It is to be lamented that the greatest part of all the deaths which occur, are from diseases that are under the power of medicine. To prevent their fatal issue, it would seem to be agreeable to the order of Heaven in other things, that they should be attacked in their forming state. Weeds, vermin, public oppression, and private vice, are easily eradicated and destroyed, if opposed by their proper remedies, as soon as they show themselves. The principal obstacle to the successful use of the antidotes of malignant fevers, in their early stage, arises from physicians refusing to declare when they appear in a city, and from their practice of calling their mild forms by other names than that of a mortal epidemic.
I shall now say a few words upon the success of the depleting practice in this epidemic.
From the more malignant state of the fever, and from the fears and prejudices that were excited against bleeding and mercury by means of the newspapers, the success of those remedies was much less than in the years 1793 and 1794. Hundreds refused to submit to them at the time, and in the manner, that were necessary to render them effectual. From the publications of a number of physicians, who used the lancet and mercury in their greatest extent, it appears that they lost but one in ten of all they attended. It was said of several practitioners who were opposed to copious bleeding, that they lost a much smaller proportion of their patients with the prevailing fever. Upon inquiry, it appeared they had lost many more. To conceal their want of success, they said their patients had died of other diseases. This mode of deceiving the public began in 1793. The men who used it did not recollect, that it is less in favour of a physician's skill to lose patients in pleurisies, colics, hæmorrhages, contusions, and common remittents, than in a malignant yellow fever.
Dr. Sayre attended fifteen patients in the disease, all of whom recovered by the plentiful use of the depleting remedies. His place of residence being remote from those parts of the city in which the fever prevailed most, prevented his being called to a greater number of cases.
A French physician, who bled and purged moderately, candidly acknowledged that he saved but three out of four of his patients.
In the city hospital, where bleeding was sparingly used, and where the physicians depended chiefly upon a salivation, more than one half died of all the patients who were admitted. It is an act of justice to the physicians of the hospital to add, that many, perhaps most of their patients, were admitted after the first day of the disease.
I cannot conclude this comparative view of the success of the different modes of treating the yellow fever, without taking notice, that the stimulating mode, as recommended by Dr. Kuhn and Dr. Stevens, in the year 1793, was deserted by every physician in the city. Dr. Stevens acknowledged the disease to require a different treatment from that which it required in the West-Indies; Dr. Kuhn adopted the lancet and mercury in his practice; and several other physicians, who had written against those remedies, or who had doubted of their safety and efficacy, in 1793, used them with confidence, and in the most liberal manner, in 1797.
In the histories I have given of the yellow fevers of 1793 and 1794, I have scattered here and there a few observations upon their degrees of danger, and the signs of their favourable or unfavourable issue. I shall close the present history, by collecting those observations into one view, and adding to them such other signs as have occurred to me in observing this epidemic.
Signs of moderate danger, and a favourable issue of the yellow fever.
1. A chilly fit accompanying the attack of the fever. The longer this chill continues, the more favourable the disease.