GENERAL REMARKS ON THE YELLOW FEVER, AND THE RESEMBLANCE WHICH THIS DISEASE BEARS TO THE PLAGUE.
When I had nearly brought these sketches to a conclusion, I met with two books which I regret that I did not see earlier, viz. Dr Chisholm’s work on the Pestilential Fever of the West Indies, and Dr Wittman’s Travels. In perusing these works, I have had great satisfaction to find a coincidence with me in some opinions which I had formed, and which I have introduced into this treatise.
It is matter of regret to me, that I did not meet Dr Wittman in Egypt. Most of my observations, I find, coincide with his; and I am glad to have mine confirmed by authority so respectable.
The frictions with oil we did use to a small extent, in an infected corps of the Indian army; but the report made to me, by the surgeon, was unfavourable, and I never recommended its use in any other corps. Since reading what Dr Wittman says on the subject of friction with oil, I think it not improbable, that, in addition to the great care which captain Burr took of the commissariat department, another circumstance may have conduced to their exemption from the plague. The camels of the army, to the number of some hundreds, were, as well as the horses and buffaloes, under the charge of the commissary of cattle, captain Burr; and his people were entrusted with the care of them. In the cold and wet season, which commenced in November, the camels became very sickly, and many of them had an eruption over the body. In the course of three months, I believe, more than three-fourths of these useful animals died. Captain Burr employed some Arabs, who were reputed to be skilful in the treatment of the camel. The plan which they followed I remember well. It was, after shaving or cutting the hair very close, to rub them all over with oil, daily. The men of the commissariat department were, during the day, constantly employed in these frictions, or in tending the cattle: and the great mortality among the camels happened in November, December, and January, the months in which the plague raged the most in the army. The circumstance I think not unworthy of notice; I leave others to ascribe to it what degree of importance they think it deserving of.
I have mentioned, that I thought I could see a characteristic similitude in many of the symptoms between the plague and the destructive fever which has for some years devastated the continent of America and the West India islands; and to the end of the account which I gave of the plague, I add a table of the principal points where it appeared to me that the two diseases agreed.[10] I am now glad to find, that in this opinion I do not stand alone; I have been particularly gratified to find that this is the opinion of so very respectable authority as Dr Chisholm.
I have had the greatest satisfaction in the perusal of the very complete history of the West India fever which Dr Chisholm gives. In most points, the result of my observations on this, coincides with the doctor’s. My experience, in a particular situation, supplied me with some very strong facts, touching the question of the contagious nature of this fever.
From my case-books and notes, while in the West Indies, I have thrown, under a few heads, a brief extract of the result of my observations, which I shall here insert. From the similitude which I think I can trace, this is not foreign to the principal subject of these Sketches; and, as the result of close observation, unattached to any theory, they may, perhaps, be not without interest or use.
1st. In Barbadoes, both in the end of 1795, and in the beginning of 1796, the only disease which prevailed was typhus. The 88th regiment was healthy at St Lucia, and continued pretty healthy at Grenada for three months after their arrival there, or as long as they remained to the windward side of the island. This was likewise the case with the 10th, 25th, and other regiments. It was only after our return to St George’s and to Richmond Hill, after we had communication with the 68th regiment, and the general hospitals, where the yellow fever had for many months prevailed, that it appeared in the 38th, and in the other corps.
2d. Before the appearance of this fever in the 88th, as well as in other corps, dysentery and intermittents prevailed most.
3d. On the 12th of July, 1796, a detachment of the 88th regiment was embarked at Grenada, in the Betsy transport, for England. We embarked one hundred and forty, and I was most particularly careful not to take any man on board with the slightest appearance of illness. Every precaution which regarded cleanliness, ventilation, or fumigation, was adopted. The remains of the 8th, 10th, 25th, and other regiments, were at the same time embarked, at Grenada, for England.
4th. From the time we sailed from Grenada, on the 19th of July to the 5th of August, seven days after we sailed from Tortola, (where we had touched for water) no case of this fever appeared in the Betsy. The other corps, which left Grenada along with us, had not been so fortunate. The 8th, 10th, and 25th regiments, all of them suffered severely on the passage from Grenada to Tortola; the 8th particularly. This corps, besides the loss of many non-commissioned officers, in this short passage, lost every officer on board, except the surgeon in second, and major and captain Armstrong; and these two gentlemen were ill of the yellow fever on coming into Tortola. I was requested to go on board to visit them, but the request was opposed by all the officers on board the Betsy, as well those of the ship as by the officers of the 88th regiment on board. So very much were all impressed with an opinion of the fatally infectious nature of this fever, that they remonstrated with me, and told me, that the ship and the regiment were now perfectly free from this fever; but that, by my going to see the 8th, I should certainly bring the fever into the Betsy. However, a second message having come for me to visit captain and major Armstrong, I instantly accompanied the messenger on board. From seeing the state of their transport, I immediately ordered major and captain Armstrong on shore, and accompanied them to the hotel. Here we found that the prejudices in the Betsy transport prevailed in the island of Tortola. The doors of the hotel were shut against the yellow fever, and it required a very forcible remonstrance to persuade them to admit these two officers, who, however, both of them, died the next day in the hotel.
5th. The state of the other corps, after sailing from Tortola, I am unacquainted with. When lying at Tortola, on the 29th and 30th of July, the Betsy communicated with the transports which had the 8th and 10th regiments on board. On the 6th of August, the first case of the yellow fever appeared on board the Betsy; from which period to the 12th of September, 1796, every person almost was once, and a great many on board twice, attacked with this fever. Of one hundred and forty people on board the Betsy, the captain of the ship, eighteen soldiers, and one woman, died in this period. It should, however, be mentioned, that, of the soldiers, several were old and worn-out invalids. During the passage from Tortola to England, our convoy, the Hebe frigate, suffered even more than the Betsy. When sent for on board, by Captain Scott, I found that he had not only lost many seamen and marines, but several officers, and two medical gentlemen.
6th. On the fleet, from Grenada, anchoring at Tortola, the yellow fever was unknown there; thereafter, I have heard, that it prevailed generally, and committed great havoc.
7th. Those labouring under dysentery, ague, &c. were those first seized with this fever.
8th. [Symptoms.]—The attack was first with extreme debility, affection of the head, and frequently the appearance of drunkenness. Next, the abdomen was complained of, and the biliary system appeared to be a principal seat of the disease. The yellowness, though not a constant, was a generally attending symptom. The eyes first appeared of a watery suffusion; they next were observed to be blood-shot; and, in a short time after, yellow; from the eye, the yellowness quickly spread over all the body, and the patient in a little time had the appearance of one highly jaundiced. Sometimes the yellow colour of the body continued for some time after the patient got well, and purgatives brought off yellow stools, while the urine was at the same time yellowish. The irritability of the stomach, and what is called the black vomiting, were pretty constant attending symptoms. The state of the pulse varied in the course of the disease; there was at first, almost always, a firm and strong pulse, with so much re-action, as would lead a stranger to the disease to blood-letting and the anti-phlogistic regimen. The bowels were, in general, very unequal; there was either a looseness or costiveness, though most frequently the latter.
9th. The duration of the disease was, in different cases, and in different situations, very different. In Grenada, when it first broke out, it generally ran its course from twenty-four, thirty-six, to forty-eight hours, in the hospitals. Soon after we sailed from Grenada, cases terminated in three days: thereafter, and as we approached the higher latitudes, and before we reached Ireland, cases were drawn out to ten, twelve, and fifteen days.
10th. The prognosis. The danger was generally in proportion to the degree of affection of the head, irritability of the stomach, and yellowness of the skin, and as these appeared early or not.
11th. In the treatment various modes were tried. Emetics appeared to be unnecessary; and, in general, seemed to do mischief, as did all antimonials. I have witnessed the practice of a large hospital, where blood-letting was premised in every case; but this was by no means a successful practice. In three cases in the Betsy, and where the state of the pulse and other symptoms seemed particularly to call for it, I performed venæsection; but I lost my three patients. Clearing the bowels appeared to be a principal indication: when this was repeatedly done by drastic purgatives, and when a free perspiration was kept up, there was always less complaint of the head, and, in some cases, a remission was thus obtained, and the bark could then be given with manifest advantage. In the few cases where it was used to produce salivation, calomel did more good than any other remedy whatever. I lost no case, where I succeeded in inducing a flow of saliva.
In some cases, and these all proved fatal, the gums became insensible to the effects of mercury; and though one drachm of calomel in one case, and two scruples in another, were given in a very short period, yet the patient died without a flow of saliva having been excited.
Nothing gave more relief than the cold bath; it generally suppressed the irritability of stomach for some time; it always induced sleep, and brought out a gentle sweat, which most commonly relieved the patient. The Brunonian practice I saw tried with no advantage.
These are the principal of the leading circumstances, regarding the yellow fever, which came immediately under my notice.
Dr Chisholm, when he formed the opinion of the similarity of the plague and the yellow fever, was not singular.
Since my arrival in England, I have received several letters addressed to me in Egypt, and which followed me from that country to India, and from thence to Europe; mostly answers to letters which I wrote from Egypt. By two of my West-India correspondents, in particular, this opinion is repeatedly expressed. I have several letters on the subject from two most respectable physicians, Dr Paterson, of Grenada, and Dr Robertson, of Barbadoes. From the opinion which he had formed, Dr Paterson repeatedly urges me to the use of mercury, and of the cold bath, in the plague.
Dr Robertson, in one letter says, “I decidedly agree with you, that there is a strong similitude between the symptoms of the yellow fever and the plague: although the latter disease never came under my observation, yet I was so struck with the appearance of yellow fever, and the histories of the other disease, which I had read, that, at one time, I was almost disposed to consider them both as different modifications of the same diseased state of body, and actually wrote a paper on the subject in February, 1797.”
In the practice in Egypt, Mr Price’s observation militates against the use of cold bathing in the plague. It should be recollected, however, that, when Mr Price made his observation, it was in the severest part of the season, when the plague raged the most, and when Mr Price laboured under many disadvantages in his practice. I anxiously wish to see cold bathing, or sponging, extensively tried in the plague. I have great expectations from it in that disease, from having so often seen how much it has done in the yellow fever and in typhus fever, where I consider it to be the most valuable part of the treatment.
In concluding, I am impelled to do an act of justice, and acquit myself of a debt of gratitude. The use of this invaluable remedy, and what else I know of tropical practice, I learned many years ago from my venerable and much-respected friend Dr Wright. By the use of the cold bathing, my life was saved in Jersey, in 1794, when I was ill of typhus fever, by Dr Jackson, then surgeon of the Buffs, who, at the same time, attended my hospital for me, and with the greatest benefit, and introduced this practice into the 88th regiment, where typhus then raged.
The use of cold water and cold bathing has since been diffused by the ingenious and elegant pen of Dr Currie. This I conceive to be one of the greatest improvements which the practice of physic has received in modern times.