Appearances on Dissection.
| PLAGUE. | YELLOW FEVER. | FEVER of BOULLAM. | FEVER of PHILADELPHIA in 1793. |
| Bile of a black and greenish colour; turning quite black by the addition of spirit of nitre; a lasting grass green by adding spirit of vitriol; and of a yellow by the addition of alkalies. Heart of an extraordinary bigness; in seven cases stuffed with thick, black blood; in one, filled with a large polypus; in another the contents not mentioned. Lungs in five cases either purple, livid, or covered with spots of these colours. Liver greatly enlarged, with mortified spots in five cases. Stuffed also with thick blood. Mortifications in the brain, intestines, &c. Abscesses in two cases; one in the muscular integuments of the thorax, the other in the aorta. | Bile of a black colour, and very viscid. Stomach affected by gangrenous spots called carbuncles by Dr. Lining. Blood very fluid, and the vessels of the viscera much distended. Duodenum and other parts of the intestines mortified. Worms from putrefaction found in the stomach in six hours. Omentum and its appendages of a dark grey colour, and uncommonly dry. Liver and spleen enlarged. | Intestines mortified. Effusions of blood and serum in the brain. Liver sometimes shrunk up into half its natural size. | Bile very viscid. Congestion of blood in the brain. Blood in a fluid state. Stomach and intestines inflamed. Liver sometimes of its natural appearance. |
Fever of 1798.
Doctors Rand and Warren’s Dissections.
| Case I. Patient died on the 6th day. Lungs filled with dark blood. Air vessels not distended. Large extravasation of firmly coagulated blood in the thorax. Fluid blood in the pericardium. Coronary veins extremely distended. Liver inflamed on both sides, and indurated as if boiled. Gall bladder contracted, and containing only about a quarter of an ounce of a substance resembling pitch. The secretion of bile had apparently ceased for some time. Stomach and intestines inflamed, and their veins distended. Omentum thickened and dark coloured from the swelling of its vessels. Spleen enlarged but without inflammation. | Case II. Death on the 12th day. Patient had been delirious since the 6th. Blood vessels of the brain greatly distended. An effusion of serum between the dura and pia mater. A band of coagulated lymph producing an adhesion between the two coverings of the brain, under the sagittal suture. Lungs adhered firmly to the pleura, and had several indurations of the size of a pigeon’s egg. Left lobe extremely diseased, and in a state of suppuration. Liver much enlarged and inflamed, the inside of the great lobe near the gall bladder appearing as if contused. Stomach covered on the inside with the matter of the black vomit, though the patient had no evacuation of that kind. Duodenum and small intestines much inflamed. Gall bladder full of bile, and ducts pervious. Bladder contracted to the size of a pullet’s egg, with a quantity of blood effused in it. | Case III. Death on the fourth day. Lungs inflamed on
the fore part, and exceedingly stuffed with blood in the back
parts. Liver inflamed, and of a very dense consistence.
Gall bladder entirely obliterated; its coats forming a confused
membranous substance by coalescence with the neighbouring
parts. Stomach covered in the inside with the
black vomit. Colon and part of the omentum inflamed. In the two cases where the gall bladder had been diseased, and the liver did not perform its functions, the patients became yellow; but not in the other, where the bile was in due quantity. In the second case the patient had previously had a pulmonary complaint. |
“Nevertheless, if this distemper was as contagious as certain physicians pretend, why should they not be the first to be taken with it; they who see, examine and touch many patients every day? Why should not those who nurse them day and night, who continually breathe those putrid miasmata; why should not those who attend the hospitals, those who daily carry 30 or 40 coffins to the grave, be taken with it? We do not hear, however, that the physicians, surgeons, nurses and sextons have enlarged the funeral list more than any other class of citizens. Some doubtless have fallen, and perhaps they owed their death to their frequent communications with the sick; but would the epidemic have spared them in any other condition, more than a number of unfortunate people who are neither physicians nor nurses?
“Another particular not less remarkable is, that the yellow fever seems hitherto to have spared the Frenchmen who have resided in the West India colonies, the greatest part of whom have nevertheless staid in New York and Philadelphia during the yellow fever, and have lived in the midst of the contagious air which proves so fatal to the Americans. The result of all this is, that, notwithstanding four years’ experience, notwithstanding the public and private researches and discussions which took place between the physicians and philosophers of the American continent, there is still much uncertainty on the nature of the distemper which so rapidly depopulates New York and Philadelphia. Every opinion, every system, presents palpable contradictions, and is liable to objections which it is difficult, not to say impossible, to answer in a satisfactory manner. If the disease be contagious, why are not the physicians, the nurses, the servants of the hospitals, taken sooner than persons who have no sort of communication with the sick?
“If it be not contagious, how happens it that the natives of every age and sex, many of which, the women and children especially, live in a pretty sober manner, and seldom drink any of those liquors so liable to inflame the blood, are taken with it, and fall, in spite of all the efforts of medicine? How happens it that the Europeans and Frenchmen who have never been in the colonies are attacked like the Americans, whilst the planters in the West Indies are spared?