NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland HISTORY OF THE YELLOW FEVER, &C. \ 1 "S THE HISTORY OF THE YELLOW FEVER, WITH THE MOST SUCCESSFUL METHOD O F TREATMENT. By JOSEPH MACKRILL, M. D. SEYERAI. VEARS RESIDENT OF THE WEST-INDIES. " guaaue ipse miserrima vidi et quorum pars magna fui.' *~ * r —VlRG. BALTIMORE: PRINTED BY JOHN HAYES, IN PUBLIC-AtLEY- M dcc xcri. -■■ ■MWi'bl'"- "■---" — " ' j^*.'•'.■•■ ->*— ■ ■■»..'.■■ ■■■>■'-'-■'"<,Hrtn,)»<^*r«i«r lh» Jpufcltfteti accoutring to 3& of Con&eft. nwi'imm w wiiwuwuwuwuw wnwnvmwi'i' w »''*»•?» if DEDICATION. To the CITIZENS of BALTIMORE and FELL's-POINT. GENTLEMEN, jOLAVING lately efcaped from the deJlruBive ra- vages of war in the Weft-Indies, / cannot but feel a lively fenfe of the many bleffings I enjoy, as an inhabitant of the republic of peace. Under this impreffion, I fit down with a heart full of grati- tude, to offer my befl endeavours, to exhibit in its true colours, a difeafe which has lately confegned many valuable citizens of the United States, tq an early grave, and to point out the mo/l effcacious means of combating this cruel ufurper—The difeafe is the YELL 0 W Fe VER. Having lived feveral years in the Wejl-Indies, as a PraBitioner of Medicine, upon a pretty extenftve fcale, I have had abundant opportunities of making myfelf well acquainted with it. The fruit of my experience, I humbly offer as a tejlimony of my befl wi/hes for your welfare and profperity. J. MACKRILL, Garrison-Forest, July 18, 179& THE HISTORY OF THE YELLOW FEVER, fcfc. JL M U S T beg the excufe of my brethren of the faculty, in not having dreifed my language in the technical garb, ufual upon thefe occafions, having carefully avoided hard words, that my fubject might be perufed with eafe, by intelligent perfons of all defcripdons; confidering it of confequence, that a treatife on a public malady, mould be written in the vulgar tongue. I beg leave to requeft the attention of my reader, in the mod particular manner, to the few following obfervations, as they may ferve to clear C 5 3 clear away an error which has uniformly created much mifchief in the treatment of the Yellow Fever. However my opinion may differ from that of many of my moft refpectable brethren, I have at leaft one confolation, that a conformity to it, if it even were erroneous, would be attended with no ill confequences. The difeafe in queflion is, perhaps, with ac- cuftomed propriety, termed Yellow Fever; but that it is the common Yellow Fever of the Weft-Indies, I take upon me to deny. Conva- lefcents from the Yellow Fever, for many years paft, have been conftantly in the habit of vifit- ing the fhores of the United States, for the change of air; but I never could learn that it was ever deemed dangerous to take fuch paflen- gers on board of veflels, the crews of fuch veffels did not catch the difeafe, nor was qua- rantine ever thought of when fuch veflels arriv- ed—Nay, the very cloaths of fuch convalefcents, which are known always to fecrete a vaft portion of contagious matter, would have been abun- dantly fufficient to communicate the difeafe; but no no inftance of this can be traced—It is necefla- ry that the reader ftiould underftand, that I al- lude to the fituation of things previous to the year 1793. Confounding this difeafe with the Weft-India Yellow Fever, has been the rock againft which, to my own knowledge, the lives of thoufands have been loft. In the year 1793, when this fever raged with fuch unheard of violence in Philadelphia, Dr. Stevens, a Phyfician of moft diftinguifhed eminence in the Weft-Indies, hap- pened to be in the city. Viewing the difeafe a.> the common Yellow Fever of the Weft-Indies, with great propriety, he adminiftered the reme- dies he had always found efficacious in fuch ca- fes, fuch as the bark, wine, &c. Thefe medi- cines were, however, found to produce the molt mifchievous effects; but no man can pretend to fay, that fuch applications as bark and wine, are improper in the Weft-India Yellow Fever, fince they are known to almoft every indifferent perfon in that country, as his ftieet anchor; neither can any man fay it was an anomalous appearance, which the difeafe put on in confequence of a dif- ference in climate, &c. fince the felf-fame dif- eafe, [ 7 ] eafe, which prevailed in Philadelphia, in the year 1793, prevailed at the fame time in the Weft-Indies, and required the felf-fame treat- ment. The fa£l is, that in the fummer months, the Weft-Indies and the United States, are pret- ty much upon a par as to climate ; but all conta- gious difeafes, which have a putrid tendency, will ever rage, with ten fold violence, amongft a people whofe conftitutions have juft before been wound up to a high pitch of health by cold weather : Thus I have uniformly obferved in the Weft-Indies, that many of the fun-dried confti- tutions of the Creoles, would feem to run no rifque of taking the difeafe, at the fame time, that every ftranger, whether American or Eu- ropean, no fooner fat his foot on fhore, but he was almoft as inftantaneoufly attacked with the difeafe, more particularly if his countenance dif- covered any thing like the eflence of roaft beef. During two years in which I attended in the capacity of Phyfician to the military hofpital of Trinidad, the years 1788 and 1789, cafes of the Yellow Fever were very common, and no patient had the fmalleft chance of recovery with- out a plentiful ufe of bark and wine; but no difeafe [ 8 ] difeafe like this in queftion, ever made its ap- pearance in that ifland till the year 1793, when great numbers were hurried to the grave by it; nor does the memory of man furnifh an exam- ple of general mortality in the Weft-Indies, by any means to be compared to that of 1793, oc- cafioned altogether by this cruel difeafe. It continues ftill to rage, but is happily brought fo much within the reach of medicine, that few, comparatively fpeaking, die of it. Having denied that this fever is an original production of the Weft-Indies, I (hall proceed in the next place, to give the reader what I conceive to be the true hiftory of the difeafe. Early in the fummer of the year 1793, being accidentally called to Grenada, to vifit a fick brother, I had an opportunity of feeing the dif- eafe for the firft time; a large Have fhip belong- ing to Simmon and Hankey, of London, had juft before arrived from Africa, on board of which, a few days after her arrival, a moft alarming fpecies of Yellow Fever made its ap- pearance—every white man on board died of the difeafe. It was foon communicated to the inhabitants, L 9 3 inhabitants, and great numbers fell victims to its rapacity, particularly thofe who had lately arrived from Europe, hardly one of whom fur- vived it. It feems that the contagion had re- mained inert during the pafiage of the fhip from Africa; but no fooner did fhe arrive than it burft forth With all its horrors, for here it found, in a great meafure, its own proper nidus, its own nutritious pabulum, in the clofe heated atmof- phere fo frequently prevailing in Grenada. From this ifland it was quickly difleminated throughout every part of the Weft-Indies, and was then, for the firft time, brought into the United States; in lhort, the whole weftern world was arrefted by this cruel tyrant, in as lhort a time as it could be carried from one place to another. Wherever it met with a fickly un- wholefome atmofphere, it prevailed with incre- dible acrimony, but where *an ifland, from its particular fituation, was more healthful, its in- fluence was not fo violent. I attended three perfons on board the veflel which carried me from Grenada to St. Euftatius, all of whom di- ed, and I had nearly fallen a viftim to it my- felf. I had occafion to remark, that although B many [ io ] many perfons died of the difeafe in St. Euftati- us, they were, in general, thofe who brought it with them from fome other ifland. I obferved but few inftances of its communication with the inhabitants, except with thofe who had lately arrived from Europe or America, fcarcely one of whom efcaped. That its influence was not fo powerful in 'Statia may be eafily accounted for: The ifland is little more than a dry rock, and is molt commonly vifited by brifk winds, which pervade every hole and corner of it, in confequence of which there is not, I believe in the world, a more healthful fpot; witnefs the number of its old native inhabitants. The dif- eafe put on fo much the appearance of the com- mon Yellow Fever, that the phyficians in the Weft-Indies, were naturally induced to treat it as fuch; but a total want of fuccefs obliged fome of them to alter their plan, and although fome few phyficians were endowed with a portion of that intuitive knowledge, which fo eminently diftinguifhed Dr. Rufh, in his treatment of this difeafe, by far the greateft number perfevered in the old fyftem, and deftroyed all before them. I have read Dr. Ru/h's Treatife on the Yel- low [ II ] low Fever, with much fatisfaction: A noble vein of philanthropy pervades the whole work, and the readinefs of his powerful and falutary applications, at a moment's warning, difcovers an almoft inftinctive knowledge of medicine. The fuccefsful mode of treating this difeafe in the Weft-Indies, is very fimilar to that of Dr. Rufh, though differing in fome eflential particu- lars, which I fhall prefently have occafion to take notice of. Whoever in the Weft-Indies, was fubjected to the mode of treatment hereafter to be laid down, provided the difeafe was recent, feldom died, and with a little extraordinary care and at- tention, I found that the difeafe was much more eafily managed than the common Yellow Fever. Thus have I attempted to fix the head quar- ters of this moft tremendous fcourge; with what fuccefs the unprejudiced reader muft de- termine; but let him call to his recolle£lion, that before the year 1793, no fuch difeafe as this in queftion was known, either in the Weft- Indies or America; that it made its appearance in both countries nearly at the fame time; that B 2 fince C 12 ] fince that year it has every fummer been import- ed to fome part or other of the United States, and raged with much violence, whether the fummer was wet or dry; and laftly, that the people are now thoroughly convinced of the neceflity of avoiding communication with thofe infected with the difeafe. If then it fhould be agreed with me in opini- on, that the late Yellow Fever was originally imported from that pregnant fource of all con- tagious difeafes, Africa, no worfe confequences can arife from fuch a coincidence, than, that in believing the difeafe to be imported, every pre- caution reflecting quarantines, will be moft ri- goroufly enforced, and in believing that a {link- ing confined air, becomes a nurfery for contagi- ous difeafes, of all defcripdons, every exertion will be made in the different towns to remedy fo great an evil. It is now become of the utmoft confequence, that the legiflature of each ftate, fhould think very ferioufly of the bufinefs of quarantines. Independent of the difeafe in queftion, there is another motive for keeping the ftricteft look out, which, [ 13 ] which, till lately, did not exift. Our affection- ate parent, whofe attention to the profperity of his ungrateful children, is unremitting, has, in fpite of oppofition from the factious and difaf- fected, procured for them the bleflings of peace, and a friendly intercourfe with all the nations of the earth. But we fhould, perhaps, rather view our alliance with the Turks, as a necefla- ry evil; at all events, we fhould take every pof- fible precaution, that our commerce with them does not bring us acquainted with that moft dreaded of all evils, the plague. Our towns are not only the precife latitudes in which the plague is wont to rage, but there are fo many local circumftances to give it every poflible fup- port, that, were it once to get a footing, fo ve- ry fubtle and infinuating is the contagion, that it would probably be very difficult to extermi- nate it. Thefe local circumftances, it fhould, at all events, be the conftant care of the police to remove as much as is in its power. The mud- holes, and pooh of ftagnant water, in confined fituations, fhould be filled up; for whoever breathes the air of fuch noifome places, runs the rifk, at befl, of inhaling fome troublefome difeafe. The ftreets in the warm feafon, might at [ 14 ] at a moft trifling expence, be kept conftantly watered, and regularly appointed fcavingers fhould be conftantly employed in removing dung-heaps and rubbifh of every kind, from our ftreets, lanes, alleys and houfes. Quarantines fhould be conducted fo as to give as little obftruction to commerce as poflible. As foon as the veffel comes to an anchor, off the hofpital, or place appointed, the moft im- portant object is to put afhore, as foon as pofli- ble, every kind of bedding, and every rag of cloaths, wherever it can be found. Dirty lin- en, of all things, is the moft likely to fecrete contagion. The fick fhould be immediately landed, that they may breathe a purer air, and the healthy fhould have as little communication with them as poflible. The fick fhould be re- frefhed with clean linen, immediately, and their bedding and fuch cloaths as cannot be wafhed, fhould be burned; the hold of the veffel fhould be expofed, as much as poflible, to the free ad- miflion of frefh air, and every cabin and corner well fcrubbed with hot vinegar. Nothing can be more neceflary than that the healthy [ i5 3 healthy part of the crew fhould conduct them- felves with great caution; they fhould avoid exceffes of every kind, particularly drinking, and never expofe themfelves to the night air; their bowels fhould be rendered rather more fo- luble than ordinary, during the firft forty-eight hours after landing. The commander of fuch veffel fhould be careful not to work any man who may appear indifpofed, if ever fo triflingly. I would recommend the perufal of Mead on Quarantines, where every particular direction is laid down with great accuracy. It certainly is a great error to fuppofe, that negroes are not fo liable to catch this difeafe as whites. This obfervation, fo far as it relates to negroes living in Africa, may hold good. A dif- eafe which makes fo much havock in this varia- ble climate, probably does not affect the inhabi- tants of its own climate, in a more fevere de- gree, than our own bilious autumnal fevers af- fect our inhabitants; but negroes born in Ame- rica, and breathing the fame atmofphere as the whites, their organization being allowed on all fides to be the fame as that of the whites, mull of neceflity, be equally liable to receive conta- gious difeafes * [ 16 ] I now proceed to enter upon the moft impor- tant part of my fabject, viz. the method of treatment. I am well aware, that a weak credulity on f:i£ts, has injured every fcience, but none fo materially as medicine; that a heated imagina- tion foon begets ideas, which it aflerts with much zeai and authenticity, but which cool and mature reflection oftentimes (lamps with incre- dulity. I lhall, therefore, in this purfuit, pro- ceed with the moft cautious circumfpection; I fhall offer no fpeculations in theory, nor chime- rical noftrums in practice; but confine myfelf, altogether, in laying down that particular me- thod of treatment, which after many trials, I obferved to be the moft fuccefsful. In all difeafes, the intentions of nature fliould be watched with the moft minute accuracy. The great Dr. Sydenham obferves, that a phyfi- cian is the fervant of nature; but he is, proba- bly, agreeable to the more modern opinion, with fomewhat more propriety termed the con- fultor of nature. If, for inftance, in the courfe of a dangerous fever, nature is preparing to form t 11 ] form an impofthume, it is the duty of the phy- fician to affift her in fuch intention, as the moft certain means of relieving his patient; but it may happen that nature has fixed upon a wrong object, fome vital organ fhe may have deftined for the feat of this impofthume; under fuch circumftances, it is furely the duty of the phy- fician, at all events, to divert her intention, to give his patient even a probable chance of re- covery; thus is the phyfician ftyled the confult- or of nature, rather than her fervant, to follow in all cafes, the track fhe points out. This ob- fervation, viewed in either light, cannot be too ftrongly imprefled upon the mind of every me- dical man. If in the courfe of a fever, nature attempts relief by perfpiration, the phyfician will beft fucceed by promoting that fecretion. In the firft attack of the Yellow Fever, or by way of diftinction, I think there would be no impropriety in calling it the African Fever, we find the pulfe either terife and quick, or flow, with a degree of hardnefs, not altogether un- like that deceitful pulfe ufual in inflammations of the ftomach. The phyfician a£lihg either as the fervant or confultor of nature, is atten- C tive [ 18 ] tive to her operations; if the pulfe are tcnfe and quick, he will obferve the countenance flufhed, and the eyes turged with blood; if na- ture is left to herfelf under thefe circumftances, hemorrhagy is generally induced; lofs of blood is then the indication fhe plainly points out; if, on the other hand, the pulfe, in the firft attack, are flow and opprefTed, the phyfician has yet a good rule for his guide. I never felt this flow, opprefTed pulfe, in the African Fever, unac- companied with a degree of hardnefs, and I believe it is one of the very few philofophica! rules in the practice of medicine, that wherever you find a hardnefs of the pulfe, let other cir- cumftances be what they may, bleeding is ne- ceflary. So great frequently is the engorge- ment of the blood veffels, in the commence- ment of this fever, that I have frequently been inclined to think the blood had a ftrong difpofi- tion to coagulate; under this idea I always avoided opium, the mifchievous effect of which, in this difeafe, is perhaps to increafe this difpo- .fition; neither has the blood that florid inflam- matory appearance at the firft operation, which you will find at the fecond; the veflels after the firft drawing, becoming in fome meafurc liberated, [ 19 3 liberated, the blood has more room to circulate; and we confequently find the pulfe much raifed, and all inflammatory appearances apparently aggravated. The firft bleeding, if the pulfe are tenfe and quick, fhould be from a large orrifice, and from eight to twenty ounces, ac- cording to the age and ftrength of the patient. If the pulfe are as has been before defcribed, flow, &c. they will generally rife upon the firft difcharge of blood, and let the quantity, in this cafe, be regulated according to the then exifting ftate of the pulfe. My own experience warrants me to affirm, that this laft ftate of the pulfe, provided it was obferved at the commencement of the fever, requires a more liberal ufe of the lancet, and is always attended with more danger than when the pulfe are tenfe and quick. The phyfician fhould, if poflible, fee his pa- tient at leaft in four hours after the firft bleed- ing. The pulfe are now his beft guide; does he find them yet tenfe and quick, or yet flow, with a degree of hardnefs, let him repeat the operation, and continue to repeat it at leaft eve- ry four hours for the firft twenty-four hours, un- lefs the pulfe fhould become foft and moderate, C z and, [ *Q 3 and the violent pain pf the head fhould be much abated. The pain of the head, in this difeafe, is very uncommon, and appears to me to be very fimilar to that which fo remarkably charac- terizes the true puerperal fever. Immediately after the firft bleeding, the pa- tient fhould take a purgative medicine, compo- fed of equal parts of frefh Jalap, finely pow- dered, and Cream of Tartar, thirty grains of each, in general cafes, varying the quantity as the judgment may direct. By attending to this method of bleeding, in the firft inftance, that obftinate conftriction, of the bowels, which is certainly the confequence of inflammation, will not take place, and the neceflity for ufing violent draftic purges, will in a great meafure be obviated. The purging plan in America, has generally been adopted previ- ous to bleeding. Experience obliges me to dif- fer from it; the fanguiferous fyftem is the feat of the difeafe, and fhould be relieved as expe- ditioufly as pofiable. Indeed, nature calls for it in the moft peremptory tone. If I had an op- portunity of attending my patient* at the com- mencement [ 21 3 mencement of the fever, I generally had the fatisfaction of feeing him out of danger in twenty-four hours. The moft agreeable drink, I ufually found to be dulcified fpirits of vitriol in water. The patient fhould have every ad- vantage of cool air, and let it be remembered, that fo long as the fkin continues hot and with- out moifture, there is not the leaft danger of expofing it to a cool draught of air; on the contrary, it furprifingly refrefhes the body, and affords the moft comfortable relief; but as foon as perfpiration takes place, air fhould be appli- ed with more caution. If the fever has exifted two or three days be- fore medical affiftance is called for, the treat- ment will differ greatly, and its fuccefs is be- come very doubtful. You will now find the opportunity for large bleeding loft; but let the phyfician carefully examine the pulfe, and if he yet finds any hardnefs in it, he may venture a general bleeding. If the general inflammatory fymptoms have fubfided, he will, notwithftand- ing, find great congeftion of blood in the head, and every topical mode of relieving the veffels of the head, fhould be had recpurfe to; the tem- poral [ 22 :• poral arteries fhould be immediately opened, and leeches applied to the hind part of the head. If the fever has been allowed to proceed as far as this fecond ftage, it becomes more fixed, and takes greater hold of the conftitution, and the patient, if he does recover, frequently contin- ues a valetudinarian for a length of time; in this particular ftage of the difeafe, I was always anxious to apply, as expeditioufly as poflible, a feton in the nape of the neck; it often happen- ed, I confefs, that my patient died before the feton could digeft; but there were many linger- ing cafes which appeared to owe their fuccefs- ful termination to this application. The bowels muft be opened, and here lies the greateft diffi- culty; the ftomach is now inflamed, and ex- tremely irritable; a large blifter fhould be imme- diately applied to its region, and let twenty grains of ftrained opium, finely powdered, be mixed with the flies, which will moft effec~lu- ally prevent that painful attendant on blifters, the ftranguary, and this may ferve as a rule in all other cafes, where this fymptom is dreaded. Glyfters compofed of ftrong foap-fuds and table fait, fhould be applied frequently, with a pewter fyringe; if a bladder is ufed in this operation, the [ 23 3 the glyfter will have no effect. Let the following purge be given as early as poflible: Take of Ca- lomel, ten grains; Jalap, thirty grains; Salt of Tartar, ten grains; mix it in any thing agreea- ble, and repeat it every four hours till it oper- ates. It will frequently happen, that the phyfician is not called in till the fever has made yet far- ther advances: I am forry to fay, that in this fi- tuation, little is to be expected; however, fome inflances of recovery I have been witnefs to; local bleeding from the nofe or temporal artery, be the quantity ever fo fmall, will afford relief; blifters in this ftage, without opium, fhould be applied to the region of the ftomach and nape of the neck; the purge above-mentioned, fhould be ufed, and if a paflage can be obtained, there is yet fome chance, and let the bark be ufed in the following form: Take of the befl pale bark, one ounce; foluble Tartar, half an ounce; Hux- ham's tincture, one ounce; water, half a pint; let this mixture be given by fpoonfuls, as much as the ftomach will bear. Glyfters compofed of a ftrong decoction of bark and Caftile foap, will be found very ufeful. If in 'he ccurfe of the C 24 3 Fever any intermiflion takes place, it is always favorable; if the bark paffes freely through the bowels, when firft applied, fuccefs may be ex- pected, and this effe£l may be modei.ivd at pleafure, by the addition of three or four drops of laudanum. Emetics of all kinds, fhould be carefully avoid- ed, and every preparation of antimony. The naufea induced by antimony, when intended on- ly to promote perforation, in all fevers which have a putrid tendency, I have found very fre- quently fatal, always dangerous; I have alfb had frequent occafions to obferve in this fever, that nitre was extremely mifchievous. I would earneftly recommend to all thofe who are obliged to live in the neighbourhood of this difeafe, temperance, fobernefs, and chaftity; to avoid, as much as poflible, a draught of air in a confined fituation, during all the hours in which the fun is abfent; the bowels fhould, at all events, be regularly opened once in twenty- four hours, and for this purpofe, if there fhould be occafion for medicine, I would univerfally recommend good common magnefia. All pur- ges [ 25 3 ges which in any degree ruffle the ftomach or bowels, fhould be avoided, when taken as pre- ventives. The lofs of a little blood, in fuch as are of a full plethoric habit, will be proper; but to thofe of a contrary temperament, prejudicial. The Weft-Indies have of late years, been uncommonly fatal to the young men of Ameri- ca; I would recommend to all perfons on their arrival in the Weft-Indies, to avoid, as much as poflible, the too common' cuftom in that country, of drinking a great deal of wine; on the contrary, to live as temperately' as poflible, and always to be aware of the poifon contained in a calipatch of turtle; they fhould always be provided with a quantity of good common mag- nefia—I mention common magnefia, becaufe I am fure it is infinitely preferable-to the calcined; the bowels fhould be gently purged with this medicine for the firft few days, one Targe table fpoonful, night and morning, in a- little water, will be fufficient. This fimple medicine will be fufficient for all the purpofes of guarding againft ficknefs, and is, in my opinion, infinitely preferable C 26 ] preferable to all other medical contrivances; Cream of Tartar beverage, is almoft univerfalty recommended. I have uniformly obfervcd, that Cream of Tartar anfwered a very good purpofe, if ufed only now and then; but if ufed for a continuance, it induced frequently, weaknefs of the ftomach or bowels. I have nothing farther to add, from my own experience, in the treatment of this difeafe; Twljat refpects diet, and a variety of effential * mihutia, have been much more ably handled than I am capable of, in Dr. Ru/h's excellent treatife on the Yellow Fever, which needs not my recommendation. In the courfe of this little work, I have ad- vanced nothing but what has fallen under my own obfervation, confidering it the duty of every man to come forward, if his avocations in life, have furnifhed him with any opportu- nities of contributing, if in ever to trifling a degree, to the alleviation of a public calamity. FINIS. Book taken apart, leaves deaoldlfled with magnesium bicarbonate. 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