ifisM UNITED STATES OF AMERICA FOUNDED 1836 WASHINGTON, D. C. B19574 A DESCRIPTION OF THE AMERICAN YELLOW FEVER, WHICH PREVAILED AT CHARLESTON, IN SOUTH CAROLINA, IN THE YEAR 1748. BY DOCTOR JOHN LINING, Printed for Thomas Dobson, at the stone-house, n° 41, south second street. 1799- * - -~ q [ 6 ] warmer or more rainy (and fome of them lefs fo) than the fummers and autumns were in feveral other years, in which we had not one inftance of any one being feized with this fever ; which is contrary to what would probably have happened, if particular confti- tutions of the weather were productive of it, without infectious miajmata. But that this is really an infectious difeafe, feems plain, not only from this, that almoft all the nurfes catched it and died of it; but likewife, as foon as it appeared in town, it foon invaded new- comers, thofe who never had the difeafe be- fore, and country-people when they came to town, while thofe who remained in the coun- try efcaped it, as likewife did thofe who had formerly felt its dire effects, though they walk- ed about the town, vifited the fick in all the differentfiadia of the difeafe, and attended the funeral of thofe who died of it. And laftly, whenever the difeafe appeared here, it was eafily traced to fome perfon who had lately arrived from fome of the Weft-Indian Iflands, where it was epidemical. Although the in- fection was fpread with great celerity through the town, yet if any from the country receiv- ed it in town, and fickened on their return home, C 7 ] home, the infedion fpread no further, not even fo much as to one in the fame houfe. III. The fubjeds which were fufceptible of this fever, were both fexes of the white colour, especially ftrangers lately arrived from cold climates, Indians, Miftees, Mulat- toes of all ages, excepting young children and of thofe only fuch as had formerly efcaped the infection. And indeed it is a great happi- ness that our constitutions undergo fuch al- terations in the fmall-pox, mealies and yel- low fever, as for ever afterwards fecure us from a fecond attack of thofe difeafes. There is fomething very singular in the constitution of the Negroes, which renders them not lia- ble to this fever; for though many of thefe were as much expofed as the nurfes to the infection, yet I never knew one inftance of this fever amongft them, though they are equally subject with the white people to the bilious fever. IV. This fever began in the middle or rather towards the end of Auguft, and con- tinued till near the middle of Odober, when the weather became cold enough to prevent its C 8 ] its further progrefs. In the beginning v... Augufty the weather was warmer than I had ever known it in that month : the mercury in Farenheit's thermometer, for fome days at 2 o'clock,/', m. rofe, in the fhaded air, to the 96th degree, at which time feveral people died of apoplexies. The latter part of Au- gust, and the firft week in September were much more temperate; the weather being then much as ufual at that feafon of the year. The fecond week in September was cold, the wind being constantly easterly and the wea- ther cloudy; after which time I kept a re- gister of the heat of the fhaded air; an ab- ftrad of which follows. In the latter part of September, and from the 1 ft to the 18 th of Odober, Septemb. Otfob. The mean heat at 2 p. m. was 72 65 The mean nodurnal heat was 68 54 The greatest heat at % p. m. was 79 75 The least heat at 2 p. m. was 60 52 The greatest nodurnal heat was 71 70 The least nodurn?! heat was 62 42 The greatest increafe of heat in 24 hours was 13 17 The C 9 1 The greatest decreafe of heat in 24 hours was 9 22 In all the month of September, and in the greateft part of Odober, the wind was easterly. The depth of the rain in August, Sep- tember and Odober refpedively, was 6.881, 7.442 and 5.550 inches; which, though it exceeded the rain of thefe three months tak- en together at a medium, from the ten pre- ceding years, by 5.570 inches, yet it was inferior to that which fell in the fame months in feveral other years; for in the years 1747, 50, 51 and 52, there fell re- fpedively, in thofe three months of thefe years, above 21, 22, 24 and 26 inches of rain. - V. For a day or two before the attack of the fever, people in general complained of a headach, pain in the loins and extremities, efpecially in the knees and calves of the legs, lofs of appetite, debility and a fpontaneous latitude. B Some, [ io 3 Some, however, were feized fuddenly, without any fuch previous fymptoms. VI. After a chillnefs and horror, with which this difeafe generally invades, a fever fucceeded, in which, i. The pulfe was very frequent till near the termination of the fever, and was gene- rally full, hard, and confequently strong: in fome, it was fmall and hard, in others, foft and fmall; but in all thofe cafes, it frequently varied in its fulnefs and hardnefs. Towards the termination of the fever, the pulfe be- came fmaller, harder, and lefs frequent. In fome there was a remarkable throbbing in the carotids and in the hypochondria ; in the latter of which it was fometimes fo great, that it caufed a conftant tremulous motion of the abdomen. 2. The heat, generally, did not exceed 102 degrees of Farenheit's thermometer; in fome it was lefs, it varied frequently, and was commonly nearly equal in all parts, the heat about the pracordia being feldom more intenfe than in the extremities, when thefe were kept covered.. In the firft day of the difeafe, C « ] difeafe, fome had frequent returns of a fenfe of chillnefs, though there was not any abate- ment of their heat. In a few, there hap- pened fo great a remiffion of the heat for fome hours, when at the fame time the pulfe was foft and lefs frequent and the fkin moift, that one from thefe circumstances might reafonably have hoped that the fever would only prove a remittent or intermit- tent. About the end of the fecond day, the heat began to abate. 3. TuLjkin was fometimes (though rare- ly) dry; but oftener, and indeed generally, it was moift and difpofed to fweat. On the firft day, the fweating was com- monly profufe and general; on the fecond day, it was more moderate: but on both thefe, there happened frequent and fhort re- miffions of the fweatings; at which times the febrile heat increafed, and the patient became more uneafy. On the third day, the difpofition to fweat was fo much abated, that the fkin was generally dry; only the forehead and backs of the hands continued moift. 4. The r « : 4. The refpiration was by no means fre- quent or difficult, but was fodfi accelerated by motion, or the fatigue of drinking a cup of any liquid. 5. Tie tongue was moift, rough and white, even to its tip and edges. On thes fecond day, its middle in fome was brown. On the third day, the whitenefs and rough- nefs of the tongue began to abate. 6. The thirfi in very few was great. 7. A naujea, vomiting or frequent reach- ings to vomit, efpecially after the exhibition of either iredicines or food, came on gene- rally the third day, as the fever began to lelfen; or rather as the fullnefs of the pulfe, heat, and disposition to fweat began to abate. Some indeed, but very few, on the firft day, had a vomiting either bilious or phlegmatic. 8. Very few complained of anxiety or oppreftion about the pracordia or hypochon- dria, nor was there any tenfion or hardnefs about the Litter. 9. On y C 13 ] 9. On the firft day they generally dozed much, but afterwards were very watchjul. 10. Rejlleffnejs and almost continual/a£7#» lions came on the fecond day. 11. A great dejpondency attended the fick from the firft attack. 12. The firength was greatly projlrated from the firft attack. 13. The pain in the head, loins, &c, of which they had complained (V) before the attack, were greatly increafed, and in fome, the pain in the forehead was very acute and darting; but thofe pains went generally off the fecond day. 14. The Jace was flufhed, and the eyes were hot, inflamed and unable to bear much light. 15. On the firft day, many of them, at times, were a little delirious, but afterwards not until the recefs of the fever. 16 The C 14 1 16. The bloodfaved at venaefedion had not any inflammatory cruft; in warm weather, it was florid like arterial blood, and continued in one foft homogeneous-like mafs, without any feparation of the ferum after it was cold. When there was any feparation, the craffa- mentum was of too lax a texture. 17. The Jlools, after the firft day, were fetid, inclined to a black colour, and were very rarely bilious, foft or liquid, excepting when forced by art; for an obstinate coftive- nefs attended the febrile state. 18. The urine was difcharged in a large quantity, was pale, fometimes limpid, and rarely of a higher than a straw colour, except when the weather was very warm, and then it was more saturated, of a deep colour, and difcharged in fmaller quantities. It had a large cloud, except when it was very pale or limpid ; but more generally it had a copious, white fediment, even in the firft day of the fever. On the fecond day, the urine continued to be difcharged very copioufly; in fome, it was C '5 ] was then turbid, and depofited a more copi- ous fediment, than on the firft day ; this fe- diment was fometimes of abrownifh colour; in which cafe it was generally followed by bloody urine, either about the end of the fe- cond or beginning of the third day. The co- lour and quantity of the urine, difcharged in equal times, were remarkably .variable, being now limpid, then of a deeper colour, now difcharged in a larger, then in a fmaller quan- tity, which could not be afcribed to any change made either in the quantity or quali- lity of the drink, &c, VII. The fever accompanied with thole (VI.) fymptoms, terminated on the third day, or generally in lefs than 72 hours from the firft attack, not by any affimulation, or codion and excretion of the morbid matter; for if by the latter, there would have been fome critical difcharge by fweat, urine, ftool, or otherwife, none of which happened; and if, by the former, nothing then would have remained but great debility. No; this fever did not terminate in either of thefe falutary ways, excepting in fome, who were happy enough to have the difeafe conquered in the beginning C 16] beginning by proper evacuations, and by keeping up a plentiful fweat, till the total fo- lution of the fever, by proper mild diapho- retics and diluents. But thofe who ha J not that good fortune, however tranquil things might appear at this period, (as great debi- lity and a little yellownefs in the white of the eyes, feemed then to be the chief com- plaints, excepting when the vomiting con- tinued), yet the face of affairs was foon chan- ged ; for this period was foon fucceeded by the fecond fiadium; a state, though without any fever, much more terrible than the firft:: the fymptoms in which were the following. VIII. i. The pulfe, immediately after the recefs of the fever, was very little more fre- quent than in health, but hard and fmall. However, tho* it continued fmall, it became, foon afterwards, flower and very foft; and this foftnefs of the pulfe remained as long as the pulfe could be felt. In many, in this stage of the difeafe, the pulfe gradually fubfid- ed, until it became fcarce perceptible; and this, notwithftanding all the means ufed to fupport and fill it; and when this was the cafe, the ideritious-like fuffufion, the vo- miting C '7 ] miting,. delirium, reft'effnefi-, &c. increafed to a great degree. In fome, the pulfe, after being exceedingly fmall and fcarce percepti- ble, recovered confiderably its fullnefs; but that favourable appearance was generally of but lhort continuance. 2. The heat did not exceed the natural animal heat; and when the pulfe subsided, the fkin became cold, and the face, breaft and extremities acquired fome what of a livid co- lour. 3. Tsie Jkin was dry when the weather was cold, but was moift and clammy when the weather was hot. 4. The refpiration was natural or rather flow. 5. The tongue was moift and mueh clean- er than in the former (VI. 5.) stage, its tip and edges, as alfo the gums and lips, were of a more florid red colour than ufual. 6. Very few complained of thitjl, though they had a great desire for cold liquors. C 7. The C i»- ] 7. The vomiting ox reaching to vomit in- creafed, and in fome was fo conftant, that neither medicines nor aliment of any kind were retained. Some vomited blood; others only what was last exhibited, mixed with phlegm; and others again had what is called the black vomit.* The reaching to vomit continued * That which is called the black vomit, at firft fight, ap- pears to be black; but on a more careful examination, I observed, that this colour proceeded from a great quantity of fmall, flakey, black fubftances which floated in the liquor thrown up by vomit; but the colour of this liquor was much the fame with that which the patient had laft drank, and was by no means black. Thofe black flakey fubftances are the bile mixed with, or adhering to the mucus which lined the ftomach. For, upon diflfe&ion of thofe who died of this difeafe, not only in this but former years, I always obferved that the mucus of the ftomach was abraded, and the bile in its cyjlis was black and fometimes very vifcid. In a lad who died of this difeafe in the beginning of the fourth day, and who was immediately opened, the bile was not only black, but had the confiftence of thick Vemce-Wt- pentine, and was exceedingly tough. On the infide of the ftomach, there were feveral carbuncles or gangrenousfpecks. And in all thofe I have differed, who have died of tins dif- eafe, I have not only always obferved the fame, but like- wife that the blood was very fluid, and the veffels of the v'tfcera much diftended ; from whence I have been very in- clinable to think, when the difeafe was not conquered in its fa&Jtadium, that, about the time of the termination of the fever, there was a nutajlafis of the morbid matter to the vlfccra. C 19 ] continued a longer or fhorter time, according to the state of the pulfe; for as that became fuller, and the heat greater, the reaching to vomit abated, and e contra. 8. The inquietude was very obstinate, and when they dozed, their flumbers were but fhort and unrefrefhing. There were fome who were drowfy; but thefe always awaked, after the fhorteft flumbers, with a great de- jedion of fpirits and strength. 9. The jablations or reftlefsnefs was fur- prising ; it was frequently fcarce possible to keep the patients in bed, though, at the fame time, they did not complain of any anxiety or uneafinefs; but if afked how they did, the reply was, Very well. 1 o. The debility was fo great, that, if the patient was raifed ered in the bed, or, in fome, if the head was only raifed from the pillow, while a cup of drink was given, the pulfe funk immediately, and became fome- times fo fmall, that it could fcarcely be felt; ,at this time, they became cold, as in a hor- ripilatio, but without the anferine-like fkin : their C 20 ] their fkin became clammy, the delirium iri- creafed, their lips and fkin, especially about the reck, face and extremities, together with their nails, acquired a livid colour. 11. The delirium returned and increafed ; it was generally conftant in thofe whofe pulfe was fmall and subsiding. 12. The inflammation of the tunica con- junctiva or white of the eyes increafed much, but without pain. 13. A yellownefs in the white of the eyes, if it did not appear before in the febrile ftate, became now very obfervable, and that ideritiouG-Iike colour was foon diffufed over the whole furface of the body, and was con- tinually acquiring a deeper faffron-like co- lour. In fome indeed no yellownefs was ob- fervable, excepting in the white of the eyes, until a little before death, when it increafed furprifingly quick, efpecially about the breaft and neck. 14. There were many fmall Jpecks, not raifed above the fkin, which appeared very thick [ 21 ] thick in the breaft and neck; but lefs fo in the extremities, and were of a fcarlet, purple or livid colour. 15. In women the menfirua flowed, and fometimes excessively, though not at their re- gular periods. 16. There was fuch a putrid diflblution of the blood in this fiadium-of. the difeafe, that, besides the vomiting of blood former- ly mentioned, and the bloody urine foon to be taken notice of, there were ha?morrhagies from the nofe, mouth, ears, eyes, and from the parts which were blistered with cantha- rides. Nay, in the year 1739 or 1745, there was one or two instances of an hsemorrhage from the fkin, without any apparent punc- ture or lofs of any part of the fcarf-fkin. 17. An obstinate cojlivenefs continued in fome; in others, the ftools were frequent and loofe; in fome, they were black, li- quid, large and greatly fatiguing ; in others, when the ftools were moderate, even though they were black, they gave great relief; in others again, the ftools nearly refembled tar in [ 22 ] in fmoothncfs, tenacity, colour and confif- tence. i S. The urine was difcharged in a large quantity, in proportion to the drink retain- ed by the patient: it was pale if the patient was not yellow ; but if yellow, then it was of a deep-faffron colour; in either cafe it had a fediment, or at least a large cloud, which remained at the bottom of the glafs ; in fome, it was very turbid, in others, it was bloody, and the quantity of blood difcharged with the urine bore always fome proportion to the ftate of the pulfe; when that became fuller, the quantity of blood in the urine was diminifhed: when the pulfe fubfided, the bloody urine increafed, and even returned af- ter it had ceafed fome days, fpon after the pulfe became fmaller. This stage of the difeafe continued fome- times feven or eight days before the patient died. IX. When thisfiadium (VIII.) of the dif- eafe terminated in health, it was by a recefs or abatement of the vomiting, hxmorrhagies, delirium, C 23 3 delirium, inquietude, jadations, and ideri- tious-like suffusion of the fkin and white of the eyes ; while, at the fame time, the pulfe became fuller, and the patient gained strength, which, after this difeafe, was very flowly. But when it terminated in death, thofe (VIII.) fymptoms not only continued, but fooner or later increafed in violence, and were fucceeded with the following, which may be termed the third Jladium of the difeafe, which quickly ended in death. X. The pulfe tho' foft became exceeding- ly fmall and unequal; the extremities grew cold, clammy and livid ; the face and lips, in fome, were flufhed ; in others, they were of a livid colour; the livid fpecks increafed fo fast, that in fome, the whole breaft and neck appeared livid; the heart palpitated ftrongly ; the heat about the pra?cordia in- creafed much; the refpiration became diffi- cult, with frequent sighing; the patient now became anxious, and extremely reftlefs; the fweat flowed from the face, neck and breast; blood flowed from the mouth, or nofe [ *4 ] nofe or ears, and in fome, from all thofe parts at once ; the deglutition became diffi- cult; the hiccoughs and Jubfulius of the tendons came on, and were frequent; the patients trifled with their fingers, and picked the naps of the bed-cloaths; they grew co- matous, or were constantly delirious. In this terrible ftate, fome continued eight, ten or twelve hours before they died, even after they had been fo long fpeechlefs, and with- out any perceptible pulfation of the arteries in the wrifts; whereas, in all other acute difeafes, after the pulfe in the wrifts ceafes, death follows immediately. When the dif- eafe was very acute, violent convulsions feized the unhappy patient, and quickly brought this Jladium to its fatal end. After death, the li- vid blotches increafed faft, efpecially about the face, breast, and neck, and the putre- fadion began very early, or rather increafed very quickly. XI. This was the progrefs of this terrible difeafe through its feveral fiadia. But in hot weather, and when the fymptoms in the first ftage were very violent, it paffed thro' thofe stages, as Dr. Warren has likewife obferved, with C 25 ] with fuch precipitation, that there was but little opportunity of diftinguifhing its diffe- rent Jladia ; the whole tragedy having been finifhed in lefs than 48 hours. XII. It was remarkable, that, 1. The infedion was increafed by warm and leffened by cold weather. 2. The fymptoms in the feveral Jladia were more or lefs violent, ac- cording to the heat or coolnefs of the wea- ther. In hot days, the fymptoms were not only more violent, but in thofe who feemed, in moderate weather, to be on the recovery, or at least in no danger, the fymptoms were all fo greatly heightened, when the weather grew confiderably warmer, as frequently to become fatal. In cool days, the fymptoms were not only milder, but many, who were apparently in great danger in hot days, were faved from the very jaws of death by the weather becoming happily cooler. 3. The difeafe was generally more fatal to thofe who lay in fmall chambers not conveniently situ- ated for the admiflion of frefh air, to thofe of an athletic and full habit, to strangers who were natives of a cold climate, to thofe who had the greatest dread of it, and to D thofe C 26 ] thofe, who, before the attack of the difeafe, had overheated themfelves by exercife in the fun, or by exceffive drinking of ftrong li- quors ; either of which indeed feemed to render the body more fufceptible of the in- fedion. Laftly, the difeafe proved moft certainly fatal to valetudinarians, or to thofe who had been weakened by any previous difeafe. XIII. TaEprognofiics in the firQ: fiadium are thefe. 1. The more acute and conftant the pains are in the head, loins, knees, &c. the more the eyes are inflamed; the greater their inability is to bear light, and the more the face is flufhed at the firft attack, the fever and all the fymptoms (VI.) in the firft fiadium will be the more violent. 2. The more intenfe the fymptoms are in the firft ftate, the fooner will the fever terminate. 3. The fooner the difeafe runs thro' the firft fiadium, the fhorter will be the duration of the fecond, and e contra. 4. The fhorter the duration is of the firft, the greater and more certain is the danger in the fecond ftate. For when the fever terminated before the beginning of the third day, death feemed inevitably c v i inevitably to be the confequence, as there was then no possibility of fupporting the pulfe, and as all the bad fymptoms were then hurried on with fuch precipitation, that the patient generally died before the end of the fifth day, excepting a considerable cool- ness of the weather happily intervened ; but on the contrary, it was a favourable circum- fiance when the fever was protraded to the end of the third day, without any remarkable hardnefs or depression of the pulfe. 5. A great depreffion of the pulfe, about the ter- mination of the fever, is bad, since, from that circumstance, the vomitings, incenant jadations, the coldnefs and lividnefs of the extremities, haemorrhagies, delirium, &c. are ufhered in with furprifing celerity. 6. The more the strength is prostrated from the firft attack, the greater is the danger. 7. A vomiting coming on early in the difeafe, and continuing or increasing, is bad, and generally prefages the black vomit. 8. A fediment in the urine in the firft and fecond day of the difeafe is bad, and the more copious the fediment is, the greater is the danger. XIV. The C 28 ] XIV. The prognoftics in the fecond/* dium are thefe: 1. An early yellownefs in the white of the eyes is bad: when it is obfervable about the end of the fecond day, in the first fiadium, the patient generally dies about the beginning of the fourth day from the firft attack of the difeafe. But when the yellownefs does not appear till the end of the third day, if the patient does not re- cover, the difeafe fometimes continues to the 9th or 10th day of the fecond fiadium before the patient dies. When the yellow- nefs of the fkin and eyes increafes faft and acquires foon a deep ideritious-like colour, the greateft danger is to be apprehended. 2. If the inflammation of the white of the eyes increafes, it is bad. 3. The more in- flamed and bloody-like the fkin is where it has been blistered, the greater is the danger. 4. If the vomiting continues or increafes, it is bad, but the black vomiting is generally mortal. 5. When the pulfe varies frequently in its fullnefs, being fometimes fmall, then fuller, it is bad. But there was lefs de- pendence to be had on the pulfe in this than is common in other difeafes; for in fome patients, in the fecond ftage of the difeafe, even E 29 } even within a few hours of their death, the pulfe, with refped to its fullnefs, foft- nefs, equality and frequency, has continued like that of one in perfed health, although, from the other fymptoms, the death of the patient could be foretold with great cer- tainty. 6. The more the ftrength of the patient is reduced in the firft, the greater is the danger in the fecond fiadium. 7. Great reftleflhefs, inquietude, an early delirium and a continuation of it are very bad. 8. Livid blotches about the neck and breaft, a livid- nefs of the lips and nails, flufhing of the face, or a livid colour thereof, are fure figns of the quick approach of death. 9. Fre- quent loofe ftools, which give not any re- lief, are bad, and the fooner they fponta- neoufly happen, the greater is the danger: but thofe which are black, and continue fo without any abatement of the fymptoms, are generally mortal. 1 o. Bloody urine and all haemorrhagies, excepting flight ones from the nofe, are bad; and the more copious they are, the greater is the danger. But a flux of the menjes, though not at their regular period, if attended with an abatement of the fymptoms, is a favourable circumstance, otherwife C 3° ] otherwife it is bad. u. A fuppreffion of urine, efpecially in thofe, who, in the courfe of the difeafe, have had large difcharges that way, is a certain fign of the quick approach of death. XV. As to the prognostics in the third (X) fiadium, it is sufficient to fay, •' Nature, alas! was now furpriz'd, " And all her forces feiz'd, " Before fhe was how to refill advis'd."* * Dr. Sjtrat's Account of the plague of Athens. FINIS. y"" Med. H