PART SECOND. (continued 4)

7. In like manner those who newly arrive in a warm climate ought to avoid as much as possible the using of violent exercise in a heat greater than that to which they have been accustomed, and by all means to avoid intemperance in spiritous liquors. We are not however to imagine from this that such as have been accustomed to drink spiritous liquors are all at once to give over the use of them, and live a life of abstinence. On this subject Mr. Hardie, in his account of the malignant fever of 1795, has the following judicious observation: “It has often been said, that temperance was the best preservative against infection. The observation, in general, is certainly just; but it may, and during the late calamity has, been carried too far. For my part, from what has come under my own knowledge, I have no hesitation in asserting, that to persons who had been accustomed to live freely, nothing could be more dangerous than to become remarkably abstemious upon the appearance of this disorder. Persons of the above description should, in my opinion, have continued to live in their usual manner; by which means they would have been more likely to repel infection, or if infected, they would have more strength to resist the attack. But, whilst I consider abstinence in such a situation as highly improper, a state of intemperance is certainly more so; for, were it necessary, I could mention the names of several individuals, who whilst in a state of intoxication were attacked with the fever, and in two days after were tenants of the grave. The fate of such people might be pronounced almost with certainty: they were seized with symptoms of a peculiarly malignant nature, and their death seemed unavoidable.”

On the subject of vegetables much declamation has been used. If we give heed to some, it might almost be supposed that all diseases incident to human nature are owing to the use of animal food. The following paragraphs from Webster’s Collection may serve as a specimen: “We shall not repeat the observations which we have heretofore made, upon the averseness the Americans feel for soup and restorative broths, on their eating their meat running with blood, with scarcely any bread, and plenty of heavy potatoes, the only vegetables which are seen on their tables; whilst the French always give the preference to vegetables, and especially to those which are light and wholesome. But we cannot help observing, that, in the months of May, June and July, the streets and markets were seen in the morning furnished with an immense quantity of fruits, the most part of which are either green or unripe. In the evening all those fruits have disappeared and have been eaten; hence bloody fluxes, dysenteries and bad chyles, which unwholsome food must undoubtedly produce.

“The city of Naples contains about four hundred thousand inhabitants; of whom thirty or forty thousand are said to belong to the class of beggars. In that climate the rains prevail, with little intermission, for three months, from February to May. From May to September, a drought, equally severe, and scarcely allayed in many years by a single plentiful rain, renders the heat almost intolerable. The wages of a labourer not exceeding eight pence this currency a day, and meat being rarely had in their markets for less than four pence the pound, and vinous liquors in the same proportion, the mass of population is excluded from any share of these luxuries; of consequence they support themselves on vegetables, roots, sallads, fruits, &c. and dilute their food, and animate their spirits, with water and lemonade. Yet this city has, for a great number of years, known no general disease. And for ten years no febrile disease, of any sort, was common among them. They also pay great attention to personal cleanliness. Facts of this sort are very important, and form the best comment on the discordant opinions of our physicians.”

As a contrast to these the reader may take the following quotation from the Medical Extracts:

“One gentleman excepted, says Dr. Shebbeare, and I never saw a gentleman or lady who wholly abstained from animal food look like other people; nothing is so easy to distinguish as a vegetable man by his physiognomy, the fittest appellation by which they can be distinguished; he neither moves, talks nor looks like other people; his face conveys a declaration of his whole body being out of order, by the lifeless insipidity which is in it, as his conversation does of his mind being disturbed, his whole time being taken up in recounting to the world his manner of living, his feelings, his weak stomach, his disturbed sleep, &c. . . . If he pretends to have spirits, it is no more than a certain equability of a lifeless, inanimate state, like that of the dormouse among animals, or the yew tree in winter among vegetables,” &c. (Medical Extracts, vol. x. p. 234.)

On the subject of vegetable and animal food we find the following observations in Willich’s Lectures on diet, &c. “In the primitive ages, people subsisted chiefly on plants and fruits. Even to this day many nations, the Bramins, for instance, abstain from the use of animal food. The ancient Germans also, who were so renowned for their bodily strength, lived upon acorns, wood-apples, sour milk, and other productions of their then uncultivated soil. In the present mode of life, here (in England) as well as on the continent, a great proportion of the poorer class of country people almost entirely subsist on vegetables. Although these people duly digest their vegetable aliment, and become vigorous, yet it is certain that animal food would answer these purposes much better. Hence, in countries where the labouring class of people live principally upon animal food, they far excel in strength and durability.”

On the subject of diet we shall take notice only of one article more, and that is, the use of warm diluting liquors. These are commonly three in number, viz. tea, coffee and chocolate. Abundance of declamations have been published against the use of these, particularly the first; but the daily experience of multitudes shows that its use, in moderation, is perfectly innocent. Indeed when people go to excess with this, as well as any thing else, bad effects must certainly ensue. Zimmerman194 mentions a Dutch physician (Bontikoe) who maintained that tea ought to be drank in the quantity of one or two hundred cups a day! But such ridiculous excesses must make any thing destructive to health; and accordingly this practice, being opposed by Boerhaave, soon fell into disuse. Coffee has the same exhilarating virtue as tea, but must be considerably different in its qualities, as having in it a portion of empyreumatic oil extracted by the toasting, and therefore a change from tea to coffee in such as come into a warm country seems to be improper. Chocolate differs considerably from both, possessing no exhilarating virtue, or only in a small degree, but is more nutritive, and in South America constitutes a considerable part of the food. On coming into warm climates it is obvious that the increased perspiration must be supplied by a considerable quantity of diluting liquids; and such of these as the person has been most accustomed to ought to be preferred. For the rest, diluted malt liquors seem preferable to spirits and water. Cyder, though very agreeable when fresh, is apt to become vapid, and even get a putrescent taint. Perhaps a plain infusion of malt, of late found so useful at sea, might also prove beneficial at land, where proper fermented liquors cannot be had.

These modes of prevention are obviously derived from the circumstances which attend every emigrant from a cold to a warm country. The indication must be, to keep themselves as cool as possible, without debilitating the body. It was formerly a custom to use bleeding and purging when people arrived in warm latitudes; but this practice fell into disuse, perhaps without sufficient reason. Dr. Rush attests the efficacy of these remedies as preventives when signs of the disease appeared. “During the existence of the premonitory symptoms (says he) and before patients were confined to their rooms, a gentle purge, or the loss of a few ounces of blood, in many hundred instances prevented the formation of the fever. I did not meet with a single exception to this remark.” As mercury is found to be one of the best remedies, if not the only one, that can be depended upon for curing the disease after it is once formed, it is natural to think that it would act as a preventive; and accordingly we find, in Dr. Walker’s account of the yellow fever in Jamaica, an instance to our purpose. When the fort of Omoa was taken from the Spaniards, a great quantity of quicksilver was carried off by the English. One ship was loaded with it, and, the vessels containing it being broken by the shot of the ship which captured her, a number of men were employed in collecting it with their hands into buckets. Not one of these men was in the least affected with sickness, though a most malignant fever raged among the rest. Preventives of such a powerful nature, however, could not well be adopted without the advice of a physician; it being evidently dangerous for any person unacquainted with medicine to tamper with himself in this way.

When the disease happens to get into a town, it then becomes an object for every person to avoid the danger; and for this Dr. Chisholm has given such instructions as seem to be quite sufficient for any individual, and may be very easily reduced to practice. His observations may be summed up as follows: 1. To avoid going into infected houses. 2. If this cannot be done, to avoid going into the chamber of the sick. 3. If neither of these is practicable, to avoid a near approach to the sick person. 4. To avoid drawing in his breath, or that peculiar smell which issues from the bodies of the sick; and not to touch the bed-clothes. By neglecting this the person becomes affected with nausea: slight rigors and head-ach succeed in a few hours by the disease. 5. Not to touch the patient’s body or his wearing apparel, or suffer the effluvia from either to be blown upon the body. The distance at which the contagion acts is by Dr. Chisholm supposed not to exceed ten feet; but Dr. Lind thinks it may extend to fifty or sixty feet; but this must depend very much upon circumstances. The only thing that can be done in such cases is to keep at as great a distance as possible. As to the preventives commonly recommended, such as vinegar, camphor, garlic, &c. we have no accounts of their having ever been efficacious in any case; and there is not the least reason to think that they can be so.

To purify rooms or ships from the infection they have received, it has formerly been observed that fumigations with the acid of nitre have been recommended. According to the theory of Dr. Mitchill of New York, however, this mode of prevention must not only be useless but pernicious. The reason is, that according to this gentleman the disease is produced by the very acid in question. His reasoning is shortly this: Putrid substances evolve various sorts of air, two of which by combination form the acid of nitre. Neither of these by themselves are capable of producing fever, though in conjunction they are. Their combination is the acid of nitre, which the Doctor thinks is always that which produces putrefaction. Dr. Girtanner has related an experiment which seems to confirm this opinion, viz. that, having injected some nitrous air into the jugular vein of a dog, the animal died in a short time, and upon opening him his lungs were found of a greenish colour and partly putrid. Dr. Beddoes adds, in a note, that the green colour is a sign of the existence of nitrous acid, not of putridity; but, notwithstanding this, Dr. Girtanner might still have been in the right, as we cannot say that the existence of nitrous acid is incompatible with putridity. But there is not any occasion to enter into a discussion of the question, as the matter seems to be determined by facts which cannot be overthrown. Dr. Carmichael Smyth, in a treatise on the jail fever, considers the disease as proceeding from putrefaction, and “particularly the putrefaction of the perspirable matter,195 when there is not a renewal of the application of air to carry it off.” With regard to specific contagions he thinks they can neither be carried off nor blunted, but by exposure to the open air or to a stream of water; but with putrid contagions he believes that they may be destroyed by the mineral acids in a state of vapour. The pernicious qualities of the fumes of sulphur prevented him from making any trials with that substance; but to nitre there was no such objection, and he therefore proceeded in the following manner; the subjects of his trial being the prison wards at Winchester, where the Spanish prisoners were kept, and among whom a typhus fever was making rapid progress: Having divided the wards into four parts, he removed the prisoners into three of them, took out of the fourth division all the hammocks and bedding, and had them thoroughly cleaned out. The hammock posts were well washed with diluted spirit of salt. The wards, when dry, were closely shut up, and pots placed in them at different distances, containing from half a pound to a pound of nitre, which was deflagrated by an iron heater put into each pot.196 The wards were then shut up for some hours, and when opened were exposed to a free ventilation. The process was repeated twice or thrice, after which the prisoners were likewise cleaned; their old clothes, bedding, &c. taken away, were replaced by others, and none of these were afterwards seized with the fever.

A much more decisive experiment was afterwards made at Sheerness on board the Union hospital ship, where there were upwards of two hundred people sick of a very malignant fever. Previous to the fumigation all the ports and scuttles were shut up. “Sand which had been heated in an iron pot was then scooped into earthen pipkins, into each of which was put a small tea-cup containing about half an ounce of vitriolic acid; to which after it had acquired a proper degree of heat an equal quantity of nitre in powder was gradually added, and the mixture stirred with a glass spatula, until vapour arose from it in considerable quantity. The pipkins were then carried through the wards by the nurses and convalescents who kept walking about with them in their hands, occasionally putting them under the cradles of the sick, and in every corner where any foul air was suspected to lodge. Thus the fumigation was continued, until the whole space between decks, fore and aft, was filled with the vapour, which appeared like a thick haze.”

The first fumigation was performed in about three hours; the vapour subsided in about an hour, when the ports and scuttles were thrown open for the admission of fresh air. Mr. Menzies, the operator, perceived that even by this first fumigation the air was considerably sweetened; and on repeating the operation next day, which (now that the people were more expert) took up only an hour, such a change was made as the nurses and attendants were very sensible of, and, beginning to put confidence in the remedy, approached the cradles of the sick with less fear. The experiment was further carried on by Mr. Bassan, to whom Mr. Menzies resigned the office of conducting it; and from repeated trials it appeared that the fumigation effectually counteracted the influence of the contagion, though numbers of patients, labouring under the most malignant fevers, were received from the Russian ships of war.

The good effects of nitrous vapour used in this way is also confirmed by Mr. David Paterson, now surgeon in Montrose in Scotland. The trial took place in the prison wards at Forton. The operation was performed in the manner above related, and with such success, that a ward 57 feet long, 10 feet and an half high, and 20 feet broad, was filled in a quarter of an hour, only by means of three pipkins. The good effects were extremely obvious, and Mr. Paterson observed that in the wards which had been fumigated at night there was an agreeable smell next morning; and by this smell he was able to discover whether the operation had been properly performed or not. The same author gives several cases in which the good effects of the pure acid vapour of nitre in cleansing putrid ulcers was manifest. A third testimony of the efficacy of this vapour is given in a letter to Dr. Garthshore of London from Mr. James McGregor, surgeon to the 88th regiment, in the island of Jersey. The disease was a typhus fever, which had formerly proved very destructive; but, while the acid vapour was used, only one out of sixty-six cases proved fatal. Mr. McGregor is not only of opinion that the nitrous fume prevented the contagion from acting fatally, but that it destroyed it altogether, so that no more cases appeared. Mr. Paterson made trial of different acids, but had not completed his experiments: we are informed, however, in the Medical Extracts, that in the year 1795, near about the time that the last experiments were made upon the Union hospital ship, Morveau in France had employed, for the same purpose, oxygenated muriatic acid197 in the form of air or vapour, with which he purified the infected hospital at Dijon; and the same method was afterwards extended to the different military hospitals by a decree of the National Assembly.

This mode of prevention seems to be established on as sure a testimony as any thing can be; but what can be said that will not be disputed? Dr. Trotter has argued in the most strenuous manner that such fumigation is not only useless, but pernicious. “The whole preservative means (says he) are comprised in the immediate removal of the sick; cleanliness in person and in clothing; fires to keep the people warm in the winter season; avoiding cold and moisture, fatigue and intoxication; and keeping the ship dry and properly ventilated.” To these he also thinks it would be expedient to add a band of music in order to keep up the spirits of the people; but, with regard to any thing else, he thinks that “a physician of a fleet, though armed with a diploma, and with the chemistry of the elements at his fingers’ ends, will find that very little has been left for him to do; whether his doctrine of prophylactics (preventives) be the vinegar of the four thieves, or the fumigations of modern physicians, under the scientific appellations of sulphureous gas, muriatic acid gas, or nitrous gas.” The Doctor was so zealous against these noxious fumigations, that he wrote to Evan Nepean, esq. at the Admiralty upon the subject. His argument was, that every possible method was taken on board of vessels to expel azote or mephitic air, by opening ports, scuttles, &c. and putting down windsails, &c. “This azote is the base of the nitrous acid: they only differ in the degrees of combination with oxygen, or what was formerly called dephlogisticated air: and in proportion to the quantity it attracts of this principle it is called azote, azotic gas, nitrous gas, nitrous acid, nitric acid. In short, Dr. Smyth’s preventive is the very substance that every intelligent officer is hourly employed to drive from the decks of his Majesty’s ships.”198 This letter was transmitted to the commissioners for the sick and wounded for their report. The answer of the commissioners was to the full as learned as the Doctor’s letter; but they considered the experiments of Dr. Smyth and others as quite decisive upon the subject, so that Dr. Trotter was obliged to submit. The matter therefore being determined by such high authority, we must take leave of the subject, and proceed to consider the mode of preventing the disease from getting entrance into any town, or of eradicating it when once it has got in.

Among these the enacting and strictly enforcing quarantine laws certainly hold the first place. But these belonging entirely to the magistracy and police of the place cannot be the subject of any discussion here. The success of these has been so great in other countries, that Dr. Willich informs us “that some of the most ingenious practitioners of Italy and Germany are, at this moment, employed in a serious attempt wholly to extirpate this contagion (the small pox) from the continent of Europe; an object which has formerly been accomplished in the cases of the plague and leprosy.”199 Perhaps, then, it is no improbable supposition, that, by a strict observance of quarantine laws, and attention to cleanliness, the yellow fever may be eradicated at least from the northern states, whose climates are less congenial to it than the southern.

Dr. Chisholm informs us that the general plan of prevention made use of in Grenada consists in the destruction of all small wooden buildings; obliging the inhabitants to build with stone or brick; to make spacious streets; to have the rooms of the houses as large as possible; stables, necessaries, &c. at a distance; and certain places appointed as receptacles for filth, to which it must be carried every morning; slaughter-houses at a distance from the town, &c. with a number of other particulars relative to cleanliness which it is needless to enumerate here; not forgetting the quarantines, lazarettos, &c. without which he does not think any activity on the part of the people can avail.

Dr. Rush, who is an enemy to quarantines, recommends to the people of Philadelphia the following particulars: “1. Let the docks be immediately cleaned, and let the accumulation of filth in them be prevented in future, by conveying water into them by a passage under the wharves, or by paving them with large flag stones inclining in such a manner towards the channel of the river as that the filth of the streets shall descend from them (after it falls into the docks) into the river. This method of paving docks has been used with success in the city of Brest. 2. Let every ship that belongs to our port be compelled by law to carry a ventilator. Let all such ships as are discovered to contain foul air in their holds be compelled to discharge their cargoes before they reach our city, and let the ships in port be compelled to pump out their bilge water every day. 3. Let the common sewers be washed frequently with streams of water from our pumps. Perhaps an advantage would arise from opening them, and removing such foul matters as streams of water are unable to wash away. 4. Let the gutters be washed every evening in warm weather. By frequently washing the streets and pavements the heat of the city would be lessened, and thereby one of the predisposing causes of the fever would in some measure be obviated. 5. The utmost care should be taken to remove the filth from the yards and cellars of every house in the city. Hog-sties should be forbidden in yards, and the walls of cellars should be whitewashed two or three times a year, and their floors should be constantly covered with a thin layer of lime. Whitewashing the outside of houses in sickly streets would probably be useful. 6. Let the privies be emptied frequently; and let them be constructed in such a manner as to prevent their contents from oozing through the earth so as to contaminate the water of the pumps. 7. Let all the filth be removed from the neighbourhood of the city, and let the brick kiln and other ponds be filled up from time to time with the earth which is obtained in digging cellars. 8. In the future improvements of our city, let there be no more dwelling houses erected in alleys. They are often the secret receptacles of every kind of filth. 9. The predisposition of our citizens to be affected by the remote and exciting causes of the yellow fever would be very much lessened by their living sparingly upon fresh animal food, and chiefly upon broths and fresh vegetables, rendered savoury by spices and a small quantity of salted meat, during the summer and autumnal months. A constant attention should be paid at the same time to bodily cleanliness.”

These are the modes of prevention which seem to be the most obvious and necessary, as well as approved by the best judges. It appears, however, that in certain cases neither human skill nor care can prevent or cure the disorder. The number of physicians who have fallen victims to this disease are too manifest proofs of this.200 Indeed, when we consider that it is the nature of the distemper first of all to attack the vital parts, and that this attack may commence with little or no pain, it is evident that an attack may be begun before we think of a preventive, and may, as it were in a moment, prevail in such a manner as to be entirely beyond the reach of medicine, before even a medicine is thought necessary. In every case therefore, where the yellow fever prevails, an attention to health becomes as necessary as procuring the means of subsistence. Every precaution must be used, and when we have done so we are not even then secure. We are ignorant of the natural causes which produce it; they are invisible to our senses, and incomprehensible by our understandings. Safety then can only be expected from the protection of that Being to whom all natural causes are known, and to whom all must yield obedience. In short, we may sum up the whole in the well known sentence, “He that will love life, and see good days, let him refrain his TONGUE from EVIL, and his LIPS that they speak no GUILE. Let him eschew EVIL and do GOOD; let him seek PEACE, and ensue it.” A very strange receipt indeed, we will say; but how often have we tried it?

The cure of the yellow fever hath been attempted in various ways, according to the theories laid down by different physicians concerning its nature. Dr. Cullen considers it as of the nature of typhus fever,201 and of consequence would have treated it with antimonials; most probably with his favourite remedy, tartar emetic. Dr. Rush, from his opinion that it is the highest degree of inflammatory fever, recommends powerful evacuants, and large blood-letting, in 1793, and 1797, though he seems to have altered his sentiments in 1798. Dr. Brown, who would have considered it as a disease of debility, would of course have prescribed opium and other stimulants; and lastly, on the theory of Dr. Mitchill, that the disease proceeds from an acid, remedies of a nature directly opposite, viz. alkalies, ought to be useful. It is not the design of this treatise to enter into any consideration or comparison of the practice of different physicians, but to point out at once, to those who are not physicians, the remedies which have been, by general consent, accounted most efficacious; and in this respect there is now a surprising unanimity among gentlemen of the medical profession. Those which hold the first rank are,

1. Mercury. In the use of this medicine the physicians of the Western world have certainly excelled those of the East. In a paper in the Medical Repository, vol. i, p. 500, Dr. Holyoke of Salem says that the practice of giving mercury was first introduced into New England about 60 or 70 years ago,202 by a physician from Scotland, a disciple of the celebrated Pitcairn. In 1734 or 1735 it was used successfully in a very malignant disease called the throat distemper, and which he thinks was of the same genus with the malignant ulcerous sore throat treated of by Huxham. About 45 years ago it was commonly used in pleurisies and other inflammatory disorders; and, ever since the year 1751 or 1752, it has been used by Dr. Holyoke himself. In Europe, however, the case was exceedingly different; mercury being there generally reckoned pernicious in such disorders, from a notion of its being inflammatory, or dissolving the blood. Thus, on the appearance of the Boullam fever in Grenada, Dr. Chisholm found himself exceedingly at a loss what to do, and he seems to have invented, rather than to have been previously instructed in, the mercurial practice. His success, however, was very great, provided he could raise a salivation; but in order to do this he was frequently obliged to give much larger doses than he had ever done before, or had any notion of doing. In p. 159 he mentions one patient who took 400 grains before the salivary glands were affected. He tells us, however, p. 271, that, on the re-appearance of the fever in 1794, he gave the medicine in much larger doses than before; beginning with mercury without any previous evacuations which he had used the year before, and with such success that he did not lose a single patient; so that he professes himself almost ready to pronounce it infallible in curing the disease. The practice of giving mercury is confirmed by Dr. Rush, and indeed by so many other physicians, that it is superfluous to quote them. Dr. Nassy, formerly mentioned, again stands almost singular in condemning the medicine, because it dissolves the blood; but it is impossible that any theory, however plausible, can stand against well attested facts. Dr. Rush is indeed very much of opinion that it is easily practicable for people to cure themselves of this disorder, dreadful as it is, provided they take it in time. But by this we must understand, that the very moment the person feels uneasiness he must apply a remedy, and not trust to nature in any case whatever. When the yellow fever prevails, every one who feels the slightest disorder may be assured that his disorder partakes of its nature, and ought immediately to have recourse to a mercurial purge. Dr. Rush says also that bleeding should be first performed. The many disputes, however, concerning the efficacy of this last remedy, must make any person hesitate at the application of it without medical advice, especially as a mercurial purge may be safely taken without it.

2. Blood-letting. This was, by Dr. Rush, considered as the capital remedy in 1793; but Dr. Chisholm, who made trial of it in the Boullam fever, found that it could not be used with any degree of safety. Dr. Jackson says it is frequently necessary in the Jamaica fever, but it was seldom of use to repeat it. Dr. Walker says it increased the debility in the same fever of 1793, 94 and 95. Dr. Moseley recommends it in the yellow fever of the West Indies, but only in the first stage, and says that the injudicious performance of this operation, when the second stage has come on, has given occasion to the opinion that a patient cannot bear two bleedings. Dr. Coffin found it useful at Newburyport in 1796, in the beginning of the disease, and says it may sometimes be repeated. Repeated bleedings are recommended by Dr. Ouviere of Philadelphia, who says they are not to be omitted even in fat and weak habits. This is confirmed by the editor of the Medical Repository, vol. i, p. 92, who says it was used with success at the hospital in New York in 1796, “at repeated times, to the amount of from 24 to 175 ounces, and in some cases several times performed after the sixth day of the disease, to the great relief of the sick.” Dr. Bruce recommends it in the island of Barbadoes in the robust and plethoric.203 Dr. Hillary says that in the same island it is always absolutely necessary, and that it may even be repeated once, but that a third bleeding was seldom necessary. Dr, Wright, in the same island, found the “lancet not only unnecessary but dangerous in the extreme.” Dr. Clarke, in Dominica, found it generally very pernicious, and assures us “that there was not a single instance of an emigrant recovering who had been bled in this disease. In the first 24 hours indeed it was admissible in the young and athletic seized a short time after their arrival, but after that time, or at most after 36 hours, it will always be found prejudicial, if not fatal.” It was not tried by Dr. Bryce on board the Busbridge. It is recommended by Dr. Currie in his treatise on bilious fevers.

It is needless to take up time with a detail of more opinions. From those already recited it is natural to conclude that the fever in some places, and at some times, differs very much from others. This is conformable to the opinion of Dr. Currie, who says, that the bilious fever “is amazingly influenced in its aspect and symptoms by the soil, situation, climate, season, and by the preceding and present state of the atmosphere, and the customary mode of living of the inhabitants.” The utility or even safety of blood letting then seems to depend on circumstances which can be only known, and that perhaps with difficulty, at the time; nor can its success in one season be a sufficient argument for the general practice of it in another.

3. Vomits have generally been found dangerous. Dr. Moseley, Dr. Rush, and indeed almost all who have practised in this disease, say, that they cannot be ventured upon without extreme caution. Dr. Chisholm, in imitation of the Russian practice in the true plague, attempted the cure of the Boullam fever by vomits; but, as one half of those to whom they were exhibited died of the disease, he did not think there was any encouragement to proceed. Perhaps as preventives they might be useful, as it seems probable indeed that any thing must be which tends to cleanse the alimentary canal.

4. Purgatives are found extremely useful, both as preventives and medicines. There are innumerable instances where an incipient attack of the disease has been carried off by a brisk purge. Dr. Chisholm was able to remove the slighter cases of Boullam fever by purgatives. He used at first glauber salts with two grains of tartarised antimony, which generally proved emetic as well as purgative; but he afterwards used with advantage the better purging salts, rendering the solution palatable by the addition of lime juice and sugar. But in all violent cases he would depend on nothing but mercury.

5. Stimulating medicines. The stimulants commonly used on the Brunonian plan, viz. opium, bark, &c. are universally owned to be pernicious. In a letter from Dr. Sayres to Dr. Currie,204 the former says, that “bark, wine, and a number of the common stimulants, were given on the first appearance of debility taking place; but with little success. Finding the common round of medicine ineffectual in the advanced state of the disease, I determined (says Dr. Sayres) to use a different mode of treatment. In three cases of adults, two of which had the black vomiting, and the third was in a gore of putrid blood from the mouth and nose, I forbid medicine, and directed very cold water and brandy mixed strong, to be given as freely as possible. It had the happy effect of checking the vomiting in two cases, when the stomach had rejected every kind of mild drink, &c. and, by continuing that practice almost so as to produce high intoxication, for two or three days, these two cases were recovered almost from a state of death. The third was apparently much benefited for three days; but, being in a high putrescent state when I saw him, and having lost a very considerable quantity of blood from the mouth, nose, &c. he died oil the ninth day.” In the Boullam fever Dr. Chisholm used the Angustura bark in twelve cases, eight of whom recovered; but, though it was greatly superior to the Peruvian bark, he did hot think proper to trust to it in violent cases.

6. Alkaline remedies. These have been recommended on the supposition that the yellow fever is occasioned by an acid. Their efficacy is attested by Dr. Jeremiah Barker of Portland, who says that they afforded more relief than any others, and that all the cases accompanied with yellowness ended favourably, but one. The alkaline remedies “would actually alleviate the distressing pain and anguish at the stomach, which would not yield to opiates. The morbid excitement too was evidently under the controul of alkalies; the febrile disturbance appeared to be in a direct ratio to the degree of virulence in the deleterious cause.”205 We have not any particular details of cases, nor any form of exhibition pointed out. In a dysenteric fever indeed he says that he used a mixture of a quarter of an ounce of salt of wormwood with a pound of lime water; the dose from one to two ounces every hour, once in some cases every half hour, or oftner, in an infusion of camomile.206 Calcined oyster shells were sometimes given from 40 to 60 grains.

7. Cooling medicines, external and internal. The good effects of cold water applied to the body in fevers has long been known. Dr. Jackson observes that it was first introduced at Rome in the infancy of the Methodic sect, and attained afterwards a high degree of celebrity. Its reputation was highly raised by a cure performed on the emperor Augustus; but soon after sunk by the death of Marcellus, the presumptive heir to the empire, to whom it had been improperly prescribed. It was soon after prescribed again, and greatly used by Galen; and after him was in still greater favour with the Arabian physicians; but, since the revival of literature, has been much neglected till of late. In the fever of Jamaica, after the fatal symptoms were removed, Dr. Jackson says, that the tone and vigour of the system was best restored by cold bathing, “which (says he) I am induced to consider as the most important remedy in the cure of the fevers of the West Indies, and perhaps in the cure of the fevers of all hot climates. Though it might not absolutely cut short the course of the disease, yet it seldom failed to change the fatal tendency of its nature.” Even in the last stage of the yellow fever, where the patient seems at the utmost extremity, our author tells us that he has alternately employed warm and cold bathing with the greatest success. He has even wrapped the body in a blanket soaked in water in which a large portion of salt had been dissolved, or which had been steeped in brandy or rum, enjoining the liberal use of wine, or more powerful cordials. Dr. Wright also mentions the cold bath with approbation; but, as it cannot be very generally depended upon, its use ought never to supersede that of other remedies, especially mercury; and indeed this may be said of every thing else; for though by the use of the remedies already mentioned the disease has sometimes been subdued, yet the success has never been so great but that every one under an attack of the yellow fever must be considered as in very considerable danger.

In the use of cooling medicines, taken internally, we must have a particular regard to the state of the stomach, which is excessively irritable; and it is surprising that this irritability is of such a nature that, though it will certainly reject the mildest drinks or medicines, it may yet retain others seemingly much more acrid, as has already been observed in the case of Dr. Sayres’s patients. As long ago as the time of Diemerbroeck a solution of common salt in vinegar was recommended in the plague. Since that time it has been found extremely useful in the dysentery; and, as in this disease the bowels are likewise in an extremely irritable state, it would seem from analogy that the same medicine might be useful also in the yellow fever. Dr. Wright of Jamaica (who attests the efficacy of the medicine in dysentery, belly-ach, remittent fever, and putrid sore throat) gives the following improved method of preparing it: “Take of lime or lemon juice three ounces; of marine salt as much as the acid can dissolve; of any simple distilled cordial water one pint; and of loaf sugar a sufficient quantity to sweeten it. The dose of this mixture must be proportioned to the age and sex of the patient, and to the violence of the disease. A wine glassful may be given to adults every two, four or six hours.”

8. Medicines proper for relieving the most urgent symptoms of the disease. The most distressing symptoms attending the yellow fever are, head-ach, vomiting, pain in the stomach, and pains in the back, loins and limbs. Blisters were tried by Dr. Chisholm to mitigate the pain in the head. “I have (says he) blistered the whole head, and the inside of each thigh, at once, in several cases, without producing the least change in that or any other symptom. I have had recourse to this remedy to lessen pain, to remove irritability of the stomach, and to raise the vital powers in the low, comatose stage, but always except in two cases without success.” In one a blister to the scrobiculus cordis completely removed the irritability; the other case is related in the next section. Another practitioner found a blister applied to the forehead of remarkable use in four cases; but Dr. Chisholm supposes them to have been of the less violent kind. Others have also found them occasionally useful; so that, though dependence cannot be placed upon these remedies, it seems improper to reject them entirely. But the most effectual method of allaying the irritability of the stomach was by the exhibition of vitriolic æther. Dr. Chisholm adopted the medicine on the recommendation of M. Poissonier, and found it to answer the character given of it by him. Dr. Chisholm gave about a teaspoonful in half a glassful of cool water, after which the patient continued undisturbed about two hours, when the dose was repeated. Sometimes, though seldom, the stomach was thus enabled to bear the bark, but otherwise the æther was given every three hours. If the stomach retained the bark after the first dose, æther was then given only once in five or six hours. Æther, says he, given in the manner I have mentioned, is extremely grateful to the patient; it occasions an agreeable warmth along the oesophagus, and gently stimulates the stomach. This effect, however, does not continue long; but the frequent production of it at length gives it permanency. It appears to act as a tonic, an antiseptic, and an agreeable stimulant; a warm glow overspreads the surface; and thirst, nausea and oppression, often have fled before it.

These are the remedies most approved, and which may with most reason be expected to succeed in the cure of the disease, where it is within the power of medicine. But there are certain cases in which medicines of the ordinary kind cannot act. Sometimes, at the very beginning of the disease, all the three stages of it seem to commence at once, or to be mingled in such a manner that medicines have not time to exert their force. Again, in the last stage, Dr. Jackson compares the attempts to overcome the torpor of the system by medicine, to that of attempting to revive a dead corpse. “I have, however (says he) seen instances of such unexpected recoveries from the most hopeless state in fevers, that I seldom totally despair as long as life remains.” It is evident, however, that the remedies employed must be different, according to the different times of the disease. In the beginning it is probable that by bleeding to an extreme degree, so that the greater part of the mass of blood was taken away, the disease might be subdued at once, and the patient recover, as has been already mentioned of the plague, p. 363. But the idea of death seems to be so firmly connected in the human mind with the loss of a great quantity of blood, that very little hopes can be entertained of any good being done in this way. It seems indeed owing to this invincible association of ideas that the enemies of Dr. Rush have found means to load him so much and so undeservedly with reproach. Another method, less exceptionable, though probably also less efficacious, is by injections into the veins. But what are we to inject? Here, to the disgrace of experimenters, let it be recorded, that such has been their innate propensity to cruelty, that though we know a number of substances which, injected into the veins of an animal, will certainly kill it, yet we scarce know one which can be injected with even a probability of doing good. In the Medical Extracts indeed we find it related that at Guadaloupe a physician had cured the most inveterate diseases by injecting certain remedies into the veins. But what these remedies were we know not. In the same paragraph indeed it is said that alarming symptoms from the bite of a viper were removed by injecting diluted spirit of hartshorn into the blood. As the bite of a viper is attended with a dissolution of the blood, and yellowness of the skin, we may thence derive some faint hope that such an injection might also be useful in desperate cases of the yellow fever; but, till further experiments are made, we can say nothing more on the subject.

Lastly, when the disease has proceeded so far that the blood flows out from all parts of the body, and it is evident that the patient must die were it only from the loss of that fluid, then, if ever, the once celebrated remedy of the transfusion of blood may be of use. An account of this remedy has been given in the former part of this work. It must be evident that human blood ought to be preferred to that of a brute creature; but the danger incurred by one who should lose a quantity of blood so near to a person capable of giving the febrile infection must certainly be very great. Nevertheless, there are cases in which the death of a beloved object inspires more horror than the thoughts of any personal danger, or even death itself, to the person who beholds it. In such cases no doubt there are many that would run all risks; and, should any case prove successful, no doubt the person who had the courage to make the experiment would find ample recompense in saving a person he loved from death, and in establishing a truth of such importance to the world in general.207

SECTION IV.

Remarkable Cases.

SO many 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 was produced internally, or externally. 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 for three 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, named Tcheremani, 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 run through 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 named Soccun, 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 a moullah. This gentleman, like too many others, did not choose to serve 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 comfort him, 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 of FEAR in rendering the contagion of the SMALL POX effectual.209 “A very beautiful girl, twenty-five years of age, servant to captain Morton, had never had the small pox, and had the most 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 of FEAR to render the contagion of YELLOW FEVER effectual. 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 attending seven persons 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, therefore it has not been so.” 6. Boullam fever cured by a blister.210 The 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.211 The 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 strong emetics 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 given before the 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 an emetic point in 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 in its malignity. These variations in diseases call for corresponding changes in our practice.”

8. Extraordinary case of yellow fever at Boston in 1798. “The subject of it212 was 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 were as 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 of health 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 a spontaneous origin 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.213 The 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.