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AN ACCOUNT

OF THE

BILIOUS REMITTING AND INTERMITTING

AS IT

APPEARED IN PHILADELPHIA,

IN 1797.

The winter of 1797 was in general healthy. During the spring, which was cold and wet, no diseases of any consequence occurred. The spring vegetables were late in coming to maturity, and there were every where in the neighbourhood of Philadelphia scanty crops of hay. In June and July there fell but little rain. Dysenteries, choleras, scarlatina, and mumps, appeared in the suburbs in the latter month. On the 8th of July I visited Mr. Frisk, and on the 25th of the same month I visited Mr. Charles Burrel in the yellow fever, in consultation with Dr. Physick. They both recovered by the use of plentiful depleting remedies.

The weather from the 2d to the 9th of August was rainy. On the 1st of this month I was called to visit Mr. Nathaniel Lewis, in a malignant bilious fever. On the 3d I visited Mr. Elisha Hall, with the same disease. He had been ill several days before I saw him. Both these gentlemen died on the 6th of the month. They were both very yellow after death. Mr. Hall had a black vomiting on the day he died.

The news of the death of these two citizens, with unequivocal symptoms of yellow fever, excited a general alarm in the city. Attempts were made to trace it to importation, but a little investigation soon proved that it was derived from the foul air of a ship which had just arrived from Marseilles, and which discharged her cargo at Pinestreet wharf, near the stores occupied by Mr. Lewis and Mr. Hall. Many other persons about the same time were affected with the fever from the same cause, in Water and Penn-streets. About the middle of the month, a ship from Hamburgh communicated the disease, by means of her foul air, to the village of Kensington. It prevailed, moreover, in many instances in the suburbs, and in Kensington, from putrid exhalations from gutters and marshy grounds, at a distance from the Delaware, and from the foul ships which have been mentioned. Proofs of the truth of each of these assertions were afterwards laid before the public.

The disease was confined chiefly to the district of Southwark and the village of Kensington, for several weeks. In September and October, many cases occurred in the city, but most of them were easily traced to the above sources.

The following account of the weather, during the months of August, September, and October was obtained from Mr. Thomas Pryor. It is different from the weather in 1793. It is of consequence to attend to this fact, inasmuch as it shows that an inflammatory constitution of the atmosphere can exist under different circumstances of the weather. It likewise accounts for the variety in the symptoms of the fever in different years and countries. Such is the influence of season and climate upon the symptoms of this fever, that it led Dr. M'Kitterick to suppose that the yellow fever of Charleston, so accurately described by Dr. Lining, in the second volume of the Physical and Literary Essays of Edinburgh, was a different disease from the yellow fever of the West-Indies.

De Febre Indiae-Occidentalis Maligna Flava, p. 12.

METEOROLOGICAL OBSERVATIONS,

AUGUST, 1797.

SEPTEMBER, 1797.

OCTOBER, 1797.

In addition to the register of the weather it may not be improper to add, that moschetoes were more numerous during the prevalence of the fever than in 1793. An unusual number of ants and cockroaches were likewise observed; and it was said that the martins and swallows disappeared, for a while, from the city and its neighbourhood.

A disease prevailed among the cats some weeks before the yellow fever appeared in the city. It excited a belief in an unwholesome state of the atmosphere, and apprehensions of a sickly fall. It generally proved fatal to them.

After the first week in September there were no diseases to be seen but yellow fever. In that part of the town which is between Walnut and Vine-streets it was uncommonly healthy. A similar retreat of inferior diseases has been observed to take place during the prevalence of the plague in London, Holland, and Germany, according to the histories of that disease by Sydenham, Diemerbroeck, Sennertus, and Hildanus. It appears, from the register of the weather, that it rained during the greatest part of the day on the 1st of October. The effects of this rain upon the disease shall be mentioned hereafter. On the 10th the weather became cool, and on the nights of the 12th and 13th of the month there was a frost accompanied with ice, which appeared to give a sudden and complete check to the disease.

The reader will probably expect an account of the effects of this distressing epidemic upon the public mind. The terror of the citizens for a while was very great. Rumours of an opposite and contradictory nature of the increase and mortality of the fever were in constant circulation. A stoppage was put to business, and it was computed that about two thirds of the inhabitants left the city.

The legislature of the state early passed a law, granting 10,000 dollars for the relief of the sufferers by the fever. The citizens in and out of town, as also many of the citizens of our sister states, contributed more than that sum for the same charitable purpose. This money was issued by a committee appointed by the governor of the state. An hospital for the reception of the poor was established on the east side of the river Schuylkill, and amply provided with every thing necessary for the accommodation of the sick. Tents were likewise pitched on the east side of Schuylkill, to which all those people were invited who were exposed to the danger of taking the disease, and who had not means to provide a more comfortable retreat for themselves in the country.

I am sorry to add that the moral effects of the fever upon the minds of our citizens were confined chiefly to these acts of benevolence. Many of the publications in the newspapers upon its existence, mode of cure, and origin partook of a virulent spirit, which ill accorded with the distresses of the city. It was a cause of lamentation likewise to many serious people, that the citizens in general were less disposed, than in 1793, to acknowledge the agency of a divine hand in their afflictions. In some a levity of mind appeared upon this solemn occasion. A worthy bookseller gave me a melancholy proof of this assertion, by informing me, that he had never been asked for playing cards so often, in the same time, as he had been during the prevalence of the fever.

Philadelphia was not the only place in the United States which suffered by the yellow fever. It prevailed, at the same time, at Providence, in Rhode-Island, at Norfolk, in Virginia, at Baltimore, and in many of the country towns of New-England, New-Jersey, and Pennsylvania.

The influenza followed the yellow fever, as it did in the year 1793. It made its appearance in the latter end of October, and affected chiefly those citizens who had been out of town.

The predisposing causes of the yellow fever, in the year 1797, were the same as in the year 1793. Strangers were as usual most subject to it. The heat of the body in such persons, in the West-Indies, has been found to be between three and four degrees above that of the temperature of the natives. This fact is taken notice of by Dr. M'Kitterick, and to this he ascribes, in part, the predisposition of new comers to the yellow fever.

In addition to the common exciting causes of this disease formerly enumerated, I have only to add, that it was induced in one of my patients by smoking a segar. He had not been accustomed to the use of tobacco.

I saw no new premonitory symptoms of this fever except a tooth-ach. It occurred in Dr. Physick, Dr. Caldwell, and in my pupil, Mr. Bellenger. In Miss Elliot there was such a soreness in her teeth, that she could hardly close her mouth on the day in which she was attacked by the fever. Neither of these persons had taken mercury to obviate the disease.

I shall now deliver a short account of the symptoms of the yellow fever, as they appeared in several of the different systems of the body.

The action of the arteries was, as usual, very irregular in many cases. In some there was a distressing throbbing of the vessels in the brain, and in one of my patients a similar sensation in the bowels, but without pain. Many people had issues of blood from their blisters in this fever.

I saw nothing new in the effects of the fever upon the liver, lungs, brain, nor upon the stomach and bowels.

Several of my patients discharged worms during the fever. In one instance they were discharged from the mouth.

A preternatural frequency in making pale water attended the first attack of the disease in Mr. Joseph Fisher.

A discharge of an unusual quantity of urine preceded, a few hours, the death of the daughter of Mrs. Read.

In two of my patients there was a total suppression of urine. In one of them it continued five days without exciting any pain.

There was no disposition to sweat after the first and second days of the fever. Even in those states of the fever, in which the intermissions were most complete, there was seldom any moisture, or even softness on the skin. This was so characteristic of malignity in the bilious fever, that where I found the opposite state of the skin, towards the close of a paroxysm, I did not hesitate to encourage my patient, by assuring him that his fever was of a mild nature, and would most probably be safe in its issue.

Dr. Caldwell informed me of a singular change which took place in the operations of his mind during his recovery from the fever. His imagination carried him back to an early period of his life, and engaged him, for a day or two, in playing with a bow and arrow, and in amusements of which he had been fond when a boy. A similar change occurred in the mind of my former pupil, Dr. Fisher, during his convalescence from the yellow fever in 1793. He amused himself for two days in looking over the pictures of a family Bible which lay in his room, and declared that he found the same kind of pleasure in this employment that he did when a child. However uninteresting these facts may now appear, the time will come when they may probably furnish useful hints for completing the physiology and pathology of the mind.

Where blood-letting had not been used, patients frequently died of convulsions.

Several persons who died of this fever did not, from the beginning to the end of the disease, feel any pain. I shall hereafter endeavour to explain the cause of this insensible state of the nerves.

The appetite for food was unimpaired for three days in Mr. Andrew Brown, at a time when his pulse indicated a high grade of the fever. I heard of several persons who ate with avidity just before they died.

Dr. Stewart informed me, that in those cases in which the serum of the blood had a yellow colour, it imparted a saline taste only to his tongue. He was the more struck with this fact, as he perceived a strong bitter state upon his skin, in a severe attack of the yellow fever in 1793.

I proceed next to take notice of the type of the fever.

In many cases, it appeared in the form of a remitting and intermitting fever. The quotidian and tertian forms were most common. In Mr. Robert Wharton, it appeared in the form of a quartan. But it frequently assumed the character which is given of the same fever in Charleston, by Dr. Lining. It came on without chills, and continued without any remission for three days, after which the patient believed himself to be well, and sometimes rose from his bed, and applied to business. On the fourth or fifth day, the fever returned, and unless copious evacuations had been used in the early stage of the disease, it generally proved fatal. Sometimes the powers of the system were depressed below the return of active fever, and the patient sunk away by an easy death, without pain, heat, or a quick pulse. I have been much puzzled to distinguish a crisis of the fever on the third or fourth day, from the insidious appearance which has been described. It deceived me in 1793. It may be known by a preternatural coolness in the skin, and languor in the pulse, by an inability to sit up long without fatigue or faintness, by a dull eye, and by great depression of mind, or such a flow of spirits as sometimes to produce a declaration from the patient that "he feels too well." Where these symptoms appear, the patient should be informed of his danger, and urged to the continuance of such remedies as are proper for him.

The following states or forms were observable in the fever:

In delivering this detail of the various forms of the yellow fever, I am aware that I oppose the opinions of many of my medical brethren, who ascribe to it a certain uniform character, which is removed beyond the influence of climate, habit, predisposition, and the different strength and combinations of remote and exciting causes. This uniformity in the symptoms of this fever is said to exist in the West-Indies, and every deviation from it in the United States is called by another name. The following communication, which I received from Dr. Pinckard, will show that this disease is as different in its forms in the West-Indies as it is in this country.

Many other authorities equally respectable with Dr. Pinckard's, among whom are Pringle, Huck, and Hunter, might be adduced in support of the unity of bilious fever. But to multiply them further would be an act of homage to the weakness of human reason, and an acknowledgment of the infant state of our knowledge in medicine. As well might we suppose nature to be an artist, and that diseases were shaped by her like a piece of statuary, or a suit of clothes, by means of a chissel, or pair of scissars, as admit every different form and grade of morbid action in the system to be a distinct disease.

Notwithstanding the fever put on the eleven forms which have been described, the moderate cases were few, compared with those of a malignant and dangerous nature. It was upon this account that the mortality was greater in the same number of patients, who were treated with the same remedies, than it was in the years 1793 and 1794. The disease, moreover, partook of a more malignant character than the two epidemics that have been mentioned. The yellow fever in Norfolk, Drs. Taylor and Hansford informed me, in a letter I received from them, was much more malignant and fatal, under equal circumstances, than it was in 1795.

During the prevalence of the fever I attended the following persons who had been affected by the epidemic of 1793, viz. Dr. Physick, Thomas Leaming, Thomas Canby, Samuel Bradford, and George Loxley, also Mrs. Eggar, who had a violent attack of it in the year 1794. Samuel Bradford was likewise affected by it in 1794.

During my intercourse with the sick, I felt the miasmata of the fever operate upon my system in the most sensible manner. It produced languor, a pain in my head, and sickness at my stomach. A sighing attended me occasionally, for upwards of two weeks. This symptom left me suddenly, and was succeeded by a hoarseness, and, at times, with such a feebleness in my voice as to make speaking painful to me. Having observed this affection of the trachea to be a precursor of the fever in several cases, it kept me under daily apprehensions of being confined by it. It gradually went off after the first of October. I ascribed my recovery from it, and a sudden diminution of the effects of the miasmata upon my system, to a change produced in the atmosphere by the rain which fell on that day.

The peculiar matter emitted by the breath or perspiration of persons affected by this fever, induced a sneezing in Dr. Dobell, every time he went into a sick room. Ambrose Parey says the same thing occurred to him, upon entering the room of patients confined by the plague.

The gutters emitted, in many places, a sulphureous smell during the prevalence of the fever. Upon rubbing my hands together I could at any time excite a similar smell in them. I have taken notice of this effect of the matters which produced the disease upon the body, in the year 1794.

The number of deaths by the fever, in the months of August, September, and October, amounted to between ten and eleven hundred. In the list of the dead were nine practitioners of physic, several of whom were gentlemen of the most respectable characters. This number will be thought considerable when it is added, that not more than three or four and twenty physicians attended patients in the disease. Of the survivors of that number, eight were affected with the fever. This extraordinary mortality and sickness among the physicians must be ascribed to their uncommon fatigue in attending upon the sick, and to their inability to command their time and labours, so as to avoid the exciting causes of the fever.

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