<\# ^ o - OP A." «> • "of.* HISTORY AN EPIDEMIC FEVER. _ HISTORY AND DESCRIPTION cY S OF AN EPIDEMIC FEYER,, C0MM6NLY CALLED SPOTTED FEVER, WHICH PREVAILED AT GARDINER, MAINE, IN THE SPRING OF 1814, Bt E. HALE, Jr. M.D. M.M.S.S, BOSTON : PRINTED BY WELLS AND LILLY; 1318. TO BENJAMIN VAUGHAN Esq.M.D. L.L.D. DEAR SIR, The kindness and friendship with which you have honoured me, as well as the strong interest you feel in the promotion of science ; and especially that of the profession to which I belong, induce me to inscribe to you this little volume. You have seen much of the disease, which I have here attempted to de- scribe, and will feel how inadequate any des- cription is, to give a full representation of its various and evanescent features. You have seen too, what anxious watching, and diligent investigation, it incessantly required from the physician ; and how little time it left him, to mature his observations upon its character. You will, therefore, I doubt not, be disposed to receive with candour and indulgence this attempt to transmit to others, an account of the principal phenomena which it exhibited. DEAR SIR, Your sincere friend and very obedient servant, E. HALE, jr. Boston, October 1, 181$. vr. o} «rf2n PREFACE. Several treatises upon the Spotted Fever have already been published in this country. But as their object has been to give such an account of it, as would apply to its general character, as it appeared in different places ; they could not of course take notice of many of the modifications, which it acquired from various local circumstances. It has been my ob- ject in this volume, to give a more clinical view of the disease ; to exhibit it in its varieties, as it appeared to the physician at the bedside of his patient, rather than to seek its place in a regular system. The materials from which the description and treatment of the disease are given, were taken at the time. At the close of every day, I recalled to mind the circumstances of each Vlll PREFACE. case, for which T had prescribed, and recorded them in my note-book. By this means I had a daily journal of every case, and could after- wards compare them with each other ; and with the state of the weather, as shewn by the Meteorological Journal, which was also kept at the same time. A particular account of the situation and symptoms of each patient, and of the remedies prescribed, was in this manner recorded, until near the close of March ; when the number became so great as to make it impossible to do it so fully. The similarity of the more important symptoms in the greatest proportion of cases, also rendered a continuance of so particular a journal less necessary. I afterwards generally mentioned only the time and manner of the attack, and such other circumstances in the course of the disease, as were peculiar in their nature, or of less frequent occurrence. This statement explains the reason that so few instances of coma are given among the cases, although I have considered it as mak- ing one of the stages of the disease. The prevalence of this symptom was much less general, in the early part of the Epidemic sea- PREFACE. IX son, than it was at a later period. But my minutes of most of the cases, late in the sea- son, are not sufficiently particular for publi- cation. Had the cases of coma been less fre- quent in proportion to the others, I should nevertheless, have been disposed to regard it as constituting a distinct stage of the disease ; in as much as it appeared in most, or all of the cases in which the character of the disease was suffered to be fully developed ; and espe- cially as the symptoms which attended it, were many of them, in a great measure peculiar to that stage. The situation of a country physician, ren- ders it necessary for him to unite much of the business of an apothecary, with that which properly belongs to his profession. He must not only prescribe the remedies, but must also prepare the medicines, and put them into doses. From this cause, some of the prescrip- tions were stated with less precision in my journal of cases, than if they had been writ- ten for another to follow ; and minute and un- important changes in the medicines, were not always mentioned. In consequence of this, rather less variety in the treatment, appears in X PREFACE. the cases given in this volume, than was actually exhibited in practice ; but the differ- ence relates only to such slight particulars, as were unimportant in their nature and effects. I have given a considerable number of cases at full length, in order that the reader may be able to judge for himself, of the accuracy of the description of the disease, and the cor- rectness of the observations which I have made upon it. These cases are taken from my note-book with only slight verbal altera- tions ; and, as at the time when the Epidemic prevailed, I had but partially formed my opinions respecting its nature, there was of course no chance for the correctness of the records, to be affected by any theoretical par- tialities. " There is at all times," says Dr. Hall, " something in individual cases, on which more reliance is placed, than on any gener- alization of facts ; for whilst the former are alone presented to our observation by nature, the latter is apt to partake of the bias of opin- ion, and of the imperfection of every produc- tion of the human mind."* * Hall on Diagnosis. Preface, page xxiii. PREFACE. Xi I make no pretensions to originality, in the course of treatment which was adopted for the cure of the disease. It was principally derived from the general principles which are to guide us, in the management of all diseases, according to their character and symptoms. I had then had opportunity to read but little, of what had been previously published res- pecting the Epidemic. I had, however, ob- tained some benefit from these treatises ; and I owe much to the suggestions of a highly re- spected friend, not in the profession. TABLE OF CONTENTS. INTRODUCTION. Page General remarks 1 Face of the country, of the District of Maine . . 3 Climate 4 Situation of Gardiner 6 Its inhabitants ....... 8 Prevailing Diseases ....... 10 Sketch of Diseases from 1813 to 1817 . . . 15 Cases of fever in 1817 . . . ... 24 CHAPTER I. ORIGIN AND PROGRESS OP THE EPIDEMIC. Its prevalence in the vicinity .... 29 Commencement in Gardiner 30 Termination 32 Other Diseases 33 Connexion of the Epidemic with changes of weather 34 Meteorological and Pathological Tables ... 38 CHAPTER II. DESCRIPTION AND SYMPTOMS OP THE FEVER. General description 49 Division into stages 50 Access 51 Rapidity of the attack . . . . . . 51 UV CONTENTS. Cases of the access ... 58 Duration of the first stage 65 The vomiting stage 67 Perspiration .... 68 Peculiar desire for cold water 71 Frequency of the vomiting 71 Its duration .... 72 Comatose stage 73 Manner of death 75 Frequency of the comatose stage 76 Its duration .... 78 The convalescence 78 Symptoms of recovery 79 Eruptions .... 81 Carbuncles 82 General Observations 87 Anomalous symptoms 88 Relish for Tobacco 90 Affections of the larynx 91 Organs exempt from the disease 92 Spots 95 State of the mind .... 96 Crisis 98 Duration of the disease 100 Number of fatal cases 101 Other diseases during the Epidemic 102 Second attack of fe ver 103 Manner of spreading 103 Appearances after death 109 CHAPTER III. TREATMENT OF THE FEVER. General Treatment Particular remedies, Venesection 111 126 CONTENTS. XV Blistering 126 Fomentations *28 Frictions 12 9 Emetics 129 Cathartics 131 Diaphoretics * 32 Stimulants, Cinchona I 36 , Gentian 138 , Quassia and other vegetable tonics . . 139 , Acids 140 9 Metallic tonics 140 , Wine . . 141 , Brandy . . . . . .141 , Opiates 143 , Cordials 144 Diet 144 Regimen 146 CHAPTER IV. CASES OF THE EPIDEMIC. I. Case of a young woman 149 II. A young married woman 152 III. A boy eleven years old . 152 IV. A boy six years old . . . . 154 V. A young woman about eighteen 154 VI. A married woman about forty 168 VII. A healthy man about thirty 170 VIII. A boy four years old 174 IX. A girl of eighteen .... 176 X. An infant, thirteen months old 177 XI. A girl five years old ... 178 XII. A man aged thirty-three years 180 XIII. A young woman of twenty-five 181 XIV. A married woman about thirty 183 XVI CONTENTS. XV. Another about the same age 188 XVI. A young married woman 190 XVII. A married woman about thirty 194 XVIII. A boy four years old . . . . 197 XIX. A young unmarried woman 198 XX. A gentleman of eighty years 201 XXI. A lady of about forty . 205 XXII. A man about thirty-five . 207 XXIII. A married woman about thirty-five 212 CHAPTER V. REMARKS UPON THE TREATMENT AND CASES. Upon the general result . Fatal cases. Similarity of the different cases . 220 221 222 CHAPTER VI. REMARKS ON THE NATURE OP THE DISEASE. Character of the Fever 226 Fever complicated with inflammation . . . 236 Congestion at the commencement .... 239 Contagion . . . . ' . . . . 240 The Epidemic the same, as has prevailed in other places 242 Its name 244 Conclusion 245 INTRODUCTION. A.N Epidemic in many respects similar to that, whose history is detailed in the following pages, prevailed extensively throughout New England, during the years 1812, 1813 and 1814. Where- ever it appeared, its ravages were severely felt. The variety and deceptive nature of its symptoms often eluded the skill of the Physician, while the quickness of its operations, frequently left him little to contemplate but its fatal termination. The dread which it has inspired, under the name of the Spotted Fever, will scarcely be forgotten so long as memory or tradition shall last. How far this was the same disease, as that, which prevailed at Gardiner in the Spring of 1814, I shall not at present stop to inquire. It is well known that peculiarities of climate, local situation and local habits have an important in- fluence in modifying diseases ; and it is by no 1 2 INTRODUCTION. means unreasonable to suppose, that local diseas- es also materially affect, and vary the character of those, which are more general. The principle, first noticed by Sydenham, is now pretty gener- ally received, as an established law of nature ; that Epidemics in their progress overpower all other diseases, and assimilate them to themselves. Yet it does not follow, that thev are not in their turn influenced by the diseases, whose principal fea- tures they destroy. On the contrary, it is at least probable, that while their characteristic symptoms remain, they are so modified, as in many cases to assume a very different appearance. It would be a very curious inquiry, to what extent an Epidemic derives its character from the inherent nature of the disease, and how far that character results from the local complaints, with which it comes in contact in its progress. A satisfactory answer to this inquiry, were it possible to obtain one, would doubtless do much to quiet the dis- putes among Physicians, respecting the nature and treatment of these diseases. But the data, upon which such an answer must be founded, are not to be obtained in regard to any Epidemic, that has ever prevailed. It would require a par- ticular historical description of the disease in a great variety of places, together with an accurate medical topography of each place : and these are circumstances, to which the attention of the pro- fession has been but little directed. INTRODUCTION. 3 Before I proceed, therefore, to the history, which is the main object of this treatise, it will be proper to notice some of the circumstances, which may be supposed to have influenced and modified the Epidemic, it describes. In this point of view, the face of the country, climate, local sit- uation, local habits and prevailing diseases, are all entitled to some consideration. I shall not pretend to enter into a full discussion of these subjects ; but shall only offer such observations, connected with my principle design, as a resid- ence of less than five years enabled me to make. This is the more necessary in the present in- stance ; as the climate of the District of Maine is little understood, and frequently misrepresented by those, who live out of the District. The face of the country throughout the District of Maine is for the most part hilly, though rare- ly mountainous. Hills and valleys are irregu- larly interspersed in every part of the country. On the banks of the Rivers, they in many places assume a more regular appearance, rising and falling, like the waves of the sea. The hills in these instances frequently terminate on the river by an abrupt precipice. The vallies between them extend onlv a short distance, but soon rise to the elevation of the surrounding country, which is much higher than the level of the river. 1 INTRODUCTION. The sea coast is pretty generally rocky, and apparently, barren. The interiour is much less rocky, and is for the most part abundantly fruit- ful. The soil is various, being in some few places sandy, more frequently clayey, and still more extensively loamy. Its fertility is sufficient to yield a liberal return to the labours of the hus- bandman, although from the recent date of the settlements, the state of cultivation is very im- perfect. Except on the sea-coast, and a few towns in the south-west part of the District, the towns have all been recently settled, very few of them being more than forty years old, and most of them still more modern. Of course, extensive forests abound in every part of the District. Per- haps no country in the world is better supplied with water, than this. Every portion of it is inter- sected by rivers, and smaller streams, and ponds, which furnish extensive advantages for inland navigation, as well as for the purposes of health and convenience. The climate varies in temperature, from the severe cold of winter to the extreme warmth of summer — a range by the thermometer, of from several degrees below the zero of Farenheit, to 80 or 90 above it. Although exceedingly cold in winter, and warm in summer, it is much less subject to frequent and violent changes of tem- perature, than the more southern parts of the INTRODUCTION. O country. It is rather remarkable for its uniform- ity. The winters are cold and long ; but the steadiness of the cold lessens the perception of its severity. The transition from winter to sum- mer is rather sudden, with the intervention of only a short period of the disagreeable weather of early spring. During the spring and sum- mer, vegetation is rapid and vigorous. Rains, which are rare in winter, are generally suffi- ciently abundant in summer. A severe drought is an unusual occurrence. The heat of summer is almost as remarkable as the cold of winter ; but on the Kennebeck river, (and I believe on the other rivers,) it is always tempered in the af- ternoon by a river breeze, which dispels the languor produced by the heat, and gives a de- lightful freshness to the atmosphere. This is usually followed by a calm, serene evening. It is remarkable, that vegetation does not seem to be at all impeded by the coolness of the air, pro- duced by the river breezes. The atmosphere, especially during the winter season, is clear and still. Violent winds are ex- ceedingly uncommon, and in the cold weather, never occur. Nothing can exceed the serenity, transparency, and brilliancy, of a cold winter's evening on the Kennebeck. Not a vestige of a cloud is any where to be seen — not a vapour to obstruct the sight, which seems to penetrate into 6 INTRODUCTION. the very immensity of space. Even the smoke> which rises from the villages does not intermix with the surrounding air, but, as if fearful of con- taminating its purity, it stands congealed by the cold, in a column surmounting the chimneys from which it issues. There is scarcely a motion in the air to disturb the universal stillness. The whole scene leaves an impression of purity and grandeur, unequalled by any thing else, that I have ever, witnessed. The atmosphere retains much of its purity and serenity through the sum- mer months, though with less constancy and bril- liancy. There was a remarkable exception to its usual transparency, in the summer of 1816, during a drought, which was said to be the most severe, ever known in the District of Maine. For several days the whole atmosphere was so obscur- ed by smoke and fog, that the sun was hardly visible, or, if at any time it appeared in sight for a few minutes, its deep red appearance only serv- ed to render the darkness more gloomy. This darkness was generally attributed to the smoke from the forests, which had taken fire, by various accidents, in consequence of the drought ; but with how much correctness, I do not pretend to determine. The preceding observations apply to a great part of the District of Maine, as well as to the town of Gardiner. This town is situated on the INTRODUCTION. 1 west side of Kennebeck river, about forty miles from its mouth, in north latitude 44° 14' and west longitude 69° 44', and contains between 1800 and 2000 inhabitants. Its principal village is, at the mouth of the Cobbossee-Contee, a small river, which empties into the Kennebeck. This river rises from a chain of ponds of considerable ex- tent ; and in the last mile of its course, furnishes by its falls an abundant supply of water power, capable of being applied to the purposes of the arts and manufactures. It is already made use of in a variety of manufacturing establishments, although to a very limited extent, in comparison with what the advantages admit of. The Kennebeck is navigable for small sea ves- sels to Augusta, seven miles above Gardiner; and is subject to tides a little farther. The mean difference, at Gardiner, between high and low water, is about seven feet. The depth of water, below this place, is sufficient to permit the access and departure of loaded vessels of nearly two hundred tons burthen, though the navigation is somewhat obstructed by rocks and shoals in some places. The river is closed by ice during the winter. The mean time of closing, for the last twenty years, has been the 28th of November ; and the mean time of opening in the spring, for the same period, the 6th of April. The mean time of closing during the last ten years was 8 INTRODUCTION. rather later, than it was the first ten years of that period. In the time of opening there has been no material alteration of this kind. It is a rare occurrence for the ice to break up, and the river to close a second time in the course of the same winter. Except the inhabitants of the village at the mouth of the Cobbossee-Contee, the people of Gardiner are generally farmers. Each one owns a small farm, and cultivates it with his own hands. The richness of the soil and the vicinity of a market furnish an abundant encouragement for their labour. There are, however, some pe- culiarities in their character, as compared with the farmers of the older towns in the country. Most of them, having removed here from differ- ent parts of the country, since the incorporation of the town in 1803, they have not had time to ac- quire that similarity of habits and customs, which is usually found in this class of people. The in- conveniences, to which they were exposed, when they first encountered the labours of making new settlements, have led them to disregard many of the common comforts of life. Others, having been long accustomed to obtain their support from the produce of the forest, are but slowly re- claimed from the irregular and improvident habits, to which their mode of life has formerly subject- ed them. There is a considerable number, who INTRODUCTION. H well sustain the regular and orderly character of New England farmers. But there are many others, who, although their character and condi- tion are fast improving, still retain much of the hardiness and improvidence of the first inhabi- tants of a wild country. The inhabitants of the village are traders, me- chanics, and manufacturers, with characters and habits as various as their employments. Many of the mechanical arts, requiring a considerable degree of bodily fatigue and exposure, are of a nature to inspire those who are engaged in them, with a sort of contempt for the luxuries, and even for many of the comforts of life. Their hardi- ness and habitual vigour render them insensible to inconveniences, which in other situations would be considered essential to health and enjoyment. This is more especially the case with those who are employed in the saw-mills, in the manufac- ture of boards. The nature of their business ex- poses them constantly to great fatigue, by night as well as by day, and often to labour in the water for several hours in succession. Yet they are in general a healthy, vigorous class of men, and ap- pear to catch their full share of the enjoyments of life as they pass through it. There is also a considerable number of persons, who have been familiarly conversant in general society, and 10 INTRODUCTION. whose habits and customs of course need no par- ticular notice. From the preceding observations, it will na- turally be inferred, that the diseases to which the inhabitants of the District of Maine are most sub- ject, are those of inflammation, or at least such as proceed from a phlogistic diathesis. This may perhaps be true in general, although, during the time I resided in Gardiner, it was so only to a very limited extent, in that place and its vicinity. Rheumatisms, especially chronic rheumatisms, were very common. But excepting these, dis- eases of inflammation were exceedingly rare ; and in those which occurred, there was such a tender cy to prostration of strength, that much caution was necessary, in the use of depleting remedies. Almost all of the cases of fever, which 1 saw r , partook more or less of the character of that de- scribed in this treatise. It is by no means true, however, that they have always been of this kind. In 1804 and 1805, an Epidemic prevailed in Gardiner and the vicinity, of a very different character. I have not had a very particular description of it : but from the course of practice, which was most efficacious in subduing it, it is evident that its characteristic was a strong tendency to inflammation. The Physicians who treated it the most successfully, used frequent bleedings, and gave large portions INTRODUCTION. 1 1 of Jalap and the submuriate of mercury daily, until the symptoms remitted, which often requir- ed twenty-one days ; and at the same time, allow- ed only the lightest species of nourishment, and that in small quantities. So successful was this mode of treatment at that time, that it became habitual, with a considerable number of practi- tioners, till they seemed almost to forget, that there were other remedies in the materia medica ; and the powder of Jalap and submuriate of mercury has become a common family medi- cine. From the best information I can obtain, the inflammatory diathesis appears to have prevailed, until within two or three years of the commence- ment of the epidemic of 1814. Whether the change from inflammatory to typhoid diseases was sudden or gradual in its progress, I have not the means of ascertaining. From the time that I commenced practice there, in the spring of 1813, the fevers were invariably those of debility, and continued to be more or less so, till the autumn of 1817, when they became more inclin- ed to inflammation. The peculiarities in the constitution of diseases, so well defined, and so accurately described by Sydenham, although generally acknowledged by medical writers, since he brought the subject in- 12 INTRODUCTION. to notice, do not appear to have excited the at- tention which they deserve. It is very observ- able, that diseases, whose general characters are so similar as to be known by the same names, in different seasons require very different modes of treatment. A fever, which at one period shall require powerful and repeated evacuations, at an- other time, will bear them with great difficulty. A striking example of this kind is given by Dr. Rush, in his accounts of the yellow fever at Phi- ladelphia, in different years, from 1793 to 1803. Even in those diseases which have a more fixed character, the same thing takes place, to a con- siderable extent. The various local inflamma- tions, although they always demand bleeding, and other antiphlogistic remedies, in proportion to their severity, require much more caution in their application, at some periods than at others. There are some seasons, when little else seems requisite to the restoration of health, than to reduce the system from its inflammatory to its natural state. The patient passes almost directly from a state of high inflammation to that of health ; or with the intervention of only a very short period of de- bility. There are other seasons, when in the same disease, and in persons of the same habits, if evacuations are prescribed incautiously, the patient sinks suddenly into a state of debility, more alarming, and more difficult to cure, than the inflammation which preceded it. INTRODUCTION. 13 Few persons will perhaps be disposed to agree with Sydenham in attributing this change in the character of diseases, to changes in the state of the air. If corresponding phenomena had been known to take place in the atmosphere, they would do but little in explaining the effects at tributed to them. Much less, since their exist ance is altogether hypothetical, should we resort to them for an explanation, which can add noth- ing to our knowledge of the facts. That such changes do take place in the constitution of dis eases, is sufficiently established by an attentive observation of their history and symptoms, at dif- ferent periods. The causes of the change seem beyond the ken of human knowledge ; and it is useless to seek them in idle speculation, where observation and experiment cannot lead us. In a practical view, these changes are of the great- est importance. Every disease being more or less influenced by the prevailing constitution of diseases, it is necessary to take this into consider- ation, before we can make up our prescriptions, in- telligibly and satisfactorily. We must not only look at the individual case before us, but must also bear in mind those which have preceded, as well as those which are cotemporary with it. Every case of disease may be considered as having some degree of relation to those which surround if, however dissimilar in their general appearance and character. Hence it is, that a physician who contents himself with ascertaining only the ge 14 INTRODUCTION. neral character of the disease to which he is called, and prescribes for it upon authority, will often be disappointed of the result he anticipates, while he who diligently investigates all the phenomena connected with it, and regulates his practice ac- cordingly, will be more successful in its manage- ment. It is exceedingly to be regretted that this sub- ject has so little excited the attention of physicians and medical writers. Since the history which Sydenham has left us of the constitutions of the diseases of his time, although the accuracy of his descriptions, and the importance of his observa- tions, seem to be fully allowed, yet very few have imitated his example, and delineated the patho- logical changes, and peculiarities of the periods in which they have lived. We have treatises on particular diseases, and systems of practice, in abundance ; but we have no continued history of diseases and their phenomena, which will con- nect those of one period with those of another, and exhibit the relation between those of diffe- rent kinds, which occur at the same time. A series of such histories, while it would furnish us with the means of tracing the origin and progress of some diseases, and the decline and disappear- ance of others, would enable us, with more satis- faction than we can now do it, to compare the phenomena and treatment of such as come under INTRODUCTION. 15 our own observation, with those which have been subject to the management of our predecessors. I shall close this introduction with a concise historical sketch of the more important diseases, which occurred in my practice, during my resi- dence in Gardiner, I commenced practice there early in May 1813. Towards the close of that month we had several cases of severe catarrh, or rather pneu- monia, complicated with bowel complaints. It- was confined to children of from four to seven years of age. It began with a severe cough, with pain in the chest and dyspncea, pain in the head and other symptoms of fever. In a day or two, there was nausea and vomiting, pain in the bow- els, and not unfrequently diarrhoea. The num- ber of cases was not great ; and the termination was favorable in all of them. The disease was treated by blistering, emetics and cathartics, ex- pectorants and alteratives, according to the va- riation of the symptoms. The summer was remarkably healthy. One severe case of pneumonia in an adult, occurred in July ; excepting which, my practice was al- most confined to occasional calls to slight affec- tions, teething children and casualties. The autumn was much the same. A singular tumoui 16 INTRODUCTION. in the left hypogastriuni of a boy five Or six years old, was the only case worth noticing. It was for some time, of a doubtful character ; but at length suppurated, was opened, and healed without difficulty. In December, a case of sudden death occurred in consequence of violent anger ; but I was not permitted to examine the body, to ascertain the in- ternal injury. Early in January 1814, I had one case of acute rheumatism, and one of severe pneumonia, which, however, terminated favor- ably. About the middle of this month, I was called into a family in Pittston, several miles dis- tant, in which were several cases of genuine ty- phus fever, as described by authors. Neither the disease nor the treatment had any thing very peculiar in them. The patients all recovered. At the same time, I had a case of a singular disposition to the formation of abscesses in a very young infant. The mother had been affect- ed with psora, received from a domestic, about the sixth month of her pregnancy ; but had cur- ed herself, as soon as it was discovered. Whether this had any thing to do with the subsequent dis- ease of the child, I do not pretend to determine. The infant seemed perfectly well, until it was about three weeks old, when an eruption com- menced, having very little of the appearance INTRODUCTION. 17 of psora however, which soon increased into small abscesses. These abscesses shewed no disposition to ulcerate through the skin. Nor could they be made to do it, by any application for that purpose : but constantly extended themselves under the integuments, until the matter was eva- cuated by an opening with the lancet. Even after an opening was made, unless the discharge was very free, and aided by compresses, the ab- scess would rather incline to extend farther, than to heal. The matter discharged was generally bland pus, and very copious in quantity. More than thirty abscesses formed and were opened in succession, before the child recovered. The general health in the mean time was less affected than might have been expected. The strength was supported by an infusion of cinchona, after the discharge had become profuse, at the same time that the bowels were care fully regulated, and alteratives occasionally given. In three or four weeks the child recovered. It became very fat soon after, but seemed to be in perfect health. In February the Epidemic began, which is the subject of the following pages. After it ceased as an Epidemic, a few cases of fever occurred, in the course of the summer and autumn, which, al- though they preserved many of its features, were too unfrequent, and too different from it in many 3 i 8 INTRODUCTION. respects, to be considered as a continuance of it The fever had more tendency to inflammation, at least to phlegmonous inflammation, than had been manifested during the Epidemic. There was not that tendency to debility, and that ex- treme exhaustion from the use of depleting reme- dies, which there had previously been. Evacua- tions were more freely required, and were borne much better. I have to regret the loss of two very valuable patients in the autumn of this year, by fever complicated with severe local affections. In June, I had a case of genuine acute rheu- matism, which continued for several weeks with considerable severity ; and another in October. Through the winter, there were a few cases of fever, some of which were severe, and of a character nearly similar to those last described. As the cold weather advanced, however, it be- came necessary to use depleting remedies with more caution, and to administer tonics more freely, than during the summer and autumn ; and the few cases that occurred towards spring, as- sumed more the appearance and character of the Epidemic of the preceding year. A case in De- cember shewed very strikingly the unfavorable effects of an unseasonable exhibition of cathartics. The patient had been sick three days when I wai* called, and had taken a powerful dose of jalap INTRODUCTION. I 9 and submuriate of mercury, two days before, which had then hardly ceased its operation. At my second visit, 1 found her determined to re- peat the cathartic, although I could see nothing in her situation or symptoms, which indicated it. I had too little influence to prevent her from fol- lowing her own inclination ; but succeeded in inducing her to substitute a little rhubarb for a part of the jalap and submuriate, which she had already prepared before I arrived. By this means I reduced the quantity about one half. Notwithstanding the reduction however, the me- dicine produced a hypercatharsis, which very nearly destroyed her life, and which could not be subdued, by any means which I thought it pru- dent to adopt, until nearly a fortnight afterwards. When it yielded, it ceased rather abruptly, but without any unpleasant consequences. In the spring of 1815, we had again several cases of pneumonia, complicated with bowel com- plaints. They were at this time principally con- fined to teething children. One or two cases proved fatal, and some others recovered with difficulty. The most efficacious mode of treat- ment was, after scarifying the gums, if they were swollen, to blister the chest, give an emetic of Ipecacuanha and submuriate of mercury, and to keep up the action of the bowels with small doses of the same submuriate, at the same time 20 INTRODUCTION. giving expectorants, and the milder tonics, par- ticularly infusion of quassia, as the symptoms might indicate. In the months of May, June and apart of July, a fever prevailed in a small neighbourhood, which in some respects resembled the Epidemic of the preceding year, although it differed from it in some important particulars. Like that, it bore evacuations badly ; yet they did not produce such an overwhelming state of exhaustion and sinking, as they had done the year before. The disease, although severe, was less rapid in its progress, and less sudden in its changes of appearance and cha- racter. The first case was in May, of a young man, who had been for several years subject to scrofulous affections. He was relieved of the fever without much difficulty, principally by the use of alteratives ; but after he had become able to ride out, he was seized with a diarrhoea, w T hich suddenly reduced him very low, in spite of all the remedies I could give him. The usual pre- scriptions for such an affection, had scarcely any effect, though administered very freely. His tongue had become black, his teeth and lips were covered with a black sordes, and other symptoms of approaching death had appeared, when suspect- ing the diarrhoea to proceed from scrofula, I gave him the solution of muriate of lime in pretty large quantities, with tincture of opium. The INTRODUCTION. 2i effect very far exceeded my expectations. His bad symptoms soon disappeared, and in a few days he was rapidly convalescent. Soon after this, two young men were taken sick in the same family, during my absence. They were treated with evacuants, principally cathartics, and died, each about the twentieth day. The other cases all terminated favourably, by the use of alteratives and tonics, care being taken at the same time, to preserve the first passages in good order. There were very few cases of fever in town this summer, except in this family and the immediate vicinity. The latter part of the summer and autumn were very healthy. The months of August and Septem- ber particularly, scarcely furnished a case of dis- ease of any kind. Indeed the remainder of this year was free from every thing worthy of notice in this sketch. A case of acute rheumatism in the winter of 1816, was treated by bandaging, upon Dr. Bal- four's plan. The bandages evidently gave ven great relief from the pain ; and thus diminished the sufferings of the patient, while other mea- sures were in operation to remove the disease. Yery little else occurred, except the unimportant cases and casualties which are perpetually re- curring in country practice, until April, when Z % 2 INTRODUCTION. a pulmonary affection, with bowel complaints, again made its appearance among teething chil- dren. The number of cases was not great ; but they were generally very severe. They were treated, as Ihe similar disease had been the year preceding, and in most cases with success, though in two instances it proved fatal. In one of them, however, nothing had been done to relieve the child, until the appearance of the convulsions which immediately precede death. I had only two or three cases of fever, this spring, which were very similar in character to those of 1815; and in May, a severe case of ophthalmia. Through the summer my practice consisted principally of occasional calls. Only one case of any importance occurred. This was a fever complicated with a spasmodic affec- tion of the leg, which at one time threatened to become a tetanus, but was subdued by the usual anti-spasmodics, combined with the treatment for fever. There was nothing the following autumn, nor in the winter and spring of 1817, which requires a particular notice here. I had one case of ophthalmia in January, and some slight rheuma- tisms, and a considerable number of various chro- nic affections in the course of the spring ; but they had nothing very peculiar in them. INTRODUCTION. 23 In the summer following, a disease of a more important character made its appearance, and at one time, threatened to become extensive in its ravages. Its course, however, was checked rather suddenly by the approach of cool weather ; and the number of cases was not large. It was a fe- ver, but of a very different character from those heretofore mentioned, and requiring a very dif- ferent course of treatment. The several cases exhibited a great variety of appearances ; but they agreed in general, in requiring evacuants much more extensively, and stimulants more sparingly than any fevers which I had seen. In a few w T eeks I bled more patients than I had, at any time before since I commenced practice ; and this arose, not from any change in my opinion respecting the propriety of bleeding in fevers ge- nerally, but from an alteration, as I believed, in the character of the fevers which came under my observation. At the same time, it was neces- sary to use evacuations with much caution, to prevent the strength from sinking too low. The disease seemed to be on a point between requir- ing a decidedly depleting, and stimulating course of remedies. In the earlier cases particularly, much cautious investigation, and anxious watch- ing were requisite, to manage them satisfactorily. I had the pleasure, however, of seeing them all terminate favourably, which came under my care where I had the control of the treatment. '24 INTRODUCTION. I found one bleeding, at the commencement of the disease, sufficient. This was generally fol- lowed by an emetic, which was sometimes re- peated, and by a liberal exhibition of antimonial diaphoretics. Cathartics were also given freely, whenever the symptoms appeared to indicate them ; and tonics as soon as the febrile excite- ment was diminished. As the excitement declin- ed, the patient in almost every case, sunk into a comatose state, from which he was always reliev- ed by the application of cold water to the head, and the internal use of stimulants. Blisters were at first tried for this symptom, but with very little, or no effect. There were two cases in which the symptoms were rather anomalous, and sufficiently remarka- ble to deserve a more particular notice. The first was a stout, athletic man, who had been se- veral days sick with severe pain in the head and back. He had been bled, and had taken a pow- erful cathartic, by which the pain was nearly re- moved. Still he seemed in great distress, though he could not refer it to any particular part. He slept very little, but lay tossing upon the bed continually. His tongue was at first coated, but had become nearly natural. His pulse was of a natural frequency, and rather feeble. His skin was dry ; and his countenance expressive of the deepest agony. At length, by giving him very large doses of antimonials, with the aid of exter- INTRODUCTION. 25 nal sudorifics, I succeeded in procuring a free per- spiration, which completely relieved him of his distress. As soon as this had taken place, the usual symploms of fever, quick pulse, coated tongue, &c. made their appearance, and were re- moved after a few days, by the remedies which were successful in other cases. The other case referred to, was a man of a feeble constitution. I was called to him the first day. He had the usual symptoms of fever, but not very severely. I gave an emetic and antimonials. As his pulse was feeble, and there was no symp- tom which seemed particularly to require it, I de- clined bleeding him, although he wished it. The next day he sent to another physician, who was not aware that I had been called, until he arrived at the house, w r hich was at a considerable dis- tance ; and reluctantly consented to prescribe without my being present. The symptoms of fever had now, in a great measure, disappeared, and given place to others, resembling those of paralysis. He bled him, and directed frictions with a solution of the meloes vesicatorii. The third day, at the particular request of this phy- sician, the sick man was again put under my care. His pulse was now slow and feeble — skin dry — tongue slightly coated. His countenance was fix- ed, with a very peculiar expression, which I know not how to describe. He had complained of no 4 -U INTRODUCTION. pain, since the first day, when he had had a little in (he head, which was relieved by the emetic. But the symptom, which was peculiarly noticeable, was an entire loss of the power of voluntary mo- tion. There was no rigidity of the muscles, and no dimunition of heat or of sensibility ; yet he could not impart the least motion to a limb, or even to his head. When raised upon his feet, he could stand, as he had been doing that morning, but as soon as he attempted to walk, he fell per- fectly helpless upon the floor. In like manner, if his head fell upon one side, while he was sit- ting upon the side of his bed, he was unable to raise it, although he could keep himself erect, when he had once gained that posture. He could not move a finger or a toe in the least degree. He spoke with a little difficulty ; but breathed well, and swallowed with ease. He had a slight sensation of numbness in his limbs, which he compared to a slight degree of the feeling which is called a sleepiness of the limbs. His mind was perfectly clear, and he was totally free from every thing like torpor or coma. I still considered this as a case of fever, and believed the febrile action to be in a manner con- centrated upon the nervous system, as in the preceding case it had been upon the brain. I accordingly directed large doses of a powder of Ipecacuanha and camphor, with a small portion INTRODUCTION. 27 of opium, to be given every four hours ; and a pretty Jarge blister to be applied to each leg, and as soon as the action of the skin was excited, to be removed to another place, without full vesi- cation. Stimulating frictions were also ordered to be diligently applied over the whole body. Upon visiting him again the next morning, 1 was mortified to find, that because the first pow- der had produced a slight nausea, no more had been given ; and the other remedies had been very carelessly applied. My patient was now in a hopeless state. The loss of power had extend- ed to the muscles of respiration and degluti- tion, and of voice. He breathed with great dif- ficulty, and could scarcely speak intelligibly. The whole surface of the body was covered with a profuse perspiration ; and a watery fluid flow- ed in considerable quantities from his mouth, which came apparently from his lungs. He had not lost his sensibility nor his powers of mind, and the heat of the body was not materially dimi- nished. Some attempts were made to rouse the system to action, by powerful stimuli ; but they were ineffectual, and he expired the same day. I could not obtain leave to have a dissection. I had afterwards another case, in which an ex- crutiating pain in the foot was attended with un- defined general distress, thirst and dry skin. I 28 INTRODUCTION. bled pretty largely, and prescribed antimonials. The next day the pain was completely gone, and my patient had only a slight fever remaining, which disappeared in a day or two. Cases of this fever continued to occur occasion- ally, though not very frequently, through the whole of the autumn, until December, when I removed from Gardiner. CHAPTER I HISTORY OF THE ORIGIN AND PROGRESS OF THE EPIDEMIC At the commencement of the year 1814, there was nothing at Gardiner, to indicate the approach of the Epidemic, that was to follow, unless it was its prevalence in some towns in the vicinity. The year preceding had been abundantly fruit- ful. The autumn and first part of the winter was drier than usual, but not so much so as to produce a drought of any importance. The winter was a pleasant one, without any unusual physical occurrence to distinguish it from others in that climate. The tables subjoined to this chapter, exhibits more particularly, the tempera- ture and state of the atmosphere during this period. Early in the autumn of 1813, we began to re- ceive accounts of a destructive Epidemic in many towns not far distant. As the winter ad vane* ed, the accounts became more and more threat- ening, as the disease approached nearer to us. i>0 ORIGIN AND PROGRESS Tt was frequently fatal ; and the character which it acquired by report, did not diminish its terrors. The first case in Gardiner, to which I was called, was on the eleventh of February. The patient had been several days ill, but not so sick as to call a physician till this time. The case proved to be a severe one, but eventually terminated in re- covery. It was nearly a fortnight before any other cases of the fever occurred. Towards the last of February, however, several attacks fol- lowed each other in such quick succession, as to produce a considerable alarm. Some of these were in the family and immediate neighbourhood of the person first seized ; others were at a dis- tance, and had had no communication whatever with the sick. Throughout the month of March, the Epi- demic extended itself rapidly in all directions. In some of the families, where it first made its appearance, almost every person was seized by- it. In others, only one or two were at any time materially affected. In some cases, it seemed to spread progressively from house to house, as if communicated from one person to another; at the same time that in others, it suddenly made its appearance in distant neighbourhoods, seizing sometimes two or three persons in a family, nearly at once. All classes of people, and all ages seemed alike exposed to its attack. OF THE EPIDEMIC. 31 Towards the end of this month, the Epidemic was more prevalent, than at any other period. Within a small circuit, more than fifty were con- fined with it at the same time. Many others, who were not reckoned among the sick, were slightly affected by similar complaints ; so that the sick and the invalids included a very large proportion of the population. Although the number of deaths was not large, yet the distress produced by the prevalence of sickness, was great. In many instances, the sick were but poorly suppli- ed with the accommodations and comforts, which such a situation requires. The distress arising from these circumstances, was much increased, by the difficulty and often the impossibility of obtain- ing suitable nurses. It was a disease which re- quired constant and unremitted care. But in such a town as Gardiner, where health generally pre- vails, there are but few, who are familiar with the course of attention and management which a sick person requires, and of these few, a large proportion were themselves sick. As I passed, with as much rapidity as possible? from one scene of wretchedness to another, my heart sickened at the sight of the sufferings which I was called to relieve, and at the pros- pect which they exhibited. The Epidemic, still extending itself in all directions, spread a gloom over the face of every object. Young Z4 OK1G1N A^D TKUGKEsS in the profession, and with but little experience, I was obliged to contend with a powerful dis- ease, in a situation where I could very rarely obtain the advantage of counsel. During the course of fatiguing practice, which this state of things required, I used no precautions to guard myself from an attack of the fever. I was con- stantly and laboriously engaged until late at night, and took my meals at irregular hours, as I could get an opportunity ; but without any injurious effects on my health. Early in the month of April, the progress of the Epidemic began to abate, and it continued to diminish throughout that month ; especially in the parts of the town in which it had previ- ously raged. About the 20th I was called to a considerable number of cases in Pittston, on the East side of the Kennebeck River ; as well as to several new cases in Gardiner. Throughout the month of May also, a consi- derable number of cases occurred. But they grew less and less frequent until the close of the month. The Epidemic may be said to have ter- minated its course in Gardiner with this month. In each of the three following months of June, July and August, I did not see more than two or three cases of Fever of any kind. of The epidemic. 33 During the whole period of the Epidemic, sores of different kinds were unusually pre- valent, as well as for some time after its termina- tion. The most frequent of these was a spe- cies of boil, somewhat resembling a carbuncle, which was very common with the convalescent, as well as with those who had not been affected with general fever. It was a very painful tu- mour which in the course of two or three days from its commencement, ulcerated, and cast off a gangrenous slough. They were not often so severe as to require any other medical treat- ment than an emollient poultice, except when they were merely symptoms of a more impor- tant disease. The whitlow was also unusually prevalent at this time. Headachs and other slight symptoms of fever were almost univer- sal. Hardly a person could be found in the vil- lage of Gardiner, or its immediate vicinity, who had not, in the course of the three sickly months, been the subject of an affection more or less se- vere, which was similar in its character to the more important cases of fever. Most of these, perhaps, would hardly have been noticed at any other time. But they deserve to be mentioned as examples of the strong and universal tenden- cy to a particular disease, which prevailed at that period. 34 ORIGIN AM) PROGRESS It was observable that the Epidemic through- out its whole course, was remarkably affected by the state of the weather, and especially by any sudden change in its temperature. This was true, not only in respect to the effect on indivi- dual cases, but also as applicable to the Epidemic, as such. A few days of unusual cold seemed to render all the existing cases more severe, and at the same time, produced a greater number of new attacks ; while on the contrary, a change from cold to milder weather produced a corres- ponding effect, in mitigating the symptoms and lessening the ravages of the disease. This was strikingly exemplified by the effect of the cold days from the twenty-first to the twenty-sixth of March, and of the warm days which followed. During these few cold days, the cases were much more frequent, and more severe than at any previ- ous time ; but as soon as the weather became mild, there was a remarkable mitigation of the symptoms, and diminution of the frequency of new attacks. Several of those to whom I was afterwards called, dated the commencement of their sickness from a period prior to the favora- ble change, in the temperature of the weather This effect seems to be attributable to the sud- den change, rather than to the coldness or warmth of the weather merely. For the fever general- ly was not more severe, nor more difficult to manage, in the early part of the season when the weather was cold, than it was at a later period, OF THE EPIDEMIC. 35 when it was warmer. Nor on (he contrary did it increase in severity with the progress of the season. There was indeed very little difference in the facility of managing it, during all the time that it raged as an Epidemic, although some of the symptoms underwent considerable alteration. The following tables exhibit the rise and pro- gress of the Epidemic ; and in some measure the state of the weather at the time. T have begun them at a period considerably anterior to the commencement of the Epidemic, and continued them several months after its termination, in or- der that the reader may have as extensive a view- as possible, of every circumstance, in any degree connected with the subject The table of diseases does not exhibit those of any particular district, but those which came within my circuit of prac- tice ; which of course cannot be very accurately defined. Previously to the Epidemic, this circuit was very limited. In the course of the Epidemic it was very considerably extended ; so that the number of cases which the tables exhibit, towards the close of its ravages, bears a much smaller ratio to the amount of population among which it prevailed, than at an earlier period. After the termination of the Epidemic, the same paucity of diseases appears, as before its commencement ; al- though the sphere of my practice was as extensive .'*b ORIGIN AND PROGRESS as at any lime during its prevalence. The depart- ment of practice, which at Gardiner is the most im- portant to the physician, does not appear in the tables, because it is not usually reckoned among diseases. In a country so generally healthy as the District of Maine, and at the same time so fruitful, this department furnishes in ordinary times the most important, as well as the most pro- ductive part of the physician's labours. The thermometrical observations, though suf- ficiently accurate for a standard of comparison of one part of the season with another, are not to be considered as a conclusive evidence of the temperature of the climate. In making them, care was taken that the thermometer should be freely exposed to the air, in the shade ; but no attention was paid to the circumstances of ra- diation, or whatever else it is, that affects a ther- mometer, when exposed to a clear sky, on a widely extended, open area. The phenomena which such an exposure exhibits, had not excited attention, when these observations were made, and of course could not be taken into considera- tion, in selecting the place for the instrument used in making them. But this circumstance does not diminish their utility, for the purposes for which they are now published, however it might invalidate their authority, as data for inves- tigations upon climate. OF THE EPIDEMIC. 37 The column in the tables for new attacks of fever is not quite complete, in consequence of my having sometimes omitted to notice in my minutes the time of attack. Notwithstanding this imperfection, the column may be of some use, to shew how far the progress of the disease was connected with changes of the weather. .38 ORIGIN AND PROGRESS Meteorological and Pathological Table. DECEMBER, 1813 Thermometer * * i Faces of the Sky. New Cases. D o7 < & pi Observation. CO ^ Q, Wednesday 1 36 45 40 Cloudy, Rain. Thursday 2 34 36 25 Cloudy. Friday 3 16 2315 Fair. Saturday 4 123121 Fair. Sunday 5 21i41 25 Clear. Monday 6 27 3431 Cloudy. Tuesday 7 34 38|31 Rain, Fair. Wednesday 8 33 40 33 Cloudy, Snow. Thursday 9 34 35 30 Snow, Fair. Amenorrhea 1. Friday 10 25 33 22 Fair. Saturday 1 1 20 32 20 Fair. Sunday 12 22 26 18 Fair. Monday 13 21 31 27 Fair. Tuesday 14 26 38 26 Fair. Dentition 1. Wednesday 15 22 33 ">4 Fair. Dent. 1. Fever 1 Thursday 16 14 34 28 Fair. Friday 17 — 39 .30 Cloudy. Saturday 18 28 31 31 Snow, Fair. Sunday 19 34 34 23 Fair. Monday 20 1824 17 Cloudy. Tuesday 21 612 Fair. Wednesday 22 927 24 Fair. Thursday 23 1938 20 Fair, Cloudy. Friday 24 3124 4 Fair. Saturday 25 -3 12 6 Fair. Sunday 26 18 5 Fair. Monday 27 -6 17 14 Fair, Cloudy. Tuesday 28 22 30 26 Cloudy. Violent Anger 1. Wednesday 29 28 30 29 Snow. Thursday 30 32 30 17 ! Cloudy, Fair. Friday 31 15 18 10 Fair, i Means 2] 30 22 OF THE EPIDEMIC. 39 Meteorological and Pathological Table. JANUARY, 1814. Day, Observation. Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday 8 Sunday 9 Monday 10 Tuesday 1 1 Wednesday 12 Thursday 13 Friday Saturday Sunday Monday Tuesday Wednesday 19 Thursday 20 Friday Saturday Sunday Monday Tuesday Wednesday 26 Thursday 27 Friday Saturday Sunday Monday Means Thermometer Faces of the Sky. New Cases. 12 30 221 15 34 26 - 3 4 - 9 -20 10 - 1 _ o 12 -10 -16 15 12 16 36 28 13 23 - 8 30 8 23 16 19 32 30 30 36 28 20 30 14 - 3 29 12 2 30 24 26 30 25 30 30 26 12 34 16 26 31 25 22 27 18 27 12 - 6 14 4 14 15 23 29 33 24 45 20 26 33 24 10 32 24 12 39 29 o 22 - 1 p 34 16 - P '0 -12 9 27 14 Cloudy, Fair. Fair. Fair and Calm. Fair. Fair. Fair, Cloudy. Cloudy, Fair. Fair. Fair. Fair. Fair, Cloudy. Cloudy. Fair. Fair. Fair, Cloudy. Snow. Snow, Fair. Cloudy, Fair Slight Snow. Fair. Fair. Fair. Snow, Cloudy. Snow, Rain. Fair. Fair, Cloudy. Fair. Fair. Cloudy, Fair. Snow, Fair. Fair. Rheumatism 1 Pneumonia 1 Abortion 1. Typhu3 Fever 3. Hysteria 1. Abscesses 1. Typhus Fever 1 * These cases of fever were all in one family, in Pittston, seve- ral miles from where the Epidemic afterwards commenced ; and w«re of a character very different from it 40 ORIGIN AND PROGRESS Meteorological and Pathological Table. FEBRUARY, 1314. Days of Observation. Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday 16 Thursday 17 Friday Saturday Sunday Monday Tuesday Wednesday 23 Thursday 24 Friday Saturday Sunday Monday Means S * Faces of the Sky. . fe |X| ■fc 1 3 3 c; £ < a Other Diseases. -19 12 16 23 41 35 22 40 12 -17 8 -16 ■26 23 - 7 10 26 14 - 3 30 25 32 35 14 6 8 12 12 18 18 26 36 33 22 24 18 20 36 27 12 36 23 23 41 28 19 46 30 36 41 42 37 49 37 32 53 32 32 40 37 27 39 21 17 33 26 24 43 36 30 40 46 40 34 25 18 32 18 12 36 32 33 37 23 18 3-1 1 23 Fair, Snow. Mist, Fair. Cloudy, Fair. Fair. Fair. Cloudy, Fair. Fair, Snow. Fair & Windy. Hazy, Snow Cloudy, Hail. Cloudy, Rain. Fair i2 > 3 Days Sj s ] 4 Paces of the Sky. c l Other Diseases. of < Ph a; : g 1 Observation. t- "3 o> < z Tuesday 1 20 26 25, Snow. 2 Wednesday 2 22 36 18| Fair. 2 Thursday 3 16 31 191 Cloudy, Snotv. 1 Friday 4 10 16 61 Fair. 1 Colic 1 . Saturday 5 -;0 18 6 Fair. 1 Worms 1. Sunday 6 - 9 29 13 Fair. ^ Monday • 7 21 35 17 Cloudy, Fair. 2 Tuesday 8 12 37 34 Fair, Cloudy. I Wednesday 9 24 46 36 Fair, Cloudy. 1 Thursday 10 32 37 30 Cloudy, Snow. Friday 1 1 21 : J -9 3'? Pair, Cloudy. Saturday 12 23 jlO 28 Fair. 1 Sunday 13 22 25 14 Fair. Cephalgia t, Monday 14 10 34 18 Fair. 4 2 Tuesday 15 23 10 38 Snow, Rain. 1 1 Wednesday 16 38 37 24 Fair. 2 Thursday 17 30 34 30 Fair. 1 Friday 18 3' 49 30 Fair. 1 2 Saturday 19 33 45 25 Fair. Sunday 20 o. 6 I 32 21 Cloudy, Sriow. 1 Monday 2 J 18 40 24 Fair, Cloudy. 5 3 Tuesday 22 12 30 15 Snow, Fair 2 3 Wednesday 23 i'e 3d 20 Cloudy, Fair. 2 3 Thursday 24 12 32 Fair. -i 2 Friday 25 16 31 26 Cloudy, Fair. ii 7 Saturday 26 13 38 38 Fair. SO Sunday 27 37 58 1 Fair. i 4 Dentition 1 Monday 28 34 49 35 Fair. 2 3 Tuesday 29 26 50 82 Fair. 2 2 Wednesday 30 34 57 -'4 Fair. 4 2 Thursday 31 38 ■ ;<-; Cloudy. 4 2 Means 21 Jl 20 a ORIGIN AND PROGRESS Meteorological and Pathological Table, APRIL, 1814. Days of Observation. Thermometer S $ £ < (C 0. Faces of the Sky. i I * c O £ 2 "3 1 I Friday Saturday Sunday Monday Tuesday Wednesday 6 7 8 9 10 11 12 Thursday Friday Saturday Sunday Monday Tuesday Wednesday 13 'Thursday 14 Friday 15 Saturday Sunday Monday Tuesday Wednesday 20 Thursday 21 Friday 22 Saturday Sunday Monday Tuesday Wednesday 27 Thursday 28 Friday 29 Saturday 30 Means 44 30 35 49 36 36 31 37 JO 4: 3: 33 3. 30 3 ';■ 38 30 40 3; 41 43 41 51 38 62 36 10 39 i9 42 30 38 46 33! 4(1 19 24 5 4; •?•_■ 5;' _. 4 c 3' :■ 3 ; J aO 44 44 47 39 hi 34 50 36 46 41 42 38 48 34 57 46 — 38 46 40 43 37 14 39 58 48 34 30 42 73 58 J r 44 58 Cloudy, Rain.' F*air. Fair. Cloudy. Rain, Fair. Fair. Cloudy, Fair, Cloudy. Fair, Cloudy. Cloudy, Rain. Fair. Fair. Fair. Cloudy, Fair. Rain. Cloudy, Fair. Fair. Fair. Cloudy. Fair. Cloudy. Cloudy. Fair. Fair. Fair, Cloudy. Cloudy, Fair. Fair. Fair. Fair. Rain. 1 3 2 1 } 2 ] 5 2 1 1 2 1 1 1 2 2 1 1 1 1 I i 2 1 1 3 2 4 1 3 1 2 3 1 4 2 2 1 1 1 1 1 1 2 2 o Other Diseases. Dentition 1 Worms I OF THE EPIDEMIC. 43 Meteorological and Pathological Table. MAY, 1814. Thermometer 1 £ Days ifl s" H Faces of the Sky. jg j ^ Other Diseases, < Oh* fc 1 ' I Observation. O IH o> < is Sunday 1 50 58 44 Fair. 1. 1 Monday 2 40 ^4 41 Fair. 2 2 Tuesday 3 38 37 3t- Cloudy, Thud'r. 2 Wednesday 4 ' 34 48 44 Cloudy. 2 1 Thursday 5 44 51 5 b Cloudy. 1 2 Friday 6 38 51 48 Cloudy. Saturday 7 46 42 40 Cloudy, Rain. Sunday 8 42 56 47 Cloudy, Fair. 1 Monday 9 47 58 43 Fair. 1 Tuesday 10 44 70 46 Fair. 1 1 Wednesday 1 1 54 60 56 Cloudy, Rain. Thursday 12 55 62 54 Cloudy. Friday 1 3 56 64 58 Cloudy, Rain. Saturday 14 55 53 49 Rain. Sunday 15 48 50 50 Rain. Deutition 1. Monday 16 51 62 53 Rain. 1 2 Tuesday 17 52 60 56 Cloudy. Wednesday 1 8 60 69 52 Cloudy, Fair. 1 Catarrh 1 . Thursday 19 55 76 55 Fair. 1 Friday 20 52 75 56 Fair. 2 Saturday 21 £8 58 60 Cloudy. 1 Sunday 22 57 70 54 Rain. 1 Monday 23 55 64 56 Fair. Tuesday 24 50 68 55 Fair. Wednesday 25 50 80 62 Fair. Thursday 26 64 84 66 Fair. Friday 27 60 78 60 Fair. Saturday 28 58 60 56 Rain. 1 Sunday 29 54 62 57 Cloudy, Rain. 1 Monday 30 54 55 52 Rain. Tuesday 31 51 54 52 Rain. Means Tl 61 52 • 44 ORIGIN AND PROGRESS Meteorological and Pathological Table. JUNE. 1814. Thermometer Davs of A. M. P- M. P. M. Faces of the Sky. New Cases. Observation. Weduesday 1 52 66 54 Fair. Thursday 2 53 63 54 Fair. Friday 3 53 64 56 Cloudy, Fair. Saturday 4 154 67 54 Cloudy, Fair. Sunday 5 56 65 50 Cloudy, Fair. Monday 6 47 64 46 Fair. Tuesday 7 44 65 50 Fair. Wednesday 8 47 70 51 Fair. Dentition 1, Fever 1. Thursday 9 53 70 55 Fair. Fever 1. Friday 10 57 72 55 Fair. Saturday 1 1 55 74 51 Fair. Sunday 12 58 82 62 Fair. Monday 13 60 70 — Fair, Rain. Tuesday 14 — L_ — Wednesday 15 — 80 — Thursday 16 62 83 G5 Friday 1 7 60 62 — Saturday 18 62 15 — Sunday 19 — — — Monday 20 — — Tuesday 21 — — Wednesday 22 52 78 60 Thursday 23 68 Fever I. Friday 24 — Pneumonia 1. Saturday 25 — Sunday 26 51 68 62 Fair. Monday 27 62 — 66 Fair, Rain. Rheumatism I Tuesday 28 63 66 64 Cloudy, Rain. Wednesday 29 59 76 70 Fair. Thursday 30 50 82 62 Fair. Means SO nu 33 OF THE EPIDEMIC. 45 Meteorological and Pathological Table. JULY, 1814. Thermometer Observation. S I 'M Faces of the Sky. New Cases. < k * ■ •O fH O) Friday. 1 58 84 66 Fair. Fever 1. Saturday 2 58 83 60, Fair. Sunday 3 60 78 60 Fair, Rain. Monday 4 62 80 70 Fair. Tuesday 5 66 70 60 Fair. Wednesday 6 60 68 57 Fair, Cloudy. Thursday 7 58 70 54 Fair. Friday * 8 52 76 56 Fair. Saturday 9 54 82 54 Fair. Sunday 10 56 78 60 Fair. Monday 1 1 60 60 59 Rain. Tuesday 12 58 68 48 Fair. Wednesday 13 49 70 61 Fair. Thursday 14 59 76 70 Fair, Shower. Friday 15 62 84 71 Fair. Saturday 16 63 92 70 Fair. Sunday 1 7 68 82 65 Cloudy, Rain. Monday 18 65 75 68 Fair. Tuesday 19 51? _L 60 Fair. Wednesday 20 52 81 58 Fair. Thursday 21 56 64 59 Cloudy. Friday 22 60 68 64 Cloudy, Fair. Saturday 23 58 82 64 Fair. Sunday 24 62 82 66 Fair. Dentition h Monday 25 64 76 64 Fair, Shower. Tuesday 26 56 — 62 Fair. Wednesday 27 59 80 65 1 Fair. Bowel Complaints I Thursday 28 61 70 70 Cloudy, Rain. Friday 29 67 67 65 Rain, Fair. Saturday 30 60 80 62 Fair. Sunday 31 DESCRIPTION AAD SYMPTOMS 1 had one case, in which an inflammation at- tacked the left eye, on the third day of the dis- ease, and in a day or two became very violent. It was principally confined to the upper eye-lid, which swelled so as to overlap the other, and en- tirely to close the eye. It however disappeared in a few days without suppuration, merely by the application of a solution of acetite of lead. It is remarkable, that in some even severe cases, the sense of taste was not destroyed, nor very considerably impaired, in any stage of the disease. Although the tongue was covered with a thick coat, some patients would take food in considerable quantity, w r ith almost as much relish as in health. Even solid, hearty food, such as boiled salted meat, was in a very few instances desired, though of course not allowed. In the same manner, the taste for tobacco continued in some of those who had been accustomed to its use. I had a patient pretty severely affected by the fever, who remarked to me one day that he not only could chew his tobacco, as in health, which he never could do in any previous sick- ness, but he could also swallow the juice of it with his saliva, a thing which he could never do, w T hen he was in health. A day ortw r o after this conversa- tion, he grew very ill in the afternoon, complain'- 4 OP THE fEYEK. 91 ed of great distress at his stomach, with extreme faint ness, with a cold clammy sweat over the whole body. These symptoms increased in se- verity until about twelve o'clock, when he vo- mited and was relieved. At my visit next day, I found on inquiry that he had been induced, by observing the facility with which he had swallow- ed the juice of tobacco, to extend his experiment still farther, and had actually eaten a pretty large piece of the manufactured herb. He attempted to repeat his experiment, at a subsequent peri- od, during his convalescence ; but his stomach had recovered the use of its functions, too much to permit him to succeed in swallowing it. Delirium is mentioned among the symptoms, with which the fever frequently commenced its attack. This was in most cases mild and of short duration. In one instance, however, it was wild and raving, and continued through the whole course of the disease, which was long and severe. The other symptoms of the case had nothing- very peculiar in them ; nor was the treatment g yery different from that of others, except the free application of blisters, and of cold to the head. The patient recovered. Two cases occurred under my observation of * singular affections of the larynx, which deserve to be mentioned. One was a total loss of the * * * 92 DESCRIPTION AND SYMPTOMS voice. The patient bad been sick several days, and bad begun to get better, when he fatigued himself, by talking a good deal with a friend. The next day his voice was very much broken, and the day following was entirely gone. He could articulate, in a whisper, with perfect dis- tinctness ; but could not make a loud sound of any kind. This continued two or three weeks. Indeed he did not perfectly recover his voice until he had repeatedly taken exercise in the open air. It was afterwards perfectly restored. The other affection referred to, assumed the ap- pearance of croup. The patient, a boy about a year old, had a constant hoarse cough, for the first two days ; and was at irregular intervals subject to difficulty of breathing, with the pecu- liar stridulous sound which characterizes the croup. At other times the respiration was free and easy. This symptom disappeared in two or three days, and the patient soon after recovered. It is very remarkable that there were some organs, which seemed generally to partake in but a very slight degree, if at all, in the disease tinder which the system was labouring. They continued to perform their functions, with near- ly the same regularity as in health. This was more particularly the case with some of the ab- dominal viscera. The bowels showed but very slight marks of disease, except in a very few •A i * $ OF THE FEVER. 93 cases. There were a few instances of diarrhoea in the commencement of the disease ; and it sometimes made its appearance at a later period. In this last case, however, the diarrhoea could generally be readily traced to some article of diet or medicine, which the patient had taken. There was much more often a tendency to cos- tiveness, than to diarrhoea. This might be the effect of the opium, which was always adminis; tered in greater or less quantities ; or it might, in part, result from torpor of the bowels, produc- ed by disease. Whatever might be the cause, the disposition to costiveness was not generally productive of much serious inconvenience, as it was readily removed by the mildest cathartics, or by emollient injections. In some cases it was more troublesome, giving rise to flatulence and pain in the bowels, and requiring more active ca- thartics, than the strength of the patient could well bear. Indeed in most cases the bowels in a slight degree partook, in common with the limbs and other parts of the body, of the liability to irregular wandering pains. But these pains did not generally require much attention, as they were rarely severe, and were easily re- moved. The urinary organs also appear to have been in general, very little affected during this fever. I find in my case-book no notice of any affection 13 1)4 DESCRIPTION Atffi SYMPTOM? of these organs; nor do T recollect any, except a flight degree of dysuria, which sometimes oc- curred. This dysuria might generally be the ef- fect of absorption from the blistering plasters which had been applied ; or it might be pro- duced by a partial retention of urine, occasioned by the torpid action of the muscular coat of the bladder : or more probably, it was the effect of both these causes combined. The retention and pain were readily relieved by friction of the bow- els with oil, and were prevented from recurring bv administering mucilaginous drinks. The uterine system in females, seemed equally free from any participation in the disease. The menses sometimes appeared in their regular course during the fever, and without modifying scarcely a symptom of it. In a few cases they appeared prematurely ; but their effects were equally unimportant. No instance of an immo- derate menstrual evacuation during the fever oc- curred in my practice. A state of pregnancy, or of child-bed does not appear to have rendered women any more liable to the fever ; nor was a miscarriage in any instance occasioned by it. Cases of pregnancy combined with fever, were not perhaps very numerous, though some certain- ly occurred, and without any apparent inconve- nience to the future offspring. There were se- veral instances in which women far advanced in OF THE FEVER. V)»> pregnancy, had the care of persons sick with the fever, without themselves becoming the subjects of it. Of a considerable number of women who were confined during the prevalence of the Epi- demic, all recovered from the puerperal state, without any attack of fever. The only case in which there could be any possible relation, be- tween the puerperal state and a subsequent fever, was a lady whose child was nearly two months old, and who had been in usual health, two or three weeks, before she was seized with the fever. Her sickness was severe, but did not manifest anv 7 * peculiar symptoms, which could in any degree be referred to her previous confinement. Her infant was taken from the breast, but was restored after her recovery ; and she was able to nurse it as before, the secretion of milk not having been materially affected. I have hitherto said nothing of any spots upon the skin, although their real or supposed appear- ance has in many places given a name to the dis- ease. The reason is, that I have very little to say respecting them. In most or all of the fatal cases, just before death, small patches of a purple or rather livid colour were irregularly dispersed over the surface of the body. They had a con- siderable resemblance in their appearance, to small extravasations of blood into the cellular mem- brane, and were probably produced by the stag- 96 DESCRIPTION AND SYMPTOMS nation of that fluid, in the small vessels of the skin. In two or three other cases, spots somewhat simi- lar to these in their appearance, but of a less livid colour, were discovered at an earlier stage of the disease. But they occurred early in the season, and only where the fever had continued several days, without any steps having been taken for its removal. They disappeared as soon as the skin was excited to action, either by friction, or by in- ternal remedies. I have never observed any ten- dency to the production of these spots, while the skin was moist, except in the fatal cases already mentioned ; unless the eruption formerly describ- ed as taking place during the convalescence, is to be confounded with them ; and this was exceeding- ly dissimilar in its appearance. There was one circumstance relating to this fever, which I mention with diffidence as a symp- tom of disease, though from the frequency of its occurrence, I think it entitled to some notice. Whenever the situation and feelings of the pa- tient were such, as to induce him to regard him- self as in danger of speedy death, he appeared to be entirely exempt from the alarm and anxiety, which such a state of things usually produces. He had no terror at the prospect of dying, nor any fearful anticipations, as to what awaited him beyond the grave. But on the contrary, he seem- ed to be elevated above every subject of appre- OF THE FEVEK. 07 hension, and was filled with joyous exultation in the contemplation of futurity. Had this peculiar excitement at the expecta- tion of death been less general, or had it been con- fined to any particular class of people, or to any re- ligious denomination, I might have regarded it as the effect of religious ardour, or enthusiasm. But it was almost as universal, as the state of the disease in which it appeared. Whatever might be the situation in life of the patient, if he was only of an age to express his feelings ; whatever his religious opinions, or his moral or religious character, he was alike subject to this singular ele- vation of feelings, at the prospect of death. It was not of course during the comatose stage, when death seemed actually the nearest, that this state of the mind was manifested, for he was then equally insensible to the hopes of life or death. It generally happened during the exhaustion pro- duced by a protracted continuance of the vomit- ing stage, although it occasionally appeared in consequence of a relapse, at other periods of the disease. This circumstance displays in a striking man- ner the influence which diseases may have upon the state of the mind and feelings, and the impro- priety of regarding these feelings as indicative of the past character, or the future prospects of a 98 DESCRIPTION AND . SYMPTOMS dying patient. But I shall not stop to take notice of the uses which the christian moralist might make of it, nor to inquire into its probable causes. I mention it, because it was one among the multitude of phenomena which this disease exhibited. OF THE CRISIS AND DURATION OF THE FEVER. I have no means of ascertaining very accu- rately, how long this fever would have continued to rage, if it had been left to itself; or whether it would ever have been disposed to throw itself off, by a crisis of its own formation. The disease w 7 as generally taken out of the hands of nature, very soon after its commencement. In every case that came under my observation, remedies were applied immediately upon my first seeing the patient ; and in many instances, some appli- cations had been made before my arrival. Al- though in consequence of the lightness of the attack, application to a physician was sometimes delayed several days, something was generally done by the patient or his friends, to endeavour to remove the disease, soon after it began. Early in the season, however, before an alarm was excited by the prevalence of the Epidemic, two or three cases occurred, in which very little if any thing was done to effect a cure, during the OF THE FEVER. 99 first three or four days of the disease. In each of these cases, it had commenced in its mildest form ; but it grew constantly worse, until arrest- ed by the application of remedies. There was not manifested in any instance, the least disposi- tion in the symptoms to remit, until forced to yield to the power of medicine. In the more se- vere attacks, the progress of the disease was so rapid, that there could hardly have been time for a perfect crisis to form, had there been any dis- position to it. If to these considerations, we add the constant disposition which the disease mani- fested, after it had been arrested by medicines, to relapse whenever their exhibition was suspended, I think we may pretty fairly conclude, that in most cases at least, the only natural crisis would have been death. When the cure was effected by medicine, no- thing appeared like the crisis which is described, as having anciently taken place in fevers : where after a certain length of time, the disease assumed a disposition to return voluntarily to health. On the contrary, every step was obstinately disput- ed ; and until the cure was firmly established, the most vigorous exertions, and unremitting vigi- lance were necessary, to prevent a recurrence of the bad symptoms, which had been relieved. The principal circumstance which had in any degree the appearance of a crisis, was the diaphoresis, 100 DESCRIPTION AND SYMPTOMS But this, after il had been produced (as it always was) by artificial means, showed no disposition to continue any considerable length of time, with- out the continuance of those means. Nor was it ever effectual to remove the disease, without the concurrence of other circumstances, which acted independently of this. The duration of the disease was exceedingly various, according as medical aid was called ear- lier or later in the disease, and as the patient and his attendants were more or less vigilant in the application of the remedies prescribed ; as well as to the severity of the attack, and a variety of other circumstances which are not under human control. In a very considerable number of cases, where I was called at the commencement of the disease, we were able to arrest it so completely, that the patient recovered immediately ; and it was not necessary to prolong my visits beyond the third day. Others continued longer, so as to require attendance from four to ten, or twelve, and a few, fourteen days ; and very rarely longer. In more than half the cases, my visits were not extended beyond the first week. It may be proper to remark here, that in consequence of the num- ber of the sick, and the distance between them, I often left my patients earlier in the convales- cence, than I otherwise should have done. When they had so far recovered, as to be able to sit up. OP THE FEVER, 101 an hour at a time without injury, unless there was some special circumstance to prevent, I generally discontinued my visits. This was before they were out of the danger of a relapse ; but the uni- formity of the management required for the last stage of the convalescence, rendered the farther attendance of a physician less necessary. Of the fatal cases, two died on the second day from the attack, one the third, one the ninth, one the thirteenth, one the sixteenth, and one the twenty- second. All of these, who lived beyond the third day, had become decidedly convalescent, and re- lapsed, before they died. These seven were the only deaths that occurred, in my practice, during the prevalence of the Epidemic ; and of these, it will hereafter appear that most, if not all were to be ascribed to circumstances, which were contin- gent and accidental, rather than inherent in the nature of the disease, or dependent upon the treat- ment which it generally received. I trust it is unnecessary to say, that in this state- ment of fatal terminations, I have not confined myself to those only, which I consider as having strictly been produced by the fever; but have included all who died after having been affected with it, whatever might have been the imme- diate cause of death. Indeed this statement includes all the deaths that occurred in my prae- 14 102 DESCRIPTION AND SYMPTOM? tice during the prevalence of the Epidemic; ex- cept that of one child, which was produced by dentition, complicated with catarrh, attacking a habit of body so feeble, that at the age of more than two years, the child had never been able to walk. While the Epidemic prevailed, no other dis- eases made their appearance, except such as had their origin in some local affection. It will be seen by a reference to the tables, that I had seve- ral calls to children made sick by dentition, and a very few other local complaints, but to no ge- neral disease, except the fever under consideration. So true is it, that an Epidemic swallows up every other disease during its continuance. It was a remarkable result of this general law of nature, that the number of deaths in the town, seems al- most to have been diminished rather than increas- ed, by the prevalence of so powerful an Epidemic as this, which we have been describing. For al- though the first five months of the year 1314 were probably more sickly than any other period of equal length, since the first settlement of the town, yet the number of deaths was less than it was during the same part of the year 1817, which was considered an unusually healthy season. I regret that the comparison cannot be extended to other years. But I have no data upon which to found it. My acquaintance with the distant parts OP THE FEVER. 103 of the town was too limited to enable me to make accurate observations of this kind, unless there was something a little unusual to attract the no- tice of the inhabitants, as in the two years I have mentioned; and there are no records from which the requisite facts can be drawn. Those who had been once sick with this fever, and had recovered, were not thereby protected from a second attack. Several cases occurred un- der my observation, of persons who having gone through the fever, and who had been perfectly restored to their usual health, after continuing to be well for several weeks, were again seized, and obliged to undergo a second course of disease and suffering. In most of these cases the first sickness had been comparatively light, and the second was generally very severe, though in no instance fatak In a few others, the first sickness was severe and the second light. I believe there was no instance in which the same patient was subjected to two attacks, both of which were severe ; nor was any one attacked the third time with the disease, in the course of the season. This is perhaps the most suitable place to speak of the manner in which the disease extended from one person to another. Not indeed to discuss the question whether or not the disease was conta- gious, for I shall defer that question till all the 104 DESCRIPTION AND SYMPTOMS facts are before the reader : but to furnish the statements upon which such a discussion must principally be founded. The disease was as variable and seemingly ca- pricious in the selection of its victims, as it often was in the subsequent disposal of them. There was a general tendency, when the fever appeared in a family, to subject a considerable proportion of its members to its influence. Yet in almost every family, into which it entered, some escaped its attacks, and in most, the number of those who were not severely affected, was greater than that of the sick. A few instances occurred, in which one person only, in the family, was seized, leaving the rest free through the whole season. Of those who were attacked, in families, where the disease had already prevailed, it often happened that those who had been the least with the sick were the first victims, while those who had been con- stantly employed in watching over and nursing the sick, often escaped. No particular reason can be given therefore, why those who were seized with the fever, should have been its victims in preference to others, who had been equally fa- miliar among the sick, and equally exposed to fatigue. Neither was the disease confined to those who might be supposed to have been exposed to its OP THE FEVER. 10.) influence in others. It often attacked persons woo had not been near the sick, and appeared in families, not one of which had seen a case of it. Sometimes two or three persons in a family, living at a distance from where the disease had before raged, were attacked almost at the same time, or in such immediate succession as to preclude the possibility of a communication of the disease from one to another. In other instances several fami- lies in a neighbourhood became nearly at the same time subject to it3 ravages, without having previously had any intercourse w r ith it. At the same time, there were other families, living in the village where its ravages were the greatest, in the immediate vicinity of the sick, and perform- ing all the kind offices of good neighbourhood, by which a constant intercourse was kept up with them, which were entirely passed over by the dis- ease. In like manner, several individuals who were the most active, in visiting and supplying the wants of the poor, that were sick, and who frequently saw the disease in its worst forms, and while exposed to great fatigue, were nevertheless entirely free from its influence upon themselves. The following cases will serve to exemplify these various modes in which the disease was ex- tended. 106 DESCRIPTION AND SYMPTOMS Abigail L. was the first person who came un- der my care sick with the fever. She was taken the 7th of February. The Epidemic had not then appeared in town, and she had not been ex- posed to it, any where else. February 25th, her sister Sally began to complain. She had lived constantly in the same house, and been engaged in various offices for her sister, although she had not had the immediate care of her. March 5th, Solomon L. was taken pretty violently. He is a brother of the others, but had not lived in the same house ; and being actively engaged in busi- ness had only visited them occasionally. March 13th, Benjamin L.'another brother who is married, and lives in the house with his sisters was seized w r ith great violence ; but recovered in a few days. He lived in another part of the house, and had no particular care of the sick, though he was in the room frequently. March 16th, Mrs. J. a sis- ter of the others, who lived at a little distance, and in whose family Solomon resided, was at- tacked. She had been frequently with her sisters, and had taken the principal care of Solomon. March 17th, Mr. L. father of the others began to be ill, though he was not so sick as to call a phy- sician, till several days later. He had not been very constantly in the sick rooms, but had been much exposed to fatigue, in attending to the out- of-door concerns of his sick family, and had been much depressed by the weight of affliction which OF THE FEVER. 107 he suffered. March 22d, R. T. a young woman, who had nursed Mrs. .1. became sick. April 1st, Samuel J. an elderly man, father of Mrs. J's. hus- band, was seized, and died the third day. He had had very little immediale communication with the sick, though he lived in the same house. April 17 th, Mrs. L. wife of Mr. L. (who died on the 30th ult.) was attacked. She had been constantly- employed in the sick rooms, ever since the dis- ease first appeared in her family ; and had been very much borne down by their complicated suf- ferings. The same day Mrs. J. wife of Samuel J. was taken sick. She had been constantly em- ployed in taking care of her husband, and the other members of her family, whose sickness had preceded hers. May 1st, Mr. T. a man w 7 ho was residing for a few days in the family of Mr. J. be- came sick. May 15th, William J. the husband of the first mentioned Mrs. J. was violently seized, and died the third day. He had not been much engaged in taking care of the sick ; but had exposed himself very much to cold, wet and fa- tigue. This w r as by far the most extensive, as well as the most destructive range, which the dis- ease took in any one family connexion. During all this time, the wife and child of Benjamin L. who had been constantly in the sick rooms, and a Mrs. D. who had been successively employed in nursing the different members of the family, and in performing the last and most disagreeable of- fices, for those who had died, and several persons 108 DESCRIPTION AiND SYMPTOMS who had constantly lived in the family of the .1 's. were not at all affected by the disease. On the 21th of March, Mr. B. a gentleman eighty years of age,was very suddenly and violent- ly attacked by the fever. On the 31st, his wife, Mrs. B. was attacked and died the third day. April 1st, a young woman, their domestic, and the only remaining member of their family, was also violently seized. Immediately after Mr. B's. at- tack, his daughter Mrs. L. and her husband, and Mr. G. the husband of another daughter, with some of his familv, came to the house and remain- ed a great part of the time till his recovery. Mrs. G. having a young infant, did not come to stay until a week later ; and was afterwards prevented by the same circumstance from being, so much as the others, in the sick room. She was notwith- standing taken very sick on the 1 5th of April, and recovered with difficulty after some time, while neither of the others, who had constantly perform- ed all the offices of kindness and attention for the sick were affected. On the 16/^ of April, the only daughter of Mr. and Mrs. L. and their ser- vant girl, neither of whom, I believe, had ever been into a house in which the fever had prevailed, were both suddenly seized about the same time,, and with great violence. OF THE FEVER. 109 April 8th, I. L. was attacked with the Epidemic. April 13th, one of his sons, and the 14th, another was also attacked. This family lived two or three miles from any house, in which the fever had be- fore appeared, and was the only one in the vici- nity, which was subject to it ; although their neigh- bours frequently visited them, and performed many of the duties of nursing for them during their sickness. No members of the family had been with the sick in any other house. In a little village about three miles from where the Epidemic had before appeared, Mrs. R. was taken sick on the 25th of March, as were two chil- dren in a family at a little distance. On the 26th, Mrs. R's daughter, and about the same time, a sister of the children just mentioned, and two children in another family in the vicinity were taken ; and on the 21th, another child in this last mentioned family. Here the disease stopped its progress in that neighbourhood. None of these persons had been with the sick, until the disease appeared in their own families. APPEARANCES AFTER DEATH. The livid spots which had begun a short time before, increased at the moment of death, and assumed much of the appearance of incipient sphacelation, for which they were often taken by 14 a I JO DESCRIPTION AND SYMPTOMS, &C. the attendants. The lividity soon after extended over nearly the whole body ; the features were speedily dissolved, and in a few hours, symptoms of putrefaction commenced. Although the funeral was generally attended the second day, in most cases the body had become quite offensive be- fore it was committed to the earth. To this short sketch I would fain have added the appearances on dissection. But I have no materials from which to do it. I am not insensi- ble of the great importance of dissections, in in- vestigating the nature and character of diseases; and was not inattentive to this part of my profes- sional duties ; though from the circumstances in which I was placed, I was prevented from accom- plishing any thing. I faithfully sought opportu- nities to examine the bodies of the patients I lost ; but could not succeed in obtaining permission from the friends of the deceased. Such exami- nations had rarely been made at Gardiner; and the prejudices, which existed against them in the families in which deaths occurred, were too strong to be overcome by a young practitioner, unaided by the support of the senior counsel, who some- times met me in consultation. The very disposi- tion to inquiry, which the desire to make dissec- tions manifested, was a cause of suspicion with those who were ignorant of their usefulness. CHAPTER III. TREATMENT OF THE FEVER. It will not be necessary, in speaking of the treat- ment of this disease, to adhere very closely to the arrangement which I have adopted in the preced- ing chapter; nor to attempt to follow the course of the symptoms, in describing the remedies which were to remove them. There were certain ge- neral circumstances, which entered into the man- agement of every case, and of almost every stage of the disease. These, although few in number^ were of essential importance. There were many others, which were applicable only to the parti- cular symptoms of individual cases; and were consequently as various as the changing features of the Epidemic itself. The first and leading object, always was to re store, and continue in force the functions of the skin. The second, which was hardly less impor- tant, was to support the strength of the patient. The remainder of the cure was effected, by re- 112 TREATMENT OP THE FEVER. moving the great variety of occasional symptoms which occurred. The means for accomplishing the two first objects, were pretty uniformly the same in the several cases. But for the last, the w r hole Materia Medica presented a field hardly enough variegated, for the complicated and per- petually changing evils to be removed. At the beginning of the Epidemic season, I pretty generally commenced the treatment, by administering an emetic. But not finding inmost cases, the benefit from its operation, which I had anticipated, I soon omitted it, except in cases where there had been symptoms of a derange- ment of the functions of the stomach, previously to the attack of fever. In these cases, an emetic at the commencement of the disease was of very great service, and sometimes entirely arrested its progress. Before the emetic was given, however, the pa- tient was put into bed, and pretty commonly had made use of the warm pediluvium. As soon as the operation of the emetic had ceased, or, if one had not been given, at the commencement of the treatment, I administered a powerful diaphoretic, which was repeated at intervals of from two to four hours, according to the urgency of the case. At the same time such external applications were often made, as should aid in the production of a TREATMENT OP THE FEVER. 113 diaphoresis. These however were ordered to be discontinued, as soon as the perspiration com- menced; and were not afterwards renewed, un- less by accident, or inattention, the skin had been suffered to become dry. It frequently happened, that these applications were made before my ar- rival, so that I found the patient already in a pro- fuse sweat. In this case, I ordered the gradual removal of the external applications, and trusted to the medicines to keep up the diaphoresis. If the limbs were cold or numb, or subject to pain, directions were given that they should be diligently rubbed, either with the naked hand, or with flannel, either dry or moistened with oil, or with some stimulating liquid, such as vinegar, or alcohol, and sometimes with a solution of cantha- rides. The quantity of bed clothes was regulat- ed by the feelings of the patient. If he was cold, they were increased, so far as it could be done without oppressing him by their weight. If he was uncomfortably warm, they were lightened. The urgent desire for liquids which the thirst occasioned, was freely gratified by allowing what- ever drinks the patient chose. These were gene- rally, decoctions of some of the aromatic herbs, particularly peppermint, pennyroyal, and ground hemlock, or dwarf yew. They were taken in large quantities, and generally as hot as they couW 15 114 TREATMENT OF THE FEVER. be borne, because they were preferred in that state by the patient. In a very few cases in which they were more grateful when cold, they were not warmed. Indeed, I did not consider it neces- sary in the commencement of the disease, to re- fuse hardly any kind of drink, which a patient desired, whatever might be its nature or tempera- ture. In a subsequent part of the disease, more caution was requisite in selecting the means of removing the thirst ; because the appetite became a fallacious indication of what was needed to sup- ply the wants of the system. In this manner the cure was always begun, and in cases in which the strength was not particularly depressed, very little else was prescribed at the first visit, except an anodyne at bed time. In the first part of the season particularly, when the pulse was often considerably full and strong, and especially if there were symptoms of a pneumo- nic affection, I waited until these symptoms had somewhat remitted, before I began to administer the tonic remedies, which held a conspicuous place in the general plan of treatment. But when, as in a great proportion of cases, the strength was low from the first ; or if it had become so by the continuance of the disease, it was necessary in addition to the treatment already described, to take vigorous measures to prevent it from sink- ing altogether. For this purpose, small quanti- TREATMENT OF THE FEVER. lib ties of brand j were occasionally given in the drinks already mentioned, — a diet as nutritive as the patient could take was recommended, and a variety of medicinal tonics prescribed. Among the tonics, the principal reliance was upon the Cinchona Officinalis, which was com- monly given in the form of a compound decoc- tion, as follows, viz. R. Cinchon. Officinalis. §i. Citri Aurant. Cort. §ss. Aristol. Serpent. 3ii. A quart of boiling water was poured upon about one third of this quantity ; and it was then boiled in a qovered vessel ten minutes. After being removed from the fire, as soon as it was sufficient- ly cooled, a little yeast to the amount of a com- mon wine glass full, and as much simple syrup or molasses were added ; when it was set by, to fer- ment. In five or six hours it was ready for use. The most common method of giving this decoc- tion, was to direct the patient to drink a wine glass full every four hours, in the intervals be- tween the times of taking the diaphoretic pow- ders. Infusion of duassia was prescribed in some instances, where the cinchona did not agree well with the stomach, as were some other tonics. When symptoms of faintness or torpor appear- ed, at whatever period of the disease it might be, 116 TREATMENT OF THE FEVER. the diffusible stimuli were diligently administered. The aromatic spirits and volatile oils in all their variety, were given in small doses frequently re- peated. A mixture of spirit of peppermint, com- pound spirit of lavender, and camphorated tinc- ture of opium, was more generally useful, than perhaps any other preparation of this class. But however efficacious they might be when first ex- hibited, it soon became necessary to vary them. For the stomach becoming accustomed to them, they lost much of their good effects ; and others, even if less powerful, were found more effectual in rousing the system to action. This was more especially the case, during the vomiting stage of the disease. The vomiting was a symptom, which, when it was severe, it required great diligence and care to remove. Only very small quantities of any substance could be received into the stomach at a time, with any chance of its being retained ; and only such articles as were stimulating in their na- ture. The diaphoretic powders were now, either altogether omitted, or only given in smaller doses, and at longer intervals. The fermented decoc- tion was sometimes retained on the stomach as well as any thing else, in which case it was con- tinued ; at others, it was necessary to omit it, because it was rejected by vomiting. The cor- dial mixture already mentioned, frequently re- TREATMENT OF THE FEVER. 117 strained the vomiting for a short time. When that failed, various other volatile oils were tried in succession, each seeming to accomplish the purpose for a little while. But in some very bad cases, each in its turn was rejected, as soon as the stomach had become accustomed to its action. The volatile oils of lavender, rosemary, cinnamon, cloves, and turpentine were occasionally given, either singly, or combined with tincture of opium. A small quantity was dropped into any of the drinks which the patient was to take, and given by single tea-spoonfuls, taking care to have it as hot as could be borne. Indeed this was a caution which it was always indispensable to observe, in this state of the dis- ease. Whatever was given, it was necessary that it should be made as hot as could be taken without burning the mouth, and this in extremely small quantities. In this manner all the drink that was to quench the thirst of the patient, and all the food that was to nourish him, as well as all his medicines, were dealt out to him by tea-spoon- fuls. Even after the vomiting had been considera- bly subdued, if the stomach was suffered to get over-loaded, it commenced again, and was only conquered by renewing the same cautious management. Besides the remedies already mentioned as ap- plicable to this state of the disease, a variety of / 118 TREATMENT OF THE FEVER. other substances not strictly medicinal were fre- quently given. Brandy, sparingly diluted with some aromatic infusion, was often very effica- cious, in checking the vomiting, as well as in re- moving the sensation of extreme faintness, by which it was attended. The small quantities of food which the patient could take, were made as nourishing and as easy of digestion as possible, and were as highly seasoned with any spices which he might choose, as they could be made, without im- pairing his relish for them. A simple chicken soup was by most persons preferred to any other food, and was in general retained best upon the stomach. Some few, either from a general dislike to soup, or from some disgust to it excited during the sickness, preferred other articles of nourishment. Frictions with oil upon the region of the stomach, were often recommended with good ef- fect at this time. Fomentations, applied as hot as they could be borne, and sometimes blisters to the same part, were in some cases of great service. The difficulty of subduing the vomiting was very much increased by the constant, and some- times almost ravenous thirst for cold water ; a thirst which it was injurious and even dangerous to gratify. Even a very small quantity of water, taken at this period of the disease invariably ren- TREATMENT OF THE FEVER. J 19 dered the vomiting more violent, and thus increas- ed the faintness and thirst, for which it was craved. Yet it was many times, difficult to convince the patient or his attendants that this would be the effect, until he had ascertained its certainty by experience ; especially as in other stages of the disease, water was sometimes allowed, not only with impunity, but with obvious advantage. Hence they were often inclined to judge for themselves, that it would be of service in their own case. The relapses from this cause were not commonly very serious, because the quantity at first taken was generally small. But they were sometimes more alarming. In one instance, in particular, an indulgence of this kind had well nigh cost a patient her life. Having heard an in- stance spoken of, in which water had been taken with advantage, she determined at whatever ha- zard, to try the experiment upon herself. Her nurse gratified her, and she drank pretty freely. Her vomiting, which had ceased for several hours* immediately returned, with great violence and obstinacy ; she complained of great coldness and faintness at the stomach, with a feeling of extreme depression and sinking; and pain in the head. Her countenance became more bloated. In short, she was every way much worse than before ; and was not restored to her former state until several days after. 120 TREATMENT OP THE FEVER. By a diligent and careful application of the remedies above mentioned, the vomiting was al- ways sooner or later subdued. In most cases, where we were aided by the careful management of the attendants, only a few of them, and those not the most powerful, were necessary. In some obstinate cases, the first effectual relief seemed to be given, by gratifying the patient in an indul- gence of his appetite for some particular article, either of food or drink. Much caution was re- quisite in this indulgence ; but it was sometimes permitted with success. The articles desired were various, and often had no apparent suitableness to the situation of the patient. That which was most frequently and most ardently craved, was cider ; and it was more generally received with- out injury than any other. As soon as the vomiting was sufficiently sub- dued, it was of great importance that the strength of the patient should be diligently supported. The facility with which the coma, that in most cases was soon inclined to succeed, was prevent- ed or removed, depended in a very great degree, upon the diligence with which remedies were ap- plied immediately after the vomiting ceased. The patient was already considerably exhausted by the vomiting, and by the small quantity of nutriment which had been received in consequence of it. This exhaustion was to be removed, by TREATMENT OF THE FEVER. 121 every means that could be adopted, without re- newing the symptom which had been one of its principal causes. For this purpose, more brandy was ordered to be given than before ; the ferment- ed decoction of cinchona was given in pretty large quantities, proportioned to the age of the patient ; and soup, or whatever other article of diet was preferred, was given very freely. At the same time, the diaphoretic powders were generally re- newed, though in smaller doses than at first. Strict injunctions were given, that the patient should not be suffered to sleep more than fifteen minutes at a time, without being waked sufficient- ly to take something. As the coma came on, tincture of opium with some of the strongest of the volatile oils, such as peppermint or lavender, was given in small doses, frequently repeated. Yeast and brandy were also given together at this time ; and if the coma continued to increase, carbonate of ammonia was added to the diaphoretic powders, or else dissolv- ed in some liquid, and administered by itself. At the same time, or rather at the commence- ment of the coma, blisters were applied to the back of the neck ; and if it had not already been done, earlier in the disease, stimulating applica- tions were made to the feet. Cold water, or vine- gar and water, and sometimes ice, were applied to the forehead and temples ; and in some cases to 16 122 TREATMENT OF THE FEVEK. the whole head. The trunk and extremities were diligently rubbed with vinegar, or with a solution of cantharides, taking particular care that the cold air should not be suffered to come in con- tact with the body. If these measures were not speedily efficacious, enemata composed of yeast, brandy, and tincture of opium, were thrown up ; and the quantity of these articles given by mouth was rapidly and largely increased. Indeed the only circumstance by which the exhibition of these articles could be regulated, was the effect which they produced. No quantity was consid- ered to be large enough, until the coma began to be subdued. When that remitted, these me- dicines were given more sparingly, and with great- er caution. This effect was uniformly produced by this course of remedies, unless the previous state of exhaustion had been extreme, or some unusual circumstance prevented the requisite quantity from being given. After the coma had disappeared, it was neces- sary to continue many of the medicines, which had been given in the preceding stages ; but in doses somewhat diminished, according to the cir- cumstances of the case. The diaphoretic pow- ders were generally ordered to be given at first every four hours ; then every six hours, and as the cure advanced only twice a day, until the skin performed its functions without their assist- TREATMENT OF THE FEVER. 123 ance, when they were discontinued altogether. A small dose of camphorated tincture of opium was generally prescribed, to be taken at bed-time every night, from the first, and was continued through the greater part of the convalescence. The tonics were continued in greater or less quantity, according as they seemed to be needed. The fermented decoction in most cases still held its place, as the most grateful, as well as the most suitable article of this class, until the cure was nearly completed, when the compound tincture of cinchona was frequently substituted for it. Brandy was given in less quantities as the strength was recovered ; so as generally to be left off al- together, or nearly so, by the time my visits were discontinued. Soup, or such other liquid food as the patient preferred, continued to be the principal article of diet, until the appetite was so far restored as to produce a desire for solid food. Beefsteaks, or such other fresh meat as the season and market afforded, were then allowed. At first the meat was masticated, and only its juices swallowed ; afterwards the whole was eaten freely. The thirst was not urgent at this period of the disease, unless occasioned by a relapse, There was, however, a pretty general and strong desire for cider, which could not easily be removed, ex- J 21 TREATMENT OP THE FEVER. cept by its gratification. This was the case with many persons, who had not been much accustom- ed to drinking it in health, and with some even, to whom it had been rather disagreeable. It sometimes happened, after the cure had gone on perfectly well for several days, that the patient suddenly lost all 'relish for food of any kind, and rather loathed it, without any considerable in- crease of the febrile symptoms, except, perhaps, some degree of restlessness and anxiety. In this case, an emetic effectually removed the unfavor- able symptoms, and restored the patient to his state of progressive recovery. The kind of eme- tic which I preferred for this purpose, was the powdered ipecacuanha. If not sufficiently active of itself to evacuate the stomach effectually, I sometimes added a small quantity of sulphate of zinc. The nausea which continues after the ope- ration of tartrite of antimony, and the great debi- lity produced by it, were a serious objection to prescribing it at this period of the disease. During the whole progress of the treatment, costiveness was carefully guarded against, by ad- ministering either mild cathartics, or emollient injections, as often as they were needed. An enema was generally preferred, when the patient was quite feeble, provided I could depend upon its being effectually administered. But in this TREATMENT OP THE FEVER. IS. f ) I was often disappointed ; for although the ope- ration is a simple one, I found but few nurses, who were accustomed to performing it. Injec- tions of a different kind, and for a different pur- pose, were not unfrequently thrown up, when the patient was low, and not able to take a suffi- cient quantity of nutriment and medicine by mouth. They were then composed of soup with- out seasoning, a small quantity of brandy, and tincture of opium sufficient to ensure their re- tention. These were often administered with a very excellent effect, where the patient had be- come much reduced by a want of support and nourishment. Whenever pain or numbness in the limbs ap- peared, they were generally very readily remov- ed by frictions with oil. The same remedy applied to the bowels was often efficacious, in removing the pain and flatulence which not un- frequently occurred in the bowels, previously to the operation of a cathartic, and in relieving the partial retentions of urine which were some- times troublesome. Such are the general outlines of the practice, which I adopted for the removal of this formida- ble disease. The particular details will best ap- pear, by a reference to the individual cases report- ed in the next chapter. Before we proceed to \ 126 TREATMENT OF THE FEVEK. them, however, it will be proper to make a few remarks upon some of the principal remedies, and the effects of their exhibition. VENESECTION. I mention venesection among the remedies for this disease, although I did not employ it myself, nor see any case in which it had been employed ; because it has generally been considered a pow- erful remedy, and because it gives me an oppor- tunity to say that I have had no experience of its efficacy. T was deterred from practising it, by the great tendency to debility which I wit- nessed in the disease, as well as by the reports which I had heard of the disastrous effects, which were said to have followed its use in other places. The foundation of these reports, or the accuracy with which they were related, it does not come within my plan to examine here. BLISTERING Blisters were remedies of very powerful effi- cacy in a variety of cases. In the first place, at the commencement of the disease, when there were symptoms of a pneumonic affection, pain in the chest, cough, and difficulty of breathing, a single blister applied as nearly as possible over the seat of the pain, was almost invariably effec- TREATMENT OF THE FEVER. 127 tual in relieving them. In obstinate vomitings, where other means had failed, a blister applied on the left epigastrium was a very powerful aux- iliary. I also generally applied blisters to the back part of the neck, and upper part of the arms, in cases of deep and obstinate coma ; but I am less satisfied of their efficacy in these cases, than in any other in which I have ever prescrib- ed them. I have often had opportunity to wit- ness their effects, not only during the Epidemic, but in many other cases of coma in fevers, while the same constitution of diseases prevailed ; and have been led more and more to doubt their being of service, until I have altogether ceased to prescribe them for this symptom. There is still one other case in which blisters were applied with advantage in the Epidemic fever. Where the debility was very great, and a sort of languor and exhaustion of the vital pow r ers seemed to pervade the whole system, small blisters were frequently applied to the wrists and ancles with very good effect. For the last two or three years, when recommending blis- ters, for this purpose, I have usually directed the vesicating plaster to be removed, after the skin has become sensible to its action, before the blister is fully formed. The principal benefit to be derived from the application, in these cases, consisting in the excitement produced by the 128 TREATMENT OF THE FEVER. action of the plaster, and not in the subsequent (discharge, we are able by this means to take ad- vantage of the excitement, and at the same time to avoid in a great measure, the inconvenience and pain which commonly follow. Another ad- vantage is, that by avoiding the disagreeable ulcers which full blisters often produce, we are able to repeat the application at pleasure, with very little suffering or inconvenience on the part of the patient. It was not until after the Epi- demic had disappeared, that I adopted this prac- tice. But as it was in cases perfectly analagous, it seems not unsuitable to mention it in this place. FOMENTATIONS. Fomentations are remedies somewhat similar in their nature and mode of action to blisters, though milder, and of course less efficient. For the removal of various local pains, particularly in the bowels, and sometimes in the back, I ofien found them very serviceable. In obstinate vo- mitings, I invariably tried their efficacy, be- fore resorting to blistering, and not unfrequently with success. In slight affections of the chest too, they were sometimes applied with benefit. The more usual mode of applying them, was to fold the leaves of some of the common bitter herbs, such as wormwood or tanzy, in flannel, TREATMENT OF THE FEVER. 129 wet it in hot vinegar, or common spirit, and lay it upon the part affected. I shall not stop to inquire, whether any benefit could be derived from any medicinal virtues of the plants made use of. Certain I am, that a fomentation of this kind was more effectual, than one made by sim- ply wetting folds of flannel in vinegar or spirit, and applied in the same manner. FRICTIONS. Friction of the skin is another external appli- cation, which was often extremely useful. In all cases of severe coma, this was resorted to in aid of the more important internal remedies. In these cases, the friction was generally performed with flannel dipped in vinegar or spirit, and if there was much appearance of torpor, in a solu= tion of cantharides. For the relief of local pains, and numbness in the limbs, the friction was best performed with the naked hand, mois= tened with oil. Whether it was owing to any virtues of the oil itself, or that the friction was more perfectly executed, oily frictions were more effectual in relieving these kinds of pain, than those which were more stimulating. EMETICS. I have already observed, that when the fever had been preceded by symptoms of a derange- 17 130 TREATMENT OF THE FEVER. ment of the functions of the stomach, an emetic was particularly serviceable. In these cases, I generally gave the powdered ipecacuanha mixed with a watery solution of tartrite of antimony, in divided doses. In a few instances of this kind, the progress of the disease was nearly or quite arrested by the operation of the emetic. In other cases, however, where the stomach had not been previously disordered, no such benefit resulted from it ; but on the contrary, the debility was increased, and sometimes a troublesome and ob- stinate vomiting was occasioned by it. At a later period of the disease, when emetics were given in consequence of loss of appetite, loathing of food, &c. it was important that their operation should be speedy, and with as little subsequent nausea as possible. For this purpose, I gave a full dose of the powder of ipecacuanha in water, taking care to have no more liquid, than was necessary to facilitate the swallowing of the medicine. If this did not evacuate the stomach in a short time, an additional quantity was given ; or more frequently a small portion of sulphate of zinc was administered in its stead. In a few instances, where the stomach seemed unusually torpid, I gave sulphate of zinc with the ipecacu- anha at first, and more rarely by itself; and once or twice I made trial of sulphate of copper, to produce vomiting. The operation of the sul- TREATMENT OF THE FEVER. 13! phate of copper was so violent and unpleasant, that I shall hardly be disposed to repeat it, unless it were to become a matter of absolute necessity. The sulphate of zinc, though much less vio- lent, is also an extremely unpleasant remedy ; and it is only where it is very important to excite vomiting without continued nausea, and where ipecacuanha fails of doing it, that I should feel inclined to recommend it. I have once seen a pretty violent inflammation of the stomach pro- duced by its action ; and although in this case I am fully persuaded that the life of the patient was saved by administering it, yet the effects were sufficiently troublesome, to teach me much caution in prescribing it in future. CATHARTICS. The only object for which I ever prescribed cathartics in the Epidemic, was to obviate cos- tiveness. For this purpose, those were always preferred which would be the least likely to give pain in their operation, and would produce the least prostration of strength. A more frequent prescription than any other of this kind, was a pill composed of equal parts of aloes, rhubarb, and soap. Castor oil, was often given, especially to children, and powdered rhubarb not unfre- quently. Sometimes carbonate of potash was 132 TREATMENT OF THE FEVER. mixed with the rhubarb, and an acid added ; and the whole given in a state of effervescence. When the debility was great, emollient injections were always preferred to cathartics administered by mouth ; and if the discharge produced by the enema alone was not sufficient, a small dose of some mild cathartic was given, and its operation aided by the exhibition of an enema. In some of these ways, if not by the spontane- ous action of the organs concerned, a discharge was generally procured every day, or every sec- ond day ; although in some few instances a cos- tiveness was suffered to continue longer, without any manifest inconvenience. A very considera- ble degree of exhaustion, and prostration of strength frequently followed the operation of the mildest cathartic or enema, and was sometimes produced even by a spontaneous and apparently healthy discharge. This was however in general easily removed, by seasonably administering cordials and tonics. DIAPHORETICS. I prescribed a considerable variety of dia- phoretics, at different times during the prevalence of the Epidemic, but preferred such as produced their effect when administered in small quanti- ties, and at the same time, had little tendency to TREATMENT OF THE FEVER. 133 create a nausea, or to increase the debility and exhaustion of the patient. I sometimes gave the powder of ipecacuanha and opium, of the pharmacopoeia ; but the bulk occasioned by so large a quantity of sulphate of potash, rendered it difficult to administer it in sufficient doses, without its oppressing the stomach ; especially where there was a strong tendency to vomiting. On this account, I occasionally prepared it with a much smaller proportion of the sulphate. This preparation was preferable to the other; but was not equal to one in which camphor was conjoined with ipecacuanha and opium, in the proportion of one part of opium, to two of cam- phor, and three of ipecacuanha, triturated togeth- er. This powder, given in as large doses as the patient could bear without nausea, rarely failed of exciting perspiration in a short time ; and by repeating it once in four hours, in smaller doses, proportioned to the exigencies of the case, it was generally easy to regulate the evacuation almost at pleasure. Being at one time, for several days, destitute of ipecacuanha, I substituted the antimonial pow- der, and in a few instances tartrite of antimony, for it in the compound powder. Neither of these articles answered the purpose so well as ipecacu- anha ; but the latter was the most objectionable of the two. They occasioned too much nausea, and increased the sensation of faintness at the 134 TREATMENT OF THE FEVER. stomach, and Ave re more liable to be rejected by vomiting. The same objections were applicable to the antimonial powder given alone, besides that it was less certain to produce the beneficial effects, for which diaphoretics were prescribed. It was upon the compound powder of ipecac- uanha, opium, and camphor, therefore, that I principally relied, to produce the diaphoresis, which was regarded as the first step towards the cure of the fever under consideration. This was generally given, except at the commencement of some very severe cases, in doses, which were repeated every four hours, until the cure was so far advanced that the skin began to resume its healthy functions, when it was given less fre- quently,andwas gradually discontinued. For chil- dren, I very commonly added half a grain or a grain of submuriate of mercury to each dose of the powder. The same thing was done in a few instances for adults, especially in cases of a pneu- monic affection, but it was by no means a gene- ral practice. Finding the fever to be manage- able by other means, I wished to avoid the incon- venience and risk of a salivation, so long as it did not appear to be necessary. These means for inducing perspiration were aided, in all severe cases at least, by applications made to the surface of the body. The patient TREATMENT OF THE FEVER. 135 commonly, though not universally, bathed his feet in hot water before going to bed. He was then covered with as many clothes as he could comfortably support ; and generally, a sort of va- pour bath was produced in his bed. Bricks were heated and rolled up in a damp cloth, or brands from the fire, or billets of porous wood boiled in water, were prepared in the same man- ner, and placed around him in the bed. Bottles of hot water were sometimes used for the same purpose. These applications were frequently made by the attendants, before the arrival of a physician. But except in very slight cases, the relief produced by them was never very com- plete, although a sufficiently profuse perspira- tion was often excited. The appearance of a diaphoresis was very much facilitated by the warm aromatic drinks which were taken, to remove the thirst. The quantity of these was sometimes very great. In the early part of the disease when the thirst was the most urgent, I generally suffered the patient to regulate the quantity, by his own feelings. He was never, by my directions, urged to drink more, on account of the diaphoresis, than his .thirst required. I make this remark because it seems to have been supposed by some, that the object was to fill the stomach with as many hot and stimulating liquids, as could be forced into it. 136 TREATMENT OF THE FEVER. STIMULANTS. Cinchona. Tonics, narcotics, and cordials were all of them, used at some part of the sickness, and not very rarely through the whole course of it. Of the tonics, the most generally and con- stantly useful, was the cinchona ; especially when it was combined with orange peal and serpentaria in the fermented decoction already described, and in the compound tincture. In a few instances, I gave a simple infusion or decoction of cincho- na, but it was only when for some particular reason, the compound could not be administered. Whenever a tonic of any kind was indicated, at whatever period of the disease, it very rarely happened that the fermented decoction could not be given with manifest advantage. It was sometimes, but not often, rejected during the vomiting stage, when a more simple bitter, such as quassia, would stay upon the stomach. In a few cases also, it was necessary to omit it on ac- count of an idiosyncracy of the constitution, which prohibited the exhibition of cinchona in any form. Yet this decoction was often received by persons who could not take that tonic in any other preparation. It was more grateful to the palate of most persons, was less liable to occa- sion strictures of the chest, and had less tenden- cy to produce or increase a febrile excitement TREATMENT OF THE FEVER. 137 in the system, than any other composition of the kind, which I have ever seen administered. If there were any considerable symptoms of reaction in the system ; that is, if the pulse was full, or if there were perfect chills, succeeded by heat ; and especially, if there were symptoms of an affection of the lungs, the decoction of cincho- na was not given until these symptoms were, at least in some degree, removed by other reme- dies. In other cases, it was prescribed at the first visit, and administered as soon as it could be prepared ; and in all cases it was administered as soon as the second, or at the latest, the third day. The dose prescribed, of course varied ac- cording to the circumstances of the case ; but was commonly for adults about the amount of a wine glass full, repeated every four hours. Dur- ing the vomiting, like every thing else, it was given in much smaller quantities at a time, and oftener repeated, and sometimes was discontinu- ed. After the vomiting had subsided, however, as large quantities were given as before. This decoction was not unfrequently continu- ed, until the patient was so far recovered as to leave off the use of tonics altogether. More commonly, however, especially in severe cases, as soon as the patient began to have a relish for solid food, the compound tincture of cinchona 18 138 TREATMENT OF THE FEVER. was preferred to the decoction, and took its place in the prescription. The tincture was also occa- sionally given earlier in the disease. Sometimes both preparations were given at the same time, at intermediate hours ; and sometimes thev were prescribed alternately, on different days, as the patient became tired of one or the other. The more common dose of the tincture was the usual one of a drachm. It was generally given in a little brandy and water, either heated or not, according to the feelings and wishes of the pa- tient. If he was feeble and exhausted, the effect was more salutary as well as more pleasant, to have it as hot as he could well drink it ; at other times it was given cold. Gentian.— Whenever any peculiar idiosyncracy of constitution rendered it difficult or impossible to give the tincture of cinchona, the compound tincture of gentian was substituted for it. A fermented decoction similar to that of cinchona, was also some few times prepared and given in these cases. It was a useful tonic, but being less powerful and less certain in its effects than cin- chona, it was only given when that could not be. During the convalescence, the tincture of rhubarb and gentian was often prescribed, to ob- viate costiveness ; and with very good effect. TREATMENT OF THE FEVER. 139 Uuassia. — Quassia was extensively useful as a tonic in this disease. In almost all cases in which from whatever cause, cinchona could not be ad- ministered, the infusion of quassia was given as a substitute. In the early part of the disease, when the cinchona would be likely to produce too much excitement, and yet it was desirable to give something* to prevent the strength of the patient from sinking, this was a remedy exactly suited to the wants of the case. In some cases of coughs, which forbad the use of more powerful tonics, it was also extremely useful. During the vomiting stage of the fever, quassia often remain- ed on the stomach, when almost every thing else was rejected ; and was therefore very frequently prescribed at that time. Besides these several cases, it was often given at intermediate hours, dur ing the exhibition of other tonics, especially when the patient was very low ; and aided very much in producing the effect desired. The quantity prescribed was not very precisely limited. I commonly ordered a spoonful of a strong infu sion to be given every hour. A variety of other vegetable tonics was oc- casionally prescribed ; but their effects were not so peculiar as to require a particular notice. Those of the serpentaria and orange peal have been sufficiently described, when speaking of the compounds into which they always entered 140 TREATMENT OF THE FEVER. whenever they were prescribed. Of the others, chamomile flowers, cascarilla, and colomba were more frequently ordered than any others. They generally fulfilled the intention for which they were prescribed, with about the same constancy as in other diseases. Acids. — The aromatic sulphuric acid was fre- quently given, especially during the convales- cence. It was generally combined with the com- pound tincture of cinchona, and seemed some- times to prevent the tincture from disagreeing with the constitution. In a few low cases, the muriatic acid was given in small quantities, with other tonics. Metallic Tonics. — The only metallic tonics of which I made any use during the Epidemic, were arsenic and iron. The arseniate of potass was the only preparation of the former ever given. In two or three of the first cases, it was given in doses of three or four drops, mixed with an equal quantity of tincture of opium, repeated every four hours, and apparently with very good effect. But, having lost a patient early in the season, in conse- quence of the carelessness of a nurse, who mistook the arseniate for something else, and gave a large quantity, I abandoned its use altogether ; not so much from a dislike to the remedy itself, as from a want of confidence in the care with which it would be administered. TREATMENT OF THE FEVER. 141 Iron, whenever it was prescribed, was given with myrrh, as in Griffith's Myrrh Mixture, or his Myrrh Pills, prepared according to the for- mulas in Thatcher's Dispensatory. It was rarely, if ever given early in the disease. But after the cure had made some progress, and especially in cases of protracted convalescence, its effects w T ere often very salutary. The quantity prescribed was regulated by the circumstances of the disease, and of course varied very much in different cases. Wine. — Wine in its simple state was made use of, only in a few instances, and then generally to- wards the close of the convalescence. It very rare- ly agreed well with the stomach, and was not com- monly grateful to the taste. Sometimes it occa- sioned vomiting, and oftener, acidity and oppres- sion. Wine whey was much more frequently taken with relish, though rather as an article of diet than of medicine. Brandy. — This article was very frequently given ; and sometimes in pretty large quantities. Much reliance was placed upon its good effects, in concurrence with other tonics, whenever the strength was very low, and particularly in cases of great faintness and a sensation of sinking. It was given at irregular intervals, and in very different quantities, according to the situation of the patient. The proper time for administering it, was gene- 142 TREATMENT Oi- THE FEVER. rally not until a perspiration had commenced, and the more violent symptoms of the access had begun to subside. In some few cases, however, where the prostration of strength, and the appa- rent depression of the vital powers, were extreme, I did not wait until these changes had taken place. Indeed it not unfrequently happened, in ordinary cases, that brandy was given at the commence- ment of the disease, before the arrival of a phy- sician. But it was not prescribed in such cases, and when taken, was many times rather injurious than beneficial in its effects. It is worthy of remark that those who had been accustomed to a free use of spiritous liquors when in health, generally took them with much less relish, when sick with the fever, than others whose habits were more temperate. The brandy was either mixed with aromatic drinks, or was diluted w T ith water, as the patient preferred. The degree of dilution was also prin- cipally regulated by the feelings and choice of the sick. In most instances it was more pleasant, as well as more useful, when given as hot as could easily be borne. This was particularly the case, when the sensation of faintness in the region of the stomach was urgent ; and still more so, when the object was to prevent vomiting. In a few cases of obstinate vomiting, a few tea-spoon- TREATMENT OF THE FEVER. 143 fuls of brandy given at short intervals, very strong, and as hot as possible, were more successful in ar- resting this troublesome symptom than any thing else. It was a few times given pure, for this pur- pose, though in very small quantities ; and even rendered more active by the addition of cinna- mon or some other aromatic. This, however, was never continued more than for a very short period, at any one time. When its use was continued longer, it was freely diluted. In coma, brandy was sometimes given in large quantities, conjoined with tincture of opium. In these and some other cases, it was not unfrequent- ly mixed with yeast, with good effect. When there was a difficulty of swallowing a sufficient quantity, this mixture was given in an enema, taking care to add tincture of opium enough to ensure its retention. Alcohol in other forms was occasionally given, although rarely, and only when some peculiar circumstance rendered it impossible for the brandy to be taken. Opiates. — Opium in substance was given only in the compound diaphoretic powders. The simple tincture was given, whenever it was indicated for the purpose of checking diarrhoea. It was also frequently prescribed with some of the volatile oils, to remove a disposition to vomiting and faint- ness. But it was bv far the most liberally used 144 TREATMENT OF THE FEVER. in cases of coma. Whatever may be the expla- nation of its mode of action, it is certain that this was a powerful agent in removing the deepest comas, which were not absolutely irrecoverable. For this purpose it was sometimes given in large quantities, both by mouth, and by injections. To allay irritation and promote rest, the campho- rated tincture of opium was frequently given at bed-time, and occasionally at other times, but al- ways in moderate doses. It was also frequently mixed with the volatile oils, in preference to the simple tincture, to excite the stomach. Cordials. — The more diffusible stimuli were resorted to, whenever the prostration of strength, or the torpor of the system seemed to require a speedy excitement. It has already been observed that the volatile oils were extensively used for this purpose. The carbonate of ammonia, either in powder or in a liquid state, was sometimes pre- scribed with the same intention ; besides a va- riety of other articles already mentioned. Diet. — It has already been remarked, that the diet was principally confined to the lighter articles of food. Simple soups made pretty strong, but with the oily parts separated, and seasoned to the taste of the patient, were preferred. When these disagreed, or could not readily and constantly be obtained, gruel, arrow root, sago, panada, and TREATMENT OF THE FEVER. 145 other light vegetable articles,, were substituted for them. After the desire for solid food return- ed, which was generally rather early in the con- valescence, a much greater variety was permitted in the diet. The appetite for solid food in many cases commenced by an urgent desire for some particular article ; and this often not apparently very well suited to the condition of the patient. Unless, however, it would be manifestly injurious, the desire was generally satisfied. The food de- sired was given, at first with much caution, and very rarely produced any injury. Of the more common drinks, decoction of aro- matic vegetables, brandy, wine whey, &c. enough has already been said. Coffee was very generally taken with much relish, and without any un- pleasant effect. Cold water was allowed at the beginning of the disease, if the patient wished it; an occurrence which sometimes, though rarely happened. During the vomiting it was always injurious, and was therefore prohibited, although the thirst for it was sometimes very urgent. Dur- ing the convalescence it was not often desired, and was not denied, unless some peculiar cir- cumstance forbad its use. I saw one or two cases of a very singular raging thirst for cold wa- ter, for which I hardly know how to account, in which a very large quantity was taken without any disadvantage. A case of this kind with its 19 146 TREATMENT OF THE FEVEK. attending circumstances, will be given in the next chapter. During the convalescence, and sometimes ear- lier, cider was more generally desired than any other article of drink. It was very freely allow- ed, and produced no inconvenience, except that in a few instances, it occasioned a slight diarrhoea. When it could be obtained, bottled cider was always preferred. But as this was not always at hand, good draught cider was often taken. REGIMEN. The object which was principally kept in view in managing the regimen, was to render the pa- tient as comfortable as possible, and at the same time to secure a constant, but mild and equable perspiration. The temperature of the room, the quantity of bed-clothes, &c. were determined by this rule. It was considered important, that the temperature of the room should be as uniform as possible. The degree of warmth which is the most agreeable to a healthy person was nearly preserved. When it could conveniently be done, the patient lay in flannel sheets, and wore a bed- gown of the same material. Flannel was prefer- red to linen or cotton, as giving less exposure to chills from changes of temperature, or from the moisture produced by perspiration. TREATMENT OF THE FEVER, 147 The bed was generally made every day. If, as was often the case, the patient was too feeble to sit up while this was done, he was lifted on to another bed ; and if his circumstances admitted of it, the bed-clothes, as well as his linen, were changed every day, or every second day. Con- siderable care was taken to have the room well ventilated. If it was small, a window was kept open nearly the whole time, taking care of course not to have the fresh air blow directly upon the patient. To effect this, where the window did not let down from the top, several folds of thick cloth were pinned closely at the bottom upon the casement of the window which was open, so as to give the air a direction upwards. The patient was allowed only very short periods of sleep, without being waked. The frequency with which it was necessary to give medicine or nourishment, in many cases caused his being wak- ed sufficiently often. If this did not require it, it was nevertheless important that he should not sleep more than from fifteen to thirty minutes at a time, according to the severity of the case, and especially according to the disposition to coma. When suffered to sleep too long, he was waked with more difficulty, and was evidently enfeebled and exhausted, rather than refreshed by it. 148 TREATMENT OF THE FEVER. A considerable degree of inconvenience was suffered from the want of such medicines as were frequently desirable. I was often under the ne- cessity of prescribing differently from what I wished to do, because the article which I prefer- red could not be obtained. There was at that time no apothecary in town ; and in consequence of the difficulty of obtaining medicine from a dis- tance, which the war with Great Britain occa- sioned, the shops in the vicinity were much more imperfectly supplied than usual. Some of the inconveniences occasioned by this circum- stance will appear in the following chapter ; others are not noticed, because they did not ap- pear materially to affect the result of the different cases. CHAPTER. IV CASES OF THE EPIDEMIC. CASE I. February 11 th 9 1814. A. L. is an unmarried woman, aged about 25 years. Her health has usually been good; until within a few months past, it has been less vigorous than formerly. I was first called to-day. She was seized with pain in the bowels and diarrhoea more than a week ago, but has been better since the first attack. Her diarrhoea, however, continued, and she has, of her own accord, taken a dose of sulphate of soda, by which her strength has been very much reduced. She has kept her bed for the last three or four days. She now complains of great pain in the head and extreme dizziness ; constant vomiting ; strength prostrate ; great numbness of the ex- tremities ; skin has a puffy, cedematous feeling. 150 CASES OF THE EPIDEMIC. Purple spots appear occasionally on her limbs. Her pulse is so feeble and quick, that it is count- ed with difficulty ; tongue covered with a dark coat. She was directed to take the powder of ipecacuanha, opium and camphor, which is de- scribed in the preceding chapter, every four hours, and between the times of taking it, to drink a wine-glass-full of the fermented decoction of cinchona. Four drops of arseniate of potass, with four of tincture of opium, were ordered to be given each time in the decoction. Small quantities of brandy and of strong soup were di- rected to be given in the intervals. February 12th. In the morning. Every symp- tom is worse. Only a trembling of the pulse can be perceived at the wrist. The stomach has re- jected every thing she has taken. Omit the powders, and the decoction. R Lavend. 01. Vol. gt. iv. Tinct. Opii gt. v. every hour, in a tea- spoonful of warm brandy and water. This pre- paration gives a very grateful sensation to the stomach. Give frequently a little brandy, spiced and warmed. Apply spiritous fomentations to the region of the stomach. Afternoon. Vomiting less urgent. Re-com- mence the diaphoretic powders, and decoction of cinchona, as directed yesterday. CASES OF THE EPIDEMIC. 151 13th. Symptoms somewhat mitigated; but the stomach still rejects the decoction of cinchona. Substitute for it, a strong infusion of quassia : of which give a table spoonful every hour, except when the powders are administered, which are to be continued as before. As she has been two days costive, an emollient enema was ordered, which produced a free stool of a natural appear- ance. 14th. Rather better. Continue the powders and the infusion of quassia. The enema was re- peated, and with the same result as yesterday. R Tinct. Cinchon. compos. $\. every four hours. 15th. Still better. Continue the medicines. A moderate dose of rhubarb was ordered to obviate costiveness. From this time her health gradually improved until in a fortnight, she was able to sit up half an hour at a time, and to eat pretty well. Substan- tially the same course of medicine was pursued, until she was perfectly recovered. In the course of her convalesence, she was affected with a pain, apparently rheumatic, in her left arm, which was readily removed by frictions with compound tincture of soap. Her health was better after her sickness than it had been for a few month? before. 152 CASES OF THE EPIDEMIC CASE II. Feb. 24th. — Mrs. S. a married woman aged about 30, of a vigorous constitution, and good general health. She complains of great pain in the head and dizziness, which have been so se- vere, as to confine her to her bed for the last two or three days ; sickness at the stomach ; thirst ; numbness of the limbs. Purple spots occasionally appear on the skin. Her tongue is much coated; pulse quick, but not remarkably feeble. These symptoms have been gradually making their appearance, and increasing for a week. She was ordered the Pul. Ipecac. &c. every four hours ; at bed time to take Tinct. Opii Camph. 31. ; to drink warm aromatic decoctions as her thirst required, and to take soup for food. Feb. 25th. Her headach and dizziness are dimin- ished, as well as the thirst ; numbness and pete- chiae gone. Continue the diaphoretic powders ; and between each dose, take a wine-glass-full of the fermented decoction of cinchona. As she is costive, take a portion of powdered rhubarb. I did not see her again. She recovered in a few days. case nr. Feb. 26th. — J. D. a boy eleven years old, was seized suddenly yesterday morning, with violent CASES OF THE EPIDEMIC. 153 pain in the head and dizziness, nausea and vomit- ing. During the night he was in a perfect deli- rium. This morning the vomiting has stopped, and he is rational. He still complains of great pain and dizziness of the head; pain in the back and limbs ; a slight numbness of the extremities ; thirst for warm drinks ; sickness, and a feeling of depression at the stomach. His skin is dry ; pulse quick, and tolerably strong, and his tongue much coated. The bowels are not apparently disordered. He was ordered the powder of Ipecac. &c. every four hours, to take warm aro- matic drinks ; and if these should not be suffi- cient to produce a diaphoresis, to make use of external sudorifics. If restless at night, he is to take a full dose of camphorated tincture of opi- um. Nourish with good soup. 21th. — He has rested well through the night. The dizziness and pain in the head are much less severe than yesterday ; vomiting nearly ceased ; thirst and numbness diminished. Continue the Pul. Ipecac. &c. Take the fermented decoction of Cinchona between each powder, 28th. — Much better ; every symptom reliev- ed ; has sat up more than an hour. His appe- tite has returned ; and he complains of nothing but debility. Continue a diaphoretic powder, night and morning ; and the fermented decoc- 20 154 CASES OF THE EPIDEMIC. tion, and a little brandy occasionally. I visited him no more. In nine days from this time he attended school in good health. CASE IV. Feb. 26th. — S. C. a healthy boy six years old, was seized last night with the usual symptoms; pain in the head and dizziness ; nausea ; tongue coated; skin dry; pulse rather fjuick, but not particularly feeble. R PuJ. Ipecacuan. gr. x. Sub- mur. Hyd. gr. viii. immediately. After the operation, give Pul. Ipecac. &c. every four hours. The medicine operated favorably ; and he requir- ed no more, except some rhubarb to open his bowels. In a few days he was as well as usual. case v. Feb. 26th. — S. L. a sister of A. L. Case I. about eighteen. She began to be a little ill three days ago, after rinsing clothes in cold water in the open air. This exposure occasioned a suppression of the menses, which had just commenced. She was not so sick, however, as to consult me, though I was every day in the house. She now complains of pain in the head and dizziness; loss of appe- tite, nausea, &c. ; but these symptoms are not so severe, but that she can sit up considerably. Her bowels are in good order, except that they are a GASES OF THE EPIDEMIC. 155 little inclined to costiveness. R Pul. Ipecac. &c. every four hours. 21th. — Worse ; beadach and dizziness increas- ed ; complains much of nausea ; vomits frequent- ly; skin dry the most of the time; has some degree of numbness ; extremities have a lifeless, oedematous feeling; costive. R Pul. Rhei gr. xxv. immediately. Continue the Pul. Ipecac. &c. every four hours; and give a table spoonful of infusion of quassia every hour. 28/fe. — Pain in the head diminished ; vomiting less ; skin moist ; the rhubarb has not operated. Having no ipecacuanha, I subsituted the common antimonial powder for it in the composition with opium and camphor, and ordered it to be continu- ed as before. Continue also the infusion of quas- sia. R Pul. Rhei gr. xv. and in two or three hours after, administer an enema. March 1st. — Has rested well through the night ; vomits occasionally a little mucus ; numbness mostly gone ; feels very little pain ; skin tolera- bly moist ; is much inclined to sleep. The ene- ma produced a natural looking stool. Repeat it towards evening. Continue the Pul. Ipecac. &c. every four hours ; and in each interval give a wine-glass- full of the fermented decoction of cin- chona. Apply a blister to the upper arm. Give 156 CASES 6t THE EPIDEMIC. brandy and well seasoned soup freely. Mem. The nurse is negligent, and the house terribly noisy. 2d. — A little better, but is still very feeble ; ha9 turns of faintness; pulse fuller, and less frequent; has very little thirst ; the enema last evening pro- duced a scanty evacuation of the bowels ; the skin is somewhat moist, though not constantly so ; she takes soup sparingly. Her nurse frets her. Con- tinue the Pul. Ipecac. &c. as before. R Tinct. Cinchon. Compos. 5i. every four hours. When- ever she is faint, give Spiritus Menth. pip. gt. viii. with Tinct. Opii Cam ph. gt. xx. 3c?.— The symptoms are much the same, but a little better, though the amendment is not very considerable. Her menses have returned, and are sufficiently moderate. Continue the powder. Give a wine-glass-full of the fermented decoc- tion of cinchona every four hours; and at least an equal quantity of wine, during each interval. In the decoction give every time, arseniate of potass and tincture of opium, of each four drops. Ath. — Appears much as yesterday; is said to have had a good night ; pulse tolerably good ; in- clines to coma ; bowels sufficiently open. Con- tinue the medicines ; but pursue the stimulants CASES OF THE EPIDEMIC. 157 more vigorously. Apply a blister to the upper part of the other arm. 5th. — Much worse; was very much worried last night by her attendants, Her puise is low and quick ; tongue black ; protruded with diffi- culty ; a black sordes collects on the teeth ; ex- tremities feel puffy. She speaks indistinctly, and is inclined to faintness. I now discovered more particularly, what I had before partly known, that she is neglected and ill treated by her niirse, who is ill-tempered, petulant and noisy. I en- joined the strictest rest and quiet. Continue the Pul. Ipecac, &c. every four hours. Give half a drachm of compound tincture of cinchona, every two hours ; infusion of quassia a table spoonful every hour, brandy at least an equal quantity every hour ; and peppermint with camphorated tincture of opium as before, whenever she is faint* Nourish with good soup. 6th. — Has rested considerably. Her pulse is better; tongue more natural; bowels in good or- der; skin moist. Continue the medicines; but do not pursue the more diffusible stimuli, quite so vigorously. At bed-time give a drachm of camphorated tincture of opium. 1th. — Has been troubled with diarrhoea in the night, accompanied by a great disturbance of the 158 CASES OF THE EPIDEMIC. bowels. Her pulse is lower and quicker; tongue and mouth extremely dry and parched ; she speaks with difficulty, and almost unintelligibly ; pro- trudes the tongue but little, and with great diffi- culty ; lips and teeth collect a black sordes ; skin moist; has turns of faintness. If the diarrhoea continues, give ten drops of tincture of opium after every stool. Continue the diaphoretic pow- der. Give a wine-glass-full of the fermented de- coction of cinchona every two hours, and other stimulants freely. Evening, — Has had no passage from the bowels since morning ; breathing laborious ; pulse pretty full, 140 in a minute. Apply a blister over the sternum. Give the decoction only half a glass in two hours. At bed time give Tinct. Opii Camph. 5i. and whenever she is faint, give peppermint and camphorated tincture of opium as before. 8th. — Has again been troubled with diarrhoea in the night, though less than before; pulse 140, less full. Continue the medicines ; but give more brandy. Evening. — Much the same. Has had one dis- charge from the bowels to-day. Apply a blister to the calf of each leg. CASES OF THE EPIDEMIC. 159 9th. — No better, but grows weaker. I have at length discovered many instances of extreme bad conduct on the part of the nurse, and after much difficulty have succeeded in getting her discharged ; although the new one does not seem entitled to much confidence. IVly patient has still some diarrhoea, pulse 140, feeble; tongue ex- tremely parched ; lips and teeth covered with a black sordes; skin continues moist; respiration difficult; partially in a delirium. Continue the medicines as before, except to substitute the com- pound tincture of cinchona, one drachm every two hours, for the decoction. Evening. — Much the same. R Spiritus Menth. Pip. gt. viii. Tinct. Opii Camph. gt. xv. every two hours. 10th. Case almost desperate ; tongue parched and black ; she is unable to thrust it out of her mouth; respiration laborious; delirious ; pulse low, quick and fluttering ; feet and legs swelled ; diarrhoea very urgent through the day, stools sometimes passed involuntarily ; fceces black, and extremely fetid ; great disturbance in the bowels ; swallows with difficulty ; refuses soup. Apply a blister over the cartilages of the lower ribs on each side. R Lavend. 01. Yol. gt. ii. Spir. Menth. Pip. gt. vi. Tinct. Opii gt. iv. every hour. Give fifteen drops of tincture of opium after every 160 CASES OF THE EPIDEMIC, stool, until the diarrhoea is checked ; infusion of quassia, a spoonful every half hour ; a spoonful of brandy at least as often ; Tinct. Cinchon. Com- pos, occasionally, as she is able to receive it. Evening. — She seems a little revived. She now takes a little soup ; swallows better. Omit the tincture of cinchona, and give brandy every twenty minutes ; other things as before. \Mh. — Somewhat revived; pulse better; tongue more moist ; delirium less complete ; speaks bet- ter than she did yesterday, though still almost unintelligibly ; swelling of the bowels less, that of the feet and legs gone ; diarrhoea continues ; stools black and fetid. Continue the tincture of cinchona, and infusion of quassia, as directed yes- terday. After every stool, give tincture of opium ten drops. Afternoon. — Diarrhoea somewhat diminished ; stools less offensive. Give only five drops of the tincture of opium after each discharge. At bed- time give twenty-five drops of the same tincture. I discovered to-day that the nurse had mistaken the phial containing arseniate of potass and tinc- ture of opium (which were mixed in equal quan- tities) for that which contained the camphorated tincture of opium, and that for several days past, CASES OF THE EPIDEMIC. 161 she had generally, if not always, given the former composition when the latter had been prescribed. I had been very particular in cautioning her against such a mistake, and in warning her of the fatal consequences, that would result from it. The two phials were so dissimilar in their ap- pearance as to be readily distinguished from each other ; but she seems to have transposed them in her mind, so as to mistake the one which she was to avoid. When the nurses were changed, the first repeated my cautions to the new one, but appears to have applied them to the wrong phial. I say this appears to have been the case, for there is so much falsehood and contradiction between them, that it is difficult to ascertain the truth. The arseniate of potass has not been prescribed for a week past, and had so passed out of my mind, that it did not occur to me, that it could be the cause of the bad symptoms, which I have detailed in the patient, until, on looking over the medicine to-day, I found that it was gone. As soon as I discovered what had been done, 1 or- dered as much carbonate of soda to be put into all her drinks, as they would bear without render- ing them very nauseous, and continued other things as before, V2th. — Seems better; has slept considerably last night; her delirium is less ; pulse one hun 21 162 CASES OF THE EPIDEMIC. dred and thirty, and fuller; tongue and mouth more moist and natural ; the tongue is still pro- truded with difficult v ; skin moist; respiration still laborious ; coughs considerably, and expectorates with ease, so far as to raise the matter into her mouth, but cannot spit it out. It is wiped out with a cloth by the nurse. The swelling of her bowels is gone ; diarrhoea moderated ; stools more natural in their appearance. She still has turns of faintness. Continue the tonics as before. At bed-time give a drachm of camphorated tinc- ture of opium ; and whenever she is faint, give fifteen drops of the same tincture with eight of spirit of peppermint. She is desirous of cider, which is to be freely allowed her. Continue the soda. 1 3th. Morning. — Appears considerably better ; has rested pretty well ; pulse one hundred and thirty, pretty strong and full ; countenance more natural; breathes more easily; delirium less; speaks better; swallows more readily. Con- tinue the medicines. Evening. — The house has been very noisy through the day, and ihe patient is worse. Her pulse is quicker and smaller. She is much de- ranged; unwilling to lie in bed ; talks much, and incoherently of children jumping in the room ; is frequently faint; and has turns of trembling. CASES OF THE EPIDEMIC. 163 Her tongue and skin are more dry ; respiration very laborious; diarrhoea less than it was yester- day. Continue the quassia, brandy and pepper- mint as before directed. R Pul. Ipecac. &c. every four hours ; the fermented decoction of cin- chona, hasf a wine-glass-full every two hours ; Tinct. Opii Cam. 3L at bed-time, to be repeated in two hours, if she continues restless. 14Lth. — The first part of the last night, she was very turbulent ; but towards morning became more quiet, and slept considerably. She is now much as she was yesterday morning ; takes her medicine and soup well ; she asked for a bit of dry biscuit, which was given her, and she ate a little of it. The diarrhoea is not troublesome ; trembling continues. Continue the medicines as before. If her delirium should increase during the day, give her a drachm of the camphorated tincture of opium. Evening. — She has had one quite restless turn, but it did not continue long. The camphorated tincture was given as directed, and relieved her. She has grown tired of the fermented decoction, and takes it unwillingly. Substitute the com- pound tincture of cinchona, a drachm every two hours. \bth. — Last night she has slept pretty well, and to-day is better. Her tongue is considerably moist ; 164 CASES OF THE EPIDEMIC. countenance improves ; trembling diminished ; diarrhoea continues moderately. She still speaks with difficulty ; coughs considerably, and expec- torates freely. She takes considerable cider with relish. Continue the medicines. 1 6th. — Has had a tolerable night ; countenance more natural ; appetite improves ; trembling less ; feeling of faintness gone ; coughs and expecto- rates considerably ; complains of sore throat ; bowels nearly regular. R PuL Ipecac. &c. every six hours. Continue other medicines as before. Make an infusion of flaxseed, and give a little frequently. 17th. — Continues to improve gradually. Her tongue has a more natural appearance. She speaks distinctly, and with her usual tone of voice ; res- piration easier ; expectoration copious and free ; possesses her mind more completely than for some time past; has still a slight trembling; diarrhoea continues slightly. Take every hour ten drops of the camphorated tincture of opium in the infusion of linseed. Continue other medi- cines as before. 18/^. — Rested well in the night ; has had no dis- charge from the bowels since yesterday morning, when she passed a natural stool ; pulse one hun- dred and thirtv, rather hard, and stronger than GASES OF THE EPIDEMIC. 165 lately ; tongue dry and black ; mouth dry ; thirst increased ; appetite for food improved ; trembling continues, perhaps increased ; no faintness ; skin moist ; speaks with more difficulty ; respiration rather more laborious ; cough loose ; expectora- tion copious and free ; had last night a paroxysm of delirium, and again this morning, but they were of short duration. I learned to-day that she has for four or five days, had an ulcer on her right hip. It is not large, and does not in any respect appear very badly. It discharges a little, and appears sufficiently, though not remarkably sensible. I could pass the probe, in one direction about an inch under the skin. I dressed it with Emp. Resin. R Pul. Ipecac. &c. every four hours. Tinct. Cinch. Comp. 31. every hour; at bed-time Tinct. Opii Camp. 3i. and put into all her common drinks as much soda as the taste will permit. Give cider freely, and brandy according to the degree of exhaustion and debility. 19/A. — Is less distressed ; tongue more moist; expectoration continues to be free ; skin gene- rally moist, although it was dry for a short time when I was present. The pulse was then one hundred and fifty, and she was more distressed ; respiration rather laborious; has passed three stools since yesterday morning. A slough as 166 CASES OF THE EPIDEMIC. large as a nine-penny piece is separating from the ulcer on her hip. Apply to it a mixture of flour and honey. ft Pul. Ipecac. &c. as before. Tinct. Cinch. Com. 31. every hour, unless the ex- pectoration should be checked, or some other dis- agreeable symptom should be produced by it; brandy freely and iiberally ; at bed-time Tinct. Opii Cam. 3L Evening. — Has been much distressed, vomited and is in some degree relieved, still, however, seems distressed ; respiration laborious ; speaks with difficulty ; lies in a partial stupor, from which however, she is easily roused ; pulse one hundred and thirty ; tongue more natural in its appearance ; skin moist. Omit the tincture of cinchona. R yeast and brandy, at least a table- spoonful of each mixed together every hour, unless it should oppress her ; brandy besides, liberally ; a strong infusion of quassia, a tea-spoonful every half hour ; Lavend. 01. Vol. gt. ii. Spir. Menth. Pip. gt. vi. Tinct. Opii gt. xii. every hour. Con- tinue the Pul. Ipecac. &e. as before, and at bed- time give Tinct. Opii Cam. 3i. 20th. — Lies in a stupor, from which nothing will rouse her. Aqua Ammoniae was given her for this purpose, but without any perceptible effect ; respiration short, slow and laborious ; pulse 160; skin moist ; had one discharge from the bowels in CASES OF THE EPIDEMIC. 167 the night, before which they were much swollen, and afterwards less. Expectoration ceased about 1 o'clock in the morning. About 10 A. M. she ceased to swallow, and about twelve expired. I earnestly sought permission to examine the body, but could not obtain it. It may perhaps be thought, by some, that the symptoms in this case, ought at an earlier period, to have led me to suspect, that arsenic had been given. But it should be remembered that the Epidemic to which this disease belonged, assum- ed almost every possible variety of appearance; so that an unusual symptom was not an object of suspicion, as it would have been at any other time. The use of arsenic had been so long discontinued, that it had passed out of my mind ; and as I was continually witnessing anomalous symptoms for which I could not account, in other cases of the same disease, it did not occur to me as the cause of those I observed in this. Besides I was con- stantly perplexed by the contradictory accounts given me by the nurse, and other members of the family. Those of the family who were the most capable of taking care of a sick person, w^ere too ill themselves, or too much occupied by fam- ily concerns, to attend to the immediate manage- ment of the sick bed ; so that the patient was left almost exclusively to the care of a nurse, in whose veracity I had very little confidence. It was therefore difficult to ascertain the real situation 168 CASES OF THE EPIDEMIC. of the patient, except from the observations which I could make my self during mv visits; and these visits were necessarily very short, in consequence of the multiplicity of other engagements which the Epidemic occasioned. If I had been able to examine the medicines daily, as I usually did. when I had sufficient leisure, and to inquire more par- ticularly into every circumstance of the case, I should doubtless have discovered the mistake sooner. But as it was, I saw that the nurse was petulant, noisy and negligent, and I imputed to her neglect and mismanagement, the bad symp- toms which were but too apparent. This opinion was strengthened by observing some improvement in the condition of the patient, for the first day or two after the nurse was changed. CASE VI. Feb. 26//*.— Mrs. H. about forty years old- has latelv been considerablv exhausted bv attend- ins upon a sick child. She was violently attack- ed to-day with severe pain in the head and dizzi- ness ; pain in the back and limbs ; occasional Tomitino; ; thirst for warm drinks. Her pulse is quick and hard ; tongue coated ; skin dry. She complains of a severe, and acute pain in the tho- rax under the rieht breast, which occasions diffi- culty of breathing. She has been for several days subject to a cough, accompanied by a : CASES OP THE EPIDEMIC. 169 expectoration, both of which continue. Apply a blister, as nearly as possible, over the seat of the pain in the chest. R Pul. Ipecac. &c. every four hours; and at bed time, Tinct. Opii Cam. si. 21th. — Has rested pretty well, during the night. The pain in the chest is somewhat mitigated, parti- cularly while the body is at rest, but is still se- vere upon motion. Pulse quick, but feeble ; vomiting rather less urgent. Continue the Pul. Ipecac. &c. and to each powder add one grain of Sub-muriate of mercury. As she is costive, give Pil. Aloes and Rhei as much as is sufficient to move the bowels. N. B. These pills are made of equal parts of aloes, rhubarb, and soap. 28/^.— Has passed a quiet night; and every symptom is relieved. The pills produced a mod- erate dejection. Continue Pul. Antimon.^ &c. as she has taken the powder of Ipecac. &c. and in each interval, take a wine-glass-full of the ferment- ed decoction of cinchona. March 1st. — Has had a good night, and is bet- ter ; pain in the thorax mostly gone ; vomiting ceased; has no pain in the head, nor dizziness; skin moist; expectorates freely ; bowels regular; likes the fermented decoction much. Continue it. & Pul. Ipecac. &c. every six hours. * The antimonial powder in this composition was used as a substi^- tnte for ipecacuanha, with camphor and opium. 22 170 CASES OP THE EPIDEMIC. 2d. — Better in every respect ; bowels regular ; expectoration free ; pulse of natural frequency, but feeble ; vomiting and thirst gone ; skin na- tural in its appearance ; has but very little ap- petite for food. Be Pul. Ipecac. &c. night and morning ; Tinct. Cinchon. Compos. 3i. every four or five hours. 3d, — Is nearly recovered ; feels pretty well, except that she is feeble ; has some appetite for food ; sleeps well ; pulse pretty good ; bowels regular ; tongue moist, coat nearly separated. Continue the Tinct. Cinchon. Compos. If at any time a paroxysm of fever should return, take a powder of Ipecac. &c. She recovered without any further attendance. In the course of her convalescence she was affect- ed with a pain apparently rheumatic, in her shoul- der, which was speedily removed by friction with 01. Ammoniatum. CASE VII. Feb. 27th. — Mr. W. a vigorous healthy man, about 30 years old. He has walked, or rather skaited upon the ice, two miles to-day to attend meeting, attended two services, and returned in the same manner. He began to feel rather ill be- fore he reached home ; and soon after, was seized CASES OP THE EPIDEMIC. 171 with extreme pain in the head and dizziness ; pain in the back and limbs; rigors, succeeded by heat and thirst; and some pain in the upper part of the thorax, nearly under the right clavicle. His tongue is dry ; skin dry, and hot to the touch ; pulse quick, full, and hard. & Tart. Antim. gr. ii. to be repeated twice after intervals of fifteen minutes, unless vomiting is sooner produced. As soon as the vomiting ceases, give Tinct. Opii Cam. 3i. ; and in an hour or two after, commence giving the Pul. Ipecac. &c. every four hours ; to each dose of which is added Sub-mur. Hyd. gr. i. At bed time, if he is restless, give him a drachm of cam- phorated tincture of opium. Nourish with soup. Apply external sudorifics, and give warm drinks, until a diaphoresis appears. 28th. — The emetic operated favorably, and gave some relief. The pain in the thorax is in- creased, that in the head somewhat diminished ; other symptoms much as before ; bowels regular. Apply a blister over the seat of the pain in the chest. Continue the Pul. Antimon. &c. every four hours. March 1st. — Rested pretty well through the night. In the morning his skin was moist, and he was nearly free from pain. But I was not able to visit him so early as I had intended, and he be- came destitute of medicine; in consequence of 172 CASES OF THE EPIDEMIC. which, his skin grew dry ; his pain in the head and dizziness returned, and became extremely severe. His tongue is coated and dry; pulse quick, and much more feeble. He is very thirsty. R Pul. Ipecac. &c. every four hours ; in the intervals, take the fermented decoction of cinchona. Use warm aromatic drinks, as freely as the thirst requires, and apply external sudorifics. 2d. — Rested well last night, and feels better to-day ; feels more strength and less pain ; pulse more nearly natural; skin keeps moist; is less thirsty ; tongue coated as much as ever. Con- tinue the medicines ; take a little brandy or wine occasionally. 3d. — Is still rather better ; rested well last night ; has very little pain ; takes soup with rel- ish ; brandy does not suit him ; pulse good ; tongue darker; skin continues moist; wishes for cider, which he is allowed to take freely. Continue the medicines. 4th. — Worse. He felt very well yesterday af- ternoon and evening; but had too much compa- ny, with whom he talked very freely, as well as in the night with his attendant. He slept tolera- bly well, most of the night ; but had several se- vere paroxysms of coughing. When he waked this morning, he was perfectly hoarse, and con- tinues so much so, that he can scarcely speak, ex- CASES OF THE EPIDEMIC. 173 cept in a whisper. His respiration is laborious; tongue dry and black ; pulse more feeble ; skin moist ; has a diarrhoea, which is probably occa- sioned by the cider, of which he has drinked very freely. Substitute wine. Take ten drops of tincture of opium after every superfluous stool. Continue the decoction of cinchona, and the Pul. Ipecac. &c. 5th. — Rested pretty well ; pulse better ; tongue more moist, but as black as ever ; is less thirsty ; feels more strength; takes soup with relish. His voice is entirely gone, so that he can only speak in a whisper. Continue the medicines, and give brandy or wine frequently. 6th. — Recovering ; rested well ; pulse preter- naturally slow ; tongue still black ; skin moist. R Tinct. Cinchon. Compos. 51. every four hours; the Pul. Ipecac. &c. every six hours. Continue the wine and soup. 7th. — Expectorates freely ; cough less trouble- some ; rests well ; pulse slow, and tolerably full ; voice still gone. Continue the medicines. Sth. — Still gaining ; sleeps well ; appetite for food good ; pulse very slow ; walked into an ad- joining room this morning. Continue the medi- cines. J 74 OASES OF THE EPIDEMIC. 9th. — Sits up more than an hour at a time, and can walk from one room to another, several times in succession without fatigue ; tongue still coated in the middle ; is still unable to speak but in a whisper ; pulse forty in a minute, tolerably strong; skin natural. Omit the Pul. Ipecac. &c. unless the skin at any time becomes dry. Continue the Tinct. Cinchon. Compos, frequently. 10th. — Still better; somewhat troubled with a diarrhoea ; pulse natural. After every stool un- til the diarrhoea is checked, take ten drops of tincture of opium. Continue the tincture of cinchona. 11th. — Sleeps well; ate a piece of beef steak this morning with good relish ; has sat up several hours at a time. He has not in any degree re- covered his voice. Continue the tincture of cin- chona. In a few days after this, his voice began to return, and he recovered perfectly well. CASE VIII. February 27th. — S. C. a boy four years old, about four o'clock this afternoon was suddenly seized, while at play, with violent pain in the head ; nausea and vomiting ; pain in the chest ; chills, succeeded by heat, &c. In a short time, delirium GASES OF THE EPIDEMIC. 175 supervened, which, however, lasted but a few hours. He is thirsty ; tongue dry ; skin dry ; pulse quick and hard. Apply a blister to the chest. R Tart. Antimon. gr. ii. one third to be given at a time, dissolved in water, and repeated every fifteen minutes until vomiting is produced. When the vomiting is completed, give Tinct. OpU Camph. gt. xxv. In an hour or two after, com- mence the Pul. Ipecac. &c. with Sub-mur. Hyd. gr. i. every four hours. At bed-time if he is restless, give him thirty drops of the camphorated tincture of opium. Give warm aromatic drinks for his thirst, and apply external sudorifics until a dia- phoresis is excited. Nourish with soup. 28th. — Rested a little in the night ; symptoms somewhat, but not greatly relieved ; a moisture begins to appear on the skin ; bowels costive. R Pul. Antim. &c. with Sub-mur. Hyd. every four hours. 01. Ricini quant, suf. March 1st. — Rested extremely well, and is so much better as to play with his toys ; sits up an hour or two at a time. Continue Pul. Ipecac. &c. night and morning ; give infusion of quassia fre- quently. I did not visit him again. In a few days he was welL 176 CASES OF THE EPIDEMIC. CASE IX. February 28th. — F. S. a girl of eighteen, com- plains in the evening of pain in the head and dizziness ; rigors, followed by heat and thirst ; tongue and skin dry ; pulse quick, full and hard ; she is not, however, very sick, and is not much disposed to take medicine, but consents to take a compound antimonial powder at bed-time, and another in the night. 28th. — She has had a very restless night. Her headach and dizziness are much increased ; tongue coated ; thirst, for cold drinks ; skin hot and dry ; pulse quick and hard. She has a cough, and pain in the left side. Apply a blister over the seat of the pain in her side. Give Pul. Anti- mon. &e. every four hours ; apply external su- doriiics ; allow such drinks as she prefers, but with caution ; and give soup for nourishment. Towards evening, she began to be in a slight delirium, but a diaphoresis soon after commenced and relieved her. March 1st. — Slept considerably last night, and is to-day much better in every respect ; was free from pain until she induced some in the he id, by too much exercise ; finds herself quite feeble. Continue the Pul. Ipecac. &c. and take the com- CASES OP THE EPIDEMIC. 177 pound tincture of cinchona. From this time, she recovered, after several partial relapses, occasion- ed by imprudent exertion. case x. March 2d, — S. C. an infant thirteen months old, was seized about nine o'clock yesterday morning, with violent distress and vomiting. She has had no medical advice, until I was called at three o'clock this afternoon. She has been growing constantly worse since her attack. She is teeth- ing, the gums being much swollen over several teeth. Her respiration has been very laborious from the first. About eleven o'clock this morn- ing she was attacked with convulsions, which have continued at intervals ever since. Indeed, the paroxysms of convulsions do not entirely leave her, so but that she is constantly much distressed, and insensible to surrounding objects. Her tongue is dry, and covered with a thick and very black coat ; mouth dry ; the skin was dry, until after the convulsions began; pulse quick, but not remarkably feeble ; bowels regular. I after- wards learned that she had fallen into the fire the day preceding her attack, and burned the back part of her head, but the burn was not thought serious enough, to. induce her friends to shew it to me, or to speak of it ; and probably had nothing to dp with her sickness. 23 178 CASES OF THE EPIDEMIC. I immediately scarified the gums, and applied a pretty large blister to the sternum. As she lay in a stupor, in the intervals of the convulsions, J first gave 01. Lavend. gi. i. Tinct. Opii Cam. gt. v. with orders to have it frequently repeated as there might be opportunity, or occasion; and then an emetico-cathartic composed of Pul. Ipecac, gr. x. Sub-mur. Hyd. gr. viii. After the emetic operation, fifteen drops of camphorated tincture of opium were directed to be given ; and in an hour, to commence with the Pul. Ipecac. &c. with Sub-mur. Hyd. every four hours, if there should be opportunity. Only a slight emetic effect was produced by the medicine. The child, however, became ap- parently easier about four o'clock, and lay quietly in a comatose state until nearly nine in the eve- ning, when the convulsions returned, and before ten, she expired. CASE XI. March 9th. — S. B. a girl five years old, was seiz- ed this afternoon with pain in one cheek. The pain soon left the cheek, when she complained of pain in the stomach, and great general distress. Vomiting soon gave a partial relief. She now has headach and dizziness ; skin, and tongue dry ; CASES OF THE EPIDEMIC. 179 thirst ; pulse quick, and rather hard. R Pul. Ipecac. &c. with Sub-mur. Hyd. one grain in each, every four hours; warm aromatic drinks, and apply external sudorifics. At bed-time give Tinct. Opii Camph. 3ss. Wlh. — She has had a restless night, was at times in a partial delirium. Has frequent vomitings ; stomach rejects most that she takes ; pulse feels better ; skin moist ; pain relieved ; thirst con- tinues. Continue the Pul. Ipecac. &c. as before. In each interval, give half a wine-glass-full of the fermented decoction of cinchona. Give Spir. Menth. Pip. gt. iv. Tinct. Opii Cam. gt. x. every hour. Nourish with soup. Evening. — Better, but still vomits considerably, though less frequently than in the morning. Try her with a cup of good coffee. Give half a drachm of the camphorated tincture of opium at bed-time. 11 th. — Considerably better ; has had a good night ; pulse more nearly natural ; tongue and skin moist; feels very little pain, though she complains of some uneasiness in her feet. Con- tinue the medicines. 12th. — In every respect better. She sleeps quietly ; has very little pain ; her appetite for 180 CASES OF THE EPIDEMIC. food increases ; tongue and skin continue moist ; has no morbid thirst; bowels regular. R Pul. Ipecac. &c. night and morning, and at any other time if the skin should become dry. Continue the decoction of cinchona. This was my last visit. CASE XII. March 14th. — B. L. brother of A. and S. L. aged thirty-three years, is a vigorous healthy mau, ex- cept that several months ago he had an attack of epilepsy ; of which, however, he has had no symp- toms since. He complained a little yesterday of pain in his head, and was kept awake by it a part of the night, but was so well as to go to his work this morning. In a short time he returned, shi- vering with rigors, which were soon followed by heat ; extreme pain in the head and dizziness ; nausea and faintness at the stomach ; thirst. His tongue is dry ; skin dry, with a burning sensation ; pulse quick and feeble. R Pul. Ipecac. &c. every four hours ; in each interval, a glass of the fermented decoction of cinchona. When he is faint, give Spir. Menth. Pip. gt. viii. Tinct. Opii Camph. gt. xv. Take warm aromatic drinks, and apply external sudorific s. Afternoon. — The pain in the head increased so as to produce a delirium for a few hours ; but CASE!? OF THE EPIDEMIC. 181 in the course of the afternoon, a free perspiration was induced, and attended by very great relief. Soon after this, a cough commenced, with a free expectoration of thick mucus. At bed-time give twenty-five drops of tincture of opium. lbth. — Has had a good night, and feels nearly well, except from debility. His tongue is moist, and the coat separating from its edges ; skin moist ; expectoration free ; pulse of natural fre- quency, but feeble. If the skin should again be- come dry, take a powder of Ipecac. &c. Con- tinue the decoction of cinchona, or substitute the compound tincture at pleasure. 16th. — Much better ; had a good night ; sits up most of the day, and has walked out into the street. Complains of a pain, which is not very severe, in the cheek, under the right eye, pro- ceeding probably from inflammation in the antrum Highmorianum ; a bloody fluid distils from the nostrils. Continue the Tinct. Cinchon. Compos, frequently, until the strength is restored. CASE XIII. March lith. — M. B. an unmarried woman of about twenty-five, of good general health, has for a week past been troubled with symptoms of indi- 182 CASES OF THE EPIDEMIC. gestion; and with a pain and soreness about the sternum, which lias perhaps arisen from the na- ture of her employment, which is picking large paper in a paper-mill. This morning she was seized rather suddenly with chilliness ; great pain in the head and dizziness ; nausea, with a feeling of general distress, which she was unable to de- scribe ; thirst. The ends of her fingers were of a livid colour, particularly about the nails. I was called in the afternoon. Her tongue was then dry, and protruded with some difficulty, skin dry ; pulse quick and feeble. It seemed to be full upon a slight touch, but yielded very much under the finger ; general distress somewhat abat- ed. R Tart. Antim. gr. iii. Pul. Ipecac, gr. xv. one half to be taken immediately, and the remain- der in twenty minutes, unless vomiting is pro- duced in the mean time. After the operation of the emetic, take a drachm of camphorated tinc- ture of opium, and in an hour commence with the Pul. Ipecac. &c. every four hours. In each interval, take a w T ine-glass-full of the ferment- ed decoction of cinchona. Apply a blister to the sternum. At bed-time, give Tinct. Opii Camph. 3i. Take warm aromatic drinks, and use external sudorifics, until a diaphoresis is excited. She recovered without any farther attendance. CASES OF THE EPIDEMIC. 183 CASE XIV. March 1 5th. — Mrs. C. a married woman about thirty, generally of very vigorous health, and rather gross habit, was yesterday morning taken with pain in the head and dizziness ; nausea and vom- iting; chills, &c. To-day she has of her own ac- cord taken a dose of tartrite of antimony, which distressed her considerably in the operation ; and towards evening, she sent for me. Her tongue is coated and dry, and protruded with some difficul- ty ; pulse feeble and rather quick; skin dry, and puffy ; she is thirsty ; her limbs are at times numb ; she has turns of faintness, and a feeling of depression at the stomach. & TPul. Ipecac. &c. every four hours; in the intervals, take the fermented decoction of cinchona; at bed-time, a drachm of camphorated tincture of opium. When- ever she is faint, give 01. La vend. gt. iv. Tinct. Opii Camph. gt. xv. Take warm aromatic drinks, and apply external sudorifics. Nourish with soup. 16th. — Pain in the head diminished ; pulse slower and fuller; skin moist by turns, but is not kept so ; vomiting and the depression at the sto- mach continue ; stomach rejects the decoction of cinchona. Continue the Pul. Ipecac. &c. Give a spoonful of infusion of quassia every half hour. 184 UASES OF THE EPLDEiMIC. When she is faint, give Spir. Menth. Pip. gt. viii. Tinct. Opii Cam. gt. xv. Continue external su- dorifics, and soup. Apply fomentations to the region of the stomach. Give braudy occasion- ally. 17 th. — She was much relieved yesterday after- noon. The vomiting was subdued by giving brandy in small quantities ; but that being after- wards omitted, the vomiting returned in the night, and still continues, accompanied by a violent de- sire to drink cold water. This morning the nurse indulged her with cold water, which she immedi- ately vomited. Her pain in the head was very much increased, as well as her thirst, and depres- sion at the stomach. I gave her some spirit of peppermint in a little hot brandy and water, which produced a very grateful sensation in the stomach, and relieved the feeling of depression. Her tongue is moist ; skin sometimes, but not con- stantly so ; countenance very much bloated ; the skin over the whole body feels very puffy and non-elastic ; pulse slow, and not remarkably fee- ble ; bowels costive. She has a strong desire for cider; which is to be gratified. R Spir. Menth. Pip. gt. viii. Tinct. Opii Camph. gt. xv. every hour, if the faintness and vomiting continue. At night give Pil. Aloes and Rhei, and repeat it in the morning if necessary. Continue other medi- cines as before. CASES OF THE EPIDEMIC. 185 18th. — She has had a pretty good night; the vomiting has ceased; pain in the head slight. The skin was moist in the mining; but she sat up until she was very much fatigued, when the skin became dry and she was much distressed. The perspiration is, however, restored, and she is considerably relieved, but complains of distress in the region of the stomach. l\ ... A 1 tat-. ■I ^ — — *°, **\^:,** A<-^*°o ^\^. : / ^ G* \5 -° . * - a ^ ■V L / a ^~ & V O « O y ^ < ^0^ Wt^o/™