return to home page
Bilious Yellow Fever,
Appeared in Philadelphia,
in the year 1799
by Benjamin Rush
The diseases which succeeded the fever of 1798, in November and December, were highly inflammatory. A catarrh was nearly universal. Several cases of sore throat, and one of erysipelas, came under my care in the month of November. The weather in December was extremely cold. It was equally so in the beginning of January, 1799, accompanied with several falls of snow.
About the middle of the month, the weather moderated so much, so as to open the navigation of the Delaware. I met with two cases of malignant colic in the latter part of this month, and one of yellow fever. The last was Swen Warner. Dr. Physick, who attended him with me, informed me that he had, nearly at the same time, attended two other persons with the same disease.
The weather was very cold, and bilious pleurisies were common, during the later part of the month of February.
March was equally cold. The newspapers contained accounts of the winter having been uncommonly severe in Canada, and in several European countries.
The first two weeks in April were still cold. The Delaware, which had been frozen a second time suring the winter, was crossed near its origin, on the ice, on the 15th day of this month. The diseases, though fewer than in the winter, were bilious and inflammatory. During this month, I was called to a case of yellow fever, which yielded to copious bleeding, and other depleting medicines.
May was colder than is usual in that month, but very healthy.
In the first week of June, several cases of highly bilious fever came under my care. In one of them, all the usual symptoms of the highest grade of that fever occurred. On the 13th of the month, Dr. Physick informed me, that he had lost a patient with that disease. On the 23d of the same month, Joseph Ashmead, a young merchant, died of it. Several other cases of the disease occurred between the 20th and 29th days of the month, in different parts of the city. About this time, I was informed that the inhabitants of Keys's-alley had predicted a return of the yellow fever, from the trees before their doors emitting a smell, exactly the same which they perceived just before the breaking out of that disease in 1793.
In July, the city was alarmed, by Dr. Griffitts, with an account of several cases of the fever in Penn-street, near the water. The strictness with which the quarantine law had been executed, for a while rendered this account incredible with many people and exposed the doctor to a good deal of obloquy. At length a vessel was discovered, that had arrived from one of the West-India islands on the 14th of May, and one day before the quarantine law was put into operation, from which the disease was said to be derived. Upon investigating the state of this vessel, it appeared that she had arrived with a healthy crew, and that no person had been sick on board of her during her voyage.
In the latter part of July and in the beginning of August, the disease gradually disappeared from every part of the city. This circumstance deserves attention, as it shows the disease did not spread by contagion.
About this time we were informed by the news-papers, that dogs, geese, and other poultry, also that wild pigeons were sickly in many parts of the country, and that fish on the Susquehannah, and oysters in the Delaware bay, were so unpleasant that the inhabitants declined eating them. At the same time, flies were found dead in great numbers, in the unhealthy parts of the city. The weather was dry in August and September. There was no second crop of grass. The gardens yielded a scanty supply of vegetables, and of an inferior size and quality. Cherries were smaller than usual, and pear and apple-trees dropped their fruits permaturely, in large quantities. The peaches, which arrived at maturity, were small and ill tasted. The grain was in general abundant, and of a good quality. A fly, of an unusual kind, covered the potatoe fields, and devoured in some instances, the leaves of the potatoe. This fly has lately been used with success in our country, instead of the fly imported from Spain. It is equal to it in every respect. Like the Spanish fly, it sometimes induces strangury.
About the middle of August the disease revived, and appeared in different parts of the city. A publication from the academy of medicine, in which they declared the seeds of the disease to spread from the atmosphere only, produced a sudden flight of the inhabitants. In no year, since the prevalence of the fever, was the desertion of the city so general.
I shall now add a short account to the symptoms and treatment of this epidemic.
The arterial system was in most cases active. I met with a tense pulse in a patient after the appearance of the black vomiting. Delirium was less frequent in adults than in former years. In children there was a great determination of the disease to the brain.
I observed no new symptoms in the stomach and bowels. One of the worst cases of the fever which I saw was accompanied with colic. A girl of Thomas Shortall, who recovered, discharged nine worms during her fever. It appeared in Mr. Thomas Roane, one of my pupils, in the form of a dysentery.
A stiffness, such as follows death, occurred in several patients in the city hospital before death.
Miss Shortall had an eruption of pimples on her breast, such as I have described in the short account I gave of the yellow fever of 1762 in this city, in my account of the disease of 1793.
The blood exhibited its usual appearances in the yellow fever. It was seldom sizy till toward the close of the disease.
The tongue was generally whitish. Sometimes it was of a red colour, and had a polished appearance. I saw no case of a black tongue; amd but few that were yellow before the seventh day of the disease.
The type of this disease was nearly the same as described in 1797. It now and then appeared in the form of a quartan, in which state it generally proved fatal. It appeared with rheumatic pains in one of my patients. It blended itself with gout and small-pox. Its union with the latter disease was evident in two patients in the city hospital, in each of whom the stools were such as were discharged in the most malignant state of the fever.
The remedies for this fever were bleeding, vomits, purges, sweats, and a salivation and blisters.
There were few cases that did not indicate bleeding. It was performed, when proper, in the usual way, and with its usual good effects. It was indicated as much when the disease appeared in the bowels as in the blood-vessels. Mr. Roane, in whom it was accompanied with symptoms of dysentery, lost nearly 200 ounces of blood by twenty-two bleedings.
Purges of calomel and jalap, also castor oil, salts, and injections were prescribed with their usual advantages.
In those cases where the system was prostrated below the point of re-action, I began the cure by sweating. Blankets, with hot bricks wetted with vinegar, and the hot bath, as mentioned formerly, when practicable, were used for this purpose. The latter produced, in a boy of 14 years of age, who came into the city hospital without a pulse, and with a cold skin, in a few hours, a general warmth and an active pulse. The determination of the disease to the pores was evinced in one of my patients, by her sweating under the use of the above-mentioned remedies, for the first time in her life. A moisture upon her skin had never before been induced, she informed me, even by the warmest day in summer.
The advantages of a salivation were as great as in former years. From the efficacy of bleeding, purges, emetics, and sweating, I had the pleasure of seeing many recoveries before the mercury had time to affect the mouth. In no one case did I rest the cure exclusively upon any one of these remedies. The more numerous the outlets were to convey off superfluous fluids and excitement from the body, the more safe and certain were the recoveries. A vein, the gall-bladder, the bowels, the pores, and the salivary glands were all opened, in succession, in part, or together, according to circumstances, so as to give the disease every possible chance of passing out of the body without injuring or destroying any of its vital parts.
Blisters were applied with advantage. The vomiting and sickness which attend this fever were relieved in many instances, by a blister to the stomach.
In those cases in which the fever was protracted to the chronic state, bark, wine, laudanum, and aether produced the most salutary effects. I think I saw life recalled, in several cases in which it appeared to be departing, by frequent and liberal doses of the last of those medicines. The bark was given, with safety and advantage. after the seventh day, when the fever assumed the form of an intermittent.
The following symptoms were generally favourable, viz. a bleeding from the mouth and gums, and a disposition to weep, when spoken to in any stage of the fever.
A hoarseness and sore throat indicated a fatal issue of the disease, as it did in 1798. Dr. Physick remarked, that all those persons who sighed after waking suddenly, before they were able to speak, died.
The recurrence of a redness of the eyes, after it had disappeared, or of but one eye, was generally followed by death. I saw but one recovery with a red face.
I saw several persons, a few hours before death, in whom the countenance, tongue, voice, and pulse were perfectly natural. They complained of no pain, and discovered no distress nor solicitude of mind. Their danger was only to be known by the circumstances which had preceeded this apparently healthy and tranquil state of the system. They had all passed through extreme suffering, and some of them had puked black matter.
The success of the mode of practice I have described was the same as in former years, in private families; but in the city hospital, which was again placed under the care of Dr. Physick and myself, there was a very different issue to it, from causes that are too obvious to be mentioned.
There were two opinions given to the public upon the subject of the origin of this fever; the one by the academy of medicine, the other by the college of physicians. The former declared it to be generated in the city, from putrid domestic exhalations, because they saw it only in their vicinity, and discovered no channel by which it could have been derived from a foreign country; the latter asserted it to be "imported, because it had been imported in former years."
For context and commentary on Rush's fight against the fever in 1799 see ch17.html