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OBSERVATIONS
ON THE
REMITTING FEVER,
      WHICH PREVAILED IN THE
         CITY OF ALBANY,
 IJrT THE SUMMER AND AUTUMN OF 1809)
      BY DR. MOSES WILLARD,
OF ALBANY, HONORARY MEMBER OF THS STATE MEDICAt
 SOCIETY, AND FELLOW OF THE COLLEGE OF ?HYSI«
 CIAN3 OF IH^ STATE OF NEW-YORK*     - . >
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       BALANCE PRESS—ALBANY,
             1810v 
 
OBSERVATIONS,  &c.
THE last winter was remarkably cold and
severe.  The spring was  also cold and dry.
Vegetation did  not come  forward as early as
usual.  Very little rain fell from the breaking
up of winter, until about the 10th of July;
at which time it began to rain, and continued
without much intermission,  for about four-
teen days.   At the same time the weather
was so cold, that warm clothing and good fires
were almost as comfortable as in winter.
  This continuance of rain,  caused the Hud-
son's river to oveiflow its banks, and do much
damage in the low lands to grass,  grain, &c.
  In this place, the docks were covered, the
cellars in the lower part of the city filled with
water, and all low places inundated : many
of which could not be drained; and the water
was left to stagnate and to be exposed to the
sun.
  The latter end  of July, a remitting fever
began to make its appearance, which has con-
tinued through the season, till this time (Jan,
1, 1810.)  However, the cases now are com-
paratively but very few.
  The summer has been remarkablv cool;
there  having been but few days but what
                  A 2 
4
 fire  has  been comfortable some  part of the
 twenty-four hours.
   There  has been but very little rain from
 the rainy season above mentioned, until this
 time.

           THE SYMPTOMS.
   At the commencement of this fever, the
 patient generally makes but very little com-
 plaint, for the first two or three days.   In
 some cases,  however, the attack has  been
 more violent.   The  patient  complains of a
 general heaviness and  languor, with some loss
 of appetite, and supposes he has taken cold.
   But on the third, or fourth day, he feels an
unusual weight on the back of his neck, as if
pressed with  a yoke ;  with some degree  of
stiffness,  and soreness in the muscles of the
part  when he attempts to move.
   In some cases there  is an unusual dull, hea-
vy pain at the stomach.
   This symptom was  very distressing to me
in this fever.   At times my distress from this
cause was so  great that it was with much dif-
ficulty I could get  my breath.
   It appeared to me,  from the sensation,  as
if a  cord was  fastened to the vertebrae, and,
passing  up thro' my body, passing out at the
inferior end of the sternum ; and  that a per-
son was standing on my breast  and pulling
up by this cord. 
5
  A painful sensation of fullness is felt in the
abdomen, and especially in the region of the
liver ;  with a pressure upward against the
diaphragm, so as to render sitting very unea-

  A  costive  habit, dryness  of skin,  and
tongue somewhat furred  with a whitish coat,
was observable.
  Pain in the  loins and inferior  extremities,
was generally  complained of.
  The pulse in general full and strong.
  In the first stage of the fever,  (in general,)
not much pain in  the head, but in  the pro-
gress of the fever, there was some pain of the
head, attended with a loss of memory and diz-
ziness.
  In  many  instances,  high  inflammatory
symptoms, so as to render repeated bleeding
necessary.
  In one  instance,  I was obliged to  take a-
bout three pounds of blood in the course of
two days,  before these symptoms gave way.
  Urine in small quantity,  and very high col-
oured, of a redish yellow.
  In all the cases I have met with, there was
evidently an inflammatory diathesis.
  In those cases  where I took blood, it exhib-
ited an inflammatory buff, similar to what ap-
pears in blood drawn in a  pleurisy.
  In  some  cases, there was  a remarkable
constipated state of the bowels, requiring the 
6
same powerful means to obviate it as is neces-
sary in a bilious colic.
  In one of these cases, the medicines not op-
erating in due season,  and my  patient being
in great distress, I recollected what that true
student of nature, Dr. Rush, had observed
upon a similar point, and finding that my pa-
tient's pulse would admit of the loss of blood,
I immediately opened  a vein, and while the
blood  was running  he called  for the  close
stool, and had a large and free discharge from
his  bowels, which gave him immediate relief:
and the medicine then had such a thorough
operation as to effect a complete cure, although
it was the first dose he had taken.

          METHOD  OF CURE.
  As to this, as far as I have been able to ob-
tain information, I expect that there has  been
a great difference in  opinion among the phy-
sicians of this city, with regard to the  treat-
ment of this disease.
  I understand  that some  have  placed  their
dependence on the free use of mercury,so as to
produce a full and free salivation, and this con-
tinued to a great degree, &c.   But as  to the
success of this practice, and its  consequences,
I leave for others to  decide upon, since, ac-
cording  to my ideas of the  nature  of this dis-
card, this practice did not appear to me to be
indicated. 
                     7

  Not having had an opportunity of knowing
precisely the opi. ions of  other physicians as
to the nature of this fever, and their mode of
treatment, I shall confine myself to the meth-
od I have adopted, with my reasons for so do-
ing, together with its effects.
  I  have long been  of opinion, that nature
does point out by certain characteristic symp-
toms, in all diseases", the part, or parts affected,
and the nature  and extent of that  affection;
together with the method of treatment most
proper for her relief.
  I do not say, that all diseases are curable :
but experience has  already proved that many
diseases have become curable, which had been
thought incurable in ages past.
  I am therefore led to believe that no disease
is necessarily incurable :  but am very willing
to suppose that many prove ->o, in consequence
of the imperfection of the medical art. Hence
I think that this should be  the physician's
motto,  viz. " Nature is the Guide.'''
  If, therefore,  after  all  the advantages we
may have had  as physicians, in our medical
studies, in knowing the opinions of both dead
and living authors,  if we  a. e not able, in some
measure, independent of other men's opinions,
to read and understand  the  book of Nature
for  ourselves ; that is, at the bed side, to com-
prehend, and understand,  by the characters,
or symptoms nature there exhibits, and in con- 
8
sequence of this  be enabled to administer by
prescribing for  the  symptoms, instead of the
name of a disease, and in this way in subser-
vience to nature afford relief;  I fear it will not
be in our power to do much good to our pa-
tients, or add much to the common stock of
real medical knowledge, for the good  of so-
ciety, or the benefit of  those who may come
after us.
  There are two things which stand in the
way  of mankind's acquiring true and useful
knowledge, viz. indolence, and credulity. Yet
many are fond of being thought wise men, and
for this purpose clothe themselves with a fine
borrowed dress, and, like the butteifly, sport
in the rays of the sun, in order to dazzle the
eves of the multitude;  but, when weighed in
the balance of true merit, they are found want-
ing, and like the meteor, soon sink in night :
having been too indolent to descend into the
shade of the valley and there to have pursued
nature in her humble path,  for the purpose of
obtaining truth and real science for themselves.
But rather being  willing to indulge their cre-
dulity and receive for facts what they  have
gotten by  rote,  and  thus imagine themselves
very wise, and learned, in being able to retail
what other men have known, and said, instead
of making this only, a foundation on which to
raise the superstructure for  themselves,  from
th ir own experience, observation, and know-
ledge. 
9
  My particular attention having been called
to the phenomena attending this fever as above
recited, it appeared evident to me, that there
was  a congestion of blood in  the  abdominal
viscera.
  When we consider  the severity of the last
winter, the coldness of the spring, together
with the cold rainy season immediately prece-
ding the commencement of this fever; and I
might add the conformity of dress  to  the sea-
son of the year, rather than to the state of the
weather :  all these circumstances tending to
check perspiration and prevent a free  circula-
tion of blood to the surface  of the body :  fur-
thermore,agreeable to the law of fluids; which
press in every direction equally where the re-
sistance is the same; yet if there is a resistance
in one part, and less in another, fluids will be
congested where there is the least resistance*
  There was a remarkable sensation of fulness
in the abdomen which gave the patient much
uneasiness.
  Although  there was  also a costive habit,
this symptom did not altogether depend on
that circumstance ; for in many instances, al-
though the bowels had been freely evacuated,
this symptom was  not  relieved until blood
was freely taken, although there  was no fixed
pain in any particular part.
  This point may be further elucidated by ad-
verting to the anatomy of the parts, and  the 
10
economy  of nature.   " The branches of the
cceliac and mesenteric arteries distribute their
contents to the stomach,  intestines, pancreas,
and spleen, besides the hepatic artery which
supplies the liver with blood for its nourish-
ment.   The  blood  circulating through   all
these viscera excepting the  liver, being re-
turned by their respective veins, is poured in-
to their common trunk, the  vena portarum ;
thus the origin of the vena portarum appears
to consist in the concurrence of all the veins
of the peritonseal viscera except  the liver."*
If therefore  there existed any  obstruction in
the liver to  prevent the  free return of blood
from those parts to the heart, the consequence
must be a congestion of blood in the abdom-
inal  viscera.   From the phenomena attending
this  fever, that appeared evidently to me to be
the fact.
   The  peculiar anatomy of the liver, with its
secretions, and  excretions,  together with the
qualities, the use, and the importance of the
bile in  the animal economy ;  and the effect
of a disordered state of the liver,  on the  rest
of the body, and especially on the rest of the
glandular system; appears to me to have been
too much overlooked in the doctrine of dis-
eases in general.
   That there was a congestion of blood in the
abdominal viscera, is  further evinced by the
            * See Saunders on the Liver. 
.11
 discharge of  blood from  the bowels, which
 took place in  some cases which appeared to be
 critical, giving  relief to the patient, although
 the quantity was so great as to cause  serious
 apprehensions that the patient would sink un-
 der the loss of so much blood.
   I think however I am correct in saying that
 this  symptom only made its  appearance in
 some full habits where  there  had not been
 sufficient evacuations from the bowels and the
 vessels not having been relieved by bleeding.
   A constipated state of the bowels was anoth-
 er symptom which claimed peculiar attention
 in this disease.
   When  food is taken  into the stomach and
 digestion has  taken place, it passes the pylorus
 and enters the duodenum,  at which place the
 chyle begins to be taken up by the lacteal ves-
 sels,  to be conveyed into  the receptaculum
 chyli, and from thence conveyed  by the tho-
 racic duct into the left  subclavian vein to be
 mixed with the circulating mass of blood.
  Now a certain time will be  necessary  for
 the  lacteals to perform  this office after every
meal.
  It then will follow that if there  is a morbid
excitement as to the peristaltic motion  of the
intestines, their contents will be too suddenly
evacuated, hence a part of the chyle will  be
discharged with  the excrementitious part, and
the system deprived of that proportion of nour- 
12
ishment it otherwise might  have had.   On
the other  hand, if the peristaltic motion of the
intestines be retarded,  and what nature  de-
signed as  excrement  be too  long retained in
the intestines,  the lacteal  vessels con inning
their  action ;  a  portion of  excrementitious
matter will be taken up  and conveyed into the
circulating mass of blood,  which will act as a
poison, and produce  a disturbance to nature,
and prove a source of irritation and fever.
   This is not the only  thing to be taken into
consideration ;  for it is evident to reason, that
if excrement be retained too long in the intes-
tines, there  will be a congestion of morbid
matter, which will not  only  act as  a septic
poison, but as an  extraneous  body producing
uneasiness and disturbance  throughout  the
whole system.
   From the symptoms  above enumerated it
was  evident to me that there was a want of
action in the glandular system in general, and
especially  of the  liver :  for, although  there
was some bile secreted  in  the liver,  it was a
morbid secretion, which did not  possess heal-
thy qualities, hence there was a want of healthy
and natural stimulus to promote  a regular pe-
ristaltic motion of the  intestines, so that the
bowels might evacuate their  contents in due
season.   r\or is  this the only important use
of the bile.
  From experiments  it   is found to possess
powerful antiseptic qualities,  it is therefore of 
13
the greatest consequence to our health  and
well being, in order to correct the septic  acid
in the  intestines  from which arises  most of
those distressing  pains of the bowels in the
colic, dysentery, cholera morbus, and in ma-
ny other diseases.  This septic  acid is the
natural consequence of the process of diges-
tion of our aliment: hence it is, that in a  state
of health, that when the stomach is filled  with
food, it presses the liver and gall bladder, pro-
curing a discharge of both cystic, and hepatic
bile, to be poured into the  duodenum to be
mixed with the digested  matter, as well as to
flow round it to  give  the natural stimulus  to
the bowels and keep up the  peristaltic motion
of the  intestines.
  The bile in its  healthy  state contains a gum-
my, resinous and bitter substance, together
with a  saponacious and  alkaline quality,  and
may be considered as nature's physic.   (See
Saunders on  the liver.)  From these consid-
erations we find the bile of much consequence
in the animal economy :  therefore,  instead
of considering it  as our enemy, we may think
it one of our best friends, without which  we
cannot possess that most invaluable blessing,
health of body.   If this  doctrine  be true,  we
may perceive the folly of searching the Mate-
ria Medica for medicines to destroy the  bile,
since the very diseases  these medicines  are
designed to cure, arise from a want of a  suffi- 
14
cient quantity of healthy bile for the purposes
above stated.
  There is one thing more however respect-
ing the use of the bile which is worthy of no-
tice.
  The bile in its healthy  state, and in due
quantity, renders the excrements soluble, sim-
ilar to what we see  to be the  effect  of good
yeast mixed with flour and water in  the pro-
cess of making bread: and any person of ob-
servation may judge of the healthy state of his
liver, and of its secretions, and excretions from
this circumstance.
  I have for many years been of opinion that
the liver  in some way or other must take the
lead of, and govern the rest of the glands, and
also the lymphatic system.  One reason a-
mong many others  was. that in  cases where
mercury was given  so as powerfully to excite
the salivary glands, yet it  did not relieve ob-
structions of the liver :   but on the other
hand, where there were obstructions of the liv-
er,  accompanied  with a torpid state of the
glandular system, by removing the  obstruc-
tions of  the  liver, the rest of the glandular,
and even the lymphatic systems, yielded their
consent.   This observation then  will serve
in some measure as a reason for my objecting
to producing a salivation in the  disease un-
der  consideration  especially ;   as  well as in
all others where there exists any  obstruction 
15
 of the liver: for it  is making use of second-
 ary, and insufficient means,  instead of those
 which will  effect the object at once, not to
 mention the painful situation a  person must
 be in, to go through a course of  salivation ;
 and in many instances its  very disagreeable
 effects.
   From the symptoms and facts above enu-
 merated it was evident to me that  there was a
 torpid state of the liver, hence a deficiency in
 its secretions and  excretions, also attended
 with some degree of tumefaction, and  a  v t it
 of a sufficient quantity of healthy bile convey-
 ed into the duodenum in order to keep ip t ic
 peristaltic  motion of the intestines,  so t'ut
 the  bowels might evacuate their contents  in
 due season.
   From hence, therefore, I suppose that a cos-
 tive habit was necessarily the consequence.
   As above  stated  when the symptom^  re-
 quired it, I took blood.   I then gave  calomel
 ppt:  gr. 20 and vitr :  cerat: antim: gr. 10,
 directing my patients to drink freely of  tain
 water-gruel  during its  operation.    The.^e
 medicines I  have been in the habit of using
in this manner about fourteen years.  I Wts
 first led to their use from my own reasoning
 with respect to their effects  when given sepa-
 rately, and from hence I concluded by uniting
 such valuable medicines much benefi: mi^ht
 be derived;  the trial has not disappointed my 
16
expectation.  I know not if any other physi-
cians have made the same trial of these medi-
cines  thus  united, except a few  to whom I
have made the communication.
  My experience of the efficacy of these med-
icines therefore dictated  my  using them  in
this disease.
  This dose generally operated freely by pu-
king and also by purging.
  The matter  thrown off the stomach was
green and  slimy,  resembling frog spawn at
first, but in many instances towards the last
of the operation they  threw up yellow bile ;
which I suppose was  brought from the liver
in the act of puking.  For wherever I saw
this take place, I found  those symptoms of
glandular obstruction to give way and my pa-
tients found great relief.  The matter also e-
vacuated from the bowels was of a dark bottle
green colour, and in  some instances almost
black.
  Jn many  cases where this dose  had a thor-
ough effect, so as to discharge yellow bile from
the stomach ; and also keep up the discharge
from the bowels until  the appearance  of the
stools was changed from b dark  green, to that of
a yellow appearance,  one single dose would
perform the cure.
  This was the case  with  myself, the dose
puked me about 12 times *vith a great deal  of
ease, and at last I threw off yellow bile from 
17
my stomach ;  it then operated as a cathartic
16 or 17 times until the discharge  from the
bowels also changed to a yellow colour.   I
then got complete relief and really felt strong-
er and better able to perform any exercise than
I did before I took the medicine, and was able
to go out  and to attend to my business.
   At evening after giving this dose I directed
my patients to bathe  their  feet and  legs in
warm soap suds, and if any pain in  the  head
to apply sinap'r ms to the feet, and drink free-
ly of some cooling drink, as baum tea.
   If much fever I gave powders of sal Nitre
and  Tart: Antim :  every two hours in the
above tea.
   If the first dose however was not thus thor-
ough in it^ nperation, I gave another the next
day ; and  I found  by observation that it was
necessary  to increase the second dose notwith-
standing the first dose had operated considera-
ble freel\.   For  I found more difficulty in pro-
curing a free discharge from the  bowels after-
wards, in  case the  first dose did not produce
the thorough  effect  above  mentioned ;  and
where this was the case, in consequence of an
increased  insensibility, and want of  action in
the glandular system, and of the intestines : I
gave (as  recommended by Dr. Rush in the
yellow fever) jalap and calomel gr. 10 of each
every two hours until a free and thorough dis- 
18
charge was produced, and until there was an
evident appearance of yellow bile.
   The sooner this could be effected the bet-
ter, and until this was  done, nothing was ef-
fected to any purpose.
   I have never found any disease (in the course
of almost thirty years practice) which requir-
ed more free and thorough evacuations than in
this fever.
  After this  point was gained the fever with
all its symptoms  easily  yielded to the com-
mon  antiphlogistic treatment.  Although it
continued  in many  cases,  more or less un-
til the fourteenth day,  at which  time a crisis
generally took place.
  In  some cases where  there had  been  the
greatest difficulty  in  procuring a free evacu-
ation  from the bowels ;  at or about the time
of the usual  crisis  a very  considerable dis-
charge of blood by stool took place attended
with dysenteric symptoms ; this circumstance
was alarming to the patient and friends :  how-
ever from  observation,  I was convinced that
it proceeded  from a plethoric  state of the ab-
dominal viscera, together wi-.h a constipated
state  of the bowels, and in not  having been
able to procure a thorough  discharge soon e-
nough as above  hinted.    I therefore gave lax-
ative  medicines and directed the free use of
glysters of mutton  broth, and flannel cloths
wet in brandy applied  to the  bowels ;  which
soon had the desired effect  of giving relief. 
19
   After the crisis had taken place I found one
thing worthy of remark,  viz.  that uniformly
patients could take neither the bark nor wine ;
but received  great benefit from weak brandy
and water  (the brandy however was of the
best kind ;) and from a decoction of a small yel-
low root which grows in cold wet land, com-
monly -known  by  the name of gold thread.
This  for several years I have made use of,
and found it a very  excellent tonic in many
cases. The patients (generally) soon got an ap-
petite for  food, and in the  course of a few
days  recovered their strength and  spirits:
and to use their own words " much better
health than usual."
   I have continued this simple mode of treat-
ment  through the season to this time, having
found no occasion to alter it, being so fortu-
nate as not to have lost a single patient of this
disease.   The number of  cases which has
fallen under my care has  been seventy-six.
   Albany, January 1, 1810. 
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