SECTION IV.
Remarkable Cases.
SOmany cases have been enumerated in the course of this work, that little more remains to be done in that way. The following are given, not merely on account of their singularity, or to give instances of surprising and unexpected recovery, but to elucidate some points of doctrine hinted at before, and not sufficiently explained.
1.Spontaneous burning.In the former part of this treatise several extraordinary instances of this kind are given; but a doubt was suggested whether the fire wasproducedinternally, orexternally. The following account, from the Medical Extracts, determines the matter. The circumstance took place in England, in the year 1613. One Hitchill, a carpenter, came home from his work as usual, without being sensible of any indisposition, and went to bed. In the night time, or early in the morning, his wife awaked and found him dead by her side. His body was so hot that it could not be touched, and he continued burning internally forthree days. No flame appeared on the outside, only an hot steam issued from his body; and we are not told what was the ultimate effect of the fire, or whether his body was consumed to ashes or not. In the same work we are told of a woman who was found dead in her room in the morning, and consumed to ashes, her very bones being calcined to whiteness. The floor on which she lay was very little burned. This last case, however, is not so directly in point as the former, which seems decisive with regard to the internal origin of the fire.
2.M. D’Obsonville’s case of the plague.In the former part of this treatise it has been said that heat destroyed the plague; but, on the authority of the Russian physicians, that the disease could not be treated in hot rooms. The following case, however, shows that even exposure to a burning sun in a desert, to the cold air of night, and to the most injurious usage, cannot always render fatal an attack even of the most dreadful distemper in the world. M. D’Obsonville had undertaken a journey over land to the East Indies, in order to execute an important commission from the French government, in 1761, the very time when the plague raged violently in the east. He describes his case in the following words: “I felt the first symptoms of the plague two small days journey from Aleppo, when I had entered the desert; and at night, when going to rest, complained of a general uneasiness and heaviness of the head. In the morning the fever was known to be inflammatory; and from that time I had no longer any sleep. The third, the fever and head-ach became more violent, two buboes began to rise on my left side, my tongue was swelled, and of a brown violet colour. The fourth and fifth days, sores began to appear on my loins, the spine of my back, and the scrotum; some of which were as large as the palm of my hand, and their colour at first was a red purple. I was obliged, however, to rise, like other passengers, at two in the morning, and travel on horseback till eleven. Unable to swallow any thing but a little water, abandoned by my Christian servant, who durst not come near me, and attended by an Arab, that I could not understand, the violence even of my illness, and a little fortitude, had hitherto contributed to support me; but my weakness increased hourly, and I could no longer sit my horse, when an Armenian lady, namedTcheremani, determined to ride him herself, and with the utmost humanity gave up her camel to me, on which was a kind of litter. On the sixth day the symptoms all appeared aggravated; at one moment my pulse beat with an astonishing quickness, and fire seemed to runthrough my veins; and the next, my blood was intercepted in its course, a moisture covered my forehead, and I felt myself fainting, though without being delirious, or losing my senses.”
The caravan having arrived at a small ruined village namedSoccun, in the desert, it was resolved to leave M. D’Obsonville to his fate, his case being considered as desperate; and indeed he says he was left alone at his own request. A small horde of Arabs resided in that village, though ruined, and our patient was consigned to the care of a religious person called amoullah. This gentleman, like too many others, did not choose toserve God for nought, and therefore demanded fifty piastres in silver, besides some effects, in recompense for the charity which he was about to extend to the unhappy traveller. Having received those, and the caravan being gone, the moullah and his wife in the night time laid M. D’Obsonville across an ass, and carried him about a mile into the desert, where they left him to shift for himself. Happily, however, either through accident or design, these religious devils had deposited their prey near some water, which undoubtedly, as he still retained his senses, was the means of preserving his life. “It was there (says he) that, extended upon the earth, with no other succour than a little water, nature laboured to expel the poison by which I was oppressed. One of the buboes burst of itself; the pestilential sores, which appeared first of a red purple, became yellowish, then brown, and lastly black. These parts then becoming gangrenous, formed hard and thick scabs, which, kernelling and falling away from the quick flesh, left very deep ulcers. This was the first epocha of health; an abundant suppuration began, and the fever almost immediately left me.”
Having remained alone in the desert for eight or ten days, he was found by chance by some Arabian women, who brought him to their place of residence, washed his sores with water, brought him dried herbs for his bed, and gave him barley bread, butter and curds for his food; endeavouring besides by their songs to comforthim, and alleviate his distress as much as possible. With these women he remained twenty days, reduced to an extremity of weakness by reason of the discharge from the sores. At last, having learnt a few Arabic words, he prevailed upon two of the husbands to conduct him to Aleppo, about seven days journey distant. He was now mounted astride on a camel (a very hard trotting animal) and by forced marches accomplished the journey in six days, when he appeared before the consul, the European merchants, and a crowd of people, in a condition without example; almost naked, with five running buboes, the little covering he had foul, infected with ulcers as long as the palm of the hand, which had eaten away the flesh, and in some places discovered the bones, having besides two holes in the scrotum. From this miserable condition he recovered in a month. It would seem that in some cases the human body, as well as mind, rises superior to every indignity; and that in proportion to the degree of injury and oppression is the tenacity of life, as well as energy of spirit.
3.Remarkable cure of the plague by exposure to cold and wet.M. Savary relates that the captain of a vessel informed him that, having touched at Constantinople when the plague was raging there, some of his sailors caught the distemper; two died suddenly, and by assisting them he was infected. “I felt excessive heat (says he) which made my blood boil; the disease seized my head, and I perceived that I had only a few moments to live. The little remaining reason I had taught me to attempt an experiment. I laid myself, quite naked, all night on the deck; the heavy dews that fell penetrated to my very bones; in a few hours I could breathe freer, and my head was better; my agitated blood became calm, and, bathing the morning after in the sea, I was perfectly cured.”
4.Extraordinary effect ofFEARin rendering the contagion of theSMALL POXeffectual.209“A very beautiful girl, twenty-five years of age, servant to captain Morton, had never had the small pox, and had themost dreadful apprehensions of that disease. On the twentieth of January, 1791, about four in the afternoon, she was standing near the kitchen fire, when a joiner in the neighbourhood came to the door, which is about sixteen feet from the fire place where the girl stood. Mrs. Morton found fault with the man for not coming sooner to finish some work, and he excused himself by saying his apprentice was ill of the small pox, which had delayed him. The girl immediately clasped her hands, and exclaimed, God forgive you, but I will lay my death to you. From that moment she became chilly, then hot and restless. She passed a very bad night, frequently exclaiming, God forgive Calder, he has killed me; meaning he had given her the small pox. In the morning of the twenty-first I was sent for, and found her very hot, with a quick pulse, great sickness and anxiety. I ordered her an emetic, and assured her she did not need to be in the least alarmed, as she could not possibly have caught the disease. She seemed to be convinced that her fears were groundless; but next day, the twenty-second, a violent rash appeared; on the twenty-third the small pox came out, of the worst kind I had ever seen, and she died on the ninth day from the eruption.”
5.Inefficacy ofFEARto render the contagion ofYELLOW FEVEReffectual. Dr. Rush mentions a young woman so exceedingly fearful of the disease, that she was troublesome to all around her. Afterwards she happened to be under the necessity of attendingsevenpersons ill of the fever, and yet escaped unhurt. This shows that fear (and the same may be said of any predisposing cause) is not always sufficient to produce the disease. The foregoing case is so extraordinary that Dr. Haygarth is of opinion that the patient must have been previously infected; but of this there is no evidence; and it is bad reasoning to endeavour to establish a fact by our own ignorance. The only argument that is or can be used in such cases is, “I cannot understand how such a thing could have happened,thereforeithas notbeen so.”6.Boullam fever cured by a blister.210The patient was a tradesman in St. George’s, Grenada, and had “all the symptoms of the disease except the febrile heat. A blister was applied between the shoulders, without administering any medicine previously except the solution (mentioned p.530) which operated very moderately. The effect was wonderful; the discharge was uncommonly large, black, and fœtid in an intolerable degree; and the instant this took place the patient became better; and soon after, without the use of any other remedy, recovered.”
7.Yellow fever of Barbadoes cured by vomiting.211The patient was a young man, about twenty-four years of age, surgeon to a Guinea ship. Being a lover of spiritous liquors, he had been drunk three days and nights successively, and in that condition had run races with the sailors on the shore, in the heat of the mid day sun. The last night he slept in the open air under a tamarind tree, and in the morning was seized with the fever, attended with the most violent retching to vomit, insomuch that he could scarcely answer yes or no to the questions asked him by the Doctor. Sixteen ounces of blood were taken away, which was very florid, thin and dissolved. He was directed then to drink warm water to cleanse his stomach, which he did to the amount of three gallons, which he discharged, together with immense quantities of yellow and blackish bilious matter. He then took a grain and an half of opium, and slept some hours, after which a dose of manna and tamarinds carried off by stool a good deal more of bilious matter, and, with the help of some elixir of vitriol, mint and snakeroot tea, he recovered in a short time.
Dr. Rush, in a letter published in the newspapers last year, after regretting the inefficacy of bleeding and purging, suspects “that death occurred from the stagnation of acrid bile in the gall-bladder, or its adherence to the upper bowels, as mentioned by Dr. Mitchell in 1741,” which he proposes to evacuate by strongemetics and purgatives, so as to occasion an artificial cholera morbus; and he greatly commends this mode of practice. “Vomits (says he) are old remedies in the yellow fever of the West Indies. I gave them on the first day of the disease in the year 1793, and always without success. They uniformly did harm when given in the beginning of the fever in its worst grade, in 1797. The reason of this failure in their efficacy I now perceive was because they were givenbeforethe violent morbid action in the system was reduced or moderated by bleeding and purging. After this change is introduced in the disease they are perfectly safe. The time for exhibiting them should be regulated by the pulse and other symptoms. In moderate cases of the fever they are as proper in its first stage as on the 4th day. As there is a blistering point in all fevers, so there appears to be anemetic pointin the yellow fever. It may occur on the second, and it may be protracted to the sixth or seventh day of the disease. I have not given the medicine I have mentioned in any case where the patient complained of pain or burning in the stomach; but I have considered a nausea, and a moderate degree of puking, as no obstacle to its use; for Dr. Physic has taught me by his dissections that these symptoms may exist without the least inflammation in the stomach, and that they have been absent where the stomach has appeared after death to have been highly inflamed.
“The cure of the fever should not rest upon a single dose of the medicine. I have given two doses of it in a day in several cases, and have given it in one case every day for three successive days.
“It has often been remarked, that no two epidemics are exactly alike. They vary not only in different climates, but in the same climate in different years. They even vary with the changes of the weather in the same season. The fever of 1797 differed in several particulars from the fever of 1793; and the present epidemic differs materially from both. In many of the cases I have seen it exceeds the fever of last year inits malignity. These variations in diseases call for corresponding changes in our practice.”
8.Extraordinary case of yellow fever at Boston in 1798.“The subject ofit212was a female of about 24 years of age, in the 9th month of pregnancy. I saw her on Monday the 17th of September. She had then a small but painful hardness on the left parotid gland, which had commenced some days before, and soon extended to the lips and neighbouring parts. The centre of the tumour resembled that of the incision of an arm about the time of the eruption of the small pox after inoculation, exhibiting a hard, florid, shining appearance. I recommended an emollient poultice, hoping to procure suppuration; but, though they were repeated steadily, not the least evidence of matter could be produced; and upon each visit I found the tumour had extended in a rapid and formidable degree. I was called up in the course of the night to her, and found her almost suffocated from the pressure of the tumour on the trachea; for it had now extended itself to all the muscles and glands of the neck and face. I changed the poultice for an embrocation of the saturnine preparations, which were repeated till about 10 o’clock of the following morning, when she was taken in travail, and soon delivered of a healthy male child. For a few hours after her delivery she appeared something better, but in the night she grew worse, and about 12 o’clock I was called to her, when she appeared to be expiring. At the request of her friends I entered my lancet into the tumour the length of the instrument; but, as I had expected, not the least particle of matter flowed, and the parts wereas hard as a schirrus. She continued however in agony till 3 o’clock of the day, and then expired.”
9.Two cases of spontaneous origin of yellow fever: from the Medical Repository, vol.ii,p.333. “At Salem (Massachusetts) there was a general prevalence ofhealth at that season; though several cases of yellow fever, and some of them fatal ones, occurred. Dr. Oliver very judiciously inclines to the belief that the exemption of this town from the ravages of yellow fever is owing, 1st, to the remarkably clean state of the town; and, 2dly, to the houses being placed at such distances as to admit of free ventilation. It was observable that the yellow fever had aspontaneousorigin in two different places of the town, where putrid matters had been suffered to accumulate, and proved fatal to two persons in different families; these unclean spots forming exceptions to the generally purified state of the town.”
10.Case of fever produced by the effluvia of putrid beef.This took place in the federal garrison on Governor’s Island.213The subject was a soldier, who had been excused from duty on account of a violent and obstinate gonorrhœa. On removing him into a lodging without the garrison he was seized with symptoms of fever, and on the commencement of these the gonorrhœa ceased. For four days the fever increased, and was attended at last with vomiting, hiccup and delirium. From the first commencement of the disease the physician had been sensible of a very offensive smell in the patient’s room. Being assured that this was not owing to want of cleanliness, he caused search to be made under it, and in the cellars found three barrels of beef so putrid that it was with difficulty they could be removed, on account of the stench. On removing them, however, the patient rapidly recovered, though till then he had constantly grown worse.
END OF THE SECOND PART.