AN
INAUGURAL ESSAY
ON THE
YELLOW  FEVER,
AS IT APPEARED IN THIS CITY IN
1795.
SUBMITTED TO THE PUBLIC EXAMINATION OF THE
FACULTY OF PHYSIC, UNDER THE AUTHORITY
OF THE TRUSTEES OF COLUMBIA COLLEGE,
IN THE STATE OF NEW-YORK,
WILLIAM SAMUEL JOHNSON, LL.D. President,
FOR THE DEGREE OF
DOCTOR OF PHYSIC,
On the 3d of May, 1797.
By ALEXANDER HOSACK, Jun. A.M.
OF NEW-YORK.
NEW-YORK:
Printed by T. and J. SWORDS, Printers to the Faculty of Physic of
Columbia College, No. 99 Pearl-street.
— 1797.— 



THE FOLLOWING PAGES ARE INSCRIBED TO
Doctor JOHN BARD,
AS A TESTIMONY OF SINCERE RESPECT FOR A
MEDICAL PRACTITIONER
WHO UNITES THE CHARACTER OF A
LEARNED PHYSICIAN
AND AN
ELEGANT SCHOLAR,
TO THAT OF AN
ACCOMPLISHED GENTLEMAN;
AND AS A TRIBUTE OF PERFECT ESTEEM, BY HIS
VERY OBLIGED AND HUMBLE SERVANT,
THE AUTHOR. 



PREFACE.
BEFORE the reader peruses the following
dissertatlon, I must beg leave to inform him,
that this is the first attempt of a young man,
inexperienced in writing, and is done only in
compliance with the regulations of this Col-
lege for conferring the degree of Doctor of
Medicine.
I have purposely avoided any inquiry as to
the origin of the disease, or the chemical com-
position of the matter or poison producing it;
referring the reader for particulars upon these
subjects to the more complete history of the
disease, as published by Doctor BAYLEY, Mr.
WEBSTER, and others; and have confined
myself to a plain detail of the symptoms,
causes, and cure of the disease, as far as fell
under

vi
under my own observatIon, in my attendance
at the New-York Hospital, and upon the
private practice of Doctor SAMUEL BARD,
and my brother Doctor DAVID HOSACK.
If a single fact, either new or useful, shall
be communicated, I shall feel myself much
gratified in having undertaken the task.

AN 
INAUGURAL ESSAY
ON THE
YELLOW FEVER.
HISTORY.
THE yellow fever is known by a va-
riety of names. By the French it has been
denominated La maladie de Siam, from a
country of that name in the East-Indies,
where it is supposed to have had its origin,
and from whence to have been conveyed
to distant parts of the world. Sometimes
they call it La fiévre matelotte, from its
attacking seafaring people and foreigners
more readily than the natives of the coun-
try in which it prevails. The Spaniards
have 

8
have given it the name of vomito préto, or
the black vomit, which is one of its most
malignant and characteristic aymptoms.
Some have called it the malignant fever—
others the putrid bilious, and bilious remit-
ting fever, &c. This disease first appeared
in this city about the year 1740; and, as I
am informed by Doctor JOHN BARD, who
was at that time a practitioner, it mani-
fested the same malignant symptoms which
characterised the late mortal epidemic.—
In some of the southern states it has been
known to prevail at a much earlier pe-
riod.* In 1791 it appeared again in New-
York, and has been described in a disser-
tation published by Doctor ADDOMS.
The epidemic I am now about to de-
scribe, and which has universally received
the name of yellow fever, first appeared
about the middle of July, and continued
until the weather became cold. The sea-
son,
* See Dr. Lining.

9
son, during its prevalence, was very hot
and moist. It raged with most violence
in those parts of the town adjacent to the
eastern shore, where the air is less pure,
and the ground lower than in any other
part of the city; which, consequently,
must, in some degree, serve as a reservoir
for the filth of the upper parts of the city.
It attacked persons of all ages, adults more
frequently than children, and males than
females—foreigners more than the natives,
or such of our inhabitants as had lived in
warm climates.* Frenchmen and blacks
B who
* The same has been remarked in the West-Indies, and
in the other parts of the United States, viz. that foreigners
from northern climates were more susceptible of the disease
than the native's. In support of this opinion, I beg leave
to introduce the following extract of a letter from Doftor
GEORGE DAVIDSON to Doctor DAVID HOSACK, dated
Fort-Royal, Martinique, September 23, 1796; in which
he offers the following ingenious explanation of this fact:
"I have already mentioned the experiments made upon the
atmospheric air here, with a view to ascertain the compo-
sition of it. Those experiments have been frequently re-
peated, in the presence of the late Doctor CHARLES WEB-
STER, of Edinburgh, Doctor SAUNDERSON, of London,

10
who had lately arrived from the West-In-
dies, were rarely the subjects of this disease,
as they appeared to have been inured, and
thence rendered insensible to the operation
of
and Doctor CHISHOLME, lately. The result has shewn a
much greater proportion of oxygene than what I could
have conceived—no less than 67/100 of oxygene gas. It may,
perhaps, tend to explain some difficulties which we meet
with in the phenomena attending upon yellow fever, viz.
why Europeans, or those from cold climates, of tense, rigid
fibres, and in the prime of life, are the subjects of its attack.
I suppose, what you will admit, that Europeans or Ame-
ricans, from cold climates, have a more tense and firmer
texture of fibres than Creoles, or those who have long re-
sided here—cold tending to brace the habit and invigorate
the body, and whilst it does so, increasing the appetite and
digestive powers. Besides this connection between the
stomach and surface, we also observe a remarkable sym-
pathy between the stomach and lungs: whatever tends to
invigorate the stomach, remarkably increases the action of
the lungs, as we may perceive from what follows after a full
meal and a few glasses of generous wine. Inspiration and
respiration are increased; a greater quantity of atmospheric
air is taken into the lungs, and a greater quantity of oxy-
gene fixed in the blood: hence the irritability; a glow of
genial heat diffused, and the circulation becomes more ra-
pid. But as the atmospheric air in Europe contains a less
proportion of oxygene, the quantity of it fixed will be
proportioned to the necessities and calls of the system. It
is, however, far different in those climates: before the ap-
petite and digestive faculties are impaired, whilst the tone

11
of its cause; but their exemption is, no
doubt, more particularly to be ascribed to
their temperate mode of life, and especially
their freer use of vegetables; for it is cer-
tain, that those who most indulged in the
use of animal food and spirituous drinks
were most susceptible of the disease.
The symptoms which marked the yel-
low fever in its first stage were, a general
languor and heaviness—depression of the
spirits, sometimes approaching to stupor—
disinclination to motion—a sense of cold,
and shivering—acute pain in the head, espe-
cially above the eyes—pains in the back,
and frequently extending down the extre-
mities—the skin was hot, dry, and much
flushed, not unlike the scarlet blush of an
erisepelatous inflammation—the eyes were
suffused
and vigour of the system still continue, and also the cor-
responding action of the lungs, a much greater proportion
of oxygene being contained in the atmospheric air, will
be fixed, and the irritability of the system increased; or, in
other words, the system surcharged with oxygene. Hence
the predisposition to fever."

12
suffused with water, and the vessels of the
tunica adnata much distended with blood:
fo constant were these last symptoms, that
they may, in a certain degree, be considered
as characteristic of the disease. The pulse
was, for the most part, frequent, full, and
hard—respiration was proportionally
quickened, attended with much anxiety,
stricture, soreness, and frequently intense
heat about the precordia—the tongue was
foul, the appetite depraved, with nausea,
vomiting, and not unfrequently pain about
the region of the stomach: these were
among the first symptoms of the disease.
The bowels were constipated, unless the
patient laboured under a diarrhœa at the
commencement of the fever—the urine, in
this stage of the disease, appeared, for the
most part, as in the first; stage of fevers in
general, viz. high-coloured, and small in
quantity; in the last stage, when the fever
had continued for some days with violence,
and

13
and the general mass of fluids became
changed, this excretion manifested the same
alterations, becoming sometimes turbid,
and at others yellow, as if tinged with bile.
—Such are the symptoms which generally
appeared at the commencement of the dis-
ease, constituting what I would call the
inflammatory stage, but differing from any
inflammatory disease, inasmuch as in the
former there was no particular part of the
body which appeared to be exclusively the
seat of inflammation. Where the disease
terminated favourably, there was, for the
most part, an evident abatement of the
above symptoms in forty-eight hours; and
in the course of five days the patients were
generally freed from fever, but were left
greatly debilitated by the violent operation
of the poison producing the disease, and the
evacuations which became necessary for the
removal of the fever: even in those instan-
ces where blood-letting, the most debilitat-
ing

14
ing of all evacuations, was not employed,
the patient was so reduced as to require all
the resources, both of nature and of art, for
his support. This stage of the disease was
rather marked by symptoms of debility, yet
accompanied with great irritability, so
much so, that the least imprudence in diet,
clothing, bodily exertion, or indulgence in
conversation and company, would frequent-
ly induce a return of fever. But where this
abatement of the disease did not take place
within the first three days, a very different
and more malignant train of symptoms ap-
peared, partaking more of the symptoms
of the last stage of putrid fever, as described
by HUXHAM and CULLEN.
In the last stage of the disease, the pulses
sunk, became more frequent, irregular, and
sometimes intermittent: the person would
lay continually on the back, with the knees
drawn up, and the body sinking toward the
bottom or foot of the bed; the breathing
became 

15
became proportionably more difficult; and
the crust which had formed on the tongue
became of a black colour, which change also
took place on the lips and teeth; the yellow-
ness became more general over the body,
attended with cold clammy sweats; the
vomiting now became more frequent and
copious; in some instances patients have
vomited incessantly, and in astonishing
quantities; and what was brought up re-
sembled the grounds of coffee: this, for the
moft part, was considered as a fatal symp-
tom: there were, however, several instan-
ces of recovery after this had taken place to
a considerable degree.* It is worthy of
remark,
* The opinions, as to the nature and origin of the black
matter vomited up, are very numerous and different. Some
have supposed it to be part of the stomach; but we must
entirely reject this idea, when we consider the enormous
quantities which patients sometimes throw up. The most
probable opinion is, that it is bile imperfectly formed. [See
Saunders on the liver.] Here I beg leave to quote the words
of Doctor JACKSON, who, from dissection, has formed the
same opinion: after opening the abdomen, &c. and no-
ticing the appearance of the viscera, he says, "The liver

16
remark, that when the vomited liquor ac-
quired this black colour, a diarrhœa some-
times followed, in which there was a dis-
charge of a similar sort of black matter, but
more resembling tar or molasses. The flo-
rid colour now left the eyes, and they be-
came yellow and sunk. The functions of
the brain and nervous system were also very
much deranged: the patient was attacked
with delirium, attended with subsultus ten-
dinum, and sometimes a perfect stupor,
with a convulsive kind of sighing. The
speech began to faulter and tremble. The     
patient
and spleen were generally enlarged in size; the colour of
the liver was often of a deeper yellow than that of any
other of the abdominal viscera; while the texture of the
spleen was frequently less firm than it is found to be in its
natural state. The gall-bladder, for the most part, was
moderately full, but the bile it contained was black and
thick. The biliary ducts were likewise enlarged, and mo-
derately filled with the same sort of bile which was found
in the gall-bladder; while the very blood-vessels of the li-
ver bore the marks of uncommon distension. In the ca-
vity of the stomach, likewise, there was usually more or
less of a dark coloured liquor, similar to what had been
thrown up in the last stage of the disease."

17
patient appeared very uneasy, and ahewed
a disposition to leave the bed. Sometimes a
deceitful tranquility appeared, and by some
was supposed to be a favourable symptom;
but the patient, upon getting asleep, was
much agitated. The stools and urine be-
came black, very offensive, and discharged
involuntarily: in some instances there was
an entire suppression of urine: the extremi-
ties became cold, but the heat still continued
about the stomach: blood was discharged
from the mouth, nose, ears and eyes, and
from those parts of the skin where blisters
had been applied. Sometimes blood was
effused in the cellular membrane, appear-
ing in the form of mortification—petechiæ
appeared about the neck and breast—vibi-
ces, or livid spots, came out upon the body,
particularly upon the abdomen—the per-
spiration became very fœtid—the eyes
shone like glass—hiccough and muttering
came on, and were followed by death.
C Doctor

18
Doctor RUSH, in his history of the yellow
fever as it prevailed in Philadelphia, has
taken notice of buboes and carbuncles as
among its symptoms. I do not know a
single instance where these symptoms have
occurred in this disease in New-York. In
the West-Indies these symptoms are not
uncommon, as would appear from the fol-
lowing extract of the before-mentioned
letter, which I have introduced, as it ferves
to establish the similarity of the yellow fever
to the plague.—"We have had a return of
the yellow fever during the months of July,
August and September, much more violent
than I ever recollect seeing. The rainy sea-
son set in very late, and the weather proved,
during these three months, remarkably
warm and sultry. The disease commenced
early in July, and was not only contagious,
but attended with pestilential symptoms.
Buboes appeared in several patients, who,
however, recovered; and I have seen seve-
ral

19
ral instances of the anthrax and pestilential
carbuncle. One patient evidently sunk
from a carbuncle on his elbow, the hæmorr-
hage from which could scarcely be suppres-
sed by pledgits dipt in diluted vitriolic acid;
and two others also appeared upon the foot
and ankle of the same patient. I am at
present attending a medical gentleman who
has above fifty carbuncles upon his body.
The discharge has reduced him, but he is
recovering. The appearance was first a red
unequal erysipelatous appearance upon the
skin; in the centre appeared an elevated
spot, which gradually changed to black,
burst, and discharged a blackish bloody
ichor, and left behind it a deep pit. Upon
other parts a white pustule appeared, which,
after bursting, discharged pus and bloody
serum, and pitted in the same manner. The
back, loins, and upper part of the thighs
were principally affected."
PREDIS- 

20
PREDISPOSING CAUSE.
PREDISPOSITION is that state of the
body not of itself capable of producing the
disease, but rendering the body more suscep-
tible of the exciting cause. In order to pro-
duce yellow fever, it is necessary that the
body should be in such a state as to receive
the action of the exciting cause. This state
appears to be a peculiar irritability in the
system, by whatever means induced. Upon
no other principle can we explain the rea-
son why the contagion does not affect every
person within its atmosphere, and why the
attendants of the sick are not always at-
tacked. The causes which produce predis-
position in the body, for the most part, are,
1st. Fear, which possesses great power in
debilitating the body, and hence rendering
it more irritable. Upon this principle we
may 

21
may account for the good effects of the dif-
ferent preventives which many were in the
habit of using; such as the wearing a small
quantity of camphor, vinegar, &c. con-
stantly about the body, inspiring them with
a certain degree of courage. The use of
tobacco was supposed to have a good effect
in counteracting the disease, probably from
its possessing more stimulus than the matter
of contagion.
2d. Heat, especially exposure to the di-
rect rays of the sun, was a common cause,
as it assisted the stimulus of contagion in
bringing on indirect debility. Fire also ren-
dered the contagion more active. To prove
this we notice, that a great majority of those
that were infected were such as, from the
nature of their occupations, were much
exposed to the heat of the sun and fire.
3d. Fatigue, whether induced upon the
mind or body, and from whatever source.
4th. Grief. Persons who attended friends
or 

22
or relatives in this disease were not unfre-
quently seized during their attendance.
5th. Excess in venery, and other evacua-
tions, such as bleeding and purging, aided
by fear, which caused some persons to adopt
these means in order to prevent the opera-
tion of contagion.
6th. Cold; accordingly such as had been
previously much heated, upon getting
themselves wet, drinking largely of cold
water, or exposing themselves to a stream
of cool air, were readily attacked with the
disease.
7th. Intemperance in eating or drink-
ing: taking either too large or small quan-
tity of improper food; or a scanty allow-
ance of common diet.
EXCITING

23
EXCITING CAUSE.
DISEASE is brought on by the action of
the exciting cause, after the body is rendered
capable of receiving the contagion by the
action of the predisposing cause. The yel-
low fever being a contagious disease, it
must undoubtedly depend upon the action
of a poison either generated or introduced
into the body. This matter, or poison, is
generally acknowledged to be exhaled from
animal and vegetable substances in a state
of putrefaction: but, as there is a great con-
trariety of opinion upon this subject, I shall
purposely pass it over, referring the reader
to the works of LAVIOSIER and others.—
There are also many different opinions as
to the mode in which this contagion acts
upon the body in producing the disease.
Some have supposed that it enters the sys-
tem

24
tem by the stomach—some that it enters by
the lungs—and others, that the body re-
ceives it by the pores of the skin. All these
opinions have their advocates; but by
whichever passage it is communicated to
the system, whether by the stomach, the
lungs, or the pores of the skin, it is certain,
that, in common with the matter of small-
pox, measles, lues venerea, the venom of
the rattle-snake, &c. it produces a violent
irritation throughout the whole system.
Its first operation I consider to be upon the
nervous system: hence the violent pains of
the head, back, and extremities of the body
—hence the sickness of stomach and vo-
miting—hence the sensation of cold and
constriction upon the secreting and excret-
ing vessels. Such an irritation upon the
nervous system, with an interruption to the
secretions and excretions, are necessarily
followed with a quickened circulation.
The irritating matter of itself is sufficient
to 

25
to produce this effect; but the suppression
of perspiration, the confined state of the
bowels, and especially the retention of bile
of an uncommonly acrid quality, must also
unquestionably have a share in adding to
this irritation and increased action.
CURE.
HAVING stated the symptoms and
caufes of the disease, we are next to consider
the indications of cure, which appear to be,
First, To prevent the further operation
of the poison producing the disease.
Secondly, To procure a solution of the
inflammatory stage of the fever.
Thirdly, To counteract the putrescent
state of the body, as described in the second
stage of the disease. And,
D Lastly, 

26
Lastly, To restore the tone of the system
when the preceding indications are ac-
complished.
First, To prevent the further operation
of the poison producing the disease. To
this end it is necessary that the patient be
removed from the atmosphere in which he
took the disease, and placed in a situation
where he may enjoy a pure, free air: all
articles capable of conveying the contagion
should be immediately removed from the
body, such as clothing, &c. in place of
which there should be clean dry clothing,
bedding, &c.
Secondly, To procure a solution of the
inflammatory stage of the fever. It is neces-
sary to moderate the increased action of the
system, and to remove, as far as possible,
every other source of irritation. To evacu-
ate immediately the poison from the body,
when once introduced, is as impossible as to
eradicate the matter of small-pox, measles,
or

27
or any other disease produced by specific con-
tagion. In the treatment of yellow fever, as
in that of the small-pox, if the analogy be a
just one, the business of the physician appears
to be, to moderate the action of the poison
producing the disease, and, at the same
time, to remove every circumstance which
can aggravate its operation upon the body.
With a view to diminish the increased ac-
tion of the system, evacuations of different
kinds were employed. Some practitioners
had recourse to blood-letting, followed by
purging and sweatlng; and others trusted
entirely to the two latter. With respect to
blood-letting, my observation has been,
that the promiscuous use of the lancet was
very injurious and unsuccessful. In the
New-York hospital it was frequently em-
ployed, but in the majority of cases the
disease terminated fatally; yet, in some
few instances, where the constitution was
uncommonly plethoric, and the determina-
tion 

28
tion to the head more violent than usual, I
have observed good effects follow the loss of
a moderate quantity of blood. But, gene-
rally speaking, blood-letting was attended
with pernicious consequences. The same
has been confirmed by the observations of
several of our most respectable practition-
ers. The more common and successful
practice was,
1. To procure a free evacuation from
the bowels. The purgative medicines
which were employed were many and va-
rious. By some, calomel and jalap were
prescribed, and, in the beginning of the dis-
ease, with good effect. Others administered
a mixture of rhubarb and magnesia with
cinnamon or mint-water. This also answer-
ed well in many cases, where the stomach
was irritable, and rejected the former me-
dicines. But the medicine which was the
most successful, and acquired the greatest
reputation, was the Glauber's salts, given
in 

29
in warm diluting drinks. The dose was
generally from one to two ounces, dissolved
in a pint of gruel made of Indian meal, and
given in divided doses until it operated
freely; the patient at the same time drink-
ing freely of gruel or chicken water, to
promote its operation. Salts, exhibited in
this form, for the most part sat well on the
stomach: they were expeditious in their
operation, and, in many instances, possessed
the additional advantage of relaxing the
skin and inducing perspiration, especially
where the patient drank largely during
their operation. But when the stomach
was so much irritated as immediately, to re-
ject every thing taken into it, recourse was
then had to glysters, composed of vinegar
and water, quickened by the addition of a
small quantity of molasses: these scarcely
ever failed to produce the intended effect.
2. Having procured copious and free
evacuations from the bowels, the next ob-
ject

30
ject appeared to be to relax the surface of
the body, and induce free perspiration. In
some instances this salutary discharge came
on immediately after the bowels had been
emptied, and was readily continued by tak-
ing plentifully of warm drinks; but, for the
most part the febrile symptoms continued
violent, the skin remained hot and dry, the
pains still distressing, and it became neces-
aary to have recourse to more active means
to induce sweating. For this purpose many
sudorific medicines were employed. Some
practitioners used emetics, and others small
doses of James's powders, and the different
preparations of antimony. Vomiting, in
this disease, I have generally observed to be
of dangerous tendency. It may, perhaps,
not be amiss, when the disease first discovers
itself, and is attended with much sickness
and vomiting, to empty the stomach freely,
by means of an infusion of chamomile
flowers: but the exhibition of emetics I con-
sider

31
sider to be highly dangerous and improper.
I believe I have seen some cases in which
the death of the patients could be ascribed
to no other cause than the incessant vomit-
ing brought on by an emetic given in the
commencement of the disease. But the
most certain and successful means were,
to wash the whole surface of the body with
cold vinegar and water, and immediately
after covering the patient with blankets—
to administer such medicines as possess the
effect of bringing on sweating: of these the
spiritus mindereri and saline draughts of
RIVERIUS succeeded well, more especially
if the warm drinks were continued, such
as the infusion of snake-root, gruel, toast
water, tamarind water, lemonade, &c.
These were much aided by applying to the
feet of the patient a warm brick, steeped in
vinegar and covered in a flannel cloth wet
with vinegar or spirits: the steam, thus
emitted and diffused through the bed, had
a won-

32
a wonderful effect in softening the skin and
exciting sweat, especially where the cold
washing had been previously employed.—
Some practitioners have preferred the prac-
tice of plunging the patient several times
in a cold bath, and violently dashing the
body with cold water. But simply wash-
ing the patient with cloths dipped in cold
vinegar and water, was found much pre-
ferable to immersion, both because it more
effectually diminished the heat of the sys-
tem, and was less fatiguing to the patient.
Experiments have proved, that repeatedly
wiping and washing with water, in the or-
dinary way in which the operation is per-
formed, diminishes the heat seven or eight
degrees more than simple immersion, or
dashing it over the body with pails.
The practice of cold bathing in fevers
of this type is not a new one, but was
very commonly employed at Breslaw, in
Silesia; 

33
Silesia;* and of late years has been very
successfully applied in the West-Indies,†
as well as in different parts of Europe,
where diseases of this type prevail.
PROFFESSOR GREGORY, of Edinburgh,
and DOCTOR CURRIE, an eminent physician
at Liverpool, have also prescribed it with
great advantage in the low typhus fevers
of those cities. But its great success in
the New-York hospital, as employed by
Doctor SAMUEL BARD, and in the private
practice of my brother, have fully con-
vinced me of the propriety of its use. It
is also proper to remark, that where the
physician was not called to the patient in
the first stage of the disease, and putrid
symptoms had appeared, and the patient
had become much debilitated, the cold bath
was injurious; and from the abuse of cold
bathing, by employing it in the last stage
E of
* See DE HAEN's Ratio Medendi.
† Doctor JACKSON on the Diseases of Jamaica.


34
of the disease, it has fallen into disrepute
with some practitioners. But as the abuse
of a thing is no argument against its use,
I repeat my observation, that in the first
or inflammatory stage of the disease, it
was one of the most useful remedies that
was employed. When the cold bath had
been thus made use of, and immediately
after followed by the spiritus mindereri or
saline mixture, with plentiful dilution, it
rarely failed to produce sweating in the
course of fifteen minutes; and when once
induced, it was easily continued by the re-
petition of the sudorific medicines and
drinks, until a solution of the fever
was obtained. In some instances where
the patient refused his drink and medicines,
or, from the carelessness of the nurses, they
had not been supplied as frequently as was
proper, and the perspiration had been sup-
pressed, it became necessary to repeat the
cold bathing, which seldom failed to pro-
cure

35
cure a return of the sweating. By the con-
tinuance of this discharge an abatement of
all the symptoms took place: it appeared
to operate as a specific in the disease; the
pulse in a short time became moderate; the
heat of the skin diminished; the pain in
the head and back, before so distressing,
was also relieved; the sickness of stomach
and vomiting were removed; and, in the
course of two or three days from the attack,
the patient had little else to contend with
but mere debility.
Thirdly, In those cases where the physi-
cian was not called in the early stage of the
disease, where the bowels were not freely
emptied, and perspiration had remained
suppressed, with a continuance of the
fever, a more distressing train of symptoms
appeared, as described in the second stage
of the disease, and required a different mode
of practice: few patients, however, reco-
vered from this stage of the disease.
WHERE

36
WHERE the stomach was much disturb-
ed with sickness and vomiting, which was
one of the most dangerous symptoms, the
saline draught was exhibited in the effer-
vescing state; and, in some instances, yeast
was employed with advantage, followed
with nourishing antiseptic drinks, as milk-
punch, lemonade, porter diluted with wa-
ter, &c. Snake-root-tea, where it sat well
upon the stomach, appeared to possess most
advantages this stage of the disease, in-
asmuch as it procured a free determination
to the surface of the body, independent of
its antiseptic properties; but where the sto-
mach rejected every thing, recourse was
had to blisters, applied immediately over
the region of the stomach, and, in some in-
stances, with the most happy effects. Spi-
rituous fomentations, applied to the lower
extremities, especially where they were
followed with perspiration, in many in-
stances gave relief to the stomach, and
rendered it more retentive.
WHERE

37
WHERE the bowels were in a costive
state, purgative medicines were given to
the patient; at the same time injections
were employed, composed of vinegar and
water, with the addition of molasses, and
repeated every hour until they produced
the desired effect.
WHEN the functions of the brain and
nervous system were much disturbed, as
indicated by delirium, subsultus tendinum,
restlessness, &c. sinapisms, composed of
rye-meal, vinegar, and mustard, applied
to the soles of the feet, blisters to the an-
kles, to the inside of the thighs, and to the
head, in some few instances procured re-
lief.—In this stage of the disease some prac-
titioners had recourse to bark, wine, and
the tonic treatment in general; but the
plan I have observed to be attended with
most success in addition to the medicines
and treatment related above, was to sup-
port the patient's strength, by the mildest
nourish-

38
nourishment, and such as was the least
stimulating to the system, viz. soups, com-
posed of a great proportion of vegetables,
sago, milk-punch, with a small quantity
of spirits or brandy, merely sufficient to
render it grateful to the stomach. In ad-
dition to this mode of treatment, great at-
tention was paid to the removal of every
external source of irritation, by frequent
changes of linen and bedding, by frequent-
ly wiping the body with cloths dipped in
spirits or vinegar, removing every offen-
sive matter from the room, and by correct-
ing the atmosphere around him, by the
explosion of gun-powder, sprinkling vine-
gar over his bed, and through the room,
and procuring a free circulation of fresh
air.
Fourthly, Having, by the means above
enumerated, procured an entire solution of
the fever, it remains to restore the strength
of the system. In the stage of the disease
alluded 

39
alluded to under the last indication, while
a degree of fever remained, an active tonic
or stimulating plan of treatment was found
injurious; but, when a perfect solution of
the disease was obtained, and the patient la-
boured under mere debility of body, this
mode of treatment was not only admissible,
but, in many instances, the patient's
strength was so completely exhausted, that
the most restorative medicines and diet be-
came necessary. In this state of body re-
course was had to the bark, serpentaria, the
different bitters, mineral acids, and the usual
medicines prescribed with this intention,
viz. wine, porter, milk-punch, &c. The diet
employed with most advantage consisted
chiefly of vegetables: sago, tapioca, indian
and oat-meal gruel, rendered palatable by
the addition of wine, were, for the most
part, grateful to the patients—were suffi-
ciently nourishing, and, being of a more
antiseptic quality, were found less hazard-
ous 

40
ous than the use of animal food. When
animal food was employed, it was in the
form of soups, with a large proportion of
vegetables, or calves-feet jelly, with the
addition of wine: in this form it became
less exceptionable. But solid animal food
was very commonly injurious, retarding
the recovery of the patient, and in many
instances producing a return of the disease;
it was therefore very generally prohibited
during the convalescent state of the patient,
The drinks employed with most benefit,
and which were found most grateful to
the sick, were wine and water, milk-
punch, porter, &c. Such was the disease,
and such the mode of treatment, as far as
has come within my knowledge.
THE END.