ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 Section.. Number J.QQJO Fobm 113c, W. D., S. G. O. »• 3—10543 (Revised June 13, 1936) YELLOW FEVER HOMEOPATHIC TREATMENT. i WM. H. IIOLCOMBE, M.D., WATERPROOF. LA. ASSOCIATE EDITOR OF THE NORTH AMERICAN HOM030PATHIC JOURNAL ; LATE ASSOCIATE PHYSICIAN TO THE MISSISSIPPI STATE HOSPITAL, NATCHEZ; AUTHOR OF THE "SCIENTIFIC BASIS OF HOMff.OPATHY," &C. i I M 11.1 A , SIM1LIBUS CURANTPR HcMarfer PUBLISHED BY WILLIAM It A DDE, 3 2 2 BROADWAY. Philadelphia: Rademachkr t specially related to yellow-fever. A medicine which is capable of producing almost the entire group of yellow-fever svmptoms of the second stage, must have a mode of action remarkably similar to that of the disease itself; and it is of that undiscovered, and perhaps undiscoverable mode of action, that the homoeopath, in accordance with his curative law, wishes to avail himself. In looking for a complemental medicine, to alternate with Arsenic, in order to fill up the morbid picture, we keep it in view, that it must be capable, chemically or otherwise, of 38 DR. HOLCOMBE ON deteriorating and devitalizing the blood, so as to give rises to hemorrhages and extravasation, aud render it unfit for the nutritive demands of the nervous system. No poisons, animal, vegetable, or mineral, do this more uniformly and effectually than the virus of serpents. With some of these poisons, par- ticularly Crotalus and Lachesis, we have been made tolerably well acquainted, through the zealous and useful labors of Dr. Constantlne Hering. They are remarkably similar in their action, like the isomorphous substances in Dr. Blake's interest- ing experiments. We chose the Lachesis, and the results were so satisfactory, that Crotalus was only used tentatively in one or two hopeless cases. I have no doubt, however, that the Crotalus would answer the same uses. I employed the fourth trituration of Arsenic, and the fifth of Lachesis, alternating. them, at intervals of an hour. Some few doubts I had enter- tained about the therapeutic value of Lachesis were dissipated by the powerful efficacy of these remedies, in many severe, and some desperate cases of yellow-fever. When Belladonna and Arsenic produced no amelioration, a change to Arsenic and Lachesis brought about the desired amendment. These remedies sufficed for very many severe cases of yellow- fever, but occasional symptoms arose from the idiosyncrasy of the individual or the peculiarity of the case, which called for other remedies. Veratrum was very useful in allaying the vomiting and abdominal pains. Tartar-emetic succeeded, promptly, in some cases of prolonged and distressing nausea. Chamomilla did more for this gastric irritability than its rather mild pathogenesis would lead us to expect, particularly in the cases of women and children. Mustard-plasters to the epigastrium, and cold enemata were also used as palliatives for the nausea and vomiting. Very hot fomentations fre- quently diminished the excruciating pains in the bowels. When diarrhoea or dysenteric symptoms supervened, Mer- curius, Phosphorus, or Colocynth relieved them readily. Can- tharides scarcely ever failed to remove strangury, and restore the renal secretions, in conjunction with Arsenic. Nux-vo- mica was freely employed, as an adjuvant in persons much addicted to alcoholic liquors. Chamomilla, Sabina, or Secale generally caused the symptoms of threatened abortion to dis- EPIDEMIC YELLOW-FEVER. 39 appear. When the strong characteristics of yellow-fever gra- dually subsided, leaving the system prostrated and torpid, Rhus and Bryonia were used with good effect. Belladonna, Cqffea and Ilyosciamus were sometimes indicated at night for nervous sleeplessness. Millefolium was used in one case of abundant haemorrhage from the mouth—and whether it was a coincidence or a cure—the bloody discharge was almost im- mediately checked. Some of our ultra Hahnemannian breth- ren may find fault with us for using such low dilutions repeat- ing them so frequently, and sometimes employing three re- medies in quick succession. But the malignity and rapidity of the disease, the diversity and frequent incongruity of the symptoms, their Protean forms and treacherous character, warranted us in active and decisive measure's. Homoeopathic aggravation under such circumstances, is very little to be ap- prehended, foreshadowing as it does a curative result. A resort to the higher dilutions—6th, 12th, or 30th—after the lower had failed, was attended, in some cases, with the hap- piest effect. If the above remedies proved inefficacious; if the patient sank; if the vomiting became worse, with brownish stains in the matters ejected, or any of those various hues which indi- cated haemorrhage from the gastric mucous membrane, Nitrate of Silver was the remedy, conjoined with Arsenic and Lachesis. A reference to Jahr's Manual will show the extensive appli- cability of this substance to yellow-fever. We made a first and second centesimal trituration—all of which we used— and as the latter did just as well as the former, perhaps better, I infer that the action, like that of Arsenic, was not topically stimulant, but dynamic. Indeed, what stimulus, in the allo- pathic sense of the word, can the one ten-thousandth of a grain of Nitrate of Silver dissolved in half a tumbler of water, and administered in tea-spoonful doses, give to the whole gastric mucous membrane? A much more curative one, I venture to say, than the same remedy would have made in larger doses. As it was, the medicine frequently aggravated; and one pa- tient complained bitterly of the nausea it produced. In her case, this remedy, with Lachesis, arrested all the dangerous symptoms, the prominent of which was vomiting of a brownish 40 DR. HOLCOMBE ON fluid, mixed with specks of pure coffeejground matter. If no improvement was produced by these agents, the case was considered hopeless. One negro woman lived a week after black vomit, apparently, but not permanently rallied by Ni- trate of Silver, Carbo-vegetdbilis and Eydrocianic-acid. Strict attention was paid to diet; a point of vast importance in managing the diseases of the blood-making apparatus. Arrow-root, rice-water, and black tea, with a little sugar and milk in it, were the standard articles for the first stage. During the second stage, the canine hunger was sometimes distressing; but besides the above nutriment, we seldom permitted any thing but a tea-spoonful of pure crean\, at regular intervals. Ice was allowed, in moderate quantities, for the thirst. During convalescence, the slightest imprudence in eating was apt to induce relapse. I have seen toasted bread, chicken-broth, soft- boiled eggs, &c, decidedly injurious. When the patient is able to pass from the farinaceous articles to something more nutritive, he may be permitted, at once, to chew pieces of good beef-steak. This is much better than beef-tea, because the act of mastication extracts the saliva, and incorporates it with the animal juice, thereby facilitating its digestion. Alcoholic stimulants were seldom given during the disease, or recom- mended to promote more rapid recovery. Confirmed topers, however, were permitted to use small quantities of their fa- vorate beverages during the latter stages of the disease. v. RESULTS. I treated 140 cases of yellow-fever between the 13th of August and the 15th of December, 1853. None of them were cases of ephemeral sickness—nothing but unequivocal, strong- ly-marked yellow-fever was admitted into the list. Of this number, 71 were white, and 69 colored; of the colored, 39 were blacks and 30 mulattoes. The adults were 93 ; children, 47; cases in town, 111; cases in the country, 29. Males, 60; females, 80. At least one-half of the cases were very severe, the patient being for several days in a critical and dangerous situation. Of the 140 cases, 9 died. Of these, 6 were treated homceopathically by me from the beginning; 3 came into my hands on the 4th or 5th day of the disease, 2 of them EPIDEMIC YELLOW-FEVER. 41 having employed allopathic measures. Of the six treated with pure homoeopathy from the beginning, one case was com- plicated with abortion and profuse haemorrhage; another, a cachectic negro, died six weeks after the day of attack, in a typhoid condition—the sequel of yellow-fever. Dr. F. A. W. Davis, the able pioneer of Homoeopathy in this region, treated 415 cases, with 24 deaths.* The combined result of our practice was, therefore, 555 cases and 33 deaths: a mortality of 1 in 16.87, or 5.94 per-cent. Of Dr. Davis' cases, 5 recovered after pure black vomit—4 children and 1 adult. Occasional recoveries after black vomit have been re- corded by almost every allopathic writer of any repute, but as nothing of the kind transpired here under allopathic practice during the late epidemic, the restoration to health after such circumstances was ignorantly and presumptuously pronounced an impossibility by the opponents of Kational Medicine. It is both just and proper for me, in this place, to express my obliga- tion to Dr. Davis for many practical and valuable suggestions in the treatment of this formidable disease, with which the epi- demic of 1837 and 1839 had made him intimately acquainted. He presents the rare spectacle of a medical man, whd had acquired a large fortune and wide reputation by the practice of one system, becoming in the middle period of his life a convert to another, and sacrificing the repose to which his wishes and his circumstances invited him, to withstand the odium and misrepresentation which always accompany the propagation of truth. It is impossible to get any satisfactory statistics which could enable me to compare impartially our results with those of allopathic practice. It is certain that there were at least 430 interments in and immediately about Natchez, besides those which died under our hands, which, divided among 8 practis- ing allopaths, would give the average of 52| for each. But to come m< >re closely ; there were 320 deaths by yellow-fever reported (many who died were not officially reported at all) by allopathic physicians, making an average of 40 deaths under each. It is very difficult to estimate the actual number of cases which occurred. The census taken during the epi- demic showed 3416 people to have remained in town. But to 42 DR. HOLCOMBE ON prove the allopathic treatment barely equal to the homoeopa- thic, there must have been 5S00 cases in the community. It is altogether improbable that more than half that number oc- curred within the circle from which the mortuary report was made. The allopathic report' of the sporadic cases which oc- curred this year in Philadelphia acknowledged a mortality of 75 per-cent. And it is perfectly evident that the average allopathic loss at New-Orleans must have been from 20 to 30 percent. The triumphant manner in which Homoeopathy has passed through this severe ordeal had made a lasting im- pression upon the South-west. This, however, is but "the beginning of the end." Every successive epidemic will re- veal the truth and superiority of the system in clearer light. And when at last its practice becomes universal, as it must and will, an invasion of yellow-fever will not drive the popu- lation from their homes nor'disturb the commercial prosperi- ty of the country. Note.—For the greater convenience of our readers, wTe have tabulated the results of Dr. Ilolcombe's experience in yellow- fever, and have added, side by side, the results of the late Epidemic in Philadelphia, as reported in the New-York Jour- nal of Medicine, (Yol. 12, p. 149:) Children Adults. Males. 60 25 Females. Total. Deaths. Per cent. Dr. Holcombe, (hom.) Dr. Davis, (hom.) Dr. Jewell, (allop.) 47 9 93 35 80 19 140 415 44 9 21 31 643 5 73 7727 We are far from desiring to maintain, that this tremendous disproportion truly represents the relative success of the two schools. The cases in Philadelphia, collected by Dr. Jewell, were from the lower orders, and subjected to unfavorable hy- gienic conditions ; but let any man of fair reasoning faculties and moderate experience, compare the treatment of the two schools, and say, whether the difference there discovered may not account for a great part of the difference in the mortality- tables. "The treatment generally pursued," says Dr. Jewell (1<>c. cit.) "in the first stage, was blood-letting from the arms, and / EPDDEMIC YELLOW-FEVER. 43 by cups to the back and abdomen, emetics, mercurial purges, diaphoretics, &c. In the second stage, or as soon as a remis- sion took place, which was generally the third or fourth day from the attack, calomel as a sialagogue was administered in some cases; in others Quinia, in three or five-grain doses, every one or two hours. If reaction was not prompt, brandy or wine internally, and local stimulating applications by blisters and rubefacients were resorted to. Quinia in full doses on the first intimation of a remission from fever, appears to have been a favorite remedy. In some cases over seventy grains were administered daily for several days, and, as far as we could learn, without any annoyance to the brain or other or- gan, (!) but with advantage. In Blockley Hospital, cases were treated without Quinia in any stage of the disease ; Ca- lomel pushed to salivation, was the principal remedy em- ployed." Blood-letting, emetics, mercurial purges, diaphoretics, qui- nine, salivation, and last of all, the formidable &c.! No one with the least homoeopathic experience can doubt, but that yellow-fever, on proper trial, would be added to the list of those diseases, in which, as in the case of pneumonia, a greater number of patients would survive, and in a better condition, left to nature alone, than subjected to the pernicious scienti- fic guesswork of allopathic medicine. Ed. Profiting by the sad experience of 1853, the citizens of Natchez very early in the ensuing year instituted a rigid quarantine. The fever appeared at New-Orleans and gradually advanced up the river, invading several places above Natchez— Vicksburg particularly—but our little city was spared an epi- demic visitation. This exemption was attributed by the con- tagionists to the efficient administration of the quarantine restrictions by the health-officer, Dr. L. P. Blackburn, who received and deserved some very flattering testimonials of public gratitude. Nevertheless, a few cases of yellow fever did occur in Natchez in 1854, if the experience of several old and able physicians is truthworthy in the diagnosis of a disease, with which they have had many melancholy opportunities of growing familiar. One of these cases was my own; and as the case itself and the attending circumstances possess a certain medical 44 DR. H0LC0MBE ON interest, I shall be excused for dwelling briefly upon the subject. i Whether the other cases, reported by Drs. Stone and Lyle, originated in Natchez or elsewhere, whether they were pure yellow fever or not, I cannot pretend to determine : I have nothing to give my reader but the positive, although perhaps partial and meagre, results of my own observation and ex- perience. Natchez was remarkably healthy during the summer and fall Fevers, remittent and intermittent, were rare, and all that oc- curred, were of the mildest character. In September, I was called to a plantation on the Louisiana side, six miles below Natchez, where, the overseer stated, a peculiar fever and entirely new to him was prevailing amongst the negroes. He thought it was emi- nently contagious: none of the negroes had left the plantation within the knowledge of the overseer, so that either the disease had a local origin on the place, or had been contracted from some steamboat, flatboat or raft, which they might have visited se- cretly for trading or other purposes. Bedding, on which yellow fever patients have died, their clothing, &c, are frequently thrown overboard, and some of these articles may have been picked up and used by the first invalid, but no absolute fact was elicited to account for the sudden appearance of the disease. It spread rapidly amongst the people, so that in the course of a month there were between 110 and 120 cases. One white person, residing on the place (there were but two who remained), had yellow fever, fully and clearly developed, haemorrhage from the gums, brown-vomit, jaundice, sleeplessness, jactitation and all the usual symptoms. The negro cases were almost all mild. The fever lasted from forty-eight to seventy-two hours and con- valescence proceeded promptly. In eight or ten of them, how- ever, the disappearance of fever was followed by gastric irrita- bility, haemorrhages, and all the asthenic signs of the second stage of yellow fever. There was no death, but two cases of a similar disease occurring later on an adjoining estate and treated allopathically, both died, one of them with unequivocal black vomit. Drs. Davis and Foster visited the plantation with me, and we all three concurred in pronouncing the disease a mild yellow fever. Allopathic incredulity ran high at the report of so many yel- EPIDEMIC YELLOW-FEVER. 45 low fever cases, and mortality reduced to zero. It was in vain, that I cited the literature of many very mild epidemics of the disease in question. Lefoulon, who in a West-Indian epidemic lost but 4 in 400. Dr. Hastings (U. S. Navy), who treated 300 cases, on the coast of Mexico, without one death. Mr. Nagle, of the Royal Navy, who treated 120 cases with but two deaths. Mr. Wilson, of the same, who did not lose one in 83 attacked. Prof. Potter, of Baltimore, who had 400 cases and five deaths. Dr. Walkly, of Mobile, who reported ten deaths out of 336, and many other instances. It was in vain, that I reminded the cavillers that the African race very readily resists the febrile diseases, and that the worst epidemics have often made very little havoc amongst negroes. All evidence was scouted, and the more illiberal of our opponents believed, or affected to believe that the yellow fever christening of the disease was gotten up by Dr. Davis and myself for the benefit of Homoeopathy in general, and of ourselves in particular. The speedy occurrence of my own violent atta-ck at length staggered the obstinacy of those who were still pervious to rational impressions. My case was no doubt rendered so much more severe than the others by my having slept in the low or swamp lands several nights, whilst the disease was in its stage of incubation. In ordinary times I might have contracted bilious remittent, but as it was unequivocal yellow fever, it was additional and confirmatory evi- dence of the correctness of our diagnosis of the epidemic pre- vailing on the plantation. I was attacked by chilly sensations, spinal rigors and head- ache, almost instantaneously at eleven o'clock at night, whilst reading, having experienced for several hours before an unusual exhilaration of spirits, wakefulness and inclination to study, although laboring under muscular fatigue from the arduous duties of the day. Next morning I was in high fever, burning hot, with red eyes, and cerebral pain and oppression amounting al- most to stupor. The pain in the back was almost insupportable and there was great restlessness. . This state continued for forty-eight hours or more without any amelioration. I slept only by snatches and would occasionally start up from a doze to a sitting position in the bed. My mental faculties were sluggish but unimpaired, and I was perfectly aware all through it of the 46 DR. H0LC0MBE ON precise status of my disease. The pulse averged 120 all the time, perspiration was partial and brought no relief, bowels con- stipated, urine very profusely secreted, indicating as it usually does a morbid impression upon the nervous system. On the third evening the febrile symptoms disappeared, pulse sank to 80, soft and compressible, skin perspiring moderately, no pain, no uneasiness, but very wakeful. On the fourth morning I hawked up bloody mucus and there was slight haemorrhage from the gums for several days afterwards. Four stools now occurred, without pain, consisting of dark venous blood, amounting in all to about a quart. I got up to the vessel each time, although it produced temporary vertigo and blindness. This was very im- prudent, and I would never have permitted it in a patient. At near night-fall I vomited, suddenly, with scarcely any previous nausea, watery mucus containing some ominous streaks of brownish blood. The urine now became scanty and black as porter, and was voided with great pain and difficulty. This symptom annoyed me more than any other in the whole course of the disease. On the fifth morning I felt perfectly well, but weak; and was con- gratulating myself on my favorable sensations, when deadly nausea seized me and in almost a second, I ejected quite forcibly a considerable quantity of brown-vomit. A portion of it was taken by a friend to Dr. Stone, who tested it aid pronounced it to be the peculiar matter thrown from the stomach in severe cases of yellow fever. At this time one unacquainted with yel- low fever would have found it difficult to have comprehended the grounds of the unfavorable prognosis which a connoisseur like Dr. Davis would make. A patient lying perfectly free of pain, with abundant perspiration, moist tongue, entirely natural pulse and even some appetite, to be perhaps within a few hours of death, appears almost incredible ! but many thousands of cases just like that I have described, have glided off rapidly into delirium, coma, black vomit, convulsions and dissolution. For- tunately, my downward momentum was checked, no more vomit- ing occurred, I slept tolerably that night, and was pronounced out of danger next morning. My mouth was in a horribly dry, bleeding, fetid condition and my great emaciation and exhaustion just began to be perceived and felt during convalescence. The EPIDEMIC YELLOW-FEVER. 47 bowels were not moved for eight or ten days, but then they seemed in a perfectly healthy state. My improvement seemed to me exceedingly tardy, and severe pains in the joints followed me for a month or two. Instead of the slow pulse I have fre- quently met with after this disease (even down to 40,) my heart became very irritable and the pulsations ranged from 100 to 120 for six weeks or two months. I made, however, a perfect re- covery, and the disease left me with no functional derangement or organic lesion. The diagnosis of yellow fever is occasionally difficult, when it assumes a remittent or more rarely, an intermittent type, or when, as sometimes occurs, there is no febrile paroxysm in its first stage, and no haemorrhagic tendency in the second. But whenever a febrile paroxysm is followed by a perfect lull of the symptoms and by the subsequent appearance of jaundice, haemor- rhages, gastric irritability, suppression of urine, or at least dy- suria, and a general asthenic condition, the existence of yellow fever becomes an unquestionable fact. Such was my case ; and it was reported to the health-officer in legal form as a case of yellow fever. That gentleman, instead of visiting me and satis- fying his medical senses of my true condition, inserted a card in the public papers, denying that a single case of yellow fever existed in Natchez, and backed his assertion that mine was not yellow fever, by the potent argument, that the hundred or more negroes, from whom I contracted my disease, had all re- covered on " homoeopathic nothings ;" statistics totally incre- dible on the supposition that the disease was really yellow fever ! Three allopathic physicians visited me, and two of them, Drs. Stone and Lyle, published a card confirming and re-iterating the true diagnosis of the case. Those gentleman believe, that yel- low fever originates spontaneously in Natchez every year, and probably viewed my case as a proof of it, but the contagionists, by far the stronger party, will concede, that I contracted it on the plantation, and that the 110 or 120 cases there treated, were bona-fide yellow fever. In this case it is an interesting question whether the discharge of a pint or more of venous blood on the fourth day was or was not a critical evacuation which promoted the subsequent recovery. It had not been preceded by any marked symptoms of abdominal 48 DR. HOLCOMBE ON congestion and was not followed by any special improvement, as brown-vomit occurred twelve or sixteen hours after the haemorr- hage had ceased. Authors generally have regarded intestinal haemorrhages as rather dangerous than salutary. We may safely say, however, that if they ever are critical, it is when they occur in the middle of the disease, and cannot be referred to the mere arterial excitement of the first stage, nor to the collapse and ca- pillary paralysis of the last. It is certain that haemorrhages * from the uterus, whether in the shape of abortions or metrorr- hagia are exceedingly ominous of a fatal event; although the appearance of the proper menstrual discharge in usual quantity and character may be hailed as the harbinger of approaching con- valescence, unless other and very unfavorable symptoms are present. There are three or four different states of the urinary organs, all of which I have met with, having different pathological relation- ships and to be carefully discriminated. 1st. Total suppression of the secretion from nervous atony of/the kidneys, a symptom common to Asiatic cholera and the oriental plague in their col- lapsed stage, and which if it persists more than twelve or eigh- teen hours in yellow fever, is almost invariably indicative of a fatal issue. 2d. An inflammatory condition of the renal pa- renchyma, in which we may have albuminous urine, bloody urine, discharges of pure blood, or a retention of urine in the cortical portion, the tubuli uriniferi being blocked up by exudation-matter, preventing its passage into the bladder. 3d. A retention of urine in the bladder from morbid condition of the sphincter and urethra, indicated by urging to urinate without success, or with only the dribbling of a few drops and accompanied by pain about the pubes and along the canal. 4th. Paralytic retention, the organs being all structurally healthy, but the sentient nerves about the sphincter not responding to the usual stimulus. 5th. An immense secretion and discharge of deep yellow, brown or quite black urine, mixed or not with bloody specks and epithelial matter, and clearly eliminative in its character. I have adduced these phenomena not only as forming part of the natural history of yellow fever, but also to illustrate the absolute necessity of thorough pathological knowledge to the Homoeopathic practitioner. In the first class here mentioned he would use such remedies as EPIDEMIC YELLOW-FEVER. 49 Arsenic and Carbo, in the second he would select Belladonna • and Cantharides or Cannabis, in the third he would rely upon Nux-vomica and Pulsatilla or Mercurius, in the fourth he would draw off the liquid by the catheter, and in the fifth he would leave nature to rid the blood of bile, urea, yellow fever-virus and all, by the great emunctory for poisonous substances. When such is our true and just appreciation of pathological knowledge, it is galling to intelligent and honorable men, that the allopathic farrago of guess-work should pass current as medical science, whilst the only rational application of Pathology to Therapeutics is denounced as puerile and visionary. Quarantine was again established at Natchez early in 1855, but it is generally conceded that its execution was not as rigid as it had been the year before. The enforcement indeed was attended with great difficulty. Persons would land below or above th.e city and find their way into it. When the roads were vigilantly watched, they passed through the woods and across the plantations. In August it was rumored that yellow fever was in the city, but our practice presented nothing ap- proximating to it, but cases of mild bilious remittent. In the first two weeks of September we had ten or a dozen cases of yellow fever, all traceable to infection from one gentleman who had re- mained forty-eight hours on the quarantine boat and then came into town. After that the disease became fairly epidemic, and it was impossible to trace the origin of any given case. Such was my limited observation as to its appearance this year, and I neither saw nor heard any thing of trustworthy nature to militate against the theory of direct importation. In No. XII. of the North American Journal of Homoeopathy I presented a monograph upon yellow fever, containing a some- what detailed account if its symptomatology and therapeutics, as it was seen and treated by Dr. Davis and myself in 1853 at Natchez. It is not my purpose in this place to go over the same ground, but rather to give some supplementary experiences de- rived from the observation and practice of last year and the pre- sent. Preferring the latitude of a clinical lecture to the studied form of an essay, I shall narrate two or three cases of consider- able, interest and make such comments as will elucidate important features of the pathology and treatment. 4 50 DR. HOLCOMBE ON Case 1st.—Mr. R. W., aged 38, stout, of bilious temperament, was attacked Monday morning, Sept. 3, with a severe chill.' Nevertheless he walked half a mile to assist some sick friends and I was not called until late in the afternoon. He had been in Baton Rouge, where there was some fever, six weeks before, but the friends he had been nursing had the disease derived from the source above indicated. I found him with intense fever, burning hot skin, pulse 130; face very red, eyes deeply suffused, * pain in the head and back very great, scarcely any in the limbs, occasional nausea, urgent, thirst, and that kind of bronzed, stolid, dejected aspect so ominous in severe tropical fevers, and also in cerebral typhus. I ordered a mustard foot-bath, copious draughts of ice water, and gave Aconite and Belladonna alternately every hour. Sept. 4th.—Patient had spent a restless, sleepless, miserable night although he had perspired freely almost all the time. Fever was reduced, pulse 90, soft and compressible, head and back still aching badly. The tongue was furred white with red edges and a brown dry streak in the centre. The eyes were very much bloodshot, and there was some photophobia. There was slight epigastric tenderness and constant thirst. Put him on Belladonna and Arsenic hourly. Evening of the same day. Pulse had risen to 120, but was not so full and hard as before. The other symptoms were about the same, but he complained bitterly of a pain in the left side just below the heart, not aggravated by respiration. Ordered Arsenic and Bryonia alternately every hour. Sept. 5th.—Morning. Found a decided remission. The pa- tient had slept nearly all night. The skin was soft and moist. Pulse 80. Headache continued, but was less ; pain in the back and limbs entirely gone; injected, muddled state of the eyes unchang- ed ; slight nausea. A cold water injection brought away a copi- ous and natural discharge of faeces. The urine had been all along scanty and high colored. Med. cont. Evening. Fever rose, pulse 100, thirst very great, little pain but quite restless. He was making occasional efforts to vomit and seemed nervous and agitated. I permitted a mustard plaster to the epigastrium and gave Belladonna and Arsenic hourly. EPIDEMIC YELLOW-FEVER. 51 Sept. 6th.—Morning. He slept quite well last night. Pulse 84. No nausea or thirst. Mental faculties sluggish ; face and eyes still injected. Dark sordes about the teeth; offensive breath ; abominal tenderness more marked. I put him on Rhus and Bryonia every two hours to meet the supposed typhoid ten- dencies. Having no reason to suppose that yellow fever.was in town, feeling well assured of the security afforded by quarantine and deceived by the occurrence of distinct remissions and the absence of jaundice, haemorrhages, urinary disturbance and any unusual degree of jactitation and pervigilium, I had mistaken this case for one of severe bilious remittent. But I was called to him about noon because he had twice vomited some glairy matter considerably specked with blood. The gums were bleed- ing a little. He had also hawked up some mouthfuls, of pure blood, as if from some small vessel ruptured in the pharynx or fauces. He expressed himself as feeling perfectly well, but com- plained of eructations, which were intensely acid; I detected yellow fever at once and put him upon Arsenic and Lachesis, every half hour. Before bed-time he passed a small black stool without effort or pain. I left Hyosciamus to be given inter- currently, if he was restless. Sept. 7th, morning. Patient much worse. Skin perspiring freely, with a clammy, sodden feel. No more vomiting or stool, respiration regular and easy, pulse 80 and of good calibre, tongue moist and almost clean. He had rolled from one side of the bed to the other every twenty minutes or half hour during the night, uncomplaining, but muttering a little in his sleep. He still had an acid stomach ; he hiccoughed every few minutes. On asking him if this symptom was painful; he answered, "yes, when it runs on from nine to thirty-five days," with a sardonic smile, the first his face had assumed since his illness. This little evidence of mental incapacity I looked upon as of very bad augury ; Arsenic and Lachesis continued. Noon. Hiccough had ceased, but he was quite restless. His face was brighter and he was more disposed to talk, expressed himself as perfectly easy and confident of recovery. His in- tellectual faculties were however slightly aberrant. He was constantly swallowing or clearing his throat and said that phlegm collected in it. A little molasses-like blood exuded 52 DR. nOLCOMBE ON from the corners of his mouth. The renal secretion was not interrupted, but it remained almost natural, there being no elimi- nation of morbid matter by that channel. He had passed by stool a tablespoonful of very black blood, which became red on exposure out of doors. There was a gurgling sound occasionally proceeding from the abdomen. His fingers and toes were cold. I considered the case as hopeless, but put him on the Nitrate of Silver, in very appreciable doses every half hour. About two o'clock, a lady present asked him if he felt any nausea. He replied "none at all," and the next moment ejected a large quantity of black vomit, with a hiccoughing motion, over the bed-clothes. After that he tried persistently to keep it down, by swallowing it, and the attendants had to wipe it con- stantly away from his mouth and chin. I saw him at four, when he was pulseless and comatose, nearly cold, and tinged deeply yellow. He died at eight o'clock, P. M., in convulsions. An obligatory summons into the country frustrated my intention of making a careful post-mortem. The reader will notice the distinct morning remission of the arterial excitement which occurred in this case. Now was this case originally bilious remittent which became converted into yellow fever, yielding to the epidemic constituton of the atmos- phere, was it yellow fever itself of a remittent type, or was there a coincident action of the two diseases upon the same system ? Those who consider yellow fever as a modified bilious remittent, endemic to this latitude and longitude, will adopt the theory of mutual convertibility, whilst those who regard it as a specific disease, imported from abroad, but engrafted here, with many peculiarities of our own antumnal fevers, would pronounce lihe case yellow fever of remittent type. I cannot undertake to decide between the very high authorities who advocate these re- spective opinions. I can only say that the result of my own study and observation leads me to coincide with the last named party. I have met several cases like the above, and even with cases of yellow fever presenting strong resemblance to severe intermittent, and yielding readily to Quinine, whilst their entire history and course did not leave a doubt on my mind of their specific yellow fever character. This death occurred on the evening of the fifth day, a very EPIDEMIC YELLOW-FEVER. 53 fatal period in the history of yellow fever. The same day was fatal to the late Dr. James D. Bratt, of Waterproof, La., whose post of professional labor I have taken. Unfamiliar with the disease, he mistook the deceptive lull on the third day for be- ginning convalescence and not only quit taking medicine, but very imprudently moved about his room. That night his friends noticed some little mental aberration and summoned me from Natchez. He passed the fourth day comfortably, but complained towards night of acid stomach and passed one or two loose, inky stools. On the fifth morning he vomited a good deal of claret- colored water, and died comatose before night. He experienced no pain or uneasiness after I saw him, but the black stools, the jaundice deepening in large patches, the sluggish, apathetic ex- pression, the acid stomach, the flatulence and borborygmi, the increasing restlessness, with the occasional desire to get up and go out of doors, all made a picture of frightful omen to the ex- perienced eye. And here I feel impelled to pause and pay a brief tribute of respect to his private virtues and his profes- sional worth. Thoroughly trained in his profession and faithful in the discharge of its duties, affectionate and sincere in his character, quiet and unobtrusive in his manners, he had won the respect and cordial support of a generous and intelligent community. In the bloom of youth, in the high road to success and happiness, he was cut down by the angel of death, whilst standing boldly and faithfully at a responsible and dangerous post. He is numbered with that band of zealous homoeopathic pioneers who have advocated the cause of truth against the mighty current of false popular opinion, and have died, in great part misrepresented and misunderstood, leaving their memorial to the tardy justice and applause of better and wiser times. Two other deaths by yellow fever occurred in my practice this year, and about both of them there was something anomalous. An old German who had just lost his wife by yellow fever, was attacked with great severity. If the disease had not been epidemic I would never have suspected him of having it. The case was more like that of a young Swiss I once saw, just landed from the old country, who was attacked with nostalgia, a dreadful home-sickness paralyzing the vital powers, and died in few days of cerebral typhus. The old man had a burning fever 54 DR. II0LC0MBE ON and great restlessless, but there was no other pathological ele- ment apparent in the case. He was constantly wringing his hands, calling on his deceased wife, muttering prayers, or talk- ing about his country. When asked the seat of his pain he would say that he was " heart-sick," " sick all over." He had no jaundice, no haemorrhages, no yellow fever aspect, smell, or urinary difficulties. The fever left him suddenly about the middle of the third night and he died before morning with black vomit. The other case was that of a bright, beautiful little boy, aged three years. I saw him on the second morning of the dis- ease. He had manifested so little sickness that no alarm what- ever was felt about him. He was lying quiet, rational, pulse soft and rapid, skin moist and pleasant. In the afternoon he was nauseated, and I noticed that his pupil was dilated. He vomited a brownish matter and afterwards appeared sleepy and stupid. He died suddenly just about night-fall, having ejected black vomit. This was the most rapid and violent case I ever witnessed. We stand in impotent silence, when asked why a disease which was prevailing around the spot in its mildest form should burst with such concentrated fury upon a bright little creature remarkable for physical and mental development and surrounded by all the comforts and conveniences of life. Cask 2.—Miss E. S., a young lady, aged 15, of fine physical constitution and resident in the country. Her case was the third in the house. The first person attacked had visited an infected house in town, but the case was so mild and so much like common remittent, that yellow fever was not suspected. The second case was severer, but still supposed to be remittent, complicated with a customary violent neuralgic headache. The first case detailed above had just assumed unmistakeable yellow fever symptoms, and I suspected this to be one, when first sum- moned. She had a slight feeling of coldness in the morning of Sept. <6tk, accompanied by considerable pain in the shoulders. Towards noon fever arose. I saw her in the afternoon. The skin was very hot, pulse 120, full and tense, headache and back- ache very severe, tongue furred white, with the characteristic red edges and apex. Her eye3 were reddened and watery, in- deed streaming with tears when exposed to the light. She was EPIDEMIO YELLOW FEVER. 55 very sensitive to sound, restless and sleepless. Prescribed Aco- nite and Belladonna alternately every hour. Sept. 1th, at noon. She had passed a miserable night. Head- ache and backache undiminished. Skin was moist and pleasant; pulse about 100 to the minute. The yellow fever smell strongly marked. Eyes still very red and sensitive. Ordered Bella- donna and Arsenic. I was called to her during the night. All pain had left her, but she complained of deadly nausea. She had vomited some specks of blood in a watery mucus and was very restless. The kidneys and skin were acting well. I put her on Arsenic and Nitrate of Silver alternately every hour. Towards morning she vomited about a pint of dirty-colored water, abundantly flecked with little brown flocculi, floating about like bees' wings, broken up, or dark cob-webs. When the water was drained off, these flocculi would trail as it were against the sides of the basin spread out, and present an exceedingly fine granular ap- pearance and a black color. The patient complained before eject- ing it of a raw, burning sensation down the oesophagus and of a lump in her throat. This last sensation is a very frequent one in severe cases of yellow fever. You are sometimes told that the lump has moved down about the middle of the sternum, and sometimes into the stomach. It reminds you of the globus hystericus, but there is nothing hysterical about it here. In- deed, when a yellow fever patient complains bitterly of acid stomach, of phlegm collecting in the throat, of a sensation of a ball or lump in it, of a burniag sensation down the oesophagus, and of " queer" or " funny" feelings in the abdomen, from which occasional gurgling sounds proceed, however natural the pulse, tongue, skin and all the secretory functions, you may apprehend the speedy appearance of brown or black vomit. Sept. 8th.—She passed a comfortable day; no thirst, no pain, only one or two transient spells of deadly nausea. She was put on Arsenic and Lachesis all day. At night she became very rest- less, complained of a terrible burning pain in the middle of the abdomen. She vomited the muddy looking water, full of choco- late or brownish flocculi, three or four times during the night, The nausea was of the most deadly kind, comparable only to that produced in a novitiate chewer of tobacco. I tried both Lobelia / 56 DR. nOLCOMBE ON and Tabacum, but they did no good. I kept her then on Tar- tar-emetic and Arsenic half-hourly. The acidity of the stomach was a prominent symptom during the night. Several times in the night the skin became cool and the pulse rapid, from 130 to 140. Towards morning she complained of severe back-ache. Sept. 9th.—The back-ache disappeared this morning, having been relieved by a profuse menstrual discharge. Her catamenia were commonly irregular and scanty. I hailed its appearance as salutary, especially as coincidently, the pulse came down to 80, the kidneys acted freely, the mind became aetive and cheerful, and some appetite returned. At night the paroxysms of deadly nausea re-appeared. I tried an ice-water injection, which is very frequently productive of relief, but it excited severe rigors and subsequent, but transitory fever. It was followed by one more, but a smaller ejection of the brown matter. Tartar-eme- tic relieved her promptly, and after a dose or two of Ignatia she passed pretty comfortably the latter part of the night, sleeping most of the time. Sept. 10th.—Doing well, as regards the yellow fever symp- toms, but the uterine flux was very profuse, and there was some little menstrual colic, nausea, and nervous restlessness, all re- lieved by a few doses of Chamomilla. At night the restless- ness returned, but yielded to Belladonna 200. after which she slept five or six hours. She convalesced slowly but thoroughly from that time. The jaundice in this case was very slight. This case presented the very dangerous symptom, which for the sake of accuracy and to distinguish it from a subsequent and more fatal degree of the same sign, I have called the brown- vomit. Our allopathic neighbors are very skeptical as to the recovery of any really severe case of yellow fever under homoeo- pathic treatment. Nature, by some cruel distribution of her favors, assigns a vast proportion of the mildest cases to the ho- moeopathic physician! Our fatal cases even might have been saved by a dose of Calomel, a little Quinine, a bowl of infallible orange-leaf tea, or the "judicious" application of a blister; and all the other cases under our charge were merely ephemeral! Such are the fancies or bare-faced assertions, which allopathic physicians endeavor to impose upon the public mind. Accor- dingly when I assert, that one case of black- and three cases of EPIDEMIC yellow-fever. 57 brown-vomit had recovered this year under my practice, they either dispute the facts, or gravely deny the existence of any such thing as brown-vomit and insinuate that through ignorance, inexperience, or perchance design, I have characterized the harmless effusion of blood or bile as a symptom of dreadful import. To refute such as know better, and to inform such as do not, I will quote a few paragraphs from La Roche, the latest and best allopathic authority upon the disease in question. " The black vomit, notwithstanding its name, is rarely of a black color. As seen in this city, it is more frequently of a dark-brown, bistre, chocolate, or umber-hue. In some instances the color approaches to a dark slate or to a muddy claret. It is of two kinds. The one consists of a number of dark, flaky par- ticles, which have been not unaptly compared to butterfly or bees' wings, and which gradually assume the appearance, with more or less distinctness, of the grounds of coffee, of soot, or of finely powdered charcoal, floating in a quantity more or less con- siderable of thin, glairy fluid, bearing a slight resemblance to a weak infusion of flax-seed or green tea. The flakes are at first, or throughout the milder forms of the disease, limited in number and of a light or greyish, slate or chocolate tinge. But as the disease advances, and especially in the more malignant cases, they increase in number, and become darker and darker until the whole appears uniformly blackish or even black. The fluid, though homogeneous in appearance when first discharged, soon separates on standing into two parts ; the one consisting of the flaky or coffee-ground matter already mentioned and the other of the fluid in which it was held in suspension." "The other form of the black vomit is more homogeneous in character and presents the appearance of dark colored or in- spissated mucus, or thin tar, or of a thick mixture of molasses and water." (Vol. 1, p. 289.) Sir William Pym describes it under two forms, one as a brownish fluid resembling dirty water, mixed with a dark colored, flaky matter, which floats on the surface, and the other as a thicker, more homogeneous material, resembling coffee-grounds or thin pitch. It is needless to quote the crowd of authorities cited by Dr. La Roche, which prove that there is a flaky brown vomit generally preceding the inspissated black vomit. As 58 DR. HOLCOMBE ON long as the matter ejected has distinct flakes or flocculi floating in a whey-colored, claret-colored or porter-like liquid, the solid and fluid portion being separable, I call it brown-vomit and con- sider the patient by no means in a hopeless condition. It is generally attended with considerable nausea, retching and in- describable malaise. But when a homogeneously turbid, black fluid is gulped, pumped or even squirted up, with no nausea or bad feeling, it is black-vomit, and scarcely one in a hundred such cases recover. I draw the distinction for the sake of scien- tific precision, in order not to claim more for our treatment than the exact truth would warrant, but if the allopathic fraternity will ignore the line of demarcation drawn in the spirit of candor, and call every dark substance ejected in yellow fever, not evi- dently blood or bile, black vomit, so be it! then have four out of eight cases presenting that dreaded symptom recovered this year under my homoeopathic treatment. The above cases are fairly typical of yellow fever and are quite sufficient for the purpose of the present essay. There was one case of relapse, which for its peculiar interest I am almost tempted to detail, but it would involve considerable repe- tition of the ground already gone over and its peculiarities may be told in a few words. The gentleman had been up and about for nearly a month, but he was very imprudent both as to diet and exposure. His relapse resembled his first attack, violent chill, followed by fever, of several days' duration, &c, but ac- companied by severe pain in the stomach, excited no doubt by a quantity of peccan-nuts he had eaten a few hours before the chill. I saw him on the evening of the fourth day. He had intense burning pain from the epigastrium to the fauces. That night he had brown-vomit which continued occasionally during the next day. On the sixth day he had black vomit, and towards night became delirious. In the night he became comatose, hic- coughed every minute or two, his hands and feet became cold, face and forehead bathed in cold, clammy perspiration, pulse weak and rapid, breathing exceedingly slow and rather stertorous. An injection procured a small stool black as ink ; and the urine, which had been profuse, of a porter-color, and slightly bloody, become suppressed. The case was looked upon as entirely hope- less, and a metallic coffin was ordered from Natchez. It arrived, epidemic yellow fever. 59 but he was not destined to occupy it. I left off the Arsenic and Nitrate of Silver and put him upon Sulphuric-acid, diluted to about the strength of good lemonade, and given every fifteen minutes. This was done at the suggestion of my friend and colleague, Dr. J. C. Peters, of New-York, who, in a letter, had * called my attention to the homoeopathic appropriateness of Sul- phuric-acid to haemorrhagic gastritis, particularly when large, blackened shreds of mucous membrane had been ejected, as had happened in the present case. Simultaneously, however, I had him rubbed with oil, hot as could be borne by the hand. The physicians of Santa Cruz, Carthagena, Havana, Vera Cruz and Cadiz have reported many cases of black vomit recovering after repeated frictions with hot oil, and I thought it at least worth the trial. The patient fluctuated between life and death, for thirty-six or forty-eight hours, but finally his consciousness returned, an immense secretion of black turbid urine occurred, and gradual improvement went on. He was in a deplorable typhoid condition for some days, but under the use of Rhus, Bryonia, China, (fee, and cautious stimulation, he made a per- fect recovery. The quantity of black vomit ejected was immense, and altogether disproportioned to the moderate measure of liquid taken. I can confirm and reiterate, from subsequent experience, the curative value of Aconite and Belladonna in the first, and of Arsenic and Lachesis in the second stage of yellow fever, as reported in my account of the epidemic of 1853 at Natchez. I do not now wait for dark matter to be ejected before giving the Nitrate of Silver, but use it when there is burning sensation, flatulence, acid stomach, and the "white," "acid," or "pre- cursory vomit. I am almost inclined to rank the Tartar-emetic with the Arsenic, their pathogenesis and curative action being quite similar. But I would especially call attention to the im- portance of some adjuvantia to our treatment, viz., the strict maintenance of the horizontal position, the free use of ice or ice-water, the application of cold water bandages to the abdomen, continued even for days, the propriety of nutriment and stimu- lation in the second stage by pure cream or by beef-tea injec- tion, and after the ejection of brown matter by iced champagne, the necessity of free ventilation and of close watching, particularly 60 dr. holcomije on between midnight and daybreak, ice-water injections for deadly nausea, mesmeric passes for nervous irritability and restlessness. and lastly the energetic use of frictions with hot oil in apparently desperate cases. It is worth recollecting that Nitrate of Silver changes the black vomit to a cream-white color, and that if used in large doses, one might be led to believe, that the hsemorrhage had been checked, when there was only a chemical decolorization. Black matter is very frequently found in the gastric and intes- tinal glandulse, in the air-cells, &c. as a pigmentory deposit, produced, Dr. Handfield Jones supposes, by the exudation of a fluid containing heematine. The exudation-matter is really blood, and the hamiatine or haematoidin, as Virchow calls its crystalline forms, is blackened by the action of the acids, with which it meets, sometimes the carbonic, but mainly in yellow fever, the hydrochloric, or as my worthy old preceptor, Prof. Hare, used to insist upon calling it, the chlorohydric. It is not probable, that Nitrate of Silver in the TtVuth of a grain will produce such chemical decomposition in sufficient quantity as to decolorize the black vomit. Certain it is, however, that it sometimes seem to arrest it, and from its pathogenesis I cannot but believe its action to be dynamic and homoeopathic. It has been used occasionally by Allopathic physicians. One declares, that it arrests the hsemorrhage, another thinks it checks the vomiting, a third pronounces it good for hiccough, &c, but they have all used it in too large doses or combined with other, and very objectionable remedies, so that their evidence is worth very little, is unsatisfactory, sometimes contradictory, and the profession at large has not been induced to try it. There are many other remedies, which promise to prove homoeopathic and curative to the second stage of yellow fever, amongst which I may suggest Phosphorus, Sulphuric-Acid, Hydrocianic-Acid, Oxalic-Acid, Croton-Oil, Creosote, Turpentine, Nitrate of Pot- ash, Hamamelis and Carbo-vegetabilis. "When the diagnostic differences between these and other similar drugs are thoroughly and delicately appreciated, I cannot doubt that our treatment of yellow fever will be made much more scientific and success- ful than it is at present. A voluminous treatise in two very large octavo volumes, con- EPDDEMIC YELLOW-FEVEE. 61 taining more than 1400 pages, has recently issued from the press, entitled, "Yellow Fever, considered in its Historical, Pa- thological, Etiological and Therapeutical relations: by R. La Roche. M.D." It is what the lawyers would call a "digest" of the whole subject. So extensive is the bibliography of yellow fever, that it requires forty-five pages of the work to catalogue the sources, whence Dr. La Roche has derived his information. In display of erudition, lucidity of statement and fidelity of execution it compares favorably with Dr. Drake's immortal work on the Diseases of the Great Valley of North-America. It is probably the most extensive and valuable monograph which has yet been added to medical literature. It should grace the library of every physician resident in latitudes where yellow fever is likely to prevail. I commend it especially to the Allopathic physicians of my own vicinity, who have en- deavored to impress sundry fallacies upon the public mind, for example, that yellow fever never presents the remittent or in- termittent types, that the*tongue and pulse afford reliable indi cations of the true state of the patient, that scarcely any reco- veries after black vomit have been recorded, and that the mor- tality under Allopathic treatment is not so great as is commonly supposed. They will find much in these pages, if they are can- did and teachable, to enlighten their understandings, diminish their arrogance, soften their self-conceit and infuse a wholesome doubt as to the real efficacy of any one allopathic measure yet proposed in the treatment of this formidable disease. Whilst the homoeopathicity of certain articles to yellow fever is still on our minds, we will quote a single suggestive para- graph from this immense store-house of facts. ."Black vomit has not unfrequently resulted from the action of various poi- sons. That such is the case in regard to Arsenic, we have the testimony of Sauvages, of Dr. Edward Miller, Dr. Waring and Dr. Shecut. Poisoning by corrosive sublimate and verdigris has been known to result in the ejection of a similar matter from the stomach. Dr. Monges mentions an interesting case in which similar effects followed the ingestion of a large dose of Carbonate of Potash. I have known a very analogous effect produced by a quantity of borate of soda, swallowed by mistake, the patient becoming jaundiced and throwing up more than a 62 DR. H0LC0MBE ON pint of black matter bearing a close resemblance to that ejected in the last stage of yellow fever, to say nothing of pain, fever, precordial distress, &c. Vegetable poisons of various kinds are reported by good authorities to have occasioned like effect. We know also, from olden times, that animal poisons, those of the viper, scorpion, &c. (such as Lachesis), produce occasion- ally effects of the kind noted above. It was long ago found, and has recently been insisted upon by Dr. Mitchell of this city, that fungi of various kinds possess the power of producing phenomena somewhat akin to those of malarial fevers gene- rally, but more particularly to those of the yellow fever, and among them figures the black vomit. The ejection of a similar fluid from the stomach or bowels is often found to follow the introduction of putrid substances into the circulation." (Vol. 1st, page 266) Dr. La Roche has been indefatigable in collecting opinions and facts bearing upon the pathology of yellow fever, but his mind lacks the analytic, generalizing and constructive power, which is necessary for true philosophic induction. He adduces arguments for each, and all of the various theories : for that of gastritis, for that of hepatitis with fatty degeneration, for that of general inflammatory action of the vascular system, for that of cerebro-spinal meningitis, for that of progressive blood-poi- soning, and for that of primary nervous adynamia, &c. He then parades forth all that can be said on the contrary and settles down into a kind of negative, conservative, indefinite amalgam of opinion. All that he cites or says, only confirms m^ in the belief of the neural pathology of yellow fever pro- pounded in nay former essay. I need not repeat here what I there adduced in detail. The yellow fever-virus, or -effluvium is most probably a subtile material substance, as attenuated in all likelihood, as our 3d dilution. It is taken into the lungs in respiration, and thence gets into the blood. Like our medicines in attenuation, this poison, whether animalcular or fungoid, takes some time of silent modification before its effects appear; the stage of incubation varying according to individual idiosyn- crasy, from one day to six wreeks. Like our attenuated medi- cines also, its first effects are functional disturbances, the organic lesions coming on afterwards as secondary symptoms. The EPIDEMIC YELLOW-FEVER. 63 molecules of the virus act on the nerve-centres, when circulating in the current of blood, just as atoms of Aconite or Arsenic operate on those centres. The blood poisoning is probably the first effect. The blood stands in as much need of what we call innervation, as the lungs or heart or muscles do. Hydrocyanic- acid and sunstroke poison, defibrinize and dissolve the blood by a morbid impression on the cerebro-spinal and the ganglionic centres; so does the yellow fever virus. The abdominal blood now reacts on the nerve-centres, and nutrition and innervation being both wofully impaired, we soon get the organic lesions, from which yet another train of reactions may arise. The universal influence of the nervous system in the animal economy, either causing or promoting and directing every motion and every secretion in the body, is alone sufficient ground for fixing our eyes upon that sys- tem as the fons et origi mali in almost all diseases. I confess I do not understand Dr. La Roche's physiology, when he speaks of " ascending higher in the scale of morbid action than the nervous system. You had as well tell me to ascend higher than the sun for the cause of those physical, chemical and elemental changes occurring upon the planets. In the chapter on Diagnosis, Dr. La Roche curiously enough omits a comparison of yellow fever with dengue. If any one will read Dr. Dickson's account of dengue, contained in his Practice, vol. 2d, pages 605—624, he will be struck, notwith- standing the Dr's. assertions to the contrary, with the remark- able similarity of this tropical disease to the yellow fever which has prevailed of late along the banks of the Mississippi. It has a first or inflammatory stage characterized by intense muscular and articular pains, suffused eyes, headache, high fevers, and great restlessness. After two or three days of violent suffering, a complete lull, or deceptive interval occurs. The patient is in free perspiration and thinks himself well. But in twelve or twenty-four hours gastric irritability appears, with jactitation, sleeplessness and sense of insufferable oppression. These diminish in a day or two on the appearance of a cutaneous rash, somewhat resembling scarlatina. The disease leaves the patient greatly debililated, with weak stomach, and long-continuing pains in the joints. It was, according to Dr. Dickson, eminently contagious, it spread with the rapidity of influenza, attacked 64 DR. HOLCOMBE ON adults and children, natives and strangers, whites and negroes. It recognized no difference between high and low, wet and dry, healthy and unhealthy localities, and spread, though to a limit- ed extent, into the country. Moreover there was occasional haemorrhage from the gums and fauces, and pregnant women were very liable to abortion. Surely here are strong features of family likeness. The points of diagnosis are these : the pre- dominance of arthritic pains in the first stage of dengue; the uniformity of a cutaneous eruption in the second, accompanied by a second paroxysm of fever, the paucity of symptoms of any blood-deterioration, its earlier appearance, its more rapid diffusion, its low rate of fatality and the non-exemption from second attacks. Dr. Dickson writes of the disease as if its outbreak in 1827—28, was its first and last appearance and its history belonged to the past alone, but the disease has repeatedly occurred in the south-west during the last ten years. An epidemic of dengue prevailed at Natchez in 1848, which some physicians confounded with mild yellow fever. These facts and the very great diversity of yellow fever symptoms at different times and in different places, make the correct diagnosis a point of some interest. Dr. La Roche devotes 200 pages of his second volume to an elaborate consideration of the etiology of yellow fever. He is a little pedantic in his division of proximate causes into percepta, ingesta, applicata, gesta, excreta and circumfata, but he treats us to an immense variety of facts and opinions. One is struck immediately with the contradictory and uncertain character of most of the reports. Electrical changes produce the epidemic at one place and time, but are totally inert again and elsewhere. Heavy rains are adduced as causative by one writer, and as wholly inert or actually dispersive by others. High winds have a great deal to do with its appearance according to some and nothing at all to do with it according to others. Any and every thing is seized upon as causative, according to the imagination, fancy, or preconceived opinion of the observer, from fear, anger, intemperance, and sleep, down to wet feet, gambling, sprains, and the eating of three oysters! There is nothing positive and definite in all this pile of literary lumber; not one proposition which others have not scouted, not one affirmation which many EPIDEMIC YELLOW-FEVER. 65 others have not denied. It is not surprizing that Dr. Alison of Edinburg -in a recent interesting essay on the exciting causes of epidemics, should have come to the conclusion that we know little or nothing about them, and that there must be influences at work both in man and nature, which have never boen recog- nized, nor even "dreamed of in our philosophy." When we deal in physical or chemical matters, our observations are not discordant but corroborative, and the results of experiment are nearly or quite identical. Astronomy, mechanics, optics and chemistry have fixed, beautiful and immutable laws. It is only when we enter the mystic area of vitality that every thing be- comes doubtful, indefinite and unsatisfactory. Nor is it difficult for those who have looked deeper than the phenomenal surface to detect the true reason, in the material and naturalistic opin- ions and tendencies of the age, which supposes that in the mo- lecular changes of matter lies the all of human knowledge, ignoring the very existence of those subtile, invisible, all-per- vading and spiritual essences and powers which constitute the life of the universe and are the primary causes of all its pheno- mena. Dr. La Roche gives 400 pages of his work to the considera- tion of the great question of contagion. He is a thorough non- contagionist and appears to uphold his opinions with great learn- ing and plausibility. We confess we have not yet read this part of the book attentively and consecutively. We have no taste for medical polemics and argumentations. We have glanced over it enough to perceive that his strongest points are negative in their character, and that he is strongly biased not to do ex- act justice to his opponents. For ourselves, we have seen enough this year alone, to say nothing of the two years previous, to convince us immovably that the vellow fever we have to deal with here on the banks of the Mississippi is a palpably contagi- ous disease, communicable by contact of persons, clothing, &c. This little village of Waterproof, La., never presented a case of it until this vear. It has raged above and below us, but never appeared amongst our population. The autumnal remittents and malignant intermittents, when prevailing here were never known to turn into yellow fever or be mistaken for it. A stran- ger from New-Orleans, sick of the disease, is landed from a boat. 5 66 DR. II0LC0MBE ON He convalesces and leaves, but in the course of a week others are taken, and very soon the constantly increasing virus infects the whole atmosphere and we have more than a hundred cases in the course of a month. A gentleman residing several miles out of Natchez rides into town to see his brother's family, sick of yellow fever, assured by the physician of its perfectly non-contagious nature. In a few days he sickens, next his wife, then the chambermaid, then a daughter who nursed them, then a woman brought in from the field to supply the place of the chambermaid, then, other children, and so on, until twelve or thirteen cases occur; all the persons on the place being exempt- ed, except those who came near the sick persons or the sick rooms. A negro accompanying his young master to college is taken sick one night at a gentleman's country-seat—remote from all towns and public roads where every body is and has been for weeks in perfect health. He gets well and goes away, but several of the family who were with him sicken, and three die of black vomit. It is now found' that the same disease has also broken out at the place the negro started from, he having had the germs of the complaint in his system in a state of incuba- tion. We need not adduce more examples. We have seen and heard of so many similar cases that we feel impelled to recommend all unprotected, unacclimatized persons to get out of its way, and to lend our cordial support to all sanitary, hygienic and quarantine regulations which may promise deliver- ance from its visitations. Dr. La Roche gives a hundred pages to the treatment, be- ginning and ending in Egyptian darkness, and presenting a most humiliating picture to the sincere student of medical science. I will let him describe allopathic practice, that coat of many colors, for us. " One advocates active depletion by the lancet, and measures the blood abstracted, not by ounces but by pounds, looking with contempt on all who prefer a less energetic method. Another dreams of nothing but Mercury, and would salivate all cases. A different writer preaches the necessity of free and profuse purging, and attributes the large mortality of the. dis- ease to the neglect of that indispensible means. Another again holds that neither bleeding, purging, or Mercury has ever done, or ever can do good, and strongly insists on the propriety, in all EPfDEMIC YELLOW-FEVER. 67 cases and under all circumstances, of administering the Peru- vian-hark in large doses. Some insist on the necessity and pos- sibility of cutting short the fever by means of Sulphate of Qui- nine, and accuse those who call for proof of the success of the abortive method with being behind the times. Some discard every method heretofore suggested, and aver that the true plan of treating the yellow fever is to oxygenate the blood by means of neutral salts. These various plans and others equally exclusive, on the saying of their promulgators and advocates, are applicable to the disease at all times and in all climes—they seldom fail.*' (Vol. 2, p. 629.) What does Dr. La Roche, a fine specimen of conservative type, propose to supply the place of these and many other ineffi- cient modes of practice? Nothing new in principle, nothing original, nothing philosophical. He merely strikes a balance between the different claimants and thinks the "moderate and judicious" employment of each and every remedy ever recom- mended, in its proper time, place, and circumstances is likely to be useful. He belongs to that very large class, constituting probably three-fourths of the medical profession, who shun all extremes of opinion and practice, and who contribute much to perpetuate the stagnant condition of modern therapeutics. It is not surprising that such men, when honest, are obliged to make Dr. La Roche's confessions. " Notwithstanding all that has been written on the subject, and the ample opportunities for ob- servation afforded by innumerable epidemics, our progress witnm the last three quarters of a century towards anything like a satisfactory treatment of the disease in its various formidable shapes, has been far from gratifying. The fever, when severe, continues to produce its usual havoc: and on comparing the remedial plans in vogue now-a-days with those suggested by our forefathers, we do not find them to differ materially, or if they do, to be attended with much better success." New re- medies in abundance, new light respecting the history and pa- thology of the disease pouring in from all quarters, and yet no improvement in practice ! What is the cause of this ? Simply the theoretic doctrines of Allopathy on which its practice is founded—simply the old " contraria contrariis curantur" that ignis fatuus, which led the whole medical world into the swamp 68 DR. H0LC0MBE ON of empiricism, until Hahnemann revealed its true nature and pointed hopefully to the homoeopathic law. Allopathic physicians generally regard homoeopathic practice as equivalent to the vis-medicatrix—a mere leaving of the pa- tient to the unaided powers of nature. Some of them have professed to look with curiosity for its results, as likely to give much valuable information respecting the natural history of dis- ease. We have indeed some valuable lessons to give our medi- cal opponents and would beg not only Dr. La Roche but all of his confreres to listen to our teachings. A distinguished allo- pathic physician of Vienna treats many cases of pneumonia with sweetened water, and with better success than had ever been heard of before in allopathic hands. If the allopaths will not adopt our practice, we beseech them at least to let their patients entirely alone, and we predict a great diminution in their bills of mortality. We have one or two items of experience, which might be of great use to them, if they were frank enough to profit thereby, and which happily illustrate a great fact, that allopathic measures generally obscure or thwart the curative efforts of nature. Dr. Davis and myself have treated during the last three years more than a thousand cases of yellow fever without blood-letting, calomel, quinine, purgatives or blisters, and with an average mortality of not more than six per-cent. We are entitled to some regard and audience when the natural course of the disease is the matter in question. We can avow, that those cases which are ushered in with very great severity, with violent head-ache and other pains, burning hot skin, full hard, strong pulse, and all the tokens of very great arterial ex- citement, which call, in allopathic practice, for bloodletting, leeches, cupping, and active depletion, are the very cases likeliest to pass off in two or three days without any trouble whatever. Such cases almost uniformly get well under our practice, and I verily believe that thousands of such cases, of what I call beautiful reaction, have been literally butchered by the lancet and antiphlogistics. Again, obstinate constipation has been reckoned by allopathists as an unfavorable sign. Now there cannot be a doubt but that they have made it a dangerous sign by the cathartic and irritative measures employed to overcome it. In our experience it was a very favorable indication, and EPIDEMIC YELLOW-FEVER. 69 we never disturbed the bowels by enemas unless there was great pain in the abdomen or insuperable nausea. Those cases in which the intestinal function was perfectly torpid or quiescent for some days, from five to ten, were generally the mildest, and the convalescence therefrom the most secure. Dr. La Roche gives a gloomy chapter on the mortality of yellow fever. lie has collected an immense mass of mortuary statistics and deduced averages of no very flattering showing to allopathic practice either private or public. He concludes that the disease takes off 1 in every 3.5 attacked or 100 in 350. He discards all reports of a mortality of 1 in 9, 10, 11, 12 and 13 (the highest mark) as either apochryphal or based upon false diagnosis, or at least as occurring in epidemics too mild to de- serve the name of yellow fever. I cannot but think he does some little injustice to his fellow-allopaths, especially those of the South-West. The average loss under the old system was about 15 in the hundred or 1 in 6.6 ; in the village of Water- proof, where all the facts are easily got at, and readily proven ; nor do I believe the average allopathic loss in private practice has been greater. According to my observation, seventy cases out of a hundred will get well any how, if not drugged; five cases in the hundred are stricken with death at the beginning, and would die under any practice. The remaining twenty-five are legitimate subjects for fair therapeutic experiment. Of this number the allopaths lose about ten, and the homoeopaths one or two, sometimes three, or even as much as five in very malig- nant epidemics as that at Norfolk. This is the precise numeri- cal estimate of the value of the two systems. This year I have treated sixty-nine cases with four deaths. Dr. Davis up to Nov. 5, had treated two hundred and eighty cases with eigh- teen deaths. Our clinical experience of the mortality of yellow fever for the last three years may be thus tabulated:— in 1853 we treated 555 cases with 33 deaths. " 1854 " " 112 " " 0 " 1855 " " 349 " " 22 Making in all 1016 cases and 55 deaths This is a mortality of 5.4 per-cent., or leaving out entirely the mild epidemic of 1854, a mortality of 6.08 per-cent., a point 70 DR. HOLCOMBE ON to which we earnestly solicit the attention of candid and truth- seeking men. We have an opportunity of comparing the relative success of Allopathy and Homoeopathy in a public institution on a small scale. The Mississippi State Hospital at Natchez was assigned to Dr. Davis and myself, 1st Jan. 1854, since which period it has been under exclusive homoeopathic management. During that time no bleeding, purgatives, calomel, blisters or other allopathic measures have been used within its walls. The deaths have all been from chronic diseases, or were of those brought in, as with collapsed cholera, in the last hours of life. The general showing, all things being considered, is at least a hundred per-cent., more favorable than that under allopathic administration, but we have now to do only with yellow fever statistics. In 1853, when Drs. I,. P. and E. M. Blackburn were physicians, there was forty-nine patients admitted and treated allopathically (fifty were admitted, but one was treated by me, the attending physician courteously permitting him to choose his practice) and of that number, twenty-seven died, a mortality of 55 per-cent. During this year there have been thirty ad- missions and ten deaths, a mortality of 33 per-cent. From careful and praiseworthy notes of each case, taken by my in- telligent and assiduous friend} Mr.* W. Howell Sprague, a resi- dent student in the Hospital, I learn that seven of the ten came into the wards in a hopeless or dying condition. Perhaps a similar proportion of the allopathic cases received were equally unpromising, but when it is recollected that all of these poor fellows had received, previous to their admission, some kind of coarse allopathic drugging, rendering their systems insensible to the action of our attenuated remedies, it will be clearly seen what peculiar disadvantages we encountered, and how much greater the triumph really is than it appears to be on the first inspection. We are aware that this arena is too small for trustworthy scientific deductions, but the result is sufficient to warrant the public authorities of New-Orleans and other cities in making a trial of Homoeopathy in larger hospitals. I cannot more appropriately close this little effort to subserve the cause of medical truth than by congratulating the friends of Homoeopathy on the steady and continuous growth of ruo be- EPIDEMIC YELLOW-FEVER. 71 loved system. The clouds of prejudice are gradually breaking away, and the light of a better era is beginning to dawn. The Allopathic School, always bitter, arrogant and unjust in its opposition, has failed to strangle the infant Hercules in its cradle. Our success in cholera, pneumonia, and yellow fever is fast be- coming one of the fixed facts in the public mind, which neither allopathic statistics nor sarcasm can uproot. Where we have not inspired confidence, we have excited inquiry—and to inquire is to test, and to test is to believe. The news from all quarters of the globe is cheering. The number of practitioners and pa- tients, of students and inquirers is constantly increasing and we need not be prophets to foresee the day, when our system, like the rod of Aaron, shall swallow up the feeble rods of the magi- cians. Freed forever from the shackles of theory and based upon fact' and observation alone, its very constitution is pro- gressive and eternal. Our colleges, hospitals and journals are shedding around them an ever-widening circle of light. Our young but sturdy literature is incorporating into its substance all that is good and true in the records of the past and in the discoveries of the present age. Happy shall I be, if, while casting my mite into the treasury of experience, I shall aid in awakening my co-laborers to a loftier sense of our great re- sponsibilities and to a severer study of our noble science.