Dr. Rush, who is an enemy to quarantines, recommends to the people of Philadelphia the following particulars: “1. Let the docks be immediately cleaned, and let the accumulation of filth in them be prevented in future, by conveying water into them by a passage under the wharves, or by paving them with large flag stones inclining in such a manner towards the channel of the river as that the filth of the streets shall descend from them (after it falls into the docks) into the river. This method of paving docks has been used with success in the city of Brest. 2. Let every ship that belongs to our port be compelled by law to carry a ventilator. Let all such ships as are discovered to contain foul air in their holds be compelled to discharge their cargoes before they reach our city, and let the ships in port be compelled to pump out their bilge water every day. 3. Let the common sewers be washed frequently with streams of water from our pumps. Perhaps an advantage would arise from opening them, and removing such foul matters as streams of water are unable to wash away. 4. Let the gutters be washed every evening in warm weather. By frequently washing the streets and pavements the heat of the city would be lessened, and thereby one of the predisposing causes of the fever would in some measure be obviated. 5. The utmost care should be taken to remove the filth from the yards and cellars of every house in the city. Hog-sties should be forbidden in yards, and the walls of cellars should be whitewashed two or three times a year, and their floors should be constantly covered with a thin layer of lime. Whitewashing the outside of houses in sickly streets would probably be useful. 6. Let the privies be emptied frequently; and let them be constructed in such a manner as to prevent their contents from oozing through the earth so as to contaminate the water of the pumps. 7. Let all the filth be removed from the neighbourhood of the city, and let the brick kiln and other ponds be filled up from time to time with the earth which is obtained in digging cellars. 8. In the future improvements of our city, let there be no more dwelling houses erected in alleys. They are often the secret receptacles of every kind of filth. 9. The predisposition of our citizens to be affected by the remote and exciting causes of the yellow fever would be very much lessened by their living sparingly upon fresh animal food, and chiefly upon broths and fresh vegetables, rendered savoury by spices and a small quantity of salted meat, during the summer and autumnal months. A constant attention should be paid at the same time to bodily cleanliness.”
These are the modes of prevention which seem to be the most obvious and necessary, as well as approved by the best judges. It appears, however, that in certain cases neither human skill nor care can prevent or cure the disorder. The number of physicians who have fallen victims to this disease are too manifest proofs of this.[200] Indeed, when we consider that it is the nature of the distemper first of all to attack the vital parts, and that this attack may commence with little or no pain, it is evident that an attack may be begun before we think of a preventive, and may, as it were in a moment, prevail in such a manner as to be entirely beyond the reach of medicine, before even a medicine is thought necessary. In every case therefore, where the yellow fever prevails, an attention to health becomes as necessary as procuring the means of subsistence. Every precaution must be used, and when we have done so we are not even then secure. We are ignorant of the natural causes which produce it; they are invisible to our senses, and incomprehensible by our understandings. Safety then can only be expected from the protection of that Being to whom all natural causes are known, and to whom all must yield obedience. In short, we may sum up the whole in the well known sentence, “He that will love life, and see good days, let him refrain his TONGUE from EVIL, and his LIPS that they speak no GUILE. Let him eschew EVIL and do GOOD; let him seek PEACE, and ensue it.” A very strange receipt indeed, we will say; but how often have we tried it?
The cure of the yellow fever hath been attempted in various ways, according to the theories laid down by different physicians concerning its nature. Dr. Cullen considers it as of the nature of typhus fever,[201] and of consequence would have treated it with antimonials; most probably with his favourite remedy, tartar emetic. Dr. Rush, from his opinion that it is the highest degree of inflammatory fever, recommends powerful evacuants, and large blood-letting, in 1793, and 1797, though he seems to have altered his sentiments in 1798. Dr. Brown, who would have considered it as a disease of debility, would of course have prescribed opium and other stimulants; and lastly, on the theory of Dr. Mitchill, that the disease proceeds from an acid, remedies of a nature directly opposite, viz. alkalies, ought to be useful. It is not the design of this treatise to enter into any consideration or comparison of the practice of different physicians, but to point out at once, to those who are not physicians, the remedies which have been, by general consent, accounted most efficacious; and in this respect there is now a surprising unanimity among gentlemen of the medical profession. Those which hold the first rank are,
1. Mercury. In the use of this medicine the physicians of the Western world have certainly excelled those of the East. In a paper in the Medical Repository, vol. i, p. 500, Dr. Holyoke of Salem says that the practice of giving mercury was first introduced into New England about 60 or 70 years ago,[202] by a physician from Scotland, a disciple of the celebrated Pitcairn. In 1734 or 1735 it was used successfully in a very malignant disease called the throat distemper, and which he thinks was of the same genus with the malignant ulcerous sore throat treated of by Huxham. About 45 years ago it was commonly used in pleurisies and other inflammatory disorders; and, ever since the year 1751 or 1752, it has been used by Dr. Holyoke himself. In Europe, however, the case was exceedingly different; mercury being there generally reckoned pernicious in such disorders, from a notion of its being inflammatory, or dissolving the blood. Thus, on the appearance of the Boullam fever in Grenada, Dr. Chisholm found himself exceedingly at a loss what to do, and he seems to have invented, rather than to have been previously instructed in, the mercurial practice. His success, however, was very great, provided he could raise a salivation; but in order to do this he was frequently obliged to give much larger doses than he had ever done before, or had any notion of doing. In p. 159 he mentions one patient who took 400 grains before the salivary glands were affected. He tells us, however, p. 271, that, on the re-appearance of the fever in 1794, he gave the medicine in much larger doses than before; beginning with mercury without any previous evacuations which he had used the year before, and with such success that he did not lose a single patient; so that he professes himself almost ready to pronounce it infallible in curing the disease. The practice of giving mercury is confirmed by Dr. Rush, and indeed by so many other physicians, that it is superfluous to quote them. Dr. Nassy, formerly mentioned, again stands almost singular in condemning the medicine, because it dissolves the blood; but it is impossible that any theory, however plausible, can stand against well attested facts. Dr. Rush is indeed very much of opinion that it is easily practicable for people to cure themselves of this disorder, dreadful as it is, provided they take it in time. But by this we must understand, that the very moment the person feels uneasiness he must apply a remedy, and not trust to nature in any case whatever. When the yellow fever prevails, every one who feels the slightest disorder may be assured that his disorder partakes of its nature, and ought immediately to have recourse to a mercurial purge. Dr. Rush says also that bleeding should be first performed. The many disputes, however, concerning the efficacy of this last remedy, must make any person hesitate at the application of it without medical advice, especially as a mercurial purge may be safely taken without it.
2. Blood-letting. This was, by Dr. Rush, considered as the capital remedy in 1793; but Dr. Chisholm, who made trial of it in the Boullam fever, found that it could not be used with any degree of safety. Dr. Jackson says it is frequently necessary in the Jamaica fever, but it was seldom of use to repeat it. Dr. Walker says it increased the debility in the same fever of 1793, 94 and 95. Dr. Moseley recommends it in the yellow fever of the West Indies, but only in the first stage, and says that the injudicious performance of this operation, when the second stage has come on, has given occasion to the opinion that a patient cannot bear two bleedings. Dr. Coffin found it useful at Newburyport in 1796, in the beginning of the disease, and says it may sometimes be repeated. Repeated bleedings are recommended by Dr. Ouviere of Philadelphia, who says they are not to be omitted even in fat and weak habits. This is confirmed by the editor of the Medical Repository, vol. i, p. 92, who says it was used with success at the hospital in New York in 1796, “at repeated times, to the amount of from 24 to 175 ounces, and in some cases several times performed after the sixth day of the disease, to the great relief of the sick.” Dr. Bruce recommends it in the island of Barbadoes in the robust and plethoric.[203] Dr. Hillary says that in the same island it is always absolutely necessary, and that it may even be repeated once, but that a third bleeding was seldom necessary. Dr, Wright, in the same island, found the “lancet not only unnecessary but dangerous in the extreme.” Dr. Clarke, in Dominica, found it generally very pernicious, and assures us “that there was not a single instance of an emigrant recovering who had been bled in this disease. In the first 24 hours indeed it was admissible in the young and athletic seized a short time after their arrival, but after that time, or at most after 36 hours, it will always be found prejudicial, if not fatal.” It was not tried by Dr. Bryce on board the Busbridge. It is recommended by Dr. Currie in his treatise on bilious fevers.
It is needless to take up time with a detail of more opinions. From those already recited it is natural to conclude that the fever in some places, and at some times, differs very much from others. This is conformable to the opinion of Dr. Currie, who says, that the bilious fever “is amazingly influenced in its aspect and symptoms by the soil, situation, climate, season, and by the preceding and present state of the atmosphere, and the customary mode of living of the inhabitants.” The utility or even safety of blood letting then seems to depend on circumstances which can be only known, and that perhaps with difficulty, at the time; nor can its success in one season be a sufficient argument for the general practice of it in another.
3. Vomits have generally been found dangerous. Dr. Moseley, Dr. Rush, and indeed almost all who have practised in this disease, say, that they cannot be ventured upon without extreme caution. Dr. Chisholm, in imitation of the Russian practice in the true plague, attempted the cure of the Boullam fever by vomits; but, as one half of those to whom they were exhibited died of the disease, he did not think there was any encouragement to proceed. Perhaps as preventives they might be useful, as it seems probable indeed that any thing must be which tends to cleanse the alimentary canal.
4. Purgatives are found extremely useful, both as preventives and medicines. There are innumerable instances where an incipient attack of the disease has been carried off by a brisk purge. Dr. Chisholm was able to remove the slighter cases of Boullam fever by purgatives. He used at first glauber salts with two grains of tartarised antimony, which generally proved emetic as well as purgative; but he afterwards used with advantage the better purging salts, rendering the solution palatable by the addition of lime juice and sugar. But in all violent cases he would depend on nothing but mercury.
5. Stimulating medicines. The stimulants commonly used on the Brunonian plan, viz. opium, bark, &c. are universally owned to be pernicious. In a letter from Dr. Sayres to Dr. Currie,[204] the former says, that “bark, wine, and a number of the common stimulants, were given on the first appearance of debility taking place; but with little success. Finding the common round of medicine ineffectual in the advanced state of the disease, I determined (says Dr. Sayres) to use a different mode of treatment. In three cases of adults, two of which had the black vomiting, and the third was in a gore of putrid blood from the mouth and nose, I forbid medicine, and directed very cold water and brandy mixed strong, to be given as freely as possible. It had the happy effect of checking the vomiting in two cases, when the stomach had rejected every kind of mild drink, &c. and, by continuing that practice almost so as to produce high intoxication, for two or three days, these two cases were recovered almost from a state of death. The third was apparently much benefited for three days; but, being in a high putrescent state when I saw him, and having lost a very considerable quantity of blood from the mouth, nose, &c. he died oil the ninth day.” In the Boullam fever Dr. Chisholm used the Angustura bark in twelve cases, eight of whom recovered; but, though it was greatly superior to the Peruvian bark, he did hot think proper to trust to it in violent cases.
6. Alkaline remedies. These have been recommended on the supposition that the yellow fever is occasioned by an acid. Their efficacy is attested by Dr. Jeremiah Barker of Portland, who says that they afforded more relief than any others, and that all the cases accompanied with yellowness ended favourably, but one. The alkaline remedies “would actually alleviate the distressing pain and anguish at the stomach, which would not yield to opiates. The morbid excitement too was evidently under the controul of alkalies; the febrile disturbance appeared to be in a direct ratio to the degree of virulence in the deleterious cause.”[205] We have not any particular details of cases, nor any form of exhibition pointed out. In a dysenteric fever indeed he says that he used a mixture of a quarter of an ounce of salt of wormwood with a pound of lime water; the dose from one to two ounces every hour, once in some cases every half hour, or oftner, in an infusion of camomile.[206] Calcined oyster shells were sometimes given from 40 to 60 grains.