Short Account of Malignant Fever in Philadelphia – Chapter II (1793), Philadelphia County, PA Contributed to the PAGenWeb Archives by Marjorie B. Winter [marjw@cox.net] Copyright. All Rights Reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/pa/pafiles.htm ********************************************************* CHAP. II – Symptoms – A slight sketch of the mode of treatment. THE symptoms which characterised the first stage of the fever, were, in the greatest number of cases, after a chilly fit of some duration, a quick, tense pulse—hot skin—pain in the head, back and limbs—flushed countenance— inflamed eye—moist tongue—oppression and sense of soreness at the stomach, especially upon pressure—frequent sick qualms, and retchings to vomit, without discharging any thing, except the contents last taken into the stomach— costiveness, etc. And when stools were procured, the first generally showed a defect of bile, or an obstruction to its entrance into the intestines. But brisk purges generally altered this appearance. These symptoms generally continued with more or less violence from one to three, four, or even five days; and then gradually abating, left the patient free from every complaint, except general debility. On the febrile symptoms suddenly subsiding, they were immediately succeeded by a yellow tinge in the opaque cornea, or whites of the eyes – and increased oppression at the præcordia – a constant puking of every thing taken into the stomach, with much straining, accompanied with a hoarse, hollow noise. If these symptoms were not soon relieved, a vomiting of matter, resembling coffee grounds in color and consistence, commonly called the black vomit, sometimes accompanied with, or succeeded by haemorrhages from the nose, sauces, gums, and other parts of the body – a yellowish purple colour, and putrescent appearance of the whole body, hiccup, agitations, deep and distressed sighing, comatose delirium, and finally, death. When the disease proved fatal, it was generally between the sixth and eighth days. (Page 14) This was the most usual progress of this formidable disease, through its several stages. There were, however, very considerable variations in the symptoms, as well as in the duration of its different stages, according to the constitution and temperament of the patient, the state of the weather, the manner of treatment, etc. In some cases, signs of putriscency appeared at the beginning, or before the end of the third day. In these, the black vomiting, which was generally a mortal symptom, and universal yellowness, appeared early. In these cases, also, a low delirium, and great prostration of strength, was constant symptoms, and coma came on very speedily. In some, the symptoms inclined more to the nervous than the inflammatory type. In these, the jaundice colour of the eye and skin, and the black vomiting, were more rare. But in the majority of cases, particularly after the nights became sensibly cooler, all the symptoms indicated violent irritation and inflammatory diathesis. In these cases, the skin was always dry, and the remissions very obscure. The febrile symptoms, however, as has been already observed, either gave way on the third, fourth, or sixth day, and then the patient recovered; or they were soon after succeeded by a different, but much more dangerous train of symptoms, by debility, low pulse, cold skin, (which assumed a tawny colour, mixed with purple) black vomiting, haemorrhages, hiccup, anxiety, restlessness, coma, etc. Many, who survived the eighth day, though apparently out of danger, died suddenly in consequence of an haemorrhage. This disorder having been new to nearly all our physicians, it is not surprising, although it has been exceedingly fatal, that there arose such a discordance of sentiment on the proper mode of treatment, and even with respect to its name. Dr. Rush has acknowledged, (Page 15) with a candour that does him honour, that in the commencement, he so far mistook the nature of the disorder, that in his early essays, having depended on gentle purges of salts to purify the bowels of his patients, they all died. He then tried the mode of treatment adopted in the West Indies, viz. bark, wine, laudanum, and the cold bath, and sailed in three cases out of four. After wards he had recourse to strong purges of calomel and jalap , and to bleeding, which he found attended with singular success. The honour of the first essay of mercury in this disorder, is by many ascribed to Dr. Hodge and Dr. Carson, who are said to have employed it a week before Dr. Rush. On this point, I cannot pretend to decide. But whoever was the first to introduce it, one thing is certain, that its efficacy was great, and rescued many from death. I have known, however, some persons, who, I have every reason to believe, fell sacrifices to the great reputation this medicine acquired; for in several cases it was administered to persons of a previous lax habit, and brought on a speedy dissolution. I am credibly informed that the demand for purges of calomel and jalap, was so great, that some of the apothecaries could not mix up every dose in detail; but mixed a large quantity of each, in the ordered proportions; and afterwards divided it into doses; by which means, it often happened that one patient had a much larger portion of calomel, and another of jalap, than was intended by the doctors. The fatal consequences of this may be easily conceived. An intelligent citizen, who has highly distinguished himself by his attention to the sick, says, that he found the disorder generally come on with costiveness; and unless that was removed within the first twelve hours, he hardly knew any person to recover; on the contrary, he says, as few died, on whom the cathartics operated within that time. The efficacy of bleeding, in all cases not attended with putridity, was great. The quantity of blood taken was in many cases astonishing. Dr. Griffits was (Page 16) bled seven times in five days, and appears to ascribe his recovery principally to that operation. Dr. Mease, in five days, lost seventy-two ounces of blood, by which he was recovered when at the lowest stage of the disorder. Many others were bled still more, and are now as well as ever they were. Dr. Rush and Dr. Wistar have spoken very favorably of the salutary effects of cold air, and cool drinks, in this disorder. The latter says, that he found more benefit from cold air, than from any other remedy. He lay delirious, and in severe pain, between a window and door, the former of which was open. The wind suddenly changed, and blew full upon him, cold and raw. Its effects were so grateful, that he soon recovered from his delirium – his pain left him – in an hour he became perfectly reasonable – and his fever abated. A respectable citizen who had the fever himself, and likewise watched its effects on eleven of his family, who recovered from it, has informed me, that a removal of the sick from a close, warm room to one a few degrees cooler, which practice he employed several times daily, produced a most extraordinary and favourable change in their appearance, in their pulse, and in their spirits.