Medical Inquiries and Observations, Vol. 4 / The Second Edition, Revised and Enlarged by the Author

by Benjamin Rush

The gutters emitted, in many places, a sulphureous smell during the prevalence of the fever. Upon rubbing my hands together I could at any time excite a similar smell in them. I have taken notice of this effect of the matters which produced the disease upon the body, in the year 1794.

In order to prevent an attack of the fever, I carefully avoided all its exciting causes. I reduced my diet, and lived sparingly upon tea, coffee, milk, and the common fruits and garden vegetables of the season, with a small quantity of salted meat, and smoked herring. My drinks were milk and water, weak claret and water, and weak porter and water. I sheltered myself as much as possible from the rays of the sun, and from the action of the evening air, and accommodated my dress to the changes in the temperature of the atmosphere. By similar means, I have reason to believe, many hundred people escaped the disease, who were constantly exposed to it.

The number of deaths by the fever, in the months of August, September, and October, amounted to between ten and eleven hundred. In the list of the dead were nine practitioners of physic, several of whom were gentlemen of the most respectable characters. This number will be thought considerable when it is added, that not more than three or four and twenty physicians attended patients in the disease. Of the survivors of that number, eight were affected with the fever. This extraordinary mortality and sickness among the physicians must be ascribed to their uncommon fatigue in attending upon the sick, and to their inability to command their time and labours, so as to avoid the exciting causes of the fever.

Among the medical gentlemen whose deaths have been mentioned, was my excellent friend, Dr. Nicholas Way. I shall carry to my grave an affectionate remembrance of him. We passed our youth together in the study of medicine, and lived to the time of his death in the habits of the tenderest friendship. In the year 1794, he removed from Wilmington, in the Delaware state, to Philadelphia, where his talents and manners soon introduced him into extensive business. His independent fortune furnished his friends with arguments to advise him to retire from the city, upon the first appearance of the fever. But his humanity prevailed over the dictates of interest and the love of life. He was active and intelligent in suggesting and executing plans to arrest the progress of the disease, and to lessen the distresses of the poor. On the 27th of August, he was seized, after a ride from the country in the evening air, with a chilly fit and fever. I saw him the next day, and advised the usual depleting remedies. He submitted to my prescriptions with reluctance, and in a sparing manner, from an opinion that his fever was nothing but a common remittent. To enforce obedience to my advice, I called upon Dr. Griffitts to visit him with me. Our combined exertions to overcome his prejudices against our remedies were ineffectual. At two o'clock in the afternoon, on the sixth day of his disease, with an aching heart I saw the sweat of death upon his forehead, and felt his cold arm without a pulse. He spoke to me with difficulty: upon my rising from his bed-side to leave him, his eyes filled with tears, and his countenance spoke a language which I am unable to describe. I promised to return in a short time, with a view of attending the last scene of his life. Immediately after I left his room, he wept aloud. I returned hastily to him, and found him in convulsions. He died a few hours afterwards. Had I met with no other affliction in the autumn of 1797 than that which I experienced from this affecting scene, it would have been a severe one; but it was a part only of what I suffered from the death of other friends, and from the malice of enemies.

I beg the reader's pardon for this digression. It shall be the last time and place in which any notice shall be taken of my sorrows and persecutions in the course of these volumes.

Soon after the citizens returned from the country, the governor of the state, Mr. Mifflin, addressed a letter to the college of physicians of Philadelphia, requesting to know the origin, progress, and nature of the fever which had recently afflicted the city, and the means of preventing its return. He addressed a similar letter to me, to be communicated to such gentlemen of the faculty of medicine, as were not members of the college of physicians.

The college, in a memorial to the legislature of the state, asserted that the fever had been imported in two ships, the one from Havannah, the other from Port au Prince, and recommended, as the most effectual means of preventing its recurrence, a more rigid quarantine law.

The gentlemen of the faculty of medicine, thirteen in number, in two letters to the governor of the state, the one in their private capacity, and the other after they had associated themselves into an “Academy of Medicine,” asserted that the fever had originated from the putrid exhalations from the gutters and streets of the city, and from ponds and marshy grounds in its neighbourhood; also from the foul air of two ships, the one from Marseilles and the other from Hamburgh. They enumerated all the common sources of malignant fevers, and recommended the removal of them from the city, as the most effectual method of preventing the return of the fever. These sources of fever, and the various means of destroying them, shall be mentioned in another place.

I proceed now to say a few words upon the treatment which was used in this fever. It was, in general, the same as that which was pursued in the fevers of 1793 and 1794.

I began the cure, in most cases, by bleeding, when I was called on the first day of the disease, and was happy in observing its usual salutary effects in its early stage. On the second day, it frequently failed of doing service, and on the subsequent days of the fever, I believe, it often did harm; more especially if no other depleting remedy had preceded it. The violent action of the blood-vessels in this disease, when left to itself for two or three days, fills and suffocates the viscera with such an immense mass of blood, as to leave a quantity in the vessels so small, as barely to keep up the actions of life. By abstracting but a few ounces of this circulating blood, we precipitate death. In those cases where a doubt is entertained of such an engorgement of stagnating blood having taken place, it will always be safest to take but three or four ounces at a time, and to repeat it four or five times a day. By this mode of bleeding, we give the viscera an opportunity of emptying their superfluous blood into the vessels, and thereby prevent their collapsing, from the sudden abstraction of the stimulus which remained in them. I confine this observation upon bleeding, after the first stage of the disease, only to the epidemic of 1797. It was frequently effectual when used for the first time after the first and second days, in the fevers of 1793 and 1794, and it is often useful in the advanced stage of the common bilious fever. The different and contradictory accounts of the effects of bleeding in the yellow fever, in the West-Indies, probably originate in its being used in different stages of the disease. Dr. Jackson, of the British army, in his late visit to Philadelphia, informed me, that he had cured nineteen out of twenty of all the soldiers whom he attended, by copious bleeding, provided it was performed within six hours after the attack of the fever. Beyond that period, it mitigated its force, but seldom cured. The quantity of blood drawn by the doctor, in this early stage of the disease, was always from twenty to thirty ounces. I have said the yellow fever of 1797 was more malignant than the fevers of 1793 and 1794. Its resemblance to the yellow fever in the West-Indies, in not yielding to bleeding after the first day, is a proof of this assertion.