fflm -Ml.il life liill "^.|M!!',«^ ' 7943764 0 NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service A SHORT ACCOUNT / OP THE QRIGIN, SYMPTOMS, and most approved METHOD OF TREATING THE PUTRID BILIOUS YELLOW FEVER VULGARLY CALLED THE BLACK VOMIT: ^hich appeared in the City of the HAVANNA, with the utmost 1 iolehcei in the Months ofJunetJulyf and Part of Augujl, 1794. / AS PRACTISED BT Mr. JOHN HOLLIDAY, An ENGLISH SURGEON, refident in that City. BOSTON : Printed »y MANNING tf LORING, For 5. HALL, No. 53, ™* c- BINGHAM, No. 44, CoRHaat. 1796. .'.J.is,...-. \ TO THE PUBLIC. \V HEN I was lately at the Havanna, the following. mode of treating the Yellow-Fever, had, by its fuc^ cefs, become the theme of general converfation : The ravages this diforder committed in Jamaica, were too recent in my memory, for me to pafs unnoticed fo in- terefting an account. I accordingly obtained the Re- cipes, and with thyem, moft undoubted and authentic teftimonies. The following letter will fhew why I cannot lay the latter before the Public at this time. Humanity induces me to this Publication, and if, on a fair trial, ?the Medicines are found to be ufeful in rem- edying the fatal Malady, the knowledge of having been of fervice to my fellow-creatures, will prove an ?mple recompenfe to Their obedient Servant, William Hunter. Montego-Bay, 20th June, I7951. jM>. William Huntm, Sir, THE Spanifh Certificate which you gave me on Friday before the Fire to tranflate into Englifh, rela- tive to the Medicines made ufe of at the Havanna, to cure the Yellow Fever, is miflaid among my papers, [ vi ] but I can fay with truth, that I have read the whole, and it is authenticated by the Governor, a Lieutenant- Governor, a Colonel of the Army, and Mr. Allwood^of the Havanna, who certify the great benefit received from ufmg it, by the Army and Men of War, The Lieu- tenant-Governor further fays, that he gave a copy of the Recipe to an Officer on board the frigate La Rofa^ bound for Vera Cruz, and that he had the pleafure to fay, that it had the defired effect, there; and was after- wards requefted by this and other Gentlemen, his friends, to procure a full Copy of the faid Recipe, mode of treatment, &c. and to fend it to them. It is certain that thefe Medicines are made trie of at the Haranna, and the many Cures performed by them* are certified by the principal Officers and other Gen- tlemen of that Grty. I am, dear Sir, Your moft humble Servant, Davh> Orqbio Furtad*. » . METHOD OF TREATING THE felLIOUS PUTRID FEVER, Wc. IN the month of June, 1794, the (hip Lord Stanley; Captain Farquhar, laden with Negroes, and her Crew enjoying the moft perfect health, arrived at the Havanna ; this felicity was of fo little duration, that after a few days of her arrival, fhe fuffered fo much from the above diforder, that, in the courfe of fifteen or fixteen days, (he loft nineteen out of twenty-four officers and feamen that fell fick. The diforder fuc- ceflively made its progrefs not only in the different Men of War and Ships in that harbour, but alfo in the city and country places, fo that in about two months, more than two thoufand perfons amongft the different ranks of people fell a facrifice to it 5 there were fhips of three and four hundred men, which re- mained with only forty or fifty \ and in general, its moft baneful effe&s were among the Marines. On the 27th of Auguft, at night, there arofe a moft furi- ous ftorm, which (though with the lofs of many of our VefTels) delivered them fronl that mournful and deplorable calamity. The contrary opinions amongft the Faculty has been great, as much in refped to the fymptoms, a,s in the method of cure, and alfo in recognizing the diforder. But as my intention is not to enter into the differ- ent opinions of every one, I fhall endeavour to give a ihort. • ' ■ ■ c j'r. fnort, but compendious relation of the fymptoms, to- gether with the method of cure, which I adqpted with the greateft fuccefs on one hundred and fifty perfons. The diforder, as I have faid, firft of all appeared on board the fhip Lord'Stanley, though I believe, by in- formation which I afterwards had, it originated in a vcffel from Philadelphia, where it raged with great violence. On the 6th day of June, there fell fick ieleven men of the Lord Stanley,, and the number in- creafed, as I have already mentioned. The fymptoms of the diforder were various, and in fome,* it termina- ted life in twenty-four hours from the firft attack, and with others, it endured until the tenth day. The characteriftic fymptoms of the difeafe, as it fhewed itfelf in this City, were as follows : The day preced- ing its attack, the patient commonly feels a heavinefs, wearinefs, a general debility in the whole body, yawn- ing, and want of appetite j the day following, or on the night of the firft indifpofition, the violence of the diforder begins thus : the patient will be found per- plexed, uneafy, generally with flight pains in different parts of the body, particularly in the head, loins, &c. accompanied with a fmall chillinefs in the extremities, (although there were many who did not feel this) at- tributing this to a flight cold, until unexpectedly he is feized with a fevere degree of fever, with a great heat all over the body, a flufhing in the face, heavinefs and rednefs in the eyes, and a longing after frefh air, the tongue white, and exceffive thirft, interior pains of the head, &c. the pulfe quick, full, and hard, at times, feeble and irregular, a naufea, heavinefs, and , an uneafy fenfation in the flomach, from the begin- ning, and the whole increafing with the diforder, par- ticularly C 9 3 ticularly after taking fomething to quench the thirft j the anxiety and un^afinefs then increafed, with vom- iting a great abundance of bilious matter, the fkin hot and dry, intenfe heat, with pain in the region of the precordia, the refpiration difficult, and the urine high- coloured and little in quantity : the fymptoms contin- ued twenty-four or forty-eight hours, and at times I have feen them endure until the third or fourth day, diifering in fome of the fymptoms, together with the times of its duration, according to the age, conflitu- tion, or malignity with which it had increafed : when in the midft of thefe complicated and violent fymp- toms, there was an apparent ceffation, and total relief from them, a flight perturbation and inclination to fleep only remaining. From fuch favourable appearances, we prognosticat- ed we had gained the defired crifis, and a total intermif- fion of the difeafe ; but, to the misfortune of the un- happy patient, at this time (by a minute examination) we obferved on the white of the eyes a flight yellow- ifh tinge, and fucceffively in every other part of the body, accompanied with a perturbation of the intel- leftual functions, a gloffy appearance of the eyes, the anxioufnefs and vomiting were augmented in fuch a manner, that they impeded the adminiftration of nour- imment or medicine : At this time, inftead of expe- riencing that irrefiftible and burning heat which was before complained of, the patient feels chilly, and the cutis is alternately dry and moift, the pulfe finking and very irregular, the urine of an high croceous ap- pearance, and at times refembling liquid and corrupt- ed blood, depofiting, as I have often feen, a black and offenfive fediment: The tongue, is in fome, dry, parch- B ed, C 'o 1 ed, and difcoloured, and in others, it is furred and moift. This ftage of the diforder lafted but a few hours in fome, and in others, from twenty-four to for- ty-eight, but feldom longer; and it is in this fecond ftage when the medicines have not produced the de- fired effects, the beginning of the diforder neglected or improperly treated, when we fee the direful efforts made between life and death, the pulfe diminifhing, more irregular and intermittent, nothing can be kept on the ftomach, the vomiting increafes with repeated efforts, voiding a black corrupted matter, fimilar to the grounds of coffee, the tongue and edges of the lips black and flicking, cold clammy fweats ; the univer- fal yellownefs, together with the aggravation of all the fymptoms, are demonftrative of the near approach of death : A total fuppreffion of urine, fitbfultus tendinumy a death-like eoldnefs of the extremities, tremblings, delirium, efforts of getting up from bed, a muttering voice, blood oozing from the mouth, noftrils, and many times from the corners of the eyes, ears, &c. black and foetid ftools, livid fpots on different parts of the body, particularly on the regions of the* pre* cordia ; hiccups, coma, and death. Thefe are the characteriftic fymptoms of the difor-' der, according as it fhewed itfelf in the city, varying, as I have already mentioned, in different perfons, par- ticularly being obferved to ad with the greateft violence, and moft fatal termination, in men of a robuft habit of body, new comers, and thofe addicted to fpirituous liquors ; and very prevalent with the. fea-faring peo- ple, by their having been much expofed to the rays of the fun, inclemency.of the weather, and that neglect of cleanlinefs too ufual among them. The truth is, that the T- » 3 the fluids in all who laboured under the complaint, continually demonftrated the greateft tendency to a ftate of diffolution and putrefadion \ and if thofe of the Faculty who have written fo voluminoufly on the diforder, would have obferved with more attention, that high degree of tendency of the fluids to diffolu- tion and putrefaction, they would not have infilled on the ufe of fuch extenfive bleeding, which, from expe- rience, we have every reafon to believe, has been the caufe of fo great a mortality. I fhall now defcribe, in the molt concife manner poffible, that particular method of' cure which I ufed with the greateft fuccefs on upwards of one hundred. and fifty patients labouring under this complaint, with- out the lofs of one. On the 6th, day of June, I was called by the Captain of the Lord Stanley, to the affift- ance of the fick of his crew, whom I thought proper iJiottld be fent on more, as much for the benefit of at- tendance, air, &c. as to remove them from where they had caught the firft infedion. Imagining their complaint to have been of the intermittent or bilious fever common to the place, of little importance, and lefs malignity, according to the cuftom of fevers of that kind, (and ignorant of the fatal confequences which were about to enfue) I made ufe of emetics, antimonials, &c. until the refult of experience coru vinced me of my error. Moved with companion, an4 always in hopes of future fuccefs, I thought,: with ma- ny others, that by the fulnefs of the pulfe, together with other inflammatory fymptoms which the diforder manifefted, the patient could probably be relieved by bleeding, which method I immediately put in pradice, ufing it from the leffer to the greateft degree, on a I « ] great number of patients, but without the leaft proba- ble benefit j rather to the contrary, hurrying on their miferable exiftence. Although I' faw, and remarked thefe direful confequences, I followed for fome time, the common and general method amongft the Faculty, until convinced of my miftake, and very erroneous pradice, I defifted from the lancet, and aiTumed an- other method widely different, which, by Divine Prov- idence, gained the defired effed. I am every day more furprized, when I fee medical men order bleeding in fuch quantities, ufque animt deliquium; and having feen fuch fatal confequences arifing from it, I am obliged to fay, and really to be- lieve, that thofe gentlemen who ufed it in fuch difor- ders to fo great an excefs, have either not met with that tendency in the fluids to a diffolution and putrid ftate, which here made itfelf apparent, or that they had but little pradice, or paid but little attention to the different fymptoms and termination of the difeafe. Having already explained the fatal confequences arif- ing from bleeding, experienced from my own prac- tice, and the innumerable ones I had the opportunity of feeing under the care of others, it is my opinion, that whoever has been fo fortunate as to efcape from this dreadful difeafe, by the ufe, or rather the abufe, of blood-letting, it arofe from his entire vigour and robuft habit of body ; or the little tendency of the flu- ids to diffolution and putrefadion ; and all thofe that have furvived this method of cure, have been under a ftate of convalescence for two, three, or four months, and frequently the diforder terminated in remittents, or intermittents of the moft difficult cure. In t *3 3 In no ftage of this diforder, can emetics or antimo- nials be adminiftered, owing to the irritable ftate of the ftomach, and its propenfity to vomit, that when once ftirred up, (that terrible and direful fymptom) it is almoft out of the power of medicine to moderate it, or even to admit the purgatives fo neceffary, and the only medicines which, from experience, have been proved to be the principal part of the cure. Any perfon that has come into thefe hot climates, and who has expofed himfelf to either of the caufes which produce this Fever, has fufficient warning, if he would attend to it, and fufficient time to cure it by anticipa- tion ; becaufe, as foon as the patient feels any extra- ordinary heavinefs in the body, with wearinefs, a ftretching and yawning, and particularly when follow- ed by a fevere. attack of the fever, intenfe pains of the head, &c. he then has very fufficient reafons of being certified that it is the beginning of the diforder, which is coming on with all the violent and cuftomary fymp- toms : This is the time that the Faculty ought to cut off the arms of the enemy, not by bleeding, (as a greater part of the profeffion order) but with adive and continual purges, until an entire ceffation, or total cafe, is obtained from all the fymptoms. When one of the Faculty is certified of his opinion, either by the diforder being prevalent, or by the fymptoms which charaderize it, without more delay or lofs of time, he mould adminifter the following medicine in three parts, with the interval of two hours between each, and the fuitable nouriihment between one and the other. Recipe.__Take beft Glauber Salts, one ounce; beft Manna, three ounces; mix and diffolve them in a pint decodion of Tamarinds, ftrained. This X '4 J This medicine is adminiftered with Intention of ef- feding an immediate and plentiful evacuation, with the greateft facility, arid without the irritation the draftic purges ufually caufe ; for which reafon, I have generally adopted this method, not only in the begin- ning of the difeafe, but alfo in different cafes, when it reached the terrible ftage of the black vomiting ; and always with equal fuccefs, conftantly procuring a total alleviation and entire intermiffion of all the fymptoms j continuing the ufe of the medicine, according to the age, ftrength, and violence of the diforder, there hav- ing occurred different cafes, in which, through the vi- olence of the diforder, a difficulty in fome to evacuate, and an urgency of the vomitings, I have been obliged to repeat the faid quantity twice Or three times in twenty-four hours, obferving the fame regimen until it effeded the defired purpofe, which it generally did in twenty-four or forty-eight hours, and in very ob- ftinate cafes, on the third or fourth day. In thefe vi- olent cafes, when on the firft dofe of the faid medicine an evacuation did not enfue fo copioufly as was defir- ed, it was then affifted with the common purging clyf- ters, or rather better with a mixture of fait water jand oil of olives, which, by the irritation that it created in the trlteftinum rettum, rarely or never failed of produc- ing the defired effed. The fortunate remiffion or erifia of the fever being-already accomplifhed, the irri- tation muft in its turn be attended to, as much for whatever it brings along with it, as for the purging medicines fo often repeated, though adminiftered with the aforefaid precautions. I ordered what follows : Recipe.—Take white Decodion, (with Cinchona and Tamarinds) a pound ; Nitre in powder, a dram and C >5 3 and a half or two drams; Crabs Eyes, two fcruples ; Syrup of Violets, one ounce, mixed. And repeated it twice, thrice, and four times, (di- viding the faid dofe into three parts, allowing an in- termediate fpace of three hours between each) until I found the pulfe foft, eafy, and regular, which it will attain on the fecond or third day. Finally, to com- plete the cure, to reftore and recover the ftomach and other vifcera from their ftate of relaxation, and at the fame time, to evacuate eafily the remaind^ of the diforder, I ufed the following : Recipe.—Take Peruvian Bark, two ounces^ Snake Root, half an ounce ; mix and boil them in two pint of water, until there remains one pint and a half, ftrain, and add Extrad of Bark, two drams ; Tinc- ture of Rhubarb, two ounces, I order that the quantity of two or three ounces might be taken every fecond or third hour, continu- ing this or any other preparation of the Peruvian Bark, until the patient is found entirely re-eftablifhed and free from every incumbrance, which rarely ex- ceeds the fixth, eighth, or tenth day from the firft at- tack. When the fymptoms were violent, and appar- ently about to terminate fatally, after a plentiful evac- uation, or on the firft remiffion, I adminiftered the febrifuge mixture of the Peruvian Bark, &c. in a great quantity, and always fortunately, not having failed in one of my endeavours after I put in pradice thefe fimple, though powerful Medicines. During the time this diforder lafted in Vera Cruz, copies of thefe Recipes were carried thither ; and, I have the fatisfadion to add, were ufed with the greateft fuccefs in every cafe to which they were applied. FINIS. DESULTORY EXTRACTS AND OBSERVATIONS, SHEWING THAT THE METHOD of TREATMENT, RELATED IK THE FOREGOING ACCOUNT, Is agreeable to the Rules laid down by Hippocrates and Galen* Sydenham and Boerhaave, And confirmed by the Pra&ice of Hillary and Lettsomj in Acute Difeafes. By THOMAS BULFINCH, M. D, Raro fallet medela, Si non fefellerit caufarum indigatio. Celscs. BOSTON : Printed by MANNING If LORING, For S. HALL, No. 53, and C. SINGHAM, N». 44i Cornsili. 1796. EXTRACTS and OBSERVATIONS, —------------- ■iWlllilllirr ---------------- IT is an obfervation of the benevolent Dr. Lett- fom, " that every perfon who difcovers a Med- icine, which tends to prevent, or cure a difeafe more efficacioufly than former remedies, is a public bene- fador, and deferves the patronage of the community. It muft however be acknowledged, that the affuming the difcoveries of others, indicates a want of genius, or what is more reprehenfible, a want of integrity/' To free myfelf therefore from thefe imputations, hav- ing been fo fortunate as never to meet with but few inftances which called for affiftance, in the diforder, which is the fubjed of the foregoing treatife ;* I free- ly acknowledge that what I have' now to offer upon it is colleded from the obfervations of others ; without vainly arrogating them to myfelf. From attending to the former part of this paragraph, we are led to con- fider how much the world is indebted to the man, who, without any view to his own emolument, vol- untarily comes forth to defcribe a method, by which he has been fo happy as to fave the lives of many of his fellow-creatures, when in the moft imminent dan- ger from a diforder, which has deftroyed its thoufands in the years paft. I will not, cannot attempt to efti- mate the thanks due to him on this occafion, but en- deavour to fhew, that the method now delivered by' him, however fummary and concife, is upheld by the concurrent teftimony of both ancients and moderns. With * Thefe were fpeedily cured by adopting Dr. Hillary's method. [ 20 ] With refped to the former, I need not call your at* tention to their own refpedive writings ; but relate them as they may be found defcribed by others, and in particular in that elaborate effay, on the agreement hetwixt ancient and modern phyficians, or a compar- ifon between the pradice of Hippocrates and Galen, Sydenham and Boerhaave in acute difeafes; intended to fhew what the pradice of phyfic in fuch diftempers ought to be—by John Barker, phyfician to the Britifh army, and fellow of the Royal College of Phyficians* As fads are ftubborn things, neither requiring proofs to confirm, nor fuffering objections to invali- date them; it may feem unneceffary to offer any thing on the fubjed : But as I have juft faid that the method adopted is fo very concife as well as uncom- mon \ it is feared, that it may not meet with, the at- tention it deferves and its magnitude requires. Our author not only informs us of the fuccefsfuj method, which he adopted, but candidly gives his reafons for departing from the methods purfued by frimfelf and other phyficians in the ifland, on finding them unfuccefsful j for he fays in page iith, " MovT ed with compaflion and always in hopes of future fuc- cefs, I thought with many others, that by the fulnefs of the pulfe, together with other inflammatory fymp- toms, which the diforder manifefted, the patient could probably be relieved by bleeding; which method \ immediately put in pradice, ufing it from the leffer to the greateft degree, on a great number of patients, but without the leaft probable benefit, rather on the con- trary hurrying on their miferable exiftence. Now if we laol^ into what Hippocrates has faid on this fubjed, we we fhall find " that* in fevers of the bilious putrid kind, he never made ufe of bleeding at all; nay, he went fo far as to forbid bleeding in fome cafes merely on account of the fever, though other circumftances feemed to make it neceffary." And again, as Martian proves at large, " Hippocrates was fo much averfe to bleeding in fevers, which arofe from Bile, that he thought it hurtful even in pleuritic pains, when they were owing to that caufe." And again in another place he fays, fpeaking of the bilious fever,| " In fuch a cafe when bleeding is inftituted,on account of the violence of the fever, it is very hurtful, for when the humors are attenuated by the febrile heat, by bleed- ing they are ftill fo much farther attenuated, that al- moft the whole mafs of blood is changed into a bilious juice or ichor. " As Hippocrates pradifed in the warm latitudes of Greece, he had reafon to forbear bleeding in difeafes, in which it is found to be of fer- vice in a colder climate. For the fevers which pre- vail in hot countries are moftly of the bilious or pu- trid kind, as thofe that happen in temperate climes are owing more frequently to a fanguine plethora, or re- dundancy of blood ; but as bleeding is indicated in the' latter, fo is purging in the former kind of fevers. The extremes of heat and cold were thought by all the old writers in phyfic, as well as by Hippocra- tes to be a reafon againft bleeding." " For Galen frequently cautions phyficians againft bleeding in very hot and very cold weather ; in fum- mer time or a hot country. But as Galen pradifed in * Dr. Barker's Effay, page 88, 89. t Hippoc. Lib. 2. Quare in hoc cafu propter fcbrim Venxfeflio plurimum iadit, quatenus humpres per Vensefeaionem attenuati a febrili calore, co ufque attenuantur, ut Sanguis totus fere in biliofum fuccum tranfmutetur. C " 3 In the temperate clime of Italy, he had much greatef reafon for ufing this evacuation freely than Hippocra- tes, and the fame way of reafoning holds good with re- gard to Sydenham and Boerhaave." Having now feen what was not the pradice of Hippocrates and Galen, in warm climates, we cannot but wonder, that phyfi- cians in thofe climates fhould fti.ll retain this uncertain and dangerous method. Our author having discov- ered the inutility of this method, wifely betakes him- felf to another, which is not only authorifed by Hip- pocrates, Galen and others, but in which he was hap- pily fuccefsful even to his utmoft wifhes. For in page 13, he fays, " In no ftage of this diforder can emet- ics or antimonials be adminiftered, owing to the irrir table ftate of the ftomach, and its propenfity to vomit 5 that when once ftirred up, it is almoft out of the pow- er of medicine to moderate it, or even to admit tne purgatives fo neceffary, and the only medicines, which from experience, have been proved to be the princi- pal part of the cure.'* After having defcribed the prelude to the diforder, he fays, " This is the time that the Faculty ought to cut off the arms of the ene- my, not by bleeding, but with adive and continual purges, until an entire ceffation or total eafe is obtain- ed from all the fymptoms." In page 14, he gives his recipe of Glaubers Salt, &c. and fays, " The medicine is given with intention of effeding an immediate and plentiful evacuation, with the greateft facility and with- out the irritation the draftic purges ufually caufe." In page 14, he fays, "The fortunate remiflion oy crifis of the fever, being already accomplished, the ir- ritation muft in its turn be attended to ; as much for whatever it brings along with it, as for the purg- ing medicines fo often repeated, though adminifter- ed C *3 J bA with the aforefaid precautions;" he then orders th; white decodion, &c. Finally, in page 15, to com- plete the cure, to reftore and recover the ftomach and other vifcera, from their ftate of relaxation, Sco- ne recommends a free, liberal life of Bark with Snake- Root, &c. Let us now cOnfider how confonant this method is to that of Hippocrates and Galen^ Sydenham and Bo- erhaave. " To know when to purge in acute difeafes is a matter of very great importance, and feems not to be fo thoroughly imderftood, even at this day, as it Ought to be ; at leaft it was fo little undefftood, but a few years ago, that Dr. Friend declares, " That it is Very difficult to lay down any certain rules about it^ and that it muft be left to the difcretion of phyficians to ufe it occasionally as they think fit." This diffi- culty however will be fully cleared up by attending to what is faid in page 130, of Hippocrates's own prac- tice, the beft comment on his Own Works; Where- in he fays, " That there are three different ftages to be obferved in fevers, viz. the beginning, the ftate and the decline. The beginning comprehends all that fpace of time, which is called the augment of the difeafe by fucceeding writers. The firft and lait of thefe ftages, are the only ones in which purging can be tifed with fafety, but chiefly the firft of them." for if it be requifite to ufe remedies- (that is, powerful remedies, fuch as bleeding and purging, &c.) they mould be ufed in the beginning of difeafes : but When they are come to the height, it is better to be quiet.* (Vid. Aph. Lib. 2d. 28.) And in another place,t he " advifes phyficians to take particular care at the firft coming on of a dif- eafe, to obferve whether purging is neceffary, for if we * Vid. EiTay, page 1%%. f Page 131. £ ^ 3 We let flip the opportunity of doing it in the begin* ning, we muft defer it, till the decline of the difeafe * but at this time, when the ftrength is exhaufted by the length of the difeafe, one cannot ventuVe upon ftrong purgatives, and weak ones do more harm than good, as they irritate the humors, and draw off only the thinner and more wholefome parts." In page 134* Hippocrates further obferves, " that in very acute dif- eafes, we ought not to wait till the urine is thick, but if the matter be turgid, we fhould purge on the very day in which the fever comes on, for fear we fhould lofe the opportunity." Hence we fee, as in page 132, Hippocrates's own pradice, was conforma- ble to his dodrine in this point : for of the two ftages of fevers, in which purging is allowable, viz. the be- ginning and the decline, he generally chofe the firft. No more need be faid to prove, that the time in which Hippocrates commonly chofe to purge was the beginning of acute difeafes. In page 154, " If we afk with what view Galen made ufe of evacuations in fe- vers, fuch as purging, fweating, &c. the anfwer is, that he trod in the fteps of Hippocrates in this, as he did in all other refpeds. For he obferved the figns of the trugefcency and concodion of the humors, and from thence he drew his indications for purging as Hippo- crates had done before him! (Vid. Comment, in Aphr. 23.) Agreeably hereto, he thought the prop- er time for purging was, either in the very beginning of a fever, when the matter was turgid and the difeafe fo acute as to make it dangerous to flip the op- portunity, as in the inftance of a peftilential fever, &c* or when figns of concodion appeared in the urine, as * Thus in a Quartan he fays, Et G. Co&ionis morbi in dicia apparuerint, tunc purgare oportet, non femel tantum, fed fsepius, fi fuerit neceffarium. Art Curat ad Glauctm, Cap. H I *5 ] a« they commonly do in the firjl part of the ftate, or laftly in the decline of thefe difeafes, to prevent a re- lapfe, by carrying off the remains of the Offending matter." With regard to Sydenham, it is faid in page 202 of this work, " that he often purged in the beginning of acute difeafes, as in the rheumatifm, in a fpurious peripneumonyi fmall-pox, catarrhs, dyf- enteries, and other kinds of fevers j and he acquaints us with his reafons for doing it in thofe fevers. But there is fortie difference however between him and Hippocrates in one point; for notwithstanding they both gave purges frequently in the beginning of acute difeafes, Hippocrates did it fometimes without previ- ous bleeding ; whereas it was an invariable rule with Sydenham never to purge in the beginning of epi- demic fevers, without firft of all taking away fome blood ;" which may be accounted for by his living in fo different a climate. Let us now hear what Boer- haave, or his friend Barker for him, fays, in page 244; " I would not be underftood by what I have now been faying, to exclude the ufe of purging remedies in fe- vers. On the contrary I think it allowable to purge off the offending matter downwards as well as up- wards, even in the firft ftage of thefe difeafes, provided there is an indication for the ufe of them." It is com- mon in the beginning of fevers, to find the ftomach and bowels loaded with fordes or filth of one kind or other; as for example with phlegm or bile, which matter by fluduating in the firft paffages occafions a fiCknefs, loathing, vomiting, griping, anxiety, &c. When this is lodged in the ftomach, it is proper to be- gin the cure with an emetic ; but if it be in the bow- els, it muft be carried off by purging. Thefe purges D however C 2C* however fhould be of the mo L lenient and gentle kind, left by occafioning too great a commotion in the blood, they fliould increafe the fever, and by that means do more harm than good." If Syden- ham, therefore," and our phyficians have always been cautious in this point, it is becaufe purging in the firft ftap*e of fevers is very feldom indicated in our climate j but we may carry our caution too far in this refped, as thofe have done, who would have perfuaded us that purging is never proper in a fever. We have fome- times Epidemic Fevers among ourfelves, in which the Hippocratic method of purging even without bleeding oufht to be purfued." Of this kind was the Epidemic which raged in the weft of England, 1740 and 1741* In this fever early purging was found to be of the greateft benefit, by others as well as by myfelf; for the learned and ingenious Dr. Glafs in giving an account of it, fays,* " I have ufed the fame method in the fpotted fever which is now epidemical with us, and the event has anfwered my expedation. Nay, I have fometimes known when the giddinefs and great pain of the head, the remarkable oppreffion of the precor- dia, and the extreme lownefs of fpirits and lofs of ftrength, which in this conftitution come on violently with the fever, were prefently removed by this meth- od, and the fpotted fever crufhed in its infancy." The fame judicious phyfician makes mention alfo of fome other kinds of fevers in which early purging is of ufe.f But * Ufurpanti mini id genus praudii in febre Petechial! apud nos hoc tempo- re Ep5demica ex Votis fucceffiit Eventtis. Imo novi aliquotids ubi Vertigo, gravis dolor Capilis, infignis prxcordiorum appreffio, multus mentis corporif- que languor, in hac Conftitutione cum febre ingruefltia, per earn medendi ra- tionem (fcilicet, purgationen per Alvum) protinus fubmota fuerint, fuppreffa febre in ipfis incunabilis. Camment de febrib. 274. f Medicamento purgante inter initia morbi utendum cfl:. a75. C *7 ] But as Ballonius obferves,* " Great judgment i* requifite to diftinguifh whether it is beft to bleed or purge, otherwife a phyfician may commit great errors in his pradice." The diftindion which he makes be- tween fevers which are feated in the firjt pajages, and thofe whofe feat is in the veins, will help to direct phy- ficians in this point; for thofe of the latter kind re- quire bleeding in the firft ftage of them ; but thofe of the former kind do not eafily yield to bleeding, but ftand in need of cathartic remedies. " Moreover," fays Donchers, in the Petechial Fever, " ft hath been found by manifold experience, that purging in this dif- eafe is the moft certain remedy ; indeed the neceffity of it, and its good effeds, are not only recommended by reafon, but fo confirmed by pradice, that if it is falfe, or can be fo, nothing is, has been, or can be true."f " But not to tire the reader with any more quota- tions on this fubjed," fays I}r. Barker, in page 278, " I can fafely affirm that by following the method of Hippocrates, and purging in fevers, where there were figns of the materia turgens, in my own pradices for fome years paft, I have often feen fuch good effeds, as even exceeded my utmoft hopes ; having not only feen continual fevers changed into intermittents, but alfo entirely carried off by this means, in a few days, when they would otherwife have been, very probably, of fome weeks' continuance." As we have now feen the rules laid down by Hip- pocrates and Galen, Sydenham and Boerhaave, for early ufe of purgatives in acute difeafes, let us attend to the confirmation of its benefit in the practice of a few phyficians, whofe names are held in high efteem. In * Ballonii Opera Tom. I. page ioS. i P-nchers de feb. peftitentiali. C •» ] In looking into the memoirs of the General Difpenfa- ry, in London, in the years 1773 and 1774, by Dr, Lettfom, we fhall find in his obfervations on fevers, with fymptoms of putrefcency as fimilar as the nature of that climate will admit, though not abfolutely the yellow fever, that out of fifty patients of different ages, labouring under that diforder, he was fo happy as to, relieve forty-fix of that number ; in which we find that in no one inftance did he ever bleed ; but confin- ed himfelf to the ufe of gentle emetics and eccoprotics to cleanfe the ftomach and bowels, and .immediately after paffed on to the free liberal ufe of the bark, with the affiftance of a free ufe of wine, porter, and expo- fure to cold air, (by which means he was happily fuc- cefsful.) With refped to cold air, indeed, he is fo fanguine, as to fay in page 120, " So far as I can cal- culate, the acceflion of air is of as much confequence to the patient as bark or diet; nay, I fhould prefume, that a putrid fever might be fooner cured '-»y the free admiffion of air without bark, than by bark without air." If the Dodor fhould be right in this conjedure, how happy would the knowledge of this magnum Dei donum prove to mankind ! The next perfon whom I would mention is Dr. Hil- lary, well known for his valuable obfervations on the fmall-pox; to whom, for his ufeful hints and methods for correding the virulence of that diforder, thou- fands, if not millions, are highly indebted. In his treatife of the Putrid Bilious Fever, in Barbadoes, commonly called the Yellow Fever, publifhed in London, in 1766", he gives a full and accurate account of it, and the manner of its treatment; and though, according to Sydenham, he began his procefs by draw- ing C »»' J Jng blood, yet he did it with great caution, and if the patient's pulfe rifes, after the firft bleeding, he fays, " I repeat it once, in the firft or fecond day of the dif- eafe, if the fymptoms indicate it; but bleeding a third time is feldom or never required, becaufe the pulfe generally finks to be low on the third day, or very foon after it, when bleeding muft be very prejudicial, as the blood is then in a diffolved ftate." Theie prob- ably were the reafons why a before-mentioned author, Dr. Warren, advifed " not to bleed at all in this fe-' ver." After bleeding, which it is prefumed may be proper in Barbadoes, though not in the Havanna, from the difference of the climate, he enters on his fecond intention of cure, which is to evacuate and carry off as much of the bilious putrid humor as foon and fafely as he can. " The great irritation of the ftomach, by the putrid bilious humors, which con- ftantly attend this fever, with almoft continual Teach- ings and violent vomitings, feems to indicate giving an emetic ; but the coats of the ftomach are here fo violently ftimulated and irritated, and moft commonly inflamed, by the acrimony of the putrescent bile, that any emetic, even the moft gentle and mild, and in the fmalleft dofe, brings on fuch an inceffant vomiting, that it continues in fpite of all remedies till an inflam- mation and mortification of the ftomach comes on, which foon ends in death. Neither," fays he, «« could I ever find that any antiemetics, fomentations, or any other methods, would very feldom avail and prevent it. Wherefore I have ftridly forbid giving any emet- ics whatever. But as the carrying off thofe putrid bilious humors, before this putrid acrimony is too much increafed by the heat of the fever, or is cariied into C 3« 3 into the blood, is fo abfolutely neceffary, I ufually or- der the patients to drink large draughts of warm wa- ter, to which I fometimes add a little fimple oxymel, or a little fmall-green tea, in order to carry off thofe putrid humors, and they are moft commonly very co- pioufly difcharged by this means, and the patient much relieved thereby, as I have often with pleafure obferv- ed. After the patient has by this means vomited fey- en, eight or nine times, and dicharged a good deal of yellow and blackifli bilious matter, as they generally do, and the ftomach is very well cleanfed, I ufually give a grain or grain and an half of Thebaic Extrad ; and order to take nothing into their ftomachs, for two hours after, that they may retain it. If the patient has not a ftcol or two after drinking the warm water and vomiting, it is neceffary to give a gentle purging clyfter foon after the vomiting and before the opiate begins tG affed the patient. After fix or eight hours reft and refpite, I order a gentle antiphlogiftic and antifeptic purge to be given, in order to carry off as much more of thofe putrid bilious humors as we pofli- bly can. Though purging in many other fevers may be deemed a bad pradice, yet in this fever (as nature indicated it) I have always found it of lingular fervice, and the patient not only greatly relieved by it, but the difeafe always rendered more moderate and managea- ble afterwards. Wherefore whenever a painful burn- ing heat in the hypochondres or about the prascordia comes on, I generally give a little manna and tama- rinds, which feldom or never fails to carry off a good deal of putrid bilious matter, and that burning pain which it caufes with it j wherefore I generally repeat this purging whenever that burning pain returns and indicates C 3< ] Indicates it, and with the fuccefs we can defire. About the third day an extraordinary change takes place, re- quiring a very different method of treatment from what it did in the firft two or three days of the difeafe. For now every fymptom and circumftance evidently fhew, that a diffolution of the globules and texture of the blood, and a putrefcent, gangrenefcent ftate of the fluids haften on apace, with all their fatal fymptoms.- Hence the third and laft intention of cure evidently appears, viz. To put a ftop to the putrefcent diathefis of the fluids, and prevent the gangrenes from coming on. In thefe circumftances it is neceffary that the vis vita? and momentum of the circulating fluids be increafed and kept up, and the moft effedual antifep- tics given, to put a flop to the putrefcent difpofition of the fluids, or gangrenes will come on. In thefe circumftances however the Cort Peru may be thought to be the beft medicine, but for reafons which he gives, the Dodor prefers the Rad Serpent V, and fays, he has found it the moft fuccefsful, given in the fol- lowing form as in the margin.* " This medicine very rarely fails to fit light and eafily on the ftomach, even when the faline and antiemetic mixtures will not. Whenever the fever begins to fink too low, we mult endeavour to keep it up in a moderate ftate, by in- creafing the quantity of the Rad Serp. and Saffron, or by adding fome Vinum Croceum or Confed. Car- diac or fome fuch like medicines, till the pulfe is raifed and the heat equally expanded all over the body. If the * R. Rad Serpent Virg. 5ij. Croci Angl. gff. M. et infund vafe cluufo in Aq Bui. q. f. Per Horam unam ut Col. gvj. adde Aq. Mentha Simp. gi,. vL Maderiens giv Syr. Croci, vel Syr. e Mecon gj. Eli*. Vitnol a„d gut q. f. Ad Gratam acidior Saporem ; M. Erfube Cochl. duo vel ma finguhs h«ns .c. hihoris, vel fspius pro Re nata. [ 3« 3 the anxiety, with a burning pain and tenfenefs of the" precordia or hypochondres return, either alone or with a coma or a delirium accompanying it, as is too often the cafe, and always arifes from an increafe or colledion of thofe putrid bilious humors, they mult be carried off by repeating the antifeptic purge, as be- fore, and the following form is what I have always found to agree the beft with moft patients, and feldom fails to remove thefe bad fymptoms.* This may be made ftronger or weaker, as the ftrength of the fick requires, and I moft commonly find it neceffary to re- peat this purging every fecond or third day for two or three times; and fometimes when the fymptoms are bad and have not much abated upon taking the firft and fecond purge, I have found it neceffary to repeat the gentle purging every day for four or five days fuc- ceffively, and with the defired fuccefs too; This meth«> od," he fays, " has been and may probably be thought by fome others too fimple and eafy, to con- quer fo violent and formidable a difeafe. What! only bleed once or twice, and give a little warm water, and two or three fimple purges, and this fimple julep, to fubdue fuch a terrible difeafe! without any fine boluf- es, cordial volatiles and veniatories ! But I muft tell ' fuch perfons, that the more fimple the method is, if it be but judicioufly and fitly adapted to the nature and caufe of the difeafe, it is fo much the better, becaufe contraria contrariis medentur. When the laft ftage of the fever is come on, before we are called in, provided that it is not at the very end of it, I have always found that * R. Manna Calab gifl*. or gij. Tamarind Cond gj. Tart Vitriol tys. Solv in Sero Lactis Vino Maderiens per ?vj. et Cola. Add Tincl. Sense *fs. Mifce divid in tres vel quatuor partes, de quibus capiat ./Egcr, TJnam omni hora, donee incipiat purgare. C 33 :) that this method of gentle purging whenever the before- mentioned fymptoms indicate it, and a liberal ufe of the antifeptic medicines in the intervals has been fo fuccefsful, that I have feen but two patients that have died in this fever during the eight years paft, in which I treated it in this manner ; and one of them fo weak that he could not take a fpoonful of any thing, and fo near his end that he died about two hours after, with- out taking any medicine ; and the other killed himfelf by drinking a gallon of cold water in lefs than three hours time, which ftruck fuch a coldnefs into his Whole body that he died ; though I have vifited fev- eral every year, and in fome a great many : therefore I take the liberty of recommending this method to others, and wifh it might be fuccefsful to all. I have faid little of the dietetic part of cure, though it is neceffary to fay fomething, efpecially as their flora* achs are generally fo very weak and fo much irritated by the acrid bile, that they almoft rejed every thing, and can often retain but very little. Their diet muft be thin, light, and in fmall quantity, and as pleafant, palatable and antifeptie as poffible. If the fever be low and the patient faint, I fometimes order him a a glafs of Old Hock, or old Madeira wine, and find them much better cordials than the Compound Spirits of the fhops, and fometimes I order a beverage of water and lemon juice, fugar and Madeira wine, a little and often, to affift the antifeptic medicines, to raife the pulfe and keep the fever in a moderate ftate." Having now given the moft material part of Dr. Hillary's method, which, though it may by fome per- £ fons t 34 ] fons be thought tedious and unneceffary, yet as it cor* refponds fo entirely with the foregoing treatife, and appears to be of fo much importance, I could not con- tent myfelf in withholding it from the public ; always bearing in mind, that mankind ar.e born for the fake of man, that by mutual good offices they may promote, the happinefs of each other.* Bojion, Auguji $d9 1796. * Homines autem homlnum caufa generatifunt, ut inter fe Ah'is Alii pro* deffe poffent. Cic de officii*. L. I. I Med, Hut, XI0 IW c x 4939