t H £ [VOL. X.] [NUMB. 4S5] AMERICAN MERCURY. MONDAY OCTOBER 21, 1793. HARTFORD: Printed By ELISHA BABCOCK. r An ACCOUNT of the Origin, Symptoms and Treatment of the EPIDEMIC FEVER, which now prevails in the city of Philadelphia, in a Let- ter from Dr. BENJAMIN*RUSH, to Dr. 70 HN RODGERS, Phyficsan, in New-York. My Dear Friend, IN compliance with your re qua ft, I fet down at a late hour, and after a bafy day, to giva you a fhort account of the origin, fymotoms, and treatment of the fetter, which has orevailed with fo much mortality in cur city, for the laft fix week*. I ffa -all begin by obferving, that I have fatisfa&ory documents to prove, that the difeafa was generated in our city. To luppofis, bssaufe the yellow fever is an endemic of the Weft-Indies, and bee s ufe it fcl dom occurs in North-America, that it can exift a- mong us, only by importation, is as abfura as to fup- pole, that the hurricanes which are io common in the “Weft-Indies, and which occur here ors;y once in a© or 30 years, are all imported from that country. 1 he difeafe attacks in a variety of ways, according to the habit and preiLfpofition of the patient, or the nature and force of the cx-titing caufr. It ibma'timcs comes on in the form of a ■ r ypdar quotidian or terti- an‘•—'■Marry' are indifpoiV0 for two or tr.fde days with head arh, and pains in me hack,Hdes, or bones,with- out much perceptible fever. B it in a majority, it attacks with chills, he ad-ah, iicknef or vomiting, and fevers pains in Hve limbs or k ck. The pulfe, in this Rate of the difeais, fine-, the 10th day o; Sapicm? bar, has generally been fuii and tenf-i the tongue whitifh and aoili— eyes rad—the pupils dilated— the urine high coloured—the thirft great, and the fkin hot and dry, 1 lit fe fymptoms remit every day, or every othey day, and tromgihc tertian type, which is its original and natural forth, a recovery or death, generally happens in acute cafes, or, 'ho 3d, 5'h, or 7th days. It attacks all ages. E'ten young cnildren arc not exempted from it, but it is moil acute, and molt mortal in young perfons, between 14 and 25. Before the 10th of September. I found urorg pur- gee of calomel and jalap, alone, given on the firft day of the difeafe, fufficient to conquer it in molt cafe?.* They brought away large quantities of green, dark coloured, or black bile of a molt fee id and acrid na- ture. I ha pulfe, which in the w arm weather, was week and low, role with every evacuation. The fkin likewii 5 which remained dry under the moll powerful fudorifics, became moift under the ufe of thofs a£Uve remedies.' Sines tne 10th of oeptemb*r, I have found bleed- ing, in addition to the mrreuri 1 purges, to be riecef- fary ia nineteen cafes out of twenty. The pulfe — the appearance of the bluo t, «.he fpontaneous hasmor- >luges, and the weather ( xclufive of the ftima.us of the contagion) i.11 indicated Ur. ufe of the lancet. At firft I found the lofs of la or 12 ounces of blood fuf- ftcient to fob due the pulte, but i have bsen obliged, gradually, as the fraf >n advanced, o increale the quantity .to fixty, fisventy, and even eighty ounces, an i in mo.ft cafes with the happieft effefts. I have obfnrved the m ill fpeedy convalefcence, where tha bleeding has been moft profufe, ahd as a proof that it has not brren car'isd to cxcefs, I have 5 in no onsinftanc s, the lea ft incon vrnience to faceted it, I have bled in three cafes where I have l ien inci- pient petechhe, nnd in each cafe, with, fuccefs. I was warranted in this bold pra&ice, not only by the tenfion of the pulfe, but by a .precedent for it, which I rscollcftad in the works of Dr. De Haen, of Vi- enna, I bleed not only in the exacerbations of the fever,* but likewife in its it mi {lions hnd interiftiOions,where I find a low, fl>w, but corded pulfe. i. have recov- ered two patients with this ptiifo, in whom it beat lefj than 50 ftrokes in a nrvute. On every day of the dlfsnfij, after giving the tJi$r* Curial medicine, I preferibe a purge. € after oil— 1 alts—creator tartar—fulphcr, and gliders, anfwer in moft cafes, but in fome, I have been obliged to have rscoui fe to calomel and gamboge in moderate dofes ft I was led to purge every day, not only by recolleQiing the advantages of that practice in th 1 yellew fever of 1762, in carry big off the re-accumulated bile, but by oofsrving the difeafe in all cafes to attack a weak or pmvioufly difordsred part of the body. The purging creates an artificial weak p-Srt, which by inviting a determination of the fluids to the bowels, prevents thole eff ifions in the brain, ftomach, bowels,liver,and lungs, which bring on death. I have n nearly every cafs for the three la ft xveeks, rejifted baik, wine and laudanum in the firft ftage of the diforder, even though the moft perfeS: intermif- (ion of the Fever took place. J Nor do I conceive thefe medicines to be neceflarv in th- convalefcent flatc of the difeafe, Mild and nourifhing diet, re- flores the ftrength much fooner than the mod pow- erful tomes. 1 have reafon to believe laudalum to bo poilon when given with an a&ivc ot corded piille in this fever. The next articles to purging and bleeding in iby materia medica,are cool air and cool drinks. I often dirtft the head to be ba;hed, and the hands and face to be wafhsd with cold water. Toaft and water, balm tea, lemonade, tamarind water, barly water,and apple water, are the common drinks of my patients. '1 he iefs they eat in tha firft ftage of the diforder, the better. As foon as the pulfe is reduced, I indulge them in wine whey, bread, or rallied apples, or mufa in milk, chicken, beef, mutton, or veal broth, coffee and tea with buttered toaft, and weak chocolate —I forbid the rife of animal food, until they are able to walk about. Cleaniinefs is advifed in every ftage of the diforder, with gentle exercise, and countrey air to complete the cure. In thofe few calcs where the difesfe comes on with typhoid or typhus fymptoms, I recommend the com- mon remedies for thofe ftates of fever. If fuffieient bleeding and purging have been omit- ted in the beginning of the diforder, and haemorrha- ges, with petechias, a low pulfe and a black vomiting, have come on, little can be done. Tha ceremonies of bark, glyfters, and the cold bath,may be performed in fuch cafes, but I have heard of no inftance in which they have derm any fcrvice. I think 1 have feen blitters afford relief in local determinations to the head, breaft arid ftomach, after fuffieient evacuations have been ufed. Where % troublefoftie vomiting does not yield to blood-letting, I know of no remedies equal to a table fpoon full of fweet miik given every halt hour, or to weak camomile tea. Where a dull pain la the bowels attends with a full, or corded pulfe, I have preferibed glyfters of cold water with evident advantage. Where flatulen- cy attends, I preferibe camomile tea,or weak brandy and water, provided the pulfe bcfufficientiy reduced. Bv means of the remedies before mentioned, I think 1 was the unworthy instrument in the hands of a kind Providence, of recovering more than ninety- nine out of an hundred of my patients, before my late indifpofiiion. A number died during the few days of my confinement, from the want of well timed bleeding and purging. SinCc my recovery, the dif- eafs has became more violent and obftiriate,and feme have diati under my care, from my inability from weaknefs, and accafional returns of my fever, to be early and punfituai in my attendance, upon them ; for a recovery often depends upon the application of the remediss, not only on a certain day,but frequent- ly at a certain hour. The concentration of the con- tagion in every part of the city, moreover has cn- crcafed the difficulty of curing the dries Ce, for it con- ftantly counteracts the ufe of the remedies which are intended to abftra£t ftimulus ; hsnee we obierve, (other circumftances being equal,) there is moft mor- tality where there is moft contagion. The delays in procuring bleeders, and the ignorance or ncglcft of nurfes added to fome other circumftances too gloomy to be mentioned, have contributed very much of late to encreafe the mortality of the difordei. But with punctual and fkilful medical affiftancc, good nutling, and airy rooms. I am ftill of the opinion, that this difoafe is as much under the power of medicine as the meefles, or influenzas The newfpapers have informed you, how much the opinions and pra£iice, I have delivered in this letter have bec'n oppofed by many of the phyficians, of our city. They firft called the prevailing epidemic, the jail fever. They might as well have called it the fmall-pox. They have declared, that we have two diftinft fevers in town—-the one a pufrid yellow le- vor, and the other a common remittent. It tvould not have been more abfurd, to have aflerted that we have two funs and two moons fhining upon our globs. What makes this raiftakc the more inexcufa- ble is, the common remitting fever, which has been confounded with the prefent highly contagious epi- demic, has not been obferved as ufual,in the fubmbi, Or in the neighborhood of the city. But the miftakes of foms of my brethren have not ended here. Where the difesfe has made its chief im.jreffion on the head, it has been called the inter- nal dropiy of the brain. Where it has attacked the throat, as it has done in fomemild cafes, it has been called an angina maligna. Where it has attacked the fidcs, it ha® been callled a plurify, and in in one per- fon in whom it firft effe&ed the bowels, it was treated as a biliious colic, 7 he diforder in this cafe termi- nated in a black vomiting,& death oh the third day.$, The fuccefs of the new remidies ba» at laft created fuch a clamor in their favor, that moft of oUr phyfi- cians have been forced to adopt them. They bleed however as yet fparingly, and purge after the fit ft day- only with lenient phy fic. Some of them blend wine, bark, and laudanum with them. They might as well throw water and oil at the fame time upon fire in or- der to eXtinguifh it. I muft here pay a tribute of refpe® to the memory of my much loved friend Dr. Pennington, who a- dopted the new remidies as foon as they were men- tioned to him. His expanded mind was not caft in a common mould. It vibrated a unifon with truth, the moment it came in coptaft with it. My excel- lent and judicious friend Dr. Griffiths, was likewife an early and decided friend to plentiful purging and bleediing. Such of my former pupils as are fettled in this city, recommend them, and I hear from all quarters, with fuccefs, It was extremely unfortunate that the new reme- dies were ever conne&ed with my name. I have no other merit, than that of having early adopted, and extended a mode of treating the diforder, which I had learned in the year 1762, from my firft preceptor in medicine, Dr, Redman, and which is ftrongly recom- mended by Hillary, Mofeiy, Mitchell, Kirby, and many other writers upon this fever. In my firft ad- drefs to the public, I acknowledged that I received the firft hints of the fafety and efficacy of Jalap and mercury in this diforder, in the military hofpitals, in the year ijjj. and from a defeription of a difeafd nearly related to ours, in an Eaft-India publication. In the ule of ail my remedies, I have in this difeafe, repudiated names and, been governed only by the CONDI HON OP THE SYSTEM. I am indebted to Dr. Sydenham, as well as to my own obfervations, for the decided manner in which 1 have rejeflted the idea of a common remittent i.t our city. I have been told, that by propagating this e- pinion, I terrify my patients. Perhaps' i do, but! fave them by their fears ; for I excite in them at ones a fpeedy application for help, and a faithful obedi- ence to all my preferiptions. Univerfal truth, is u- niverlal intereft, and faifehood and tnifery always go hand in hand. The opinion which has been publiffi- ed by forne of bur phyficians, that we have now a mild and a malignant fever in our city, has led all thofe people, in whom the fever has coma on in aa infidious form, to neglefi thcmfelves for feveral days, under the idea, that they had nothing but a common fall fever, and frorh this deception, 1 believe hund- reds have porifh-d by the disorder. I cannot conclude this letter, without lamenting; further, that feveral publications, from men who had never fern the diforcer, or who had feen only a few cafes of it, Hava contributed very much todiftrafl thd public mind ; to lefTort a confidence in meicurtal purges and bleeding—and to produce an indiferimi- nate ufe of general remedies,, without any refpeft to the ftate of the fyftcm, and thereby to add to the mortality of the difeafe, ' Adieu, my dear triend.—I fii ill only add, my prayers, that your citv tray be prefeved from the ca- lamities which now afflict* ours, and that you may never know, from experience, the labors,the anxiety, the deep domeftic diftrefs, and the calumnies, w hich for fix weeks paft, have been the portion of Your fincere friend, and Former prfcceptor in Medicine, BENJAMIN RUSH. Philadelphia, 0&6ber 3d, 1733. NO T E 5. , * Each purge confifts of 1 o grains of calomel, and 1 5 ofjalap. Cne fhould be given every 6 hours, until 4 or 5 large evacuations are pro- cured from the bowels. t Each clofe confifts of two or three grains of calomel, and 2 grair.tt cf gamboge, made into a pill with a little flour and common fyrup, A dofc Ihouid be given two or three times a day, fo as to procure largo evacuations from the bowels. I 'I he Bark has been recommended as a preventative of the fever. However proper it might have been during the warm weather, I am fatisfied that it is not fo now. So univctfally is the contagion diffus- ed, through every part of the city,that out of a great numberof perfona in apparent and good health, whofe pulfes I have examined, I have met with only two, in whom they were nietfuller and quicker than na. tural. In two old perfons in good health, between 70 and 80, the pulfe beat between ninety and an hundred ftrokes in a minute. I hay* found this preternatural fulnefs and quicknefs in the pulfes