“I was surprised to find so few marks of hepatic affection. I met with but two cases in which the patient could lie only on the right side. Many complained of a dull pain in the region of the liver, but very few complained of that soreness to the touch, about the pit of the stomach, which is taken notice of by authors, and which was universal in the yellow fever of 1762. In proportion as the cool weather advanced, a preternatural determination of the blood took place to the brain and lungs. Many were affected with pneumonic symptoms, and some appeared to die of sudden effusions of blood or serum in the lungs. . . . The disease seldom appeared without nausea or vomiting. In some cases they both occured for several days, or a week, before any fever took place. This was more frequently the case where the disease was taken by exhalation from the putrid coffee, than by contagion. The stomach was so extremely irritable as to reject drinks of every kind. Sometimes green or yellow bile was rejected on the first day of the disorder; but I much oftener saw it continue for two days without discharging any thing from the stomach, but the drinks which the patient had taken. If the fever in any case came on without vomiting, or if it had been checked by remedies that were ineffectual to remove it altogether, it generally appeared or returned on the 4th or 5th day of the disorder. I dreaded this symptom on those days; for, though it was not always the forerunner of death, yet it generally rendered the recovery more difficult and tedious. In some cases the vomiting was more or less constant from the beginning to the end of the disorder, whether it terminated in life or death. The vomiting which came on about the 4th or 5th day was accompanied with a burning pain in the region of the stomach. It produced great anxiety and tossing of the body from one part of the bed to another. In some cases this painful burning occured before any vomiting took place. Drinks were now rejected so suddenly as often to be discharged over the hand that lifted them to the head of the patient. The contents of the stomach were sometimes thrown up with a convulsive motion which propelled them in a stream to a great distance, and in some cases all over the clothes of the by-standers. . . . On the first and second days many puked from half a pint to nearly a quart of yellow or green bile. In four (three of whom recovered) the bile, even at this time, was black. On the 4th or 5th day a matter resembling coffee-grounds was discharged. . . . Many recovered in whom this symptom appeared. Towards the close of the disease there was a discharge of a deep or pale-coloured black matter, with flakey substances frequently swimming on the top of it.”
A quantity of grumous blood, dark coloured on the outside, was frequently discharged by vomit towards the end of the disease; and, along with all the discharges from the stomach, there was occasionally a large worm, and frequently large quantities of mucus and tough phlegm. Our author supposes the black blood and coffee-coloured matter to be different from that which constitutes the true black vomit. This last he supposes to arise in some cases from matter formed in consequence of a mortification of the stomach.
The bowels were generally costive, sometimes with extreme pain, tenesmus, and mucous and bloody discharges. Sometimes the disease came on with diarrhœa, principally in those who had weak bowels. Sometimes there was a tension of the abdomen, with pain in the lower part of it. Flatulency, chiefly in the stomach, was almost universal in the disorder throughout all its stages.
The colour and consistence of the fæces was various according to the mode of treatment the patient had undergone. Where they were spontaneous, or brought away only by gentle purgatives, their appearance was natural; but when the patient was strongly purged, they were dark-coloured, fœtid, and in large quantity. The colour was sometimes green, sometimes olive. Their fœtor was proportioned to the time they had been detained in the bowels. In one case, where tonics had been used, and the patient had no stool for several days, a purge produced such an excessively fœtid discharge, that the smell produced fainting in an old woman who attended. Their acrimony was so great that the rectum was excoriated, and an extensive inflammation sometimes produced round its extremity. In some cases the stools were as white as in the jaundice. Large round worms were frequently discharged with them.
The urine in this disease was sometimes plentiful and high-coloured, sometimes clear, and sometimes turbid; sometimes discharged with a burning pain, as in a gonorrhœa; sometimes it was suppressed; and in one case the patient voided several quarts of limpid urine just before he died.
Many were relieved on the first day by sweats, sometimes spontaneous, and sometimes produced by diluting drinks, or strong purges; sometimes of a yellow colour, and offensive smell. Sometimes they were cold, though the pulse was full at the same time. In general, however, the skin was dry, and there were but few instances of the disease terminating by sweat after the third day. In some there was a great discharge of mucus from the throat, occasioning an almost constant hawking and spitting; and those always recovered.
In this fever, as in that of Boullam, and in the true plague, people sometimes fell down suddenly in apoplexy, syncope or universal convulsions. Some had numbness and immobility of their limbs. Some had a coma (a continual sleepiness) or an obstinate wakefulness; the latter chiefly attended a state of convalescence. In some the distemper began with a violent cramp in the legs or arms. The last stage was attended with a strong hiccup, which was a very dangerous symptom, as indeed it is in all fevers. In some cases there was a deficiency of sensibility, in others too much, so that the mere motion of the limbs was attended with pain.
In this, as in the Boullam fever, the patient often manifested a considerable degree of strength, even without any delirium. One of Dr. Rush’s patients stood up before a looking-glass, and shaved himself, the day on which he died. A delirium, however, was common, alternating in some cases with the exacerbations and remissions of the fever, but in some continuing without intermission to a few hours before death. Some had maniacal symptoms, without any appearance of fever; but in many the understanding was not impaired throughout the whole course of the disease.
In this disease the pains in almost every part of the body were very distressing. In those cases, however, “where the system sunk under the violent impression of the contagion, there was little or no pain.” In other cases the patients were distressed with pains in their head, particularly affecting the eyeballs. Sometimes it extended from the back down the neck. A pain was felt in the ears, as if they were drawn together by strings. The sides, stomach, liver and bowels were all affected. A burning pain in the stomach was sometimes so excessive that the patient shrieked out violently. The back was often the seat of violent pain, which sometimes extended from the back to the thighs; and the arms and legs were sometimes affected in such a manner that one patient said his limbs felt as if scraped with a sharp instrument.
The thirst was generally moderate, but sometimes otherwise; and, when excessive thirst came on in the last stage of the disorder, it was a dangerous symptom. Water was preferred to all other drinks. The appetite for food returned much sooner in this than in other fevers, and was excessively keen. Coffee was relished in the remissions, in every stage of the disorder. Wine was disliked, but malt-liquors were agreeable. In some cases the recovery was attended with a great propensity to venery, as in the true plague, but in an inferior degree.