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“In some cases, signs of putrescency appeared at the beginning, or before the end of the third day. In these, the black vomiting, which was generally a mortal symptom, and universal yellowness, appeared early. In these cases, also, a low delirium, and great prostration of strength, were constant symptoms, and coma came on very speedily.
“In some, the symptoms inclined more to the nervous than the inflammatory type. In these, the jaundiced colour of the eye and skin, and the black vomiting, were more rare. But in the majority of cases, particularly after the nights became sensibly cooler, all the symptoms indicated violent irritation and inflammatory diathesis. In these cases, the skin was always dry, and the remissions very obscure.
“The febrile symptoms, however, as has been already observed, either gave way on the third, fourth, or fifth day; and then the patient recovered; or they were soon after succeeded by a different, but much more dangerous train of symptoms, by debility, low pulse, cold skin, (which assumed a 'tawny colour, mixed with purple) black vomiting, hæmorrhages, hiccup, anxiety, restlessness, coma, &c. Many, who survived the eighth day, though apparently out of danger, died suddenly in consequence of an hæmorrhage."
This disorder having been new to nearly all our physicians, it is not surprising, although it has been exceedingly fatal, that there arose such a discordance of sentiment on the
mode of treatment, and even with respect to its name. Dr. Rush has acknowledged, with a candour that does him honour, that in the commencement, he so far mistook the nature of the disorder, that in his early essays, having depended on gentle purges of salts to purify the bowels of his patients, they all died. He then tried the mode of treatment adopted in the West Indies, viz. bark, wine, laudanum, and the cold bath, and failed in three cases out of four. Afterwards he had recourse to strong purges of calomel and jalap, and to bleeding, which he found attended with singular success.
The honour of the first essay of mercury in this disorder, is by many ascribed to Dr. Hodge and Dr. Carson, who are said to have employed it a week before Dr. Rush. On this point, I cannot pretend to decide. But whoever was the first to intro
For this account of the symptoms of the disorder, I am indebted to the kindness of Dr. Currie, from whose letter to Dr. Senter, it is extracted.
duce it, one thing is certain, that its efficacy was great, and rescued many from death. I have known, however, some persons, who, I have every reason to believe, fell sacrifices to the great reputation this medicine acquired; for in several instances it was administered in immoderate quantities, in which case, with persons of a previous lax habit, it brought on a speedy dissolution.
The demand for purges of calomel and jalap, was so great, that some of the apothecaries could not mix up every dose in detail; but mixed a large quantity of each, in the ordered proportions; and afterwards divided it into doses; by which means, it often happened that one patient had a much larger portion of calomel, and another of jalap, than was intended by the doctors. The fatal consequences of this may be easily conceived.
An intelligent citizen, who has highly distinguished himself by his attention to the sick, says, that he found the disorder generally come on with costiveness; and unless that was removed within the first twelve hours, he hardly knew any person to recover; on the contrary, he says, as few died, on whom the cathartics operated within that time.
The efficacy of bleeding, in all cases not attended with putridity, was great. The quantity of blood taken was in many cases astonishing. Dr. Griffits was bled seven times in five days, and appears to ascribe his recovery principally to that operation. Dr. Mease, in five days, lost seventy-two ounces of blood, by which he was recovered when at the lowest stage of the disorder. Many others were bled still more, and are now as well as ever they were.
Dr. Rush and Dr. Wistar have spoken very favourably of the salutary effects of cold air, and cool drinks, in this disorder. The latter says, that he found more benefit from cold air, than from any other remedy. He lay delirious, and in severe pain, between a window and a door, the former of which was open. The wind suddenly changed, and blew full upon him, cold and raw. Its effect was so grateful, that he soon recovered from his delirium-his pain left him-in an hour he became perfectly reasonable and his fever abated.
A respectable citizen who had the fever himself, and likewise watched its effects on eleven of his family, who recovered from it, has informed me, that a removal of the sick from a close, warm room to one a few degrees cooler, which practice
he employed several times daily, produced a most extraordinary and favourable change in their appearance, in their pulse, and in their spirits.
First Alarm in Philadelphia. Flight of the Citizens.' Guar
dians of the Poor borne down with Labour.
It was some time before the disorder attracted public notice. It had in the meanwhile swept off many persons. The first death that was a subject of general conversation, was that of Peter Aston, on the 19th of August, after a few days illness. Mrs. Lemaigre's, on the day following, and Thomas Miller's, on the 25th, with those of some others, after short sicknesses, spread an universal terror.
The removals from Philadelphia began about the 25th or 26th of this month: and so great was the general terror, that, for some weeks, carts, wagons, coachees, gigs, and chairs, were almost constantly transporting families and furniture to the country in every direction. Many people shut up their houses wholly; others left servants to take care of them. Business became extremely dull. Mechanics and artists were unemployed ; and the streets wore the appearance of gloom and melancholy.
The first official notice of the disorder, was on the 22d of August, on which day the Mayor of Philadelphia, Matthew Clarkson, Esq. wrote to the city commissioners; and after acquainting them with the state of the city, issued most peremptory orders, to have the streets properly cleaned and purified by the scavengers, and all the filth immediately hauled away. These orders were repeated on the 27th, and similar ones given to the clerks of the market.
The 26th of the same month, the college of physicians had a meeting, at which they took into consideration the nature of the disorder, and the means of prevention and of cure. They published an address to the citizens, signed by the president and secretary, recommending “to avoid all unnecessary intercourse with the infected; to place marks on the doors or windows where they were; to pay great attention to cleanliness and airing the rooms of the sick; to provide a large and airy hospital in the neighbourhood of the city for their reception; to put a stop to the tolling of the bells; to convey to the burying ground, those who died of the disorder, in carriages, and as privately as possible; to keep the streets and wharves clean; to avoid all fatigue of body and mind, and standing or sitting in the sun, or in the open air; to accommodate the dress to the weather, and to exceed rather in warm than in cool clothing; and to avoid intemperance; but to use fermented liquors, such as wine, beer and cider, with moderation. They likewise declared their opinion, that fires in the streets were very dangerous, if not ineffectual means of stopping the progress of the fever, and that they placed more dependance on the burning of gunpowder. The benefits of vinegar and camphor, they added, were confined chiefly to infected rooms; and they could not be too often used on handkerchiefs, or in smelling bottles, by persons who attended the sick.”
In consequence of this address, the bells were immediately stopped from tolling. The expedience of this measure was obvious; as they had before been almost constantly ringing the whole day, so as to terrify those in health, and drive the sick, as far as the influence of imagination could produce that effect, to their graves. An idea had gone abroad, that the burning of fires in the streets, would have a tendency to purify the air, and arrest the progress of the disorder. The people had, therefore, almost every night, large fires lighted at the corners of the streets. The 29th, the Mayor, conformably with the opinion of the college of physicians, published a proclamation, forbidding this practice. As a substitute, many had recourse to the firing of guns, which they imagined was a certain preventive of the disorder. This was carried so far, and attended with such danger, that it was forbidden by an ordinance of the Mayor.
The 29th, the Governor of the state wrote a letter to the Mayor, strongly enforcing the necessity of the most vigorous and decisive exertions “to prevent the extension of, and to destroy, the evil.” He desired that the various directions given by the college of physicians, should be carried into effect. The same day, in his address to the legislature, he acquainted them, that a contagious disorder existed in the city; and that he had taken every proper measure to ascertain the origin, nature, and extent of it. He likewise assured them that the healthofficer and physician of the port, would take every precaution to allay and remove the public inquietude.
The number of the infected daily increasing, and the existence of an order against the admission of persons labouring under infectious diseases into the Alms House, precluding them from a refuge there,* some temporary place was requisite; and three of the guardians of the poor, about the 26th of August, took possession of the circus, in which Mr. Ricketts had lately exhibited his equestrian feats, being the only place that could be then procured for the purpose. Thither they sent seven persons afflicted with the malignant fever, where they lay in the open air for some time, and without any assistance. Of these, one crawled out on the commons, where he died at a distance from the houses. Two died in the circus, one of whom was seasonably removed; the other lay in a state of putrefaction for above forty-eight hours, owing to the difficulty of procuring a person to remove him. On this occasion occurred an instance of courage in a servant girl, of which at that time few men were capable. The carter, who finally undertook to remove the corpse, having no assistant, and being unable alone to put it into the coffin, was on the point of relinquishing his design, and quitting the place. The girl perceived him, and understanding the difficulty he laboured under, offered her services, provided he would not inform the family with whom she lived. She accordingly helped him to put the body into the coffin, though it was, by that time, in the most loathsome state of putrefaction. It gives me pleasure to add, that she still lives, notwithstanding her very hazardous exploit.
The inhabitants of the neighbourhood of the circus took the alarm, and threatened to burn or destroy it, unless the sick were removed; and it is believed they would have actually carried their threats into execution, had compliance been delayed a day longer.
The 29th, seven of the guardians of the poor had a conference with some of the city magistrates on the subject of the fever, at which it was agreed to be indispensably necessary,
* At this period, the number of paupers in the Alms House was between three and four hundred; and the managers, apprehensive of spreading the disorder among them, enforced the abovementioned order, which had been entered into a long time before. They, however, supplied beds and bedding, and all the money in their treasury, for their relief, out of that house.
+ High wages were offered for nurses for these poor people,,but none could be procured.
| Had they known of the circumstance, an immediate dismissal would have been the consequence.