2. There were open cases, in which the pulse was full and tense as in a pleurisy or rheumatism, from the beginning to the end of the fever. They were generally attended with a good deal of pain.
3. There were depressed or locked cases, in which there were a sense of great debility, but little or no pain, a depressed and slow pulse, a cool skin, cold hands and feet, and obstructed excretions.
4. There were divided or mixed cases, in which the pulse was active until the 4th day, after which it became depressed. All the other symptoms of the locked state of the fever accompanied this depressed state of the pulse.
5. There were cases in which the pulse imparted a perception like that of a soft and shattered quill. I have before mentioned that this state of the pulse occurred in Dr. Jones and Dr. Dobell. I felt it but once, and on the day of his attack, in the latter gentleman, and expressed my opinion of his extreme danger to one of my pupils upon my return from visiting him. I did not meet with a case which terminated favourably, where I perceived this shattered pulse. A disposition to sweat occurred in this state of the fever.
6. There were what Dr. Caldwell happily called walking cases. The patients here were flushed or pale, had a full or tense pulse, but complained of no pain, had a good appetite, and walked about their rooms or houses, as if they were but little indisposed, until a day or two, and, in some instances, until a few hours before they died. We speak of a dumb gout and dumb rheumatism; with equal propriety, the epithet might be applied to this form of yellow fever in its early stage. The impression of the remote cause of the fever, in these cases, was beyond sensation, for, upon removing a part of it by bleeding or purging, the patients complained of pain, and the excitement of the muscles passed so completely into the blood-vessels and alimentary canal, as to convert the fever into a common and more natural form. These cases were always dangerous, and, when neglected, generally terminated in death. Mr. Brown's fever came on in this insidious shape. It was cured by the loss of upwards of 100 ounces of blood, and a plentiful salivation.
7. There was the intermitting form in this fever. This, like the last, often deceived the patient, by leading him to suppose his disease was of a common or trifling nature. It prevented Mr. Richard Smith from applying for medical aid in an attack of the fever for several days, by which means it made such an impression upon his viscera, that depleting remedies were in vain used to cure him. He died in the prime of life, beloved and lamented by a numerous circle of relations and friends.
8. There was a form of this fever in which it resembled the mild remittent of common seasons. It was distinguished from it chiefly by the black colour of the intestinal evacuations.
9. There were cases of this fever so light, that patients were said to be neither sick nor well; or, in other words, they were sick and well half a dozen times in a day. Such persons walked about, and transacted their ordinary business, but complained of dulness, and, occasionally, of shooting pains in their heads. Sometimes the stomach was affected with sickness, and the bowels with diarrhœa or costiveness. All of them complained of night sweats. The pulse was quicker than natural, but seldom had that convulsive action which constitutes fever. Purges always brought away black stools from such patients, and this circumstance served to establish its relationship to the prevailing epidemic. Now and then, by neglect or improper treatment, it assumed a higher and more dangerous grade of the fever, and became fatal, but it more commonly yielded to nature, or to a single dose of purging physic.
10. There were a few cases in which the skin was affected with universal yellowness, but without more pain or indisposition than usually occurs in the jaundice. They were very frequent in the year 1793, and generally prevail in the autumn, in all places subject to bilious fever.
11. There were chronic cases of this fever. It is from the want of observation that physicians limit the duration of the yellow fever to certain days. I have seen many instances in which it has been protracted into what is called by authors a slow nervous fever. The wife of captain Peter Bell died with a black vomiting after an illness of nearly one month. Dr. Pinckard, formerly one of the physicians of the British army in the West-Indies, in a late visit to this city informed me, that he had often seen the yellow fever put on a chronic form in the West-India islands.