Chapter VI: Part 6

JULY, 1793.
+-----+------------+-----------+-------------+--------------------+
| | Barom. | Ther. | Winds. | Weather. |
| | 6 3 | 6 3 | 6 3 | |
|Days.|A. M. P. M.|A. M. P. M.|A. M. P. M.| |
| | | | | |
| 1 |30 0 29 9| 77 88 | W W |fair. |
| 2 |29 8 29 7| 77 81 | W |fair, showers. |
| 3 |29 9 30 0| 74 80 | E E |cloudy. |
| 4 |30 1 30 0| 70 83 | E SW |cloudy, fair, rain. |
| 5 |30 0 29 9| 76 90 | NW SW |fair, ditto. |
| 6 |29 9 29 9| 78 91 | SW SW |cloudy, thunder. |
| 7 |29 9 30 0| 73 88 | NE NW |fair, clouds. |
| 8 |30 1 30 1| 72 85 | E E |cloudy, fair. |
| 9 |30 0 29 8| 73 81 | S SW |cloudy, ditto. |
| 10 |30 0 30 0| 70 84 | W NW |fair, ditto. |
| 11 |30 0 30 0| 74 88 | NW NW |fair, clouds. |
| 12 |30 1 30 2| 70 84 | N N |fair, ditto. |
| 13 |30 1 30 0| 68 83 | NW NW |fair, ditto. |
| 14 |30 0 30 0| 65 80 | N Calm |fair, hazy. |
| 15 |30 0 29 9| 66 75 | SW SW |cloudy, ditto. |
| 16 |29 8 29 7| 70 83 | W W |rain, fair. |
| 17 |29 8 29 9| 68 81 | NW NW |fair, ditto. |
| 18 |30 0 30 0| 66 86 | W SW |fair, ditto. |
| 19 |29 9 29 9| 75 85 | SW W |fair, cloudy, rain. |
| 20 |30 0 30 0| 72 87 | W NW |fair, ditto, shower.|
| 21 |30 1 30 1| 70 86 | NW NW |fair, ditto. |
| 22 |30 0 30 0| 72 87 | SW SW |fair, ditto. |
| 23 |30 0 30 0| 73 91 | SW SW |fair, cloudy. |
| 24 |29 9 29 9| 75 89 | Calm W |cloudy, fair. |
| 25 |30 1 30 1| 71 83 | NW NNW |fair, ditto. |
| 26 |30 2 30 2| 63 82 | N NE |fair, ditto. |
| 27 |30 2 30 1| 64 81 | S calm S |fair, cloudy. |
| 28 |30 1 30 0| 72 85 | Calm NNE |cloudy, fair. |
| 29 |30 1 30 1| 74 85 | SSE NE |cloudy, ditto, rain.|
| 30 |30 1 30 0| 73 86 | S SW |cloudy, fair. |
| 31 |29 9 29 8| 76 80 | SSW SW |cloudy, rain, fair. |
+-----+------------+-----------+-------------+--------------------+

AUGUST, 1793.
+-----+------------+-----------+-------------+--------------------+
| | Barom. | Ther. | Winds. | Weather. |
| | 6 3 | 6 3 | 6 3 | 6 3 |
|Days.|A. M. P. M.|A. M. P. M.|A. M. P. M.|A. M. P. M. |
| 1 |29 95 30 0| 65 77 | WNW NW |cloudy, fair, |
| 2 |30 1 30 1| 63 81 | NW SW |fair, fair, |
| 3 |30 6 29 95| 62 82 | N NNE |fair, fair, |
| 4 |29 97 30 0| 65 87 | S SW |fair, fair, |
| 5 |30 5 30 1| 73 90 | SSW SW |fair, fair, |
| 6 |30 2 30 0| 77 87 | SW W |cloudy, fair, |
| 7 |30 12 30 1| 68 83 | NW W |fair, fair, |
| 8 |30 1 29 95| 69 86 | SSE SSE |fair, rain, |
| 9 |29 8 29 75| 75 85 | SSW SW |cloudy, fair, |
| 10 |29 9 29 9| 67 82 | W SW |fair, fair, |
| 11 |30 0 30 0| 70 84 | SW WSW |cloudy, cloudy, |
| 12 |30 0 30 0| 70 87 | W W |fair, fair, |
| 13 |30 5 30 0| 71 89 | SW W |fair, fair, |
| 14 |30 0 29 95| 75 82 | SW SW |fair, rain, |
| 15 |30 0 30 1| 72 75 | NNE NE |fair, cloudy, |
| 16 |30 1 30 1| 70 83 | NNE NE |fair, fair, |
| 17 |30 1 30 0| 71 86 | SW SW |fair, fair, |
| 18 |30 1 30 1| 73 89 | calm SW |fair, fair, |
| 19 |30 1 30 0| 72 82 | N N |fair, cloudy, |
| 20 |30 1 30 12| 69 82 | NNE NNE |fair, fair, |
| 21 |30 15 30 25| 62 83 | N NNE |fair, fair, |
| 22 |30 3 30 35| 63 86 | NE SE |fair, fair, |
| 23 |30 25 30 15| 63 85 | calm S |fair, fair, |
| 24 |30 1 30 1| 73 81 | calm calm |cloudy, rain, |
| 25 |30 1 30 1| 71 66 | NE NE |rain, gr. rain, |
| 26 |30 15 30 2| 59 69 | NE NE |cloudy, cloudy, |
| 27 |30 2 30 2| 65 73 | NE NE |cloudy, cloudy, |
| 28 |30 2 30 15| 67 80 | S calm |cloudy, clearin. |
| 29 |30 16 30 15| 72 86 | calm SW |cloudy, fair, |
| 30 |30 1 30 1| 74 87 | calm SW |fair, fair, |
| 31 |30 0 30 0| 74 84 | SW NW |rain, fair. |
+-----+------------+-----------+-------------+--------------------+

SEPTEMBER, 1793.
+-----+------------+-----------+-------------+--------------------+
| | Barom. | Ther. | Winds. | Weather. |
| | 6 3 | 6 3 | 6 3 | 6 3 |
|Days.|A. M. P. M.|A. M. P. M.|A. M. P. M.|A. M. P. M. |
| 1 |30 0 29 30| 71 86 | calm SW |fog, fair, |
| 2 |29 75 29 8| 73 86 | SW SW |fair, fair, |
| 3 |30 0 | 60 | NW N |fair, fair, |
| 4 |30 15 30 15| 55 75 | W W |fair, fair, |
| 5 |30 15 30 1| 62 80 | SE S |fair, cloudy, |
| 6 |29 97 29 95| 70 89 | WSW W |fair, cloudy, |
| 7 |30 0 30 0| 65 77 | WNW NW |fair, fair, |
| 8 |30 1 30 1| 64 70 | calm calm |cloudy, cloudy, |
| 9 |30 0 30 0| 66 80 | SE NW |rain, fair, |
| 10 |30 0 30 0| 64 72 | N NNE |fair, cloudy, |
| 11 |30 1 30 0| 62 72 | NNE N |cloudy, fair, |
| 12 |29 96 29 9| 58 76 | NW NNW |fair, fair, |
| 13 |29 95 30 0| 57 72 | NW N |fair, fair, |
| 14 |30 0 30 5| 58 79 | NW NW |fair, fair, |
| 15 |30 0 29 97| 65 80 | N S |fair, fair, |
| 16 |29 9 29 | 70 84 | S SW |cloudy, fair, |
| 17 |29 8 29 85| 66 67 | N N |cloudy, cloudy, |
| 18 |30 3 | 44 | N |fair, |
| 19 |30 4 30 35| 45 70 | calm SW |fair, fair, |
| 20 |30 3 30 15| 54 69 | calm SE |hazy, hazy, |
| 21 |30 0 29 0| 59 78 | calm |cloudy, fair, |
| 22 |30 0 30 0| 63 83 | calm |cloudy, fair, |
| 23 |30 1 30 1| 62 80 | calm SE |cloudy, cloudy, |
| 24 |30 2 30 2| 65 70 | NE ENE |cloudy, fair, |
| 25 |30 15 30 0| 61 68 | NE NE |cloudy, cloudy, |
| 26 |29 8 29 7| 58 79 | N N |cloudy, fair, |
| 27 |29 7 | 64 | NW NW |cloudy, fair, |
| 28 |30 5 30 15| 54 73 | NW NW |fair, fair, |
| 29 |30 3 30 3| 56 74 | NE ENE |cloudy, fair, |
| 30 |30 35 30 3| 57 75 | calm SW |foggy, fair. |
+-----+------------+-----------+-------------+--------------------+

OCTOBER, 1793.
+-----+------------+-----------+-------------+--------------------+
| | | | | |
| | Barom. | Ther. | Winds. | Weather. |
| | | | | |
| | 7 2 | 7 2 | 7 2 | 7 2 |
|Days.|A. M. P. M.|A. M. P. M.|A. M. P. M.|A. M. P. M. |
| 1 |30 15 30 5| 64 80 | SW SW |cloudy, fair, |
| 2 |29 9 30 5| 70 72 | W NNW |cloudy, fair, |
| 3 |30 2 30 15| 50 72 | W SW |fair, fair, |
| 4 |29 75 29 7| 59 72 | SW W |cloudy, cloudy, |
| 5 |30 0 30 1| 58 66 | N N |fair, fair, |
| 6 |30 3 30 3| 43 66 | NE W |fair, fair, |
| 7 |30 45 | 46 | calm |fair, |
| 8 |30 6 30 6| 53 68 | N N |fair, fair, |
| 9 |30 5 30 4| 53 70 | NW NW |fair, fair, |
| 10 |30 2 30 2| 49 74 | E NW |fair, fair, |
| 11 |30 0 29 85| 51 74 | W W |fair, fair, |
| 12 |29 6 29 55| 58 64 | SW NW |rain, rain, |
| 13 |29 85 29 9| 49 69 | NW NW |fair, fair, |
| 14 |30 5 30 0| 52 76 | SW SW |calm, fair, |
| 15 |29 75 29 8| 56 54 | SW N |fair, rain, |
| 16 |30 0 30 0| 37 53 | NNW N |fair, fair, |
| 17 |30 1 30 1| 37 60 | NE NE |fair, fair, |
| 18 |30 1 30 1| 41 62 | NW NW |fair, fair, |
| 19 |30 0 29 9| 51 66 | N N |cloudy, fair, |
| 20 |30 0 30 0| 44 54 | NW N |fair, fair, |
| 21 |30 0 30 2| 49 59 | N NW |fair, fair, |
| 22 |29 6 29 5| 51 65 | NW NW |fair, fair, |
| 23 |29 8 29 8| 47 60 | W W |fair, fair, |
| 24 |30 3 30 4| 36 59 | W NW |fair, fair, |
| 25 |30 4 30 3| 46 71 | S S |cloudy, do. h-w. |
| 26 |30 2 30 2| 60 72 | calm SW |cloudy, cloudy, |
| 27 |30 3 30 3| 44 44 | NNE NNE |cloudy, cloudy, |
| 28 |30 2 30 1| 34 37 | N N |cloudy, cloudy, |
| 29 |29 85 29 85| 28 44 | NNW NW |fair, fair, |
| 30 |30 1 30 1| 28 49 | calm SW |hazy, hazy, |
| 31 |30 15 30 2| 42 45 | calm NNE |cloudy, rain. |
+-----+------------+-----------+-------------+--------------------+

NOVEMBER, 1793.
+-----+------------+-----------+-------------+--------------------+
| | Barom. | Ther. | Winds. | Weather. |
| | 7 2 | 7 2 | 7 2 | 7 2 |
|Days.|A. M. P. M.|A. M. P. M.|A. M. P. M.| A. M. P. M. |
| 1 |30 1 30 1| 40 41 | NNE NE |rain, cloudy, |
| 2 |30 3 30 25| 32 49 | NNE NE |fair, fair, |
| 3 |30 1 30 0| 43 56 | calm SW |cloudy, cloudy, |
| 4 |29 8 29 9| 55 67 | SW SW |cloudy, fair, |
| 5 |30 15 30 1| 50 64 | NE NE |rain, rain, |
| 6 |29 8 29 65| 63 67 | S S |cloudy, cloudy, |
| 7 |29 8 29 8| 44 64 | calm SW |fair, fair, |
| 8 |29 8 29 85| 43 56 | SSW SW |fair, fair, |
| 9 |29 9 29 95| 42 64 | SW SW |fair, fair, |
+-----+------------+-----------+-------------+--------------------+

OF THE METHOD OF CURE.

In the introduction to the history of the fever, I mentioned the remedies which I used with success, in several cases which occurred in the beginning of August. I had seen, and recorded in my note book, the efficacy of gentle purges in the yellow fever of 1762; but finding them unsuccessful after the 20th of August, and observing the disease to assume uncommon symptoms of great prostration of strength, I laid them aside, and had recourse to a gentle vomit of ipecacuanha, on the first day of the fever, and to the usual remedies for exciting the action of the sanguiferous system. I gave bark in all its usual forms of infusion, powder, and tincture. I joined wine, brandy, and aromatics with it. I applied blisters to the limbs, neck, and head. Finding them all ineffectual, I attempted to rouse the system by wrapping the whole body, agreeably to Dr. Hume's practice, in blankets dipped in warm vinegar. To these remedies I added one more: I rubbed the right side with mercurial ointment, with a view of exciting the action of the vessels in the whole system, through the medium of the liver, which I then supposed to be principally, though symptomatically, affected by the disease. None of these remedies appeared to be of any service; for although three out of thirteen recovered, of those to whom they were applied, yet I have reason to believe that they would have recovered much sooner had the cure been trusted to nature. Perplexed and distressed by my want of success in the treatment of this fever, I waited upon Dr. Stephens, an eminent and worthy physician from St. Croix, who happened then to be in our city, and asked for such advice and information upon the subject of the disease, as his extensive practice in the West-Indies would naturally suggest. He politely informed me, that he had long ago laid aside evacuations of all kinds in the yellow fever; that they had been found to be hurtful, and that the disease yielded more readily to bark, wine, and, above all, to the use of the cold bath. He advised the bark to be given in large quantities by way of glyster, as well as in the usual way; and he informed me of the manner in which the cold bath should be used, so as to derive the greatest benefit from it. This mode of treating the yellow fever appeared to be reasonable. I had used bark, in the manner he recommended it, in several cases of sporadic yellow fever, with success, in former years. I had, moreover, the authority of several other physicians of reputation in its favour. Dr. Cleghorn tells us, that "he sometimes gave the bark when the bowels were full of vicious humours. These humours (he says) are produced by the fault of the circulation. The bark, by bracing the solids, enables them to throw off the excrementitious fluids, by the proper emunctories[65]."

[65] Page 223.

I began the use of each of Dr. Stevens's remedies the next day after my interview with him, with great confidence of their success. I prescribed bark in large quantities: in one case I ordered it to be injected into the bowels every four hours. I directed buckets full of cold water to be thrown frequently upon my patients. The bark was offensive to the stomach, or rejected by it, in every case in which I prescribed it. The cold bath was grateful, and produced relief in several cases, by inducing a moisture on the skin. For a while I had hopes of benefit to my patients from the use of these remedies, but, in a few days, I was distressed to find they were not more effectual than those I had previously used. Three out of four of my patients died, to whom the cold bath was administered, in addition to the tonic remedies before-mentioned.

Baffled in every attempt to stop the ravages of this fever, I anticipated all the numerous and complicated distresses in our city, which pestilential diseases have so often produced in other countries. The fever had a malignity and an obstinacy which I had never before observed in any disease, and it spread with a rapidity and mortality far beyond what it did in the year 1762. Heaven alone bore witness to the anguish of my soul in this awful situation. But I did not abandon a hope that the disease might yet be cured. I had long believed that good was commensurate with evil, and that there does not exist a disease for which the goodness of Providence has not provided a remedy. Under the impression of this belief I applied myself with fresh ardour to the investigation of the disease before me. I ransacked my library, and pored over every book that treated of the yellow fever. The result of my researches for a while was fruitless. The accounts of the symptoms and cure of the disease by the authors I consulted were contradictory, and none of them appeared altogether applicable to the prevailing epidemic. Before I desisted from the inquiry to which I had devoted myself, I recollected that I had, among some old papers, a manuscript account of the yellow fever as it prevailed in Virginia in the year 1741, which had been put into my hands by Dr. Franklin, a short time before his death. I had read it formerly, and made extracts from it into my lectures upon that disease. I now read it a second time. I paused upon every sentence; even words in some places arrested and fixed my attention. In reading the history of the method of cure I was much struck with the following passages.

"It must be remarked, that this evacuation (meaning by purges) is more necessary in this than in most other fevers. The abdominal viscera are the parts principally affected in this disease, but by this timely evacuation their feculent corruptible contents are discharged, before they corrupt and produce any ill effects, and their various emunctories and secerning vessels are set open, so as to allow a free discharge of their contents, and consequently a security to the parts themselves, during the course of the disease. By this evacuation the very minera of the disease, proceeding from the putrid miasmata fermenting with the salivary, bilious, and other inquiline humours of the body, is sometimes eradicated by timely emptying the abdominal viscera, on which it first fixes, after which a gentle sweat does as it were nip it in its bud. Where the primæ viæ, but especially the stomach, is loaded with an offensive matter, or contracted and convulsed with the irritation of its stimulus, there is no procuring a laudable sweat till that is removed; after which a necessary quantity of sweat breaks _out of its own accord_, these parts promoting it when by an absterging medicine they are eased of the burden or stimulus which oppresses them."

"All these acute putrid fevers ever require some evacuation to bring them to a perfect crisis and solution, and that even by stools, which must be promoted by art, where nature does not do the business herself. On this account an _ill-timed scrupulousness about the weakness of the body_ is of bad consequence in these urging circumstances; for it is that which seems chiefly to make evacuations necessary, which nature ever attempts, after the humours are fit to be expelled, but is not able to accomplish for the most part in this disease; and I can affirm that I have given a purge in this case, when _the pulse has been so low, that it could hardly be felt_, and the _debility extreme_, yet _both one and the other_ have been _restored by it_."

"This evacuation must be procured by _lenitive chologoque_ purges."

Here I paused. A new train of ideas suddenly broke in upon my mind. I believed the weak and low pulse which I had observed in this fever, to be the effect of debility from a depressed state of the system, but the unsuccessful issue of purging, and even of a spontaneous diarrh[oe]a, in a patient of Dr. Hutchinson, had led me not only to doubt of, but to dread its effects. My fears from this evacuation were confirmed, by the communications I had received from Dr. Stevens. I had been accustomed to raising a weak and low pulse in pneumony and apoplexy, by means of blood-letting, but I had attended less to the effects of purging in producing this change in the pulse. Dr. Mitchell in a moment dissipated my ignorance and fears upon this subject. I adopted his theory and practice, and resolved to follow them. It remained now only to fix upon a suitable purge to answer the purpose of discharging the contents of the bowels. I have before described the state of the bile in the gall-bladder and duodenum, in an extract from the history of a dissection made by Dr. Mitchell. I suspected that my want of success in discharging this bile, in several of the cases in which I attempted the cure by purging, was owing the feebleness of my purges. I had been in the habit of occasionally purging with calomel in bilious and inflammatory fevers, and had recommended the practice the year before in my lectures, not only from my own experience, but upon the authority of Dr. Clark. I had, moreover, other precedents for its use in the practice of sir John Pringle, Dr. Cleghorn, and Dr. Balfour, in diseases of the same class with the yellow fever. But these were not all my vouchers for the safety and efficacy of calomel. In my attendance upon the military hospitals during the late war, I had seen it given combined with jalap in the bilious fever by Dr. Thomas Young, a senior surgeon in the hospitals. His usual dose was ten grains of each of them. This was given once or twice a day until it procured large evacuations from the bowels. For a while I remonstrated with the doctor against this purge, as being disproportioned to the violence and danger of the fever; but I was soon satisfied that it was as safe as cremor tartar or glauber's salts. It was adopted by several of the surgeons of the hospital, and was universally known, and sometimes prescribed, by the simple name of _ten_ and _ten_. This mode of giving calomel occurred to me in preference to any other. The jalap appeared to be a necessary addition to it, in order to quicken its passage through the bowels; for calomel is slow in its operation, more especially when it is given in large doses. I resolved, after mature deliberation, to prescribe this purge. Finding ten grains of jalap insufficient to carry the calomel through the bowels in the rapid manner I wished, I added fifteen grains of the former to ten of the latter; but even this dose was slow and uncertain in its operation. I then issued three doses, each consisting of fifteen grains of jalap and ten of calomel; one to be given every six hours until they procured four or five large evacuations. The effects of this powder not only answered, but far exceeded my expectations. It perfectly cured four out of the first five patients to whom I gave it, notwithstanding some of them were advanced several days in the disease. Mr. Richard Spain, a block-maker, in Third-street, took eighty grains of calomel, and rather more of rhubarb and jalap mixed with it, on the two last days of August, and on the first day of September. He had passed twelve hours, before I began to give him this medicine, without a pulse, and with a cold sweat on all his limbs. His relations had given him over, and one of his neighbours complained to me of my neglecting to advise them to make immediate preparations for his funeral. But in this situation I did not despair of his recovery, Dr. Mitchell's account of the effects of purging in raising the pulse, exciting a hope that he might be saved, provided his bowels could be opened. I now committed the exhibition of the purging medicine to Mr. Stall, one of my pupils, who mixed it, and gave it with his own hand, three or four times a day. At length it operated, and produced two copious, f[oe]tid stools. His pulse rose immediately afterwards, and a universal moisture on his skin succeeded the cold sweat on his limbs. In a few days he was out of danger, and soon afterwards appeared in the streets in good health, as the first fruits of the efficacy of mercurial purges in the yellow fever.

After such a pledge of the safety and success of my new medicine, I gave it afterwards with confidence. I communicated the prescription to such of the practitioners as I met in the streets. Some of them I found had been in the use of calomel for several days, but as they had given it in small and single doses only, and had followed it by large doses of bark, wine, and laudanum, they had done little or no good with it. I imparted the prescription to the college of physicians, on the third of September, and endeavoured to remove the fears of my fellow-citizens, by assuring them that the disease was no longer incurable. Mr. Lewis, the lawyer, Dr. M'Ilvaine, Mrs. Bethel, her two sons, and a servant maid, and Mr. Peter Baynton's whole family (nine in number), were some of the first trophies of this new remedy. The credit it acquired, brought me an immense accession of business. It still continued to be almost uniformly effectual in all those which I was able to attend, either in person, or by my pupils. Dr. Griffitts, Dr. Say, Dr. Pennington, and my former pupils who had settled in the city, viz. Dr. Leib, Dr. Porter, Dr. Annan, Dr. Woodhouse, and Dr. Mease, were among the first physicians who adopted it. I can never forget the transport with which Dr. Pennington ran across Third-street to inform me, a few days after he began to give strong purges, that the disease yielded to them in every case. But I did not rely upon purging alone to cure the disease. The theory of it which I had adopted led me to use other remedies to abstract excess of stimulus from the system. These were _blood-letting_, _cool air_, _cold drinks_, _low diet_, and _applications of cold water_ to the body. I had bled Mrs. Bradford, Mrs. Leaming, and one of Mrs. Palmer's sons with success, early in the month of August. But I had witnessed the bad effects of bleeding in the first week in September, in two of my patients who had been bled without my knowledge, and who appeared to have died in consequence of it. I had, moreover, heard of a man who had been bled on the first day of the disease, who died in twelve hours afterwards. These cases produced caution, but they did not deter me from bleeding as soon as I found the disease to change its type, and instead of tending to a crisis on the third, to protract itself to a later day. I began by drawing a small quantity at a time. The appearance of the blood, and its effects upon the system, satisfied me of its safety and efficacy. Never before did I experience such sublime joy as I now felt in contemplating the success of my remedies. It repaid me for all the toils and studies of my life. The conquest of this formidable disease was not the effect of accident, nor of the application of a single remedy; but it was the triumph of a principle in medicine. The reader will not wonder at this joyful state of my mind when I add a short extract from my note book, dated the 10th of September. "Thank God! out of one hundred patients, whom I have visited or prescribed for this day, I have lost none."

Being unable to comply with the numerous demands which were made upon me for the purging powders, notwithstanding I had requested my sister, and two other persons to assist my pupils in putting them up; and, finding myself unable to attend all the persons who sent for me, I furnished the apothecaries with the recipe for the mercurial purges, together with printed directions for giving them, and for the treatment of the disease.

Hitherto there had been great harmony among the physicians of the city, although there was a diversity of sentiment as to the nature and cure of the prevailing fever. But this diversity of sentiment and practice was daily lessening, and would probably have ceased altogether in a few days, had it not been prevented by two publications, the one by Dr. Kuhn, and the other by Dr. Stevens, in which they recommended bark, wine, and other cordials, and the cold bath, as the proper remedies for the disease. The latter dissuaded from the use of evacuations of all kinds. This method of cure was supported by a letter from Alexander Hamilton, Esq. then secretary of the treasury of the United States, to the college of physicians, in which he ascribed his recovery from the fever to the use of those remedies, administered by the hand of Dr. Stevens. The respectable characters of those two physicians procured an immediate adoption of the mode of practice recommended by them, by most of the physicians of the city, and a general confidence in it by all classes of citizens. Had I consulted my interest, or regarded the certain consequences of opposing the use of remedies rendered suddenly popular by the names that were connected with them, I should silently have pursued my own plans of cure, with my old patients who still confided in them; but I felt, at this season of universal distress, my professional obligations to _all_ the citizens of Philadelphia to be superior to private and personal considerations, and therefore determined at every hazard to do every thing in my power to save their lives. Under the influence of this disposition, I addressed a letter to the college of physicians, in which I stated my objections to Dr. Kuhn and Dr. Stevens's remedies, and defended those I had recommended. I likewise defended them in the public papers against the attacks that were made upon them by several of the physicians of the city, and occasionally addressed such advice to the citizens as experience had suggested to be useful to _prevent_ the disease, particularly low diet, gentle doses of laxative physic, avoiding its exciting causes, and prompt applications for medical aid. In none of the recommendations of my remedies did I claim the credit of their discovery. On the contrary, I constantly endeavoured to enforce their adoption, by mentioning precedents in favour of their efficacy, from the highest authorities in medicine. This controversy with my brethren, with whom I had long lived in friendly intercourse, carried on amidst the most distressing labours, was extremely painful to me, and was submitted to only to prevent the greater evil of the depopulation of our city by the use of remedies which had been prescribed by myself, as well as others, not only without effect, but with evident injury to the sick. The repeated and numerous instances of their inefficacy, in some of the most opulent families in the city, and the almost uniform success of the depleting remedies, happily restored the public mind, after a while, from its distracted state, and procured submission to the latter from nearly all the persons who were affected by the fever.

Besides the two modes of practice which have been described, there were two others: the one consisted of _moderate_ purging with calomel only, and moderate bleeding, on the first or second day of the fever, and afterwards by the copious use of bark, wine, laudanum, and aromatic tonics. This practice was supported by an opinion, that the fever was inflammatory in its first, and putrid in its second stage. The other mode referred to was peculiar to the French physicians, several of whom had arrived in the city from the West-Indies, just before the disease made its appearance. Their remedies were various. Some of them prescribed nitre, cremor tartar, camphor, centaury tea, the warm bath, glysters, and moderate bleeding, while a few used lenient purges, and large quantities of tamarind water, and other diluting drinks. The dissentions of the American physicians threw a great number of patients into the hands of these French physicians. They were moreover supposed to be better acquainted with the disease than the physicians of the city, most of whom, it was well known, had never seen it before.

I shall hereafter inquire into the relative success of each of the four modes of practice which have been mentioned.

Having delivered a general account of the remedies which I used in this disease, I shall now proceed to make a few remarks upon each of them. I shall afterwards mention the effects of the remedies used by other physicians.

OF PURGING.

I have already mentioned my reasons for promoting this evacuation, and the medicine I preferred for that purpose. It had many advantages over any other purge. It was detergent to the bile and mucus which lined the bowels. It probably acted in a peculiar manner upon the biliary ducts, and it was rapid in its operation. One dose was sometimes sufficient to open the bowels; but from two to six doses were often necessary for that purpose; more especially as part of them was frequently rejected by the stomach. I did not observe any inconvenience from the vomiting which was excited by the jalap. It was always without that straining which was produced by emetics; and it served to discharge bile when it was lodged in the stomach. Nor did I rest the discharge of the contents of the bowels on the issue of one cleansing on the first day. There is, in all bilious fevers, a reproduction of morbid bile as fast as it is discharged. I therefore gave a purge every day while the fever continued. I used castor oil, salts, cremor tartar, and rhubarb (after the mercurial purges had performed their office), according to the inclinations of my patients, in all those cases where the bowels were easily moved; but where this was not the case, I gave a single dose of calomel and jalap every day. Strong as this purge may be supposed to be, it was often ineffectual; more especially after the 20th of September, when the bowels became more obstinately constipated. To supply the place of the jalap, I now added gamboge to the calomel. Two grains and a half of each, made into a pill, were given to an adult every six hours, until they procured four or five stools. I had other designs in giving a purge every day, besides discharging the re-accumulated bile. I had observed the fever to fall with its principal force upon such parts of the body as had been previously weakened by any former disease. By creating an artificial weak part in the bowels, I diverted the force of the fever to them, and thereby saved the liver and brain from fatal or dangerous congestions. The practice was further justified by the beneficial effects of a plentiful spontaneous diarrh[oe]a in the beginning of the disease[66]; by hæmorrhages from the bowels, when they occurred from no other parts of the body, and by the difficulty or impracticability of reducing the system by means of plentiful sweats. The purges seldom answered the intentions for which they were given, unless they produced four or five stools a day. As the fever showed no regard to day or night in the hours of its exacerbations, it became necessary to observe the same disregard to time in the exhibition of purges: I therefore prescribed them in the evening, at all times when the patient had passed a day without two or three plentiful stools. When purges were rejected, or slow in their operation, I always directed opening glysters to be given every two hours. The effects of purging were as follow:

1. It raised the pulse when low, and reduced it when it was preternaturally tense or full.

2. It revived and strengthened the patient. This was evident in many cases, in the facility with which patients who had staggered to a close-stool, walked back again to their beds after a copious evacuation. Dr. Sydenham takes notice of a similar increase of strength after a plentiful sweat in the plague. They both acted by abstracting excess of stimulus, and thereby removing the depression of the system.

3. It abated the paroxysm of the fever. Hence arose the advantage of giving a purge in some cases in the evening, when an attack of the fever was expected in the course of the night.

4. It frequently produced sweats when given on the first or second day of the fever, after the most powerful sudorifics had been taken to no purpose.

5. It sometimes checked that vomiting which occurs in the beginning of the disease, and it always assisted in preventing the more alarming occurrence of that symptom about the 4th or 5th day.

6. It removed obstructions in the lymphatic system. I ascribe it wholly to the action of mercury, that in no instance did any of the glandular swellings, which I formerly mentioned, terminate in a suppuration.

7. By discharging the bile through the bowels as soon and as fast as it was secreted, it prevented, in most cases, a yellowness of the skin.

[66] In some short manuscript notes upon Dr. Mitchell's account of the
yellow fever in Virginia, in the year 1741, made by the late Dr.
Kearsley, sen. of this city, he remarks, that in the yellow fever
which prevailed in the same year in Philadelphia, "some recovered
by an _early_ discharge of _black_ matter by stool." This
gentleman, Dr. Redman informed me, introduced purging with
glauber's salts in the yellow fever in our city. He was preceptor
to Dr. Redman in medicine.

However salutary the mercurial purge was, objections were made to it by many of our physicians; and prejudices, equally weak and ill-founded, were excited against it. I shall enumerate, and answer those objections.

1. It was said to be of too drastic a nature. It was compared to arsenic; and it was called a dose for a horse. This objection was without foundation. Hundreds who took it declared they had never taken so mild a purge. I met with but one case in which it produced bloody stools; but I saw the same effect from a dose of salts. It sometimes, it is true, operated from twenty to thirty times in the course of twenty-four hours; but I heard of an equal number of stools in two cases from salts and cremor tartar. It is not an easy thing to affect life, or even subsequent health, by copious or frequent purging. Dr. Kirkland mentions a remarkable case of a gentleman who was cured of a rheumatism by a purge, which gave him between 40 and 50 stools. This patient had been previously affected by his disease 16 or 18 weeks[67]. Dr. Mosely not only proves the safety, but establishes the efficacy of numerous and copious stools in the yellow fever. Dr. Say probably owes his life to three and twenty stools procured by a dose of calomel and gamboge, taken by my advice. Dr. Redman was purged until he fainted, by a dose of the same medicine. This venerable gentleman, in whom 70 years had not abated the ardour of humanity, nor produced obstinacy of opinion, came forward from his retirement, and boldly adopted the remedies of purging and bleeding, with success in several families, before he was attacked by the disease. His recovery was as rapid, as the medicine he had used was active in its operation. Besides taking the above purge, he lost twenty ounces of blood by two bleedings[68].

[67] Treatise on the Inflammatory Rheumatism, vol. i. p. 407.

[68] Dr. Redman was not the only instance furnished by the disease, in
which _reason_ got the better of the habits of old age, and of the
formalities of medicine. About the time the fever declined, I
received a letter from Dr. Shippen, sen. (then above 82 years of
age), dated Oxford Furnace, New-Jersey, October 13th, 1793, in
which, after approving in polite terms of my mode of practice, he
adds, "Desperate diseases require desperate remedies. I would only
propose some small addition to your present method. Suppose you
should substitute, in the room of the jalap, _six_ grains of
gamboge, to be mixed with ten or fifteen grains of calomel; and
after a dose or two, as occasion may require, you should bleed
your patients _almost_ to death, at least to _fainting_; and then
direct a plentiful supply of mallows tea, with fresh lemon juice,
and sugar and barley water, together with the most simple, _mild_,
and nutricious food." The doctor concludes his letter by
recommending to my perusal Dr. Dover's account of nearly a whole
ship's crew having been cured of a yellow fever, on the coast of
South-America, by being bled until they fainted.

But who can suppose that a dozen or twenty stools in a day could endanger life, that has seen a diarrh[oe]a continue for several months, attended with fifteen or twenty stools every day, without making even a material breach in the constitution? Hence Dr. Hillary has justly remarked, that "it rarely or never happens that the purging in this disease, though violent, takes the patient off, but the fever and inflammation of the bowels[69]." Dr. Clark in like manner remarks, that evacuations do not destroy life in the dysentery, but the fever, with the emaciation and mortification which attend and follow the disease[70].

[69] Diseases of Barbadoes, p. 212.

[70] Diseases in Voyages to Hot Climates, vol. ii. p. 322.

2. A second objection to this mercurial purge was, that it excited a salivation, and sometimes loosened the teeth. I met with but two cases in which there was a loss of teeth from the use of this medicine, and in both the teeth were previously loose or decayed. The salivation was a trifling evil, compared with the benefit which was derived from it. I lost only one patient in whom it occurred. I was taught, by this accidental effect of mercury, to administer it with other views than merely to cleanse the bowels, and with a success which added much to my confidence in the power of medicine over this disease. I shall mention those views under another head.

3. It was said that the mercurial purge excoriated the rectum, and produced the symptoms of pain and inflammation in that part, which were formerly mentioned.

To refute this charge, it will be sufficient to remark that the bile produces the same excoriation and pain in the rectum in the bilious and yellow fever, where no mercury has been given to discharge it. In the bilious remitting fever which prevailed in Philadelphia in 1780, we find the bile which was discharged by "gentle doses of salts, and cream of tartar, or the butternut pill, was so acrid as to excoriate the rectum, and so offensive as to occasion, in some cases, sickness and faintness both in the patients, and in their attendants[71]."

[71] Vol. i.

Dr. Hume says further upon this subject, that the rectum was so much excoriated by the natural discharge of bile in the yellow fever, as to render it impossible to introduce a glyster pipe into it.

4. It was objected to this purge, that it inflamed and lacerated the stomach and bowels. In support of this calumny, the inflamed and mortified appearances, which those viscera exhibited upon dissection in a patient who died at the hospital at Bush-hill, were spoken of with horror in some parts of the city. To refute this objection it will only be necessary to review the account formerly given of the state of the stomach and bowels after death from the yellow fever, in cases in which no mercury had been given. I have before taken notice that sir John Pringle and Dr. Cleghorn had prescribed mercurial purges with success in the dysentery, a disease in which the bowels are affected with more irritation and inflammation than in the yellow fever. Dr. Clark informs us that he had adopted this practice. I shall insert the eulogium of this excellent physician upon the use of mercury in the dysentery in his own words. "For several years past, when the dysentery has resisted the common mode of practice, I have administered mercury with the greatest success; and am thoroughly persuaded that it is possessed of powers to _remove inflammation_ and _ulceration_ of the intestines, which are the chief causes of death in this distemper[72]."

[72] Vol. ii. p. 342.

5. It was urged against this powerful and efficacious medicine, that it was prescribed indiscriminately in all cases, and that it did harm in all weak habits. To this I answer, that there was no person so weak by constitution or a previous disease, as to be injured by a single dose of this medicine. Mrs. Meredith, the wife of the treasurer of the United States, a lady of uncommon delicacy of constitution, took two doses of the powder in the course of twelve hours, not only without any inconvenience, but with an evident increase of strength soon afterwards. Many similar cases might be mentioned. Even children took two or three doses of it with perfect safety. This will not surprise those physicians who have been in the practice of giving from ten to twenty grains of mercury, with an equal quantity of jalap as a worm purge, and from fifty to a hundred grains of calomel, in the course of four or five days, in the internal dropsy of the brain. But I am happy in being able to add further, that many women took it in every stage of pregnancy without suffering the least inconvenience from it. Out of a great number of pregnant women whom I attended in this fever I did not lose one to whom I gave this medicine, nor did any of them suffer an abortion. One of them had twice miscarried in the course of the two or three last years of her life. She bore a healthy child three months after her recovery from the yellow fever.

No one has ever objected to the _indiscriminate_ mode of preparing the body for the small-pox by purging medicines. The _uniform_ inflammatory diathesis of that disease justifies the practice, in a certain degree, in all habits. The yellow fever admits of a sameness of cure much more than the small-pox, for it is _more_ uniformly and more highly inflammatory. An observation of Dr. Sydenham upon epidemics applies, in its utmost extent, to our late fever. "Now it must be observed (says this most acute physician) that some epidemic diseases, in some years, are uniformly and constantly the same[73]." However diversified our fever was in some of its symptoms, it was in all cases accompanied by more or less inflammatory diathesis, and by a morbid state of the alimentary canal.

[73] Vol. i. p. 9.

Much has been said of the bad effects of this purge from its having been put up carelessly by the apothecaries, or from its having been taken contrary to the printed directions, by many people. If it did harm in any one case (which I do not believe) from the former of the above causes the fault is not mine. Twenty men employed constantly in putting up this medicine would not have been sufficient to have complied with all the demands which were made of me for it. Hundreds who were in health called or sent for it as well as the sick, in order to have it in readiness in case they should be surprised by the disease in the night, or at a distance from a physician.

In all the cases in which this purge was supposed to have been hurtful, when given on the first or second day of the disease, I believe it was because it was not followed by repeated doses of the same, or of some other purge, or because it was not aided by blood-letting. I am led to make this assertion, not only from the authority of Dr. Sydenham, who often mentions the good effects of bleeding in moderating or checking a diarrh[oe]a, but by having heard no complaints of patients being purged to death by this medicine, after blood-letting was universally adopted by all the physicians in the city.

It was remarked that the demand for this purging powder continued to increase under all opposition, and that the sale of it by the apothecaries was greatest towards the close of the disease. I shall hereafter say that this was not the case with the West-India remedies.

It is possible that this purge sometimes proved hurtful when it was given on the fifth day of the disease, but it was seldom given for the _first_ time after the third day, and when it was, the patient was generally in such a situation that nothing did him either good or harm.

I derived great pleasure from hearing, after the fever had left the city, that calomel had been given with success as a purge in bilious fevers in other parts of the union besides Philadelphia. Dr. Lawrence informed me that he had cured many patients by it of the yellow fever which prevailed in New-York, in the year 1791, and the New-York papers have told us that several practitioners had been in the habit of giving it in the autumnal fevers, with great success, in the western parts of that state. They had probably learned the use of it from Dr. Young, who formerly practised in that part of the United States, and who lost no opportunity of making its praises public wherever he went.

I have only to add to my account of that purging medicine, that, under an expectation that the yellow fever would mingle some of its bilious symptoms with the common inflammatory fevers of the winter and first spring months, I gave that purge in the form of pills, in every case of inflammatory fever to which I was called. The fatal issue of several fevers in the city, during the winter, in which this precaution had been neglected, convinced me that my practice was proper and useful.

It is to be lamented that all new remedies are forced to pass through a fiery ordeal. Opium and bark were long the objects of terror and invective in the schools of medicine. They were administered only by physicians for many years, and that too with all the solemnity of a religious ceremony. This error, with respect to those medicines, has at last passed away. It will, I hope, soon be succeeded by a time when the prejudices against _ten_ and _ten_, or _ten_ and _fifteen_, will sleep with the vulgar fears which were formerly entertained of the bark producing diseases and death, years after it had been taken, by "lying in the bones."

OF BLOOD-LETTING.

The theory of this fever which led me to administer purges, determined me to use blood-letting, as soon as it should be indicated. I am disposed to believe that I was tardy in the use of this remedy, and I shall long regret the loss of three patients, who might probably have been saved by it. I cannot blame myself for not having used it earlier, for the immense number of patients which poured in upon me, in the first week of September, prevented my attending so much to each of them, as was necessary to determine upon the propriety of this evacuation. I was in the situation of a surgeon in a battle, who runs to every call, and only stays long enough with each soldier to stop the bleeding of his wound, while the increase of the wounded, and the unexpected length of the battle, leave his original patients to suffer from the want of more suitable dressings. The reasons which determined me to bleed were,

1. The state of the pulse, which became more tense, in proportion as the weather became cool.

2. The appearance of a moist and _white_ tongue, on the first day of the disease, a certain sign of an inflammatory fever.

3. The frequency of hæmorrhages from every part of the body, and the perfect relief given in some cases by them.

4. The symptoms of congestion in the brain, resembling those which occur in the first stage of hydrocephalus internus, a disease in which I had lately used bleeding with success.

5. The character of the diseases which had preceded the yellow fever. They were all more or less inflammatory. Even the scarlatina anginosa had partaken so much of that diathesis, as to require bleeding to subdue it.