Volume 2 — AN ACCOUNT OF THE INFLUENZA, AS IT APPEARED IN PHILADELPHIA, IN THE AUTUMN OF 1789, IN THE SPRING OF 1790, AND IN THE WINTER OF 1791.

The latter end of the month of August, in the summer of 1789, was so very cool that fires became agreeable. The month of September was cool, dry, and pleasant. During the whole of this month, and for some days before it began, and after it ended, there had been no rain. In the beginning of October, a number of the members of the first congress, that had assembled in New-York, under the present national government, arrived in Philadelphia, much indisposed with colds. They ascribed them to the fatigue and night air to which they had been exposed in travelling in the public stages; but from the number of persons who were affected, from the uniformity of their complaints, and from the rapidity with which it spread through our city, it soon became evident that it was the disease so well known of late years by the name of the influenza.

The symptoms which ushered in the disease were generally a hoarseness, a sore throat, a sense of weariness, chills, and a fever. After the disease was formed, it affected more or less the following parts of the body. Many complained of acute pains in the head. These pains were frequently fixed between the eye-balls, and, in three cases which came under my notice, they were terminated by abscesses in the frontal sinus, which discharged themselves through the nose. The pain, in one of these cases, before the rupture of the abscess, was so exquisite, that my patient informed me, that he felt as if he should lose his reason. Many complained of a great itching in the eye-lids. In some, the eye-lids were swelled. In others, a copious effusion of water took place from the eyes; and in a few, there was a true ophthalmia. Many complained of great pains in one ear, and some of pains in both ears. In some, these pains terminated in abscesses, which discharged for some days a bloody or purulent matter. In others, there was a swelling behind each ear, without a suppuration.—Sneezing was a universal symptom. In some, it occurred not less than fifty times in a day. The matter discharged from the nose was so acrid as to inflame the nostrils and the upper lip, in such a manner as to bring on swellings, sores, and scabs in many people. In some, the nose discharged drops, and in a few, streams of blood, to the amount, in one case, of twenty ounces. In many cases, it was so much obstructed, as to render breathing through it difficult. In some, there was a total defect of taste. In others, there was a bad taste in the mouth, which frequently continued through the whole course of the disease. In some, there was a want of appetite. In others, it was perfectly natural. Some complained of a soreness in their mouths, as if they had been inflamed by holding pepper in them. Some had swelled jaws, and many complained of the tooth-ach. I saw only one case in which the disease produced a coma.

Many were affected with pains in the breast and sides. A difficulty of breathing attended in some, and a cough was universal. Sometimes this cough alternated with a pain in the head. Sometimes it preceded this pain, and sometimes it followed it. It was at all times distressing. In some instances, it resembled the chin-cough. One person expired in a fit of coughing, and many persons spat blood in consequence of its violence. I saw several patients in whom the disease affected the trachea chiefly, producing great difficulty of breathing, and, in one case, a suppression of the voice, and I heard of another in which the disease, by falling on the trachea, produced a cynanche trachealis. In most of the cases which terminated fatally, the patients died of pneumonia notha.

The stomach was sometimes affected by nausea and vomiting; but this was far from being a universal symptom.

I met with four cases in which the whole force of the disease fell upon the bowels, and went off in a diarrhœa; but in general the bowels were regular or costive.

The limbs were affected with such acute pains as to be mistaken for the rheumatism, or for the break-bone-fever of 1780. The pains were most acute in the back and thighs.

Profuse sweats appeared in many over the whole body in the beginning, but without affording any relief. It was in some instances accompanied by erysipelatous, and in four cases which came to my knowledge, it was followed by miliary eruptions.

The pulse was sometimes tense and quick, but seldom full. In a great majority of those whom I visited it was quick, weak, and soft.

There was no appearance in the urine different from what is common in all fevers.

The disease had evident remissions, and the fever seldom continued above three or four days; but the cough, and some other troublesome symptoms, sometimes continued two or three weeks.

In a few persons, the fever terminated in a tedious and dangerous typhus.

In several pregnant women it produced uterine hæmorrhages and abortions.

It affected adults of both sexes alike. A few old people escaped it. It passed by children under eight years old with a few exceptions. Out of five and thirty maniacs in the Pennsylvania hospital, but three were affected by it. No profession or occupation escaped it. The smell of tar and tobacco did not preserve the persons who worked in them from the disease, nor did the use of tobacco, in snuff, smoking, or chewing, afford a security against it.[88]

Even previous and existing diseases did not protect patients from it. It insinuated into sick chambers, and blended itself with every species of chronic complaint.

It was remarkable that persons who worked in the open air, such as sailors, and 'long-shore-men, (to use a mercantile epithet) had it much worse than tradesmen who worked within doors. A body of surveyors, in the eastern woods of Pennsylvania, suffered extremely from it. Even the vigour of constitution which is imparted by the savage life did not mitigate its violence. Mr. Andrew Ellicott, the geographer of the United States, informed me that he was a witness of its affecting the Indians in the neighbourhood of Niagara with peculiar force. The cough which attended this disease was so new and so irritating a complaint among them, that they ascribed it to witchcraft.

It proved most fatal on the sea-shore of the United States.

Many people who had recovered, were affected a second time with all the symptoms of the disease. I met with a woman, who, after recovering from it in Philadelphia, took it a second time in New-York, and a third time upon her return to Philadelphia.

Many thousand people had the disease who were not confined to their houses, but transacted business as usual out of doors. A perpetual coughing was heard in every street of the city. Buying and selling were rendered tedious by the coughing of the farmer and the citizen who met in market places. It even rendered divine service scarcely intelligible in the churches.

A few persons who were exposed to the disease escaped it, and some had it so lightly as scarcely to be sensible of it. Of the persons who were confined to their houses, not a fourth part of them kept their beds.

It proved fatal (with few exceptions) only to old people, and to persons who had been previously debilitated by consumptive complaints. It likewise carried of several hard drinkers. It terminated in asthma in three persons whose cases came under my notice, and in pulmonary consumption, in many more. I met with an instance in a lady, who was much relieved of a chronic complaint in her liver; and I heard of another instance of a clergyman whose general health was much improved by a severe attack of this disease.

It was not wholly confined to the human species. It affected two cats, two house-dogs, and one horse, within the sphere of my observations. One of the dogs disturbed his mistress so much by coughing at night, that she gave him ten drops of laudanum for several nights, which perfectly composed him. One of the cats had a vomiting with her cough. The horse breathed as if he had been affected by the cynanche trachealis.

The scarlatina anginosa, which prevailed during the summer, disappeared after the first of October; but appeared again after the influenza left the city. Nor was the remitting fever seen during the prevalence of the reigning epidemic.

I inoculated about twenty children for the small-pox during this prevalence of the influenza, and never saw that disease exhibit a more favourable appearance.

In the treatment of the influenza I was governed by the state of the system. Where inflammatory diathesis discovered itself by a full or tense pulse, or where great difficulty of breathing occurred, and the pulse was low and weak in the beginning of the disease, I ordered moderate bleeding. In a few cases in which the symptoms of pneumony attended, I bled a second time with advantage. In all these instances of inflammatory affection, I gave the usual antiphlogistic medicines. I found that vomits did not terminate the disease, as they often do a common catarrh, in the course of a day, or of a few hours.

In cases where no inflammatory action appeared in the system, I prescribed cordial drinks and diet, and forbad every kind of evacuation. I saw several instances of persons who had languished for a week or two with the disease, who were suddenly cured by eating a hearty meal, or by drinking half a pint of wine, or a pint of warm punch. In all these cases of weak action in the blood-vessels, liquid laudanum gave great relief, not only by suspending the cough, but by easing the pains in the bones.

I met with a case of an old lady who was suddenly and perfectly cured of her cough by a fright.

The duration of this epidemic in our city was about six weeks. It spread from New-York and Philadelphia in all directions, and in the course of a few months pervaded every state in the union. It was carried from the United States to several of the West-India islands. It prevailed in the island of Grenada in the month of November, 1789, and it was heard of in the course of the ensuing winter in the Spanish settlements in South-America.

The following winter was unusually mild, insomuch that the navigation of the Delaware was not interrupted during the whole season, only from the 7th to the 24th of February. The weather on the 3d and 4th days of March was very cold, and on the 8th and 9th days of the same month, the mercury in Fahrenheit's thermometer stood at 4° at 7 o'clock in the morning. On the 10th and 11th, there fell a deep snow. The weather during the remaining part of the month was cold, rainy, and variable. It continued to be variable during the month of April. About the middle of the month there fell an unusual quantity of rain. The showers which fell on the night of the 17th will long be connected in the memories of the citizens of Philadelphia with the time of the death of the celebrated Dr. Franklin. Several pleurisies appeared during this month; also a few cases of measles. In the last week of the month the influenza made its appearance. It was brought to the city from New-England, and affected, in its course, all the intermediate states. Its symptoms were nearly the same as they were in the preceding autumn, but in many people it put on some new appearances. Several persons who were affected by it had symptoms of madness, one of whom destroyed himself by jumping out of a window. Some had no cough, but very acute pains in the back and head. It was remarked that those who had the disease chiefly in the breast the last year, complained now chiefly of their heads, while those whose heads were affected formerly, now complained chiefly of their breasts. In many it put on the type of an intermitting fever. Several complained of constant chills, or constant sweats; and some were much alarmed by an uncommon blue and dark colour in their hands. I saw one case of ischuria, another of an acute pain in the rectum, a third of anasarca, and a fourth of a palsy in the tongue and arms; all of which appeared to be anomalous symptoms of the influenza. Sneezing, and pains in the ears and frontal sinus, were less common now than they were in the fall; but a pain in the eye-balls was a universal symptom. Some had a pain in the one eye only, and a few had sore eyes, and swellings in the face. Many women who had it, were affected by an irregular appearance of the catamenia. In two persons whom I saw, the cough was incessant for three days, nor could it be composed by any other remedy than plentiful bleeding. A patient of Dr. Samuel Duffield informed me, after his recovery, that he had had no other symptom of the disease than an efflorescence on his skin, and a large swelling in his groin, which terminated in a tedious abscess.

The prisoners in the jail who had it in the autumn, escaped it this spring.

During the prevalence of this disease, I saw no sign of any other epidemic.

It declined sensibly about the first week in June, and after the 12th day of this month I was not called to a single patient in it.

The remedies for it were the same as were used in the fall.

I used bleeding in several cases on the second, third, and fourth days of the disease, where it had appeared to be improper in its first stage. The cases which required bleeding were far from being general. I saw two instances of syncope of an alarming nature, after the loss of ten ounces of blood; and I heard of one instance of a boy who died in half an hour after this evacuation.

I remarked that purges of all kinds worked more violently than usual in this disease.

The convalescence from it was very slow, and a general languor appeared to pervade the citizens for several weeks after it left the city.

The month of December, 1790, was extremely and uniformly cold. In the beginning of the month of January, 1791, the weather moderated, and continued to be pleasant till the 17th, on which day the navigation of the Delaware, which had been completely obstructed by the ice, was opened so as to admit of the arrival of several vessels. During the month of December many people complained of colds; but they were ascribed wholly to the weather. In January four or five persons in a family were affected by colds at the same time; which created a suspicion of a return of the influenza. This suspicion was soon confirmed by accounts of its prevailing in the neighbouring counties of Chester and Montgomery, in Pennsylvania, and in the distant states of Virginia and Rhode-Island. It did not affect near so generally as in the two former times of appearance. There was no difference in the method of treating it. While the common inflammatory diseases of the winter bore the lancet as usual, it was remarked that patients who were attacked by the influenza, did not bear bleeding in a greater proportion, or in a larger quantity, than in the two former times of its appearance in the city.

I shall conclude this account of the influenza by the following observations:

1. It exists independently of the sensible qualities of the air, and in all kinds of weather. Dr. Patrick Russel has proved the plague to be equally independent of the influence of the sensible qualities of the atmosphere, to a certain degree.

2. The influenza passes with the utmost rapidity through a country, and affects the greatest number of people, in a given time, of any disease in the world.

3. It appears from the histories of it which are upon record, that neither climate, nor the different states of society, have produced any material change in the disease. This will appear from comparing the account I have given, with the histories of it which have lately been given by Dr. Grey, Dr. Hamilton, Dr. A. Fothergill, Mr. Chisholm, and other modern physicians. It appears further, that even time itself has not been able materially to change the type of this disease. This is evident, from comparing modern accounts of it with those which have been handed down to us by ancient physicians.

I have hinted in a former essay at the diminutives of certain diseases. There is a state of influenza, which is less violent and more local, than that which has been described. It generally prevails in the winter season. It seems to originate from a morbid matter, generated in crowded and heated churches, and other assemblies of the people. I have seen a cold, or influenza, frequently universal in Philadelphia, which I have distinctly traced to this source. It would seem as if the same species of diseases resembled pictures, and that while some of them partook of the deep and vivid nature of mosaic work, others appeared like the feeble and transient impressions of water colours.

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