I was struck, during my attendance upon this fever, in observing the analogy between its mixed form and the malignant state of the small-pox. The fever, in both, continues for three or four days without any remission. They both have a second stage, in which death usually takes place, if the diseases be left to themselves. By means of copious bleeding in their first, they are generally deprived of their malignity and mortality in their second stage. This remark, so trite in the small-pox, has been less attended to in the yellow fever. The bleeding in the first stage of this disease does not, it is true, destroy it altogether, any more than it destroys an eruption in the second stage of the small-pox, but it weakens it in such a manner that the patient passes through its second stage without pain or danger, and with no other aid from medicine than what is commonly derived from good nursing, proper aliment, and a little gently opening physic.
It is common with those practitioners who object to bleeding in the yellow fever, to admit it occasionally in robust habits. This rule leads to great error in practice. From the weak action of predisposing, or exciting causes, the disease often exists in a feeble state in such habits, while from the protracted or violent operation of the same causes, it appears in great force in persons of delicate constitutions. A physician, therefore, in prescribing for a patient in this fever, should forget the natural strength of his muscles, and accommodate the loss of blood wholly to the morbid strength of his disease.
The quantity of blood drawn in this fever was always proportioned to its violence. I cured many by a single bleeding. A few required the loss of upwards of a hundred ounces of blood to cure them. The persons from whom that large quantity of blood was taken, were, Messieurs Andrew Brown, Horace Hall, George Cummins, J. Ramsay, and George Eyre. But I was not singular in the liberal and frequent use of the lancet. The following physicians drew the quantities of blood annexed to their respective names from the following persons, viz.
| Dr. Dewees | 176 | ounces from | Dr. Physick, |
| Dr. Griffitts | 110 | Mr. S. Thomson, | |
| Dr. Stewart | 106 | Mrs. M'Phail, | |
| Dr. Cooper | 150 | Mr. David Evans, | |
| Dr. Gillespie | 103 | himself. |
All the above named persons had a rapid and easy recovery, and now enjoy good health. I lost but one patient who had been the subject of early and copious bleeding. His death was evidently induced by a supper of beef-stakes and porter, after he had exhibited the most promising signs of convalescence.
OF PURGING.
From the great difficulty that was found in discharging bile from the bowels, by the common modes of administering purges, Dr. Griffitts suggested to me the propriety of giving large doses of calomel, without jalap or any other purging medicine, in order to loosen the bile from its close connection with the gall-bladder and duodenum, during the first day of the disease. This method of discharging acrid bile was found useful. I observed the same relief from large evacuations of fœtid bile, in the epidemic of 1797, that I have remarked in the fever of 1793. Mr. Bryce has taken notice of the same salutary effects from similar evacuations, in the yellow fever on board the Busbridge Indiaman, in the year 1792. His words are: “It was observable, that the more dark-coloured and fœtid such discharges were, the more early and certainly did the symptoms disappear. Their good effects were so instantaneous, that I have often seen a man carried up on deck, perfectly delirious with subsultus tendinum, and in a state of the greatest apparent debility, who, after one or two copious evacuations of this kind, has returned of himself, and astonished at his newly acquired strength[2].” Very different are the effects of tonic remedies, when given to remove this apparent debility. The clown who supposes the crooked appearance of a stick, when thrust into a pail of water, to be real, does not err more against the laws of light, than that physician errs against a law of the animal economy, who mistakes the debility which arises from oppression for an exhausted state of the system, and attempts to remove it by stimulating medicines.
After unlocking the bowels, by means of calomel and jalap, in the beginning of the fever, I found no difficulty afterwards in keeping them gently open by more lenient purges. In addition to those which I have mentioned in the account of the fever of 1793, I yielded to the advice of Dr. Griffitts, by adopting the soluble tartar, and gave small doses of it daily in many cases. It seldom offended the stomach, and generally operated, without griping, in the most plentiful manner.