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

by Benjamin Rush

The scarlatina continued to be the reigning disease. I saw one fatal case of it, in which a redness only, without any ulcers or sloughs, appeared in the throat; and I attended another, in which a total immobility in the limbs was substituted by nature for the pain and swellings in those parts which generally attend the disease. There were three distinct grades of this epidemic. It was attended with such inflammatory or malignant symptoms, in some instances, as to require two or three bleedings; in others it appeared with a typhoid pulse, which yielded to emetics: turbith mineral was preferred for this purpose; while a redness, without a fever, which yielded to a single purge, was the only symptom of it in many people.

The weather was cool, rainy, and hot, in succession, in the month of June. The scarlatina continued to be the prevailing disease.

During the first and second weeks in July, there fell a good deal of rain. On the 4th of the month I was called to visit Mrs. Harris, in Front-street, between Arch and Market-streets, with a bilious fever. The scarlatina had imparted to it a general redness on her skin, which induced her to believe it was that disease, and to neglect sending for medical relief for several days. She died on the 13th of the month, with a red eye, a black tongue, hiccup, and a yellow skin. Three other cases of malignant bilious fever occurred this month. Two of them were attended by Dr. Dewees and Dr. Otto.

On the 15th of the month, the city was alarmed by an account of this fever having appeared near the corners of Front and Vine-streets, a part of the city which had for many weeks before been complained of by many people for emitting a fœtid smell, derived from a great quantity of filthy matters stagnating in that neighbourhood, and from the foul air discharged from a vessel called the Esperanza, which lay at Vine-street wharf.

On the 2d of August, it appeared in other parts of the city, particularly in Front and Water-streets, near the draw-bridge, where it evidently originated from putrid sources. Reports were circulated that it was derived from contagion, conveyed to Vine-street wharf in the timbers of a vessel called the St. Domingo Packet, but faithful and accurate inquiries proved that this vessel had been detained one and twenty days, and well cleaned at the lazaretto, and that no one, of fourteen men who had worked on board of her afterwards, had been affected with sickness of any kind.

On the 5th of August, the board of health publicly declared the fever to be contagious, and advised an immediate desertion of the city. The advice was followed with uncommon degrees of terror and precipitation.

The disease continued, in different parts of the city, during the whole of August and September. On the 5th of October, the citizens were publicly invited from the country by the board of health.

During this season, the yellow fever was epidemic in Baltimore and Wilmington. In the former place it was admitted by their board of health, and in the latter it was proved by Dr. Vaughan, to be of domestic origin. It prevailed, at the same time, in Sussex county and near Woodbury, in New-Jersey. Sporadic cases of it likewise occurred in New-York and Boston, and in Portsmouth, in New-Hampshire. The chronic fever was epidemic in several of the towns of North-Carolina; cases of fever, which terminated in a swelling and mortification of the legs, and in death on the third day, appeared on the waters of the Juniata, in Pennsylvania; and bilious fevers, of a highly inflammatory grade, were likewise common near Germantown and Frankford, in the neighbourhood of Philadelphia.

But few of the cases of yellow fever which have been mentioned came under my care, but I saw a considerable number of fevers of a less violent grade. They were the inflammatory, bilious, mild remitting, chronic, and intermitting fevers, and the febricula. They appeared, in some instances, distinct from each other, but they generally blended their symptoms in their different stages. The yellow fever often came on in the mild form of an intermittent, and even a febricula, and as often, after a single paroxysm, ended in a mild remittent or chronic fever. When it appeared in the latter form, it was frequently attended with a slow or low pulse, and a vomiting and hiccup, such as attend in the yellow fever. This diversity of symptoms, with which the summer and autumnal fever came on, made it impossible to decide upon its type on the day of its attack. Having been deceived in one instance, I made it a practice afterwards to watch every case I was called to with double vigilance, lest it should contract a malignant form in my hands, without my being prepared to meet it. Of the five original and obvious cases of yellow fever to which I was called, I saved none, for I saw but one of them before the last stage of the disease. In many others, I have reason to believe I prevented that malignant form of fever, by the early and liberal use of depleting medicines. The practice of those physicians who attended most of the persons who had the yellow fever, was much less successful than in our former epidemics. I suspected at the time, and I was convinced afterwards, that it was occasioned by relying exclusively upon bleeding, purges, and mercury. The skin, in several of the cases which I saw, was covered with moisture. This clearly pointed out nature's attempt to relieve herself by sweating. Upon my mentioning this fact to the late Dr. Pfeiffer, jun. he instantly adopted my opinion, and informed me, as a reason for doing so, that he had heard of several whole families in the Northern Liberties, where the disease prevailed most, who, by attacking it in its forming state by profuse sweats, had cured themselves, without the advice of a physician.