Seaport in Virginia / George Washington's Alexandria

by Gay Montague Moore

I am in great hopes that the instructions I shall be able to give thee with regard to the general treatment of the prevailing disease, will be found on trial to be so far successful as to quiet in a good measure thy present apprehensions. Having received applications by letter from several physicians at a distance requesting information as to the character of the disease and the plan of treatment possessed by myself, I have thrown together a few practical remarks, which I shall here transcribe, and then add such other observations as may seem more especially necessary for thee in the present emergency.

The disease usually commences with a chill, succeeded by fever and accompanied either in the beginning or at a subsequent stage with pain in the head back breast or sides, and sometimes with an affection of the throat.

Though it is a disease attended sometimes if not generally with signs of local inflammation, yet owing to some peculiar affection or tendency of the nervous system, blood letting is in my opinion inadmissible. Of those who have been bled it has appeared that they either die or have tedious recoveries.

The disease is frequently though not always of a bilious character—that is an abundance of bile is found floating in the stomach or intestines. There seems to be neither torpor nor enlargement of the liver which have characterized the diseases of this country for 21 years past; hence culomel especially in the beginning has been avoided.

Emetics, if employed at all, (and in some cases they may be necessary) should not be given till the intestines have been well evacuated. The leading curative indication is purging, for which purpose Glaubers Salt has been preferred as acting upon the bowels with most ease and certainty. The purging process to be diligently persisted in, day and night or day after day according to the force and duration of the disease.

Warm, stimulating drinks such as toddy, made of whiskey, is frequently, though not in every case, indispensible. This stimulus, is to be resorted to whenever there are signs of prostration of body or mind, both in the beginning and after stages of the disease.

Excessive pain in the trunk may be generally mitigated in every stage of the disease by anodyne injections; for an adult two or three teaspoonsful of laudunum with a half pint of warm water. A beneficial persperation often follows this exhibition. Spontaneous sweats are commonly useful, but I have not found them critical.

Blisters may be employed for the mitigation of pain, and perhaps ought not to be omitted when ... is either fever [?] is obstinate, but I have not found them in this disease to evidence their usually efficacy.

If the disease be attended with sore throat, swelling of the tonsils or palate, stricture of the trachea, with or without external swelling, a gargle of warm strong toddy, in the water of which has been boiled a pod of red pepper, will it is believed from past experience, be found uniformly and promptly effectual even in cases when suffacation seems immediately threatened. When this affection has existed to any considerable extent, I have generally with the use of the gargle also applied a blister around the throat.

In order that thou may not easily be discouraged in the prosecution of the purging plan, it is necessary to inform thee that I often find it expedient to give 3 to 6 ounces of salts in 24 hours. I usually divide 2 ounces into three portions giving one every two hours dissolved in a teacupful thin gruel. When the bowels are brought readily and freely into operation I have little difficulty in the management of the case—but I never discontinue the process till all fever and pain have subsided. Sometimes when the salts appear to be in operation I interpose with 60 or 70 grains of the cathartic powder repeated at intervals of two or three hours. When there is a despression of the pulse and something of coldness of the extremities, especially of the feet, I use with advantage mustard plaster to the feet, to which in such cases may be added with advantage hot bricks or bottles of hot water to various parts of the body.