected with univerfal yellownefs, but without more pain or indifpofition than ufually occurs in the jaun- dice. They were very frequent in the year 1793* and generally prevail in the autumn, in all places fubjecl: to bilious fever,
11. There were chronic cafes of this fever. It is from the want of obfervation that phyficians limit the duration of the yellow fever to certain days. I have feen many inflances in which it has been protracted into what is called by authors a flow nervous fever. The wife of captain Peter Bell died of a black vomit- ing after an illnefs of nearly one month. Dr. Pinck- ard formerly one of the phyficians of the Britifli army in the Weft Indies, in a late vifit to this city informed me, that he had often feen the yellow fever put on a chronic form in the Weft India Iflands.
In delivering this detail of the various forms of the yellow fever, I am aware that I oppofe the opinions of many of my medical brethren who afcribe to it, a certain uniform chara&er which is removed beyond the influence of climate, habit, predifpofition, and the different ftrength and combinations of remote and
exciting
BILIOUS YELLOW FEVER IN T797. 35
exciting caufes. — This uniformity in the fymptoms of this fever is faid to exift in the Weft Indies, and every deviation from it in the United States is called by another name. The following communication which I received from Dr. Pinkard will fhew that this difeafe is as different in its forms in the Weft Indies, as it is in this country.
" The yellow fever, as it appeared, among the " troops, in Guiana, and the Weft India Iflands, " in the years 1796, and 1797, exhibited fuch " perpetual inftability, and varied fo incefTantly in " its character, that I could not difcover any one " fymptom to be, decidedly diagnoftic ; and, hence, " I have been led into an opinion that the yellow " fever, fo called, is not a diftincl:, or fpecific, *' difeafe, but, merely, an aggravated degree of the " common remittent or bilious fever of hot climates, " rendered irregular in form, and augmented in " malignity, from appearing in fubjecls unaccuf- * tomed to the climate."
Philadelphia, January 12th, 1798.
Many other authorities equally refpectable with Dr. Pinckard's, among whom are Pringle, Huck, and Hunter, might be adduced in fupport of the unity of bilious fever. But to multiply them fur- ther, would be an act of homage to the weaknefs D 2 of
36 AN ACCOUNT OF THS
of human reafon, and an acknowledgement of the infant flate of our knowledge in medicine. As well might we fuppofe nature to be an artift, and that difeafes were fhaped by her like a piece of ftatuary, or a fuit of clothes, by means of a chiffel, or pair of fciffars, as admit every different form and grade of morbid action in the fyfteiru to be a diftinct dif- eafe.
Notwithftanding the fever put on the eleven forms which have been defcribed, the moderate cafes were few, compared with thofe of a malignant and dangerous nature. It was upon this account that the mortality was greater in the fame number of patients, who were treated with the fame reme- dies, than it was in the years 1793 and 1794. The difeafe moreover partook of a more malignant character than the two epidemics that have been mentioned. The yellow fever in Norfolk, Drs. Taylor and Hansford informed me in a letter I re- ceived from them, was much more malignant and fatal under equal circumflances than it was in 1795.
During the prevalence of the fever I attended the following perfons who had been affected by the epi- demic of 1793 — viz. Dr. Phyfick, Thomas Learning, Thomas Canby, Samuel Bradford, and George Loxley, alfo Mrs. Eggar who had a violent attack
of
/
BILIOUS YELLOW FEVER IN 1797. $J
of it in the year 1794. Samuel Bradford was likewife affected by it in 1794.
There are two opinions which verge to equal ex- tremes upon the fubjecl: of the contagious nature of the yellow fever. While mod of the Weft India phyficians deny its contagious quality altogether, many American phyficians act as if they believed it could be communicated by the deck of a fhip, af- ter me has performed a voyage from a tropical country. In a Weft India climate where the accu- mulation of the effluvia from fick people is prevent- ed by open doors and windows, it is eafy to conceive this fever cannot be often propagated by contagion. Even in our own country it has rarely been obferv- ed to be contagious, in the months of July and Auguft. But after cool weather renders it necefla- ry to exclude the frefti air from fick rooms, it is as eafy to conceive the fame effluvia may be fo ac- cumulated, and concentrated, as to produce the dif- eafe in other people. In this way it was propagated in fome inftances during the year 1797, but by no means fo often as in 1793 under equal circumftan- ces. The reafon of this difference in the contagi- ous nature of this fever in thofe two years muft be fought for in the difference of the fenftble qualities of the atmofphere.
During
38 AN ACCOUNT OF THE
During my intercourfe with the fick, I felt the contagion of the fever operate upon my fyftem in the mofl fenfible manner. It produced languor, a pain in my head, and ficknefs at my ftomach. A fighing attended me occafionally for upwards of two weeks. This fymptom left me fuddenly, and was fucceeded by a hoarfenefs, and at times, with fuch a feeblenefs in my voice as to make fpeaking painful to me. Having obferved this affection of the trachea, to be a precurfor of the fever in feve- ral cafes, it kept me under daily apprehenfions of being confined by it. It gradually went off after the 1 ft of October. I afcribed my recovery from it, and a fudden diminution of the effects of the contagion upon my fyftem, to a change produced in the atmofphere by the rain which fell on that day.
The contagion a&ed in a peculiar manner upon Dr. Dobell. It induced a fneezing every time he went into a fick room.
The gutters emitted in many places, a fulphuri- ous fmell during the prevalence of the fever. Up- on rubbing my hands together I could at any time excite a fimilar fmell in them. I have taken notice of this effect of the matters which produced the dif- eafe, upon the body, in the year 1 794.
In
BILIOUS YELLOW FEVER IN 1797. 39
In order to prevent an attack of the fever, I care- fully avoided all its exciting caufes. I reduced my diet, and lived fparingly upon tea, coffee, milk, and the common fruits and garden vegetables of the fea- fon, with a fmall quantity of falted meat, and fmoked herring. My drinks were milk and water, weak claret and water, and weak porter and water. I metered my- felf as much as poflible from the rays of the fun, and from the action of the evening air, and accommo- dated my drefs to the changes in the temperature of the atmofphere. By fimilar means, I have rea- fon to believe, many hundred people efcaped the difeafe who were conftantly expofed to it. There appears to be no combination of climate and miaf- mata that can refill the good effects of abftinence or depleting medicines in preventing, or moderating an attack of this fever. Of this Dr. Borland of the Britifh military hofpitals in the Weft Indies has lately furnifhed me with the following proof. " In " the beginning of Augufl 1797 (fays the Doctor <c in a report which he politely put into my hands) u 109 Dutch artillery arrived at Port-au-Prince in " the Bangalore tranfport. The florid appearance Cf of the men, their heavy cumberfome cloathing, " and the feafon of the year, feemed all unfavour- " able omens of the melancholy fate we prefumed " awaited them. It was however thought a favour- " able opportunity by Dr. Jackfon and myfelf to
" try
40 AN ACCOUNT OF THE
" try what could be done in warding off the fever. " It was accordingly fuggefled to Monfieur Con- " turier the chief furgeon of the foreign troops, " and the furgeon of the regiment, that the whole " detachment fhould be blooded freely, and that the " morning after a dofe of phytic fhould be admini- " flered to every man. This was implicitly complied " with in a day or two after, and at this moment in " which I write, ^although a period of four months " has elapfed, but two of that detachment have died, " one of whom was in a dangerous date when he " landed. A fuccefs unparalleled during the war in " St. Domingo ! It is true feveral have been attack- " ed with the difeafe, but in thofe, the fymptoms " were lefs violent, and readily fubfided by the early w ufe of the lancet.
" The crew of the Bangalore on her arrival at ce Port-au-Prince confuted of twenty eight men. " With them no preventive plan was followed : in a " very few weeks eight died, and at prefent, of the " original number but fourteen remain."
I met with one inftance in which a light attack of the fever was excited by the breath of a perfon who was infected, but in whom the difeafe had not made its appearance.
One
BILIOUS YELLOW FEVER IN 1797. 4!
One of my patients who was under a falivation wafhed his mouth with milk, and difcharged it into a bafon. Two cats licked up part of this milk. They both fickened immediately, with the fymptoms of fever. One of them died on the 4th and the other on the 7th day afterwards.
The number of deaths by the fever in the months of Augufl, September and October, amounted to be- tween ten and eleven hundred. In the lift of the dead were nine practitioners of phyfic, feveral of whom were gentlemen of the mod refpeclable cha- racters. This number will be thought confiderable when it is added, that not more than three or four and twenty phyficians attended patients in the dif- eafe. . Of the furvivors of that number, eight were affected with the fever. This extraordinary mortal- ity andficknefs among the phyficians, muftbe afcrib- ed to their uncommon fatigue in attending upon the lick, and to their inability to command their time, and labours, fo as to avoid the exciting caufes of the fever. Among the medical gentlemen whofe deaths have been mentioned, was my excellent friend Dr. Nicholas Way. I fhall carry to my grave an affectionate remembrance of him. We paffed our youth together in the ftudy of ni cine, and lived to the time of his death in the 1 bits of the tenderefl friendfnip. In the year 1
4- AN ACCOUNT OF THE
he removed from Wilmington, in the Delaware ftate, to Philadelphia, where his talents and man- ners foon introduced him into extenfive bufinefs. His independent fortune furnifhed his friends with arguments to advife him to retire from the city upon the firft appearance of the fever. But his humanity prevailed over the dictates of intereft, and the love of life. He was active and intelligent in fuggefting and executing plans to arreft the pro- grefs of the difeafe, and to leffen the diftreffes of the poor. On the 27th of Auguft he was feized, after a ride from the country in the evening air, with a chilly fit and fever. I faw him the next day, and advifed the ufual depleting remedies. He fub- mitted to my prefcriptions with reluctance, and in a fparing manner, from an opinion that his fever was nothing but a common remittent. To enforce obe- dience to my advice, I called upon Dr. Griffiths to vifit him with me. Our combined exertions to overcome his prejudices againfl our remedies were ineffectual. At two o'clock in the afternoon, on the fixth day of his difeafe, with an aching heart I faw the fweat of death upon his forehead, and felt his cold arm without a pulfe. He fpoke to me with difficulty : upon my rifmg from his bed fide to leave him, his eyes filled with tears, and his countenance fpoke a language which I ftill feel, but am unable to defcribe. I promifed to return in a fhort time,
with
BILIOUS YELLOW FEVER IN 1797. 43
with a view of attending the lafl fcene of his life. Immediately after I left his room, he wept aloud. I returned haftily to him, and found him in convul- fions. He died a few hours afterwards. Had I met with no other affliction in the autumn of 1797 than that which I experienced from this affecting fcene, it would have been a fevere one, but it was a part only of what I fuffered from the death of other friends, from the malice of enemies, and from the complicated diftrefles of my family. I beg the reader's pardon for this digreflion. It mall be the only time, and place, in which any notice mall be taken of my forrows and perfecutions in the courfe of this publication.
It remains now to mention the origin of the fe- yer.
Soon after the citizens returned from the coun- try, I rece ved the following letter from the gover- nor of the ftate.
" Letter
44 AN ACCOUNT OF THE
<( Letter from Thomas Mifflin, Efq. Governor of the State of Pennfylvania, to Dr. Benjamin- Rush.
u Philadelphia, 6th November, 1797. " Sir,
cc I am defirous to obtain, for the infor- mation of the Legiflature, the moil correct account of the origin, progrefs, and nature of the difeafe that has recently afflicted the city of Philadelphia, with a view that the moil efficacious fteps fhould be taken to prevent a recurrence of fo dreadful a calamity. I have requefted the opinion of the college of phy- licians on the fubjecl: ; but, as I underftand that you and many other learned members of the faculty do not attend the deliberations of that inftitution, the refult of my inquiries cannot be perfectly fatisfac- tory without your co-operation and affiftance. Per- mit me, therefore, Sir, to beg the favour of you, and of fuch of your brethren as you fhall be pleafed to confult, to ftate, in anfwer to this letter, the opinion which your refearches and experience have enabled you to form on the important object of the prefent inveftigation.
I am refpectfully, Sir, Your moil obedient Humble fervant, THOMAS MIFFLIN." " Dr. Benjamin Rush."
To
BILIOUS YELLOW FEVER IN 1 797. 45
To this letter the following anfwer was fent, fubfcribed by thirteen of the phyficians of the city.
" Sir,
" IN compliance with your requeft, the fubfcribers have devoted themfelves to the invert le- gation of the origin, progrefs, and nature of the fever which lately prevailed in our city, and we have now the honor of communicating to you the refult of our inquiries and obfervations.
" We conceive the fever which has lately prevail- ed in our city, commonly called the yellow fever, to be the bilious remitting fever of warm climates ex- cited to a higher degree of malignity by clrcuitt- rtances to be mentioned hereafter.
" Our reafons for this opinion are as. follows z
cc I. The famenefs of their origin ; both being the offspring of putrefaction. Of this there are many proofs in the hiftories of the yellow fever in the Weft Indies. Where there is no putrefaction, the Weft India iflands enjoy a perfect exemption from that difeafe in common with northern climates.
Ci II. The yellow fever makes its appearance in thofe months chiefly in which- the bilious fever pre- vails
4<5 AN ACCOUNT OF THE
vails in our country, and is uniformly checked and deftroyed by the fame caufes, viz* heavy rains and
froils.
" III. The fymptoms of the bilious and yellow fever are the fame in their nature. They differ only in their degree. It is noobje&ion to this affer- tion that there is fometimes a deficiency or abfencc of bile in the yellow fever. This fymptom is the effect only of a torpid ftate of the liver, produced by the greater force of the difeafe acting upon that part of the body. By means of depleting reme- dies this torpor is removed and the difeafe thereby made to affume its original and fimple bilious cha- racter.
" IV. The common bilious and yellow fever often run into each other. By depleting remedies the mod malignant yellow fever may be changed into a common bilious fever, and by tonic remedies, im- properly applied, the common bilious fever may be made to affume the fymptoms of the mofl malignant yellow fever.
a V. The common bilious and yePow fevers are alike contagious, under certain circumftances of the weather and of predifpofition in the body. That the common bilious fever is contagious, wc
affert
BILIOUS YELLOW FEVER IN 1797. 47
aflert from the obfervations of fome of us, and from the authority of many phyficians, who have long commanded the higheft refpect in medicine.
" VI. The yellow and mild bilious fevers mutu- ally propagate each other. We conceive a belief in the unity of thefe two ftates of fever, to be deeply in- terefting to humanity, inafmuch as it may lead pa- tients to an early application for medical aid, and phyficians to the ufe of the fame remedies for each of them, varying thofe remedies only according to the force of the diforder. It is nu ubjc&ion to this opinion, that that ftate of bilious fever called the yellow fever, is a modern appearance in our coun- try. From certain revolutions in the atmofphere as yet obferved only, but not accounted for by phy- ficians, difeafes have in all ages and countries alter- nately rifen and fallen in their force and danger. At prefent a conftitution of the atmofphere prevails in the United States which difpofes to fevers of a highly inflammatory character. It began in the year 1793. Its duration in other countries has been from one to fifty years. It is not peculiar to the common bilious fever to have put on more in- flammatory fymptoms than in former years. There is fcarcely a difeafe which has not been affected in a fimilar way by the late change in our atmofphere, and that does not call for a greater force of deplet- ing
4$ AN ACCOUNT OF THE
ing remedies than were required to cure them be- fore the year 1793.
" VTL And Lastly. The yellow fever affects the fyftem more than once, in common with the bilious fever. Of this there were many inftances during the prevalence of our late epidemic.
" The fever which lately prevailed in our city, appears from the documents which accompany this letter, to have been derived from the following fources.
<c I. Putrid exhalations from the gutters, ffiree&j ponds, and marlhy grounds in the neighbourhood of the city. From fome one of thefe fources we derive a cafe attended by Dr. Caldwell on the 9th o*f June — one attended by Dr. Pafcalis on the 2 2d July, and two cafes attended by Dr. Riifh and Dr. Phyfick on the 5th and 15th of the fame month ; and alfo moft of thofe cafes of yellow fever, which appeared in the northern parts of the city, and near Kenfington bridge, in the months of Augufl, Sep- tember and October. We are the more fatisfied of the truth of this fource of the fever, from the nu- merous accounts we have received of the prevalence of the fame fever, and from the fame caufes, dur- ing the late autumn in New York, and in various
parts
BILIOUS YELLOW FEVER IN 1 797. 49
parts of New Jerfey, Pennfylvania, Maryland, Vir- ginia, and South Carolina, not only in fea ports, but inland towns. The peculiar difpofition of thefe exhalations to -produce difeafe and death, was evin- ced early in the feafon by the mortality which pre- vailed among the cats, and during every part of the feafon, by the mortality which prevailed in many parts of our country among horfes. The difeafe which proved fo fatal to the latter animals, is known among the farmers by the name of the Tellow Water. We conceive it to be a modifica- tion of the yellow fever.
cc II. A fecond fource of our late fever appears to have been derived from the noxious air emitted from the hold of the fnow Navigation, capt. Linflroom, which arrived with a healthy crew from Marfeilles on the 25th of July, and difcharged her cargo at Latimer's wharf after a paffage of eighty days. We are led to afcribe the principal part of the dif- eafe which prevailed in the fouth end of the city to this noxious air, and that for the following rea- fons :
" 1. The fever appeared firfl on board this veffei and in its neighbourhood, affecling a great number of perfons nearly at the fame time, and fo remote from each other that it could not be propagated by
contagion*
<i
There
50 A ^ACCOUNT OP TH2
1 tr^ft frjFQherc was in the hold of this veffel a quant!- tf"&P ¥%etabj^ijfiatter55 fuch as prunes, almonds, $r*u olives, .cstt^te^and feveral other articles, fome of 'ere 1a a itate of putrefa&ion.
cc 3. A moft offenfive fmell was emitted from this veffel, after fhe had difcharged her cargo, which was perceived by perfons leveral hundred feet from the wharf where (lie was moored.
" 4. A fimilar fever has been produced from fimi- !ar caufes, in a variety of inftances : we fhall brief- ly mention a few of them.
c: At Tortofc, a fever was produced in the month of June, in the year 17S7, on board the fhip Bri- tannia, capt. James Welch, from the noxious air generated from a few bufhels of potatoes, which deftroyed the captain, mate, and mod of the crew, in a few days.
" Two failors were affected with a malignant fe- ver, on board the , capt. Thomas Egger, in the
month of March, 1797, from the noxious air pro- duced by wine that had putrefied in the hold of the fhip, one of whom died foon after her arrival at Philadelphia.
" In the month of June, 1793, the yellow fever was generated by the noxious air of fome rotted
bags
BILIOUS YELLOW FEVER IN 1797. 51
bags of pepper on board a French Indiaman, which was carried into the port of Bridgetown, by the Britifh letter of marque Pilgrim. All the white men, and mofl: of the negroes employed in remov- ing this pepper, perifhed with the yellow fever, and the foul atmofphere affected the town, where it proved fatal to many of the inhabitants.
cc On board the Bufbridge Indiaman, a yellow fe- ver was produced in the month of May, 1792, on her paffage from England to Madras, which affect- ed above two hundred of the crew. It was fuppof- cd to be derived from infection, but many circum- flances concur to make it probable that it was de- rived from noxious air. The abfence of fmell in the air does not militate againft: this opinion, for there are many proofs of the mod malignant fe- vers being brought on by airs which produced no impreffion on the fenfe of fmelling. This is more frequently the cafe when the impure air has paffed a considerable diftance from its fource, and becomes diluted with the purer air of the atmofphere.
" Several cafes are related by Dr. Lind, in his treatife upon Fever and Infection of the Yellow Fever, originating at fea under circumftances which forbade the fufpicion of infection, and which can only be afcribed to the impure air generated from putrid vegetables,
E.3 " So
AN ACCOUNT OF THS
c:
So well known, and fo generally admitted is this fource of yellow fever in warm climates, that Dr. Shannon, a late writer upon the means of prevent- ing the difeafes of warm climates, in enumerating its various caufes, exprefsly mentions " the putrid " effluvia of a ihip's hold."
" We wifti due attention to be paid to thefe facts, not only becaufe they lead to the certain means of preventing one of the fources of this fever, but becaufe they explain the reafons, why failors are fo often its firit victims, and why from this circum- fiance the origin of the difeafe has been fo haftily, but erroneouily, afcribed folely to importation.
" The fever which prevailed along the fhore of the Delaware, in Kenfmgton, and which proved fatal to Mr. Jofeph Bowers and two of his family, wc believe originated from the noxious air emitted from the hold of the fhip Huldah, capt. Wm. Warner. This air was generated by the putrefaction of cof- fee, which had remained there during her voyage from Philadelphia to Hamburgh, and back again. *
" In the courfe of our inquiries, we were led to fufpect. one fource of our late fever, to be of foreign origin. The fails of the armed fhip Hinde, on
board
** Sec Appendix, letter A.
SILIOUS YELLOW F£Y£Jt IN 1797. $$
board of which feveral perfons had died of the yel- low fever, on her paffage from Port-au-Prince, and which arrived on the 4th of Augufl, were fent to the fail ftore of Mr. Moyfe. Four perfons belong- ing to the loft were foon afterwards affected with fymptoms of a bilious yellow fever. We mail not decide pofitively upon the origin of the fever in thefe cafes •> but the following facts render it probable that it was not derived from the perfons who had died of it on board the fufpefted veiTel.
" 1. The fails emitted an offenfive fmell ; 2. three of the cafes of the perfons affected fn the fail loft were of a mild grade of the fever ; 3. the fever was not propagated by contagion from any one of them ; 4. the fail loft was within the influence of the noxious air, which was emitted from the hold of the fnow Navigation, being not more than fifty yards, and was in the direction of the wind which blew at that time over her. The extent of this air has not been accurately afcertained^ but many analogies gave us reafon to believe lhat it may be conveyed by the wind, in its deleterious Rate, from half a mile, to a mile.
" In fupport of the opinion we have delivered cf the origin of our late fever, we mud add further, that in that part of the city which lies between
Walnut
54 AN ACCOUNT OF THE
Walnut and Vine fbreets, and which appeared to be free from the effects of exhalation and the noxious air of the mips, there were but few cafes of the fever which appeared to fpread by contagion, even under the moil favourable circumftances for that purpofe.
<f Having pointed out the nature and origin of our late fever, we hope we fhall be excufed in men- tioning the means of preventing it in future. Thefe are,
" First, A continuance of the prefent laws for preventing the importation of the difeafe from the Weft Indies, and other parts of the world where it ufually prevails.
" Secondly, Removing all thofe matters from our flreets, gutters, cellars, gardens, yards, ftores, vaults, ponds, &c. which by putrefaction in warm weather afford the mod frequent remote caufe of the difeafe, in this country. For this purpofe we recommend the appointment of a certain number of phyficians, whofe bufinefs it mail be to infpect all fuch places in the city, the Northern Liberties and Southwark, as contain any matters capable by putrefaction of producing the difeafe, and to have them removed,
" Thirdly,
BILIOUS YELLOW FLVER IN I Jij]:. 55
w; Thirdly, We earneftiy recommend the fre- quent wa filing of all impure parts of the city in warm and dry weather, by means of the pumps, until the water of the Schuylkill can be made to wafli all the fireets of the city ; a meafure which we conceive promifes to our citizens the mod durable exemption from bilious fevers of all kinds, cf do- meftic origin.
" Fourthly, To guard againft: the frequent fource of yellow fever from the noxious air of the holds of fliips, we recommend the unlading all fhips, with cargoes liable to putrefaction, at a di- fiance from the city, during the months of June, July, Aug lift, September and October. To pre- vent the generation cf noxious air in the fliips, we conceive every vefTel fliould be obliged by law to carry and ufe a ventilator, and we recommend in a particular manner the one lately contrived by Mr. Benjamin Wynkoop. — We believe this invention to be one of the moft important and ufeful, that has been made in modern times, and that it is calcu- lated to prevent not only the decay of mips and cargoes, but a very frequent fource of pefti. lential difeafes of all kinds^ in commercial cities.
" In thus deciding upon the nature and origin of our late fever, we expect to adminifter confolation
to
$6 AN ACCOUNT OF THE
to our fellow citizens upon the caufe of our late calamity ; for in pointing out its origin to the fenfes, we are enabled immediately and certainly to pre- vent it. But while the only fource of it is believ- ed to be from abroad, and while its entrance into our city is believed to be in ways fo numerous and infidious, as to elude the utmoft pofiible vigilance of health officers, we are led in defpair to confider the difeafe as removed beyond the prevention of human power or wifdom. It has been by adopting meafures, fimilar to thofe we have delivered for pre- venting peftilential difeafes, that mod of the cities in Europe, which are fituated in warm latitudes, have become healthy in warm feafons, and amidfl the clofeft commercial intercourfe with nations and iflands conflantly airlifted with thole difeafes. The extraordinary cleanlinefs of the Hollanders was ori- ginally impofed upon them, by the frequency of peftilential fevers in their cities. This habit of cleanlinefs has continued to characterize thofe peo- ple, after the caufes which produced it, have pro- bably ceafed to be known,
" In thus urging a regard to the domeflic fources of the yellow fever, we are actuated by motives of a magnitude far beyond thofe which determine or- dinary queftions in fcience. Though we feel the flrongeft conviction that the value of property, the
increafe
BILIOUS YELLOW FEVER IN I jgj. §J
mcreafe of commerce and 'he general profperity of our city, will be eminently forwarded by the adop- tion of the foregoing proportions, yet thefe are but little objects in our view, when compared with the prevention of the immenfe mafs of diftrefs, which never fails to accompany a mortal epidemic. We confider ourfelves moreover as deciding upon a queftion, which is to affect the lives and happi- r.efs, not only of the prefent inhabitants of Phila* delphia, but of millions yet unborn, in every part of the globe.
" We are with the greatefl refpect, Sir,
Your very humble fervants, BENJAMIN RUSH, CHARLES CALDWELL, WILLIAM DEWEES, JOHN REDMAN COXE, PHILIP SYNG PHYS1CK, JAMES REYNOLDS, FRANCIS BOWES SAYRE, JOHN C. OTTO, WILLIAM BOYS, SAMUEL COOPER, JAMES STUART, FELIX PASCALIS, JOSEPH STRONG." Dec. i; 1797.
5^ AN ACCOUNT OF THE
A few day9 after the publication of this letter, the following memorial, and narrative of facts, were prefented to the legillature of Pennfylvania by the college of phyflcians.
MEMORIAL OF THE COLLEGE OF PHTSICIANS.
ct To the Senate and Houfe of Reprefcntatives of the Commonwealth of Pennfylvania, the Memorial of the College of Pbyficians of Philadelphia ref peel- fully reprefents :
<c THAT your memorialifls, deeply affect- ed with the calamities produced by the difeafe which has recently occurred amongft us, are impelled by a fenfe of duty to their fellow citizens and themfelves, to inform yon, that they confider the laws which were enacted for the purpofe of preferving this city from malignant, contagious diforders, as very im- perfect.
" The fubject being of immenfe importance, they hope to be excafed for {taring their fentiments with refpect to it at large.
" They are of opinion, that the difeafe which produced fo much mortality and diilrefs in the year
*793*
BILIOUS YELLOW FEVER IN 1 797. 59
1 793, "was imported into this city from the Wert: Indies ; and they are confirmed in this fentiment, by the circumftances attending the difeafe of this year, which they confider as of the fame nature, and derived from the fame fource.
" Some of their moft important reafons for this opinion, are as follow : — The difeafe in queftion is effentially different from the fevers that occur in this climate, and which originate from domeftic caufes. This difference particularly regards the ge- neral progrefs of the fymptoms, and the mortality, as is evident upon a comparifon of its hiftory with that of the ordinary difeafes of this city.
M A difeafe which refembles the fever of 1793 and of this year, in many important points, has long been known in the Weft Indies, and thofe parts of America fituated between the tropics ; and in fe- ven or eight different inftances in which a fimilar difeafe has occurred in the United States, in the courfe of this century, there is good reafon to be- lieve that it was derived from thofe countries. In moft of the inftances, the original hiftory of the difeafe contains the information that it was import- ed. In feme cafes, the infection can be traced to the imported clothing of perfons who died in the Weft Indies. In moft of the cafes where the im- portation
Go AN ACCOUNT OF THE
portation cannot be afcertained, the firft appearance of the difeafe has been, as in the other inftances, in the neighbourhood of the (hipping, or among perfons connected with vefTels,
cc The circumftances attending the fever of this year are extremely in point; and the narrative which accompanies this, will, we truft, fatisfy you that it was imported.
cc The difeafe in queftion, commences invariably in our fea-ports, while inland towns, equally expofed to the ordinary caufes of fever, efcape ; and in the two laft inftances of its occurrence in Philadelphia, the fuburbs and the country adjacent, were more healthy than ufual at the fame feafon ; and at the commencement of the difeafe, all the parts of the city, excepting the fmall fpaces to which it was confined, were remarkably healthy.
" It exifts in the Weft Indies, particularly in time of war, when great numbers of ftrangers are to be found there ; and reference to dates will fliew, that in mofl: of the inftances of the occurrence of the difeafe in the United States, there has been war in the Weft Indies,
" Your
BILIOUS YELLOW FEVER IN 1797. 6l
" Your memorial iffcs are aware, that cafes may be adduced where the difeafe has occurred in perfons, who were not known to have been expofed to im- ported contagions, but fuch is the fubtile nature of this power, that it often exifls unfufpe&ed ; and fimilar difficulties occur refpe&ing the fmall-pox, and other contagions, allowed by all to be of fo- reign origin. There alfo occur, although very rare* ly, folitary cafes of malignant remitting fevers, the, fymptoms of which refemble fo much the difeafe. in queftion, that they are often fuppofed to be the fame ; but there is this elfential difference, that a malignant remittent fever has never been to oun knowledge contagious in this climate.
" The difference of fentiments among phyficians* now fo much regretted, refembles that which almofl always takes place, when the plague .is introduced into any of the civilized parts of Europe, where it is not well known. The identity of the difeafe, its origin and its contagious nature, have been often the fubjeft of controverfy. Some phyficians have confidered it as of domeftic origin ; but proper health laws, ftri&ly enforced, have latterly protect- ed the commercial parts of Europe from its ravages.
" With thefe fentiments of the nature of the dif- eafe, your memorialifts cannot but regard a proper
law
62 AN ACCOUNT OF THE
law refpecting the fubject, as a matter of the great- eft importance, and although they are perfectly fenfible of the imperfection of the fcience of medi- cine, yet from a conviction that phyficians are the beft informed, as well as the mod interefted in the fubject, they approach you with that refpect which is due to your legiflative authority, and declare their belief, that the exifting health laws of this Commonwealth are not fuch as are beft calculated to obtain the defired end, and that they ought to be improved.
" Having lately communicated in writing to the governor their ideas refpecting the beft methods of preventing the introduction of contagious difeafes, they beg leave to refer you to that communication. At the fame time they tender you their profcflional aftiftance in .framing an efficient law for this pur- pofe ; and thus having performed their duty, they hold themfelves difcharged from all refponfibility, on account of the evils which may arife from the prefent imperfect ftate of the legiflative arrange- ments refpecting this important fubject.
By order of the College, Attest, JOHN REDMAN, Prefident."
" Thomas C. James, Secretary."
" Philadelphia, Dec. 5//;, 1797."
" Narrative
BILIOUS YELLOW FEVER IN 1/97- 63
u Narrative of fads relative to the probable origin, and prcgrcfs, of the malignant contagious fever which lately appeared at the junction of Penn and Pine flreets.
" THE fliip Arethufa, Captain Keith, fail- ed about June i, 1797, from Port Royal in Jamaica for the Havannah, with flaves ; during the paiTage two men died with a fever, which Mr. Stephen King- flon, a gentleman of this city, who was a paffenger on board, and has frequently feen the difeafe, believe* to have been the yellow fever, one having the black vomit. After remaining fome days at the Havannah, the veiTel proceeded for Philadelphia, and arrived in the ftream oppofite to Pine ftreet, July 23, 1797. At the capes of Delaware fhe took on board a pilot, and performed a quarantine of five days at State Ifland. The pilot was at- tacked with a fever, the day of their arrival at the city, and went on more the fame day, when he was vifited by Dr. Currie, who has been much converfant with the yellow fever, and was fo fenfi- ble of the refemblance of his fymptoms to thofe of that difeafe, that he mentioned the cafe as fufpici- ous, to one of his friends.
<c The Arethufa was moored at Mr. Jofeph Ruf- fell's wharf, putfide of two veffels which lay there
when
64 AN ACCOUNT OF THE
■when (he arrived, her crew left her immediately af* ter ftie was moored, and the next day returned for their clothing, &c. when they croffed and re- croiTed the above mentioned mips. Two boys on- ly and the captain (who was on board occafionally) compofed the crew of the outermofl (hip, or that immediately contiguous to the Arethufa ; but the innermost vefTel, the brig Iris from Oporto, had a crew of the ufual number. On the twenty-ninth day of July, five men of this crew were taken ill with fever, and attended by Dr. J. Stuart, who ftates in his report to the College of Phyficians, that the fymptoms were fimilar in all, tho' varying in the degree of violence ; four of thefe recovered, but one died with unequivocal marks of the malig- nant yellow fever. A fervant of George Lati- mer, Efq. who lived about 100 yards to the north of this vefTel, and was frequently on the wharves, was attacked, July 30th, with a fever which wa3 highly contagious and malignant, of which he died in a few days.
" Mr. N. Lewis, who kept a compting room which was about the fame diftance from the Arethufa, was attacked about the fame time, and died alfo in five days, of a fever which was fuppofed to be of the fame nature.
Mr,
BILIOUS YELLOW FEVEk IN 1 797. 65
" Mr. Dominick Joyce, who was much engaged on board a fliip near the Arethufa, was attacked, Auguft 3d, with a fever of the fame kind, but re- covered. A man who lived in a ftore on the fouth fide of Pine ftreet, about 150 yards from the river, was attacked with a malignant fever about this time, and died in a few days.
" About the 6th of Auguft, Mr. Fergufon, whofe yard adjoined the wharf where the Arethufa and Iris lay, was attacked with a malignant fever> and the fame day Mr. John Plankinghorn's girl, who lived nearly oppofite to Mr. Fergufon's acrofs Penn ftreet, and worked in a yard which was fituated very near to the above mentioned ftore in Pine ftreet, was alfo attacked with fever, they both died on the fifth or fixth day after the attack, Mrs. Fergufon with very fufpicious, and Mr. Planking- horn's girl, with complete and unequivocal fymp- toms of the yellow fever. In this manner the dif- eafe continued to fpread, fo that by the middle of Auguft, or within three weeks from the arrival of .the Arethufa, above ten perfons had died, who either lived or were engaged in bufinefs within 300 yards of the Arethufa, and this at a time when the other parts of the city were fo healthy, that it is probable all the other deaths which occurred in it were not equal in number to. thofe which oc-
F curred
66 AN ACCOUNT OF THfc
curred in this finall diftrich After this the difeafc gradually extended itfelf to Southwark, and at the fame time became thinly fcattered through the city, where its deilru&ive effects are but too well known.
December 26th, 1797.
Fads relative to the fickly state of the/hip Hind.
" It appears from the depofitions of Francis Tow, Nicholas Benfon, and William Cooper, feamen on board the armed fhip Hind, taken before chief juflice M'Kean, that about the beginning of July 1797, the Hind failed from Port-au-Prince, bound to Philadelphia, with a cargo of fugar and coffee, and with 43 paffengers ; of which number 23 were whites and twenty coloured perfons, that they touch- ed at Cape Nichola Mole, where they remained eight days and difcharged a part of their cargo, in lieu thereof taking in a quantity of ftone ballad ; during the time they lay at the Mole the paffengers were occafionally on fhore. It would appear that they left the Mole between the 12th, and 15th, of July, and arrived at this port, after a paffage of twenty or twenty-one days. About three or four days after their departure from the Mole, five or fix white perfons and one negro of the paffengers were attacked with fever, the white perfons fo at- tacked
BILIOUS YELLOW FEVER IN 1 797. 6 J
tacked were obferved to become very yellow. Dur- ing the paffage four other coloured perfons and five of the crew fell ill of fever : one or two of the latter number, after the vefTel entered the capes of Delaware ; but only a coloured boy and child died during the paffage, and were thrown overboard af- ter the vefTel entered the riv\Tr. Upon the arrival of the vefTel oppofite to the Marine Hofpital', in confequence of orders from the captain, four fick perfons were fecreted and did not come under the infpection of the Phyfician of the Port ; excluiive of thefe, two women were fick in the cabin. Af- ter pafTing the Fort one of the feamen was taken ill, went on fhore, and was afterwards carried to the Marine Hofpital ; and two other perfons were taken on fhore fick. So far go the depofitions.
" From information obtained from the Health Of- fice, it appears, that the Hind was examined at the Fort on the 2d, and arrived at Philadelphia on the 4th of Auguft ; and that Mr. Doughty, one of? the Infpe&ors of the Health Office, fent to the Marine Hofpital on the 13th of Auguft., Peter Malofio, one of the crew of the Hind then redding in Love Lane, and on the 14th a Portuguefe from near the junction of Penn and South ftreets, who had been landed there ; and that another perfon was fick of a fufpicious fever at Mrs. O'Connor's,
F 2 ia
<58 AN ACCOUNT OF THE
in Almond near Front flreet. Both thefc were from on board the Hind, and the Portuguefe above-mentioned had been vifited by Dr. Currie, who declares his difeafe to have been yellow fever.'*
To thefe publications, the following reply was addreffed to the Gove nor of the fiate.
<c Letter from the Academy of Medicine to Tho- mas Mifflin, Efq. Governor of the State of Perm* fylvania.
Sir,
" THE Phyficians, who anfwered your letter of the fixth of November, respecting the ori- gin and nature of the epidemic fever which lately prevailed in the city of Philadelphia, having, with others of their medical brethren, affociated them- felves under the name of " The Academy of Medi- cine of Philadelphia," beg leave, in that capacity, to addrefs you again upon the interefting fubject of the faid letter.
" The academy have feen, with regret, a memori- al, from the college of phyficians of the city, to the le- giflature, accompanied with a" narrative of facts"
intended to cftablifh an opinion contrary to that,
which
BILIOUS YELLOW TEV2R IN 179/. ^9/
which the fubfcribers of the anfwer to your letter, conceive they had therein proved in the mod irrefra- gable manner.
" As the opinion appears to us replete with danger to the lives of our fellow citizens, and to the prof- perity of our city, we deem ourfelves bound by the principles of humanity, and the obligations of patri- otifm, to make a few remarks upon it ; and to fhew that it is founded upon partial inveftigations, and miflaken ideas of the nature of the yellow fever.
" The college have afcribed the origin of the late epidemic to the mips Arethufa, captain Keith, from Havanna, and Hind, captain Patot, from Port-au- Prince. The memorial fets forth that, " the fhip " Arethufa, capt. Keith, failed about the fird: of " June, from Port Royal in Jamaica, for the Ha- M vannah with flaves ; during the pafTage two men u died with a fever, which Mr Stephen Kingflon, a <c gentleman of this city who was a pafTenger on '• board, and has frequently feen the difeafe, be- " lieves to have been the yellow fever, one having the " black vomit." Admitting the fitft, which refh merely upon the belief of a perfon not medically edu- cated, yet the arguments hereafter to be adduced, it is prefumed, will deftroy the probability of its be- ing introduced by this fhip. That the ifland of Ja- maica
yO AN ACCOUNT OF THE
maica was healthy at the time the Arethufa failed, appears from the anfwers given by the captain of the faid mip, to the official interrogatories filed in the Health-Office relative to this fubjecl ; and from thofe of capt. Henry Latimer, of the brig Maria, who failed from the above port about the fame day. That the difeafe of which the men died was not contagi- ous is rendered probable by its not having fpread among the paifengers or crew who amounted to feven- ty, all of whom arrived in good health at the Ha- vanna on the 21ft of June. But fuppofmg the dif- eafe to have been of a contagious nature, the precau- tions taken after the deaths, would have been fuffi- cient to have defiroycd any remains of the contagion. From Mr. Brien's depoiition it appears, that " The Ci clothing, bedding and articles belonging to the cc deceafed were thrown overboard, and their births cc cJeanfed and well fprinkled with vinegar." And we are authorized furrher to afTert, that the ftiip underwent fuch a complete cleanfmg while at the Havanna, after landing the Haves, as prudence would dictate to a fhip-mafter, in every fimilar cafe. The fhip, moreover, after lying at the Havanna four- teen days, during which time all on board remain- ed well, arrived oppofite the Health-Office on State Ifland, on the eighteenth of July. During the whole of this paiTage her hatches were conftantly open, whereby the moil ample means for a free cur- rent
BILIOUS YELLOW FEVER IN 1797. 7*
rent of air were afforded, which could not fail to difiipate any remains of contagion which could poffi- bly have continued after her former purifications. The fhip performed five days quarantine oppofite the health-office, on State-Ifland, during which time the bedding was every day expofed upon deck and was once warned by a rain. The crew moreover remain- ed well, except the captain, who was affected with a rheumatifm, and the mate, with a lax, both of whom foon recovered. The pilot who conducted this fhip was attacked on the twenty-third of July, and allowing three days for the time he had been ex- pofed to the contagion before his fever appeared, there will remain forty-fix days from the time the fhip left Kingfton till her arrival in our river. From the known laws of the contagion of the yellow fever, and the diftance of time at which it ufually appears, after perfons have been expofed to the contagion, the academy conceive it fcarcely poffible, if any por- tion of contagion had been left by the before-menti- oned perfons, that it would have remained inactive for above forty-fix days, expofed as the crew were to the exciting caufes of fatigue, night watching and the viciflitudes of the weather. The perfect freedom from difeafe which all on board enjoyed, mud there- fore be admitted as a proof that no contagion did exifl, and confequently that the pilot and others could not have derived their difeafe from that fource.
The
72 AN ACCOUNT OF THE
" The college further (late that " the pilot was at-. " tacked with a fever, the day of his arrival with the " fliip at the city, and went on fhore the fame day, " when he was vifited by Dr. Currie, who has been " much converfant with the yellow fever,- and who " was fo fenfible of the refemblancc of his fymptoms " to thofe of that difeafe, that he mentioned the cafe " as fufpicious to one of his friends."
" In addition to the arguments, before adduced, for fuppofing that the pilot could not have taken his difeafe from any remains of contagion on board, the academy further remark, that the fource from whence he derived his difeafe was probably, and as he be- lieves, from a current of cold air during the night, while flecping in the open cabin of the fliip, after a warm day, which preceded that on which the quaran- tine of the fhip was ended. His indifpofition came on the next morning, and foon after his arrival in this city, a violent fever fucceeded, of a kind, which We every year obferve in Philadelphia, from fudden changes of the weather, in the fummer and autumnal months, and efpecially from fimilar expofure on the river. It may be added, that he was but a few days' confined, and that none of his friends who nurfed him, or others who daily vifited him were afFefted by him ; neither were there any precautions taken to avoid contagion, nor the leaft intimation of dan- ger
BILIOUS YELLOW FEVER IN I 797. 73
ger given to thofe who conftantly attended him. Under all the circumflances which have been men- tioned, it is impoflible to believe that the pilot's dif- cafe was derived from an imported contagion.
" The college in their memorial have infmuated that the crew of the brig Iris were infected with the yellow fever by the crew of the Arethufa palling acrofs her deck to the wharf. If this had been true or even poiTible, it mufl have been in one of the three following ways : ift. By the actual ficknefs of the crew ; 2d. By the contagion blowing off their clothes in pairing over the decks ; or 3d. By the contagion, which had adhered to the timbers of the Arethufa, being conveyed by the wind over two intermediate vefTels to the Iris.
" It is not pretended that any of the crew of the Arethufa were indifpofed, therefore the firft fuppofi- tion mufl be rejected. They could not have infect- ed the crew of the Iris in the fecond mode, becaufe it is not alleged that they flopped a moment when pairing over her deck. But admitting they did, it cannot be believed, that a difeafe could be convey- ed by their clothes, to the crew of the Iris in the open air, when it is well known, that thofe clothes when worn, and even warned in confined lodging houfes afterwards, did not infect a fingle perfon, in
any
74 ^N ACCOUNT OF THE
any part of the city. Lailly, it is highly impro- bable that the crew of the Iris could have been in- fected by the timbers of the Arethufa, becaufe, •we have no proofs that the contagion of the yellow fever ever adheres to wood ; but admitting this to be poffible, we reject the probability of it, becaufe, as we before obferved, the fhip had been well cleanfed and freely ventilated on her voyage from the Havannah to Philadelphia. We are the more difpofed to afcribe the deftruction of contagion, if any had exifled, to the pure air of the ocean, from having fo repeatedly obferved the effects of country air in weakening or deftroying it in the United States* The academy are moreover authorifed by Dr. Stewart to affert, that none of the family, with whom the five men of the Iris boarded, were infect- ed ; but that they preferved their health the whole lime of the prevalence of our late epidemic.
" As the Iris lay at Pine flreet wharf, and entire- ly within the limits of the exhalations from the fnow Navigation, to which we formerly referred, it is highly probable that they were infected thereby, and that the difeafe was excited by their intempe- rance in the ufe of Port wine, with which the brig was loaded, and by the practice of bathing them- felves in the river while under the influence of li- quor, and heated by labour. From this conduct it
is
BILIOUS YELLOW FEVER IN 1 797. 75
is conceived by the Academy, the peculiar violence of their difeafes can be accounted for, as a fimilar caufe is always ranked among the moil powerful, in the production of malignant cafes of bilious yellow fever ; and Dr. Stewart authorifes the Academy to alTert his belief, that the fever, in the cafes he com- municated to the college, proceeded from exhala- tion ; and he thinks mod probably, that of the fnow Navigation. *
" Two of the other perfons mentioned by the col- lege, viz. Mr. Lewis and Mr. Latimer's man, faid to have been infected by the Arethufa, were much nearer the fnow Navigation than the Iris was, and were expofed to the exhalation from the former veffel. With regard to Mr. Lewis, we fliall ob- ferve that he was abfent from the city when the Arethufa arrived, and did not return until fix days afterwards, which was on the thirtieth of July. On the flrd of Auguft, the day of his attack, it is known that he complained very much of the
flench
* Though at an early period of cur late epidemic, Dr. Stewart fufpe&ed that the crew of the brig Iris were infected by an intercourse with that of the ihip Arethufa, yet, a far- tlv.r inveftigation and afcertainment of facls, have fmce fatis- fisd him that this was not the cafe, but that they mod pro* bably, as above ftated, derived their difeafe from foul air iiTuing from the hold of the fnow Navigation.
yS AN ACCOUNT OF THE
flench of the fnow Navigation, which had now per- vaded the whole neighbourhood, and expreffed great concern at her being permitted to remain at the wharf. The Academy are authorifed, by Mr. Do- minick Jojxe, to exprefs his furprife at the affer- tion of his having taken his fever from the Arethu- fa ; for, though his bufmefs led him to the neigh- bourhood of that fhip, yet he was ftill within the fphere of the extent of the foul air from the fnow Navigation, and he acknowledges he was almoft every day upon the wharf at which this veflel lay, and from which he, in all probability, derived his difeafe.
" As all the other perfons whofe cafes are men- tioned by the college, lived within the extent of the exhalation from the fnow Navigation, there can be little doubt, but that they derived it from the fame air which affected the perfons, whofe names they have mentioned. It is remarkable, that the difeafe was in no inflance propagated from any of them.
" The academy have good reafon to believe, that the perfons who were indifpofed on board the armed fhip Hind, after her arrival, derived their difeafes from the noxious air of the fnow Navigation, in common with the perfons who were affected on board the Iris, and in the neighbourhood of Mr. I Latimer's
BILIOUS YELLOW FEVER IN 1797. 77
Latimer's wharf. It appears that none of them propagated the difeafe to any of their attendants in the city, or in the hofpital at State Ifland, to which place fome of them were fent. It is well known, moreover, that many citizens repeatedly vifited and fpent whole days on board this veflel, none of whom were indifpofed in confequence of it.
cc From the depofitions of the fupercargo and of the pilot of the Hind, it will likewife appear, that the whole of the teftimony of the three boys is dif- proved, except as to fome unimportant particulars.*
" We are unable to -give credit to the traditional rumours of the foreign origin of the yellow fever, in any part of the United States, inafmuch as from the inaccuracy of the few records which have been preferved, of the places from whence it was faid to be derived, and of the manner in which it wag faid to have been introduced into our country, we have reafon to conclude they were aiTumed with- out fufficient inveftigation. Had the proper fteps been taken at all times to invefligate its origin, if is probable it would have been difcovered, in moil cafes, to have been the offspring of domeftic pu- trefaction. We cannot clofe the arguments againfl
the
* See Appendix, (B.)
AN ACCOUNT OF THE
Mr
the importation of the yellow fever, without re- marking, that many recent facts and obfervations render it probable, that the reports of its contagi- ous nature have been exaggerated, and that it is not fo often propagated by contagion as has been fuppofed, more efpecially in warm weather, when- lick rooms are open night and day, to the conftant acceflion of frefli air.
" We obferve in the memorial of the college of phyficians an affertion, that the yellow fever " Is <c effentially different from the fevers that occur in " this climate, and which originate from domeftic " caufes :" but as no proofs are adduced in favour of that affertion, we fhall reft our opinion of the original famenefs of both thofe ftates of fever, upon the facts and arguments which were ftated in our , former communication. We fhall only obferve, that the idea maintained by the college, has been exploded by fome of the moft diftinguifhed writers upon tropical difeafes ; and by moft of the Ame- rican phyficians of the fouthern ftates, who con- ftantly confider and treat both the common bilious fever, and its higher grade, called yellow fever, as the fame difeafe, varying only in violence.
" The academy obferve alfo, with furprife, ano- ther affertion made by the college, that " The difeafe
" in
BILIOUS YELLOW FEVPR. IN 1797. J§
•c in queftion, invariably commences in our fea- ** ports, while inland towns, equally expofed to the " ordinary caufes of fever, efcape." To this we reply, it is well known, that in various parts of the United States, remote from fea-ports, precifely the fame difeafe, with all its chara&eriftic fymptoms., has frequently prevailed.
" The college in their narrative have taken no notice of the origin of the yellow fever in Kenfing- ton, nor at and near Red-Bank upon the eaftern fliore of the Delaware. Its origin in the former of thofe places from the noxious air emitted from the putrid coffee of the fhip Huldah, and in the latter from marfli exhalation, we conceive to be fully eftablifhed by the documents communicated in our appendix. * The college have alfo obferved a total filence in their report refpefting thofe cafes of yel- low fever, which appeared in our city, before the arrival of the Arethufa, Hind, or Navigation. Thefe cafes were evidently derived from fome of the numerous fources of exhalation, from putrid fubftances in and about the city. They were at- tended by Doctors Rufh, Phyfick, Caldwell, and Pafcalis.
« i&6
Sec Appendix (C.)
So AN ACCOUNT OF THE
cc We cannot take leave of this important fubjed without expreffing our earneft defire for its candid and clofe examination, by the legiflature of the ftate.
u Fa&s and arguments fimilar to thofe we have urged, have produced a conviction of the domeftic origin of the yellow fever, in Bofton, New York, Baltimore, Norfolk and Charleflon, and many of the other towns of the United States. This con- viction has been followed by meafures, in New York, which promife in future years an exemption from the diforder.
" With ardent wiflies for the prevalence of truth, upon this important fubjeel:, in the capital of the United States, we have the honor to add our mofl refpe&ful wifhes, for your health and happinefs.
Ctf Signed by order of The Academy of Medicine of Philadelphia*
" March 20, 1798.
PHILIP SYNG PHYSICK, Prefident. FRANCIS BOWES SAYRE, Secretary:9
" lo Thomas Mifflin, Efqr. Governor of Pennfylvania"
APPENDIX.
BILIOUS YELLOW FEVER IN 1797.- 8:
" Appendix.
(A)
" IN feveral interefting particulars, refpecl:- ing the origin of the epidemic of 1797, mifreprefen- tations of facts have much deceived the public mind. Thefe mifreprefentations, we believe to have been entirely the refult of an eafy credulity, difpofed to reft fatisfied with popular report, and not of any fettled intention to miflead. They have been mod ftriking and fallacious in the accounts propa- gated, refpecting the origin of the difeafe in Ken- fington, and at Red-Bank, on the Jerfey fhore of the river Delaware. * To be able the more effec- tually to counteract the pernicious influence of fuch. miftatements, the academy of medicine have found it neceiTary, to fet on foot particular inveftigations. The refult of thefe, they now beg permuTion to fubmit, in the form of a few documents, to the candid connderation of the public.
It
• On the fubjeft of the true fourca of the epidemic, in thefe two fituations, the public are by no means at prefent in pofTeflion of accurate information.
$2 AN" ACCOUNT OF T^E
" It is known to have been very generally report- ed, and aJmoft as generally believed, that the late epi- demic was introduced into Kenfmgton by Mr. John Brufter, who was faid to have received the infec- tion by going on board the armed fhip Hind, from Port-au-Prince. It is true, that Mr. Brufter was, at lead, among the firft (if not, indeed, himfelf the very firft) who was attacked by this difeafe in Kenfington, in the fummer of 1797; but that he could not poffibly have derived his illnefs from any intercourfe with the fhip Hind, is a truth unequi- vocally eftablifhed by the following documents, par- ticularly by the affidavit of Michael Lynn.
"DOCUMEN T.
66 Proofs of the difeafe, occurring from exhalation in Kenjingion ; from marfhy grounds ; and from the hold of a fhip, by Dr. Coxe.
" From the books kept at the Merchants' Cof- fee-houfe, it appears that the Britifh armed fhip, Hind, Francis Patot commander, from Port-au- Prince, was feen below the Fort on the 2d of Au- guft ; and at ten o'clock of the fame day fhe came within fight $ and lay off the Fort for examination.
" The
BILIOUS YELLOW FEVER IN 1 797. 83
u The ufual queftions were this day {26. of Aug.) propofed, by the health-officer, to the commander, as appears by the paper preferved on the files at the health-office in this city. She came up to the city on the 3d ; and entered at the health-office on the 4th of the month.
cc As no mention is made, previously, of her being feen in the river ; the probability is that fhe had a fpeedy paflage up the Delaware.
" The perfon who firft had the yellow fever in Kenfington, was a young man of the name of John Brufter. He is faid to have taken the difeafe by having been on board the Hind ; and through him, the fever was faid to have been introduced into Kenfington. Upon an examination into dates, this is altogether impoffible : Brufter died on the 2d of Auguft, after an illnefs of four days and four hours, according to his father's account, which brings the commencement of his attack to the 29th July, or four days previoujly to the arrival of the Hind at the Fort. Exclufively of this fact, I have added the affidavit of Michael Lynn, to prove that he did not go on board of any veilel in a voyage down the river to Reedy Ifland. Some other fource for his difeafe mud then be looked for ; and this I de- rive from the marffiy exhalations (arifmg from the
G 2 low
S4 AN ACCOUNT OF TH"
iow grounds and meadows on one or both fides of the river) to which he was expofed in his pafTage in a fmall fchooner, to and from "Reedy Iiland in the middle and clofe of July, aided by imprudent expofure, by fleepmg upon the wet detk of the veffel
" Wm. Reed, who died on the 5th of Auguft, after feven days illnefs, appears in all probability to have derived his difeafe from fome of the local fources which are numerous in and about Kenfing- ton ) although if common report had been credited, we mould have afcribed it to the picking up of a calk which was faid to have been thrown from the Hind. As, however, he died on the 5th, after feven days illnefs ; the (lory is altogether impofTible, as it brings die commencement of the difeafe to the 29th of July, or four day 3 preceding the ar- rival of the Hind. The fame fources, which in Kenfingtcn, commonly produce in the autumnal months, remittents and intermittents, have this fea- fon by the peculiar couftitutioii of the atmofphere, ("whatever that may be owing to) railed thofe drf- eafes to the more violent grade of yellow fever*
" To thefe local fources I would alio without hefi- ration afcribe many of thofe cafes which occurred
BILIOUS YELLOW FEVER IN 1 79;. 85
in Kenfington, and which were all aiTertcd to be traced to contagion.
" In that range of houfes, extending northward from the bridge over Kohockfmg creek, and to the weft of the main York road, not lefs than fix or feven people died of the yellow fever. Thefe houfes, it will be recoilecled, are bounded on the wed by that large portion of low marfliy ground to the northward of the bridge ; and from this abundant fource of exhalation, I think it mod rational to deduce the feeds of the fever which occurred there. And this is rendered much more probable by the collateral evidence, of the fame fever having exid- ed in the families of Mr. Boudinot and Mr. Learn- ing, near the Frankfort road, where low and marfliy grounds aiiord ample origin to thofe noxious miafmata which produce intermitting and remitting fevers. The draggling manner alfo, in which the difeafe occurred in Kenfmgton, renders it mere probable that it originated from local fources, than that it was introduced and fpread through the me- dium of contagion.
" The next perfons who were attacked in Ken- fmgton, were in the family of Mr. Jofeph Bowers. Thefe appear to have received the difeafe from the noxious miafmata originating in the hold of a fhip
called
85 AX ACCOUNT OP TH!
called the Huldah, which went up to Kenfington to
clear out at Mr. Bowers' wharf, after difcharging her cargo in this city. The following is the ftate- ment procured reflecting this fhip,
chiefly from the houfe of Summerl and Brown, to whom (he was cornigncd.
c: The Clip Huldah, captain William Warner, failed from this port for Hamburgh, on the 1 8th of October, 1796, laden with coffee, fugar, and furs. After landing her cargo, me does not appear to have cleared out her ballair, Sec. but failed from Hamburg for this place on the 1 ith of Apri], 1797, laden with hemp, iron, cordage, dry goods, glafs, and brandy, She arrived at New York on or about id day of July, where me difcharged 109 pipes of brandy. On the 15th, fhe failed for Phi-
[phia, and entered at the health-office on the 17th of the month, having 13 feamen on board in perfect health, which had been the cafe during the whole voyage of upwards of ninety days. She
harged her cargo at Vanrruxem's wharf, be- . tween Arch and Race ftreets, and on Sunday the 13th of Augufr, (he was carried to Mr. Bowers'
irf at Kenfington, by the mate and one of the failors, (jofeph Way of Wilmington, nephew to the late Br. Nicholas Way, of this city) affiled by Nicholas Painter of Kenfington. They proceed- ed
EILIOUS YELLOW FEVER IX IJQT. 87
cd to clear her out the following day, Auguil 14th. After getting through a quantity of (arid, which lay above the ballad, fo naufeous and offenfive a fmell proceeded from her, that the mate was indif- pofed for feveral days. Jofeph Way was obliged to lay by ; and after drooping ibme days, he went down to Wilmington, and there died, with a fevere attack of the yellow fever, on the fame day with his uncle, in this city, viz. on the 2d of Septem- ber.
" Nicholas Painter and Chriftopher Rufh, who affifted in cleaning her out, flood the eilecls of this exhalation till Wednefday, 16th of Augud ; when they were feized with violent head-ach, efpecially above the eyes ; ficknefs and vomiting, and pain of the back ; accompanied by fever. Rufh fays, he has never completely regained his health fince that period. He further fays, that the fmell of the hold of the Huldah was fo naufeous, that he could not get it out of his nofe for feveral days.
" Upon invefligation it appeared, that the fmell proceeded from a quantity of coffee, (which muft have efcaped during the voyage to Hamburgh) mixed with the bilge water and fand, and which was in the higheil ftate of vegetable puirefa-fiion ;
being
8$ AN ACCOUNT OF THE
being very black, and containing worms or mag- gots nearly two inches in length.
cc Mr. Jofeph Bowers' boy was the firir. of his fa- mily who was attacked. He worked in a fchooner which lay along-fide of the Huldah, and was feized on Tucfday, the 15th of Augud, and died on the 2 2d. Mr. Bowers himfelf feems to have received the feeds cf the difeafe on Tuefday, the 15th, at which time he was on board the Huldah, and no- ticed the very offenfive fmell proceeding from her hold. He fickened on the Sunday following, the 20th of Augud, and died on the 25th. A maid- fervant and two children alfo had the difeafe ; one of the children died. It is poflible that thefe lad, took the difeafe by contagion from Mr. Bowers or his boy ; though I think it more probable, that they derived it from the original fource, viz. the Blip's hold ; as the wharf is not very didant from the houfe, and as yet we know not the exact, limits to which thefe noxious miafmata may be carried, without lofing their baneful influence by dilution with the atmofphere.
Many cafes which occurred in Kenfmgton after this period, were, mod probably, derived from this fource. The accounts of them are altogether wrapt in doubt and fuppoiltion. Mod of them are faid to
have
BILIOUS YELLOW FEVER IN 1 797. 89
have taken it by contagion from others ; but this is rendered highly improbable by the very mode- rate degree in which this fever has evinced itfelf to be poflefled of a contagious power ; and more cfpecialiy in fo airy and extended a village as that of Kenfmgton.
" It would appear then, from the preceding pages, that the difeafe as it exifled in Kenfmgton, had three different fources, viz.
(C First ; By exhalation or marjh-ejflwu ia, derived from the low grounds on the banks of the Dela- ware ; as was the cafe with Bruster.
" Secondly; From exhalation or marfh-effluvia, derived from the local fources of low grounds in, and about Kenfmgton ; as evinced in thofe cafes which occurred in the range of buildings, to the weflward of the York road : and,
cc Thirdly ; From the exhalation or noxious effluvia, proceeding from putrefying vegetable mat- ter, in the hold of the fhip Huidah ; as in the cafes of Mr. Bowrers and his family, and perhaps in others.
The
90 AN ACCOUNT OF THE
" The difeafe, pofiibly, in forne few cafes fpread by contagion. King, a coffin-maker, who affiled in putting the dead into their coffins, may have de- rived his difeafe, of which he died, from this fource. It is however problematical ; for he was with others, expofed to thofe caufes which produ- ced it in them.
JOHN REDMAN COXE." " Philadelphia, Decern-^} ber i, 1797." 3
Affidavit of Chriftopher Rum.
«* County of Philadelphia^.
" Perfonally appeared before me, Peter Brown, one of the juftices of the Peace, in, and for the county aforefaid, Chriftopher Rulli ; and being du- ly fworn upon the holy evangelifts, did depofe, and fwear, that, in working on board the lhip, Huldah, at Jofeph Bowers' wharf, on the 14th of Auguft laft, he perceived a mofl oftenfive fmell on board the faid fliip, ariling from fome putrefied coffee in the hold of the fhip. That he, the faid Chriftopher Ru&, was made fick for feveral days
from
BILIOUS YELLOW FEVER IN 1 797. QX
from the faid fmell, as alfo were Nicholas Painter and Jofeph Way, who worked with faid Chriftopher Rufh on board the fhip Huldah. He depofeth fur- ther, that Jofeph Bowers and his man ware expofed to the faid fmell, from working and attending on board the faid fliip ; and further this deponent fay- cth not.
his " CHRISTOPHER C. R. RUSH, mark. " Taken and fubferibed before me1, this 30th day of November, 1797.
c- Signed, " fSeal) PETER BROWN."
A true copy, J. R. Coxe.
Affidavit of Michael Lynn.
" County of Philadelphia, Jf.
Ci Perfonally appeared before me the fubferiber, one of the Juflices of the Peace, in, and for the county aforefaid, Michael Lynn ; who being duly fworn upon the holy evangeliits, doth depofe and fay, that on the 17th day of July lad, he accompa- nied John Brufter from Kenfington, at which place
the
92 AN ACCOUNT OF THE
the deponent refides, down the river Delaware, in a fraall fchconer, and returned home on the 23d day of July, making an abfence of fix days ; during which time, neither the deponent nor the faid John Brufter was on board of, or along fide of, any fhip or veffel whatfoever ; and that on the Sunday fol- lowing, which was exactly one week after their re- turn, John Brufter was taken fick, and died the Thurfday following.
" Signed MICHAEL LYNN.
" Taken and fubfcribed before me, this 30th day of November, 1797, " Signed, « (Seal) ^ PETER BROWN."
A true copy, J. R. Coxe.
" Copied from the original documents, in the pof- feflion of the fecretary of the flate of Pennfylvania.
J. R. C.
u The academy of Medicine cannot do other wife than exprefs their furprife, that the College of phyfi- cians, in their refearches after the origin of our late epidemic, fhould have thought it neceffary to make the armed fhip Hind an object: of attention. It is a truth well known, that the fever had prevailed in our city feveral days previoufly to the arrival of that
veffel 1
BILIOUS YELLOW FEVER IN 1797. 93
veffel j and it is, in like manner, a truth which ought to be known, that none of thofe perfons fup- pofed to have been infe&ed by an intercourfe with her, communicated their difeafe to any of their vifit- tants or attendants. Where then, the academy would beg leave to aik, is even the fainted evidence, of the fhip Hind having been at all inftrumental, in the introduction of this difeafe ? There certainly ex- ifts none. Nor, in a candid inveiligation of the fubjecl, does there appear to be ground fufficient to authorife, even the mention of the name of this vef- fel.
M As the college of phyficians appear, however, by their late pamphlet, to have directed to the Hind, an undue (hare of public attention, it has become ne- ceifary to make their narrative refpecting her, a fub- ject of particular confideration. The only evidence of which that learned body are poffeffed, refpe&ing the fickly date of this veffel, is derived from the af- fidavits of three common mariners belonging to her crew ; two of whom were nothing more than boys. In oppofition to the evidence delivered in thefe affi- davits, we would here beg leave to fubmit to the public, the affidavit of the fupercargo of the Hind. The report, delivered in his depofltion, is farther corroborated by the joint teftimony of three other refpe&abk cbara&ers, on board the fame veffel.
From
p.£ AN ACCOUNT OF THE
From this document, it will at once appear, on how equivocal a foundation, the college have thought proper to reft this part of their inveftigation, refpeft- ing the origin of the difeafe in queftion.
" Affidavit of the Supercargo of the Hind,
" Perfonally, before me, Hilary Baker, Mayor of the city of Philadelphia, came Thomas Badaraque ; who being duly fworn, doth depofe and fay, that he was fupercargo of the {hip Hind, captain Patot,. from Port-au-Prince to Philadelphia, in the fummer of 1797. That they touched at Cape Nichola Mole, and five days after, a child, about fix months old, died from teething: that a negro boy, of about nine years of age, died of the fcurvy, the day be- fore the pilot came on board. That no other per- fons were fick during the voyage, except Mr. Cam- pan a paffenger, who had been indifpofed, before he came on board, with a lax, and other chronic complaints. That no orders were given to conceal any body, upon the arrival of the fhip, by the cap- tain, from the phyfician at the fort.
T. BADARAQUE.
Sworn, the 15th day of March, 1798, before me, HILARY BAKER, Mayor.
" The
EILIOUS YELLOW FEV£R IN 1797. 9^
*c The under-figned, paflengers on board the fliip Hind, at the time alluded to, having been duly fworn, do depofe and fay, that the facts above re- lated, by Thomas Badaraque, are juft and true.
MATHIEU DUPOTEE. PIER VIDAU. PONIMIER.
Sworn, the 15th day of March, 1798, before me9 HILARY BAKER, Mayor.
(C)
cl By fome, the yellow fever, which prevailed at or near Red-bank, is fuppofed to have originated from an imprudent communication with the (hipping in the river, while others alledge, that it was derived from an intercourfe with the city of Philadelphia. That both thefe allegations, however, are equally unfounded, is a truth, which the Academy of Me- dicine conceive to be fatisfa&orily efiablifhed by the following
" DOCUMENT, by Dr. Otto.
•* I do hereby certify, that I vifited the farms at and in the vicinity of Red-bank, fituated on the
eaftera
t)6 AN ACCOUNT OF THE
eaflern fliore of the Delaware, for the purpofe of inveftigating the origin of the yellow fever, that raged fo violently amongft them, during the late autumn. I fought every poflible information from the attending phyfician, the families who had been attacked, and from their neighbours. Knowing that a difeafe of this kind might have been derived from domeflic fources, from the city of Philadelphia, and, poflibly, from the (kipping performing quaran- tine, I was exceedingly particular upon thefe points of inquiry and investigation. After examining the documents upon this fubjec*t, I do not hefitate to pronounce it the offspring of local caufes.
M The moft valuable part of thefe farms confuts in meadows, which had been overflowed, for ten or twelve days, by a deluge of rain that commenced on the firft of Auguft. The waters gradually difap- peared, and depofited a fcUm that was exceedingly naufeous. The roots of the grafs were dead in many places for an acre or more in extent; even fix inches below the furface of the earth, they were deftroyed-^- ihe vegetable putrefaction was great, and the fmell arifing from it extremely difagreeable. To this fource I attribute the difeafe that prevailed amongft them. Twenty-nine perfons were attacked in five" families ; but fo local was the calamity, that, al- though the neighbours kept up a conftant communi- cation,
BILIOUS YELLOW FEVER IN 1 797. 97
cation, by vifiting the ;fick rooms, and rendering their fervices, no perfon, that thefe families recol* Je<ft, was affected with it, in confequence. And there is but one poffible cafe in which it could have been communicated, by any one of thefe families to any of the others*
My opinion of the local origin of the yellow fever, derives fupport from its being the idea of the phy- fician who attended the fick, and the univerfal fenti- ment of thofe who have fuffered by it. Documents, entering into detail, to eftablifh thefe, and a variety of other points connected with the difeafe, are fub- fcribed by all the perfons alluded to, and depofited among the records of the Academy of Medicine. Signed, JOHN C. OTTO.
March 23^, 1798*
There is one affertion by the college of phyfl- cians, which has efcaped refutation by the academy of medicine. It is faid in the memorial of the col- lege, that the yellow fever " exifts in the Weft Indies " particularly in the time of war, when great num- " bers of ftrangers are to be found there, and refer- *6 ence to dates will fliew that in moil of the inftan-
H Ck ces
98 AN ACCOUNT OF TJiE
" ces of the occurrence of the clifeafe in the United " States, there has beeu war in the Weft Indies*"
It appears that the difeafe was unknown in the United States during the iaft war in the Weft Indies, and that it prevailed but once in America during the war before the laft, and that was in Philadelphia in 1762. It ought to be remembered in this place, that the intercourfe between the Weft India Iilands and the United States at that time, was of fuch a nature, as to favour the importation of the fever, much more than it has been flnce, for American troops who had ferved with the Britifh army in the Weft Indies arrived occafionally with the remains of the yellow fever upon them, and yet in no inftance was the difeafe imported by them. The fever in Philadelphia in 1 762 was generated by putrid exhala- tions from the dock near the draw-bridge. I infer this from its prevailing chiefly in that neighbourhood, and from its being rarely contagious when carried into any other part of the city. — It was believed, it is true, at the time, to have been imported. The reader muft not be furprifed at this traditional error having been adopted by the citizens of Philadelphia without examination, when he recollects that the college of phyficians of Philadelphia have twice a- dopted it after a formal inveftigation of the origin of
the
BILIOUS YELLOW FEVER IN 1J9J* 99
the difeafe, without the leaft evidence from fa&s, or principles in fupport of their opinion.
It is to be lamented that the legiflature of the (rate took no notice of the proofs of the domeftic 6rigin of the yellow fever which were laid before them by the academy of medicine. A law was palfed to pre- vent the importation of the difeafe. It has fince been enforced with a rigor which has been expen- five and diftreiEng to the commerce of the city. I wifh it may not be the means of generating the dif- eafe, by obliging mips to remain ten days at State Ifland in the hot months, with vegetable cargoes putrefying in their holds ; or if this fhould not be the cafe, I hope the law will not compel the owners of veflels who have been exhaufted by the expenfes, or fea captains who have been worn down by the fa- tigue of tedious voyages, to feek a more open port in fome of the rival cities of the United States, where jufl opinions prevail refpecting the ufual origin of the yellow fever. A belief in the importation of the epidemics of 1793 and 1797 is difgraceful to the fcience of medicine ; and unlefs man fhould become retrograde in the ufe of his reafoning faculties, the records and laws which are intended to eftablifh this belief, will probably be preferred with the laws againft witchcraft, as curious monuments of the
H 2 weaknefs
OF THE
derftanding, at the clofc
I have taken pains to collect an account of all the vegetable and animal matters which,, in a flate of pu- trefaction, produce bilious, remitting and malignant fevers. The following is a lift of fuch of them as I have met with in books, or picked up from conver- fation, and obfervation.
i. Matters which compofe marfh exhalations, and which are fuppofed to be partly of a vegetable, and partly of animal nature. They are derived from the fhores of rivers, creeks and mill-ponds, as well as from low and wet grounds.
2. Cabbage.
3. Potatoes.
4. Pepper.
5. Indian meal.
6. Onions.
7. Mint.
8. Annifeed
•BILIOUS YELLOW FEVER IN 1 797. IOI
8. Annifeed and caraway feed confined in the hold of a fliip.
9. Coffee. — " About the time," fays Dr. Trot- ter, " when notice was taken of the putrefying coffee on the wharf at Philadelphia, in the year 1793, a captain of a man of war jufl returned from the Jamaica ftation, informed me, that feve- ral velfels laden with the fame produce came to Kingfton from St. Domingo. During the diftracl:- ed ftate of that colony, this article, with other productions, had been allowed to fpoil and fer- ment. The evolution of a great quantity of fixed air, or carbonic acid gas, was the confequence ; and in thefe veffels, when opening the hatchways, fuch was its concentrated ftate, that the whole of the crew in fome of them, were found dead on the deck. A pilot boarded one of them in this condi- tion, and had nearly perifhed himfelf."*
10. Cotton, that had been wetted on board of a veffel that arrived in New York a few years ago from Savannah in Georgia.
1 1 . Hemp, flax, and ftraw.
12. The
* Medicina Nautica, p. 324,
102 AX ACCOUNT OF TH^
12. The canvafs of an old tent.
13. Old books and old paper money that had been wetted, and confined in ciofe rooms and clofets.
14. The timber of an old houfe. A fever pro- duced by this caufe is mentioned by Dr. Haller in his Bibliotheca Medicince.
15. Green wood confined in a clofe celiar during the fummer months. A fever from this caufe was once produced in this city in a family that was at- tended by the late Dr. Cadwallider.
16. The green timber of a new mip. Captain Thomas Bell informed me, that in a voyage to the Eafl Indies in the year 1784, he loft fix of his men with the fcurvy, which he fuppofed to be derived wholl) from the foul air emitted by the green timber of his {hip. The hammocks which were near the fides of the fiiip rotted during the voyage, while thofe which were fufpended in the middle of the mip re- tained their found and natural ftate. This fcurvy has been lately proved by Dr. Claiborne in an inge- nious inaugural dilTertation publiihed on the 22d of May of the prefent year, to be a mi i placed ftate of malignant fever. Dr. Lind mentions likewife the
timber
BILIOUS YELLOW FEVER IN 1 797. I03
timber of new fhips as one of the fources of febrile difeafes.
1 7. The flagnating air of the hold of a ftiip.
18. Bilge water.
1 9. The flagnating air of clofe cellars. To pre- vent this fource of fever, chimneys fhould always be made in them.
20. The matters which ufually flagnate in the gutters, common fewers, docks, and alleys of cities, and in the fmks of kitchens.
21. Air emitted by agitating foul, and flagnating water. Dr. Franklin once derived an intermitting fever from this caufe.
22. A duck-pond, and
23. A hog-ftye have been known to produce vio- lent bilious fevers in Philadelphia.
Fevers are feldom produced by decayed or putrid animal matters. There are, however, records of their having been generated by the following fub- fiances in a Hate of putrefaction.
1. Human
104 AN ACCOUNT OF THE
i. Human bodies that have been left unburied upon a field of battle,
2. A whale thrown upon the feafhore in Holland,
3. Locufls.
4. Raw hides confined in ftores and in the holds of Slips, and
5. The entrails of fifh expofed to the heat of the fun.
The following fact communicated to me by Mr. Samuel Lyman, a member of Congrefs from the flate of MafTachufetts, fhews the importance of at- tending to the condition of butchers meat in our attempts to prevent malignant fevers.
A farmer in New Hampfhire who had overheated a fat ox by exceflive labour in the time of harveft, perceiving him to be indifpofed, inftantly killed him, and fent his flefli to a neighbouring market. Of 24 perfons who ate of this flefli, 15 died in a few days. The fatal difeafc produced by this aliment, fell, with its chief force, upon the ftomach and
bowels.
The
BILIOUS YELLOW FEVER IN 1797. I05
The gentlemen who fubfcribed the firft letter to the governor of Pennfylvania, have remarked, that an offenfive fmell is not eiTential to the nature of thofe gafes which produce fevers. It is poflible this fmell, by exciting a morbid action in the nofe, may prevent their being felt in more vital parts of the body. It would feem further, as if heaven had kindly connected a difagreeable fmell with pu- trefying vegetable and animal matters, on purpofe to prompt us to remove or avoid them.
From a review of the numerous and common caufes of fever which have been mentioned, we are led again to lament that they have been fo long overlooked and neglected by the citizens of Phila- delphia. We behold here a melancholy inftance of the force of prejudice, prevailing, not only over reafon, but over the evidence of the fenfes them- felves. While the inhabitants of our city are look- ing with terror to the mips which arrive from the Weft. Indies in the fummer months, and fliunning even the refrefhing breezes which fill their fails at the diflance of five or fix miles, it appears that the true caufe of all their peflilential calamities, like the fin of Cain, " lieth at their door."
I proceed now to fay a few words upon the treat- ment which was ufed in this fever. It was in ge- neral
Io6 AN ACCOUNT OF TH£
ncral the fame as that which was purfued in the fevers of 1793 and 1794.
Ibegan the cure, in mod cafes, bf bleeding, where I was called on the firfl day of the difeafe, and was happy in obferving its ufual falutary effe&s in its early ltage. On the fecond day, it frequently failed of doing fervice, and on the fubfequent days of the fever, I believe it often did harm ; more efpecially if no other depleting remedy had preced- ed it. The violent action of the blood-veffels in this difeafe, when left to itfelf for two or three days, fills and fufFocates the vifcera with fuch an immenfe mafs of blood, as to leave a quantity in the veffels fo fmall, as barely to keep up the ac- tions of life. By abflra&ing but a few ounces of this circulating blood, we precipitate death. In thole cafes where a doubt is entertained of fuch an engorgement of fiagnating blood having taken place, it will always be fafefl to take but three or four ounces at a time, and to repeat it four or five times a-day. By this mode of bleeding we give the vif- cera an opportunity of emptying their fuperfluous blood into the veffels, and thereby prevent their collapfing from the fudden abflra&ion of the ftimu- lus which remained in them. I confine this obfer- vation upon bleeding, after the firfl flage of the dif- eafe, only to the epidemic of 1797, It was fre- quently
BILIOUS YELLOW FEVER IK I/9/, I07
quently effectual when ufed for the firfl: tiir.e after the firft and fecond days in the fevers of 1793 and 1794, and it is often ufeful in the advanced ftage of the common bilious fever. The different and contradictory accounts of the effects of bleeding in the yellow fever in the Well: Indies, probably ori- ginate in its being ufed in different flages of the dif- eafe. Dr. Jackfon, of the Britifh army, in his jate vifit to Philadelphia, informed mc, that he had cured 19 out of 20 of all the foldiers whom he attended, by copious bleeding, provided it was performed within fix hours after the attack of the fever. Beyond that period, it mitigated its force, but feldom cured. The quantity of bleed drawn by the Doctor, in this early ftage of the difeafe, was always from 20 to 30 ounces. I have faid the yellow fever of 1797 was more malignant than the fevers of 1793 an^ J794' ^ts refemblance to the yellow fever in the Weft Indies, in not yielding to bleeding after the firfl day, is a proof of this affer- tion.
I was (truck during my attendance upon this fe- ver in obferving the analogy between its mixed form and the malignant ftate of the fmall pox. The fever in both, continues for three or four days with- out any remiffion. They both have a fecond ftage h which death ufually takes place if the difeafes be
left \
Io8 AN ACCOUNT OF THE
left to themfelves. By means of copious bleeding in their firft, they are generally deprived of their malignity and mortality in their fecond flage. This remark fo trite in the fmall pox, has been lefs at- tended to in the yellow fever. The bleeding in the firft flage of this difeafe does not it is true deflroy it al- together, any more that it deflroys an eruption in the fecond flage of the fmall pox, but it weakens it in fuch a manner, that the patient paffes through its fecond flage without pain or danger, and with no other aid from medicine than what is commonly de- rived from good nurfing, proper aliment, and a little gently opening phyfic.
It is common with thofe practitioners who object: to bleeding in the yellow fever, to admit it occafion- ally in robust habits. This rule leads to great error in practice. From the weak action of predifpofmg, or exciting caufes, the difeafe often exifts in a feeble flate in fuch habits, while from the protracted, or violent operation of the fame caufes, it appears in great force in perfons of delicate conflitutions. A phyfician therefore in prefcribing for a patient in this fever, fhould forget the natural ftrength of his muf- cles, and accommodate the lofs of blood wholly to the morbid ftrength of his difeafe,
In
BILIOUS YELLOW FEVER "IN 1797. Io9
In a former work* I hinted at thofe ftates of this fever in which bleeding is proper. Dr. Jackfon has confirmed me, by his inftruc"Hng communications upon this fubject, in all the remarks which I have publifhed, and has added to them a caution which deferves the attention of practitioners, and that is, to avoid bleeding in the clofe of a paroxyfm of the fever. The debility which accompanies the inter- mhTion of the fever is often fo much increafed by this evacuation, as to endanger life.
The quantity of blood drawn in this fever was al- ways proportioned to its violence. I cured many by a fingle bleeding. — A few required the lofs of up- wards of an hundred ounces of blood to cure them. The perfons from whom that large quantity of blood was taken were Meffieurs Andrew Brown, Horace Hall, George Cummins, J. Ramfay and George Eyre. But I was not fmgular in the liberal and frequent ufe of the lancet. The following phyficians drew the quantities of blood annexed to their refpective names from the following perfons, viz.
Dr. Dewees 176 ounces from Dr. Phyfick,
Dr. Griffitts 1 1 o from Mr. S. Thomfon,
Dr. Stewart 106 from Mrs. M'Phail,
Dr-
* Medical Inquiries and Obfervations, vol. iv.
IIO A1ST ACCOUNT OF THE
Dr. Cooper 150 from Mr. David Evans,
Dr. Gillcfpie 103 from himfelf.
All the above named perfons had a rapid and eafy recovery, and now enjoy good health. I loft but one patient who had been the fubject of early and copious bleeding. Kis death was evidently induced by a fupper of beef-flakes and porter after he had exhibited the moil promiling figns of convalefcence.
I am aware how much I fliall detract for the pre- fent from the reputation of thofe phyllcians whofe names are connected with the records of the above facts. But I know them too well to fuppofe they wifli to accommodate to the prejudices of the day, by concealing their modes of practice. Fear and er- ror will not always maintain their ground upon this fubject. The objections to copious bleeding in ma- lignant fevers, will fooner or later lleep with the pre- judices againfl bark and opium. Ample juflice will then be done to thofe men who have fubmitted to a temporary facrifice of interefl and reputation, in or- der to fave the lives of their fellow creatures.
Of PURGING.
From the great difficulty that was found in dif- sharging bile from the bowels by the common modes
of
BILIOUS YELLOW- FEVER IN 1797. Ill
of adininiftering purges, Dr. Griffitts fuggefted to me the propriety of giving large dofes of calomel with- out jalap, or any other purging medicine, in order to loofen the bile from its clofe connection with the gall-bladder and duodenum during the firft day of the difeafe. This method of difcharging acrid bile was found ufcful. I obferved the fame relief from large evacuations of fcetid bile in the epidemic of 1797 that I have remarked in the fever cf 1793". Mr. Bryce has taken notice of the fame falutary ef- fects from fimilar evacuations in the yellow fever on board the Bufbridge Indiaman in the year 1792. His words are, " It was obfervable that the more dark coloured, and fcetid, fuch difcharges were, the more early, and certainly, did the fymptoms difap- pear. Their good effects were fo inftantaneous, that I have often feen a man carried up on deck per- fectly delirious with fubfukus tendinum, and in a date of the greatefl apparent debility, who after one or two copious evacuations of this kind, has return- ed of himfelf, and aftonifhed at his newly acquired ftrength." * Very different are the effects of tonic remedies when given to remove this apparent debility. The clown who fuppefes the crooked appearance or a flick, when thrufl into a pail of water, to be real, does not err more againft the laws of light than
that * Annals of Medicine, p. 123.
112 AN ACCOUNT OF TH£
that phyfician errs againft a law of the animal ceco- nomy, who miftakes the debility which arifes from oppreifion, for an exhaufted ftate of the fyftem, and attempts to remove it by flimulating medicines.
After unlocking the bowels by means of calo- mel and jalap in the beginning of the fever, I found no difficulty afterwards in keeping them gently open by more lenient purges. In addition to thofe which I have mentioned in the account of the fever of 1793, I yielded to. the advice of my friend Dr. Griffitts, by adopting the foluble Tartar, and gave fmall dofes of it daily in many cafes. It feldom offended the ftomach, and generally operated, with- out griping, in the mofl plentiful manner.
However powerful bleeding and purging were in the cure of this fever, they often required the aid of a salivation to aim! them in fubduing it.
Befldes the ufual methods of introducing mercu- ry into the fyftem, Dr. Stewart accelerated its ac- tion by obliging his patients to wear focks filled with mercurial ointment ; and Dr. Gillefpie aimed at the fame thing by injecting the ointment in a fuitable vehicle into the bowels in the form of glyfterSi
The
BILIOUS YELLOW FEVER IN Ijqj. I 13
The following fa£ communicated to me by Dn Stewart, will (hew the fafety of large dofes of calomel in this fever. Mrs. M'Phail took 60 grains of calomel, by miftake, at a dole, after having taken three or four dofes, of 20 grains each, on the fame day. She took, in all, 356 grains in fix days, and yet, fays the Doctor, " fuch was the ftate of her ftomach and inteftines, that that large quantity was retained without producing the leafl griping, or more ftools than fhe had when fhe took three grains every two hours."
I obferved the mercury to affect the mouth and. throat in the following ways. 1. It fometimes pro- duced a fwelling only in the throat refembling a common inflammatory angina. 2. It fometimes produced ulcers upon the lips, cheeks, and tongue, without any difcharge from the falivary glands. 3. It fometimes produced fwellings and ulcers in the rums, and loofened the teeth without inducing a, falivation. 4. There were indances in which the mercury induced a rigidity in the mafTeter mufcles of the jaw, by which means the mouth was kept conftantly open, or fo much clofed, as to render it difficult for the patient to take food, and impof- fible for him to maflicate it. 5. It fometimes affected the falivary glands only, producing from them a copious fecretion and excretion of faliva.
I But,
114 AH ACCOUNT OF THE
But. 6. It more frequently acted upon all the above parts, and it was then it produced mod fpeedily its falutary effects. 7. The difcharge of the faliva fre- quently took place only during the remhTion or in- termiiTion of the fever, and ceafed with each return of its paroxyfms. 8. The falivation did not take place in fome cafes until the folution of the fever. This was more efpecially the cafe in thofe forms of the fever in which there were no remrffions or inter- miflions. 9. It ceafed in mod cafes with the fever, but it fometimes continued for fix weeks or two months, after the complete recovery of the patient. 10. The mercury rarely diflodgcd the teeth. Not a Angle inftance occurred of a patient lofing a tooth in the city hofpital where the phyficians, Dr. J. Duffield informed me, relied chiefly upon a faliva- tion for a cure of the fever. 1 1 . Sometimes the mercury produced a difcharge of blood with the faliva. Dr. Coulter of Baltimore gave me an ac- count in a letter, dated the 17th of September, 1797, of a boy in whom an hemorrhage from the falivary glands excited by calomel, was fucceeded by a plentiful flow of faliva, which faved his pa- tient. I faw no inconvenience from the mixture of blood with faliva in any of my patients. It occur- red in Dr. Caldwell, Mr. Bradford, Mr. Brown, and feveral others.
It
BILIOUS YELLOW JEVER IN 1797. IIJ
It has been faid that mercury does no fervice un- lefs it purges or falivates. I am difpofed to believe that it may aft as a counter ftimulus to that of the miafmata or contagion of the yellow fever, and thus be ufeful, without producing any evacuation from the bowels or mouth. It more certainly acts in this way, provided blood-letting has preceded its exhibition. I have fuppofed the ftimulus from the remote caufe of the yellow fever to be equal in force to five, and that of mercury, to three. To enable the mercury to produce its action upon the fy- ftem, it is neceffary to reduce the febrile action by bleeding, to two and an half or below it, fo that the ftimulus of the mercury (hall tranfcend it. The fafety of mercury when introduced into the fyftem has three advantages as a ftimulus over that of the matter which produces the fever. It excites an ac- tion in the fyftem preternatural only in force. It does not derange the natural order of actions. 2. It determines the actions chiefly to external parts of the body, and 3dly it fixes them when it affects the mouth and throat upon parts which are capable of bearing great inflammation and effufion without any danger to life. The ftimulus which produces the yellow fever acts in ways the reverfe of thofe which have been mentioned. It produces violent irregular or 'wrong actions. It determines them to internal parts of the body, and it fixes them upon
I 2 vifcera
I l5 AN ACCOUNT OF THfi
vifcera which bear with difficulty and danger the ufual effects of difeafe. A late French writer, Dr. Fabre, afcribed to difeafes a centrifugal, and a cen- tripetal direction. From what has been faid, it would feem, the former belongs to mercury, and the lat- ter to the yellow fever.
Confidering the great prejudices againfl blood- letting, I have wifhed to combat this fever with mercury alone. But for reafens formerly given, I have been afraid to trull: to it without the afliftance of the lancet. The character of the fever more- over, like that which the poet has afcribed to Achilles, is of " fo fwift, irritable, inexorable, and " cruel" a nature, that it would be mifafe to rely exclufively upon a medicine which is not only of lefs efficacy than bleeding, but often flow, and un- certain in its operation, more cfpccially upon the throat and mouth.
Let not the reader be offended at my attempts to reafon. I am aware of the evils which the weak and perverted exercife of this power of the mind, has introduced into medicine. But let us acl with the fame confiftency upon this fubjeft, that we do in other things.
We
BILIOUS YELLOW 1£V£R IN 1/9/. I 1 7
We do not conflgn a child to its cradle for life, becaufe it falls in its firit unfuccefsful efforts to ufe its legs. In like manner, we mufl not abandon rea- fon, becaufe in our firit efforts to ufe it, we have been deceived. A fingle juft principle in our fcience, will lead to more truth in one year, than whole vo- lumes of uncombined facts will do in a century.
I loft but two patients in our iate epidemic in whom the mercury excited a falivation. One of them died from the want of nurfing ; the other by the late application of the remedy.
Cf VOMITS.
It was faid, a practitioner who was oppofed to bleeding and mercury, cured this fever by means of flrong vomits. I gave one to a man who refuf- ed to be bled. It operated freely, and brought on a plentiful fweat. The next day he arofe from his bed, and went to his work. On the 4th day he fent for me again. My foil vifited him and found him without a pulfe. lie died the next day.
I heard of two other perfons who took emetics in the beginning of the fever without the advice of a phyfician, both of whom died.
Dr.
I iS AN ACCOUNT OF THE
Dr. Pinkard informed me that their effe&s were generally hurtful in the violent grades of the yellow fever in the Wed Indies — The fame information has llnce been given to me by Dr. Jackfon. In the 2d and 3d grades of the bilious fever, they ap- pear not only to be fafe, but ufeful.
Of DIET and DRINKS.
The advantages of a weak vegetable diet were very great in this fever. I found but little difficulty in mod cafes in having my prohibition of animal food complied with before the crifis of the fever, but there was often fuch a fudden excitement of the appetite for it, immediately afterwards, that it was difficult to reftrain it. 1 have mentioned the cafe of a young man who was upon the recovery, who died in confequence of fupping upon beef-flakes. Many other inilances of the mortality of this fever from a fimiiar caufe, I believe, occurred in our epi- demic, which were concealed from our phyficians. I am not fingular in afcribing the death of convale- fcents to the too early ufe of animal food. Dr. PoilTonnier has the following important remark up- on this fubjecl. " The phyficians of Brefl have obferved, that the relapfes in the malignant fever which prevailed in their naval hofpitals, were as
much
BILIOUS YELLOW FEVER IN 1797. I 19
much the efFect of a fault in the diet of the fick as of the contagious air to which they were expofed, and that as many patients perifhed from this caufe, as from the original fever. For this reafon light lbups, with leguminous vegetables in them, panada, rice feafoned with cinnamon, frefh eggs, &:c. are all that they mould be permitted to eat. The ufe of flefh fhould be forbidden for many days after the entire cure of the diforder."*
Dr. Huxham has furnifhed another evidence of the danger from the premature ufe of animal food, in his hiftory of a malignant fever which prevailed at Plymouth in the year 1740. " If any one (Tays the doctor) made ufe of a flefh, or fiili diet, before he had been very well purged, and his recovery confirmed, he infallibly indulged himfelf herein at the utmofl danger of his life."f
In addition to the mild articles of diet, mention- ed by Dr. PoiiTonnier, I found bread and milk with a little water, fugar, and the pulp of a roafled ap- ple mixed with it, very acceptable to my patients during their convalefcence. Oyflqrs were equally innocent, and agreeable. Ripe grapes were de- voured
* Maladies de gens de mer, vol. 1. p. 34.5. \- Epidemics, vol. 11. p. 6-j-.
*20 AN ACCOUNT OF THE
voured by them with avidity, in every ftagc of the fever. The feafen had been favourable to the per- fection of this pleafant fruit, and all the gardens in the city and neighbourhood in which it was cul- tivated, were gratuitouily opened by the citizens for the benefit of the fick.
The drinks were, co!d water, toaft and water, balm tea, water in which gellies of different kinds had been diffclved, lemonade, apple water, barley and rice water, and in cafes where the ftomach was affected with ficknefs, or puking, weak porter and water, and cold camomile tea. In the convalefcent ilage of the fever, and in fuch of its remiffions or intermiffions, as were accompanied with great lan- guor in the pulfe, wine-whey, porter and water, and brandy and water, were taken with advantage.
Cold water applied to the body, cool and frefh air, and cleanlinefs. produced their ufual good effects in this fever. In the external ufe of cold water, care was taken to confine it to fuch cafes as were accompanied with preternatural heat, and to forbid it in the cold fit of the fever and in thofe cafes which were attended with cold hands and feet, and where the difeafe fhewed a difpofition to terminate in its firfl ilage, by a profufe perfpiration. It has lately given me great pleafure to find the fame prac- tice
BILIOUS YELLOW FEVER IN 1797. 121
tice in the external ufe of cold water in fevers, re- commended by Dr. Currie of Liverpool in his me- dical reports of the effects of water, cold and warm, as a remedy in febrile difeafes. Of the be- nefit of frefh air in this fever, Dr. Dawfon of Tor- tola has lately furnifhed me with a ftriking inflance. He informed me that by removing patients from the low grounds on that ifland, where the tcvcr is gene- rated, to a neighbouring mountain, they generally recovered in a few days.
Finding a difagreeable fmell to arife from vinegar fprinkled upon the floor after it had emitted all its acid vapor, I directed the floors of fick rooms to be fprinkled only with water. I found the vapor which arofe from it to be grateful to my patients. A citizen of Philadelphia whofe whole family reco- vered from the fever, thought he perceived evident advantages from tubs of frefh water being kept con- ftantly in the fick rooms.
Of TONIC REMEDIES.
There were now and then remuTions and inter- miflions of the fever accompanied with fuch figns of danger from debility, as to render the exhibition of a few drops of laudanum, a little wine-whey, a
glafc
122 AN ACCOUNT OF THE
glafs of brandy and water, and in fome inftances a cup of weak chicken-broth highly neceffary and ufefuL In addition to thefe cordial drinks, I direct- ed the feet to be placed in a tub of warm water which was introduced under the bed clothes, fo that the patient was not weakened by being raifed from a horizontal pofture. All thefe remedies were laid afide upon the return of a paroxyfm of fever.
I did not prefcribe bark in a fingle cafe of this difeafe. An infufion of the quaffia root was fub- flituted in its room in feveral inftances with advan- tage.
Blisters were applied as ufual, but from the jnfenfibility of the ikin, they were lefs effectual than applications of muftard to the arms and legs. It is a circumftance worthy of notice, that while the flomach, bowels, and even the large blood- veffels, are fometimes in a highly excited ftate, and overcharged as it were with life, the whole furface of the body is in a ftate of the greateft torpor. To attempt to excite it by internal remedies is like adding fuel to a chimney already on fire. The ex- citement of the blood-veffels, and the circulation of the blood, can only be equalized by the application of flimulants to the ikin. Thefe, to be effectual, mould be of the mod powerful kind. Candies might
probably
BILIOUS YELLOW FEVER IN 1 79/. 1 23
probably be ufcd in fuch cafes with advantage, I am led to this opinion by a fact communicated to me by Dr. Stewart. A lighted candle which had been left on the bed of a woman whom he was at- tending in the apparent lad flage of the yellow fe- v^r, fell upon her bread. She was too infenfible to feel, or too weak to remove it. Before her nurfe came into her room, it had made a deep and extenfive impreflion upon her flefh. From that time fhe revived, and in the courfe of a few days recovered. As a tonic remedy in this fever, Dr. Jackfon has fpoken to me in high terms of the good effec"b of riding in a carriage. Patients, he inform- ed me, who were moved with difficulty, after riding a few miles, were able to fit up, and when they re- turned from their excurfions, were frequently able to walk to their beds.
Much has been faid of late years in favor of the application of warm olive oil to the body in the plague, and a wifli has been expreffed by fome people that its efficacy might be'tried in the yellow fever. Up- on examining the account of this remedy as publish- ed by Mr. Baldwin, two things fugged themfelves to our notice.
1. That the oil is effe&ual only in t\\tfor?ning (late of the difeafe, and 2dly, that it acts chiefly by deplet- ing from the pores of the body. From the unity of
the
3 24 AN ACCOUNT OF THE
the remedy of depletion, it is probable, purging or bleeding might be fubftifuted to the expenfive parade of the fweat induced by the warm oil, and the fmoke of odoriferous vegetables. But I mult not conceal here, that there are facts which favour an idea, that oil produces a fedative action upon the blood-vefTels through the medium of the fkin. The Africans, and the American Indians, protect themfelves from fevers in the mod fickly fituations, by anointing their bodies with oil. Bontius fays, the fame application is ufed in the Eaft Indies, for the cure of malignant fevers, afrer the previous ufe of bleeding and purg- ing. It feems to have been a remedy well known among the Jews, hence we find the apoftle James advifes its being applied to the body, in addition to the prayers of the elders of the church.* It is thus Sn other cafes, the bleffings of heaven are conveyed to men through the ufe of natural means.
I have wiihed the effects of irTues to be tried among the prophylactic remedies of. the yellow fever. They have prevented the plague in many hundred in- stances, according to Parifmus, Florentinus, Foreflus ;:nd ievera! other authors quoted by Diemerbroeck.i Paraeus fays that all who had ulcers from the vene- real difeafe, or any other caufe, efcaped it. Br. Hodges owed his prefervation from ficknefs and
death * Chapter v. verfe 14. f De Pefte, p. j.03.
BILIOUS YELLOW TEVER IN 1797. 125
llcath in the hid plague in London, to an iiTue in his ley. He tells us that it always gave him fome pain when he was expofed to the contagion, in vifiting his patients. The peftilential matter was probably attracted by the artificial weak part in his leg, and thus thrown out of his fyftem.
During the existence of the premonitory fymptoms# and before patients were confined to their rooms, a gentle purge, or the lofs of a few ounces of blood, in many hundred inftances prevented the formation of the fever. I did not meet with a fingle exception to this remark.
Fevers are the affliction chiefly of poor people. To prevent, or to cure them, remedies muft be cheap, and capable of being applied with but little attend- ance. From the affinity eftablifhed by the creator between evil and its antidotes in other parts of his works, I am difpofed to believe no remedy will ever be effectual in any general difeafe, that is not cheap* and that cannot eafily be made univerfal.
It is to be lamented that the greateft part of all the deaths which occur, are from difeafes that are under the power of medicine. To prevent their fatal ifTue, it would feem to be agreeable to the order of heaven in other things, that they fliould be attacked in
their
126 AN ACCOUNT OF THE
their forming date. Weeds, vermin, public oppref- lion, and private vice, are eafily eradicated and de- ftroyed, if oppofed by their proper remedies, as foon as they fhow themfelves. The principal obftacle to the fuccefsful ufe of the antidotes of malignant fevers in their early ftage arifes from phyficians refufmg to declare when they appear in a city, and from their practice of calling their mild forms, by other names than that of a mortal epidemic. If every record of the hiftory of man were deflroyed, and this inftance only of the conduct of phyficians preferved, it would be fufficient to eftablifh the depraved character of our fpecies. Tyrants opprefs, and heroes butch- er their fellow creatures for plunder and fame, but phyficians who conceal the exiflence, or deny the real names of peflilential difeafes, often become the means of deftroying the lives of thoufands, without deriving any material benefit from their inhuman con- duct.
I mail now fay a few words upon the fuccefs of the depleting practice in our late epidemic.
From the more malignant flate of the fever, and from the fears and prejudices that were excited againft bleeding and mercury by means of the news- papers, the fuccefs of thofe remedies was much lefs than in the years 1793 and 1794. Hundreds
refufed
BILIOUS YELLOW FEVER IN 1797. I27
refuted to fubmit to them at the time, and in the manner that were neceffary to render them effectual. From the publications of a number of phyficians who ufcd the lancet and mercury in their greateft extent, it appears that they loft but one in ten of all they attended. It was faid of feveral practition- ers who were oppofed to copious bleeding, that they loll a much fmaller proportion of their pa- tients with the prevailing fever. Upon inquiry, it appeared they had loft many more. To conceal their want of fuccefs, they faid their patients had died of other difeafes. This mode of deceiving the public began in 1793. The men who ufed it, did not recollect, that it is lefs in favour of a phyfician's fkill to lofe patients in pleurifies, colics, hcemcrrha- gies, contufions, and common remittents, than in a malignant yellow fever.
Dr. Sayre attended fifteen patients in the difeafe, all of whom recovered by the plentiful ufe of the depleting remedies. His place of refidence being remote from thofe parts of the city in which the fever prevailed mod, prevented his being called to a greater number of cafes.
A French phyfician who bled and purged mode- rately, candidly acknowledged that lie faved but three out of four of his patients.
Tn
120 AN ACCOUNT Of THE
In the city hofpital, where bleeding was fparifig- ly ufed, and where the phyficians depended chiefly upon a falivation ; more than one half died of all the patients who were admitted. It is an act of juftice to the phyficians of the hofpital to add, that many, perhaps mod of their patients were admitted after the firfr. day of the difeafe.
I cannot conclude this comparative view of the fuccefs of the different modes of treating the yello\T fever, without taking notice that the Simulating mode, as recommended by Dr. Kuhn and Dr. Ste- vens in the year 1793, was deferted by every phyfi- cian in the city. Dr. Stevens, with a candor which does honor to his integrity, acknowledged the dif- eafeto require a different treatment from that which it required in the Weft Indies ; and feveral other phyficians who had written againft bleeding and mer- cury, or who had doubted of their fafety and effi- cacy in 1793, ufed them with confidence, and in the moft liberal manner, in 1797. It was remark- able that the phyficians who ufed thofe remedies more fparingly, reprobated in the fame language the lofs of ten ounces of blood in the fever of 1793, that they did the lofs of 100 in the fever cf the lad year. They forgot likewife in their ufe of iod or 200 grains of mercury to excite a falivation, their former execrations of Dr. Young's fafe and
fimplc
BILIOUS YELLOW FEVER IN 1 797.
129
fimple purge of ten grains of jalap, and ten of calomel.
In the hiftories I have given of the yellow fe- vers of 1793 and 1794, I have fcattered here and there, a few obfervations upon their degrees of danger, and the figns of their favourable and un- favourable ifTue. I mall clofe the prefent hiftory, by cohering thofe obfervations into one view, and adding to them fuch other figns as have occurred to me in obferving our late epidemic.
Signs of moderate danger, and a favourable iffue of the yellow fever.
1. A chilly fit accompanying the attack of the fever. The longer this chill continues, the more favourable the difeafe.
2. The recurrence of chills every day, or twice a- day, or every other day, with the return of the exa- cerbations of the fever. A coldnefs of the whole body at the above periods without chills, a coldnefs with a profufe fweat, cold feet and hands with febrile heat in other parts of the body, and a profufe fweat without chills, or coldnefs, are all lefs favourable fymptoms than a regular chilly fit, but they indicate lefs danger than their total abfence during the courfe of the fever.
K
j*
•■■ *.
X30 AN ACCOUNT OF THE
3. A puking of green or yellow bile on the firfl day of the difeafe is favourable. A difcharge of black bile, if it occur on the first day of the fever, is not unfavourable.
4. A difcharge of green and yellow flools. It is more favourable if the flools are of a dark or black colour, and of a foetid and acrid nature, on the firfl: or fecond day of the fever.
5. A foftnefs and moiflure on the ikin, in the beginning of the fever.
6. A fenfe of pain in the head, or a hidden tranflation of pain from internal to external parts of the body, particularly to the back. An in- creafe of pain after bleeding.
7. A fore mouth.
8. A white or a yellow tongue.
9. An early difpofition to fpit freely, whether excited by nature, or the ufe of mercury.
10. Blood becoming iizy, after having exhibited the ufual marks of great morbid action in the blood- veffels.
11. Great
BILIOUS YELLOW FEVER IN 1 797. 1 3
1 >
11. Great and cxquifite fenfibility in the fenfe of 'eeling coming on near the clofe of the fever.
Signs of great danger, and of an unfavourable flue of the yellow fever.
1. An attack of the fever, fuddenly fucceeding great terror, anger, or the intemperate life of ve- il ery.
2. The firft paroxyfm coming on without any premonitory fymptoms, or a chilly fit.
3. A coldnefs over the whole body without chills for two or three days.
4. A fleepinefs on the firfl and fecond days of the fever.
5. Uncommon palenefs of the face not induced by blood-letting.
6. Conflant, or violent vomiting without any difcharge of bile.
7. Obftinate coftivenefs, or a difcharge of natu- ral, or white (tools.
8. A
132 AN ACCOUNT OF THE
8. A diarrhoea towards the clofe of the fever. I loft two patients in 1797 with this fymptom who had exhibited a few days before, figns of a reco- very. Dr. Pinkard informed me that it was gene- rally attended with a fatal iffue in the yellow fever of the Weft Indies. t)iemerbroeck declares, that " fcarcely one in an hundred recovered, with this fymptom, from the plague." #
9. A fuppreilion of urine. It is moil alarming when it is without pain.
10. A difcharge of dark coloured and bloody urine.
11. A cold, cool, dry, fmooth, or fhining ikin.
12. The appearance of a yellow colour in the face on the firft or fecond day of the fever,
13. The abfence of pain or a fudden celfation of it, with the common fymptoms of great danger.
14. A difpofition to faint upon a little motion, and fainting after lofing but a few ounces of blood.
* Lib. 1. cap. x^.
BILIOUS YELLOW FEVER IN 1797. *33
15. A watery, glaffy, or brilliant eye. A red eye on the 4th or 5th day of the difeafe. It is more alarming if it become fo after having been previoufly yellow.
16. Imperfect vifion, and blindnefs in the clofe of the difeafe.
17. Deafne'fs.
1 8. A preternatural appetite, more efpecially in the lafl flage of the fever.
19. A flow, intermitting, and fhattered pulfe.
20. Great reftleffnefs, delirium and long conti- nued coma.
21. A difcharge of coffee-coloured, or black bile from the itomach after the 4th day of the fever.
I mall conclude this head by the following re- marks.
1. The violence, danger, and probable iflue of this fever, feem to be in proportion to the duration and force of the predifpofing and exciting caufes. However fteady the former "are in bringing on debi- lity,
!^4 •---' ACCODNT OF T
lity, and the btl itimulants upon ac-
cumulated exc: : a knowledge of their
duration and : ufeful, not only in
forming an opinion of the probable HTue of the fever, but in regulating the force of remedies.
2. The figns of danger vary in different years m the infmer. eather upon the difeafe.
Nottrithftanding the figns of the favourable and unfavourable iffue of the fever, are in general uniform when the cure of the dife limit ted
to nature, or to tonic medicines, yet they are far from bem* fo when the treatment of the fever is co oat of the hai ature, and attempted
by the uie of & ig remedies. We often fee
patients r with nearly all the unfavourable
fymptoms that have been mentioned, and we fome- times fee them die, with all thofe that are favour- able. The words Gf M therefore which he cd to the plague, are equally true, when applied to the yellow iV. er. '; In the plague our fenfes deceive us. R The aphorifms cf Hippocrates deceive us."* An im- portant
ttrt2 -rxdiQac:.
H
BILIOUS YELLOW FEVER IN 1 797- 135
jiortant lcffon may be learned from thefe fa&s, and that is, never to give a patient over. On the con- trary, it is our duty in this, as well as in all other acute difeafes, to difpute every inch of ground with death. By means of this practice which is war- ranted by fcience, as well as dictated by humanity, the grave has often been deprived for a while of its prev, and a prelude thereby exhibited of that ap- proaching and delightful time foretold by ancient prophets, when the power of medicine over dif- eafes fhall be fuch, as to render old age the on- ly outlet of human life.
OBSERVATIONS
UPON THE
NATURE AND CURE
OF THE
GOUT
OBSERVATIONS, <&V
J_ N treating upon the gout, I (hall deliver a few preliminary proportions.
i. The gout is a difeafe of the whole fyftem. It aifecls the ligaments, blood-veffcls, flomach, bowels, brain, liver, lymphatics, nerves, mufcles, cartila- ges, bones and ikin.
2. The gout is a primary difeafe, only of the fo- lids. Chalk-fiones, abfeeffes, dropfcal eftufions into cavities, and cellular membrane, and eruptions on the ikin, are ail the eiTecls of a morbid action in the blood-veiTels. The truth of this propofition has been ably proved by Dr. Cullen in his firft lines.
3- &
14© OBSERVATIONS ON
3. It affe&s moil frequently perfons of a fanguine- ous temperament ; but fometimes it affects perfons of nervous, and phlegmatic temperaments. The idle and luxurious are more fubject to it, than the labouring and temperate part of mankind. Women are faid to be lefs fubject to it than men. 1 once believed, and taught this opinion, but I now retract it. From the peculiar delicacy of the female confli- tution, and from the thin covering they wear on- their feet, and limbs, the%out is lefs apt to fall up- on thofc parts than in men, but they exhibit all its other fymptoms, perhaps more frequently than men, in oilier parts of the body. The remote caufes of gout moreover to be mentioned prefently, act: with equal force upon both fexes, and more of them I be- lieve upon women than upon men.
It generally attacks in thofe periods of life, and in thofe countries, and feafons of the year, in which in- flammatory difeafes arc moft common. Jt feldom affects perfons before puberty, or in old age, and yet I have heard of its appearing with all its moft charac- terise fymptoms in this city in a child of 6, and in a man abo\ e cc rears of age. Men of active minds are faid to be moft fubjecl: to it, but 1 think I have (ccn it as frequently in perfons of {lender and torpid in- tellects, as in perfons of an oppofite character. I have h.urd of a cafe of gout in an Indian at Pittfburgh, and
I have
THE GOUT. 141
have cured a fit of it in an Indian in this city. They had both been intemperate in the life of wine and fermented liquors.
4. It is in one refpect. an hereditary difeafe depend- ing upon the propagation of a fimilar temperament from father to ion. When a predifpofition to the gout has been derived from anceftors, lefs force in ex- citing caufes will induce it than in thofe habits where this has not been the cafe. This predifpofition fometimes pafTes by children, and appears in grand- children. There are inftances likewife in which it has paifed by the males, and appeared only in the females of a family. It even appears in the defend- ants of families who have been reduced to poverty, but not often where they have been obliged to labour for a fubfiflence. It generally pafTes by thofe chil- dren who are born before the gout makes its appear- ance in a father. It is curious to obferve, how exten- iively the predifpofition pervades fome families. An Englifh gentleman who had been afHi&ed with the gout married a young woman in Philadelphia many years ago, by whom he had one daughter. His wife dying three weeks after the birth of this child, he returned to England, where he married a fecond wife, by whom he had fix children, all of whom except one died with the gout before they attained to the ufual age of matrimony in Great Britain. One of
them
142 OBSERVATIONS ON
them died in her 16th year. Finally the father and grand-father died with the fame diibrder. The daughter whom this afflicted gentleman left in this city, paiTed her life fubject to the gout, and finally died under my care in the year 1789 in the 68th year cf her age. She left a family of children, two of whom have had the gout. One of them, a lady, has fuffered exquiiitely from it.
5. The gout is always induced by general predif- pcfing direct or indirect debility.
6. The remote caufes of the gout which induce this debility, are, indolence, great bodily labour, long protracted bodily exercife, intemperance in eat- ing, and in venery, acid aliments and drinks, flrong tea and coffee, public and domeftic vexation, the violent, or. long continued exercife of the under- ftanding, imagination and pailions in fludy, bufmefs or pleafure, and laflly, the ufe of ardent, and fer- mented liquors. The laft are abfolutely neceffary to produce that form of gout which appears in the ligaments and mufcles. I affert this, not only from my own obfervations, but from thofe of Dr. Cado- gan, and Dr. Darwin, who fay they never faw a cafe of gout in the limbs in any perfon who had not ufed fpirits or wine in a greater or lefs quan- tity. Perhaps this may be another reafon why wo- men*
THE GOUT. I43
men, who drink lefs of thofe liquors than men, are fo rarely affected with this difeafe in the extreme parts of their bodies. Wines of all kinds are more difpofed to produce this form of gout than fpirits. The reafon of this mufl be refolved into the lefs ftimulus in the former, than in the latter liquors. Wine appears to referable in its action upon the body, the moderate ftimulus of miafmata which produce a common remitting fever, or inter- mitting fever, while fpirits refemble that violent ac- tion induced by miafmata which pafTes by the blood- veffels, ligaments and mufcles, and invades at once the liver, bowels and brain. There is one fymp- tom of the gout in the extremities which feems to be produced exclufively by ardent fpirits, and that is a burning in the palms of the hands, and foles of the feet. This is fo uniform, that I have fometimes been able to convict my patients of intemperance in the ufe of fpirits, when no other mark of their having taken them in exccfs, appeared in the fy- ftem.
7. The exciting caufes of the gout are frequently a greater degree, or a fudden application of its re- mote and predifpofing caufes. They act upon the accumulated excitability of the fyftem, and by de- flroying its equilibrium of excitement, and regular order of actions, produce convulfion, or irregular
morbid
144 OBSERVATIONS ON
morbid and local excitement. Thefe exciting caufel are either of a ftimulating, or of a fedative nature. The former are violent exercife, of body or mind, night-watching, and even fitting up late at night* a hearty meal, a fit of drunkennefs, a few glaffes of claret or a draught of cyder, where thofe liquors have not been habitual to the patient, a hidden pa- roxyfm of joy, anger, or terror, a diflocation of a bone, {training of a joint, particularly of the an- kle, undue prefTure upon the foot, or leg, from a tight fhoe or boot, an irritated corn, and the ufual remote caufes of fever. The latter exciting caufes, are fudden inanition from bleeding, purging, vo- miting and fading. Cold, fear, grief, excefs in venery, and the debility left upon the fyitem by the crifis of a fever. All thefe caufes aft more certainly when they are aided by the additional debility induced upon the fyftem in ileep. It is for this reafon that the gout generally makes its firfl attack in the middle of the night, and in a part of the fyflem moft remote from the action of the heart, and the energy of the brain, viz. in the great toe, or in fome part of the foot. — In afcribing a fit of the gout to a caufe which is of a fedative nature, the reader will not fuppofe that I have departed from the fimplicity and uniformity of a proposition, I have elfewhere delivered,* that difeafe is the ef- fect
* Medical Inquiries and Obfervations, vol. it.
'•?HE GOUT. I45
left of ftimulus. The abftraftion of a natural and habitual impreflion of any kind, by increafmg the force of thoie which remain, renders the producti- on of morbid, and exceflive aftions in the fyftem as much the efFeft of preternatural or difproportioned ftimulus, as if they were induced by caufes that are externally and evidently flimulating. It is thus in many other of the operations of nature, oppofite caufes produce the fame effects.
8. The proximate caufe of the gout as of all other difcafes, is morbid excitement, accompanied with irregular action, or the abfence of all action from the force of ftimulus. There is nothing fpecific in the morbid excitement and aftions which take place in the gout different from what occur in fevers. However varied morbid aftions may be by their caufes, feats, and effefts, they are all of the fame, and the time will probably come when the whole nomenclature of morbid aftions will be abforbed in the fmgle name of difeafe.
I ftiall now briefly enumerate the fymptoms of the gout as they appear in the ligaments, the blood- veffels, the vifcera, the nervous fyftem, the alimen- tary canal, the lymphatics, the lkin, and the bone? of the human body.
L The
I46 OBSERVATIONS ON
I. The ligaments which connect the bones are the feats, of what is called a legitimate or true gout. They are affected with pain, fwelling, and inflammation. The pain is fometimes fo acute as to be compared to the gnawing of a dog. We per- ceive here the famenefs of the gout with the rheu- matifm. Many pages, and indeed whole effays have been compofed by writers to diflinguifh them, but they are exactly the fame difeafe while the mor- bid actions are confined to this part of the body. They are it is true produced by different remote caufes, but this conftitutes no more difference in their nature, than is produced in a coal of fire whe- ther it be inflamed by a candle, or by a fpark of electricity. The morbid actions which are induced by the ufual caufes of rheumatifm affect, though lefs frequently, the lungs, the trachea, the head, the bowels, and even the heart, as well as the gout. Thofe actions, moreover, are the means of a fluid being effufed which is changed into calcarious mat- ter in the joints and other parts of the body ex- actly like that which is produced by the gout. They likewife twift and diflocate the bones in common with the gout, in a manner to be defcribed here- after. The only difference between what are called gouty, and rheumatic actions, confifts in their feats and in the degrees of their force. The debility which predifpofes to the gout, being greater, and
more
THE GOUT. 147
more extenfively diffufed through the body than the debility which precedes rhcuraatifm, the mor- bid anions in the former cafe, pafs more readily from external to internal parts, and produce in both, more acute and more dangerous effects. A fimile derived from the difference in the dsgrees of action produced in the fyftem by marlh miafmata, made ufe of upon a former occafion, will ferve me again to illuftrate this part of our fubject. A mild re- mittent, and a yellow fever are different grades of the fame difeafe. The former, like the rheuma- tifm, affects the bones chiefly with pain, while the latter, like the gout, affects not only the bones, but the ftomach, bowels, brain, nerves, lympha- tics, and all the internal parts of the body,
II. In the arterial fyftem the gout produces fe- ver. This fever appears not only in the increafed force or frequency of the pulfe, but in morbid affections of all the vifcera. It puts on all the dif- ferent grades of fever from the malignity of the plague, to the mildnefs of a common intermittent. It has moreover its regular exacerbations and remif- fions once in every four and twenty hours, and its crifis ufually on the 14th day in violent cafes. In moderate attacks, it runs on from 20 to 40 days in common with the typhus or flow chronic ftate of fever. It is common for thofc perfons who confider
the
OBSERVATIONS ON
T
the gout as a fpecific difeafe, when it appears iff the above forms, to fay, that it is complicated with fever ; but this is an error, for there can exiil but one morbid action in the blood-veffels at once, and the fame laws are impofed upon the morbid actions excited in thofe parts of the body by the remote caufes of the gout3 as by the common caufes of fever. I have feen two inflances of this difeafe ap- pearing in the form of a genuine he<ftic, and one in which it appeared to yield to lunar influence in the manner defcribed by Dr. Balfour. * In the highly inflammatory ftate of the gout the fenfibility of the blood-velTels far exceeds what is feen in the fame ftate of fever from more common caufes. I have known an inftance in which a tranflation of the gouty action to the eye produced fuch an ex-
quifite
:1. Diemerbroeck has the following remark upon it in his treatife upon the plague in Holland, lib. i. cap. v. " Duobus tribufVe diebus, ante et poll novilunium, ut et " plenilunium, haec dira lues fjmper e::acerbata fuit, ecque u tempore, et plurimos morbos corripiebat, et quos tunc in- <; vadebat, illi fere omnes moriebantur." Dr. Pinkard in- formed me that he had obferved perfons in Demerara to be more dlipoied to attacks, and relapfes of fever, within the lunar periods than at any other time. From fome facts that have lately come to my knowledge, I am fatisned the influ- ence of the full and new moon, is fenfibly felt in the fevers of Philadelphia..
THE GOUT. I49
quifite degree of fenfibility, that the patient was unable to bear the feeble light which was emitted from a few coals of fire in his room, at a time too n the coldnefs of the weather would have made a large fire agreeable to him. It is from the ex- treme fenfibility which the gout imparts to the flo- mach that the bark is fo generally rejected by it. I knew a Britifh officer who had nearly died from taking a fpoonful of the infufion of that medicine while his arterial fyftem was in this ft ate of morbid excitability from a fie of the gout. It is remark- able that the gout is mod difpofed to affume a ma- lignant character during the prevalence of an in- flammatory conflitution of the atmofphere. This has been long ago remarked by Dr. Huxham. Several inftances of it have occurred in this city fince the year 1793.
III. The gout affects moil of the vifcera. In the brain it produces head-ach, vertigo, coma, apo- plexy, and palfy. In the lungs it produces pneu- monia vera, notha, aflhma, haemoptyfis, pulmona- ry confumption, and a fhcrt becking cough, firft de- fcribed by Dr. Sydenham. In the throat it pro- duces inflammatory angina. It affects the kidneys with inflammation, ftrangury, diabetes and calculi. The pofition of the body for weeks or months on the back, by favouring the comprefSon of the kid- neys
*5° OBSERVATIONS ON
oeys by the bowels, is the principal rcafon why thofe parts fuffer fo much in gouty people. The flrangury appears to be produced by the fame kind of engorgement or choking of the veffels of the kidneys, which takes place in the fmall-pox and yellow fever. Four cafes of it are defcribed in the 3d volume of the Phyfical and Literary Effays of Edinburgh, by Dr. David Clerk. I have feen one in- fiance cf death in an old man from this caufe. The catheter brought no water from his bladder. The late Mr. John Penn formerly governor of Pennfyl- vania, I have been informed by one of his phyfi- cians, died from a fimilar affection in his kidneys from gout. The catheter was as ineffectual in giv- ing him relief, as it was in the cafe of my patient. The neck of the bladder fometimes becomes the feat of the gout. It difcovers itfelf by fpafm, and a fuppreffion of urine in fome cafes, and occafionally by an habitual difcharge of mucus through the ure- thra. This diforder has been called by Lieuteaud, cc a catarrh of the bladder." But of all the vif- cera, the liver fuffers moft from the gout. It pro- duces in it inflammation, fuppuration, meiena, fchir- rus, gaii-frcnes, jaundice, and an habitual increafed fecretion and excretion of bile. Thefe diforders- in the liver appear molt frequently in fouthern coun- tries, and in female habits. They are fubflitutes for a gout in the ligaments, and in the extremities
of
THE GOUT. I5I
of the body. They appear likewife in drunkards from ardent fpiriis. It would feem that certain fli- rnuli act fpecifically upon the liver, probably for the wife purpoic of difcharging fuch parts of the blood from the body, as are vitiated by the rapidity of its circulation. I have in a former publication, * taken notice of the action of marfli miafmata upon the livers of men and beads. It has been obferved that hogs that live near brewhoufes, and feed upon the fermented grains of barley, always difcovcr en- larged or difeafed livers. But a determination of the blood to the liver, and an incrcafed action of its veflels, are produced by other caufes than marfli miafmata, and fermented and diftillcd liquors. They appear in the fever which accompanies madnefs and the malignant fore-threat, alfo in contufions of the brain, and in the excited ftate of the blood- vcffels which is produced by anger and exercife. 1 have found an attention to thefe facts ufeful in prefcribing for difeafes of the liver, inafinuch as they have led me from confidering them as idiopa- thic affections, but as ilic effects only of morbid ac- tions excited in other parts of the body.
IV. The gout fbmetimes affe&s the arterial, and nervous fyftems jointly, producing in the brain9
coma,
* Medical Inquiries and Obfervations, vol. iv.
IJ2 OBSERVATIONS ON
coma, vertigo, apoplexy, palfy, lofs of memory, and macinefs, and in the , hyfteria, hypocon-
driafis, and fyncope. It is common to fay the gout counterfeits all thefe difeafes. But this is an in- accurate mode oi fpeaking. All thofe difeafes have but one proximate caufe, and they are exactly the fame, however different the flimulus may be, from which they are derived. Sometimes the gout af the brain and nerves exclufively, without producing the lead morbid action in the blood-veiTels. I once amended a gentleman from Barbadoes who differed 1 this affection of his brain and nerves, the mod intolerable depreihon of fpirits. It yielded to large dofes of wine, but his relief was perfect, and more durable, when a pain was excited by nature or art, hands or feet.
The mufcles are fometimes affected by the gout with fpafm, with general and partial convulfions, and laftly with great pain. The angina pectoris, or a fudden inability to breathe after climbing a hill, or a pair of flairs, and after a long walk, is fome- times a fymptom of the gout. There is a pain which faddeniy pervades the head, bread and limbs, which : an eleciric fhock. I have known
two inftances of it in gz~:y patients, and have d the liberty of calling it the " aura^arthritica." But • affects the mufcles is often of
THE GOUT. I$$
a more permanent nature. It is felt with moil fe- verity in the calves of the legs. Sometimes it affects the mufcles of the head, bread: and limbs, exciting in them large and diflrefling fwcllings. But further ; the gout in fome cafes feizes upon the tendons, and twifts them in fuch a manner as to diflocate bones in the hands and feet. It even af- fects the cartilages. Of this I once faw an inftance in Col. Adams of the (late of Maryland. The ex- ternal parts of both his ears were fo much inflamed in a fit of the gout, that he was unable to lie on either of his fides.
V. The gout affects the alimentary canal from the ftomach, to its termination in the rectum. Flatulency, ficknefs, indigeftion, pain, or vomiting, ufually ufher in a fit of the difeale. The fick head- ach, alfo dyfpepfia* with all its train of diflreiTing evils, are frequently the effects of gout concentrat- ed in the ftomach. I have feen a cafe in which the gout, by retreating to this vifcus, produced the fame burning fenfation which is felt in the yellow fever. The patient who was the fubject of this fymptom died two days afterwards with a black vomiting. It was Mr. Patterfon, formerly collector of the port of Philadelphia, under the Britifh government. I was not furprifed at thefe two uncommon fymp- toms in the gout, for I had long been familiar with
M its
154 OBSERVATIONS ON
its difpofition to affect the biliary fecretion, and the actions of the flomach. The colic and dyfentery, are often produced by the gout in the bowels. In the fouthern dates of America it often produces a chronic diarrhoea, which is known in fome places by the name of the " downward confumption." The piles are a common fymptom of gout, and where they pour forth blood occafionally render it a harmlefs difeafe. I have known an inftance in which a gouty pain in the rectum produced involuntary flools in a gentleman in this city, and I have heard from a fouthern gentleman who had been afflicted with gouty fymptoms, that a fimilar pain was ex- cited in the fame part to fuch a degree, whenever he went into a crouded room lighted by candles, as to oblige him to leave it. In confidering the effects of the gout upon this part, I am led to take notice of a troublefome itching in the anus which has been defcribed by Dr. Lettfom, and juftly attribut- ed by him to this difeafe. # I have known fevcral cafes of it. They always occurred in gouty habits.
Of the above morbid affections of the nerves, ftomach and bowels, the hyfteria, the fick head- ach, and the colic, appear much oftener in women than in men. I have faid that dyfpepfia is a fymp- tom
* Medical Memoirs, vol. iii.
THE GOUT. I'55
tern cf gout. Out of more than 500 perfons who were the patients of the Liverpool infirmary and difpenfary in one year, Dr. Currie informs u&9 " a great majority were females. V t
VI. The gout affects the glands and lymphatics. It produced a falivation of a profuie nature in Major Pearce Butler, which continued for two days. It produced a bubo in the groin in a citizen of Phi- ladelphia. He had never been infected with the venereal difeafe, of courfe no fufpicion was enter- tained by me of its being derived from that caufe. I knew a lady who had periodical fwellings in her breads, at the fame feafon of the year in which fhe had before been accuftomed to have a regular fit of the gout. The fcrophula and all the forms of dropfy are the effects in many cafes of the difpofi- tion of the gout to attack the lymphatic fyftem. There is a large hard fwelling without pain, of one, or both the legs and thighs, which has been called a dropfy, but is very different from the com- mon difeafe of that name. It comes on, and goes off fuddenly. It has lately been called in England the dumb gout. In the fpring