October 9th. “It is not possible for me to pass the streets without walking in a line with the dead, passing infected houses, and looking into open graves. This has been the case for many weeks.” “I don't know what to write; my head is gone, and my heart is torn to pieces.” “I intreat you to have no fears on my account. I am in the hands of a just and merciful God, and his will be done.”
October 11th. “Don't wonder that I am so low to-day. My heart is sunk down within me.”
The next day this excellent woman sickened, and died on the 19th of the same month.
If in a person possessed naturally of uncommon equanimity and fortitude, the distresses of our city produced such dejection of spirits, what must have been their effect upon hundreds, who were not endowed with those rare and extraordinary qualities of mind! Death in this, as well as in many other cases in which medicine had done its duty, appeared to be the inevitable consequence of the total abstraction of the energy of the mind in restoring the natural motions of life.
Under all the circumstances which have been mentioned, which opposed the system of depletion in the cure of this fever, it was still far more successful than any other mode of cure that had been pursued before in the United States, or in the West-Indies.
Three out of four died of the disease in Jamaica, under the care of Dr. Hume.
Dr. Blane considers it as one of the “most mortal” of diseases, and Dr. Jackson places a more successful mode of treating it among the subjects which will admit of “innovation” in medicine.
After the 15th of September, my success was much limited, compared with what it had been before that time. But at no period of the disease did I lose more than one in twenty of those whom I saw on the first day, and attended regularly through every stage of the fever, provided they had not been previously worn down by attending the sick.
The following statement, which will admit of being corrected, if it be inaccurate, will, I hope, establish the truth of the above assertions.
About one half of the families whom I have attended for many years, left the city. Of those who remained, many were affected by the disease. Out of the whole of them, after I had adopted my second mode of practice, I lost but five heads of families, and about a dozen servants and children. In no instance did I lose both heads of the same family. My success in these cases was owing to two causes: 1st, To the credit my former patients gave to my public declaration, that we had only one fever in the city: hence they applied on the first day, and sometimes on the first hour of their indisposition; and 2dly, To the numerous pledges many of them had seen of the safety and efficacy of copious blood-letting, by my advice, in other diseases: hence my prescription of that necessary remedy was always obeyed in its utmost extent. Of the few adults whom I lost, among my former patients, two of them were old people, two took laudanum, without my knowledge, and one refused to take medicine of any kind; all the rest had been worn down by previous fatigue.
I have before said that a great number of the blacks were my patients. Of these not one died under my care. This uniform success, among those people, was not owing altogether to the mildness of the disease, for I shall say presently, that a great proportion of a given number died, under other modes of practice.
In speaking of the comparative effects of purging and bleeding, it may not be amiss to repeat, that not one pregnant woman, to whom I prescribed them, died, or suffered abortion. Where the tonic remedies were used, abortion or death, and, in many instances, both, were nearly universal.
Many whole families, consisting of five, six, and, in three instances, of nine members, were recovered by plentiful purging and bleeding. I could swell this work by publishing a list of those families; but I take more pleasure in adding, that I was not singular in my success in the use of the above remedies. They were prescribed with great advantage by many of the physicians of the city, who had for a while given tonic medicines without effect. I shall not mention the names of any of the physicians who totally renounced those medicines, lest I should give offence by not mentioning them all. Many large families were cured by some of them, after they adopted and prescribed copious purging and blood-letting. One of them cured ten in the family of Mr. Robert Haydock, by means of those remedies. In one of that family, the disease came on with a vomiting of black bile.
But the use of the new remedies was not directed finally by the physicians alone. The clergy, the apothecaries, many private citizens, several intelligent women, and two black men, prescribed them with great success. Nay more, many persons prescribed them to themselves, and, as I shall say hereafter, with a success that was unequalled by any of the regular or irregular practitioners in the city.
It was owing to the almost universal use of purging and bleeding, that the mortality of the disease diminished, in proportion as the number of persons who were affected by it increased, about the middle of October. It was scarcely double of what it was in the middle of September, and yet six times the number of persons were probably at that time confined by it.
The success of copious purging and bleeding was not confined to the city of Philadelphia. Several persons, who were infected in town, and sickened in the country, were cured by them.
Could a comparison be made of the number of patients who died of the yellow fever in 1793, after having been plentifully bled and purged, with those who died of the same disease in the years 1699, 1741, 1747, and 1762, I am persuaded that the proportion would be very small in the year 1793, compared with the former years[95]. Including all who died under every mode of treatment, I suspect the mortality to be less, in proportion to the population of the city, and the number of persons who were affected, than it was in any of the other years that have been mentioned.
Not less than 6000 of the inhabitants of Philadelphia probably owe their lives to purging and bleeding, during the autumn.
I proceed with reluctance to inquire into the comparative success of the French practice. It would not be difficult to decide upon it from many facts that came under my notice in the city; but I shall rest its merit wholly upon the returns of the number of deaths at Bush-hill. This hospital, after the 22d of September, was put under the care of a French physician, who was assisted by one of the physicians of the city. The hospital was in a pleasant and airy situation; it was provided with all the necessaries and comforts for sick people that humanity could invent, or liberality supply. The attendants were devoted to their duty; and cleanliness and order pervaded every room in the house. The reputation of this hospital, and of the French physician, drew patients to it in the early stage of the disease. Of this I have been assured in a letter from Dr. Annan, who was appointed to examine and give orders of admission into the hospital, to such of the poor of the district of Southwark, as could not be taken care of in their own houses. Mr. Olden has likewise informed me, that most of the patients who were sent to the hospital by the city committee (of which he was a member) were in the first stage of the fever. With all these advantages, the deaths between the 22d of September and the 6th of November, amounted to 448 out of 807 patients who were admitted into the hospital within that time. Three fourths of all the blacks (nearly 20) who were patients in this hospital died. A list of the medicines prescribed there may be seen in the minutes of the proceedings of the city committee. Calomel and jalap are not among them. Moderate bleeding and purging with glauber's salts, I have been informed, were used in some cases by the physicians of this hospital. The proportion of deaths to the recoveries, as it appears in the minutes of the committee from whence the above report is taken, is truly melancholy! I hasten from it therefore to a part of this work, to which I have looked with pleasure, ever since I sat down to compose it.
I have said that the clergy, the apothecaries, and many other persons who were uninstructed in the principles of medicine, prescribed purging and bleeding with great success in this disease. Necessity gave rise to this undisciplined sect of practitioners, for they came forward to supply the places of the regular bred physicians who were sick or dead. I shall mention the names of a few of those persons who distinguished themselves as volunteers in this new work of humanity. The late Rev. Mr. Fleming, one of the ministers of the catholic church, carried the purging powders in his pocket, and gave them to his poor parishioners with great success. He even became the advocate of the new remedies. In a conversation I had with him, on the 22d of September, he informed me, that he had advised four of our physicians, whom he met a day or two before, “to renounce the pride of science, and to adopt the new mode of practice, for that he had witnessed its good effects in many cases.” Mr. John Keihmle, a German apothecary, has assured me, that out of 314 patients whom he visited, and 187 for whom he prescribed from the reports of their friends, he lost but 47 (which is nearly but one in eleven), and that he treated them all agreeably to the method which I had recommended. The Rev. Mr. Schmidt, one of the ministers of the Lutheran church, was cured by him. I have before mentioned an instance of the judgment of Mr. Connelly, and of his zeal in visiting and prescribing for the sick. His remedies were bleeding and purging. He, moreover, bore a constant and useful testimony against bark, wine, laudanum, and the warm bath[96]. Mrs. Paxton, in Carter's-alley, and Mrs. Evans, the wife of Mr. John Evans, in Second-street, were indefatigable; the one in distributing mercurial purges composed by herself, and the other in urging the necessity of copious bleeding and purging among her friends and neighbours, as the only safe remedies for the fever. These worthy women were the means of saving many lives[97]. Absalom Jones and Richard Allen, two black men, spent all the intervals of time, in which they were not employed in burying the dead, in visiting the poor who were sick, and in bleeding and purging them, agreeably to the directions which had been printed in all the newspapers. Their success was unparalleled by what is called regular practice. This encomium upon the practice of the blacks will not surprise the reader, when I add that they had no fear of putrefaction in the fluids, nor of the calumnies of a body of fellow-citizens in the republic of medicine to deter them from plentiful purging and bleeding. They had, besides, no more patients than they were able to visit two or three times a day. But great as their success was, it was exceeded by those persons who, in despair of procuring medical aid of any kind, purged and bled themselves. This palm of superior success will not be withheld from those people when I explain the causes of it. It was owing to their early use of the proper remedies, and to their being guided in the repetition of them, by the continuance of a tense pulse, or of pain and fever. A day, an afternoon, and even an hour, were not lost by these people in waiting for the visit of a physician, who was often detained from them by sickness, or by new and unexpected engagements, by which means the precious moment for using the remedies with effect passed irrevocably away. I have stated these facts from faithful inquiries, and numerous observations. I could mention the names and families of many persons who thus cured themselves. One person only shall be mentioned, who has shown by her conduct what reason is capable of doing when it is forced to act for itself. Mrs. Long, a widow, after having been twice unsuccessful in her attempts to procure a physician, undertook at last to cure herself. She took several of the mercurial purges, agreeably to the printed directions, and had herself bled seven times in the course of five or six days. The indication for repeating the bleeding was the continuance of the pain in her head. Her recovery was rapid and complete. The history of it was communicated to me by herself, with great gratitude, in my own house, during my second confinement with the fever. To these accounts of persons who cured themselves in the city, I could add many others, of citizens who sickened in the country, and who cured themselves by plentiful bleeding and purging, without the attendance of a physician.
From a short review of these facts, reason and humanity awake from their long repose in medicine, and unite in proclaiming, that it is time to take the cure of pestilential epidemics out of the hands of physicians, and to place it in the hands of the people. Let not the reader startle at this proposition. I shall give the following reasons for it.
1. In consequence of these diseases affecting a great number of people at one time, it has always been, and always will be impossible, for them all to have the benefit of medical aid, more especially as the proportion of physicians to the number of sick, is generally diminished upon these occasions, by desertion, sickness, and death.
2. The safety of committing to the people the cure of pestilential fevers, particularly the yellow fever and the plague, is established by the simplicity and uniformity of their causes, and of their remedies. However diversified they may be in their symptoms, the system, in both diseases, is generally under a state of undue excitement or great depression, and in most cases requires the abstraction of stimulus in a greater or less degree, or in a sudden or gradual manner. There can never be any danger of the people injuring themselves by mistaking any other disease for an epidemic yellow fever or plague, for no other febrile disease can prevail with them. It was probably to prevent this mistake, that the Benevolent Father of mankind, who has permitted no evil to exist which does not carry its antidote along with it, originally imposed that law upon all great and mortal epidemics.
3. The history of the yellow fever in the West-Indies proves the advantage of trusting patients to their own judgment. Dr. Lind has remarked, that a greater proportion of sailors who had no physicians recovered from that fever, than of those who had the best medical assistance. The fresh air of the deck of a ship, a purge of salt water, and the free use of cold water, probably triumphed here over the cordial juleps of physicians.
4. By committing the cure of this and other pestilential epidemics to the people, all those circumstances which prevented the universal success of purging and bleeding, in this disease, will have no operation. The fever will be mild in most cases, for all will prepare themselves to receive it, by a vegetable diet, and by moderate evacuations. The remedies will be used the moment the disease is felt, or even seen, and its violence and danger will thereby be obviated. There will then be no disputes among physicians, about the nature of the disease, to distract the public mind, for they will seldom be consulted in it. None will suffer from chronic debility induced by previous fatigue in attending the sick, nor from the want of nurses, for few will be so ill as to require them, and there will be no “foreboding” fears of death, or despair of recovery, to invite an attack of the disease, or to ensure its mortality.
The small-pox was once as fatal as the yellow fever and the plague. It has since yielded as universally to a vegetable diet and evacuations, in the hands of apothecaries, the clergy, and even of the good women, as it did in the hands of doctors of physic.
They have narrow conceptions, not only of the Divine goodness, but of the gradual progress of human knowledge, who suppose that all pestilential diseases shall not, like the small-pox, sooner or later cease to be the scourge and terror of mankind.
For a long while, air, water, and even the light of the sun, were dealt out by physicians to their patients with a sparing hand. They possessed, for several centuries, the same monopoly of many artificial remedies. But a new order of things is rising in medicine. Air, water, and light are taken without the advice of a physician, and bark and laudanum are now prescribed every where by nurses and mistresses of families, with safety and advantage. Human reason cannot be stationary upon these subjects. The time must and will come, when, in addition to the above remedies, the general use of calomel, jalap, and the lancet, shall be considered among the most essential articles of the knowledge and rights of man.
It is no more necessary that a patient should be ignorant of the medicine he takes, to be cured by it, than that the business of government should be conducted with secrecy, in order to insure obedience to just laws. Much less is it necessary that the means of life should be prescribed in a dead language, or dictated with the solemn pomp of a necromancer. The effects of imposture, in every thing, are like the artificial health produced by the use of ardent spirits. Its vigour is temporary, and is always followed by misery and death.
The belief that the yellow fever and the plague are necessarily mortal, is as much the effect of a superstitious torpor in the understanding, as the ancient belief that the epilepsy was a supernatural disease, and that it was an offence against Heaven to attempt to cure it. It is partly from the influence of this torpor in the minds of some people, that the numerous cures of the yellow fever, performed by a few simple remedies, were said to be of other diseases. It is necessary, for the conviction of such persons, that patients should always die of that, and other dangerous diseases, to prove that they have been affected by them.
The repairs which our world is destined to undergo will be incomplete, until pestilential fevers cease to be numbered among the widest outlets of human life.
There are many things which are now familiar to women and children, which were known a century ago only to a few men who lived in closets, and were distinguished by the name of philosophers.
We teach a hundred things in our schools less useful, and many things more difficult, than the knowledge that would be necessary to cure a yellow fever or the plague.
In my attempts to teach the citizens of Philadelphia, by my different publications, the method of curing themselves of yellow fever, I observed no difficulty in their apprehending every thing that was addressed to them, except what related to the different states of the pulse. All the knowledge that is necessary to discover when blood-letting is proper, might be taught to a boy or girl of twelve years old in a few hours. I taught it in less time to several persons, during the prevalence of the epidemic.
I would as soon believe that ratafia was intended by the Author of Nature to be the only drink of man, instead of water, as believe that the knowledge of what relates to the health and lives of a whole city, or nation, should be confined to one, and that a small or a privileged order of men. But what have physicians, what have universities or medical societies done, after the labours and studies of many centuries, towards lessening the mortality of pestilential fevers? They have either copied or contradicted each other, in all their publications. Plagues and malignant fevers are still leagued with war and famine, in their ravages upon human life.
To prevent the formation and mortality of this fever, it will be necessary, when it makes its appearance in a city or country, to publish an account of those symptoms which I have called the precursors of the disease, and to exhort the people, as soon as they feel those symptoms, to have immediate recourse to the remedies of purging or bleeding. The danger of delay in using one, or both these remedies, should be inculcated in the strongest terms, for the disease, like Time, has a lock on its forehead, but is bald behind. The bite of a rattle-snake is seldom fatal, because the medicines which cure it are applied or taken as soon as the poison comes in contact with the blood. There is less danger to be apprehended from the yellow fever than from the poison of the snake, provided the remedies for it are administered within a few hours after it is excited into action.
Let persons who are subject to chronic pains, or diseases of any kind, be advised not to be deceived by them. Every pain, at such a time, is the beginning of the disease; for it always acts first on debilitated parts of the body. From an ignorance of this law of epidemics many persons, by delaying their applications for help, perished with our fever.
Let nature be trusted into no case whatever, to cure this disease; and let no attack of it, however light, be treated with neglect. Death as certainly performs his work, when he steals on the system in the form of a mild intermittent, as he does, when he comes on with the symptoms of apoplexy, or a black vomiting.
Cleanliness, in houses and dress, cannot be too often inculcated during the prevalence of a yellow fever.
Let it not be supposed, that I mean that the history which I have given of the method of cure of this epidemic, should be applied, in all its parts, to the yellow fevers which may appear hereafter in the United States, or which exist at all times in the West-India islands. Season and climate vary this, as well as all other diseases. Bark and wine, so fatal in this, may be proper in a future yellow fever. But in the climate of the United States, I believe it will seldom appear with such symptoms of prostration and weakness, as not to require, in its first stage, evacuations of some kind.
The only inquiry, when the disease makes its appearance, should be, from what part of the body these evacuations should be procured; the order which should be pursued in obtaining them; and the quantity of each of the matters to be discharged, which should be withdrawn at a time.
Thus far did I venture, from my theory of the disease, and from the authorities of Dr. Hillary and Dr. Mosely, to decide in favour of evacuations in the yellow fever; but Dr. Wade, and Mr. Chisholm again support me by their practice in the fevers of the East and West-Indies. They both gave strong mercurial purges, and bled in some cases. Dr. Wade confirmed, by his practice, the advantage of gradually abstracting stimulus from the system. He never drew blood, even in the most inflammatory cases, until he had first discharged the contents of the bowels. The doctor has further established the efficacy of a vegetable diet and of water as a drink, as the best means of preventing the disease in a hot climate.
The manner in which the miasmata that produce the plague act upon the system is so much like that which has been described in the yellow fever, and the accounts of the efficacy of low diet, in preparing the body for its reception, and of copious bleeding, cold air, and cold water, in curing it, are so similar, that all the directions which relate to preventing, mitigating, or curing the yellow fever may be applied to it. The fluids in the plague show a greater tendency to the skin, than they do in the yellow fever. Perhaps, upon this account, the early use of powerful sudorifics may be more proper in the former than in the latter disease. From the influence of early purging and bleeding in promoting sweats in the yellow fever, there can be little doubt but the efforts of nature to unload the system in the plague, through the channel of the pores, might be accelerated by the early use of the same remedies. One thing, with respect to the plague, is certain, that its cure depends upon the abstraction of stimulus, either by means of plentiful sweats, or of purulent matter from external sores. Perhaps the efficacy of these remedies depends wholly upon their elevating the system from its prostrated state in a gradual manner. If this be the case, those natural discharges might be easily and effectually imitated by small and repeated bleedings.
To correspond in quantity with the discharge from the skin, blood-letting in the plague, when indicated, should be copious. A profuse sweat, continued for twenty-four hours, cannot fail of wasting many pounds of the fluids of the body. This was the duration of the critical sweats in the famous plague which was known by the name of the English sweating sickness, and which made its appearance in the army of Henry VII. in Milford-Haven in Wales, and spread from thence through every part of the kingdom.
The principles which lead to the prevention and cure of the yellow fever and the plague, apply with equal force to the mitigation of the measles, and to the prevention or mitigation of the scarlatina anginosa, the dysentery, and the inflammatory jail fever. I have remarked elsewhere[98], that a previous vegetable diet lessened the violence and danger of the measles. Dr. Sims taught me, many years ago, to prevent or mitigate the scarlatina anginosa, by means of gentle purges, after children are infected by it[99]. Purges of salts have in many instances preserved whole families and neighbourhoods from the dysentery, where they have been exposed to its remote cause. During the late American war, an emetic seldom failed of preventing an attack of the hospital fever, when given in its forming state[100]. I have had no experience of the effects of previous evacuations in abating the violence, or preventing the mortality of the malignant sore throat, but I can have no doubt of their efficacy, from the sameness of the state of the system in that disease, as in other malignant fevers. The debility induced in it is from depression, and the supposed symptoms of putrefaction are nothing but the disguised effects of a sudden and violent pressure of an inflammatory stimulus upon the arterial system.
With these observations I close the history of the rise, progress, symptoms, and treatment of the bilious remitting yellow fever, which appeared in Philadelphia in the year 1793. My principal aim has been to revive and apply to it the principles and practice of Dr. Sydenham, and, however coldly those principles and that practice may be received by some physicians of the present day, I am convinced that experience, in all ages and in all countries, will vouch for their truth and utility.
Narratives of escapes from great dangers of shipwreck, war, captivity, and famine have always formed an interesting part of the history of the body and mind of man. But there are deliverances from equal dangers which have hitherto passed unnoticed; I mean from pestilential fevers. I shall briefly describe the state of my body and mind during my intercourse with the sick in the epidemic of 1793. The account will throw additional light upon the disease, and probably illustrate some of the laws of the animal economy. It will, moreover, serve to furnish a lesson to all who may be placed in similar circumstances to commit their lives, without fear, to the protection of that Being, who is able to save to the uttermost, not only from future, but from present evil.
Some time before the fever made its appearance, my wife and children went into the state of New-Jersey, where they had long been in the habit of spending the summer months. My family, about the 25th of August, consisted of my mother, a sister, who was on a visit to me, a black servant man, and a mulatto boy. I had five pupils, viz. Warner Washington and Edward Fisher, of Virginia, John Alston, of South-Carolina, and John Redman Coxe (grandson to Dr. Redman) and John Stall, both of this city. They all crowded around me upon the sudden increase of business, and with one heart devoted themselves to my service, and to the cause of humanity.
The credit which the new mode of treating the disease acquired, in all parts of the city, produced an immense influx of patients to me from all quarters. My pupils were constantly employed; at first in putting up purging powders, but, after a while, only in bleeding and visiting the sick.
Between the 8th and the 15th of September I visited and prescribed for between a hundred and a hundred and twenty patients a day. Several of my pupils visited a fourth or fifth part of that number. For a while we refused no calls. In the short intervals of business, which I spent at my meals, my house was filled with patients, chiefly the poor, waiting for advice. For many weeks I seldom ate without prescribing for numbers as I sat at my table. To assist me at these hours, as well as in the night, Mr. Stall, Mr. Fisher, and Mr. Coxe accepted of rooms in my house, and became members of my family. Their labours now had no remission.
Immediately after I adopted the antiphlogistic mode of treating the disease, I altered my manner of living. I left off drinking wine and malt liquors. The good effects of the disuse of these liquors helped to confirm me in the theory I had adopted of the disease. A troublesome head-ach, which I had occasionally felt, and which excited a constant apprehension that I was taking the fever, now suddenly left me. I likewise, at this time, left off eating solid animal food, and lived wholly, but sparingly, upon weak broth, potatoes, raisins, coffee, and bread and butter.
From my constant exposure to the sources of the disease, my body became highly impregnated with miasmata. My eyes were yellow, and sometimes a yellowness was perceptible in my face. My pulse was preternaturally quick, and I had profuse sweats every night. These sweats were so offensive, as to oblige me to draw the bed-clothes close to my neck, to defend myself from their smell. They lost their fœtor entirely, upon my leaving off the use of broth, and living entirely upon milk and vegetables. But my nights were rendered disagreeable, not only by these sweats, but by the want of my usual sleep, produced in part by the frequent knocking at my door, and in part by anxiety of mind, and the stimulus of the miasmata upon my system. I went to bed in conformity to habit only, for it ceased to afford me rest or refreshment. When it was evening I wished for morning; and when it was morning, the prospect of the labours of the day, at which I often shuddered, caused me to wish for the return of evening. The degrees of my anxiety may be easily conceived when I add, that I had at one time upwards of thirty heads of families under my care; among these were Mr. Josiah Coates, the father of eight, and Mr. Benjamin Scull and Mr. John Morell, both fathers of ten children. They were all in imminent danger; but it pleased God to make me the instrument of saving each of their lives. I rose at six o'clock, and generally found a number of persons waiting for advice in my shop or parlour. Hitherto the success of my practice gave a tone to my mind, which imparted preternatural vigour to my body. It was meat and drink to me to fulfil the duties I owed to my fellow-citizens, in this time of great and universal distress. From a hope that I might escape the disease, by avoiding every thing that could excite it into action, I carefully avoided the heat of the sun, and the coldness of the evening air. I likewise avoided yielding to every thing that should raise or depress my passions. But, at such a time, the events which influence the state of the body and mind are no more under our command than the winds or weather. On the evening of the 14th of September, after eight o'clock, I visited the son of Mrs. Berriman, near the Swedes's church, who had sent for me early in the morning. I found him very ill. He had been bled in the forenoon, by my advice, but his pulse indicated a second bleeding. It would have been difficult to procure a bleeder at that late hour. I therefore bled him myself. Heated by this act, and debilitated by the labours of the day, I rode home in the evening air. During the ensuing night I was much indisposed. I rose, notwithstanding, at my usual hour. At eight o'clock I lost ten ounces of blood, and immediately afterwards got into my chair, and visited between forty and fifty patients before dinner. At the house of one of them I was forced to lie down a few minutes. In the course of this morning's labours my mind was suddenly thrown off its pivots, by the last look, and the pathetic cries, of a friend for help, who was dying under the care of a French physician. I came home about two o'clock, and was seized, immediately afterwards, with a chilly fit and a high fever. I took a dose of the mercurial medicine, and went to bed. In the evening I took a second purging powder, and lost ten ounces more of blood. The next morning I bathed my face, hands, and feet in cold water for some time. I drank plentifully, during the day and night, of weak hyson tea, and of water, in which currant jelly had been dissolved. At eight o'clock I was so well as to admit persons who came for advice into my room, and to receive reports from my pupils of the state of as many of my patients as they were able to visit; for, unfortunately, they were not able to visit them all (with their own) in due time; by which means several died. The next day I came down stairs, and prescribed in my parlour for not less than a hundred people. On the 19th of the same month, I resumed my labours, but in great weakness. It was with difficulty that I ascended a pair of stairs, by the help of a banister. A slow fever, attended with irregular chills, and a troublesome cough, hung constantly upon me. The fever discovered itself in the heat of my hands, which my patients often told me were warmer than their own. The breath and exhalations from the sick now began to affect me, in small and infected rooms, in the most sensible manner. On the morning of the 4th of October I suddenly sunk down, in a sick room, upon a bed, with a giddiness in my head. It continued for a few minutes, and was succeeded by a fever, which confined me to my house the remaining part of the day.
Every moment in the intervals of my visits to the sick was employed in prescribing, in my own house, for the poor, or in sending answers to messages from my patients; time was now too precious to be spent in counting the number of persons who called upon me for advice. From circumstances I believe it was frequently 150, and seldom less than 50 in a day, for five or six weeks. The evening did not bring with it the least relaxation from my labours. I received letters every day from the country, and from distant parts of the union, containing inquiries into the mode of treating the disease, and after the health and lives of persons who had remained in the city. The business of every evening was to answer these letters, also to write to my family. These employments, by affording a fresh current to my thoughts, kept me from dwelling on the gloomy scenes of the day. After these duties were performed, I copied into my note book all the observations I had collected during the day, and which I had marked with a pencil in my pocket-book in sick rooms, or in my carriage. To these constant labours of body and mind were added distresses from a variety of causes. Having found myself unable to comply with the numerous applications that were made to me, I was obliged to refuse many every day. My sister counted forty-seven in one forenoon before eleven o'clock. Many of them left my door with tears, but they did not feel more distress than I did from refusing to follow them. Sympathy, when it vents itself in acts of humanity, affords pleasure, and contributes to health; but the reflux of pity, like anger, gives pain, and disorders the body. In riding through the streets, I was often forced to resist the entreaties of parents imploring a visit to their children, or of children to their parents. I recollect, and even yet with pain, that I tore myself at one time from five persons in Moravian-alley, who attempted to stop me, by suddenly whipping my horse, and driving my chair as speedily as possible beyond the reach of their cries.
The solicitude of the friends of the sick for help may further be conceived of, when I add, that the most extravagant compensations were sometimes offered for medical services, and, in one instance, for only a single visit. I had no merit in refusing these offers, and I have introduced an account of them only to inform such physicians as may hereafter be thrown into a similar situation, that I was favoured with an exemption from the fear of death, in proportion as I subdued every selfish feeling, and laboured exclusively for the benefit of others. In every instance in which I was forced to refuse these pathetic and earnest applications, my distress was heightened by the fear that the persons, whom I was unable to visit, would fall into improper hands, and perish by the use of bark, wine, and laudanum.
But I had other afflictions besides the distress which arose from the abortive sympathy which I have described. On the 11th of September, my ingenious pupil, Mr. Washington, fell a victim to his humanity. He had taken lodgings in the country, where he sickened with the disease. Having been almost uniformly successful in curing others, he made light of his fever, and concealed the knowledge of his danger from me, until the day before he died. On the 18th of September Mr. Stall sickened in my house. A delirium attended his fever from the first hour it affected him. He refused, and even resisted force when used to compel him to take medicine. He died on the 23d of September[101]. Scarcely had I recovered from the shock of the death of this amiable youth, when I was called to weep for a third pupil, Mr. Alston, who died in my neighbourhood the next day. He had worn himself down, before his sickness, by uncommon exertions in visiting, bleeding, and even sitting up with sick people. At this time Mr. Fisher was ill in my house. On the 26th of the month, at 12 o'clock, Mr. Coxe, my only assistant, was seized with the fever, and went to his grandfather's. I followed him with a look, which I feared would be the last in my house. At two o'clock my sister, who had complained for several days, yielded to the disease, and retired to her bed. My mother followed her, much indisposed, early in the evening. My black servant man had been confined with the fever for several days, and had on that day, for the first time, quitted his bed. My little mulatto boy, of eleven years old, was the only person in my family who was able to afford me the least assistance. At eight o'clock in the evening I finished the business of the day. A solemn stillness at that time pervaded the streets. In vain did I strive to forget my melancholy situation by answering letters, and by putting up medicines, to be distributed next day among my patients. My faithful black man crept to my door, and at my request sat down by the fire, but he added, by his silence and dullness, to the gloom which suddenly overpowered every faculty of my mind.
On the first day of October, at two o'clock in the afternoon, my sister died. I got into my carriage within an hour after she expired, and spent the afternoon in visiting patients. According as a sense of duty, or as grief has predominated in my mind, I have approved, and disapproved of this act, ever since. She had borne a share in my labours. She had been my nurse in sickness, and my casuist in my choice of duties. My whole heart reposed itself in her friendship. Upon being invited to a friend's house in the country, when the disease made its appearance in the city, she declined accepting the invitation, and gave as a reason for so doing, that I might probably require her services in case of my taking the disease, and that, if she were sure of dying, she would remain with me, provided that, by her death, she could save my life. From this time I declined in health and strength. All motion became painful to me. My appetite began to fail. My night sweats continued. My short and imperfect sleep was disturbed by distressing or frightful dreams. The scenes of them were derived altogether from sick rooms and grave-yards. I concealed my sorrows as much as possible from my patients; but when alone, the retrospect of what was past, and the prospect of what was before me, the termination of which was invisible, often filled my soul with the most poignant anguish. I wept frequently when retired from the public eye, but I did not weep over the lost members of my family alone. I beheld or heard every day of the deaths of citizens, useful in public, or amiable in private life. It was my misfortune to lose as patients the Rev. Mr. Fleming and Mr. Graesel, both exhausted by their labours of piety and love among the poor, before they sickened with the disease. I saw the last struggles of departing life in Mr. Powel, and deplored, in his death, an upright and faithful servant of the public, as well as a sincere and affectionate friend. Often did I mourn over persons who had, by the most unparalleled exertions, saved their friends and families from the grave, at the expence of their own lives. Many of these martyrs to humanity were in humble stations. Among the members of my profession, with whom I had been most intimately connected, I had daily cause of grief and distress. I saw the great and expanded mind of Dr. Pennington, shattered by delirium, just before he died. He was to me dear and beloved, like a younger brother. He was, moreover, a Joab in the contest with the disease. Philadelphia must long deplore the premature death of this excellent physician. Had he lived a few years longer, he would have filled an immense space in the republic of medicine[102]. It was my affliction to see my friend Dr. John Morris breathe his last, and to hear the first effusions of the most pathetic grief from his mother, as she bursted from the room in which he died. But I had distress from the sickness, as well as the deaths of my brethren in physic. My worthy friends, Dr. Griffitts, Dr. Say, and Dr. Mease, were suspended by a thread over the grave, nearly at the same time. Heaven, in mercy to me, as well as in kindness to the public and their friends, preserved their lives. Had they died, the measure of my sorrows would have been complete.
I have said before, that I early left off drinking wine; but I used it in another way. I carried a little of it in a vial in my pocket, and when I felt myself fainty, after coming out of a sick room, or after a long ride, I kept about a table spoonful of it in my mouth for half a minute, or longer, without swallowing it. So weak and excitable was my system, that this small quantity of wine refreshed and invigorated me as much as half a pint would have done at any other time. The only difference was, that the vigour I derived from the wine in the former, was of shorter duration than when taken in the latter way.
For the first two weeks after I visited patients in the yellow fever, I carried a rag wetted with vinegar, and smelled it occasionally in sick rooms: but after I saw and felt the signs of the universal presence of miasmata in my system, I laid aside this and all other precautions. I rested myself on the bed-side of my patients, and I drank milk or ate fruit in their sick rooms. Besides being saturated with miasmata, I had another security against being infected in sick rooms, and that was, I went into scarcely a house which was more infected than my own. Many of the poor people, who called upon me for advice, were bled by my pupils in my shop, and in the yard, which was between it and the street. From the want of a sufficient number of bowls to receive their blood, it was sometimes suffered to flow and putrify upon the ground. From this source, streams of miasmata were constantly poured into my house, and conveyed into my body by the air, during every hour of the day and night.
The deaths of my pupils and sister have often been urged as objections to my mode of treating the fever. Had the same degrees of labour and fatigue, which preceded the attack of the yellow fever in each of them, preceded an attack of a common pleurisy, I think it probable that some, or perhaps all of them, would have died with it. But when the influence of the concentrated miasmata which filled my house was added to that of constant fatigue upon their bodies, what remedies could be expected to save their lives? Under the above circumstances, I consider the recovery of the other branches of my family from the fever (and none of them escaped it) with emotions, such as I should feel had we all been revived from apparent death by the exertions of a humane society.
For upwards of six weeks I did not taste animal food, nor fermented liquors of any kind. The quantity of aliment which I took, inclusive of drinks, during this time, was frequently not more than one or two pounds in a day. Yet upon this diet I possessed, for a while, uncommon activity of body. This influence of abstinence upon bodily exertion has been happily illustrated by Dr. Jackson, in his directions for preserving the health of soldiers in hot climates. He tells us, that he walked a hundred miles in three days, in Jamaica, during which time he breakfasted on tea, supped on bread and salad, and drank nothing but lemonade or water. He adds further, that he walked from Edinburgh to London in eleven days and a half, and that he travelled with the most ease when he only breakfasted and supped, and drank nothing but water. The fatigue of riding on horseback is prevented or lessened by abstinence from solid food. Even the horse suffers least from a quick and long journey when he is fed sparingly with hay. These facts add weight to the arguments formerly adduced, in favour of a vegetable diet, in preventing or mitigating the action of the miasmata of malignant fevers upon the system. In both cases the abstraction of stimulus removes the body further from the reach of undue excitement and morbid depression.
Food supports life as much by its stimulus, as by affording nourishment to the body. Where an artificial stimulus acts upon the system the natural stimulus of food ceases to be necessary. Under the influence of this principle, I increased or diminished my food with the signs I discovered of the increase or diminution of the seeds of the disease in my body. Until the 15th of September I drank weak coffee, but after that time I drank nothing but milk, or milk and water, in the intervals of my meals. I was so satisfied of the efficacy of this mode of living, that I believed life might have been preserved, and a fever prevented, for many days, with a much greater accumulation of miasmata in my system, by means of a total abstinence from food. Poison is a relative term, and an excess in quantity, or a derangement in place, is necessary to its producing deleterious effects. The miasmata of the yellow fever produced sickness and death only from the excess of their quantity, or from their force being increased by the addition of those other stimuli which I have elsewhere called exciting causes.
In addition to low diet, as a preventive of the disease, I obviated costiveness by taking occasionally a calomel pill, or by chewing rhubarb.
I had read and taught, in my lectures, that fasting increases acuteness in the sense of touch. My low living had that effect, in a certain degree, upon my fingers. I had a quickness in my perception, of the state of the pulse in the yellow fever, that I had never experienced before in any other disease. My abstemious diet, assisted perhaps by the state of my feelings, had likewise an influence upon my mind. Its operations were performed with an ease and a celerity, which rendered my numerous and complicated duties much less burdensome than they would probably have been under other circumstances of diet, or a less agitated state of my passions.
My perception of the lapse of time was new to me. It was uncommonly slow. The ordinary business and pursuits of men appeared to me in a light that was equally new. The hearse and the grave mingled themselves with every view I took of human affairs. Under these impressions I recollect being as much struck with observing a number of men, employed in digging the cellar of a large house, as I should have been, at any other time, in seeing preparations for building a palace upon a cake of ice. I recollect, further, being struck with surprise, about the 1st of October, in seeing a man busily employed in laying in wood for the approaching winter. I should as soon have thought of making provision for a dinner on the first day of the year 1800.
In the account of my distresses, I have passed over the slanders which were propagated against me by some of my brethren. I have mentioned them only for the sake of declaring, in this public manner, that I most heartily forgive them; and that if I discovered, at any time, an undue sense of the unkindness and cruelty of those slanders, it was not because I felt myself injured by them, but because I was sure they would irreparably injure my fellow-citizens, by lessening their confidence in the only remedies that I believed to be effectual in the reigning epidemic. One thing in my conduct towards these gentlemen may require justification; and that is, my refusing to consult with them. A Mahometan and a Jew might as well attempt to worship the Supreme Being in the same temple, and through the medium of the same ceremonies, as two physicians of opposite principles and practice attempt to confer about the life of the same patient. What is done in consequence of such negotiations (for they are not consultations) is the ineffectual result of neutralized opinions; and wherever they take place, should be considered as the effect of a criminal compact between physicians, to assess the property of their patients, by a shameful prostitution of the dictates of their consciences. Besides, I early discovered that it was impossible for me, by any reasonings, to change the practice of some of my brethren. Humanity was, therefore, on the side of leaving them to themselves; for the extremity of wrong in medicine, as in morals and government, is often a less mischief than that mixture of right and wrong which serves, by palliating, to perpetuate evil.
After the loss of my health I received letters from my friends in the country, pressing me, in the strongest terms, to leave the city. Such a step had become impracticable. My aged mother was too infirm to be removed, and I could not leave her. I was, moreover, part of a little circle of physicians, who had associated themselves in support of the new remedies. This circle would have been broken by my quitting the city. The weather varied the disease, and, in the weakest state of my body, I expected to be able, from the reports of my pupils, to assist my associates in detecting its changes, and in accommodating our remedies to them. Under these circumstances it pleased God to enable me to reply to one of the letters that urged my retreat from the city, that “I had resolved to stick to my principles, my practice, and my patients, to the last extremity.”
On the 9th of October, I visited a considerable number of patients, and, as the day was warm, I lessened the quantity of my clothing. Towards evening I was seized with a pain in the back, which obliged me to go to bed at eight o'clock. About twelve I awoke with a chilly fit. A violent fever, with acute pains in different parts of my body, followed it. At one o'clock I called for Mr. Fisher, who slept in the next room. He came instantly, with my affectionate black man, to my relief. I saw my danger painted in Mr. Fisher's countenance. He bled me plentifully, and gave me a dose of the mercurial medicine. This was immediately rejected. He gave me a second dose, which likewise acted as an emetic, and discharged a large quantity of bile from my stomach. The remaining part of the night was passed under an apprehension that my labours were near an end. I could hardly expect to survive so violent an attack of the fever, broken down, as I was, by labour, sickness, and grief. My wife and seven children, whom the great and distressing events that were passing in our city had jostled out of my mind for six or seven weeks, now resumed their former place in my affections. My wife had stipulated, in consenting to remain in the country, to come to my assistance in case of my sickness; but I took measures which, without alarming her, proved effectual in preventing it. My house was enveloped in foul air, and the probability of my death made her life doubly necessary to my family. In the morning the medicine operated kindly, and my fever abated. In the afternoon it returned, attended with a great inclination to sleep. Mr. Fisher bled me again, which removed the sleepiness. The next day the fever left me, but in so weak a state, that I awoke two successive nights with a faintness which threatened the extinction of my life. It was removed each time by taking a little aliment. My convalescence was extremely slow. I returned, in a very gradual manner, to my former habits of diet. The smell of animal food, the first time I saw it at my table, forced me to leave the room. During the month of November, and all the winter months, I was harassed with a cough, and a fever somewhat of the hectic kind. The early warmth of the spring removed those complaints, and restored me, through Divine goodness, to my usual state of health.
I should be deficient in gratitude, were I to conclude this narrative without acknowledging my obligations to my surviving pupils, Mr. Fisher and Mr. Coxe, for the great support and sympathy I derived from them in my labours and distresses.
I take great pleasure likewise in acknowledging my obligations to my former pupil, Dr. Woodhouse, who assisted me in the care of my patients, after I became so weak as not to be able to attend them with the punctuality their cases required. The disinterested exploits of these young gentlemen in the cause of humanity, and their success in the treatment of the disease, have endeared their names to hundreds, and, at the same time, afforded a prelude of their future eminence and usefulness in their profession.
But wherewith shall I come before the great FATHER and REDEEMER of men, and what shall I render unto him for the issue of my life from the grave?