The fever prevailed at the same time in the town of Chester, in Pennsylvania; in Wilmington, in the state of Delaware; in New-York; in New-London, in Connecticut; in Windsor, in Vermont; and in Boston; in all which places its origin was traced to domestic sources.
I shall now deliver a short account of the remedies employed in the cure of this disease.
I have said that the pulse was less active in this fever than in the fevers of former years. It was seldom, however, so feeble as to forbid bleeding. In Dr. Mease it called for the loss of 162 ounces of blood, and in Mr. J. C. Warren for the loss of 200, by successive bleedings, before it was subdued. But such cases were not common. In most of them, the pulse flagged after two or three bleedings. But there were cases in which the lancet was forbidden altogether. In these, the system appeared to be prostrated, by the force of the miasmata, below the point of re-action. This state of the disease manifested itself in a weak, quick, and frequent pulse, languid eye, sighing, great inquietude, or great insensibility. However unsafe bleeding was on the first day of this fever, when it appeared with those symptoms, nature often performed that operation upon herself from the gums, on the fourth or fifth day. I saw several pounds of blood discharged on those days, and in that way, with the happiest effects. It appeared to take place after the revival of the blood-vessels from their prostrated state.
From a conviction that the system was depressed only in these cases, and finding that it did not rise upon blood-letting, I resolved to try the effects of emetics, in exciting and equalizing the action of the blood-vessels. The experience I had had of the inefficacy of this remedy in 1793, and of its ill effects in one instance in 1797, led me to exhibit it with a trembling hand. I gave it for the first time to a son of Richard Renshaw. I had bled him but once, and had in vain tried to bring on a salivation. On the fifth day of his disease, his pulse became languid and slow, his skin cool, a hæmorrhage had taken place from his gums, and he discovered a restlessness and anxiety which I had often seen a few hours before death. He took four grains of tartar emetic, with twenty grains of calomel, at two doses. They operated powerfully, upwards and downwards, and brought away a large quantity of bile. The effects of this medicine were such as I wished. The next day he was out of danger. I prescribed the same medicine in many other cases with the same success. To several of my patients I gave two emetics in the course of the disease. Some of them discharged bile resembling in viscidity the white of an egg. But I saw one case in which great relief was obtained from the operation of an emetic, where no bile was discharged.
In the exhibition of this remedy, I was regulated by the pulse. If I found it languid on the first day of the fever, I gave it before any other medicine. When it was full and tense, I deferred it until I had reduced the pulse to the emetic point by bleeding and purges. I observed, with great pleasure, that mercury affected the mouth more speedily and certainly where an emetic had been administered, than in other cases, probably from awakening, by its stimulus, the sensibility of the stomach; for such was its torpor, that in one case ten grains of tartar emetic, and in another thirty grains, did not operate upon it, so as to excite even the slightest degree of nausea.
In many cases, an emetic, given in the forming state of the disease, seemed to effect an immediate cure.
Purges produced the same salutary effects that they did in former years. I always combined calomel with them in the first stage of the disease.
A salivation was found to be the most certain remedy of any that was used in this fever. I did not lose a single patient, in whom the mercury acted upon the salivary glands. It was difficult to excite it in many cases, from the mercury being rejected by the stomach, from its passing off by the bowels, or from its stimulus being exceeded by the morbid action in the blood-vessels.