Volume 4 — AN ACCOUNT OF THE BILIOUS YELLOW FEVER, AS IT APPEARED IN PHILADELPHIA, IN 1803.

The weather in January was uniformly cold. On the 21st of the month, the Delaware was completely frozen.

On the 4th of February there was a general thaw, attended with a storm of hail, thunder, and lightning, which lasted about three quarters of an hour. The diseases of both these winter months were catarrhs and bilious pleurisies. The latter appeared in a tertian type. The pain in the side was most sensible every other day.

The weather was cold and dry in March, in consequence of which, vegetation was unusually backward in April. The hooping cough, catarrhs, and scarlatina were the diseases of this month.

The beginning of May was very cool. There was ice on the 7th of the month. The winds, during the greatest parts of this and the previous month, were from the north-east.

In June, the weather was cool. Intermittents were common in this month, as well as in May. Such was the predominance of this type of fever over all other diseases, that it appeared in the form of profuse sweats, every other night, in a lady under the care of Dr. Dewees and myself, in the puerperile fever. On the intermediate nights she had a fever, without the least moisture on her skin. There were a few choleras this month. During the latter end of the month, I lost a patient with many of the symptoms of yellow fever.

The weather in July was alternately hot, moderate, and cool, with but little rain. The first two weeks of this month were healthy. A few tertian fevers occurred, which readily yielded to bark, without previous bleeding. Between the 25th and 31st of the month, three deaths took place from the yellow fever.

In the month of August, the weather was the same as in July, except that there fell more rain in it. Mild remittents and cholera infantum were now common. There were likewise several cases of yellow fever during this month. One of them was in Fromberger's-court. It was induced by the fœtor of putrid fish in a cellar. A malignant dysentery was epidemic during this month in the upper part of Germantown, and in its neighbourhood. Several persons, Dr. Bensell informed me, died of it in thirty hours sickness. It prevailed, at the same time, in many parts of the New-England states.

In September, cases of yellow fever appeared in different parts of the city, but chiefly in Water, near Walnut-street. On the 12th of the month, the board of health published a declaration of its existence in the city, but said it was not contagious. This opinion gave great offence, for it was generally said to have been imported by means of a packet-boat from New-York, where the fever then prevailed, because a man had sickened and died in the neighbourhood of the wharf where this packet was moored. It was to no purpose to oppose to this belief, proofs that no sick person, and no goods supposed to be infected, had arrived in this boat, and that no one of three men, who had received the seeds of the disease in New-York, had communicated it to any one of the families in Philadelphia, in which they had sickened and died.

The disease assumed a new character this year, and was cured by a different force of medicine from that which was employed in some of the years in which it had prevailed in Philadelphia.

I shall briefly describe it in each of the systems, and then take notice of some peculiarities which attended it. Afterwards I shall mention the remedies which were effectual in curing it.

1. The pulse was moderately tense in most cases. It intermitted in one case, and in several others the tension was of a transient nature.

Hæmorrhages occurred in many cases. They were chiefly from the nose, but in some instances they occurred from the stomach, bowels, and hæmorrhoidal vessels.

2. Great flatulency attended in the stomach, but sickness and vomiting were much less frequent than in former years. I saw but one case in which diarrhœa attended this fever.

3. I did not meet with a single instance of a glandular swelling in any part of the body.

4. There was a general disposition to sweat in this fever from its beginning. Two of my patients died, in whom no moisture could be excited on the skin. But I recovered one with a dry skin, by means of a purge, two bleedings, and blisters.

An efflorescence on the skin occurred in several instances. I saw black matter discharged from a blister in one case, and blood in another.

5. The stools were green and black. Bile was generally discharged in puking.

6. The blood exhibited the following appearances: siziness, lotura carnium, sunken crassamentum, red sediment, and what is called dense or unseparated blood. I saw no instance of its being dissolved.

7. The tongue was whitish and dark-coloured. This diseased appearance continued, in some instances, several days after a recovery took place. I saw no smooth, red, nor black tongue, and but one dry and one natural tongue. The latter was followed by death.

I did not see a single case in which the disease came on without an exciting cause; such as light clothing and bed-clothes, sitting at doors after night, a long walk, gunning, and violent and unusual exercises of any kind. It was excited in a number of people by their exertions to extinguish a fire which took place in Water-street, between Market and Chesnut-streets, on the morning of the 25th of August. I saw a fatal instance of it succeed a severe tooth-ach. Whether this pain was the exciting cause, or the first morbid symptom of the fever, I know not; but I was led by it to bleed a young lady twice who complained of that pain, and who had at the same time a tense pulse. Her blood had the usual appearances which occur in the yellow fever.

The disease had different appearances in different parts of the city. It was most malignant in Water-street; but in many instances it became less so, as it travelled westward, so that about Ninth-street it appeared in the form of a common intermittent.

In every part of the city it often came on, as in the year 1802, in all the milder forms of autumnal fever formerly enumerated, and went off with the usual symptoms of yellow fever. Again, it came on with all the force and malignity of a yellow fever, and terminated, in a day or two, in a common remittent or intermittent. These modes of attack were so common, that it was impossible to tell what the character, or probable issue of a fever would be, for two or three days.

The following remedies were found, very generally, to be effectual in this fever.

1. Moderate bleeding. I bled but three patients three, and only one, four times. In general, the loss of from ten to twenty ounces of blood, reduced the pulse from a synocha to a synoichoid or typhoid state, and thereby prepared the system for other remedies.

2. Purges were always useful. I gave calomel and jalap, castor oil, salts, and senna, according to the grade of the disease, and often according to the humour or taste of the patient. I aided these purges by glysters. In one case, where a griping and black stools attended, I directed injections of lime water and milk to be used, with the happiest effects.

3. I gave emetics in many cases with advantage, but never while the pulse was full or tense.

4. Having observed, as in the year 1802, a spontaneous moisture on the skin on the first day of the disease, in several cases, I was led to assist this disposition in nature to be relieved by the pores, by means of sweating remedies, but in no instance did I follow it, without previous evacuations from the blood-vessels or bowels; for, however useful the intimations of nature may be in acute diseases, her efforts should never be trusted to alone, inasmuch as they are in most cases too feeble to do service, or so violent as to do mischief. I saw one death, and I heard of another, from an exclusive reliance upon spontaneous sweats in the beginning of this fever. The remedies I employed to promote this evacuation by the pores were, an infusion of the eupatorium perfoliatum in boiling water, aided by copious warm drinks, and hot bricks and blankets, applied to the external surface of the body. The eupatorium sometimes sickened the stomach, and puked. The sweats were intermitted, and renewed two or three times in the course of four and twenty hours.

5. I derived great advantage from the application of blisters to the wrists, before the system descended to what I have elsewhere called, the blistering point. This was on the second and third days. My design, in applying them thus early, was to attract morbid excitement to the extremities, and thereby to create a substitute for a salivation. They had this effect. The pain, increase of fever, and occasional strangury, which were produced by them, served like anchors to prevent the system being drifted and lost, by the concentration of morbid excitement in the stomach and brain, on the fourth, fifth, sixth, and seventh days of the disease. It gave me great pleasure to find, upon revising Dr. Home's account of the yellow fever, that this mode of applying blisters, in the early stage of the disease, was not a new one. He often applied them in the first stage of the fever, more especially when the yellow colour of the skin made its appearance on the first or second day. By the advice of Dr. Cheney, of Jamaica, he was led to prefer them to the thighs, instead of the trunk of the body, or the legs and arms. He forbids their ever being applied below the calf of the legs. This caution is probably more necessary in the West-Indies than in the United States. The pain and inflammation excited by the blisters were mitigated by soft poultices of bread and milk. The strangury soon yielded to demulcent drinks, particularly to flaxseed tea.

I was happy in not being compelled, by the violence or obstinacy of this fever, to resort to a salivation in order to cure it, in a single instance; the discharges from the stomach and bowels, and from the veins, pores, and skin, having proved sufficient to convey the disease out of the system.

Two persons recovered this year who had the black vomiting. One of them was by means of large quantities of brandy and volatile alkali, administered by Dr. John Dorsey, in the city hospital; the other was by means of lime and water and milk, given by an intelligent nurse to one of my patients, during the interval of my visits to her.

From the history which has been given of the symptoms of this fever; from the less force of medicine that was necessary to subdue it; from the safety and advantage of blisters in its early stage; and from the small proportion which the deaths bore to the number of those who were affected, being seldom more than five in a hundred (including all the grades and forms of the disease), in the practice of most of the physicians, it is evident this fever was of a less malignant nature than it had been in most of the years in which it had been epidemic. There was one more circumstance which proved its diminution of violence, and that was, a more feeble operation of its remote cause. In the year 1802, nearly all the persons who were affected with the fever in the neighbourhood of Vine and Water-streets, and in Water, between Walnut and Spruce-streets, died. This year, but two died of a great number who were sick in the former, and not one out of twelve who were sick in the latter place. The filth, in both parts of the city, was the same in both years. This difference in the violence and mortality of the fever was probably occasioned by a less concentrated state of the miasmata which produced it, or by the co-operation of a less inflammatory constitution of the atmosphere.

The yellow fever was epidemic, during the summer and autumn of this year, in New-York, and in Alexandria, in Virginia. In the latter place, Dr. Dick has informed the public, it was derived from domestic putrefaction.