A desire to ride out, or to go home, in persons who were absent from their families, was, in every instance where it took place, a fatal symptom. These desires arose from an insensibility to pain, or a false idea of the state of the disease. It existed to such a degree in some of the patients in the city hospital, that they often left their beds, and dressed themselves, in order to go home. All these patients died, and some of them in the act of putting on their clothes.
From the history that has been given of the symptoms, treatment, and prognosis of this fever, we see how imperfect all treatises upon epidemics must be, which are not connected with climate and season. As well might a traveller describe a foreign climate, by the state of the weather, or by the productions of the earth, during a single autumn, as a physician adopt a uniform opinion of the history, treatment, and prognosis of a fever, from its phenomena in any one country, or during a single season.
There were three modes of practice used in this epidemic. The first consisted in the exhibition of purges of castor oil, salts, and manna, and cooling glysters, and in the use of the warm bath. These remedies were prescribed chiefly by the French physicians. The second consisted in the use of mercury alone, in such doses, and in such a manner, as to excite a salivation. This mode was used chiefly by an itinerant and popular quack. The third mode consisted in using all the remedies which I have mentioned in the account of the treatment of this fever, and accommodating them to the state of the disease. This mode of practice was followed by most of the American physicians.
The first mode of practice was the least successful. It succeeded only in such cases as would probably have cured themselves.
The second mode succeeded in mild cases, and now and then in that malignant state of the fever, in which the action of the blood-vessels was so much prostrated by the force of the miasmata, as to permit the mercury to pass over them, and thus to act upon the salivary glands in the course of four or five days.
The last mode was by far the most successful. It is worthy of notice, that the business and reputation of the physicians, during this epidemic, were in the inverse ratio of their success. The number of deaths by it amounted to between three and four thousand, among whom were three physicians, and two students of medicine. Its mortality was nearly as great as it was in 1793, and yet the number of people who were affected by it was four times as great in 1793 as it was in 1798, for, in the latter year, the city was deserted by nearly all its inhabitants. The cause of this disproportion of deaths to the number who were sick, was owing to the liberal and general use of the lancet in 1793, and to the publications in 1797 having excited general fears and prejudices against it in 1798. Such was the influence of these publications, that many persons who had recovered from this fever in the two former years, by the use of depleting remedies, deserted the physicians who had prescribed them, and put themselves under the care of physicians of opposite modes of practice. Most of them died. Two of them had been my patients, one of whom had recovered of a third attack of the fever under my care.
Footnote:
[8] History of the Fever in 1797.