Footnote:
[8] History of the Fever in 1797.
The diseases which succeeded the fever of 1798, in November and December, were highly inflammatory. A catarrh was nearly universal. Several cases of sore throat, and one of erysipelas, came under my care in the month of November. The weather in December was extremely cold. It was equally so in the beginning of January, 1799, accompanied with several falls of snow.
About the middle of the month, the weather moderated so much, so as to open the navigation of the Delaware. I met with two cases of malignant colic in the latter part of this month, and one of yellow fever. The last was Swen Warner. Dr. Physick, who attended him with me, informed me that he had, nearly at the same time, attended two other persons with the same disease.
The weather was very cold, and bilious pleurisies were common, during the latter part of the month of February.
March was equally cold. The newspapers contained accounts of the winter having been uncommonly severe in Canada, and in several European countries.
The first two weeks in April were still cold. The Delaware, which had been frozen a second time during the winter, was crossed near its origin, on the ice, on the 15th day of this month. The diseases, though fewer than in the winter, were bilious and inflammatory. During this month, I was called to a case of yellow fever, which yielded to copious bleeding, and other depleting medicines.
May was colder than is usual in that month, but very healthy.
In the first week of June, several cases of highly bilious fever came under my care. In one of them, all the usual symptoms of the highest grade of that fever occurred. On the 13th of the month, Dr. Physick informed me, that he had lost a patient with that disease. On the 23d of the same month, Joseph Ashmead, a young merchant, died of it. Several other cases of the disease occurred between the 20th and 29th days of the month, in different parts of the city. About this time, I was informed that the inhabitants of Keys's-alley had predicted a return of the yellow fever, from the trees before their doors emitting a smell, exactly the same which they perceived just before the breaking out of that disease in 1793.
In July, the city was alarmed, by Dr. Griffitts, with an account of several cases of the fever in Penn-street, near the water. The strictness with which the quarantine law had been executed, for a while rendered this account incredible with many people, and exposed the doctor to a good deal of obloquy. At length a vessel was discovered, that had arrived from one of the West-India islands on the 14th of May, and one day before the quarantine law was put into operation, from which the disease was said to be derived. Upon investigating the state of this vessel, it appeared that she had arrived with a healthy crew, and that no person had been sick on board of her during her voyage.
In the latter part of July and in the beginning of August, the disease gradually disappeared from every part of the city. This circumstance deserves attention, as it shows the disease did not spread by contagion.
About this time we were informed by the newspapers, that dogs, geese, and other poultry, also that wild pigeons were sickly in many parts of the country, and that fish on the Susquehannah, and oysters in the Delaware bay, were so unpleasant, that the inhabitants declined eating them. At the same time, flies were found dead in great numbers, in the unhealthy parts of the city. The weather was dry in August and September. There was no second crop of grass. The gardens yielded a scanty supply of vegetables, and of an inferior size and quality. Cherries were smaller than usual, and pear and apple-trees dropped their fruits prematurely, in large quantities. The peaches, which arrived at maturity, were small and ill-tasted. The grain was in general abundant, and of a good quality. A fly, of an unusual kind, covered the potatoe fields, and devoured, in some instances, the leaves of the potatoe. This fly has lately been used with success in our country, instead of the fly imported from Spain. It is equal to it in every respect. Like the Spanish fly, it sometimes induces strangury.
About the middle of August the disease revived, and appeared in different parts of the city. A publication from the academy of medicine, in which they declared the seeds of the disease to spread from the atmosphere only, produced a sudden flight of the inhabitants. In no year, since the prevalence of the fever, was the desertion of the city so general.
I shall now add a short account of the symptoms and treatment of this epidemic.
The arterial system was in most cases active. I met with a tense pulse in a patient after the appearance of the black vomiting. Delirium was less frequent in adults than in former years. In children there was a great determination of the disease to the brain.
I observed no new symptoms in the stomach and bowels. One of the worst cases of the fever which I saw was accompanied with colic. A girl of Thomas Shortall, who recovered, discharged 9 worms during her fever. It appeared in Mr. Thomas Roan, one of my pupils, in the form of a dysentery.
A stiffness, such as follows death, occurred in several patients in the city hospital before death.
Miss Shortall had an eruption of pimples on her breast, such as I have described in the short account I gave of the yellow fever of 1762 in this city, in my account of the disease in 1793.
The blood exhibited its usual appearances in the yellow fever. It was seldom sizy till towards the close of the disease.
The tongue was generally whitish. Sometimes it was of a red colour, and had a polished appearance. I saw no case of a black tongue, and but few that were yellow before the seventh day of the disease.
The type of this disease was nearly the same as described in 1797. It now and then appeared in the form of a quartan, in which state it generally proved fatal. It appeared with rheumatic pains in one of my patients. It blended itself with gout and small-pox. Its union with the latter disease was evident in two patients in the city hospital, in each of whom the stools were such as were discharged in the most malignant state of the fever.
The remedies for this fever were bleeding, vomits, purges, sweats, and a salivation and blisters.
There were few cases that did not indicate bleeding. It was performed, when proper, in the usual way, and with its usual good effects. It was indicated as much when the disease appeared in the bowels as in the blood-vessels. Mr. Roan, in whom it was accompanied with symptoms of dysentery, lost nearly 200 ounces of blood by twenty-two bleedings.
I found the same benefit from emetics, in this fever, that I did in the fever of 1798. They were never administered except on the first day, before violent action had taken place in the system, or after it was moderated by one or two bleedings.
Purges of calomel and jalap, also castor oil, salts, and injections were prescribed with their usual advantages.
In those cases where the system was prostrated below the point of re-action, I began the cure by sweating. Blankets, with hot bricks wetted with vinegar, and the hot bath, as mentioned formerly, when practicable, were used for this purpose. The latter produced, in a boy of 14 years of age, who came into the city hospital without a pulse, and with a cold skin, in a few hours, a general warmth and an active pulse. The determination of the disease to the pores was evinced in one of my patients, by her sweating under the use of the above-mentioned remedies, for the first time in her life. A moisture upon her skin had never before been induced, she informed me, even by the warmest day in summer.
The advantages of a salivation were as great as in former years. From the efficacy of bleeding, purges, emetics, and sweating, I had the pleasure of seeing many recoveries before the mercury had time to affect the mouth. In no one case did I rest the cure exclusively upon any one of these remedies. The more numerous the outlets were to convey off superfluous fluids and excitement from the body, the more safe and certain were the recoveries. A vein, the gall-bladder, the bowels, the pores, and the salivary glands were all opened, in succession, in part, or together, according to circumstances, so as to give the disease every possible chance of passing out of the body without injuring or destroying any of its vital parts.
Blisters were applied with advantage. The vomiting and sickness which attend this fever were relieved, in many instances, by a blister to the stomach.
In those cases in which the fever was protracted to the chronic state, bark, wine, laudanum, and æther produced the most salutary effects. I think I saw life recalled, in several cases in which it appeared to be departing, by frequent and liberal doses of the last of those medicines. The bark was given, with safety and advantage, after the seventh day, when the fever assumed the form of an intermittent.
The following symptoms were generally favourable, viz. a bleeding from the mouth and gums, and a disposition to weep, when spoken to in any stage of the fever.
A hoarseness and sore throat indicated a fatal issue of the disease, as it did in 1798. Dr. Physick remarked, that all those persons who sighed after waking suddenly, before they were able to speak, died.
The recurrence of a redness of the eyes, after it had disappeared, or of but one eye, was generally followed by death. I saw but one recovery with a red face.
I saw several persons, a few hours before death, in whom the countenance, tongue, voice, and pulse were perfectly natural. They complained of no pain, and discovered no distress nor solicitude of mind. Their danger was only to be known by the circumstances which had preceded this apparently healthy and tranquil state of the system. They had all passed through extreme suffering, and some of them had puked black matter.
The success of the mode of practice I have described was the same as in former years, in private families; but in the city hospital, which was again placed under the care of Dr. Physick and myself, there was a very different issue to it, from causes that are too obvious to be mentioned.
There were two opinions given to the public upon the subject of the origin of this fever; the one by the academy of medicine, the other by the college of physicians. The former declared it to be generated in the city, from putrid domestic exhalations, because they saw it only in their vicinity, and discovered no channel by which it could have been derived from a foreign country; the latter asserted it to be “imported, because it had been imported in former years.”
The weather in the month of January was less cold than is common in that month. Catarrhs, the cynanche trachealis, and bilious pleurisies were prevalent in every part of it. A few cases of yellow fever occurred likewise during this month.
Several cases of erysipelas appeared in February.
The month of March was unusually healthy.
The weather was warm in April, and the city as healthy as in March.
It was equally so in May and June. The spring fruits appeared early in the latter month, in large quantities, and were of an excellent quality. Locusts were universal in June. They had not appeared since the year 1783. A record from the journal of the Swedish missionaries was published at this time, which described their appearance in 1715, in which year it was said to be very healthy.
On the 14th of June there was a severe thunder gust, with more lightning than had been known for seven years before.
There fell, during all the months that have been mentioned, frequent and plentiful showers of rain, which rendered the crops of grass luxuriant in the neighbourhood of Philadelphia.
The winds at this time were chiefly from the south-east.
A few intermittents appeared in June, which yielded readily to the bark.
On the 16th day of June, Dr. Physick informed me he had a black boy under his care with the yellow fever.
In July, the hooping cough, cholera infantum, and some cases of dysentery and bilious fever appeared in the city.
On the 30th of July, Dr. Pascalis informed me that he had lost a patient on the fifth day of a yellow fever.
In August, the dysentery was the principal form of disease that prevailed in the city.
On the 22d of this month, a woman died of the yellow fever in Gaskill-street, under the care of Dr. Church.
On the 28th and 30th, there fell an unusual quantity of rain. The winds were south-west and north-west during the greatest part of the summer months. The latter were sometimes accompanied with rain.
On the 11th of September, a clerk of Mr. Levi Hollingsworth, and, on the 12th, a clerk of Mr. John Connelly, died with the yellow fever.
A plentiful shower of rain fell on the night of the 21st of this month.
About this time there appeared one and twenty cases of yellow fever in Spruce-street, between Front and Second-streets. They were all in the neighbourhood of putrid exhalations. Fourteen of them ended fatally.
No one of the above cases of malignant fever could be traced to a ship, or to a direct or indirect intercourse with persons affected by that disease.
While Philadelphia was thus visited by a few sporadic cases only of yellow fever, it was epidemic in several of the cities of the United States, particularly in New-York, Providence, in Rhode Island, Norfolk, and Baltimore. In the last named place, it was publicly declared by the committee of health to be of domestic origin.
The dysentery was epidemic, at the same time, in several of the towns of Massachusetts and New-Hampshire. It was attended with uncommon mortality at Hanover, in the latter state.
This difference in the states of health and sickness in the different parts of the United States must be sought for chiefly in the different states of the weather in those places. The exemption of Philadelphia from the yellow fever, as an epidemic, may perhaps be ascribed to the strength and vigour of the vegetable products of the year, which retarded their putrefaction; to frequent showers of rain, which washed away the filth of the streets and gutters; and to the perfection of the summer and autumnal fruits.
The months of November and December this year were uncommonly healthy. During the former, several light shocks of earthquakes were felt in Lancaster and Harrisburg, in Pennsylvania, and in Wilmington, in the state of Delaware.
The month of January was intensely cold. In February it became more moderate. The diseases, during these two months, were catarrhs and a few pleurisies.
In March and April there fell an unusual quantity of rain. The hay harvest began in the neighbourhood of Philadelphia on the 28th of May. A few mild cases of scarlatina anginosa occurred during these months.
In June the weather was dry and healthy.
On the 8th of July, a case of yellow fever occurred in the practice of Dr. Stewart. About the 15th of the month, a patient died with it in the Pennsylvania hospital. Dr. Physick informed me that he had, at the same time, two patients under his care with that disease. Several cases of the measles appeared in the south end of the city during this month. In every part of it, the weather was warm and dry, in consequence of which there were no second crops of grass, and a smaller quantity than usual of summer fruits and vegetables. The winds were less steady than they had been for seven years. They blew, every two or three days, from nearly every point of the compass.
On the 4th of August there fell a considerable quantity of rain, which was succeeded by cool and pleasant weather. The cholera morbus was a frequent disease among both adults and children in the city, and the dysentery in several of the adjoining counties of the state.
A number of emigrant families arrived this month from Ireland and Wales, who brought with them the ship fever. They were carefully attended, at the lazaretto and the city hospital, in airy rooms, by which means they did not propagate the disease. Contrary to its usual character, it partook of the remissions of the bilious fever, probably from the influence of the season upon it.
In September there were a few extremely warm days. In the beginning and middle of the month a number of mild remittents occurred, and about the 22d there were five or six cases of yellow fever in Eighth-street, between Chesnut and Walnut-streets, in two houses ill ventilated, and exposed to a good deal of exhalation. I attended most of these cases in consultation with Dr. Gallaher. One of the persons who was affected with this fever puked black matter while I sat by his bed-side, a few hours before he died.
During the summer and autumn of this year, a number of cases of yellow fever appeared at New-Bedford, Portland, and Norwich, in the New-England states; in New-York; in some parts of New-Jersey; and in Northampton and Bucks counties, in Pennsylvania. It prevailed so generally in New-York, as to produce a considerable desertion of the city. In none of the above places could the least proof be adduced of the disease being imported. In Philadelphia its existence was doubted or denied by most of the citizens, because it appeared in situations remote from the water, and of course could not be derived from any foreign source.
It will be difficult to tell why the fever appeared only in sporadic cases in Philadelphia. Perhaps its prevalence as an epidemic was prevented by the plentiful rains in the spring months, by the absence of moisture from the filth of the streets and gutters, in consequence of the dry weather in June and July, by the vigour and perfection of the products of the earth, and by the variable state of the winds in the month of July. If none of these causes defended the city from more numerous cases of the yellow fever, it must be resolved into the want of a concurring inflammatory constitution of the atmosphere with the common impure sources of that disease.
On the 12th of November, about twelve o'clock in the night, an earthquake was felt in Philadelphia, attended with a noise as if something heavy had fallen upon a floor. Several cases of scarlet fever appeared in December, but the prevailing disease, during the two last autumnal and the first winter months, was the measles. I have taken notice that it appeared in the south end of the city in July. During the months of August and September it was stationary, but in October, November, and December it spread through every part of the city. The following circumstances occurred in this epidemic, as far as it came under my notice.
I. The disease wore the livery of the autumnal fever in the following particulars.
It was strongly marked by remissions and intermissions. The exacerbations came on chiefly at night.
There were in many cases a constant nausea, and discharge of bile by puking.
I saw one case in which the disease appeared with a violent cholera morbus, and several in which it was accompanied with diarrhœa and dysentery.
II. Many severe cases of phrenzy, and two of cynanche trachealis appeared with the measles.
III. A distressing sore mouth followed them, in a child of two years old, that came under my care.
IV. A fatal hydrocephalus internus followed them in a boy of eight years old, whom I saw two days before he died.
V. I met with a few cases in which the fever and eruption came on in the same day, but I saw one case in which the eruption did not take place until the tenth, and another, in which it did not appear until the fourteenth day after the fever.
VI. Two children had pustules on their skins, resembling the small-pox, before the eruption of the measles.
VII. Many children had coughs and watery eyes, but without the measles. The same children had them two or three weeks afterwards.
VIII. Many people who had had the measles, had coughs during the prevalence of the measles, resembling the cough which occurs in that disease.
The remedies made use of in my practice were,
1. Bleeding, from four to sixty ounces, according to the age of the patient, and the state of the pulse. This remedy relieved the cough, eased the pains in the head, and in one case produced, when used a third time, an immediate eruption of the measles.
2. Lenient purges.
3. Demulcent drinks.
4. Opiates at night.
5. Blisters. And,
6. Astringent medicines, where a diarrhœa took place.
I saw evident advantages from advising a vegetable diet to many children, as soon as any one of the families to which they belonged were attacked by the measles.
I lost but one patient in this disease, and that was a child in convulsions. I ascribed my success to bleeding more generally and more copiously than I had been accustomed to do, in the measles of former years.
The weather during the month of January was unusually moderate and pleasant. In the latter end of it, many shrubs put forth leaves and blossomed. I saw a leaf of the honeysuckle, which was more than an inch in length, and above half an inch in breadth. There was but one fall of snow, and that a light one, during the whole month.
The winds blew chiefly from the south-west in February. There was a light fall of snow on the 6th. A shad was caught in the Delaware, near the city, on the 17th. On the 18th and 19th of the month, the weather became suddenly very cold. On the 22d there was a snow storm, and on the 28th, rain and a general thaw.
In March, the weather was wet, cold, and stormy, with the exception of a few pleasant days.
The scarlatina anginosa and the cynanche trachealis were the principal diseases that prevailed during the three months that have been mentioned.
In April, there were several frosts, which destroyed the blossoms of the peach-trees.
In May, the weather was so cool as to make fires agreeable to the last day of the month. The wind blew chiefly, during the whole of it, from the north-east.
The scarlatina continued to be the reigning disease. I saw one fatal case of it, in which a redness only, without any ulcers or sloughs, appeared in the throat; and I attended another, in which a total immobility in the limbs was substituted by nature for the pain and swellings in those parts which generally attend the disease. There were three distinct grades of this epidemic. It was attended with such inflammatory or malignant symptoms, in some instances, as to require two or three bleedings; in others it appeared with a typhoid pulse, which yielded to emetics: turbith mineral was preferred for this purpose; while a redness, without a fever, which yielded to a single purge, was the only symptom of it in many people.
The weather was cool, rainy, and hot, in succession, in the month of June. The scarlatina continued to be the prevailing disease.
During the first and second weeks in July, there fell a good deal of rain. On the 4th of the month I was called to visit Mrs. Harris, in Front-street, between Arch and Market-streets, with a bilious fever. The scarlatina had imparted to it a general redness on her skin, which induced her to believe it was that disease, and to neglect sending for medical relief for several days. She died on the 13th of the month, with a red eye, a black tongue, hiccup, and a yellow skin. Three other cases of malignant bilious fever occurred this month. Two of them were attended by Dr. Dewees and Dr. Otto.
On the 15th of the month, the city was alarmed by an account of this fever having appeared near the corners of Front and Vine-streets, a part of the city which had for many weeks before been complained of by many people for emitting a fœtid smell, derived from a great quantity of filthy matters stagnating in that neighbourhood, and from the foul air discharged from a vessel called the Esperanza, which lay at Vine-street wharf.
On the 2d of August, it appeared in other parts of the city, particularly in Front and Water-streets, near the draw-bridge, where it evidently originated from putrid sources. Reports were circulated that it was derived from contagion, conveyed to Vine-street wharf in the timbers of a vessel called the St. Domingo Packet, but faithful and accurate inquiries proved that this vessel had been detained one and twenty days, and well cleaned at the lazaretto, and that no one, of fourteen men who had worked on board of her afterwards, had been affected with sickness of any kind.
On the 5th of August, the board of health publicly declared the fever to be contagious, and advised an immediate desertion of the city. The advice was followed with uncommon degrees of terror and precipitation.
The disease continued, in different parts of the city, during the whole of August and September. On the 5th of October, the citizens were publicly invited from the country by the board of health.
During this season, the yellow fever was epidemic in Baltimore and Wilmington. In the former place it was admitted by their board of health, and in the latter it was proved by Dr. Vaughan, to be of domestic origin. It prevailed, at the same time, in Sussex county and near Woodbury, in New-Jersey. Sporadic cases of it likewise occurred in New-York and Boston, and in Portsmouth, in New-Hampshire. The chronic fever was epidemic in several of the towns of North-Carolina; cases of fever, which terminated in a swelling and mortification of the legs, and in death on the third day, appeared on the waters of the Juniata, in Pennsylvania; and bilious fevers, of a highly inflammatory grade, were likewise common near Germantown and Frankford, in the neighbourhood of Philadelphia.
But few of the cases of yellow fever which have been mentioned came under my care, but I saw a considerable number of fevers of a less violent grade. They were the inflammatory, bilious, mild remitting, chronic, and intermitting fevers, and the febricula. They appeared, in some instances, distinct from each other, but they generally blended their symptoms in their different stages. The yellow fever often came on in the mild form of an intermittent, and even a febricula, and as often, after a single paroxysm, ended in a mild remittent or chronic fever. When it appeared in the latter form, it was frequently attended with a slow or low pulse, and a vomiting and hiccup, such as attend in the yellow fever. This diversity of symptoms, with which the summer and autumnal fever came on, made it impossible to decide upon its type on the day of its attack. Having been deceived in one instance, I made it a practice afterwards to watch every case I was called to with double vigilance, lest it should contract a malignant form in my hands, without my being prepared to meet it. Of the five original and obvious cases of yellow fever to which I was called, I saved none, for I saw but one of them before the last stage of the disease. In many others, I have reason to believe I prevented that malignant form of fever, by the early and liberal use of depleting medicines. The practice of those physicians who attended most of the persons who had the yellow fever, was much less successful than in our former epidemics. I suspected at the time, and I was convinced afterwards, that it was occasioned by relying exclusively upon bleeding, purges, and mercury. The skin, in several of the cases which I saw, was covered with moisture. This clearly pointed out nature's attempt to relieve herself by sweating. Upon my mentioning this fact to the late Dr. Pfeiffer, jun. he instantly adopted my opinion, and informed me, as a reason for doing so, that he had heard of several whole families in the Northern Liberties, where the disease prevailed most, who, by attacking it in its forming state by profuse sweats, had cured themselves, without the advice of a physician.
The weather in January was uniformly cold. On the 21st of the month, the Delaware was completely frozen.
On the 4th of February there was a general thaw, attended with a storm of hail, thunder, and lightning, which lasted about three quarters of an hour. The diseases of both these winter months were catarrhs and bilious pleurisies. The latter appeared in a tertian type. The pain in the side was most sensible every other day.
The weather was cold and dry in March, in consequence of which, vegetation was unusually backward in April. The hooping cough, catarrhs, and scarlatina were the diseases of this month.
The beginning of May was very cool. There was ice on the 7th of the month. The winds, during the greatest parts of this and the previous month, were from the north-east.
In June, the weather was cool. Intermittents were common in this month, as well as in May. Such was the predominance of this type of fever over all other diseases, that it appeared in the form of profuse sweats, every other night, in a lady under the care of Dr. Dewees and myself, in the puerperile fever. On the intermediate nights she had a fever, without the least moisture on her skin. There were a few choleras this month. During the latter end of the month, I lost a patient with many of the symptoms of yellow fever.
The weather in July was alternately hot, moderate, and cool, with but little rain. The first two weeks of this month were healthy. A few tertian fevers occurred, which readily yielded to bark, without previous bleeding. Between the 25th and 31st of the month, three deaths took place from the yellow fever.
In the month of August, the weather was the same as in July, except that there fell more rain in it. Mild remittents and cholera infantum were now common. There were likewise several cases of yellow fever during this month. One of them was in Fromberger's-court. It was induced by the fœtor of putrid fish in a cellar. A malignant dysentery was epidemic during this month in the upper part of Germantown, and in its neighbourhood. Several persons, Dr. Bensell informed me, died of it in thirty hours sickness. It prevailed, at the same time, in many parts of the New-England states.
In September, cases of yellow fever appeared in different parts of the city, but chiefly in Water, near Walnut-street. On the 12th of the month, the board of health published a declaration of its existence in the city, but said it was not contagious. This opinion gave great offence, for it was generally said to have been imported by means of a packet-boat from New-York, where the fever then prevailed, because a man had sickened and died in the neighbourhood of the wharf where this packet was moored. It was to no purpose to oppose to this belief, proofs that no sick person, and no goods supposed to be infected, had arrived in this boat, and that no one of three men, who had received the seeds of the disease in New-York, had communicated it to any one of the families in Philadelphia, in which they had sickened and died.
The disease assumed a new character this year, and was cured by a different force of medicine from that which was employed in some of the years in which it had prevailed in Philadelphia.
I shall briefly describe it in each of the systems, and then take notice of some peculiarities which attended it. Afterwards I shall mention the remedies which were effectual in curing it.
1. The pulse was moderately tense in most cases. It intermitted in one case, and in several others the tension was of a transient nature.
Hæmorrhages occurred in many cases. They were chiefly from the nose, but in some instances they occurred from the stomach, bowels, and hæmorrhoidal vessels.
2. Great flatulency attended in the stomach, but sickness and vomiting were much less frequent than in former years. I saw but one case in which diarrhœa attended this fever.
3. I did not meet with a single instance of a glandular swelling in any part of the body.
4. There was a general disposition to sweat in this fever from its beginning. Two of my patients died, in whom no moisture could be excited on the skin. But I recovered one with a dry skin, by means of a purge, two bleedings, and blisters.
An efflorescence on the skin occurred in several instances. I saw black matter discharged from a blister in one case, and blood in another.
5. The stools were green and black. Bile was generally discharged in puking.
6. The blood exhibited the following appearances: siziness, lotura carnium, sunken crassamentum, red sediment, and what is called dense or unseparated blood. I saw no instance of its being dissolved.
7. The tongue was whitish and dark-coloured. This diseased appearance continued, in some instances, several days after a recovery took place. I saw no smooth, red, nor black tongue, and but one dry and one natural tongue. The latter was followed by death.
I did not see a single case in which the disease came on without an exciting cause; such as light clothing and bed-clothes, sitting at doors after night, a long walk, gunning, and violent and unusual exercises of any kind. It was excited in a number of people by their exertions to extinguish a fire which took place in Water-street, between Market and Chesnut-streets, on the morning of the 25th of August. I saw a fatal instance of it succeed a severe tooth-ach. Whether this pain was the exciting cause, or the first morbid symptom of the fever, I know not; but I was led by it to bleed a young lady twice who complained of that pain, and who had at the same time a tense pulse. Her blood had the usual appearances which occur in the yellow fever.
The disease had different appearances in different parts of the city. It was most malignant in Water-street; but in many instances it became less so, as it travelled westward, so that about Ninth-street it appeared in the form of a common intermittent.
In every part of the city it often came on, as in the year 1802, in all the milder forms of autumnal fever formerly enumerated, and went off with the usual symptoms of yellow fever. Again, it came on with all the force and malignity of a yellow fever, and terminated, in a day or two, in a common remittent or intermittent. These modes of attack were so common, that it was impossible to tell what the character, or probable issue of a fever would be, for two or three days.
The following remedies were found, very generally, to be effectual in this fever.
1. Moderate bleeding. I bled but three patients three, and only one, four times. In general, the loss of from ten to twenty ounces of blood, reduced the pulse from a synocha to a synoichoid or typhoid state, and thereby prepared the system for other remedies.
2. Purges were always useful. I gave calomel and jalap, castor oil, salts, and senna, according to the grade of the disease, and often according to the humour or taste of the patient. I aided these purges by glysters. In one case, where a griping and black stools attended, I directed injections of lime water and milk to be used, with the happiest effects.
3. I gave emetics in many cases with advantage, but never while the pulse was full or tense.
4. Having observed, as in the year 1802, a spontaneous moisture on the skin on the first day of the disease, in several cases, I was led to assist this disposition in nature to be relieved by the pores, by means of sweating remedies, but in no instance did I follow it, without previous evacuations from the blood-vessels or bowels; for, however useful the intimations of nature may be in acute diseases, her efforts should never be trusted to alone, inasmuch as they are in most cases too feeble to do service, or so violent as to do mischief. I saw one death, and I heard of another, from an exclusive reliance upon spontaneous sweats in the beginning of this fever. The remedies I employed to promote this evacuation by the pores were, an infusion of the eupatorium perfoliatum in boiling water, aided by copious warm drinks, and hot bricks and blankets, applied to the external surface of the body. The eupatorium sometimes sickened the stomach, and puked. The sweats were intermitted, and renewed two or three times in the course of four and twenty hours.
5. I derived great advantage from the application of blisters to the wrists, before the system descended to what I have elsewhere called, the blistering point. This was on the second and third days. My design, in applying them thus early, was to attract morbid excitement to the extremities, and thereby to create a substitute for a salivation. They had this effect. The pain, increase of fever, and occasional strangury, which were produced by them, served like anchors to prevent the system being drifted and lost, by the concentration of morbid excitement in the stomach and brain, on the fourth, fifth, sixth, and seventh days of the disease. It gave me great pleasure to find, upon revising Dr. Home's account of the yellow fever, that this mode of applying blisters, in the early stage of the disease, was not a new one. He often applied them in the first stage of the fever, more especially when the yellow colour of the skin made its appearance on the first or second day. By the advice of Dr. Cheney, of Jamaica, he was led to prefer them to the thighs, instead of the trunk of the body, or the legs and arms. He forbids their ever being applied below the calf of the legs. This caution is probably more necessary in the West-Indies than in the United States. The pain and inflammation excited by the blisters were mitigated by soft poultices of bread and milk. The strangury soon yielded to demulcent drinks, particularly to flaxseed tea.
I was happy in not being compelled, by the violence or obstinacy of this fever, to resort to a salivation in order to cure it, in a single instance; the discharges from the stomach and bowels, and from the veins, pores, and skin, having proved sufficient to convey the disease out of the system.
Two persons recovered this year who had the black vomiting. One of them was by means of large quantities of brandy and volatile alkali, administered by Dr. John Dorsey, in the city hospital; the other was by means of lime and water and milk, given by an intelligent nurse to one of my patients, during the interval of my visits to her.
From the history which has been given of the symptoms of this fever; from the less force of medicine that was necessary to subdue it; from the safety and advantage of blisters in its early stage; and from the small proportion which the deaths bore to the number of those who were affected, being seldom more than five in a hundred (including all the grades and forms of the disease), in the practice of most of the physicians, it is evident this fever was of a less malignant nature than it had been in most of the years in which it had been epidemic. There was one more circumstance which proved its diminution of violence, and that was, a more feeble operation of its remote cause. In the year 1802, nearly all the persons who were affected with the fever in the neighbourhood of Vine and Water-streets, and in Water, between Walnut and Spruce-streets, died. This year, but two died of a great number who were sick in the former, and not one out of twelve who were sick in the latter place. The filth, in both parts of the city, was the same in both years. This difference in the violence and mortality of the fever was probably occasioned by a less concentrated state of the miasmata which produced it, or by the co-operation of a less inflammatory constitution of the atmosphere.
The yellow fever was epidemic, during the summer and autumn of this year, in New-York, and in Alexandria, in Virginia. In the latter place, Dr. Dick has informed the public, it was derived from domestic putrefaction.
The month of January was marked by deep snows, rain, clear and cold weather, and by the general healthiness of the city.
In February there fell a deep snow, which was followed by several very cold days. There was likewise a fall of snow in March, which was succeeded by an uncommon degree of cold. Catarrhs and bilious pleurisies were very common during both these months.
In the beginning of April, the weather was cold and rainy. There were but few signs of vegetation before the 15th of the month. Bilious pleurisies were still the principal diseases which prevailed in the city.
The month of May was wet, cool, and healthy.
In June, the winds were easterly, and the weather rainy. The crops of grass were luxuriant. It was remarked, that the milk of cows that fed upon this grass yielded less butter than usual, and that horses that fed upon it, sweated profusely with but little exercise. On the third of the month, I was called upon by Dr. Physick to visit his father, who was ill with a bilious fever. He died on the seventh, with a red eye, hiccup, and black vomiting.
Four persons had the yellow fever in the month of July. One of them was in Fourth-street, between Pine and Lombard-streets, another was in Fifth-street, between Race and Vine-streets, both of whom recovered. The remaining two were in the Pennsylvania hospital, both of whom died. Remitting and intermitting fevers were likewise common in this month.
In August, those fevers assumed a chronic form. During this month, there died an unusual number of children with the cholera morbus.
The city was uncommonly healthy in September. A storm of wind and rain, from the south-east, proved destructive to the crops of cotton this month, on the sea coast of South-Carolina.
In October, intermittents were very common between Eighth-street and Schuylkill. One case of yellow fever came under my care, in conjunction with Dr. Gallaher, on the western banks of that river.
While Philadelphia and all the cities of the United States (Charleston excepted) were thus exempted from the yellow fever as an epidemic, the western parts of all the middle, and several of the southern states, were visited with the bilious fever, in all its different forms. In Delaware county, in the state of New-York, at Mill river, in Connecticut, and in several of the middle counties of Pennsylvania, it prevailed in the form of a yellow fever. In other parts of the United States, it appeared chiefly as a highly inflammatory remittent. It was so general, that not only whole families, but whole neighbourhoods were confined by it. Many suffered from the want of medical advice and nursing, and some from the want of even a single attendant. In consequence of the general prevalence of this fever in some parts of Pennsylvania, the usual labours of the season were suspended. Apples fell and perished upon the ground; no winter grain was sowed; and even cows passed whole days and nights without being milked.
The mortality of this fever was considerable, where those distressing circumstances took place. In more favourable circumstances, it yielded to early depletion, and afterwards to the bark. Relapses were frequent, from premature exposure to the air. Those only escaped them who had been salivated, by accident or design, for the cure of the fever.
This disease was observed very generally to prevail most in high situations, which had been for years distinguished for their healthiness, while the low grounds, and the banks of creeks and rivers, were but little affected by it. The unusual quantity of rain, which had fallen during the summer months, had produced moisture in the former places, which favoured putrefaction and exhalation, while both were prevented, in the latter places, by the grounds being completely covered with water.
For a history of the uncommonly cold and tempestuous winter of 1804 and 1805, the reader is referred to the Account of the Climate of Pennsylvania, in the first volume of these Inquiries and Observations.
During the months of January, February, and March, there were a number of bilious catarrhs and pleurisies.
On the 7th of April, I visited a patient in the yellow fever with Dr. Stewart. He was cured, chiefly by copious bleeding.
The weather was rainy in May. After the middle of June, and during the whole month of July, there fell no rain. The mercury in Fahrenheit fluctuated, for ten days, between 90° and 94°, during this month. The diseases which occurred in it were cholera infantum, dysenteries, a few common bilious, and eight cases of yellow fever. Three of the last were in Twelfth, between Locust and Walnut-streets, and were first visited, on the 14th and 15th of the month, by Dr. Hartshorn, as out-patients of the Pennsylvania hospital. Two of them were attended, about a week afterwards, by Dr. Church, in Southwark, and the remaining three by Dr. Rouisseau and Dr. Stewart, in the south end of the city.
On the third of August, there fell a heavy shower of rain, but the weather, during the remaining part of the month, was warm and dry. The pastures were burnt up, and there was a great deficiency of summer vegetables in the neighbourhood of Philadelphia. The water in the Schuylkill was lower by three inches than it had been in the memory of a man of 70 years of age, who had lived constantly within sight of it.
In September, a number of cases of yellow fever appeared in Southwark[9], near Catharine-street. They were readily traced to a large bed of oysters, which had putrified on Catharine-street wharf, and which had emitted a most offensive exhalation throughout the whole neighbourhood, for several weeks before the fever made its appearance. This exhalation proved fatal to a number of cats and dogs, and it now became obvious that the two cases of yellow fever, that were attended by Dr. Church, in the month of July, were derived from it. An attempt was made to impose a belief that they were taken by contagion from a ship at the lazaretto, which had lately arrived from the West-Indies, but a careful investigation of this tale proved, that neither of the two subjects of the fever had been on board that, nor any other ship, then under quarantine.
The fever prevailed during the whole of this month in Southwark. A few cases of it appeared in the city, most of which were in persons who had resided in, or visited that district. It was brought on by weak exciting causes in Southwark, but the cases which originated in the city, required strong exciting causes to produce them.
A heavy rain, accompanied with a good deal of wind, on the 28th of September, and a frost on the night of the 7th of October, gave a considerable check to the fever.
But few cases of it came under my care. Having perceived the same disposition in nature to relieve herself by the pores, that I observed in the years 1802 and 1803, my remedies were the same as in the latter year, and attended with the same success. Dr. Caldwell and Dr. Stewart, whose practice was extensive in Southwark, informed me, those remedies had been generally successful in their hands.
The only new medicine that the experience of this year suggested in this disease, was for one of its most distressing and dangerous symptoms, that is, the vomiting which occurs in its second stage. Dr. Physick discovered, that ten drops of the spirit of turpentine, given every two hours, in a little molasses, or syrup, or sweet oil, effectually checked it in several instances, in patients who afterwards recovered. It was administered with equal success in a case which came under my care, after an absence of pulse, and a coldness of the extremities had taken place. Dr. Church informed me that he gave great relief to the sick in the city hospital, by this medicine, by prescribing it in glysters, as well as by the mouth, in distressing affections of the stomach and bowels.
Dr. Stewart observed that all those persons who had been affected by the yellow fever in former years, had mild remittents in the same situations that others had the prevailing epidemic in a malignant form.
In one of four bodies the doctor examined, he found six, and in another three intussusceptions of the intestines, without any signs of inflammation. He discovered the common marks of disease from this fever in other parts of those bodies.
The deaths from this fever amounted to between three and four hundred. They would probably have been more numerous, had not those families who were in competent circumstances fled into the country, and had not the poor been removed, by the board of health, from the infected atmosphere of Southwark, to tents provided for them in the neighbourhood of the city; and they would probably have been fewer, considering the tractable nature of the disease, when met by suitable remedies in its early stage, had not the sick concealed their indisposition, in many instances, for two or three days, lest they should be dragged to the city hospital, or have centinels placed at their doors, to prevent any communication with their friends and neighbours. While these attempts were made to check the progress of the fever, it did not escape the notice of many of the citizens of Philadelphia, that not a single instance occurred of its being communicated by contagion, in any of the families in the city, in which persons had sickened or died with it, and that while the sick were deprived of the kind offices of their friends and neighbours, lest they should be infected, physicians, and the members of the board of health, passed by the guards every day, in their visits to the same sick people, and afterwards mixed with their fellow-citizens, in every part of the city, without changing their clothes.
The yellow fever appeared early in the season in New-Haven, in Connecticut, and in Providence, on Rhode-Island, in both of which places it was derived from putrid exhalation, and was speedily and effectually checked by removing the healthy persons who lived in its neighbourhood to a distance from it. Several sporadic cases of it occurred during the autumn in Gloucester county, in New-Jersey, and in Mifflin and Chester counties, in Pennsylvania. It was epidemic in New-York at the same time it prevailed in Southwark and Philadelphia. The following extract of a letter from the health officer of New-York, to one of his friends, contains a satisfactory proof that it was not, in that city, an imported disease.
Quarantine-ground, Sept. 7.
I most sincerely and tenderly deplore the unfortunate situation of our city. What do people say now of the origin of the disease? You may state, for the information of those who wished to be informed, that not a single vessel, on board of which a person has been sick with fever of any kind, or on board of which any person has died with any disease, while in the West-Indies, or on the voyage home, has ever gone up to the city during this whole season. This we know, and this we vouch for; and farther state, that all the cases of fever that have come down as from the city, have been all people of, and belonging to the city, and unconnected with the shipping, excepting one, a sailor, who had no connection with any foul vessel. There is not a shadow of proof or suspicion that can attach to the health-office, or to infected vessels, this season. I am, &c.
JOHN R. B. RODGERS.
Having concluded the history of the bilious yellow fever, as it has appeared in eleven successive years, since 1793, as an epidemic, or in sporadic cases, I shall proceed next to enumerate all the sources of that fever, as well as all the other usual forms of the summer and autumnal disease of the United States, and afterwards mention the means of preventing them.