“Through the whole period of the sickness scarcely a person was taken ill who had not resided, or been in daily employment, in the vicinity of these places. The subjects of the disease were generally natives of the town, chiefly in the prime of life, and in the vigour of health. I recollect no instance of any French inhabitants being assailed by it, and have heard of only one or two instances of the blacks being affected with it.
“That the fever was in a degree contagious, I cannot entertain a doubt; but that it was not so in a very high degree, I am as fully persuaded, from the number of cases in which there was reason to believe it could not have been taken in that way. In most instances, where contagion might have been suspected, the subjects were so situated that they might have received it from the same source as those with whom they had communicated. I cannot learn that any evidence has been furnished of infection from the sick who had been removed into the country, though there were many instances of such removals, under the most malignant forms which it assumed.
“The fever was generally ushered in by a chill, but I think by no means equal to that which commonly precedes fevers of the ardent kind, nor in proportion to the violence of its subsequent periods. In a short time the rigors were succeeded by excessive heat; the pulse, which had been small and contracted, became hard and full; the respiration laborious from violent oppression at the scrobiculus cordis; the tongue assumed a whitish cast; the eyes became highly inflamed, while the pains in the head, back, and legs, were intolerably severe. To these symptoms succeeded nausea, and vomiting sometimes of a highly bilious matter, seldom attended with diarrhœa, but often with a burning at the stomach, tenderness of the abdomen, parcity of urine; and, in one instance, a dysuria, with a great proportion of blood at each evacuation of that fluid.
“These appearances usually continued about 48 hours, after which they often suddenly gave place to a very different train of symptoms. The pulse sunk astonishingly, and became intermittent; the heat and pains entirely subsided; and the patient supposed himself to be out of danger. From a perfect possession of all his intellectual faculties, with a serenity of mind, which in no other disease, I believe, is so generally observed to accompany its last stages, on or about the 5th day from the accession of the fever, he fell into a state of insensibility, and thence sunk gently into the arms of death. In others this change was less rapid; the pulse became gradually smaller, the distressing symptoms slowly abated, a coldness of the extremities took place, and continued for several days before death, accompanied with clammy sweats, often without any perceptible pulse in the wrists, for several hours before the fatal termination. The tongue seldom became much coated, to the last. Delirium was by no means generally attendant; and a yellowness of the skin was far from being universal; sometimes, however, this appearance was observed within the three first days; often on the fourth and fifth; and I was induced to consider it as an accident, rather than a constituent character of the disease.
“The black vomit, as it has been usually called, though in my opinion by no means to be considered as a pathognomic sign of the disease (as I have frequently seen it take place in other acute fevers, especially the puerperal) was very frequently attendant on the last stages of the disorder; very few recovered after this circumstance had taken place; in one person, however, who had it in the most alarming form, together with an intermittent pulse, coldness of the extremities, singultus, and every usual mark of immediate dissolution, a most unexpected recovery happily disappointed the positive prognostics of his physicians. As the cure advanced, the skin in this instance became extremely yellow, and continued so for many weeks after the fever had subsided; the biliary ducts having been completely obstructed, and consequently the alvine evacuations of a clayey colour, and with much difficulty procured. Frequent repetitions of rhubarb and calomel in large doses, the continuance of the mercurial medicine in small doses, so as to keep up a continual ptyalism, and a laxative diet, restored him to perfect health.
“For the discoveries which were made on dissecting the bodies of some of those who died with the disease, I beg leave to refer you to a publication in the Boston Centinel, made during the prevalence of the disorder in this place, and subscribed by Dr. Isaac Rand, sen. President of the M. Medical Society, and myself.” (For these discoveries see the [table], facing p. 434.)
“We had heretofore treated our patients agreeably to the method practised at Philadelphia in 1793, with bleeding in most instances, and active purges of jalap and calomel, or Rochelle salts. The diseased state of the liver, the known effects of mercury in hepatitis, and the recollection of the suggestions contained in Dr. Rush’s publication on the yellow fever, together with those of several other celebrated writers on the same subject, induced us to enter immediately on the use of calomel in small doses, as recommended in our paper above referred to.
“In my own practice I now usually commenced the treatment by bleeding from ten to sixteen ounces, and followed it by a dose of between ten and fifteen grains of calomel with between twenty and twenty-five grains of jalap, or an ounce of Rochelle salts, or more, according to the constitution. Immediately after the operation of these medicines I began with the use of calomel in small doses, in pills of a grain, every hour, and sometimes of 3 grains every two hours. Within the first twenty-four hours, but scarcely ever after, I found occasion frequently to repeat the bleeding, and it is worthy of remark, that in scarcely a single instance was this operation performed without almost instantaneous relief; although in most cases, a few hours after, there was a recurrence of the symptoms. The blood for the most part was dark. In three cases there was no separation of serum from the coagulated mass at the end of forty-eight hours. In two of these (and they were the only cases in which I observed it) a firm buff was formed on its surface; and all three died of the disease.
“The calomel was often continued through the whole course of the fever; and ptyalism was usually brought on within three or four days: though sometimes upwards of 200 grains were given, at the rate of a grain every hour, without any specific effect on the salivary glands. In proportion as the soreness of the mouth advanced, the symptoms universally gave way; and in every patient, two only excepted, this effect of the remedy was a sure pledge of recovery. In this exception were comprehended two persons of the same family, a father and daughter, both of whom had survived the 14th day of the disease, had copious hæmorrhages from the mouth (a circumstance which also attended on many who recovered) and died in a state of apparent putrefaction.
“The purgative medicines were generally repeated every second day; or an enema of water gruel was administered occasionally, if the bowels were constipated; but if otherwise, and the calomel passed off by those emunctories, opium was combined with it in sufficient quantities to restrain the discharge. The evacuations which took place from the intestines, during the use of the mercury, were almost universally of a remarkably dark colour, generally approaching to a deep green, but by no means remarkably fœtid. When spontaneous, they were often observed to be of the colour and consistence of water gruel.