AN ACCOUNTOF THEBILIOUS REMITTING AND INTERMITTINGYellow Fever,AS ITAPPEARED IN PHILADELPHIA,IN THE YEAR 1794.

———Here all language fails:———Come then, expressive silence, muse his praise.

Footnotes:[14]Outlines of a Theory of Fever.[15]Treatise on the Fevers of Jamaica, p. 298.[16]Outlines of a Theory of Fever.[17]Vergasca, Sorbait, and Boate in Haller's Bibliotheca Medicinæ, vol. iii. also by Dr. Stubbs in the Philosophical Transactions, and Riverius in his treatise de febre pestilenti.[18]Historia Anatomica Medica, vol ii. obs. 405, 418, 423, 510.[19]Medical Histories and Reflections, p. 150.[20]Vol. i. p.167.[21]Treatise on the Intestinal Remitting Fever, p. 125.[22]Outlines of a theory of fever.[23]Essay on the Epidemic Disease of Lying-in Women, of the years 1787 and 1788, p. 34.[24]Wallis's edition, vol. i. p. 197.[25]Rosier's Journal for January, 1790, vol. xxxvi. p. 380.[26]Essay on the Bilious or Yellow Fever, p. 35.[27]Outlines of a Theory of Fever.[28]See Wallis's edition of Sydenham, vol. i. p. 165. vol. ii. p. 52, 94, 98, 350; De Haen's Ratio Medendi, vol. ii. p. 162. vol. iv. p. 172; Gaubii Pathologia, sect. 498; and Dr. Seybert's inaugural dissertation, entitled “An Attempt to Disprove the Doctrine of Putrefaction of the Blood in Living Animals,” published in Philadelphia in 1793.[29]Wallis's edition, vol. i. p. 344.[30]De Febre Pestilenti, vol. xi. p. 93.[31]Diseases of Minorca, p. 185.[32]Dr. Hodge's Account of the Plague in London, p. 26.[33]Sed hoc observatu dignum fuit, omnes alios morbos acutos, durante peste siluisse, et omnes morbos acutos e pestis genere suisse. Nosologia Methodica, vol. i. p. 416.[34]Vol. i. p.340.[35]Vol. i. p.353.[36]Vol. ii. p.164. See also p.1,109,122,204,212,233,274,355,358–9, and436.[37]De Aere et Morb. Epidem. p. 33, 34.[38]Page285.[39]De Febre Pestilenti, vol. ii. p. 95.[40]Vol.i.[41]Page28.[42]Page132.[43]Observations on the Diseases in Long Voyages to the East-Indies, vol. i. p. 13, 14, 48, 151. vol. ii. p. 99, 318, and 320.[44]Lib. ii. cap. v.[45]Hunter on the Venereal Disease, introduction, p. 3.[46]Essays and Observations, Physical and Literary, vol. xi. page 409.[47]Diseases of Warm Climates, p. 169.[48]“Pulsus sanorum pulsibus similes admodum, periculosi.”—De Febre Pestilenti, p. 114.[49]“Sine aura, usque annus fuit.”—Epid. 3.[50]Letter from Sir John Bernard to Dr. Floyer, p. 233.[51]Vol. i. p.5.[52]Diseases of the Army, p. 5. of the 7th London edition.[53]Experiments on Animal Electricity, p. 90.[54]Diseases of Warm Climates, p. 125.[55]In the Life of Thomas Story, a celebrated preacher among the friends, there is an account of the distress of the city, in its infant state, from the prevalence of the yellow fever, in the autumn of 1699, nearly like that which has been described. I shall insert the account in his own words. “Great was the fear that fell on all flesh. I saw no lofty or airy countenance, nor heard any vain jesting to move men to laughter. Every face gathered paleness, and many hearts were humbled, and countenances fallen and sunk, as such that waited every moment to be summoned to the bar, and numbered to the grave.” The same author adds, that six, seven, and sometimes eight, died of this fever in a day, for several weeks. His fellow-traveller, and companion in the ministry, Roger Gill, discovered upon this occasion an extraordinary degree of christian philanthropy. He publicly offered himself, in one of the meetings of the society, as a sacrifice for the people, and prayed that “God would please to accept of his life for them, that a stop might be put to the contagion.” He died of the fever a few days afterwards.[56]In the above accounts there is a deficiency of returns from several grave-yards of 163.[57]From a short note in the register of the interments in the friends' burying-ground, it appears that the fever this year made its first appearance in the month of June. The following is a copy of that note: “12th of the 6th month (O. S.), 1741, a malignant yellow fever now spreads much.” Besides that note, there is the following: “25th of the 7th month (O. S.), 1741, many who died of the above distemper were persons lively, and strong, and in the prime of their time.”[58]Vol.i.[59]P.5,56,180, and323.[60]Introduction to a Treatise on the Venereal Disease, p. 3. of the American edition.[61]Page273.[62]Lind on the Diseases of Hot Climates, p. 36 and 124.[63]Cleghorn, p. 176.[64]Diseases of Hot Climates, p. 123.[65]Page223.[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 anearlydischarge ofblackmatter 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.[67]Treatise on the Inflammatory Rheumatism, vol. i. p. 407.[68]Dr. Redman was not the only instance furnished by the disease, in whichreasongot 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,sixgrains 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 patientsalmostto death, at least tofainting; 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.[69]Diseases of Barbadoes, p. 212.[70]Diseases in Voyages to Hot Climates, vol. ii. p. 322.[71]Vol.i.[72]Vol. ii. p.342.[73]Vol. i. p.9.[74]Diseases of Barbadoes, p. 16, 43, 46, 48, 52, 122.[75]Page147.[76]Vol. ii. p.351.[77]Ratio Medendi, vol. ii. p. 162. vol. iv. p. 172.[78]Vol. i. p.210, and264.[79]Page114.[80]Skenkius, lib. vi. p. 881.[81]Essay on the Bilious or Yellow Fever of Jamaica, p. 40.[82]De Febre Pestilenti, vol. ii. p. 145, 146, and 147.[83]Page209.[84]Bruce's Travels.[85]Page185.[86]Bibliotheca Medicinæ Practicæ, vol. iii. p. 491.[87]Diseases of Long Voyages to Hot Climates, vol. ii. p. 334.[88]Medical Commentaries, vol. xviii. p. 209, 288.[89]Bibliotheca Medicinæ Practicæ, vol. ii. p. 93. and 387.[90]Vol. i. p.440.[91]Omnes qui vini potione non abstinuerunt, interiere, adeo ut summa spes salvationis in vini abstinentia collocata videreter. Lib. vi. p. 847.[92]Fevers of Jamaica.[93]Vol. ii. p.254.[94]Vol, ii. p.354.[95]It appears from one of Mr. Norris's letters, dated the 9th of November, O. S. that there died 220 persons, in the year 1699, with the yellow fever. Between 80 and 90 of them, he says, belonged to the society of friends. The city, at this time, probably, did not contain more than 2 or 3000 people, many of whom, it is probable, fled from the disease.[96]In the letter before quoted, from Mr. Connelly, he expresses his opinion of those four medicines in the following words: “Laudanum, bark, and wine have put a period to the existence of some, where the fever has been apparently broken, and the patients in a fair way of recovery; a single dose of laudanum has hurried them suddenly into eternity. I have visited a few patients where the hot bath was used, and am convinced that it only tended to weaken and relax the system, without producing any good effect.”[97]The yellow fever prevailed at the Caraccos, in South-America, in October, 1793, with great mortality, more especially among the Spanish troops. Nearly all died who were attended by physicians. Recourse was finally had to the old women, who were successful in almost every case to which they were called. Their remedies were a liquor callednarencado(a species of lemonade) and a tea made of a root calledfistula. With these drinks they drenched their patients for the first two or three days. They induced plentiful sweats, and, probably, after blunting, discharged the bile from the bowels. I received this information from an American gentleman, who had been cured, by one of those Amazons in medicine, in the above way.[98]Vol.ii.[99]Medical Memoirs, vol. i.[100]Vol.i.[101]This accomplished youth had made great attainments in his profession. He possessed, with an uncommon genius for science, talents for music, painting, and poetry. The following copy of an unfinished letter to his father (who had left the city) was found among his papers after his death. It shows that the qualities of his heart were equal to those of his head.“Philadelphia, September 15, 1793.“MY DEAR FATHER,“I take every moment I have to spare to write to you, which is not many; but you must excuse me, as I am doing good to my fellow-creatures. At this time, every moment I spend in idleness might probably cost a life. The sickness increases every day, but most of those who die, die for want of good attendance. We cure all we are called to on the first day, who are well attended, but so many doctors are sick, the poor creatures are glad to get a doctor's servant.”[102]Before he finished his studies in medicine, he published a volume of ingenious and patriotic “Chemical and Economical Essays, designed to illustrate the connection between the theory and practice of chemistry, and the application of that science to some of the arts and manufactures of the United States of America.”

Footnotes:

[14]Outlines of a Theory of Fever.

[15]Treatise on the Fevers of Jamaica, p. 298.

[16]Outlines of a Theory of Fever.

[17]Vergasca, Sorbait, and Boate in Haller's Bibliotheca Medicinæ, vol. iii. also by Dr. Stubbs in the Philosophical Transactions, and Riverius in his treatise de febre pestilenti.

[18]Historia Anatomica Medica, vol ii. obs. 405, 418, 423, 510.

[19]Medical Histories and Reflections, p. 150.

[20]Vol. i. p.167.

[21]Treatise on the Intestinal Remitting Fever, p. 125.

[22]Outlines of a theory of fever.

[23]Essay on the Epidemic Disease of Lying-in Women, of the years 1787 and 1788, p. 34.

[24]Wallis's edition, vol. i. p. 197.

[25]Rosier's Journal for January, 1790, vol. xxxvi. p. 380.

[26]Essay on the Bilious or Yellow Fever, p. 35.

[27]Outlines of a Theory of Fever.

[28]See Wallis's edition of Sydenham, vol. i. p. 165. vol. ii. p. 52, 94, 98, 350; De Haen's Ratio Medendi, vol. ii. p. 162. vol. iv. p. 172; Gaubii Pathologia, sect. 498; and Dr. Seybert's inaugural dissertation, entitled “An Attempt to Disprove the Doctrine of Putrefaction of the Blood in Living Animals,” published in Philadelphia in 1793.

[29]Wallis's edition, vol. i. p. 344.

[30]De Febre Pestilenti, vol. xi. p. 93.

[31]Diseases of Minorca, p. 185.

[32]Dr. Hodge's Account of the Plague in London, p. 26.

[33]Sed hoc observatu dignum fuit, omnes alios morbos acutos, durante peste siluisse, et omnes morbos acutos e pestis genere suisse. Nosologia Methodica, vol. i. p. 416.

[34]Vol. i. p.340.

[35]Vol. i. p.353.

[36]Vol. ii. p.164. See also p.1,109,122,204,212,233,274,355,358–9, and436.

[37]De Aere et Morb. Epidem. p. 33, 34.

[38]Page285.

[39]De Febre Pestilenti, vol. ii. p. 95.

[40]Vol.i.

[41]Page28.

[42]Page132.

[43]Observations on the Diseases in Long Voyages to the East-Indies, vol. i. p. 13, 14, 48, 151. vol. ii. p. 99, 318, and 320.

[44]Lib. ii. cap. v.

[45]Hunter on the Venereal Disease, introduction, p. 3.

[46]Essays and Observations, Physical and Literary, vol. xi. page 409.

[47]Diseases of Warm Climates, p. 169.

[48]“Pulsus sanorum pulsibus similes admodum, periculosi.”—De Febre Pestilenti, p. 114.

[49]“Sine aura, usque annus fuit.”—Epid. 3.

[50]Letter from Sir John Bernard to Dr. Floyer, p. 233.

[51]Vol. i. p.5.

[52]Diseases of the Army, p. 5. of the 7th London edition.

[53]Experiments on Animal Electricity, p. 90.

[54]Diseases of Warm Climates, p. 125.

[55]In the Life of Thomas Story, a celebrated preacher among the friends, there is an account of the distress of the city, in its infant state, from the prevalence of the yellow fever, in the autumn of 1699, nearly like that which has been described. I shall insert the account in his own words. “Great was the fear that fell on all flesh. I saw no lofty or airy countenance, nor heard any vain jesting to move men to laughter. Every face gathered paleness, and many hearts were humbled, and countenances fallen and sunk, as such that waited every moment to be summoned to the bar, and numbered to the grave.” The same author adds, that six, seven, and sometimes eight, died of this fever in a day, for several weeks. His fellow-traveller, and companion in the ministry, Roger Gill, discovered upon this occasion an extraordinary degree of christian philanthropy. He publicly offered himself, in one of the meetings of the society, as a sacrifice for the people, and prayed that “God would please to accept of his life for them, that a stop might be put to the contagion.” He died of the fever a few days afterwards.

[56]In the above accounts there is a deficiency of returns from several grave-yards of 163.

[57]From a short note in the register of the interments in the friends' burying-ground, it appears that the fever this year made its first appearance in the month of June. The following is a copy of that note: “12th of the 6th month (O. S.), 1741, a malignant yellow fever now spreads much.” Besides that note, there is the following: “25th of the 7th month (O. S.), 1741, many who died of the above distemper were persons lively, and strong, and in the prime of their time.”

[58]Vol.i.

[59]P.5,56,180, and323.

[60]Introduction to a Treatise on the Venereal Disease, p. 3. of the American edition.

[61]Page273.

[62]Lind on the Diseases of Hot Climates, p. 36 and 124.

[63]Cleghorn, p. 176.

[64]Diseases of Hot Climates, p. 123.

[65]Page223.

[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 anearlydischarge ofblackmatter 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.

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

[68]Dr. Redman was not the only instance furnished by the disease, in whichreasongot 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,sixgrains 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 patientsalmostto death, at least tofainting; 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.

[69]Diseases of Barbadoes, p. 212.

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

[71]Vol.i.

[72]Vol. ii. p.342.

[73]Vol. i. p.9.

[74]Diseases of Barbadoes, p. 16, 43, 46, 48, 52, 122.

[75]Page147.

[76]Vol. ii. p.351.

[77]Ratio Medendi, vol. ii. p. 162. vol. iv. p. 172.

[78]Vol. i. p.210, and264.

[79]Page114.

[80]Skenkius, lib. vi. p. 881.

[81]Essay on the Bilious or Yellow Fever of Jamaica, p. 40.

[82]De Febre Pestilenti, vol. ii. p. 145, 146, and 147.

[83]Page209.

[84]Bruce's Travels.

[85]Page185.

[86]Bibliotheca Medicinæ Practicæ, vol. iii. p. 491.

[87]Diseases of Long Voyages to Hot Climates, vol. ii. p. 334.

[88]Medical Commentaries, vol. xviii. p. 209, 288.

[89]Bibliotheca Medicinæ Practicæ, vol. ii. p. 93. and 387.

[90]Vol. i. p.440.

[91]Omnes qui vini potione non abstinuerunt, interiere, adeo ut summa spes salvationis in vini abstinentia collocata videreter. Lib. vi. p. 847.

[92]Fevers of Jamaica.

[93]Vol. ii. p.254.

[94]Vol, ii. p.354.

[95]It appears from one of Mr. Norris's letters, dated the 9th of November, O. S. that there died 220 persons, in the year 1699, with the yellow fever. Between 80 and 90 of them, he says, belonged to the society of friends. The city, at this time, probably, did not contain more than 2 or 3000 people, many of whom, it is probable, fled from the disease.

[96]In the letter before quoted, from Mr. Connelly, he expresses his opinion of those four medicines in the following words: “Laudanum, bark, and wine have put a period to the existence of some, where the fever has been apparently broken, and the patients in a fair way of recovery; a single dose of laudanum has hurried them suddenly into eternity. I have visited a few patients where the hot bath was used, and am convinced that it only tended to weaken and relax the system, without producing any good effect.”

[97]The yellow fever prevailed at the Caraccos, in South-America, in October, 1793, with great mortality, more especially among the Spanish troops. Nearly all died who were attended by physicians. Recourse was finally had to the old women, who were successful in almost every case to which they were called. Their remedies were a liquor callednarencado(a species of lemonade) and a tea made of a root calledfistula. With these drinks they drenched their patients for the first two or three days. They induced plentiful sweats, and, probably, after blunting, discharged the bile from the bowels. I received this information from an American gentleman, who had been cured, by one of those Amazons in medicine, in the above way.

[98]Vol.ii.

[99]Medical Memoirs, vol. i.

[100]Vol.i.

[101]This accomplished youth had made great attainments in his profession. He possessed, with an uncommon genius for science, talents for music, painting, and poetry. The following copy of an unfinished letter to his father (who had left the city) was found among his papers after his death. It shows that the qualities of his heart were equal to those of his head.“Philadelphia, September 15, 1793.“MY DEAR FATHER,“I take every moment I have to spare to write to you, which is not many; but you must excuse me, as I am doing good to my fellow-creatures. At this time, every moment I spend in idleness might probably cost a life. The sickness increases every day, but most of those who die, die for want of good attendance. We cure all we are called to on the first day, who are well attended, but so many doctors are sick, the poor creatures are glad to get a doctor's servant.”

“Philadelphia, September 15, 1793.

“MY DEAR FATHER,

“I take every moment I have to spare to write to you, which is not many; but you must excuse me, as I am doing good to my fellow-creatures. At this time, every moment I spend in idleness might probably cost a life. The sickness increases every day, but most of those who die, die for want of good attendance. We cure all we are called to on the first day, who are well attended, but so many doctors are sick, the poor creatures are glad to get a doctor's servant.”

[102]Before he finished his studies in medicine, he published a volume of ingenious and patriotic “Chemical and Economical Essays, designed to illustrate the connection between the theory and practice of chemistry, and the application of that science to some of the arts and manufactures of the United States of America.”

I concluded the history of the symptoms of the bilious remitting yellow fever, as it appeared in Philadelphia in the year 1793, by taking notice, that the diseases which succeeded that fatal epidemic were all of a highly inflammatory nature.

In that history I described the weather and diseases of the months of March and April, in the spring of 1794.

The weather, during the first three weeks of the month of May, was dry and temperate, with now and then a cold day and night. The strawberries were ripe on the 15th, and cherries on the 22d day of the month, in several of the city gardens. Ashower of hail fell on the afternoon of the 22d, which broke the glass windows of many houses. A single stone of this hail was found to weigh two drachms. Several people collected a quantity of it, and preserved it till the next day in their cellars, when they used it for the purpose of cooling their wine. The weather, after this hail storm, was rainy during the remaining part of the month. The diseases were still inflammatory. Many persons were afflicted with a sore mouth in this month.

The weather in June was pleasant and temperate. Several intermittents, and two very acute pleurisies, occurred in my practice during this month. The intermittents were uncommonly obstinate, and would not yield to the largest doses of the bark.

In a son of Mr. Samuel Coates, of seven years old, the bark produced a sudden translation of this state of fever to the head, where it produced all the symptoms of the first stage of internal dropsy of the brain. This once formidable disease yielded, in this case, to three bleedings, and other depleting medicines. The blood drawn in every instance was sizy.

From the inflammatory complexion of the diseases of the spring, and of the beginning of June,I expected the fevers of the summer and autumn would be of a violent and malignant nature. I was the more disposed to entertain this opinion from observing the stagnating filth of the gutters of our city; for the citizens of Philadelphia, having an interest in rejecting the proofs of the generation of the epidemic of 1793 in their city, had neglected to introduce the regulations which were necessary to prevent the production of a similar fever from domestic putrefaction. They had, it is true, taken pains to remove the earth and offal matters which accumulated in the streets; but these, from their being always dry, were inoffensive as remote causes of disease. Perhaps the removal of the earth did harm, by preventing the absorption of the miasmata which were constantly exhaled from the gutters.

On the 6th of June, Dr. Physick called upon me, and informed me that he had a woman in the yellow fever under his care. The information did not surprise me, but it awakened suddenly in my mind the most distressing emotions. I advised him to inform the mayor of the city of the case, but by no means to make it more public, for I hoped that it might be a sporadic instance of the disease, and that it might not become general in the city.

On the 12th of the month, my fears of the return of the yellow fever were revived by visiting Mr. Isaac Morris, whom I found very ill with a violent puking, great pain in his head, a red eye, and a slow tense pulse. I ordered him to be bled, and purged him plentifully with jalap and calomel. His blood had that appearance which has been compared by authors to the washings of raw flesh in water. Upon his recovery, he told me that he “suspected he had had the yellow fever, for that his feelings were exactly such as they had been in the fall of 1793, at which time he had an attack of that disease.”

On the 14th of June, I was sent for, in the absence of Dr. Mease, to visit his sister in a fever. Her mother, who had become intimately acquainted with the yellow fever, by nursing her son and mother in it, the year before, at once decided upon the name of her daughter's disease. Her symptoms were violent, but they appeared in an intermitting form. Each paroxysm of her fever was like a hurricane to her whole system. It excited apprehensions of immediate dissolution in the minds of all her friends. The loss of sixty ounces of blood, by five bleedings, copious doses of calomel and jalap, and a large blister to her neck, soonvanquished this malignant intermittent, without the aid of a single dose of bark.

During the remaining part of the month, I was called to several cases of fever, which had symptoms of malignity of an alarming nature. The son of Mr. Andrew Brown had a hæmorrhage from his nose in a fever, and a case of menorrhagia occurred in a woman, who was affected with but a slight degree of fever.

In the course of this month, I met with several cases of swelled testicles, which had succeeded fevers so slight as to have required no medical aid. Dr. Desportes records similar instances of a swelling in the testicles, which appeared during the prevalence of the yellow fever in St. Domingo, in the year 1741[103].

In the month of July, I visited James Lefferty and William Adams, both of whom had, with the usual symptoms of yellow fever, a yellow colour on their skin. I likewise attended three women, in whom I discovered the disease under forms in which I had often seen it in the year 1793. In two of them it appeared with symptoms of a violentcolic, which yielded only to frequent bleedings. In the third, it appeared with symptoms of pleurisy, which was attended with a constant hæmorrhage from the uterus, although blood was drawn almost daily from her arm, for six or seven days. About the middle of this month many people complained of nausea, which in some cases produced a puking, without any symptoms of fever.

During the month of August, I was called to Peter Denham, Mrs. Bruce, a son of Jacob Gribble, Mr. Cole, John Madge, Mrs. Gardiner, Miss Purdon, Mrs. Gavin, and Benjamin Cochran, each of whom had all the usual symptoms of the yellow fever. I found Mr. Cochran sitting on the side of his bed, with a pot in his hand, into which he was discharging black matter from his stomach, on the 6th day of the disease. He died on the next day. Mrs. Gavin died on the 6th day of her disease, from a want of sufficient bleeding, to which she objected from the influence of her friends. Besides the above persons, I visited Mr. George Eyre at Kensington, Mr. Thomas Fitzsimons, and Thomas M'Kean, jun. son of the chief justice of Pennsylvania, all of whom had the disease, but in a moderate degree. During this time I took no steps to alarm my fellow-citizens with the unwelcome news of its being in town. But my mind wasnot easy in this situation, for I daily heard of persons who died of the disease, who might probably have been saved had they applied early for relief, or had a suspicion become general among all our physicians of the existence of the yellow fever in the city. The cholera infantum was common during this, and part of the preceding month. It was more obstinate and more fatal than in common years.

On the 12th of this month, a letter from Baltimore announced the existence of the yellow fever in that city. One of the patients whom I visited in this month, in the fever, Mr. Cole, brought the seeds of it in his body from that place.

On the 25th of the month, two members of a committee, lately appointed by the government of the state, for taking care of the health of the city, called upon me to know whether the yellow fever was in town. I told them it was, and mentioned some of the cases that had come under my notice; but informed them, at the same time, that I had seen no case in which it had been contagious, and that, in every case where I had been called early, and where my prescriptions had been followed, the disease had yielded to medicine.

On the 29th of the month I received an invitation to attend a meeting of the committee of health, at their office at Walnut-street. They interrogated me respecting the intelligence I had given to two of their members on the 25th. I repeated it to them, and mentioned the names of all the persons I had attended in the yellow fever since the 9th of June.

Neither this, nor several subsequent communications to the committee of health produced the effect that was intended by them. Dr. Physick and Dr. Dewees supported me in my declaration, but their testimony did not protect me from the clamours of my fellow-citizens, nor from the calumnies of some of my brethren, who, while they daily attended or lost patients in the yellow fever, called it by the less unpopular names of

1. A common intermittent. 2. A bilious fever. 3. An inflammatory remitting fever. 4. A putrid fever. 5. A nervous fever. 6. A dropsy of the brain. 7. A lethargy. 8. Pleurisy. 9. Gout. 10. Rheumatism. 11. Colic. 12. Dysentery. And 13. Sore throat.

It was said further, by several of the physicians of the city, not to be the yellow fever, because somewho had died of it had not a sighing in the beginning, and a black vomiting in the close of the disease. Even where the black vomiting and yellow skin occurred, they were said not to constitute a yellow fever, for that those symptoms occurred in other fevers.

Let not the reader complain of the citizens and physicians of Philadelphia alone. A similar conduct has existed in all cities upon the appearance of great and mortal epidemics.

Nor is it any thing new for mortal diseases to receive mild and harmless names from physicians. The plague was called a spotted fever, for several months, by some of the physicians of London, in the year 1665.

Notwithstanding the pains which were taken to discredit the report of the existence of the yellow fever in the city, it was finally believed by many citizens, and a number of families in consequence of it left the city. And in spite of the harmless names of intermitting and remitting fever, and the like, which were given to the disease, the bodies of persons who had died with it were conveyed to the grave, in several instances, upon a hearse, theway in which those who died of the yellow fever were buried the year before.

From the influence of occasional showers of rain, in the months of September and October, the disease was frequently checked, so as to disappear altogether for two or three days in my circle of practice. It was observed, that while showers of rain lessened, moist or damp weather, without rain, increased it.

The cold weather in October checked the fever, but it did not banish it from the city. It appeared in November, and in all the succeeding winter and spring months. The weather, during these months, being uncommonly moderate, will account for its not being destroyed at the time in which the disease usually disappeared in former years.

The causes which predisposed to this fever were the same as in the year 1793. Persons of full habits, strangers, and negroes, were most subject to it. It may seem strange to those persons who have read that the negroes are seldom affected with this fever in the West-Indies, that they were so much affected by it in Philadelphia. There were two reasons for it. Their manner of living was as plentiful as that of white people in the West-Indies,and they generally resided in alleys and on the skirts of the city, where they were more exposed to noxious exhalation, than in its more open and central parts.

The summer fruits, from being eaten before they were ripe, or in too large a quantity, became frequently exciting causes of this fever. It was awakened in one of my patients by a supper of peaches and milk. Cucumbers, in several instances, gave vigour to the miasmata which had been previously received into the system. Terror excited it in two of my patients. In one of them, a young woman, this terror was produced by hearing, while she sat at dinner, that a hearse had passed by her door with a person on it who had died of the yellow fever. Vexation excited it in a foreign master of a vessel, in consequence of a young woman suddenly breaking an engagement to marry him. The disease terminated fatally in this instance.

It was sometimes unfortunate for patients when the disease was excited by an article of diet, or by any other cause which acted suddenly upon the system; for it led both them, and in some instances their physicians, to confound those exciting causes with its remote cause, and to view the disease withoutthe least relation to the prevailing epidemic. It was from this mistake that many persons were said to die of intemperance, of eating ice creams, and of trifling colds, who certainly died of the yellow fever. The rum, the ice creams, and the changes in the air, in all these cases, acted like sparks of fire which set in motion the quiescent particles of tinder or gunpowder.

I shall now proceed to describe the symptoms which this fever assumed during the periods which have been mentioned. This detail will be interesting to physicians who wish to see how little nature regards the nosological arrangement of authors, in the formation of the symptoms of diseases, and how much the seasons influence epidemics. A physician, who had practised medicine near sixty years in the city of Philadelphia, declared that he had never seen the dysentery assume the same symptoms in any twosuccessiveyears. The same may be said probably of nearly all epidemic diseases.

In the arrangement of the symptoms of this fever, I shall follow the order I adopted in my Account of the Yellow Fever of 1793, and describe them as they appeared in the sanguiferous system, the liver, lungs, and brain, the alimentary canal, the secretions and excretions, the nervous system,the senses and appetites, upon the skin, and in the blood.

Two premonitory symptoms struck me this year, which I did not observe in 1793. One of them was a frequent discharge of pale urine for a day or two before the commencement of the fever; the other was sleep unusually sound, the night before the attack of the fever. The former symptom was a precursor of the plague of Bassora, in the year 1773.

I. I observed but few symptoms in the sanguiferous system different from what I have mentioned in the fever of the preceding year. The slow and intermitting pulse occurred in many, and a pulse nearly imperceptible, in three instances. It was seldom very frequent. In John Madge, an English farmer, who had just arrived in our city, it beat only 64 strokes in a minute, for several days, while he was so ill as to require three bleedings a day, and at no time of his fever did his pulse exceed 96 strokes in a minute. In Miss Sally Eyre, the pulse at one time was at 176, and at another time it was at 140; but this frequency of pulse was very rare. In a majority of the cases which came under my notice, where the danger was great, it seldom exceeded 80 strokes in a minute. I havebeen thus particular in describing the frequency of the pulse, because custom has created an expectation of that part of the history of fevers; but my attention was directed chiefly to the different degrees offorcein the pulse, as manifested by its tension, fulness, intermissions, and inequality of action. Thehobblingpulse was common. In John Geraud, I perceived a quick stroke to succeed every two strokes of an ordinary healthy pulse. The intermitting, chorded, and depressed pulse occurred in many cases. I called it the year before asulkypulse. One of my pupils, Mr. Alexander, called it more properly alockedpulse. I think I observed this state of the pulse to occur chiefly in persons in whom the fever came on without a chilly fit.

Hæmorrhages occurred in all the grades of this fever, but less frequently in my practice this year than in the year before. It occurred, after a ninth bleeding, in Miss Sally Eyre, from the nose and bowels. It occurred from the nose, after a sixth bleeding, in Mrs. Gardiner, who was at that time in the sixth month of her pregnancy. This symptom, which was accompanied by a tense and quick pulse, induced me to repeat the bleeding a seventh time. The blood was very sizy. I mention this fact to establish the opinion that hæmorrhages dependupon too much action in the blood-vessels, and that they are not occasioned by a dissolved state of the blood.

There was a disposition at this time to hæmorrhage in persons who were in apparent good health. A private, in a company of volunteers commanded by Major M'Pherson, informed me that three of his messmates were affected by a bleeding at the nose, for several days after they left the city, on their way to quell the insurrection in the western counties of Pennsylvania.

II. The liver did not exhibit the usual marks of inflammation. Perhaps my mode of treating the fever prevented those symptoms of hepatic affection which belong to the yellow fever in tropical climates. The lungs were frequently affected; and hence the disease was in many instances called a pleurisy or a catarrh. This inflammation of the lungs occurred in a more especial manner in the winter season. It was distinguished from the pleurisies of common years by a red eye, by a vomiting of green or yellow bile, by black stools, and by requiring very copious blood-letting to cure it.

The head was affected, in this fever, not only with coma and delirium, but with mania. Thissymptom was so common as to give rise to an opinion that madness was epidemic in our city. I saw no case of it which was not connected with other symptoms of the bilious remitting fever. The Rev. Mr. Keating, one of the ministers of the Roman church, informed me that he had been called to visit seven deranged persons in his congregation, in the course of one week, in the month of March. Two of them had made attempts upon their lives. This mania was probably, in each of the above cases, a symptom only of general fever. The dilatation of the pupil was universal in this fever.

Sore eyes were common during the prevalence of this fever. In Mrs. Leaming, this affection of the eyes was attended with a fever of a tertian type.

III. The alimentary canal suffered as usual in this fever. A vomiting was common upon the first attack of the disease. I observed this symptom to be less common after the cold and rainy weather which took place about the first of October.

I have in another place mentioned the influence of the weather upon the symptoms of this disease. In addition to the facts which have been formerly recorded, I shall add one more from Dr. Desportes.He tells us, that in dry weather the disease affects the head, and that the bowels in this case are more obstinately costive than in moist weather. This influence of the atmosphere on the yellow fever will not surprise those physicians who recollect the remarkable passage in Hippocrates, in which he says, that in the violent heats of summer, fevers appeared, but without any sweat; but if a shower, though ever so slight, appeared, a sweat broke out in the beginning[104]. I observed further, that a vomiting rarely attended those cases in which there was an absence of a chilly fit in the beginning of the fever. The same observation is made by Dr. Desportes[105].

The matter discharged by vomiting was green or yellow bile in most cases. Mrs. Jones, the wife of Captain Lloyd Jones, and one other person, discharged black bile within one hour after they were attacked by the fever. I have taken notice, in the History of the Yellow Fever of 1793, that a discharge of bile in the beginning of this fever was always a favourable symptom. Dr. Davidson of St. Vincents, in a letter to me, dated the 22d July, 1794, makes the same remark. It showsthat the biliary ducts are open, and that the bile is not in that viscid and impacted state which is described in the dissections of Dr. Mitchel[106]. A distressing pain in the stomach, called by Dr. Cullen gastrodynia, attended in two instances. A burning pain in the stomach, and a soreness to the touch of its whole external region, occurred in three or four cases. Two of them were in March, 1795. In Mrs. Vogles, who had the fever in September, 1794, the sensibility of the pit of the stomach was so exquisite, that she could not bear the weight of a sheet upon it.

Pains in the bowels were very common. They formed the true bilious colic, so often mentioned by West-India writers. In John Madge these pains produced a hardness and contraction of the whole external region of the bowels. They were periodical in Miss Nancy Eyre, and in Mrs. Gardiner, and in both cases were attended with diarrhœa.

Costiveness without pain was common, and, in some cases, so extremely obstinate as to resist, for several days, the successive and alternated use of all the usual purges of the shops.

Flatulency was less common in this fever than in the year 1793.

The disease appeared with symptoms of dysentery in several cases.

IV. The following is an account of the state of thesecretionsandexcretionsin this fever.

A puking of bile was more common this year than in the year 1793. It was generally of a green or yellow colour. I have remarked before, that two of my patients discharged black bile within an hour after they were affected by the fever, and many discharged that kind of matter which has been compared to coffee grounds, towards the close of the disease.

The fæces were black in most cases where the symptoms of the highest grade of the fever attended. In one very malignant case the most drastic purges brought away, by fifty evacuations, nothing but natural stools. The purges were continued, and finally black fæces were discharged, which produced immediate relief[107]. In one person the fæceswere of a light colour. In this patient the yellowness in the face was of an orange colour, and continued so for several weeks after his recovery.

The urine was, in most cases, high coloured. It was scanty in quantity in Peter Brown, and totally suppressed in John Madge for two days. I ascribed this defect of natural action in the kidneys to anengorgementin their blood-vessels, similar to that which takes place in the lungs and brain in this fever. I had for some time entertained this idea of a morbid affection of the kidneys, but I have lately been confirmed in it by the account which Dr. Chisholm gives of the state of one of the kidneys, in a man whom he lost with the Beullam fever, at Grenada. “The right kidney (says the doctor) was mortified, although, during his illness, no symptom of inflammation of that organ was perceived[108].” It would seem as if the want ofaction in the kidneys, and a defect in their functions were not necessarily attended with pain. I recollect to have met with several cases in 1793, in which there was a total absence of pain in a suppression of urine of several days continuance. The same observation is made by Dr. Chisholm, in his account of the Beullam fever of Grenada[109]. From this fact it seems probable, that pain is not the effect of any determinate state of animal fibres, but requires the concurrence of morbid or preternatural excitement to produce it. I met with but one case of strangury in this fever. It terminated favourably in a few days. I have never seen death, in a single instance, in a fever from any cause, where a strangury attended, and I have seldom seen a fatal issue to a fever, where this symptom was accidentally produced by a blister. From this fact there would seem to be a connection between a morbid excitement in the neck of the bladder, and the safety of more vital parts of the body. The idea of this connection was first suggested to me, above thirty years ago, by the late Dr. James Leiper, of Maryland, who informed me that he had sometimes cured the most dangerous cases of pleurisy, after the usual remedies had failed, by exciting astrangury, by means of the tincture of Spanish flies mixed with camphorated spirit of wine.

The tongue was always moist in the beginning of the fever, but it was generally of a darker colour than last year. When the disease was left to itself, or treated with bark and wine, the tongue became of a fiery red colour, or dry and furrowed, as in the typhus fever.

Sweatswere more common in the remissions of this fever, than they were in the year 1793, but they seldom terminated the disease. During the course of the sweats, I observed a deadly coldness over the whole body to continue in several instances, but without any danger or inconvenience to the patient. In two of the worst cases I attended, there were remissions, but no sweats until the day on which the fever terminated. In several of my patients, the fever wore away without the least moisture on the skin. Themilk, in one case, was of a greenish colour, such as sometimes appears in the serum of the blood. In another female patient who gave suck, there was no diminution in the quantity of her milk during the whole time of her fever, nor did her infant suffer the least injury from sucking her breasts.

I observed tears to flow from the eye of a young woman in this fever, at a time when her mind seemed free from distress of every kind.

V. I proceed next to mention the symptoms of this fever in the nervous system.

Delirium was less common than last year. I was much struck in observing John Madge, who had retained his reason while he was so ill as to require three bleedings a day, to become delirious as soon as he began to recover, at which time his pulse rose from between 60 and 70, to 96 strokes in a minute. I saw one case of extreme danger, in which a hysterical laughing and weeping alternately attended.

I have before mentioned the frequency of mania as a symptom of this disease. An obstinate wakefulness attended the convalescence from this fever in Peter Brown, John Madge, and Mr. Cole.

Fainting was more common in this fever than in the fever of 1793. It ushered in the disease in one of my patients, and it occurred in several instances after bleeding, where the quantity of blood drawn was very moderate.

Several people complained of giddiness in the first attack of the fever, before they were confined to their beds. Sighing was less common, but a hiccup was more so, than in the year before.

John Madge had an immobility in his limbs bordering upon palsy. A weakness in the wrists in one case succeeded a violent attack of the fever.

Peter Brown complained of a most acute pain in the muscles of one of his legs. It afterwards became so much inflamed as to require external applications to prevent the inflammation terminating in an abscess. Mrs. Mitchell complained of severe cramps in her legs.

The sensations of pain in this fever were often expressed in extravagant language. The pain in the head, in a particular manner, was compared to repeated strokes of a hammer upon the brain, and in two cases, in which this pain was accompanied by great heat, it was compared to the boiling of a pot.

The more the pains were confined to the bones and back, the less danger was to be apprehended from the disease. I saw no case of death from theyellow fever in 1793, where the patient complained much of pain in the back. It is easy to conceive how this external determination of morbid action should preserve more vital parts. The bilious fever of 1780 was a harmless disease, only because it spent its whole force chiefly upon the limbs. This was so generally the case, that it acquired, from the pains in the bones which accompanied it, the name of the “break bone fever.” Hippocrates has remarked that pains which descend, in a fever, are more favourable than those which ascend[110]. This is probably true, but I did not observe any such peculiarity in the translation of pain in this fever. The following fact from Dr. Grainger will add weight to the above observations. He observed the pains in a malignant fever which were diffused through the whole head, though excruciating, were much less dangerous than when they were confined to the temples or forehead[111].

I saw two cases in which a locked jaw attended. In one of them it occurred only during one paroxysm of the fever. In both it yielded in half an hour to blood-letting. I met with one case inwhich there was universal tetanus. I should have suspected this to have been the primary disease, had not two persons been infected in the same house with the yellow fever.

The countenance sometimes put on a ghastly appearance in the height of a paroxysm of the fever. The face of a lady, admired when in health for uncommon beauty, was so much distorted by the commotions of her whole system, in a fit of the fever, as to be viewed with horror by all her friends.

VI. The senses and appetites were affected in this fever in the following manner.

A total blindness occurred in two persons during the exacerbation of the fever, and ceased during its remissions. A great intolerance of light occurred in several cases. It was most observable in John Madge during his convalescence.

A soreness in the sense of touch was so exquisite in Mrs. Kapper, about the crisis of her fever, that the pressure of a piece of fine muslin upon her skin gave her pain.

Peter Brown, with great heat in his skin, and a quick pulse, had no thirst, but a most intense degreeof thirst was very common in this fever. It produced the same extravagance of expression that I formerly said was produced by pain. One of my patients, Mr. Cole, said he “could drink up the ocean.” I did not observe thirst to be connected with any peculiar state of the pulse.

George Eyre and Henry Clymer had an unusual degree of appetite, just before the usual time of the return of a paroxysm of fever.

A young man complained to me of being afflicted with nocturnal emissions of seed during his convalescence. This symptom is not a new one in malignant fevers. Hippocrates takes notice of it[112]. I met with one instance of it among the sporadic cases of yellow fever which occurred in 1795. It sometimes occurs, according to Lomius, in the commotions of the whole system which take place in epilepsy.

VII. The disease made an impression upon the lymphatic system. Four of my patients had glandular swellings: two of them were in the groin; a third was in the parotid; and the fourth was in themaxillary glands. Two of these swellings suppurated.

VIII. The yellowness of the skin, which sometimes attends this fever, was more universal, but more faint than in the year 1793. It was, in many cases, composed of such a mixture of colours, as to resemble polished mahogany. But, in a few cases, the yellowness was of a deep orange colour. The former went off with the fever, but the latter often continued for several weeks after the patients recovered. In some instances a red colour predominated to such a degree in the face, as to produce an appearance of inflammation.

In Mrs. Vogles a yellowness appeared in her eyes during the paroxysm of her fever, and went off in its remissions.

In James Lefferty the yellowness affected every part of his body, except his hands, which were as pale as in a common fever.

Peter Brown tinged his sheets of a yellow colour, by night sweats, many weeks after his recovery.

There was an exudation from the soles of the feet of Richard Wells's maid, which tinged a towel of a yellow colour.

In my Account of the Yellow Fever of 1793, I ascribed the yellow colour of the skin wholly to a mixture of bile with the blood. I believe that this is the cause of it, in those cases where the colour is deep, and endures for several weeks beyond the crisis of the fever; but where it is transitory, and, above all, where it is local, or appears only for a few hours, during the paroxysm of the fever, it appears probable that it is connected with the mode of aggregation of the blood, and that it is produced wholly by some peculiar action in the blood-vessels. A similar colour takes place from the bite of certain animals, and from contusions of the skin, in neither of which cases has a suspicion been entertained of an absorption or mixture of bile with the blood.

A troublesome itching, with an eruption of red blotches on the skin, attended on the first day of the attack of the fever, in Mrs. Gardiner.

A roughness of the skin, and a disposition in it to peel off, appeared about the crisis of the fever, in Miss Sally Eyre.

That species of eruption, which I have elsewhere compared to moscheto bites, appeared in Mrs. Sellers.

John Ray, a day labourer, to whom I was called in the last stage of the fever, had petechiæ on his breast the day before he died.

That burning heat on the skin, called by the ancients “calor mordens,” and from which this fever, in some countries, has derived the name ofcausus, was more common this year than last. It was sometimes local, and sometimes general. I perceived it in an exquisite degree in the cheeks only of Miss Sally Eyre, and over the whole body of John Ray. It had no connection with the rapidity or force of the circulation of the blood in the latter instance, for it was most intense at a time when he had no pulse.

It is remarkable that the heat of the skin has no connection with the state of the pulse. This fact did not escape Dr. Chisholm. He says he found the skin to be warm while the pulse was at 52, and that it was sometimes disagreeably cold when the pulse was as quick as in ordinary fever[113].

IX. I have in another place rejected putrefaction from the blood as the cause or effect of this fever. I shall mention the changes which were induced in its appearances when I come to treat of the method of cure.

Having described the symptoms of this fever as they appeared in different parts of the body, I shall now add a few observations upon its type or general character.

I shall begin this part of the history of the fever by remarking, that we had but one reigning disease in town during the autumn and winter; that this was a bilious remitting, or intermitting, and sometimes a yellow fever; and that all the fevers from other remote causes than putrid exhalation, partook more or less of the symptoms of the prevailing epidemic. As well might we distinguish the rain which falls in gentle showers in Great-Britain, from that which is poured in torrents from the clouds in the West-Indies, by different names and qualities, as impose specific names and characters upon the different states of bilious fever.

The forms in which this fever appeared were as follow.

1. A tertian fever. Several persons died of the third fit of tertians, who were so well as to go abroad on the intermediate day of the fever. It is no new thing for malignant fevers to put on the form of a tertian. Hippocrates long ago remarked, that intermittents sometimes degenerate into malignant acute diseases; and hence he advises physicians to be on their guard upon the 5th, 7th, 9th, and even on the 14th day of such fevers[114].

2. It appeared most frequently in the form of a remittent. The exacerbations occurred most commonly in the evening. In some there were exacerbations in the morning as well as in the evening. But I met with several patients who appeared to be better and worse half a dozen times in a day. In each of these cases, there were evident remissions and exacerbations of the fever.

It assumed, in several instances, the symptoms of a colic and cholera morbus. In one case the fever, after the colic was cured, ended in a regular intermittent. In another, the colic was accompanied by a hæmorrhage from the nose. I distinguished this bilious colic from that which is excited by lighter causes, by its always coming on withmore or less of a chilliness[115]. The symptoms of colic and cholera morbus occurred most frequently in June and July.

4. It appeared in the form of a dysentery in a boy of William Corfield, and in a man whom my pupil, Mr. Alexander, visited in the neighbourhood of Harrowgate.

5. It appeared, in one case, in the form of an apoplexy.

6. It disguised itself in the form of madness.

7. During the month of November, and in all the winter months, it was accompanied with pains in the sides and breast, constituting what nosologists call the “pleuritis biliosa.”

8. The puerperile fever was accompanied, during the summer and autumn, with more violent symptoms than usual. Dr. Physick informed me, that two women, to whom he was called soon after their delivery, died of uterine hæmorrhages; and that he had with difficulty recovered two other lying-in women, who were afflicted with that symptom of a malignant diathesis in the blood-vessels.

9. Even dropsies partook more or less of the inflammatory and bilious character of this fever.

10. It blended itself with the scarlatina. The blood, in this disease, and in the puerperile fever, had exactly the same appearance that it had in the yellow fever. A yellowness in the eyes accompanied the latter disease in one case that came under my notice.

A slight shivering ushered in the fever in several instances. But the worst cases I saw came on without a chilly fit, or the least sense of coldness in any part of the body.

Such was the predominance of the intermitting, remitting, and bilious fever, that the measles, the small-pox, and even the gout itself, partook more or less of its character. There were several instances in which the measles, and one in which the gout appeared with quotidian exacerbations; and two in which madness appeared regularly in the form of a tertian.

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