But, if the heat of the sun cannot produce the true yellow fever, it can kill suddenly without any fever whatever. This is said by Dr. Moseley to be less frequent in the West India islands than on the eastern and western continents. He says that he has felt as great inconvenience from the sun’s heat at Venice, Naples, Rome, Montpelier, and in Virginia, as in the West Indies;187but he concludes that thetransitionsfrom heat to cold are more pernicious to the human body than any continued heat, however violent.
With regard to the effluvia of marshes, it is not denied that they produce fevers, but those fevers are of the intermittent or remittent kind. Dr. Smith indeed, in the first volume of the Medical Repository, labours to prove that the plague described by Thucydides was notessentially different from the fevers which sometimes prevail in North America, and that it had its origin from marsh effluvia and the ravages of war. That this distemper was not the plague described by Russel we may gather from a single circumstance: for Russel tells us thatsneezingnever occurred in the plague described by him,188while Thucydides says that it was one of the common symptoms of his. Neither does the description of it (Appendix No. 1) at all agree with any of the accounts of the yellow fever we have. The climate of Attica no doubt was variable, and may in this respect resemble that of North America; but so is the climate of China, yet no such diseases are there produced. The Doctor concludes that the distemper originated fromlocalcauses; but the difficulty we find in proving such origin of diseases in our own days, and in the country where we reside, must certainly make us look upon the proofs which can be brought for the local origin of a disease which happened two thousand years ago, and in a distant country, as very equivocal. The following extract from the Paris Medical Memoirs may be adduced as a proof of the intrinsic power of marsh mud to produce fevers. It is contained in a paper written by Dr. Perkins of Boston. “A farmer was in the practice of spreading, upon about thirty acres of land, some new marsh mud, from October to April annually, to increase the fertility of the soil. In the summer of the third year, those inhabitants who lived to the northward and eastward of the place were attacked with a very malignant fever, which generally proved mortal. What is a proof that the marsh mud was the cause of the disease is, its extent, which was not more than a mile and an half from the farmer’s house, in the direction of the southerly and westerly winds. Perhaps had this marsh mud been washed by plentiful rains, the danger would have been less. Something like it happened to the inhabitants of the marshesin East Sudbury, (les marais situes a l’est dans le Sudberg) where the passage for the waters was too deep, and too confined. In regular seasonsthey were attacked with simple intermittent fevers; but, after wet seasons, there prevailed among them malignant fevers, and very obstinate remittents. Since the marshes have been drained, the inhabitants are no longer subject to fevers, and are as healthy as those of others places. We know that there are local epidemics, which are produced by a low, wet and rich soil; such are, probably, those which prevail in the lower part of New York, which, according to the informations obtained by Mr. Perkins, is more unhealthy towards the end of the summer than the other part of the city, and whose inhabitants are subject to diseases of a putridcaractere.
“It appears, from several observations, that the most mortal epidemic fevers are not commonly produced by causes operating immediately; the cause often existing several months before the disease even appears.”
The other arguments used by Dr. Smith in his letters to Dr. Buel proceed upon the state of the city, the mode of living, &c. and the condition of most of the emigrants, their bad accommodations, and especially their abuse of spiritous liquors. The neglect of bathing is also much complained of, and a comparison made with the conduct of the French in this and other respects, greatly to the advantage of the latter.
Drs. Taylor and Hansforth consider the disease which took place in Norfolk in Virginia as only an higher degree of the common remittent fever which usually prevails, and ascribe it to the long-continued heat, putrescence, &c. Some French ships were said to have brought the disease, but these arrived “so long before the disease appeared, that (the Doctors think) it would be absurd to suppose even a possibility of its being derived from them.” Mr. Webster adds, in a note, that the French corvettes, three of which squadron were taken by the Thetis, capt. Cochran, “anchored in Hampton Roads, May 18th. The fever did not appear in Norfolk till August. Captain Cochran’s crew, however,took the fever from the French prisoners, and twelve of them died before the Thetis reachedHalifax.” This is certainly a suspicious circumstance.
Dr. Ramsay, in his letter to Dr. Mitchill concerning the same distemper, observes that it was confined almost entirely to foreigners, of whom he gives a very unfavourable account. The situation of the town, putrescence, &c. are likewise brought in for a share, as well as the season, which had been uncommonly warm.
These are the principal evidences that have been brought for and against the origin of the disease which since 1792 has raged with such violence in the United States. Innumerable pieces have appeared in the Newspapers on both sides of the question, the most remarkable of which are the letters of Mr. Noah Webster to Dr. Currie. These, however, we cannot now consider, as we cannot expect indeed that they should contain any thing else than a fuller detail of what has already been set forth. Mr. Webster besides, in his letters, owns that he is not a medical man; nay, that he had not “read above three or four medical books.” I hope therefore the reader will excuse the preference given in this treatise to the writings and arguments of those who are acquainted with medicine both by reading and practice. The dispute between the College and Academy of medicine can be settled only by themselves; the only safe line of conduct seems to be to admit both doctrines, and to take every method of preventing the introduction of the disease, whether supposed to be generated or imported.
Whether the distemper which has so fatally prevailed since the year 1793 be naturally connected with the troubles in Europe and the West Indies or not, it is certain that it has been cotemporary with them. In New York the disease appeared in 1791, but we are not furnished with any particular accounts of it at that time; nor does it appear to have made any great ravages, either on the continent or the West India islands, till 1793. At this time the war raged in Europe with fury; the French royalists were every where driven out, and distressed in every possible way. Desolation and slaughter prevailed at St. Domingo, while an unbounded intercoursetook place between the United States and all those nations who were involved in the calamities resulting from the unbridled passions of man excited to their utmost pitch of ferocity. In the midst of this general commotion the fever broke out in the West India islands, appearing first in the island of Grenada. We have seen, that, according to Dr. Chisholm, this disease was brought to Grenada in the Hankey, from the coast of Africa, on the 18th of February. About the middle of April it began to appear on land. In the beginning of May it reached a detachment of the royal artillery lying at a distance from the focus of infection, “but (says Dr. Chisholm) by the communication which the gunners in Fort George had with the 45th regiment, and the predisposition of the men to receive the infection as far as that could be induced by excesses in drinking, and other irregularities.” About the first of June the disease began to appear among the negroes of the estates in the neighbourhood of the town, but never attacked them with the same violence that it did the white people. During the months of May, June and July, it appeared in different parts of the country; being, as our author supposes, carried thither by infected persons. From Grenada, the Doctor says, the disease spread to the islands of Jamaica and St. Domingo, and from the latter to Philadelphia, “by vessels on which the infection was retained by the clothes, more especially the woollen jackets, of the deceased sailors.”
This account of the origin of the fever at Philadelphia, as we have already seen, is inadmissible by those who deny the contagious nature of the disease; but as the latter have never given any distinct account of its rise, or shown why it should first appear in one island and then in another, instead of beginning in them all at once, we must adhere to that of Dr. Chisholm, till we are furnished with a better.
In Philadelphia it has already been observed, that Dr. Rush was called to his first patient on the 5th of August; but Mr. Carey mentions a child of Dr. Hodges “as probably the first victim;” who was taken ill on the26th or 27th of July. This same month the unfortunate fugitives had arrived from Cape Francois; and we have already seen, from Dr. Clarke, that the arrival of some of their fellow-sufferers in Dominica had the same dreadful attendant. Whether the disorder is to be ascribed to the arrival of these people in either place, the reader will judge. Other vessels are charged with having imported the same; but, facts being disputed, we cannot enter into the controversy.
The disease began in Water-street, to a particular part of which, near to that where the suspected ships lay, it was for some time confined, but did not excite public alarm till about the 19th of August. From this time to the 25th of the month the attention of the citizens was so much aroused, that they began to move into the country; and on the 22d, the city commissioners were peremptorily ordered by the mayor to keep the city clean. On the 26th the College met, and addressed the citizens on the subject; recommending such means of preventing the spreading of the sickness as to them seemed most proper. Among these were, to avoid any intercourse with the infected, to live temperate, keep their minds easy, and to avoid fatigue. Lighting of fires was particularly disapproved of; but the burning of gunpowder, and the steams of vinegar and camphor, were recommended for infected rooms, and for using on handkerchiefs, and in smelling-bottles.
In consequence of this address also the bells were stopped from tolling, the constant noise of which had greatly contributed to increase the public alarm. The people, who had been in use to light large fires in the corners of the streets, being forbid on the 29th by proclamation to do so, had recourse to firing of guns; which was at last carried to such excess, that it also was prohibited by proclamation on the 4th of September.
Notwithstanding all these precautions, the distemper continued to increase in such a manner as to produce the most dreadful terror and dismay. “Indeed (says Mr. Carey) it is not probable that London, at the last stage of the plague, exhibited stronger marks of terror thanwere to be seen in Philadelphia, from the 26th or 27th of August, till pretty late in September.” This produced scenes of distress unparalleled till this time in the city, and of which many instances are to be met with in Mr. Carey’s account. It cannot, however, be doubted that the violence of the distemper, its contagious nature, and the consequent danger of visiting the metropolis, were greatly exaggerated. Thus terror was struck throughout all the adjacent states. At Chester-town, in Maryland, a meeting was held, on the 10th of September, in consequence of which the Eastern shore line of stages was quickly stopped. On the 10th of the same month it was ordered by the mayor of New York that the names of all such persons as had arrived or should arrive from Philadelphia or other place, by land or water, that were orshould be sick, should be reported to him, that those who were sick of infectious diseases might be removed out of the city. Next day the governor proclaimed that all vessels from Philadelphia should approach no nearer than Bedlow’s island, about two miles from the town, till license was given. But these precautions not being deemed sufficient, a night watch was established, and next day an address was published by delegates, purporting the insufficiency of all that had been done, and again calling upon their fellow-citizens to exert their utmost vigilance in detecting the fugitives from Philadelphia. Various other resolutions were passed in New York; and throughout the whole continent such measures were taken as seemed most likely to proscribe the unhappy Philadelphians, and to prevent their having any place of refuge from the sickness they so much dreaded. On the 1st of October, however, the inhabitants of Springfield, in New Jersey, passed a resolve, offering their town as an asylum for the people of Philadelphia, and directing an hospital to be provided for the reception of such as might fall sick. Similar resolutions were passed by the inhabitants of Elizabethtown, and Elkton in Maryland.
The distemper in the mean time arrived at the most dreadful height in Philadelphia, and almost all thosewho could take the charge and burthen of public affairs were absent. An hospital had been established at Bush Hill, but, for want of superintendence, had fallen into such disorder, that the poor chose rather to deny their illness than to be sent to it. On the 15th of September, however, Stephen Girard, a native of France, and a wealthy merchant, together with Peter Helm, a native of Pennsylvania, offered their services as superintendants. By their exertions the credit of the hospital was soon retrieved, and such numbers demanded admittance, that it became necessary for each candidate to procure a certificate from a physician, that the patient really laboured under a malignant fever. In a short time the affairs of the city went on, in every respect, with as much regularity as could be expected; but the mortality increased throughout the month of September, and the three first weeks of October. Great hopes were entertained from some cold and rainy weather in the end September; but they proved illusive, and the disease became even more fatal than before, till the 26th of October, when it suddenly ceased, as Mr. Carey says, with hardly any rain, and a very moderate degree of cold. “That day (adds he) was as warm as many of the most fatal ones in the early part of the month. To account for this is perhaps above our power. In fact, the whole of the disorder, from its first appearance to its final close, has set human wisdom and calculation at defiance.” During the time of this calamity Mr. Carey computes thatseventeenthousand left the city, andfourthousand and thirty-one perished.
This city suffered another attack in 1794 but far less severe than before. In 1795 and 1796 the disease seems scarcely to have made its appearance; but in 1797 it revived, and, in 1798, broke out with greater fury than even in 1793. No particular history hath been published of this last severe attack. We know only in general, that, though a much greater number of the inhabitants fled out of town in 1798 than in 1793, the number of deaths was almost as great; being estimated at three thousand eight hundred and forty-one. Great disputes,as has been observed, have taken place concerning the origin of these diseases; on which we shall only further remark, that if, after such repeated and dreadful experience of the bad effects of allowing putrid matters to accumulate, such quantities could be collected as to produce the very fatal sickness of last year, it argues a most unaccountable, and indeed incredible, insensibility on the part of the people, as well as remissness on that of the magistrates; and this perhaps may be accounted as strong an argument in favour of contagion as can be adduced.
That such a violent distemper should cease all at once, is indeed not to be expected; and we have already heard of its again appearing in the city. Fear has been very justly excited, there and in other places; but it is to be hoped that the remarkable coolness of the season will operate favourably in preventing any very violent attack for this year.
New York has also suffered very considerably from this disease. Here it appeared in 1791, in the autumn, and in a part of the town remarkable for its vicinity to a collection of filth. In 1792 it made no progress; and in 1793, though some died of it who fled from Philadelphia, it did not spread. In 1794 it returned with considerable violence, and with still greater in 1795. In the history of this disease by Dr. Seaman,189he takes notice that in July and August an unusual number of persons suffered from drinking cold water, and some fell down and died in the streets; but the Doctor supposes this to have happened rather through the excessive heat of the sun than the drinking of water. As the disease came on, all others gave way to it, even “the common remitting bilious fever;”190and in the month of July some cases occurred. We have already had occasion to take notice of the death of Dr. Treat, who was taken ill on the 22d of July; but before that time, on the 6th of the same month, Dr. Seaman says that, in conjunction with this gentleman, he had visited a patient “affected with all the full-marked and decided symptoms of an highlymalignant yellow fever.”191The disease continued to gain ground in August, and became extremely violent in that and the following month; but, according to our author, the low ground in the southeast part of the city was the “grand centre of the calamity, diffusing its effects like diverging rays, aiding, by its most powerful influence, different secondary centres, already smoking hot, to flame out its pestiferousoperations.” In this part of the town five hundred died in three months.
The attack at this time did not arouse the people to a proper sense of their danger. As formerly, the origin of the disease in 1795 had been attributed to the filth of the city. Next year it was attributed to the same, and so in 1797 and 1798. This last year, particularly, it is said to have originated partly from great quantities of putrid beef and fish, collected for exportation, and which could not be exported. In Mr. Hardy’s account of this fever, it is calculated that there died in 1798 two thousand and eighty-six; but that, if it were taken into the account how many left the town and died in the country, the number would amount to between two thousand four hundred, and two thousand five hundred.
It is not in Philadelphia and New York alone that this distemper has prevailed. Boston, Newburyport, Portsmouth, Portland, and even detached spots in the country, to which it is not possible to trace any infection, have felt its ravages. At Salem also, where the disease was never known before, twenty-one cases, including some doubtful ones, appeared in 1798; and of these, eleven proved fatal. In 1796, when it prevailed in Newburyport, it was supposed to have been introduced by a vessel from the West Indies; and, according to Dr. Coffin, the opinion would have been incontrovertible, had not a large quantity of fish-garbage been collected at the place where the vessel landed; so that, though the disease spread from that place, it could not be known whether it proceeded fromthe vessel, or the fish, or both. It seems now unfortunately to be the case, that where this disease once gets footing it cannot easily be eradicated. If we suppose it always to be imported, the continual intercourse with the West India islands will account for this; but the extreme difficulty, or rather impossibility, of procuring an account of facts or even a single fact which cannot be controverted, renders every thing that can be said upon the subject uncertain and precarious. In the case of New London particularly, where 81 persons were destroyed by it last year, neither importation nor collections of filth could be assigned as the cause; nevertheless it began near awharf; but Mr. Holt, in his account of the disease, thinks it was most probably owing to the mere heat and dryness of the season. On the other side of the question, however, we must still insert Dr. Brackett’s account of the origin of the disease at Portsmouth, in answer to a letter from Dr. Oliver of this place.
“The yellow or pestilential fever made its first appearance at Portsmouth, about the first of August last. Eight or ten days before that time a vessel arrived here from Martinico, and brought a French family (four or five in number.) This vessel, before she left the West Indies, had two sailors taken sick (as the captain informed me) one of whom died on the passage home; the other was on the recovery when the vessel came into this port.
“There was not, nor had not been for a long time before, any fever in this town. Two or three days after, I heard that one or two men, who were labourers (and probably had been on board, as they lived nigh where the vessel lay at the wharf) died suddenly with fever, but am uncertain whether with yellow fever, as I never saw them. The first of August, the owner, whose house was about four or five rods distant from the vessel, had a child of four or five years of age taken sick; the next day I visited it, and two days after he died. The symptoms appeared like a cholera morbus—sick stomach, and frequent puking of blackbile. The day before he died a brother of his, fifteen years old, was taken ill, and had much the same symptoms, only greater inflammation and distress. He was blooded freely, took calomel, bark, &c. He died five days after sickened. Between the 8th and the 20th of August, four or five of the other children and servants were taken with the same symptoms, and recovered. On the sixteenth day, a daughter, seventeen years of age, was taken down with the same disease: she was treated in the same manner, with bleeding, mercury, warm bath, bark, &c. and died on the 9th day. This patient had a great discharge of blood from her mouth and gums for three days before she died. One or two more of the family had it afterwards, and recovered. All these patients took the infection, I believe, about the same time. Many others in that neighbourhood had the fever during this time, about one half of whom died: out of forty-six patients I lost fifteen. If I could procure a soreness of the fauces, by administering calomel in small doses, and rubbing it in the gums, or by frictions on the legs and arms with mercurial ointment, the third or fourth day, I was sure of their recovery.
“How many died of this disease in the whole, I have forgotten; as, through fatigue, and debility of body and mind, I kept no notes: I think rather more than half of those who had it. The fever agreed in every symptom, almost, with that described by Dr. Rush and others. The contagion did not appear to be propagated, as the largest number who had the disease were seized in the month of August, and lived in the streets only which communicated with the wharf where the vessel lay, and the beach where she was graved. These streets are in the highest part of the town, and always esteemed the most healthy, and as free of putrid substances as any in it. In the months of September and October the fever was followed by dysentery, and spread through almost every part of the town and its environs. There has been no case of fever or dysentery since last fall: this place, during the winter, andsummer thus far, has been uncommonly healthy; and it appears likely to continue so, if the committee of health should not be remiss in their duty. Thus, without any comments, I have endeavoured to give you a short history of the pestilential fever, as it appeared here last summer. The ideas, you may communicate to the author of the book intended to be published.”
The following letter from Dr. Warren, which he obligingly sent to two physicians in Salem, gives an accurate account of the distemper which prevailed in Boston last year:
“I should immediately have answered your favour of last month, but for a wish to give you as complete an account of the causes and mortality of the late epidemic as could be collected.
“There were a number of suspected causes, which, though concealed during the prevalence of the disease, it was hoped would be developed after the agitation of the public mind had entirely subsided; and I was in expectation that some regular returns would have been made of the numbers who had passed through the disease, and of those who had died with it, so that some estimate might be formed of its malignity and mortality; but such returns have not yet been made, and it is therefore impossible to obtain any satisfactory evidence on those heads. I suppose the number of deaths to have been rather short of two hundred; but this is only a rude guess, and should not be relied on in forming any consequential deductions on the subject. I shall, however, now offer such an account of the disorder as my present materials have enabled me to prepare.
“The first unequivocal appearance of the malignant fever, in the town of Boston, was on the 20th of July 1798 (though one family had been attacked with a fever, attended with unusual symptoms, as early as the middle of June; but, as no other instances occurred for so long a time, of an alarming nature, some doubts may perhaps be justly entertained of the identity of theaffection.) Three or four cases only, I believe, happened between this and the latter end of the month. The two first of these were young men employed in stores directly opposite to each other, on Green’s wharf, near the Town-dock. A few days after, three or four persons were seized with the same complaint, whilst following their respective occupation in Market square, on the east and south sides of Faneuil Hall, or the Market-house. In the beginning of the month of August several persons were taken sick in the same neighbourhood, chiefly young men between 16 and 24 years of age, whilst employed in stores and counting houses there situated. The stores in Merchant’s row, extending from the Market to State-street were more especially visited with the disease, and, in the course of the same month, a family at the bottom of State-street, and several persons at Oliver’s dock, were taken sick. At this place a kind of bason is formed between a point of the town projecting from Fort hill, and the Long wharf, which is constantly receiving the offals of fish, and other animal substances, which from its situation could not be washed off by the waters contained in it. This spot is remarkable for having been the residence of most of the persons first attacked with the bilious remittent fever of 1796. To the latter end of this month the number of sick continued to be increasing; but the attacks were principally confined to the above-mentioned quarters, till at length the disease appeared on the south side of Fort hill, at some distance to the southward of Oliver’s dock, leaping, as it were, over the summit of the hill, without lighting upon the inhabitants on the north of that eminence. The fatality of the disease was here probably greater than in any part of the town of equal population; and it was nearly the last place in which it disappeared. Very few families who remained in their own houses upon the hill escaped its attack; and the progress of the disease, in all the places above mentioned, seemed to have been arrested only by means of the evacuation of the buildings bythe people who inhabited them. In the latter end of August, and through the month of September, many persons were taken sick in Fore-street, which runs northerly from Market of Dock square, along the heads of the wharves, on the eastern side of the town.
“Through the whole period of the sickness scarcely a person was taken ill who had not resided, or been in daily employment, in the vicinity of these places. The subjects of the disease were generally natives of the town, chiefly in the prime of life, and in the vigour of health. I recollect no instance of any French inhabitants being assailed by it, and have heard of only one or two instances of the blacks being affected with it.
“That the fever was in a degree contagious, I cannot entertain a doubt; but that it was not so in a very high degree, I am as fully persuaded, from the number of cases in which there was reason to believe it could not have been taken in that way. In most instances, where contagion might have been suspected, the subjects were so situated that they might have received it from the same source as those with whom they had communicated. I cannot learn that any evidence has been furnished of infection from the sick who had been removed into the country, though there were many instances of such removals, under the most malignant forms which it assumed.
“The fever was generally ushered in by a chill, but I think by no means equal to that which commonly precedes fevers of the ardent kind, nor in proportion to the violence of its subsequent periods. In a short time the rigors were succeeded by excessive heat; the pulse, which had been small and contracted, became hard and full; the respiration laborious from violent oppression at the scrobiculus cordis; the tongue assumed a whitish cast; the eyes became highly inflamed, while the pains in the head, back, and legs, were intolerably severe. To these symptoms succeeded nausea, and vomiting sometimes of a highly bilious matter, seldom attended with diarrhœa, but often with a burning at the stomach, tenderness of the abdomen,parcity of urine; and, in one instance, a dysuria, with a great proportion of blood at each evacuation of that fluid.
“These appearances usually continued about 48 hours, after which they often suddenly gave place to a very different train of symptoms. The pulse sunk astonishingly, and became intermittent; the heat and pains entirely subsided; and the patient supposed himself to be out of danger. From a perfect possession of all his intellectual faculties, with a serenity of mind, which in no other disease, I believe, is so generally observed to accompany its last stages, on or about the 5th day from the accession of the fever, he fell into a state of insensibility, and thence sunk gently into the arms of death. In others this change was less rapid; the pulse became gradually smaller, the distressing symptoms slowly abated, a coldness of the extremities took place, and continued for several days before death, accompanied with clammy sweats, often without any perceptible pulse in the wrists, for several hours before the fatal termination. The tongue seldom became much coated, to the last. Delirium was by no means generally attendant; and a yellowness of the skin was far from being universal; sometimes, however, this appearance was observed within the three first days; often on the fourth and fifth; and I was induced to consider it as an accident, rather than a constituent character of the disease.
“The black vomit, as it has been usually called, though in my opinion by no means to be considered as a pathognomic sign of the disease (as I have frequently seen it take place in other acute fevers, especially the puerperal) was very frequently attendant on the last stages of the disorder; very few recovered after this circumstance had taken place; in one person, however, who had it in the most alarming form, together with an intermittent pulse, coldness of the extremities, singultus, and every usual mark of immediate dissolution, a most unexpected recovery happily disappointed the positive prognostics of his physicians. As the cure advanced, theskin in this instance became extremely yellow, and continued so for many weeks after the fever had subsided; the biliary ducts having been completely obstructed, and consequently the alvine evacuations of a clayey colour, and with much difficulty procured. Frequent repetitions of rhubarb and calomel in large doses, the continuance of the mercurial medicine in small doses, so as to keep up a continual ptyalism, and a laxative diet, restored him to perfect health.
“For the discoveries which were made on dissecting the bodies of some of those who died with the disease, I beg leave to refer you to a publication in the Boston Centinel, made during the prevalence of the disorder in this place, and subscribed by Dr. Isaac Rand, sen. President of the M. Medical Society, and myself.” (For these discoveries see thetable, facing p. 434.)
“We had heretofore treated our patients agreeably to the method practised at Philadelphia in 1793, with bleeding in most instances, and active purges of jalap and calomel, or Rochelle salts. The diseased state of the liver, the known effects of mercury in hepatitis, and the recollection of the suggestions contained in Dr. Rush’s publication on the yellow fever, together with those of several other celebrated writers on the same subject, induced us to enter immediately on the use of calomel in small doses, as recommended in our paper above referred to.
“In my own practice Inowusually commenced the treatment by bleeding from ten to sixteen ounces, and followed it by a dose of between ten and fifteen grains of calomel with between twenty and twenty-five grains of jalap, or an ounce of Rochelle salts, or more, according to the constitution. Immediately after the operation of these medicines I began with the use of calomel in small doses, in pills of a grain, every hour, and sometimes of 3 grains every two hours. Within the first twenty-four hours, but scarcely ever after, I found occasion frequently to repeat the bleeding, and it is worthy of remark, that in scarcely a single instance was this operation performed without almost instantaneousrelief; although in most cases, a few hours after, there was a recurrence of the symptoms. The blood for the most part was dark. In three cases there was no separation of serum from the coagulated mass at the end of forty-eight hours. In two of these (and they were the only cases in which I observed it) a firm buff was formed on its surface; and all three died of the disease.
“The calomel was often continued through the whole course of the fever; and ptyalism was usually brought on within three or four days: though sometimes upwards of 200 grains were given, at the rate of a grain every hour, without any specific effect on the salivary glands. In proportion as the soreness of the mouth advanced, the symptoms universally gave way; and in every patient, two only excepted, this effect of the remedy was a sure pledge of recovery. In this exception were comprehended two persons of the same family, a father and daughter, both of whom had survived the 14th day of the disease, had copious hæmorrhages from the mouth (a circumstance which also attended on many who recovered) and died in a state of apparent putrefaction.
“The purgative medicines were generally repeated every second day; or an enema of water gruel was administered occasionally, if the bowels were constipated; but if otherwise, and the calomel passed off by those emunctories, opium was combined with it in sufficient quantities to restrain the discharge. The evacuations which took place from the intestines, during the use of the mercury, were almost universally of a remarkably dark colour, generally approaching to a deep green, but by no means remarkably fœtid. When spontaneous, they were often observed to be of the colour and consistence of water gruel.
“In cases of very laborious respiration, which was frequently in an extreme degree distressing, especially after the first 36 or 48 hours had elapsed, blisters, applied either to the chest or extremities, had a favourable effect; on the latter, they were most useful in theadvanced stages of the disease, by exciting to action the debilitated vessels, and by restoring circulation and warmth to the parts. In the same intention, wine, snake-root, and the bark, were sometimes used with advantage.
“The diet was generally of the lightest and most cooling nature; barley-water, apple-water, and spruce-beer, were generally both grateful and salutary. The warm bath was often exhibited with apparent success, especially in the beginning of the disease, and when a copious sweat had been induced by it. The cold bath was also resorted to by some respectable practitioners, and perhaps, under some circumstances, with good effects; but I have no reason to think it was generally advantageous.
“Upon the whole, I believe that the most efficacious remedy, and the only one to be relied on, is mercury. It is certain that, as far as my observation has extended, under no other method of treatment did so many recover; and there were but few instances of a fatal termination, when it had been administered from the commencement of the fever.
“Various have been the causes assigned to this disease. That its origin was domestic, I have not a single doubt. No instance of the arrival of any vessel from the warmer latitudes, with this sickness on board, has been discovered; and it is believed that the local causes are sufficiently numerous to account for its existence. At most of the places, where its ravages have been made, very large quantities of putrid substances had been for some time accumulating. The offals from the fish market, as well as damaged fresh and salted fish to an immense amount, had been thrown into the dock. A very great number of raw hides had been imported, and stored in places contiguous to those in which business was constantly going on. The influence of a continued heat through the summer, to a degree scarcely before known in this country, had rendered these articles highly putrid; and from the same cause several articles of provision, such as barrelled beef, &c.which had been prepared for exportation, but, by reason of the restraints laid on our commerce, retained in store, had become tainted. The effects of these were in some instances incontestibly evinced; three lads, who had been employed in repacking beef, were at about the same time seized with the disease in its most fatal form; and a person, who had purchased some of the hides at a low price, immediately after their removal fell a sacrifice to his folly.
“Two or three thousand of the inhabitants removed into the country, and began to return about the middle of October, when the decline of the disease justified the measure.”192