A DESCRIPTION OF THE Malignant, Infectious Fever PREVAILING AT PRESENT IN PHILADELPHIA; WITH AN ACCOUNT OF THE MEANS TO PREVENT INFECTION, AND THE REMEDIES AND METHOD OF TREATMENT, WHICH HAVE BEEN FOUND MOST SUCCESSFUL.
BY WILLIAM CURRIE, Fellow of the College of Physicians of Philadelphia.
PHILADELPHIA: PRINTED BY T. DOBSON, NO. 41, SOUTH SE|COND-STREET.
* THE Fever at present prevailing in the city of Philadelphia (which is highly in|fectious and malignant) generally begins with, and may be distinguished from every other species or form of fever, by the following symptoms, viz.
Page 4 THE patient first complains of weariness and weakness, which, in a few hours, is suc|ceeded by a sense of chilliness, and an oppres|sive dull pain and giddiness in the head, an oppressive weight and stricture about the breast, particularly at the region of the heart, as if the space was too narrow for its pulsations. The breathing is performed with quickness and uneasiness.
THESE symptoms in most cases, are soon succeeded by a frequent propensity to puke, and this by a quick, full, but soft and irregular pulse; great heat about the head, neck, and breast; the skin generally hot and moist a|bout the neck and forehead, but dry, and but little increase of heat about the feet and legs.*
IF, to these symptoms, we add an extraor|dinary prostration of strength or sudden de|bility in the animal functions of the body, we have a perfect description of the fever un|der consideration, from the first day of its at|tack to the third of its progress.
Page 5 WHEN no amendment takes place by the 3d or 4th day, most of the recited symptoms become more distressing and alarming, with the pulse low and sunk. Frequent vomiting of matter resembling coffee grounds in colour and consistence, generally occurs before the disease terminates, when it proves mortal, to|gether with a cadaverous appearance of the countenance, succeeded by a deep yellow or leaden colour of the skin and nails; the eyes become suffused with blood, and the counte|nance appears like that of one strangled; but no signs of jaundice appear, either in the urine or feces. In some cases, a profuse discharge of blood from the nose, concludes the catastro|phe—A hiccup is a very frequent but not a constant symptom, nor does vomiting al|ways occur. The tongue is seldom very soul or dry, nor does the patient always crave drink. His intellects, though always con|fused, are seldom so much disordered as to amount to a delirium—Subsultus tendinum are very rare.
Page 6 WHEN the disease terminates favourably, the symptoms generally abate on the third or fourth day, accompanied by a profuse sweat. When it ends fatally, it is generally between the fifth and eighth day, though some have survived the tenth, and died afterwards.
THE characteristic or leading symptoms of the disease, as has already been observed, are sudden debility in the voluntary powers, oppressive pain, giddiness and sense of full|ness and distention in the vessels of the fore|part of the head, and an oppressive weight, or an inexpressible sensation of tightness about the heart and lungs, accompanied with ex|cruciating anguish and restlessness.
THIS fever, like all other varieties of pu|trid fever, arises from, and is produced by specific contagion, and may be communicated from those labouring under the disease, to persons in the most perfect state of health.
Page 7 How the disease was introduced into the city, whether imported from some other country, in consequence of the contagion ad|hering to goods or to the apparel of diseased persons, which is the most common source from whence infectious diseases are communi|cated, or generated in the low and filthy a|partments of some of the inhabitants of Water-street, can only be determined by a collection and faithful statement of facts, and must be left for future investigation.
IT ought, however, to afford us much con|solation, when we are assured, (and on this as|surance we may rely with the most perfect security) that the disease under consideration, though certainly infectious is nevertheless on|ly communicable under particular circumstan|ces. Those circumstances removed, no in|fection can possibly take place.
To suppose that the air in the streets can be contaminated by the contagion so as to com|municate the disease through that medium, is Page 8 contrary to, and is contradicted by, the ob|servations and experience of the learned of the faculty of every age and country; and any apprehension of an infectious disease from that source, can only be excused in those who have not had suitable opportunities of better information.
BURNING heaps of odorous and noisom substances in the streets is therefore not only useless, but injurious, as it not only con|sumes or changes the quality of the pure or vital air of the atmosphere, but conveys into it from the burning materials, a proportiona|ble quantity of deleterious gas, commonly call|ed fixed air.
PEOPLE in walking the streets, are by no means in any danger of infection, as the mi|asmata, or contagious exhalations from the bo|dies of the diseased have never been known to be conveyed by the air many feet beyond the chamber of the sick, except by means of clothes or other porous substances which have Page 9 been in contact with, or very near to, the body of one labouring under the disease.
THE principal, and perhaps the only cir|cumstances which render the present fever communicable, if analogy and past experi|rience are to have any weight, are the follow|ing, viz. Confinement for any length of time in the bed-chamber of the sick, especi|ally when the apartment is not large, and freely ventilated—coming in immediate contact with the patient, his body, or bed-clothes, or those of the nurse or other attend|ants before they have been for some time ex|posed to the action of the open air, or by re|ceiving the breath, or the scent of the several excretions of the sick.*
IF people rigorously shun the above cir|cumstances, pay a strict attention to cleanli|ness; Page 10 to constant ventilation of their own as well as the apartments of the sick; take mo|derate and frequent exercise in the open air when dry and serene; make moderate use of relishing aliment copiously seasoned with salt and culinary spices, and drink wine or other strong liquors more liberally than customary; avoiding intemperance of every description; but above all, the monstrous and abomina|ble vice of getting drunk—I venture to pro|nounce with the most positive confidence, that the disease will not, cannot spread.
WITH respect to the various expedients made use of by all classes to preserve them|selves from infection, such as camphor bags, amulets of dried frogs, tarred ropes, spunge dipped in the vinegar of the four thieves, the salt of spices (as it is vulgarly called) the smoaking of segars—they are productive of more evil than good, because they continually attract the mind to one melancholy object, and serve to keep alive fearful apprehensions, Page 11 which might otherwise be diverted by other objects and a succession of new ideas.
THE best, and I believe I may say the on|ly neutralizer or corrector of contagion yet discovered, is the pure vital air of the atmos|phere. The putrid noxious effluvia confined in tombs and vaults (than which few things are more suddenly fatal to life) has been ren|dered perfectly innocent by the copious ad|mixture of vital air, or that portion of the at|mosphere which serves the purpose of respi|ration and combustion.
THIS salubrious aeriform fluid may there|fore be most usefully employed for restoring to health the unfortunate sufferers under the present malignant disorder.
SICK rooms may at least be purified and rendered much more comfortable to the pa|tient and safe to the attendants by frequently deflagrating nitre on burning charcoal in different parts of the apartment: this is known Page 12 to evolve considerable quantities of this vivi|fying air. Pouring vinegar upon a hot iron produces the same effect in an inferior de|gree, as it undergoes a partial decomposition, and a quantity of vital air, one of its constitu|ent parts, is thereby set at liberty. The contaminated air may be also removed by frequently kindling fires in the chimney of the chamber of the sick; the air thus rarefi|ed in the chimney ascends, being compressed and followed by that in the chamber, and the place, which the contaminated air has left, is immediately occupied by a fresh sup|ply of that which is pure.
WHITE-WASHING the walls of the cham|ber has been found by the late humane and benevolent Mr. Howard, highly conducive to the removal of infection, and is strongly recommended by Dr. Blane.
ALL kinds of plants in a state of vegetation furnish more or less pure air, at the same time that they absorb and correct that which is Page 13 contaminated. Vessels of fresh water there|fore with cotton steeped in them, and the seed of pepper grass sown upon it, which will im|mediately vegetate, may with propriety be placed in different parts of the chamber, with this caution that they be removed during the night, and the water renewed every morn|ing.
MANY melancholy examples of a fever, with a complexion and features, nearly re|sembling the one under consideration occur|red during the late war, between United Ame|rica and Great-Britain, in the military hospi|tals and prison ships.
THAT a contagious fever may be generat|ed in any situation where fresh air is exclud|ed, and cleanliness neglected, especially in the winter season; and that the contagion or miasmata so generated, is rendered active by the summer's heat in such confined and filthy places, is now generally admitted by the most accurate observers: The account given of Page 14 the periodical rise, progress and decline, of the plague at Aleppo by Dr. Russel, renders this a matter of certainty. The miasma or contagion thus generated, is propagated and spread by infection.
IT is also generally admitted, that the con|tagion by which putrid fevers are produced, is not like that of many other diseases perma|nent and constantly existing, but in the cir|cumstances just related, it is occasionally gene|rated and propagated. At the same time it is a rational inference to suppose, that all fe|vers arising in such circumstances are of the same specific nature, however they may dif|fer in the number and violence of their symp|toms, and that such difference may be im|puted to the circumstances of climate, season, soil and constitution, concurring with the contagion and modifying its force.
How far the fever at present prevalent here may be combined with, or modified by the contagion of the influenza, which has also Page 15 for some time past, been very epidemic, is a question that I shall not at present enter into the discussion of.*
Page 16 The following method of cure has been hitherto found more successful than any other, Page 17 which I hope will plead my apology for com|municating it at this early period.
† The early exhibition of half a grain of tartar emetic every half hour, in barley water or camomile tea, till it operates either up|wards Page 18 or downwards, succeeded next day by a mild purgative occasionally repeated, a sudorific anodyne at night, with copi|ous dilution, for the purpose of promot|ing a free perspiration, generally affords some alleviation of the most distressing symp|toms. The patient, if his stomach will ad|mit and retain it, may also take a spoonful Page 19 of camphorated vinegar, or a solution of salt of tartar in lime juice, in a draught of barley water or gruel, every two hours, rather cold than warm, and should drink copiously of lime juice, or tamarind beverage, to en|courage perspiration; his feet and hands be|ing at the same time frequently immersed in, or fomented with, clothes dipped in cool vinegar and water, and wiped very dry with a warm cloth; his body and bed linen to be changed regularly twice a day, previously im|mersed in vinegar, and afterwards gradually dried, so as to be perfectly free from mois|ture. His bed to be in the middle of the floor, without curtains, all the windows, as well as the doors of the chamber to be kept open, and where practicable, he should be re|moved to the high lands in the country, upon the first attack of the disease. Perhaps lying in a tent placed in a dry verdant field would be preferable to the most spacious chamber.
So soon as the violent determination to the head is diminished, which may be known by Page 20 the abatement in the action of the carotid and temporal arteries, the patient may take every night at bed time, half a grain of tartar eme|tic, mixed in a peppermint or cinnamon draught, with 25 drops of laudanum, and 2 drachms or 3 of acetated ammonia, increas|ing or diminishing the proportion of the lau|danum, according to circumstances. This composition has generally the most pleasing effect in procuring rest, and promoting pers|piration, particularly when the impetus of the blood in the vessels of the head is mode|rate.
WHEN the propensity to puke in the early period of the disease is urgent, it may fre|quently be relieved by giving six or eight grains of calomel* combined with one or two grains of solid opium (made into a bolus with common syrup) every three or four hours, till it produces a copious discharge from the intes|tines; repeating the anodyne in an effervesc|ing neutral mixture at bed time.
Page 21 IF notwithstanding the use of these means the disease does not give way, but on the contrary the patient's strength evidently de|clines, or sooner if the activity of the pulse is considerably reduced, recourse should be had to blisters; one to be applied between the shoul|ders, and two to the legs. The sudorific anodyne should also be given at night, and the red bark should be exhibited in as large doses as the stomach can be made to retain it, and in substance if possible. Wine should al|so now be exhibited (and not before) begin|ning with a small quantity, and gradually in|creasing it as it is found to agree. When it aggravates the pain in the head, and distress|ing anguish at the breast, it should be dimi|nished or discontinued for a time.*
IF the pulse becomes feeble, or the throb|bing of the arteries in the neck and temples, languid, the stomach irritable, and disposed to reject every thing, a cataplasm of mustard and vinegar should be applied warm to the Page 22 stomach and feet, and occasionally repeated. At the same time the bark and wine, or where wine disagrees, the bark mixed with a strong peppermint julep, with the addition of a small quantity of thebaic tincture should be almost constantly given*.
WINE and volatiles, as well as large doses of opium, given at the commencement of the disease, have proved highly injurious, and ap|pear, in some instances, to have occasioned, or at least to have increased the profuse haemor|rhages from the nose. But elixir of vitriol has produced more salutary effects.
WINE and volatiles under such circumstan|ces, appear to render the action of the system disproportioned to its state of power, for there must be a certain degree of strength, to bear the action excited by stimulating and cordial me|dicines, and regimen: For nothing is more pernicious, or even fatal, than that any part or function should be forced to make exertions Page 23 incompatible with its strength; and there is the more danger of ill-timed remedies in the present fever, as with the state of weakness there is conjoined a state of excessive irritabi|lity for the first two or three days.
In the latter stage of this fever, at which time the most common symptoms are great weakness, restlessness, anxiety and impaired sensibility, nothing seemed to retard the fatal event so effectually, as a volatile aromatic ju|lep, with the addition of laudanum and the es|sence of peppermint and the moderate use of claret or port wine.
EVERY case where the skin became yel|low, and the countenance appeared cadave|rous, has hitherto proved mortal.
I not this the same as the synochus of Dr. Cullen? The treatment which has suc|ceeded best seems to indicate that it is.
WHEN treating of the synochus, Dr. Cul|len expresses himself in the following terms: Page 24 "In the synochus a violent reaction and phlogistic diathesis appear, and prevail dur|ing some part of the course of the disease; while at the same time, these circumstances do not constitute the principal part of the dis|ease, nor are to be expected to continue dur|ing the whole course of it; and it is well known, that, in many cases, the state of vi|olent reaction is to be succeeded sooner or later, by a state of debility, from the excess of which the danger of the disease is chiefly to arise. It is therefore necessary, that in ma|ny cases blood letting is to be avoided; and even although during the inflammatory state of the disease, it may be proper, it will be ne|cessary to take care that the evacuation be not so large as to increase the state of debility which is to follow."
THE fever however which I have been de|scribing, differs from the synochus of Doctor Cullen, in the time of its duration, as well as in the violence of its symptoms. "It is rare," says that great reformer of medicine, "in this Page 25 climate [Scotland] that cases either of typhus or synochus, terminate before the eleventh day; and when they do terminate on this day, it is for the most part fatally.
WHEN they are protracted beyond this time, I have very constantly found that their terminations were upon the 14th, 17th, or 20th day."
Cullen's first lines, vol. 1st.
SINCE the above was written, I have taken particular pains to investigate the ori|gin of the fever, described in the prece|ding pages, and have discovered that the first case of it occurred at Richard Den|nie's, who kept a lodging-house in Water-street, nearly opposite to Dr. Hodge's. A man and his wife of the name of Parkinson, passengers in the brig Ann and Mary, from Dublin, took lodgings there the latter end of Page 26 June. They had one Englishman lodging with them at that time. Two young French|men afterwards took lodgings in the same house. The rest of the family consisted of Richard Parkinson, his wife and two daugh|ters. On the 3d. of August Dr. Cathrall visited Mrs. Parkinson, labouring under a highly malignant fever, as will appear by the annexed letter.
ON the 4th of the same month, Dr. Phy|sick, at the request of the overseers, visited the Englishman, who died suddenly the same night. The next day he opened the body, but could discover nothing except some de|rangement in the colon and vessica fellis, that could lead to a discovery of the nature of the disease or the cause of his death. On open|ing his head, he found the vessels of the brain uncommonly distended, and turgid with blood.
MRS. PARKINSON died on the 7th of August. One of the French lads was taken Page 27 ill soon after Mrs. Parkinson—was attended by a French physician who lodged at Mrs. Sage's in Front-street: but I was not able to ascertain the day of his death.
SOON after the death of the French lad, Mr. Dennie was attacked by the fever, and his wife two days after. They were both buried the same day—He survived the attack seven, and she only five days.
MRS. PARKINSON's husband, and Mr. Dennie's two daughters escaped the infection, but the other French lad who took fresh lodg|ings higher up Water-street, died a few days after.
ONE of the young women from whom I received the most circumstantial part of the above account, now resides at Dr. Hodge's who has humanely afforded her and her sis|ter an asylum in their distress.
Page 28 THE most material parts of the above cir|cumstances have also been confirmed by the Rev. Mr. Keating.
TWO of the family next door to the lodg|ing-house, died soon after of the same com|plaint. Dr. Hodge's maid-servant, a young woman from the country, and his little daughter, have also died since of the same complaint; and a number of others in the same neighbourhood.
IT is also said, but for this I cannot vouch, that a carpenter in Kensington, who assisted in breaking open the sheathing of the cabin of Mr. Steinmetz's brig, which had 117 French West-Indians on board, was soon after at|tacked with feverish symptoms; of which he died in a few days; and that several Danish sailors have been affected by the same disease at Kensington.
THAT the disease made its first appearance in the house already mentioned, is clearly Page 29 established; but whether it was imported and introduced there by the Irish family, or by the French lads, or was generated there, I have not been able to collect a sufficiency of evidence to determine.
September 3d. 1793.
Copy of a Letter from Dr. Cathrall.
In compliance with your request, I now send you the case of Mrs. P. transcribed from my Jour|nal.
AUGUST 3d. 1793, Mrs. P. was taken chilly, succeeded by violent pain in the head and back, increase of heat, much thirst, &c. On the morning of the 4th I saw her, found her complaining of great sickness at stomach, with frequent vomiting, tightness across the lower part of the chest, attended with heavy Page 30 sighing, bowels costive, tongue dry and black, particularly in the middle, and brown towards the edges; heat and thirst much aug|mented, pulse quick and feeble, urine small in quantity, and of a high colour.—5th. Rested ill last night; symptoms much as yesterday, excepting, has had several very offensive stools.—6th. Has been very deliri|ous during the night, but rational at present; still vomits every substance received into the stomach; a number of crimson coloured spots appeared on her neck, breast, and arms; has frequent stools which are very putrid; tongue much cleaner than before; pulse slow|er; heat diminished; pain in the head and back very considerable—7th. Passed a very restless night, though not delirious; tongue black; spots of a livid colour, attended with slight yellowness of the skin; eyes heavy, with dimness of vision; complains of much soreness of the throat, and difficulty in swal|lowing. Diarrhoea and vomiting continue; Page 31 is now delirious, accompanied with singul|tus, &c. Died at 11 at night.
IT appears from authentic documents, that the same kind of fever as the one which I have described in the preceding pages, has been prevalent in Philadelphia at two differ|ent periods. The first, A. D. 1740; sup|posed to have been introduced by means of a quantity of wearing apparel brought in a trunk from Barbadoes, belonging to a gentleman who died of it in that Island.
THE second time of its appearance was A. D. 1762, introduced by a mariner, who arrived sick with it from the Havanna, and communicated it to the family where he lodged; from whence it spread rapidly from Page 32 house to house as families had intercourse with one another.
ACCORDING to the notes of Dr. Redman, the worthy President of the Philadelphia College of Physicians (who has favoured me with the privilege of making use of them) it made its appearance the latter end of August of the year last mentioned. About the 20th or 25th of September, its progress seems to have arrived to its height. From the 27th it gradually declined, so that by the 10th of October, instead of 18 or 20 patients of a day, which Dr. Redman had before attended in it, he had now only two or three.
THE fever at that period was circumscri|bed between Pine-street, northerly, and three or four squares from thence southerly, and extended from Water-street, to Third or Fourth-street westerly. Its first and greatest ravages were about the New Market, which lay near the source of the contagion. The fever as it appeared at that time, is thus de|scribed Page 33 by Dr. Redman in a communication just presented to, and read in the College of Physicians.
THE patients were generally seized with a sudden and severe pain in the head and eye-balls, which frequently appeared a little inflamed, or had a reddish cast, great pain in the back and limbs, and much dejection of spirits. A sick stomach generally attended, but in various degrees of violence, with fre|quent vomiting, more or less of green or yel|lowbile, and was distinguished from the cholera morbus by not having a purging with it. There was also a kind of cardialgia, or burn|ing heat about the scrobiculus cordis, with great oppression; but if I remember right, not much pain like a colic; nor do I recol|lect any chill generally preceding the above symptoms—however, it might be with some. The skin was dry with a disagreeable burning heat in it, sensible to the hand of others. The tongue was not very dry at first, but rather Page 34 moist, and covered with whitish mucus. The pulse was not generally either full or tense, but very quick in the beginning, by which the degree of fever was chiefly designa|ted. Yet in some persons previously very ple|thoric from high living and other circumstances, some fullness without tension was observed in the pulse in the first stage; after which in many, the pulse became so moderate in every respect, as to be scarcely distinguishable from that of a person in health. Though very restless and often tossing about, or changing position from oppression at the praecordia, I think they were but seldom very delirious; but if the disease continued to increase, and resist the power of medicines, they rather grew comatose, which was a bad symptom, and generally continued till death, unless, the black vomiting came on and occasionally roused them. But even those who were comatose, when roused appeared quite sensible, though not capable of preserving a regular connection of ideas on any one subject for any length of time. They Page 35 soon became yellow in their eyes and skin universally, which became extreme in some before, and in almost all after death: and in those that recovered, it continued during the whole convalescent state, and in some, a great part of the cuticle peeled off.
"WHEN the disease terminated fatally, it was generally on the 4th, 5th or 6th day; some few later; but after the 7th day, or even sooner if the pulse became much calmer and slower without a coma, and the patient inclin|ed to a natural easy sleep, though short, with a moist skin and tongue, &c. we were en|couraged to hope, and promise much, and generally succeeded in our prognostica|tions," &c.
THE method of treatment adopted by the most sagacious physicians at that time in the city, was nearly similar to that recommend|ed in the text of the preceding pages; except Page 36 that they were more reserved in the use of emetics, but more liberal in that of saline ca|thartics. They never employed blisters ex|cept when the patients were affected with coma, and then seldom with much benefit.
Sept. 4, 1793.